Robotic-assisted THA may decrease length of stay vs. manual THA
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Key takeaways:
- Robotic hip arthroplasty was associated with shorter length of stay and better discharge disposition vs. manual hip arthroplasty.
- Robotic arm-assisted procedures may improve patient outcomes.
Compared with manual total hip arthroplasty, robotic-assisted THA was linked to shorter average length of stay and fewer patients requiring discharge to a skilled nursing facility, according to published results.
Researchers performed a multicenter, propensity-matched retrospective review of data from 8,536 patients who underwent robotic THA (Mako, Stryker) and 8,536 patients who underwent manual THA between January 2016 and December 2021. Researchers compared outcomes such as insurance type, length of stay, same-day discharge, discharge disposition and 90-day all-cause readmission rates.
Researchers found patients who underwent robotic THA had a significantly shorter average length of stay (1.39 days vs. 1.48 days) compared with patients who underwent manual THA. Researchers noted 5.3% of patients who underwent robotic THA and 5.6% of patients who underwent manual THA had a same-day discharge. At 90 days, all-cause readmission rates were 3% for the robotic THA group and 3.4% for the manual THA group.
According to the study, researchers found significant differences in discharge disposition between the cohorts. Rates of discharge home without home health care were 47.9% for the robotic THA cohort and 45.5% for the manual THA group. Rates of discharge to a skilled nursing facility were 5.6% for the robotic THA group and 6.9% for the manual THA group.
“Utilization of robotic-arm assisted technology in total joint procedures has been shown to have many potential advantages, including greater component accuracy and precision, soft-tissue protection, increased patient satisfaction, a short learning curve and less surgeon fatigue, and is thus of interest to improve patient outcomes,” the researchers wrote in the study.
Perspective
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The merits of robotic-assisted joint replacement have certainly been enthusiastically debated during the past decade. While the ultimate patient outcomes seem similar to manual surgery, robotic-assisted joint replacement does appear to offer improved accuracy in component positioning. Now there are also data demonstrating shorter lengths of stay in the robotic-assisted total knee and hip replacement patients.
The reason for this trend is unclear. It may be related to reduced soft tissue stripping, the haptic boundaries of the robotic system limiting soft tissue injury and better functional positioning, which allows for improved initial mobilization. There are also data supporting that patients who undergo robotic surgery experience fewer mechanical complications, blood loss, anemia and thromboembolic disease. These could all lead to quicker recovery and shorter length of stay.
But as joint replacement continues to migrate toward shorter lengths of stay, I think equally if not more important are the improvements in anesthesia techniques, nerve blocks, motor-sparing analgesic techniques, enhanced recovery protocols and setting proper patient expectations.
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