Outcome measures of SRS that addressed total hip arthroplasty
| Functional outcomes | |
| Harris Hip Score (HHS)dd | |
| SR | Results |
| Karunaratne, 2019 | Long term: low-quality evidence of no difference between groups (mean difference=−2.90 (−9.04 to 3.24)) |
| Chen, 2018 | Pooled analysis of functional scores found no significant differences between robotic-assisted and conventional THA (weighted mean difference=0.12; 95% CI −0.09 to 0.34) |
| Merle d'Aubigne | |
| Karunaratne, 2019 | Short-term: no significant differences between groups (mean difference=−0.41 (−5.31 to 4.48)) Long-term: low-quality evidence of no difference between groups (mean difference=−1.25 (−3.90 to 1.41)) |
| Chen, 2018 | Pooled analysis of functional scores found no significant differences between robotic-assisted and conventional THA (weighted mean difference=0.12, 95% CI −0.09 to 0.34) |
| Radiological outcomes | |
| The number of outliers of acetabular cups | |
| Gandhi 2009 | The statistically significant beneficial OR for the number of outliers was 0.285 (95% CI 0.143 to 0.569, p<0.001). There was no evidence of statistical heterogeneity between studies (p=0.88) |
| Liu 2015 | No significant difference between the two groups (−1.46; CI −3.00 to −0.08, p=0.06) |
| Cup inclination | |
| Xu 2014 | No significant difference between the groups (MD=−0.93°; 95% CI −3.88 to 2.02, p=0.54) |
| Snijders 2017 | Significantly better accuracy for the NAV group than for the freehand group (mean difference= −1.87; 95% CI −3.31 to –0.44) |
| Liu 2015 | The weighted mean difference in inclination between conventional and imageless navigation groups was not statistically significant (0.2; 95% CI −1.69 to 2.09, p=0.83) |
| Beckmann, 2009 | The weighted mean difference in inclination between conventional and computer-assisted positioning was not statistically significant (–0.89°; 95% CI −4.2 to 2.4) |
| Cup anteversion | |
| Xu 2014 | No significant difference between the groups (MD=−0.96°; 95% CI −4.29 to 2.37, p=0.57) |
| Snijders 2017 | Significantly better accuracy for the NAV group than for the freehand group (mean difference= −3.95 (95% CI −5.06 to –1.42)) |
| Liu 2015 | No significant difference between the two groups in respect of mean anteversion (−0.19; 95% CI −2.98 to 2.60, p=0.89) |
| Beckmann, 2009 | No statistically significant difference in mean anteversion of cups placed with and without navigational support −1.7% and 95% CI −4.8 to 1.5 |
| Cup positioning outside the safe zone | |
| Xu 2014 | This difference was significant (RR=0.13; 95% CI 0.08 to 0.22, p<0.00001) |
| Liu 2015 | RR with navigation was statistically significantly reduced (RR=0.31; CI 0.17 to 0.55, p<0.0001) |
| Beckmann, 2009 | Statistically significantly reduced RR of cup positioning outside the safe zone with navigation: the pooled RR=0.2% and 95% CI 0.1% to 0.3% |
| Moskal 2011 | Abduction safe zone: OR=1.53; 95% CI 1.01 to 2.33, p=0.0444 Anteversion safe zone: OR=1.96; 95% CI 1.33 to 2.88, p=0.0005 In both safe zones OR= 2.48; 95% CI 1.51 to 4.06, p=0.0003 |
| Abduction (degrees) | |
| Moskal 2011 | Mean=43.08; 95% CI 41.46 to 44.71; Fisher’s p=0.5686 |
| Anteversion (degrees) | |
| Moskal 2011 | Mean=20.17; 95% CI 16.98 to 23.36, Fisher’s p=0.9672 |
| Leg length discrepancy | |
| Xu 2014 | The pooled results show a significant difference between the groups (Mean difference =4.61 mm; 95% CI 7.74 to 1.48, p=0.004). |
| Chen, 2018 | Not significantly different (weighted mean difference: −0.24; 95% CI −0.61 to 0.12, p=0.19) |
| Postoperative dislocation | |
| Moskal 2011 | OR=0.41; 95% CI 0.17 to 0.95, p=0.0317 |
| Xu 2014 | The difference between the groups was not significant (RR=1.44; 95% C I0.04 to 56.79, p=0.85) |
| Patient safety and other outcomes | |
| Operative time | |
| Xu, 2014 | Duration of navigated procedures was significantly longer (MD=19.87 min, 95% CI 14.04 to 24.35, p<0.00001) than that of conventional surgery |
| Chen, 2018 | No significant difference between patients who underwent robotic-assisted and conventional THA: (weighted mean difference=23.21 min, 95% CI −3.76 to 50.09) |
| Deep venous thrombosis (DVT) | |
| Xu, 2014 | There was no significant difference between the groups (RR=1.21; 95% CI 0.30 to 4.98, p=0.79) |
| Infections | |
| Moskal, 2011 | OR=0.29; 95% CI 0.03 to 2.81, p=0.2569 |
| Intraoperative complications | |
| Chen, 2018 | The intraoperative complication rate was significantly higher in patients who underwent conventional compared with robotic-assisted THA |
| Xu 2014 | Significantly higher in patients who underwent conventional compared with robotic-assisted THA (OR=0.12; 95% CI 0.05 to 0.34, p<0.0001) |
MD, Mean difference; NAV, navigation; RR, relative risk; SR, systematic review; THA, total hip arthroplasty; WMD, Weighted Mean Difference.