Robotic-assisted versus conventional hip arthroplasty: A comparative analysis of perioperative blood management and early outcomes

Purpose: This study aimed to evaluate the impact of Robotic-Assisted Total Hip Arthroplasty (RATHA) versus Conventional Total Hip Arthroplasty (CTHA) on perioperative blood loss and blood transfusion requirements in patients with hip arthritis. Methods: This was a prospective cohort study, conducted at a high-volume tertiary care center from January 2021 to January 2023. Two hundred patients undergoing primary THA, were equally divided between RATHA (using the MAKO SmartRobotics system) and CTHA cohorts. Primary outcomes measured were perioperative hemoglobin changes, estimated blood loss (EBL), and transfusion rates. Secondary outcomes included operative times, hospital stays, and transfusion-related adverse events. Results: The mean pre-operative hemoglobin levels were comparable between the cohorts. However, the RATHA group demonstrated significantly lower post-operative day 1 hemoglobin drops, reduced EBL (1212.7 mL vs. 1565.24 mL in CTHA; p < 0.0001), and fewer transfusions (7 vs. 29 in CTHA; p < 0.0001). Operative times were shorter in the RATHA group (68.01 min vs. 77.1 min in CTHA; p < 0.0001). All robotic cohort patients were discharged within 3 days, while 14% (N = 7) of the CTHA group required extended hospital stay. Conclusion: This study demonstrates that RATHA significantly reduces perioperative blood loss, hemoglobin drop, and blood transfusion rates compared to CTHA. The observed decrease in operative time and hospital stay in the RATHA group further suggests that robotic assistance may enhance procedural efficiency and support faster patient recovery.