Journal of the American Academy of Orthopaedic Surgeons · IF 2.9 · August 13, 2026 · LoE III
Robotic-Assisted Total Hip Arthroplasty Is Associated With Lower Prosthetic Complications in Patients With Lumbar Fusion or Stiff Spine: A Propensity-Matched Cohort Study
Ali Rteil, Majd Mzeihem, Marcelline Kemmy, Hristo Piponov, Lalit Puri, Dustin H. Massel, Farid Amirouche
This retrospective database study used TriNetX records to compare robotic-assisted versus manual total hip arthroplasty in patients with lumbar fusion or a stiff spine, a group known to have higher dislocation risk. After propensity matching 2,147 patients per group, robotic THA was associated with fewer prosthetic complications at 3 months (1.4% vs 2.7%, OR 1.86, P=0.01), fewer dislocations at 1 year (0.9% vs 1.8%, OR 2.07, P=0.01), and lower revision rates at 2 years (2.0% vs 3.7%, OR 1.86, P<0.001). Benefits were driven mainly by the larger nonfusion 'stiff spine' subgroup, while the smaller spinal fusion subgroup showed no significant differences.
AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing
Why it mattersThis adds observational support for using robotic assistance in a high dislocation-risk THA population, a decision point residents will face increasingly often as spinopelvic considerations become standard in preoperative planning.
Conclusion strengthConfirms prior evidence
The harm exceeds a 25% relative increase, though the 95% CI 1.2 to 2.9 reaches below it.
Presenting this at rounds? Start here
- ?Should surgeons preferentially offer robotic-assisted THA to patients with degenerative spinal stiffness even when they lack a formal fusion, given this study's finding that nonfused stiff-spine patients had similar risk reduction?
- ?How should the absence of a significant benefit in the spinal fusion subgroup change counseling and technique selection for patients who have already undergone lumbar fusion before THA?