Low rates of dislocation and reoperation following robotic-assisted total hip arthroplasty for femoral neck fracture.

Introduction: Total hip arthroplasty (THA) is widely used for active, elderly patients with femoral neck fractures (FNF). Compared to THA for osteoarthritis, THA for FNF is associated with a higher incidence of dislocation and reoperation. Robotic assistance may improve component positioning and leg-length restoration in THA, but its use in FNF has not been described. The objective of this study was to assess the feasibility and perioperative outcomes of robotic-assisted THA (rTHA) for FNF.

Methods: A retrospective review identified 93 patients undergoing 94 THAs for FNF from 2016 to 2023. 18 patients treated with MAKOplasty rTHA were compared to 76 non-rTHA. There were 69 (73%) women, the mean age was 71 years, and the mean follow-up was 3 years.

Results: There was no significant difference in operative time between rTHA and non-rTHA cohorts (100 vs. 108 minutes,  = 0.19), and sub-analysis of acute FNFs (< 6 weeks), showed no difference in the meantime from presentation to surgery (18 vs. 25 hours,  = 0.24). There was no significant difference in mean leg-length discrepancy (LLD) ( = 0.19), number of outliers for acetabular anteversion ( = 0.80), or inclination ( = 0.55). There were no postoperative dislocations or reoperations in the rTHA cohort, compared to 4 dislocations (5%) and 6 reoperations (8%) in the non-rTHA cohort ( = 1.00 and 0.59, respectively).

Conclusions: In this series of THA for FNF, robotic assistance did not significantly delay the time to surgery or increase the operative time compared to non-rTHA. At a mean follow-up of 3 years, there were no postoperative dislocations or reoperations in the rTHA cohort.