JOA - 2026-04-30 - Journal Article
Surgeon Experience Influences Posterior Approach Total Hip Arthroplasty Dislocation Risk, But It is Mitigated by Robotic Assistance.
Hollenberg AM, Reddy GB, Sauer M, Blum E, McCoy LH, Barrack RL, Schneider AM, Bendich I
Topics
Key Takeaway
Robotic assistance reduced early-career surgeon PA-THA dislocation rate from 4.5% to 0.3% (OR 0.08, 95% CI 0.004–0.42), matching experienced-career manual technique (1.2%) and DAA rates (0.5%).
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Summary
This study asked whether early-career surgeons have higher PA-THA dislocation rates than experienced-career surgeons and whether computer navigation or robotic assistance mitigates that risk across 5,516 consecutive primary THAs at a single academic institution (2018–2024). Manual PA-THA dislocation rates were 4.5% for early-career vs. 1.2% for experienced-career surgeons (P<0.001), while DAA rates were uniformly low regardless of experience (0.2–0.6%). Robotic assistance for early-career PA-THA reduced dislocation to 0.3%, statistically indistinguishable from experienced-career manual PA-THA and DAA THA.
Key Limitation
Retrospective single-institution design with only 10 surgeons (6 early-career, 4 experienced) introduces significant confounding by unmeasured surgeon-specific factors including fellowship training, implant selection, and soft-tissue repair technique.
Original Abstract
BACKGROUND
Dislocation remains a common complication after total hip arthroplasty (THA). While higher annual surgical volume has been associated with lower dislocation rates, the influence of surgeon experience is poorly understood. We evaluated whether early-career surgeons have higher rates of dislocation compared to experienced-career surgeons and whether enabling technology, specifically computer navigation (CN) or robotic assistance (RA), mitigates this risk.
METHODS
A retrospective review of 5,516 consecutive primary THAs was performed at a single academic institution between June 1, 2018, and November 1, 2024. Patients were ≥ 18 years, had primary osteoarthritis, and underwent posterior approach (PA) or direct anterior approach (DAA) THA. Surgeons were categorized as early-career (n = 6) or experienced-career (n = 4) based on having fewer or more than five years in practice, respectively. Demographics, history of lumbar spinal fusion, use of enabling technology, surgical variables, and postoperative dislocations and revisions were collected from the electronic medical record and telephone follow-up. Multivariate logistic regressions were performed to identify factors associated with dislocation.
RESULTS
Dislocation was more common after PA compared to DAA THA (1.7 versus 0.5%, P < 0.001). Experience did not affect the DAA dislocation rate (early-career 0.2 versus experienced-career 0.6%, P = 0.311). For manual PA THA, early-career surgeons had a higher dislocation rate than experienced-career surgeons (4.5 versus 1.2%, P < 0.001). Early-career surgeons using RA for PA THA had a dislocation rate comparable to experienced-career surgeons using manual technique (0.3 versus 1.2%, P = 0.240) and to DAA THA (P > 0.999). On multivariate analysis, RA was protective against dislocation for early-career surgeons (odds ratio 0.08, 95% confidence interval 0.004 to 0.42, P = 0.001).
CONCLUSION
Early-career surgeons had a higher dislocation rate after manual PA THA compared to experienced-career surgeons. Use of RA reduced PA dislocation risk to levels comparable to those of experienced-career surgeons and those performing DAA THA.