JOA - 2026-08-10 - Journal Article
Racial and Ethnic Disparities in the Utilization of Robotic-Assisted Total Hip Arthroplasty: A Propensity Score-Matched Analysis.
Ogu E, Valencia A, Sambandam S
Topics
Key Takeaway
Minority THA patients have 47% lower odds of receiving robotic-assisted THA compared to White patients (OR 0.53), with Black/African American patients facing the greatest disparity (OR 0.41), persisting after propensity score matching.
Summary Depth
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Summary
This propensity score-matched retrospective database study examined racial and ethnic disparities in RA-THA utilization across 224,954 patients from 2014–2026. Minority patients had significantly lower odds of receiving RA-THA versus White patients (OR 0.53), with Black/African American patients most affected (OR 0.41), Asian patients intermediate (OR 0.67), and Hispanic/Latino patients similar to Asian (OR 0.68). Disparities were unchanged after 1:1 nearest-neighbor matching on age, sex, BMI, and comorbidities, implicating structural rather than clinical drivers.
Key Limitation
The database lacks insurance type, socioeconomic status, hospital academic affiliation, and RA-THA availability at the treating facility—factors that likely mediate the observed disparity and cannot be distinguished from structural racism in this analysis.
Original Abstract
BACKGROUND
Robotic-assisted total hip arthroplasty (RA-THA) has seen rapid adoption across the United States, yet whether racial and ethnic disparities in conventional total hip arthroplasty (THA) utilization extend to this emerging technology remains unknown. This study evaluated differences in RA-THA utilization across racial and ethnic groups.
METHODS
A retrospective propensity score-matched cohort study was conducted using a national database. Patients aged 18 years or older who underwent THA between January 1, 2014, and February 12, 2026, were identified. A minority cohort (Hispanic/Latino, Black/African American, Asian, and other non-White patients) was compared with a non-Hispanic White cohort. A total of 224,954 patients were included (37,992 minority; 186,962 White). The primary outcome was the odds of undergoing RA-THA, expressed as odds ratios (OR) with 95% confidence intervals (CI). Propensity score matching was performed using a 1:1 nearest-neighbor algorithm, balancing covariates including age, sex, body mass index (BMI), and relevant comorbidities.
RESULTS
In the unmatched analysis, minority patients had significantly lower odds of receiving RA-THA compared with White patients (OR 0.53, 95% CI 0.50 to 0.57, P < 0.001). Disparities were most pronounced among Black/African American patients (OR 0.41, 95% CI 0.38 to 0.45), followed by Asian (OR 0.67, 95% CI 0.56 to 0.80) and Hispanic/Latino patients (OR 0.68, 95% CI 0.59 to 0.78). After propensity score matching, these disparities persisted with nearly identical effect estimates across all groups (overall minority OR 0.53, 95% CI 0.50 to 0.59; P < 0.001).
CONCLUSION
Major racial and ethnic disparities exist in RA-THA utilization in the United States. The persistence of these disparities after adjustment for clinical and demographic factors implicates structural and systemic barriers as primary drivers. As RA-THA adoption expands, targeted efforts are needed to ensure equitable access to this emerging surgical technology across all patient populations.