Patients Use Less Pain Medication After Robot-Assisted Hip Replacement Compared With Conventional Surgery

Patients who have robot-assisted total hip replacement with a new pin-less platform require less pain medication than those whose surgeries are done manually, according to new research by Cleveland Clinic.

The findings add to the growing list of advantages of robotic surgery, says the study’s senior author, Atul F. Kamath, MD, MBA, professor of orthopaedic surgery and Director of the Center for Hip Preservation at Cleveland Clinic. Previous studies by Dr. Kamath have found that robotic surgeries offer improved accuracy and more precise component positioning.

“I’ve been seeing great technical and clinical results in my practice, but this study adds insight on the benefit of narcotic reduction as well,” he says.

The study, published in Arthroplasty, is the first to review the association of a pin-less robot-assisted hip replacement (ROSA® Hip System, Zimmer Biomet) with postoperative narcotic consumption, he notes.

Greatest benefit seen in first 48 hours

For the retrospective study, Dr. Kamath evaluated the outcomes of more than 200 surgeries he performed, approximately half involving fluoroscopy-assisted (pin-less) robotic total hip arthroplasty and half involving manual surgery using a conventional fluoroscopy technique.

“The only variable was the robotic technique,” he says. “Everything else — the surgeon, the hospital, the postoperative physical therapy — was the same.”

He found that the robot-assisted surgery group had significantly lower total postoperative narcotic use in the first six weeks after surgery, with 103.7 morphine milligram equivalents (MME) compared with 127.8 MME for the manual surgery group.

This difference also was seen among opioid-tolerant patients, with 123.6 MME for the robotic group compared with 181.3 MME for the manual group.

Dr. Kamath noted that the greatest benefit was seen with perioperative in-hospital narcotic use during the first 24 to 48 hours after surgery. Differences seemed to even out after discharge.

“It was an early benefit, but any reduction in opioids is a benefit overall and augments patients’ early functional recovery,” he says.

Improved precision may lead to less pain

While he was pleased with the findings, Dr. Kamath said the results were not surprising. In addition to visual guidance, robotic systems can provide detailed data on factors like leg length and offset, which can help surgeons precisely adjust the biomechanics of the hip reconstruction.

“I think that’s why patients are recovering faster and having less pain after robot-assisted surgery — because their biomechanics are optimized and their components are better positioned,” he says.

Dr. Kamath plans to continue to study outcomes of hip replacement — including longer time horizons, objective gait analysis and wearable technology — to determine which patients benefit most from robotic surgery. He’d also like to see larger studies on pain to determine if other surgeons also report reduced opioid use in patients undergoing the pin-less robotic surgery technique.

“As a community, we’re always looking to reduce the need for narcotic medications,” he says. “Any new tool we adopt, like robotics, must help our patients with functional improvement, but if it can also help with pain and narcotic use, that’s a huge benefit.”