Physical and mental demand during direct anterior total hip arthroplasty: Comparison of robotic-assisted and conventional techniques

Introduction: The adoption of new techniques, such as the direct anterior (DA) approach, and technologies, such as robotic assistance, in total hip arthroplasty (THA) has the potential to alleviate the intraoperative physical and mental demand that surgeons experience. Therefore, the aim of this study is to compare the physical and mental demand of surgeons performing conventional DA THA with fluoroscopy and robotic-assisted DA THA without fluoroscopy. Methods: Two orthopaedic surgeons completed bilateral DA THA's on six cadaveric specimens. To assess physical demand, heart rates (HR), respirations, HR variability (stress), calories burned, and sweat loss were recorded using smartwatches. Surgeons completed a modified SURG-TLX questionnaire to assess physical and mental demand. Data were pooled together and two-sample t-tests were performed. Results: Physical and mental demand metrics such as maximum HR, maximum stress, mean caloric expenditure and sweat loss were lower in robotic-assisted DA THA without fluoroscopy. Robotic-assisted THA was associated with a decreased percentage change for both the overall procedure and all surgical steps. Robotic-assisted THA also resulted in a significant difference in percentage change for maximum HR during acetabular reaming. Via questionnaire results, surgeons reported that robotic-assisted DA THA was significantly less physically and mentally demanding compared to conventional DA THA for the overall procedure and acetabular reaming. Discussion: It is important to understand how robotic-assisted THA impacts the health of the surgeons using them. Robotic-assisted DA THA without fluoroscopy resulted in less physical and mental demand for orthopaedic surgeons for the overall procedure and individual surgical steps.