Comparative study on the performance and early clinical outcomes of senior and junior orthopaedic surgeons in traditional versus robot-assisted total hip arthroplasty

The differential impact of robotic assistance on surgeons with varying levels of experience in total hip arthroplasty (THA) remains underexplored. This retrospective study investigated whether robotic-assisted THA (RA-THA) differentially affects the surgical performance and early clinical outcomes of senior versus junior surgeons compared to manual THA (M-THA). A total of 211 patients who underwent primary THA were divided into four groups based on surgeon seniority (senior, with > 10 years of experience vs. junior, with < 2 years of experience) and surgical technique (RA-THA vs. M-THA). All six participating surgeons (three senior, three junior) completed standardized robotic training before performing RA-THA. Perioperative parameters, radiographic outcomes, and one-month clinical follow-up data were analyzed. The results demonstrated a significant effect with use of robotic assistance, which differed slightly based on seniority level. For junior surgeons, RA-THA dramatically elevated their performance to the level of senior experts. While junior surgeons in the M-THA group exhibited significant variability, with a lower rate of acetabular cups placed within the Lewinnek safe zone (79.2%) andless precise restoration of leg length and offset, robotic assistance enabled them to achieveresults similar to senior surgeonsfor these parameters, including a safe zone attainment rate of 94.2%. RA-THA further improvedthe precision of senior surgeons (safe zone rate from 88.7% to 94.3%) but at the cost of significantly prolonged operative time, with no observable advantage in early functional outcomes or complications. Notably, early clinical outcomes at one month were insignificant across all groups, suggesting that the precision benefits of RA-THA may require longer follow-up to fully elucidate .Ultimately RA-THA serves as a powerful equalizer between tiers of surgical experience, effectively enabling junior surgeons toclosely replicate the technical precision of their senior counterparts. For senior surgeons, the technology offers marginaltechnical benefit at the expense of efficiency, potentiallycreating barriers to adoption. These findings suggest that the value proposition of RA-THA should be tailored to surgeon seniority, prioritizing its use for training novice surgeons and managing complex cases.