Perceptions and attitudes regarding robotic total hip arthroplasty: a patient stakeholder survey

Perceptions and attitudes regarding robotic total hip arthroplasty: a patient stakeholder survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Perceptions and attitudes regarding robotic total hip arthroplasty: a patient stakeholder survey Hassaan Abdel Khalikm MD MMI, Asher Selznick, MD, Kamal Bali, MBBS FRCSC MSc MS, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5368700/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Dec, 2024 Read the published version in Journal of Robotic Surgery → Version 1 posted 4 You are reading this latest preprint version Abstract Purpose: To describe the attitudes and preferences of patients pertaining to robotic-assisted total hip arthroplasty (RA-THA) with the long-term objective of designing a prospective randomized-controlled trial (RCT) to evaluate the efficacy of RA-THA compared to conventional technique. Methods: A cross-sectional survey of patients attending an outpatient high-volume academic arthroplasty clinic chosen was administered from December 2023 to May 2024. The survey was comprised of 31 items including patient demographic, patient reported factors of significance and perceptions surrounding RA-THA. Results: Ninety-seven patients completed the survey with a mean age of 67.5 ± 9.1 years and with 63% of patients being female. The majority of respondents were not at all familiar with RA-THA (69%). Common perceptions of RA-THA compared to conventional technique included a smaller incision (41%), lower chance of developing infection (47%), shorter length of surgery (41%), less blood loss (41%), lower cost (22%), shorter length of stay (30%), more precise implant positioning (46.8%), lower post-operative pain (29%), and lower post-operative complications (36%). Very important outcomes to be assessed in future investigations included post-operative range of motion (91%), implant longevity (91%), dislocation risk (90%), post-operative pain (89%), and infection risk (87%). Conclusion: Patient familiarity with robotic-assisted total hip arthroplasty is low. Patient perceptions regarding RA-THA compared to conventional technique are favorable, despite limited evidence to date. Important factors to be assessed in future RCTs include range of motion, implant longevity, dislocation risk and infection risk. Findings of this study can inform a clinically relevant RCT assessing RA-THA compared to conventional technique. total hip arthroplasty total joint arthroplasty robotics robotic surgery survey Figures Figure 1 Figure 2 INTRODUCTION Total hip arthroplasty (THA) is a commonly performed procedure that effectively reduces pain, improves mobility, and enhances the quality of life in patients suffering from disorders of the hip [ 1 ]. However, serious complications such as dislocation, infection, and implant failure persist despite continual advances in implant design and surgical techniques. Furthermore, up to 10% of patients report dissatisfaction after their total hip surgery, primarily due to persistent pain and functional limitations [ 2 ]. Robotic-assisted total hip arthroplasty (RA-THA) is a relatively nascent technology that has been consistently demonstrated to improve implant positioning which may improve patient functional outcomes and decrease certain post-operative complications such as dislocations [ 3 , 4 ]. The use of RA-THA is only projected to rise, with a population registry study estimating that 24% of all THAs conducted in the United States in 2025 will be robotic-assisted, from only 1% in 2015 [ 5 ]. Expectedly, patient interest has mirrored this phenomenon with research demonstrating a liner growth in online searches over the last ten years [ 6 ]. Despite the rapid adoption of RA-THA, limited high-quality randomized controlled trials (RCTs) exist to provide methodologically sound recommendations [ 7 ]. In order to ensure a clinically relevant trial design, all relevant stakeholders should by surveyed regarding their thoughts, perceptions and preferences surrounding the research question of interest [ 8 ]. There have been a small number of studies assessing patient perceptions surrounding robotic joint replacement surgery, though the applicability of their conclusions to RA-THA are often limited by methodology that does not delineate between knee and hip arthroplasty, or due to surveys solely focusing on robotic total knee arthroplasty (TKA) [ 9 – 12 ]. Common conclusions across such studies include a limited proportion of patients being familiar with robotic joint replacement surgery as well as patients believing that the use of robotic-assistance in surgery would result in improved outcomes and faster recovery times [ 10 – 12 ]. Nonetheless, there is paucity of studies assessing patient perceptions surrounding robotic-assistant total hip arthroplasty. Therefore, the purpose of the present study is to elicit current patient perceptions and attitudes towards robotic hip surgery and their preferences regarding possible outcomes. Findings of this study will aid in the design of a clinically relevant randomized controlled trial evaluating robotic-assisted THA compared to conventional technique. METHODS Survey Design A 31-item survey questionnaire was developed utilizing both content and face validity methods, with input from a group of fellowship trained orthopaedic surgeons and reviewed by patient stakeholders, to ensure it accurately measured the intended constructs and resonates with patients. The survey included questions addressing patient socio-demographic parameters, patient reported factors of significance and perceptions surrounding robotic-assisted total hip arthroplasty was administered (Appendix I). The survey was comprised of both multiple choice and open-ended questions. Patient Selection A cross-sectional study of patients attending an outpatient high-volume academic arthroplasty clinic (Juravinski Hospital, Hamilton, Ontario, Canada) was conducted through convenience sampling from December 2023 to May 2024. Statistical Analysis Survey responses were anonymously coded into a secure database. Open-ended questions were thematic assessed and grouped into appropriate categories. Descriptive statistics were conducted using Statistical Package for the Social Sciences (SPSS) for Mac Version 29.0 (IBM Corp., New York). RESULTS Of the 95 respondents, 61 (63%) were female and the mean age was 67.5 (SD, 9.1) years (Table 1). Most respondents were college graduates (47%) and were either awaiting hip arthroplasty surgery (65%) or had had a hip replacement in the past (28%). The majority of respondents were not at all familiar with robotic-assisted hip replacement surgery (71%) (Figure 1). When asked about their perception of robotic-assisted hip replacement surgery compared to conventional techniques in various domains, a large proportion of patients responded with ‘unsure’ (range, 37% to 51%). Excluding ‘unsure’ responses, robotic-assisted THA was consistently perceived as the same or superior to conventional THA with common responses including a smaller incision (41%), lower chance of developing infection (47%), shorter length of surgery (41%), less blood loss (41%), lower cost (22%), shorter length of stay (30%), more precise positioning of implants (47%), lower pain (29%), and lower post-operative complications (36%) (Table 2). When asked about the relative importance of outcomes for future investigation, most patients felt that post-operative range of motion (91%), implant longevity (91%), risk of dislocation (90%), post-operative pain (89%), and risk of infection (87%) were ‘very important’ (Figure 2). Conversely, most patients reported that the size of the incision, the length of the surgery, and the cost to the healthcare system was either only ‘somewhat important’ or ‘unimportant.’ One fifth of patients (n = 18/90, 20%) reported concerns regarding the use of robotics in hip replacement surgery, with the most common concerns elicited being regarding a lack of information (39%), a risk of infection (28%), the possibility of mechanical failure (22%) and the level of precision allowed by the technology (22%) (Table 3). Many respondents (n = 69/97, 71%) provided questions they felt were still unanswered regarding RA-THA. Common questions were regarding post-operative outcomes compared to conventional approaches (22%), the risk to benefit ratio of this technology (20%), the reliability and safety of robotics (19%), and the efficacy and success rate (16%) (Table 4). DISCUSSION The primary purpose of this study was to assess patient familiarity with robotic-assisted total hip arthroplasty, patient perception of RA-THA compared to conventional THA, as well as outcomes of importance as perceived by the patient. This study found that the majority of patients were not familiar with RA-THA. Further, patients generally perceived robotic-assisted THA to be equal or superior to conventional THA across several domains such as infection risk, implant positioning, and duration of surgery. Outcomes rated as the most important for future investigations included post-operative range of motion, longevity of implant, risk of dislocation, post-operative pain. Conversely, size of incision, cost to the healthcare system and length of surgery were of the least importance. Thematic analysis of patient concerns identified lack of information on the subject matter, infection risk, precision, and risk of mechanical failure as the most common. Findings of this study will inform the design of a prospective RCT assessing RA-THA compared to conventional THA. This study demonstrated that despite arthroplasty surgeons being increasingly familiar with robotics, most patients are not adequately informed about the subject matter. Further, while certain patient perceptions about RA-THA accurately reflected the evidence, such as precision of implant positioning [13], many perceptions were either inaccurate or lacked definitive evidence. For example, 41% of respondents believed RA-THA to be shorter in duration relative to C-THA, whereas several studies to date have reported longer durations for RA-THA [14, 15]. Similarly, almost half of respondents (47%) perceived RA-THA to be associated with lower infection rates, though evidence to date has not demonstrated any differences across RA-THA and C-THA [4, 15]. This finding ultimately highlights the importance of patient education and knowledge translation of current and future evidence on the subject matter. This study notably highlights several outcomes of importance from a patient perspective. To our knowledge, this is the first patient preference survey conducted with a focus on robotic-assisted THA. Outcomes felt to be most important by at least 90% of respondents were post-operative range of motion, longevity of implants, as well as risk of hip dislocation. While implant longevity and dislocation risk have been assessed in prior observational studies, there is a paucity of reporting on post-operative range of motion in the literature [7, 16, 17]. This study also sheds light on how patient perceptions and priorities regarding RA-THA may or may not align with those of surgeons. For example, while cost is often cited as a common deterrent for the adoption of robotic arthroplasty technology by surgeons, this was not the case for patients in this study [18, 19]. Such preferences and priorities should also be considered in the context of the healthcare system in which these surveys are conducted as funding models may drastically vary. Interestingly, surgeons using robotics in arthroplasty cited higher precision in procedures (77.1%) and marketing (12.2%) as the most common reasons for adoptions, with superior long-term outcomes (2.5%) and patient satisfaction (4.7%) as less important reasons. Conversely, 73% of surgeons cited lack of superior outcomes in favor of robotics as the primary reasons for not adopting the technology. This highlights the important of high-quality, prospectively designed RCTs that are able to assess relevant outcomes to inform both surgeons and patients as to the benefits, or lack thereof, of robotics in arthroplasty. Patient education was another important area of future research identified through this study. Seventy-one percent of respondents were not familiar with robotics at all, with thematic analysis of open-ended questions demonstrating a lack of information as the most common concern. A prior study by Abdelaal et al. reported that the internet/social media is the most common source of information for patients on robotic joint arthroplasty [11]. Concurrently, several studies to date have demonstrated that online resources on arthroplasty vary greatly in terms of quality [20, 21]. As identified by Marmura et al., novel knowledge translation strategies in orthopaedic surgery that incorporate social media are necessary today for the successful implementation of new interventions following randomized controlled trials [22]. Therefore, designing an RCT with both a robust methodology and a relevant knowledge translation plan is necessary to ensure all relevant stakeholders are accurately updated with relevant findings. Limitations This study is not without its limitations. First, due to a limited sample size, it was not possible to conduct various regression analysis without risking overfitting of the model. Nonetheless, descriptive statistics presented to provide actionable recommendations for the design of future RCT. Second, this survey was conducted across patients in a universal single-payer healthcare system which may have impacted certain preferences (i.e. cost to healthcare system). As such, these preferences may not be applicable healthcare systems of other funding models. Thirdly, there was a large proportion of unsure responses throughout the survey, which further highlights the importance of future patient education on the subject matter. Lastly, while there were several additional areas of interest, the comprehensiveness of the survey needed to be balanced with its length. Despite the above limitations, this study sheds invaluable insight into patient preferences surrounding RA-THA and is the first of its focus to date. CONCLUSION Patient familiarity with robotic-assisted total hip arthroplasty is low. Patient perceptions regarding RA-THA compared to conventional technique are favorable, despite limited evidence to date. Important factors to be assessed in future RCTs include range of motion, implant longevity, dislocation risk and infection risk. Findings of this study can inform a clinically relevant RCT assessing RA-THA compared to conventional technique. Declarations Funding No funding was obtained for this study. Author Contribution H.K. was involved in data analysis, manuscript writing and editing. A.S. was involved in conception, study design, and manuscript editing. K.B. was involved in conception, study design, and manuscript editing and provided content expert input.Y.A. was involved in ethics submissions, data collection and analysis. I.T. was involved data collection, manuscript editing and preparation. T.W. contributed to study design, manuscript editing, and provided content expert input. References Montin L, Leino-Kilpi H, Suominen T, Lepistö J (2008) A systematic review of empirical studies between 1966 and 2005 of patient outcomes of total hip arthroplasty and related factors. J Clin Nurs 17:40–45. https://doi.org/10.1111/j.1365-2702.2007.01944.x Halawi MJ, Jongbloed W, Baron S, et al (2019) Patient Dissatisfaction After Primary Total Joint Arthroplasty: The Patient Perspective. J Arthroplasty 34:1093–1096. https://doi.org/10.1016/j.arth.2019.01.075 Shaw JH, Rahman TM, Wesemann LD, et al (2022) Comparison of Postoperative Instability and Acetabular Cup Positioning in Robotic-Assisted Versus Traditional Total Hip Arthroplasty. J Arthroplasty 37:S881–S889. https://doi.org/10.1016/j.arth.2022.02.002 Bendich I, Vigdorchik JM, Sharma AK, et al (2022) Robotic Assistance for Posterior Approach Total Hip Arthroplasty Is Associated With Lower Risk of Revision for Dislocation When Compared to Manual Techniques. J Arthroplasty 37:1124–1129. https://doi.org/10.1016/j.arth.2022.01.085 Emara AK, Zhou G, Klika AK, et al (2021) Is there increased value in robotic arm-assisted total hip arthroplasty?: a nationwide outcomes, trends, and projections analysis of 4,699,894 cases. Bone Joint J 103-B:1488–1496. https://doi.org/10.1302/0301-620X.103B9.BJJ-2020-2411.R1 Brinkman JC, Christopher ZK, Moore ML, et al (2022) Patient Interest in Robotic Total Joint Arthroplasty Is Exponential: A 10-Year Google Trends Analysis. Arthroplast Today 15:13–18. https://doi.org/10.1016/j.artd.2022.02.015 Ng N, Gaston P, Simpson PM, et al (2021) Robotic arm-assisted versus manual total hip arthroplasty: a systematic review and meta-analysis. Bone Joint J 103-B:1009–1020. https://doi.org/10.1302/0301-620X.103B6.BJJ-2020-1856.R1 Gwilym SE, Perry DC, Costa ML (2021) Trauma and orthopaedic research is being driven by priorities identified by patients, surgeons, and other key stakeholders. Bone Joint J 103-B:1328–1330. https://doi.org/10.1302/0301-620X.103B8.BJJ-2020-2578.R1 Chang J, Wu C, Hinton Z, et al (2024) Patient Perceptions and Interest in Robotic-Assisted Total Joint Arthroplasty. Arthroplast Today 26:101342. https://doi.org/10.1016/j.artd.2024.101342 Pinci MV, Torres-Lugo NJ, Deliz-Jimenez DE, et al (2024) Patient Perception of Robotic-Assisted Total Joint Arthroplasty in a Hispanic Population. Arthroplast Today 25:101286. https://doi.org/10.1016/j.artd.2023.101286 Abdelaal MS, Wiafe BM, Khan IA, et al (2023) Robotic-Assisted Total Knee Arthroplasty: What are Patients’ Perspectives, Understanding and Expectations? J Arthroplasty 38:1726–1733.e4. https://doi.org/10.1016/j.arth.2023.03.020 Pagani NR, Moverman MA, Puzzitiello RN, et al (2021) Online Crowdsourcing to Explore Public Perceptions of Robotic-Assisted Orthopedic Surgery. J Arthroplasty 36:1887–1894.e3. https://doi.org/10.1016/j.arth.2021.02.027 Domb BG, El Bitar YF, Sadik AY, et al (2014) Comparison of robotic-assisted and conventional acetabular cup placement in THA: a matched-pair controlled study. Clin Orthop Relat Res 472:329–336. https://doi.org/10.1007/s11999-013-3253-7 Sweet MC, Borrelli GJ, Manawar SS, Miladore N (2021) Comparison of Outcomes After Robotic-Assisted or Conventional Total Hip Arthroplasty at a Minimum 2-Year Follow-up: A Systematic Review. JBJS Rev 9:. https://doi.org/10.2106/JBJS.RVW.20.00144 Singh V, Realyvasquez J, Simcox T, et al (2021) Robotics Versus Navigation Versus Conventional Total Hip Arthroplasty: Does the Use of Technology Yield Superior Outcomes? J Arthroplasty 36:2801–2807. https://doi.org/10.1016/j.arth.2021.02.074 Samuel LT, Acuña AJ, Mahmood B, et al (2022) Comparing early and mid-term outcomes between robotic-arm assisted and manual total hip arthroplasty: a systematic review. J Robot Surg 16:735–748. https://doi.org/10.1007/s11701-021-01299-0 Han P-F, Chen C-L, Zhang Z-L, et al (2019) Robotics-assisted versus conventional manual approaches for total hip arthroplasty: A systematic review and meta-analysis of comparative studies. Int J Med Robot 15:e1990. https://doi.org/10.1002/rcs.1990 Sherman WF, Wu VJ (2020) Robotic Surgery in Total Joint Arthroplasty: A Survey of the AAHKS Membership to Understand the Utilization, Motivations, and Perceptions of Total Joint Surgeons. J Arthroplasty 35:3474–3481.e2. https://doi.org/10.1016/j.arth.2020.06.072 Luyckx T, Monk AP, Müller JH, et al (2023) What are the perceived benefits and barriers to the use of robot-assisted total knee arthroplasty? A survey of members of the European Knee Society. Int Orthop 47:405–412. https://doi.org/10.1007/s00264-022-05623-7 Ng MK, Emara AK, Molloy RM, et al (2021) YouTube as a Source of Patient Information for Total Knee/Hip Arthroplasty: Quantitative Analysis of Video Reliability, Quality, and Content. J Am Acad Orthop Surg 29:e1034–e1044. https://doi.org/10.5435/JAAOS-D-20-00910 Wong M, Desai B, Bautista M, et al (2019) YouTube is a poor source of patient information for knee arthroplasty and knee osteoarthritis. Arthroplast Today 5:78–82. https://doi.org/10.1016/j.artd.2018.09.010 Marmura H, Kothari A, Getgood AM, et al (2022) From study to scalpel: knowledge translation for research in orthopaedic surgery. Br J Sports Med 56:363–365. https://doi.org/10.1136/bjsports-2021-104406 Tables Table 1 Patient demographics Demographics N (%) Sex (n = 97) Male 34 (35) Female 61 (63) Other 2 (2) Level of Education (n = 97) Less than high school 2 (2) High school 21 (21) College 46 (47) Professional 28 (29) Do you have hip arthritis? (n = 97) Yes 71 (73) No 26 (27) Have you had a hip replacement? (n = 97) Yes 27 (28) No 70 (72) Are you currently waiting for a hip replacement? (n = 96) Yes 63 (65) No 33 (34) Table 2 Patient perceptions of robotic-assisted hip replacement surgery compared to conventional technique Smaller Same Size Larger Unsure The usual incision size in robotic hip surgery is (n = 96): 39 (41%) 10 (10%) 0 (0%) 47 (49%) Lower Same Higher Unsure The patient’s chance of developing a hip infection is (n = 96): 45 (47%) 21 (22%) 0 (0%) 30 (31%) Shorter Same Length Longer Unsure The length of the surgery is (n = 96): 39 (41%) 14 (15%) 3 (3%) 40 (42%) Less Same More Unsure The amount of blood loss is (n = 96): 39 (41%) 14 (15%) 0 (0%) 43 (45%) Less Same More Unsure The cost to the healthcare system is (n = 96): 21 (22%) 11 (11%) 15 (16%) 49 (51%) Shorter Same Longer Unsure The length of stay in hospital after surgery is (n = 94): 28 (30%) 27 (29%) 1 (1%) 38 (40%) Less Precise Same More Precise Unsure The precision of positioning of the implants is (n = 94): 0 (0%) 14 (15%) 44 (47%) 36 (38%) Less Same More Unsure The amount of pain after surgery is (n = 93): 27 (29%) 29 (31%) 0 (0%) 37 (40%) Lower Same Greater Unsure The chance of complications overall is (n = 95): 34 (36%) 25 (26%) 0 (0%) 36 (38%) Table 3 Patient concerns regarding use of robotics in total hip arthroplasty Patient Concern Responses, n (%) Lack of Information on Robotic Surgeries & Knowledge Gaps 7 (39) Risk of infection 5 (28) The level of Precision 4 (22) Safety and Possibility of mechanical failure 4 (22) Risk of unforeseen complications 3 (17) Success rate 3 (17) Efficacy and efficiency 2 (11) The robotic surgical technical skills of attending surgeons 1 (6) Determining patient eligibility 1 (6) Quality control and Calibration Techniques 1 (6) Total Respondents 18 (100) Table 4 Important questions to be answered Question Responses, n (%) Post-operative outcomes compared to conventional surgical approaches 15 (22) Risk benefit ratio and the risk evaluation (infection, bleeding) 14 (20) Reliability and safety 13 (19) Efficacy and success rate 11 (16) Long-terms effects and durability of outcomes 10 (14) The frequency of complications 7 (10) Technical feasibility and possibility of equipment malfunction 7 (10) Medical oversight during surgery 7 (10) Adaptability of equipment to patient physiology and determining the appropriate alignment and placement 7 (10) Competency evaluation and or personnel training/experience level 6 (9) The extent of clinical evidence and research on robotic surgeries 4 (6) Future implications 4 (6) Waiting time requirements 3 (4) Quality checks and precautionary measures 1 (1) Ethical considerations 1 (1) Total Respondents 69 (100) Additional Declarations No competing interests reported. Supplementary Files Appendix1.docx Cite Share Download PDF Status: Published Journal Publication published 12 Dec, 2024 Read the published version in Journal of Robotic Surgery → Version 1 posted Editorial decision: Revision requested 07 Nov, 2024 Editor assigned by journal 02 Nov, 2024 Submission checks completed at journal 02 Nov, 2024 First submitted to journal 31 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5368700","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":375367078,"identity":"b1e3dceb-f91e-474a-9d28-11b232ed3a1d","order_by":0,"name":"Hassaan Abdel Khalikm MD MMI","email":"","orcid":"","institution":"Division of Orthopaedic Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada","correspondingAuthor":false,"prefix":"","firstName":"Hassaan","middleName":"Abdel Khalikm","lastName":"MD","suffix":"MD"},{"id":375367079,"identity":"6a0bf718-4ebf-4b48-a722-b9c03817be5b","order_by":1,"name":"Asher 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2","display":"","copyAsset":false,"role":"figure","size":31141,"visible":true,"origin":"","legend":"\u003cp\u003eRelative importance of outcomes to be investigated in future research\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5368700/v1/14e7db6eb745ae6f68e78114.png"},{"id":71552482,"identity":"0d92b3eb-bce8-4bb1-8c3b-e5e19cb8caee","added_by":"auto","created_at":"2024-12-16 16:06:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":503834,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5368700/v1/644856ae-9abd-47a7-bb5b-f5d8d9644cbb.pdf"},{"id":68887033,"identity":"0ea98a60-080e-4f3f-82c6-7dcb86152415","added_by":"auto","created_at":"2024-11-13 06:49:49","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":16287,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix1.docx","url":"https://assets-eu.researchsquare.com/files/rs-5368700/v1/816b915f86b6293c742d4131.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perceptions and attitudes regarding robotic total hip arthroplasty: a patient stakeholder survey","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eTotal hip arthroplasty (THA) is a commonly performed procedure that effectively reduces pain, improves mobility, and enhances the quality of life in patients suffering from disorders of the hip [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, serious complications such as dislocation, infection, and implant failure persist despite continual advances in implant design and surgical techniques. Furthermore, up to 10% of patients report dissatisfaction after their total hip surgery, primarily due to persistent pain and functional limitations [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Robotic-assisted total hip arthroplasty (RA-THA) is a relatively nascent technology that has been consistently demonstrated to improve implant positioning which may improve patient functional outcomes and decrease certain post-operative complications such as dislocations [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The use of RA-THA is only projected to rise, with a population registry study estimating that 24% of all THAs conducted in the United States in 2025 will be robotic-assisted, from only 1% in 2015 [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Expectedly, patient interest has mirrored this phenomenon with research demonstrating a liner growth in online searches over the last ten years [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the rapid adoption of RA-THA, limited high-quality randomized controlled trials (RCTs) exist to provide methodologically sound recommendations [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In order to ensure a clinically relevant trial design, all relevant stakeholders should by surveyed regarding their thoughts, perceptions and preferences surrounding the research question of interest [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. There have been a small number of studies assessing patient perceptions surrounding robotic joint replacement surgery, though the applicability of their conclusions to RA-THA are often limited by methodology that does not delineate between knee and hip arthroplasty, or due to surveys solely focusing on robotic total knee arthroplasty (TKA) [\u003cspan additionalcitationids=\"CR10 CR11\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Common conclusions across such studies include a limited proportion of patients being familiar with robotic joint replacement surgery as well as patients believing that the use of robotic-assistance in surgery would result in improved outcomes and faster recovery times [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Nonetheless, there is paucity of studies assessing patient perceptions surrounding robotic-assistant total hip arthroplasty.\u003c/p\u003e \u003cp\u003eTherefore, the purpose of the present study is to elicit current patient perceptions and attitudes towards robotic hip surgery and their preferences regarding possible outcomes. Findings of this study will aid in the design of a clinically relevant randomized controlled trial evaluating robotic-assisted THA compared to conventional technique.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSurvey Design\u003c/h2\u003e \u003cp\u003eA 31-item survey questionnaire was developed utilizing both content and face validity methods, with input from a group of fellowship trained orthopaedic surgeons and reviewed by patient stakeholders, to ensure it accurately measured the intended constructs and resonates with patients. The survey included questions addressing patient socio-demographic parameters, patient reported factors of significance and perceptions surrounding robotic-assisted total hip arthroplasty was administered (Appendix I). The survey was comprised of both multiple choice and open-ended questions.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePatient Selection\u003c/h3\u003e\n\u003cp\u003eA cross-sectional study of patients attending an outpatient high-volume academic arthroplasty clinic (Juravinski Hospital, Hamilton, Ontario, Canada) was conducted through convenience sampling from December 2023 to May 2024.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eSurvey responses were anonymously coded into a secure database. Open-ended questions were thematic assessed and grouped into appropriate categories. Descriptive statistics were conducted using Statistical Package for the Social Sciences (SPSS) for Mac Version 29.0 (IBM Corp., New York).\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eOf the 95 respondents, 61 (63%) were female and the mean age was 67.5 (SD, 9.1) years (Table 1). Most respondents were college graduates (47%) and were either awaiting hip arthroplasty surgery (65%) or had had a hip replacement in the past (28%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe majority of respondents were not at all familiar with robotic-assisted hip replacement surgery (71%) (Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhen asked about their perception of robotic-assisted hip replacement surgery compared to conventional techniques in various domains, a large proportion of patients responded with \u0026lsquo;unsure\u0026rsquo; (range, 37% to 51%). Excluding \u0026lsquo;unsure\u0026rsquo; responses, robotic-assisted THA was consistently perceived as the same or superior to conventional THA with common responses including a smaller incision (41%), lower chance of developing infection (47%), shorter length of surgery (41%), less blood loss (41%), lower cost (22%), shorter length of stay (30%), more precise positioning of implants (47%), lower pain (29%), and lower post-operative complications (36%) (Table 2). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhen asked about the relative importance of outcomes for future investigation, most patients felt that post-operative range of motion (91%), implant longevity (91%), risk of dislocation (90%), post-operative pain (89%), and risk of infection (87%) were \u0026lsquo;very important\u0026rsquo; (Figure 2). Conversely, most patients reported that the size of the incision, the length of the surgery, and the cost to the healthcare system was either only \u0026lsquo;somewhat important\u0026rsquo; or \u0026lsquo;unimportant.\u0026rsquo;\u003c/p\u003e\n\u003cp\u003eOne fifth of patients (n = 18/90, 20%) reported concerns regarding the use of robotics in hip replacement surgery, with the most common concerns elicited being regarding a lack of information (39%), a risk of infection (28%), the possibility of mechanical failure (22%) and the level of precision allowed by the technology (22%) (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMany respondents (n = 69/97, 71%) provided questions they felt were still unanswered regarding RA-THA. Common questions were regarding post-operative outcomes compared to conventional approaches (22%), the risk to benefit ratio of this technology (20%), the reliability and safety of robotics (19%), and the efficacy and success rate (16%) (Table 4).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe primary purpose of this study was to assess patient familiarity with robotic-assisted total hip arthroplasty, patient perception of RA-THA compared to conventional THA, as well as outcomes of importance as perceived by the patient. This study found that the majority of patients were not familiar with RA-THA. Further, patients generally perceived robotic-assisted THA to be equal or superior to conventional THA across several domains such as infection risk, implant positioning, and duration of surgery. Outcomes rated as the most important for future investigations included post-operative range of motion, longevity of implant, risk of dislocation, post-operative pain. Conversely, size of incision, cost to the healthcare system and length of surgery were of the least importance. Thematic analysis of patient concerns identified lack of information on the subject matter, infection risk, precision, and risk of mechanical failure as the most common. Findings of this study will inform the design of a prospective RCT assessing RA-THA compared to conventional THA.\u003c/p\u003e\n\u003cp\u003eThis study demonstrated that despite arthroplasty surgeons being increasingly familiar with robotics, most patients are not adequately informed about the subject matter. Further, while certain patient perceptions about RA-THA accurately reflected the evidence, such as precision of implant positioning [13], many perceptions were either inaccurate or lacked definitive evidence. For example, 41% of respondents believed RA-THA to be shorter in duration relative to C-THA, whereas several studies to date have reported longer durations for RA-THA [14, 15]. Similarly, almost half of respondents (47%) perceived RA-THA to be associated with lower infection rates, though evidence to date has not demonstrated any differences across RA-THA and C-THA [4, 15]. This finding ultimately highlights the importance of patient education and knowledge translation of current and future evidence on the subject matter.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study notably highlights several outcomes of importance from a patient perspective. \u0026nbsp;To our knowledge, this is the first patient preference survey conducted with a focus on robotic-assisted THA. Outcomes felt to be most important by at least 90% of respondents were post-operative range of motion, longevity of implants, as well as risk of hip dislocation. While implant longevity and dislocation risk have been assessed in prior observational studies, there is a paucity of reporting on post-operative range of motion in the literature [7, 16, 17]. This study also sheds light on how patient perceptions and priorities regarding RA-THA may or may not align with those of surgeons. For example, while cost is often cited as a common deterrent for the adoption of robotic arthroplasty technology by surgeons, this was not the case for patients in this study [18, 19]. Such preferences and priorities should also be considered in the context of the healthcare system in which these surveys are conducted as funding models may drastically vary. Interestingly, surgeons using robotics in arthroplasty cited higher precision in procedures (77.1%) and marketing (12.2%) as the most common reasons for adoptions, with superior long-term outcomes (2.5%) and patient satisfaction (4.7%) as less important reasons. Conversely, 73% of surgeons cited lack of superior outcomes in favor of robotics as the primary reasons for not adopting the technology. This highlights the important of high-quality, prospectively designed RCTs that are able to assess relevant outcomes to inform both surgeons and patients as to the benefits, or lack thereof, of robotics in arthroplasty.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatient education was another important area of future research identified through this study. Seventy-one percent of respondents were not familiar with robotics at all, with thematic analysis of open-ended questions demonstrating a lack of information as the most common concern. A prior study by Abdelaal et al. reported that the internet/social media is the most common source of information for patients on robotic joint arthroplasty [11]. Concurrently, several studies to date have demonstrated that online resources on arthroplasty vary greatly in terms of quality [20, 21]. \u0026nbsp;As identified by Marmura et al., novel knowledge translation strategies in orthopaedic surgery that incorporate social media are necessary today for the successful implementation of new interventions following randomized controlled trials [22]. Therefore, designing an RCT with both a robust methodology and a relevant knowledge translation plan is necessary to ensure all relevant stakeholders are accurately updated with relevant findings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study is not without its limitations. First, due to a limited sample size, it was not possible to conduct various regression analysis without risking overfitting of the model. Nonetheless, descriptive statistics presented to provide actionable recommendations for the design of future RCT. Second, this survey was conducted across patients in a universal single-payer healthcare system which may have impacted certain preferences (i.e. cost to healthcare system). As such, these preferences may not be applicable healthcare systems of other funding models. Thirdly, there was a large proportion of unsure responses throughout the survey, which further highlights the importance of future patient education on the subject matter. Lastly, while there were several additional areas of interest, the comprehensiveness of the survey needed to be balanced with its length. Despite the above limitations, this study sheds invaluable insight into patient preferences surrounding RA-THA and is the first of its focus to date. \u0026nbsp;\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003ePatient familiarity with robotic-assisted total hip arthroplasty is low. Patient perceptions regarding RA-THA compared to conventional technique are favorable, despite limited evidence to date. Important factors to be assessed in future RCTs include range of motion, implant longevity, dislocation risk and infection risk. Findings of this study can inform a clinically relevant RCT assessing RA-THA compared to conventional technique.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eNo funding was obtained for this study.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eH.K. was involved in data analysis, manuscript writing and editing. A.S. was involved in conception, study design, and manuscript editing. K.B. was involved in conception, study design, and manuscript editing and provided content expert input.Y.A. was involved in ethics submissions, data collection and analysis. I.T. was involved data collection, manuscript editing and preparation. T.W. contributed to study design, manuscript editing, and provided content expert input.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMontin L, Leino-Kilpi H, Suominen T, Lepist\u0026ouml; J (2008) A systematic review of empirical studies between 1966 and 2005 of patient outcomes of total hip arthroplasty and related factors. J Clin Nurs 17:40\u0026ndash;45. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/j.1365-2702.2007.01944.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1365-2702.2007.01944.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHalawi MJ, Jongbloed W, Baron S, et al (2019) Patient Dissatisfaction After Primary Total Joint Arthroplasty: The Patient Perspective. J Arthroplasty 34:1093\u0026ndash;1096. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.arth.2019.01.075\u003c/span\u003e\u003cspan address=\"10.1016/j.arth.2019.01.075\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShaw JH, Rahman TM, Wesemann LD, et al (2022) Comparison of Postoperative Instability and Acetabular Cup Positioning in Robotic-Assisted Versus Traditional Total Hip Arthroplasty. J Arthroplasty 37:S881\u0026ndash;S889. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.arth.2022.02.002\u003c/span\u003e\u003cspan address=\"10.1016/j.arth.2022.02.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBendich I, Vigdorchik JM, Sharma AK, et al (2022) Robotic Assistance for Posterior Approach Total Hip Arthroplasty Is Associated With Lower Risk of Revision for Dislocation When Compared to Manual Techniques. J Arthroplasty 37:1124\u0026ndash;1129. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.arth.2022.01.085\u003c/span\u003e\u003cspan address=\"10.1016/j.arth.2022.01.085\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEmara AK, Zhou G, Klika AK, et al (2021) Is there increased value in robotic arm-assisted total hip arthroplasty?: a nationwide outcomes, trends, and projections analysis of 4,699,894 cases. Bone Joint J 103-B:1488\u0026ndash;1496. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1302/0301-620X.103B9.BJJ-2020-2411.R1\u003c/span\u003e\u003cspan address=\"10.1302/0301-620X.103B9.BJJ-2020-2411.R1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrinkman JC, Christopher ZK, Moore ML, et al (2022) Patient Interest in Robotic Total Joint Arthroplasty Is Exponential: A 10-Year Google Trends Analysis. Arthroplast Today 15:13\u0026ndash;18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.artd.2022.02.015\u003c/span\u003e\u003cspan address=\"10.1016/j.artd.2022.02.015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNg N, Gaston P, Simpson PM, et al (2021) Robotic arm-assisted versus manual total hip arthroplasty: a systematic review and meta-analysis. Bone Joint J 103-B:1009\u0026ndash;1020. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1302/0301-620X.103B6.BJJ-2020-1856.R1\u003c/span\u003e\u003cspan address=\"10.1302/0301-620X.103B6.BJJ-2020-1856.R1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGwilym SE, Perry DC, Costa ML (2021) Trauma and orthopaedic research is being driven by priorities identified by patients, surgeons, and other key stakeholders. Bone Joint J 103-B:1328\u0026ndash;1330. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1302/0301-620X.103B8.BJJ-2020-2578.R1\u003c/span\u003e\u003cspan address=\"10.1302/0301-620X.103B8.BJJ-2020-2578.R1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChang J, Wu C, Hinton Z, et al (2024) Patient Perceptions and Interest in Robotic-Assisted Total Joint Arthroplasty. Arthroplast Today 26:101342. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.artd.2024.101342\u003c/span\u003e\u003cspan address=\"10.1016/j.artd.2024.101342\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePinci MV, Torres-Lugo NJ, Deliz-Jimenez DE, et al (2024) Patient Perception of Robotic-Assisted Total Joint Arthroplasty in a Hispanic Population. Arthroplast Today 25:101286. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.artd.2023.101286\u003c/span\u003e\u003cspan address=\"10.1016/j.artd.2023.101286\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdelaal MS, Wiafe BM, Khan IA, et al (2023) Robotic-Assisted Total Knee Arthroplasty: What are Patients\u0026rsquo; Perspectives, Understanding and Expectations? J Arthroplasty 38:1726\u0026ndash;1733.e4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.arth.2023.03.020\u003c/span\u003e\u003cspan address=\"10.1016/j.arth.2023.03.020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePagani NR, Moverman MA, Puzzitiello RN, et al (2021) Online Crowdsourcing to Explore Public Perceptions of Robotic-Assisted Orthopedic Surgery. J Arthroplasty 36:1887\u0026ndash;1894.e3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.arth.2021.02.027\u003c/span\u003e\u003cspan address=\"10.1016/j.arth.2021.02.027\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDomb BG, El Bitar YF, Sadik AY, et al (2014) Comparison of robotic-assisted and conventional acetabular cup placement in THA: a matched-pair controlled study. Clin Orthop Relat Res 472:329\u0026ndash;336. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11999-013-3253-7\u003c/span\u003e\u003cspan address=\"10.1007/s11999-013-3253-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSweet MC, Borrelli GJ, Manawar SS, Miladore N (2021) Comparison of Outcomes After Robotic-Assisted or Conventional Total Hip Arthroplasty at a Minimum 2-Year Follow-up: A Systematic Review. JBJS Rev 9:. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2106/JBJS.RVW.20.00144\u003c/span\u003e\u003cspan address=\"10.2106/JBJS.RVW.20.00144\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh V, Realyvasquez J, Simcox T, et al (2021) Robotics Versus Navigation Versus Conventional Total Hip Arthroplasty: Does the Use of Technology Yield Superior Outcomes? J Arthroplasty 36:2801\u0026ndash;2807. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.arth.2021.02.074\u003c/span\u003e\u003cspan address=\"10.1016/j.arth.2021.02.074\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSamuel LT, Acu\u0026ntilde;a AJ, Mahmood B, et al (2022) Comparing early and mid-term outcomes between robotic-arm assisted and manual total hip arthroplasty: a systematic review. J Robot Surg 16:735\u0026ndash;748. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11701-021-01299-0\u003c/span\u003e\u003cspan address=\"10.1007/s11701-021-01299-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHan P-F, Chen C-L, Zhang Z-L, et al (2019) Robotics-assisted versus conventional manual approaches for total hip arthroplasty: A systematic review and meta-analysis of comparative studies. Int J Med Robot 15:e1990. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/rcs.1990\u003c/span\u003e\u003cspan address=\"10.1002/rcs.1990\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSherman WF, Wu VJ (2020) Robotic Surgery in Total Joint Arthroplasty: A Survey of the AAHKS Membership to Understand the Utilization, Motivations, and Perceptions of Total Joint Surgeons. J Arthroplasty 35:3474\u0026ndash;3481.e2. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.arth.2020.06.072\u003c/span\u003e\u003cspan address=\"10.1016/j.arth.2020.06.072\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuyckx T, Monk AP, M\u0026uuml;ller JH, et al (2023) What are the perceived benefits and barriers to the use of robot-assisted total knee arthroplasty? A survey of members of the European Knee Society. Int Orthop 47:405\u0026ndash;412. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00264-022-05623-7\u003c/span\u003e\u003cspan address=\"10.1007/s00264-022-05623-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNg MK, Emara AK, Molloy RM, et al (2021) YouTube as a Source of Patient Information for Total Knee/Hip Arthroplasty: Quantitative Analysis of Video Reliability, Quality, and Content. J Am Acad Orthop Surg 29:e1034\u0026ndash;e1044. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5435/JAAOS-D-20-00910\u003c/span\u003e\u003cspan address=\"10.5435/JAAOS-D-20-00910\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWong M, Desai B, Bautista M, et al (2019) YouTube is a poor source of patient information for knee arthroplasty and knee osteoarthritis. Arthroplast Today 5:78\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.artd.2018.09.010\u003c/span\u003e\u003cspan address=\"10.1016/j.artd.2018.09.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarmura H, Kothari A, Getgood AM, et al (2022) From study to scalpel: knowledge translation for research in orthopaedic surgery. Br J Sports Med 56:363\u0026ndash;365. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bjsports-2021-104406\u003c/span\u003e\u003cspan address=\"10.1136/bjsports-2021-104406\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":" \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003ePatient demographics\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDemographics\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eN (%)\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSex (n\u0026thinsp;=\u0026thinsp;97)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e34 (35)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e61 (63)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eOther\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e2 (2)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLevel of Education (n\u0026thinsp;=\u0026thinsp;97)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLess than high school\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e2 (2)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHigh school\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e21 (21)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCollege\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e46 (47)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eProfessional\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e28 (29)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDo you have hip arthritis? (n\u0026thinsp;=\u0026thinsp;97)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e71 (73)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e26 (27)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHave you had a hip replacement? (n\u0026thinsp;=\u0026thinsp;97)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e27 (28)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e70 (72)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAre you currently waiting for a hip replacement? (n\u0026thinsp;=\u0026thinsp;96)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e63 (65)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e33 (34)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003ePatient perceptions of robotic-assisted hip replacement surgery compared to conventional technique\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSmaller\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eSame Size\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eLarger\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnsure\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eThe usual incision size in robotic hip surgery is (n\u0026thinsp;=\u0026thinsp;96):\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e39\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(41%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(10%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(0%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e47\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(49%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLower\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSame\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eHigher\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eUnsure\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eThe patient\u0026rsquo;s chance of developing a hip infection is (n\u0026thinsp;=\u0026thinsp;96):\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e45\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(47%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e21\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(22%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(0%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e30\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(31%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eShorter\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSame Length\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLonger\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eUnsure\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eThe length of the surgery is (n\u0026thinsp;=\u0026thinsp;96):\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e39\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(41%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e14\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(15%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e3\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(3%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e40\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(42%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLess\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSame\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eMore\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eUnsure\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eThe amount of blood loss is (n\u0026thinsp;=\u0026thinsp;96):\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e39\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(41%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e14\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(15%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(0%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e43\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(45%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLess\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSame\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eMore\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eUnsure\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eThe cost to the healthcare system is (n\u0026thinsp;=\u0026thinsp;96):\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e21\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(22%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e11\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(11%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e15\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(16%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e49\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(51%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eShorter\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSame\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLonger\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eUnsure\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eThe length of stay in hospital after surgery is (n\u0026thinsp;=\u0026thinsp;94):\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e28\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(30%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e27\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(29%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(1%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e38\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(40%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLess Precise\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSame\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eMore Precise\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eUnsure\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eThe precision of positioning of the implants is (n\u0026thinsp;=\u0026thinsp;94):\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(0%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e14\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(15%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e44\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(47%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e36\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(38%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLess\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSame\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eMore\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eUnsure\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eThe amount of pain after surgery is (n\u0026thinsp;=\u0026thinsp;93):\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e27\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(29%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e29\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(31%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(0%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e37\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(40%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLower\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSame\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eGreater\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eUnsure\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eThe chance of complications overall is (n\u0026thinsp;=\u0026thinsp;95):\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e34\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(36%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e25\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(26%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(0%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e36\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(38%)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003ePatient concerns regarding use of robotics in total hip arthroplasty\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePatient Concern\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eResponses, n (%)\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLack of Information on Robotic Surgeries \u0026amp; Knowledge Gaps\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e7 (39)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRisk of infection\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e5 (28)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eThe level of Precision\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e4 (22)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSafety and Possibility of mechanical failure\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e4 (22)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRisk of unforeseen complications\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e3 (17)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSuccess rate\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e3 (17)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eEfficacy and efficiency\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e2 (11)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eThe robotic surgical technical skills of attending surgeons\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (6)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDetermining patient eligibility\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (6)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eQuality control and Calibration Techniques\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (6)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eTotal Respondents\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e18 (100)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eImportant questions to be answered\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eQuestion\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eResponses, n (%)\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePost-operative outcomes compared to conventional surgical approaches\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e15 (22)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRisk benefit ratio and the risk evaluation (infection, bleeding)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e14 (20)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eReliability and safety\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e13 (19)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eEfficacy and success rate\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e11 (16)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLong-terms effects and durability of outcomes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e10 (14)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eThe frequency of complications\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e7 (10)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTechnical feasibility and possibility of equipment malfunction\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e7 (10)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMedical oversight during surgery\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e7 (10)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAdaptability of equipment to patient physiology and determining the appropriate alignment and placement\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e7 (10)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCompetency evaluation and or personnel training/experience level\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e6 (9)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eThe extent of clinical evidence and research on robotic surgeries\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e4 (6)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFuture implications\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e4 (6)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eWaiting time requirements\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e3 (4)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eQuality checks and precautionary measures\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (1)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eEthical considerations\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (1)\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eTotal Respondents\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003e69 (100)\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"total hip arthroplasty, total joint arthroplasty, robotics, robotic surgery, survey","lastPublishedDoi":"10.21203/rs.3.rs-5368700/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5368700/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose:\u003c/h2\u003e \u003cp\u003eTo describe the attitudes and preferences of patients pertaining to robotic-assisted total hip arthroplasty (RA-THA) with the long-term objective of designing a prospective randomized-controlled trial (RCT) to evaluate the efficacy of RA-THA compared to conventional technique.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA cross-sectional survey of patients attending an outpatient high-volume academic arthroplasty clinic chosen was administered from December 2023 to May 2024. The survey was comprised of 31 items including patient demographic, patient reported factors of significance and perceptions surrounding RA-THA.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eNinety-seven patients completed the survey with a mean age of 67.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.1 years and with 63% of patients being female. The majority of respondents were not at all familiar with RA-THA (69%). Common perceptions of RA-THA compared to conventional technique included a smaller incision (41%), lower chance of developing infection (47%), shorter length of surgery (41%), less blood loss (41%), lower cost (22%), shorter length of stay (30%), more precise implant positioning (46.8%), lower post-operative pain (29%), and lower post-operative complications (36%). Very important outcomes to be assessed in future investigations included post-operative range of motion (91%), implant longevity (91%), dislocation risk (90%), post-operative pain (89%), and infection risk (87%).\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003ePatient familiarity with robotic-assisted total hip arthroplasty is low. Patient perceptions regarding RA-THA compared to conventional technique are favorable, despite limited evidence to date. Important factors to be assessed in future RCTs include range of motion, implant longevity, dislocation risk and infection risk. Findings of this study can inform a clinically relevant RCT assessing RA-THA compared to conventional technique.\u003c/p\u003e","manuscriptTitle":"Perceptions and attitudes regarding robotic total hip arthroplasty: a patient stakeholder survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-13 06:49:44","doi":"10.21203/rs.3.rs-5368700/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-07T14:29:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-02T16:42:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-02T10:15:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Robotic Surgery","date":"2024-10-31T18:11:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-robotic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jors","sideBox":"Learn more about [Journal of Robotic Surgery](http://link.springer.com/journal/11701)","snPcode":"11701","submissionUrl":"https://submission.nature.com/new-submission/11701/3","title":"Journal of Robotic Surgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"d3f8c376-c7e5-45e9-ac78-6a0e2ee35504","owner":[],"postedDate":"November 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-16T16:04:00+00:00","versionOfRecord":{"articleIdentity":"rs-5368700","link":"https://doi.org/10.1007/s11701-024-02172-6","journal":{"identity":"journal-of-robotic-surgery","isVorOnly":false,"title":"Journal of Robotic Surgery"},"publishedOn":"2024-12-12 15:57:12","publishedOnDateReadable":"December 12th, 2024"},"versionCreatedAt":"2024-11-13 06:49:44","video":"","vorDoi":"10.1007/s11701-024-02172-6","vorDoiUrl":"https://doi.org/10.1007/s11701-024-02172-6","workflowStages":[]},"version":"v1","identity":"rs-5368700","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5368700","identity":"rs-5368700","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}