Robotic-Assisted Total Hip Arthroplasty: Implications for Surgical Practice and Operating Theatre Design

Isabelle Middleton, Thomas W. Wainwright, Dr Robert Middleton

The introduction of robotic-assisted total hip arthroplasty (THA) has had significant effects over and above the more accurate component position it delivers. Diagnosis and templating are improved as a result of the planning CT scan. Complex cases involving abnormal anatomy are simplified surgically by a single ream for the acetabular component and feedback for hip length and offset for the femoral component. The learning curve for surgeons relates primarily to operative time rather than complications. Once planned, robotic systems may reduce variability in component positioning between surgeons with differing levels of experience. Patient Reported Outcome Measures (PROMs) will need to be supplemented with gait lab data and functional tests to prove the added value of robotic-assisted THA. As robotic-assisted surgery (RAS) becomes increasingly reliant on imaging systems and digital workflows, operating theatres face greater complexity in technology integration and intraoperative coordination. Emerging evidence links spatial organisation, equipment positioning, and workflow to operative efficiency, intraoperative safety, and surgical performance. This paper provides an evidence-informed narrative perspective on how advances in robotic-assisted THA are influencing the spatial and functional requirements of operating theatres, thereby affecting clinical performance. As surgical practice advances, there is a need to move towards future-proofed design strategies informed by clinical performance and systems-based evidence. This includes a greater focus on flexibility and integrated digital infrastructure to support evolving technologies, changing team dynamics, and increasing procedural demands. Operating theatres must therefore evolve to enable effective integration of RAS in THA, and support improved patient safety and clinical outcomes.