Robot-assisted total hip arthroplasty on infection outcomes: a systematic review and meta-analysis.

Postoperative infection represents a major adverse outcome after total hip replacement (THA). Although robotic technology improves the precision of prosthetic component positioning, its effect on infection risk remains uncertain.A systematic search was conducted across four databases. Clinical studies reporting postoperative infection rates following robotic-assisted THA (R-THA) and manual THA (M-THA) were included, with infection outcomes defined as pin site infection (PSI) and periprosthetic joint infection (PJI). Summary measures were synthesized using the Mantel–Haenszel approach, incorporating odds ratios (OR) effect metrics.Across 53 included investigations comprising 1,833,785 THAs, R-THA demonstrated a reduction in both overall postoperative infections (OR 0.76; 95% CI 0.61 to 0.94; P = 0.01) and PJI occurrence (OR 0.77; 95% CI 0.60 to 0.99; P = 0.04). Subgroup analyses indicated that these associations remained robust after adjustment for conflicts of interest, age, body mass index, study design and comorbidities. Statistical analysis indicated comparable PSI rates between R-THA and M-THA (OR 0.73; 95% CI 0.50 to 1.05; P = 0.09).R-THA appears to offer a reduction in overall postoperative infections and PJI compared with M-THA, while maintaining comparable rates of PSI. However, further high-quality studies are warranted to confirm these findings and better define long-term infection outcomes.