Robot-assisted versus conventional percutaneous sacroiliac screw fixation for posterior pelvic ring injuries: a systematic review and meta-analysis

Purpose Robot-assisted pelvic screw fixation is a new technology with promising benefits on intraoperative outcomes for patients with posterior pelvic ring injuries. We aim to compare robot-assisted pelvic screw fixation to the traditional fluoroscopy-assisted technique with regards to intraoperative and postoperative outcomes. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used along with a search of electronic information to identify all studies comparing the outcomes of robot-assisted versus conventional screw fixation in patients with posterior pelvic ring injuries. Primary outcomes included operative duration (minutes), intraoperative bleeding (mL), fluoroscopy exposure and intraoperative drilling frequency. Secondary outcome measures included Majeed score, healing time (minutes) and rate (%), postoperative complications, screw positioning, incision length (cm) and guide wire insertion times (minutes). The random effects model was used for analysis. Results Four observational studies including a total of 294 patients were identified. There was a significant difference between robot-assisted and conventional groups in terms of operative duration (MD = - 24.66, p < 0.05), intraoperative bleeding (MD = - 10.37, P < 0.05), fluoroscopy exposure (MD = - 2.15, P < 0.05) and intraoperative drilling frequency (MD = - 2.42, P = < 0.05). For secondary outcomes, no significant difference was seen in Majeed score, healing time and rate and postoperative complications. The robot-assisted group had better screw positioning, smaller incision length, and shorter anaesthesia and guide wire insertion times. Conclusions Robot-assisted fixation has superior intraoperative outcomes compared to conventional fixation. Further studies are needed to look at postoperative outcomes as there is no significant difference in postoperative prognosis between the techniques.