{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T10:27:29Z","timestamp":1793701649329,"version":"4.5.1"},"reference-count":58,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to evaluate the efficacy and safety of robotic\u2010arm assisted (RA) direct anterior approach (DAA) total hip arthroplasty (THA) in facilitating tensor fasciae latae (TFL) preservation and subsequent functional recovery, and to explore the correlation between TFL preservation and postoperative inflammation, pain, and early functional recovery in obese patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively reviewed 69 obese patients (BMI \u2265\u200930\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ) undergoing primary DAA\u2010THA from September 2023 to December 2024 with 12\u2010month follow\u2010up. Surgical procedures were performed by RA technology in 31 patients (RA group) and manual technology in 38 patients (M group). Demographic characteristics, perioperative parameters, TFL injury index, unsupported ambulation duration, creatine kinase (CK), C\u2010reactive protein (CRP), Visual Analog Scale scores (VASs), Harris Hip Scores (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Forgotten Joint Score\u201012 (FJS\u201012), radiologic measurements, and complications were retrieved from patients. Student's\n                      <jats:italic>t<\/jats:italic>\n                      \u2010test and Mann\u2013Whitney\n                      <jats:italic>U<\/jats:italic>\n                      test were used to compare continuous data. Fisher test and Chi\u2010square test were used to compare the categorical data. Longitudinal data were evaluated by generalized estimating equations. The relationships between TFL injury index and early clinical outcomes were evaluated using Spearman's correlation analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline demographic characteristics of both groups were comparable. RA group demonstrated significantly lower TFL injury index (18.05 [IQR 14.51\u201330.05] % vs. 38.31 [IQR 20.58\u201350.70] %,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) and shorter unsupported ambulation duration (3.00 [IQR 2.00\u20134.00] week vs. 5.00 [IQR 3.00\u20136.00] week,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) compared to M group. Besides, TFL injury index showed a strong positive correlation with unsupported ambulation duration (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u20090.775) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Compared to M group, RA group significantly reduced CK, CRP, and VASs at the initial 72\u2009h postoperatively (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). RA group exhibited significantly superior HHS, WOMAC, and FJS\u201012 compared to M group at postoperative 1\u2009month (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). TFL injury index demonstrated strong positive correlations with CK (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u20090.619), CRP (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u20090.628), and VASs (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u20090.652) at postoperative 72\u2009h (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Furthermore, it showed a strong negative correlation with HHS (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u2009\u22120.615) and FJS\u201012 (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u2009\u22120.759), and moderate positive correlations with WOMAC\u2010pain (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u20090.410) and WOMAC\u2010function (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u20090.583) at postoperative 1\u2009month (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Despite longer operative duration in RA group, it exhibited a significantly higher proportion of acetabular components positioned within the Lewinnek safe zone and a significantly lower incidence of incision\u2010related adverse events compared to M group (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In obese patients undergoing DAA\u2010THA, RA technology significantly reduced intraoperative injury to TFL. This muscle preservation effect was significantly associated with attenuated early postoperative inflammation, lower pain levels, and faster functional recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/os.70444","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T23:34:21Z","timestamp":1791848061000},"page":"2463-2479","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Robotic\u2010Arm Assisted Direct Anterior Approach Total Hip Arthroplasty Facilitates Tensor Fasciae Latae Preservation and Early Functional Recovery in Obese Patients"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7351-4496","authenticated-orcid":false,"given":"Shijie","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Orthopedics Fujian Medical University Union Hospital  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4568-2044","authenticated-orcid":false,"given":"Dasheng","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Fujian Medical University Union Hospital  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huihuang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Fujian Medical University Union Hospital  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7787-450X","authenticated-orcid":false,"given":"Wentao","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Fujian Medical University Union Hospital  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3290-8203","authenticated-orcid":false,"given":"Dongmin","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Fujian Medical University Union Hospital  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7245-3098","authenticated-orcid":false,"given":"Eryou","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Fujian Medical University Union Hospital  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2017.03.043"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891\u2010018\u20102133\u20104"},{"issue":"6","key":"e_1_2_14_4_1","first-page":"537","article-title":"Direct Anterior Total Hip Arthroplasty","volume":"115","author":"Galakatos G. 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