Understanding acceptance before intervention: patient perspectives on robotic-assisted femoral neck fracture fixation

Patient acceptance is important for surgical robotics implementation, but evidence in acute orthopaedic trauma is limited. We examined preoperative acceptance of robotic-assisted femoral neck fracture fixation and factors associated with behavioral intention. This prospective multicenter observational study included 378 adults with femoral neck fractures assessed before definitive fixation technique selection. A Chinese-adapted questionnaire assessed six acceptance constructs and behavioral intention. Multivariable linear regression with heteroskedasticity-consistent type 3 (HC3) robust standard errors examined associations with intention, while logistic regression assessed factors associated with post-introduction self-reported understanding of the robot's role. Performance expectancy (B = 0.524; 95% CI, 0.391-0.657; P < 0.001), social influence (B = 0.262; 95% CI, 0.151-0.373; P < 0.001), and pleasure (B = 0.159; 95% CI, 0.038-0.281; P = 0.010) were associated with greater intention. In a separate contextual model, prior knowledge of femoral neck fracture surgical techniques (B = 0.905), self-reported understanding (B = 0.540), and robotic-option offering (B = 0.545) were positively associated with intention, whereas additional-cost concern was inversely associated (B = - 0.242). The association with robotic-option offering was not significant in a restricted-center analysis (B = 0.447; P = 0.125). Prior knowledge (aOR = 7.46; 95% CI, 4.01-13.89) and robotic-option offering (aOR = 2.54; 95% CI, 1.15-5.61) were associated with self-reported understanding. Acceptance of robotic-assisted femoral neck fixation reflects perceived technological value and the clinical decision context. Implementation should emphasize realistic expectations, clear explanations of the robot's role, cost transparency, and informed patient choice.