Is Robotic-Assisted Technology Still Accurate in Total Hip Arthroplasty for Fibrous-Fused Hips?

Robotic-Assisted Total Hip Arthroplasty Provides Greater Implant Placement Accuracy and Lower Complication Rates, but Not Superior Clinical Results Compared to the Conventional Manual Approach: A Systematic Review and Meta-Analysis

BACKGROUND

Accurate component placement plays a critical role in the outcome of total hip arthroplasty (THA). Robotic-assisted THA (R-THA) has emerged as an option to optimize this aspect compared to the conventional manual THA (C-THA). The aim of this meta-analysis was to analyze the studies comparing R-THA and C-THA. The hypothesis was that the use of robotic technology could improve component positioning, but this advantage may not translate into clinically relevant benefits.

METHODS

The literature search was conducted on three databases (PubMed, Cochrane Library, and Web of Science) in January 2024. The screening process and analysis were conducted separately by two independent observers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The inclusion criteria were comparative studies, English language, no time limitation, and focusing on the comparison of R-THA and C-THA. Among the 1,883 articles retrieved, 38 studies (10,055 patients) were included. The meta-analysis covered radiological outcomes, clinical outcomes, perioperative parameters, complications, and revisions. The quality of each article was assessed using the "Downs and Black's checklist for measuring quality".

RESULTS

Robotic THA provided superior radiological results compared to C-THA in terms of acetabular cup placement within the Lewinnek safe zone (P < 0.01) and horizontal change of the rotation center (P = 0.03). No statistically significant difference was obtained in terms of clinical scores between the two approaches, including Harris Hip Score, Western Ontario and McMaster Universities Arthritis Index, Forgotten Joint Score, and Merle d'Aubigné Hip Score. Robotic THA showed longer operative time (P < 0.01), but lower complication rates (P = 0.04). No difference was obtained in terms of intraoperative blood loss and revision rates.

CONCLUSIONS

The results of this meta-analysis suggest that R-THA can provide more accurate cup placement and better restoration of the native hip anatomy while reducing complication rates compared to C-THA. However, these benefits did not translate into clinical differences in terms of patient-reported outcomes between the two approaches, and R-THA required longer operative time. While the overall results suggest some benefits with the robotic technology, future studies should investigate if further technical improvements will translate into clinically relevant benefits for patients undergoing THA.

Why robot-assisted total hip arthroplasty aborted: Chinese experience of four hundred and twenty nine consecutive cases

PURPOSE

Robot-assisted total hip arthroplasty (RA-THA) helps with precise orientation of the prosthesis, but some RA-THA procedures are aborted intraoperatively and are converted to manual total hip arthroplasty (THA). This study aimed to analyse why RA-THA is sometimes aborted intraoperatively and to make recommendations accordingly.

METHODS

A total of 429 consecutive Mako THA cases in our prospective database from August 2018 to June 2021 were included in our study. All robotic procedures aborted intraoperatively for any reason were recorded. The patients' demographics, diagnoses, and surgeons' information were included in the statistical analysis to pinpoint the risk factors for intraoperative robot to manual conversion.

RESULTS

Intraoperative RA-THA abortions occurred in 17 cases (3.96%) and the patients had to be converted to manual THA. The adverse events leading to intraoperative abortions included pelvic array loosening or malposition (5, 1.17%), inaccurate bone mapping or construction (6, 1.40%), inaccurate initial registration (4, 0.93%), and other reasons (2, 0.47%).

CONCLUSION

Robot-related adverse events could be found in all perioperative steps of RA-THA, and some of these events might result in intraoperative abortion. Complex hip disease was a statistically significant factor for an increased risk of intraoperative abortion of RA-THA. Standardized surgical procedures and preoperative assessments can be helpful in reducing the rate of RA-THA abortions.

Robotic Arm-Assisted System Improved Accuracy of Cup Position and Orientation in Cementless Total Hip Arthroplasty for Dysplastic Hips: A Comparison Among Groups With Manual Placement, Computed Tomography-Based Navigation, and Robotic Surgery

Background

Accurate cup placement in total hip arthroplasty (THA) for patients with dysplasia is challenging due to the distinctive bone deformities. This study aimed to compare the accuracy of cup placement position and orientation across robotic arm-assisted systems (R-THA), computed tomography-based navigation (N-THA), and manual procedure (M-THA) in THA for osteoarthritis secondary to dysplasia.

Methods

A total of 167 patients (197 hips), including 88 R-THAs, 45 N-THAs, and 46 M-THAs, were analyzed. Propensity score matching was performed to align the patient backgrounds. Horizontal and vertical centers of rotation were measured for cup position, whereas radiographic inclination and anteversion were measured for cup orientation. The proportion of cases with cup placement within 3 mm and 5° from the target was compared.

Results

R-THA had a significantly higher percentage of cup placement within 3 mm of the target compared to N-THA (78% vs 49%; P = .0041) and M-THA (78% vs 53%; P = .013). Similarly, R-THA was significantly more successful in placing the cup within 5° of the target compared to N-THA (84% vs 58%; P = .0049) and M-THA (91% vs 20%; P < .0001). Moreover, N-THA was significantly better at placing the cup within 5° of the target compared to M-THA (62% vs 14%; P < .0001), whereas there was no significant difference in the percentage of cup placement within 3 mm of the target (51% vs 51%; P = 1.0).

Conclusions

Robotic arm-assisted system and computed tomography-based navigation improved accuracy in cup orientation compared to the manual procedure. Additionally, the robotic arm-assisted system further improved cup position accuracy.

Robotic-assisted total hip arthroplasty in patients with developmental dysplasia of the hip

PURPOSES

Due to the morphological diversity of deformities, technical difficulties, improperly designed components, and so on, THA remains a challenging task in dysplastic hips, especially in highly dislocated hips. The purpose of this study was to comprehensively evaluate the clinical outcomes of robot-assisted THA in patients with DDH through a large cohort study, including the precision of acetabular cup positioning, indicators of inflammatory response, indicators of muscle damage, and complications.

METHODS

We retrospectively analyzed patients with DDH who underwent THA in our prospectively constructed joint registry between August 2018 and August 2022. Finally, 147 manual THAs and 147 robotic-assisted THAs were included in the final analysis. Patient demographics, indicators of inflammation, indicators of muscle damage, operative time, Harris hip scores (HHS), and forgotten joint score (FJS) were recorded for analysis. The precision of the positioning of the acetabular component was assessed with plain radiographs.

RESULTS

In the Crowe II/III groups, the reconstructed center of rotation (COR) in the robotic-assisted group was closer to the anatomical COR with less variation than the manual group (absolute horizontal distances of COR 3.5 ± 2.8 vs. 5.4 ± 4.9 mm, p < 0.05; absolute vertical distances of COR 6.4 ± 4.1 vs. 11.7 ± 8.2 mm, p = 0.001). For all Crowe subtypes, the robotic-assisted THA significantly increased the proportion of acetabular cups located in the safety zone within 5° (all p < 0.05). Interleukin-6 and creatine kinase levels were slightly lower and significantly different in the robotic-assisted group at three days postoperatively (all p < 0.05).

CONCLUSIONS

Compared to the manual technique, the robot-assisted technique improved the precision and reproducibility of acetabular component positioning, particularly in DDH patients with Crowe types II/III. The robotic-assisted technique did not increase operative time, bleeding, complications, or revision rates, and had a slighter early inflammatory response and muscle damage.