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Nakdhamabhorn S, Pillai BM, Chotivichit A, Suthakorn J. Sensorless Based Haptic Feedback Integration In Robot-assisted Pedicle Screw Insertion For Lumbar Spine Surgery: A preliminary cadaveric study. Comput Struct Biotechnol J 2024; 24:420-433. [PMID: 38841212 PMCID: PMC11152607 DOI: 10.1016/j.csbj.2024.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 05/14/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024] Open
Abstract
Pedicle screw fixation is an essential surgical technique for addressing various spinal pathologies, including degenerative diseases, trauma, tumors, neoplasms, and infections. Despite its efficacy, the procedure poses significant challenges, notably the limited visibility of spinal anatomical landmarks and the consequent reliance on surgeon's hand-eye coordination. These challenges often result in inaccuracies and high radiation exposure due to the frequent use of fluoroscopy X-ray guidance. Addressing these concerns, this study introduces a novel approach to pedicle screw insertion by utilizing a robot-assisted system that incorporates sensorless based haptics incorporated 5-DOF surgical manipulation. This innovative system aims to minimize radiation exposure and reduce operating time while improving the surgeon's hand posture capabilities. The developed prototype, expected to be implemented using bilateral control, was tested through preliminary cadaveric experiments focused on the insertion of both percutaneous and open pedicle screws at the L4-L5 level of the lumbar spine. Validation of the Sensorless Haptic Feedback feature was an integral part of this study, aiming to enhance precision and safety. The results, confirmed by fluoroscopic x-ray images, demonstrated the successful placement of two percutaneous and two open pedicle screws, with average position and torque errors of 0.011 radians and 0.054 Nm for percutaneous screws, and 0.0116 radians and 0.0057 Nm for open screws, respectively. These findings underscore the potential of the sensorless haptic feedback in a robot-assisted pedicle screw insertion system to significantly reduce radiation exposure and improve surgical outcomes, marking a significant advancement in spinal surgery technology.
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Affiliation(s)
- Sakol Nakdhamabhorn
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Branesh M. Pillai
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Areesak Chotivichit
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - Jackrit Suthakorn
- Department of Biomedical Engineering, Center for Biomedical and Robotics Technology (BART LAB), Faculty of Engineering, Mahidol University, Nakhon Pathom 73170, Thailand
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2
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Wang J, Miao J, Zhan Y, Duan Y, Wang Y, Hao D, Wang B. Spine Surgical Robotics: Current Status and Recent Clinical Applications. Neurospine 2023; 20:1256-1271. [PMID: 38171293 PMCID: PMC10762389 DOI: 10.14245/ns.2346610.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/05/2023] [Accepted: 08/10/2023] [Indexed: 01/05/2024] Open
Abstract
With the development of artificial intelligence and the further deepening of medical-engineering integration, spine surgical robot-assisted (RA) technique has made significant progress and its applicability in clinical practice is constantly expanding in recent years. In this review, we have systematically summarized the majority of literature related to spine surgical robots in the past decade, and not only classified robots accordingly, but also summarized the latest research progress in RA technique for screw placement such as cervical, thoracic, and lumbar pedicle screws, cortical bone trajectory screws, cervical lateral mass screws, and S2 sacroiliac screws; guiding targeted puncture and placement of endoscope via the intervertebral foramen; complete resection of spinal tumor tissue; and decompressive laminectomy. In addition, this report also provides a detailed evaluation of RA technique's advantages and disadvantages, and clarifies the accuracy, safety, and practicality of RA technique. We consider that this review can help clinical physicians further understand and familiarize the current clinical application status of spine surgical robots, thereby promoting the continuous improvement and popularization of RA technique, and ultimately benefiting numerous patients.
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Affiliation(s)
- Jiangtao Wang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Medical School of Yan’an University, Yan’an, China
| | - Junxian Miao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Shaanxi University of Chinese Medicine, Xi’an, China
| | - Yi Zhan
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Shaanxi University of Chinese Medicine, Xi’an, China
| | - Yongchao Duan
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Department of Intraoperative Imaging, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Yuanshun Wang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Department of Orthopedics, The Third People’s Hospital of Xining, Qinghai, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Biao Wang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
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Guo X, Wang D, Li J, Zhang H. Global research status and trends in orthopaedic surgical robotics: a bibliometric and visualisation analysis study. J Robot Surg 2023:10.1007/s11701-023-01579-x. [PMID: 37017859 DOI: 10.1007/s11701-023-01579-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/18/2023] [Indexed: 04/06/2023]
Abstract
This study aimed to investigate and summarise the current state of research and trends in orthopaedic surgical robots. Data on publicly available publications related to orthopaedic surgical robots were extracted by abstract searches of the Web of Science Core Collection database. A bibliometric analysis and detailed reading of the publications were then carried out and the information was visualised using co-authorship analysis, coupling analysis, co-citation analysis and co-occurrence analysis in VOSviewer. With 436 publications included in the study from 1993 to 2022, the overall contribution of publications to the world showed an increasing trend year by year, with a particularly pronounced after 2017, and a geographical trend of predominantly East Asia, North America, and Western Europe. Of these, China was the largest contributor (n = 128). Overall, the UK affiliates and their scholars were leaders in the field, with a high number of publications, total citations, average citations per article and H-index. The most published institutions and authors were Imperial College London (n = 21) and Professor Fares Sahi Haddad of University College London (n = 12), respectively. Journals with a high overall impact on robotic orthopaedic surgery were the Journal of Arthroplasty, Bone Joint Journal, International Journal of Medical Robotics and Computer Assisted Surgery. Keyword co-occurrence network analysis revealed four main clusters: robot-assisted knee, hip arthroplasty, spine surgery, and robotic technology research and development. The top three most common sites for robot-assisted surgery use were the knee, hip and spine. The most used robot types were the knee and spine, with Mako and Arobot being the most used robots for the knee and TiRobot for the spine. This study comprehensively reveals the current status and trends of global research on orthopaedic surgical robots, covering countries, institutions, authors, journals, research hotspots, robot types and surgical sites, providing directional guidance and research ideas for further research on the technological development and clinical evaluation of orthopaedic surgical robots.
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Affiliation(s)
- Xinmeng Guo
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Daofeng Wang
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Jiantao Li
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Hao Zhang
- Department of Orthopedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
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Magan AA, Radhakrishnan GT, Kayani B, Ronca F, Khanduja V, Meek RMD, Haddad FS. Time for return to sport following total hip arthroplasty: a meta-analysis. Hip Int 2023; 33:221-230. [PMID: 34538122 DOI: 10.1177/11207000211041975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Total Hip Arthroplasty (THA) is being increasingly undertaken in younger and more active patients, with many of these patients wanting to return to sport (RTS) after surgery. However, the percentage of patients RTS and time at which they are able to get back to sport following surgery remains unknown. The objective of this meta-analysis was to determine the time patients RTS after THA. METHODS A search was performed on PUBMED, MEDLINE, EMBASE, and the Cochrane Library for trials on THA and RTS, in the English language, published from the inception of the database to October 2020. All clinical trials reporting on to RTS following THA were included. Data relating to patient demographics, methodological quality, RTS, clinical outcomes and complications were recorded. The PRISMA guidelines were used to undertake this study. RESULTS The initial literature search identified 1720 studies. Of these, 11 studies with 2297 patients matched the inclusion criteria. 3 studies with 154 patients demonstrated an overall pooled proportion of 40.0% (95% CI, 32.5-47.9%) of patients RTS between 2 and 3 months after surgery. 4 studies with 242 patients demonstrated an overall pooled proportion of 76.9% (95% CI, 71.5-82.0) of patients RTS by 6 months after surgery. Pooled proportion analysis from 7 trials with 560 patients demonstrated 93.9% (95% CI, 82.7-99.5%) of patients RTS between 6 and 12 months after surgery. CONCLUSIONS Pooled proportion analysis showed increasingly more patients were able to RTS after THA over the first 1 year after surgery. There remains marked inter and intra-study variations in time for RTS but the pooled analysis shows that over 90% of patients were able to RTS at 6-12 months after THA. These finding will enable more informed discussions between patients and healthcare professionals about time for RTS following THA.
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Affiliation(s)
- Ahmed A Magan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Ganan T Radhakrishnan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Flaminia Ronca
- Institute of Sports, Health and Exercise, University College Hospital, London, UK
| | - Vikas Khanduja
- Department of Trauma and Orthopaedic Surgery, Young Adult Hip Service, Addenbrooke's - Cambridge University Hospital, Cambridge, UK
| | - Robert M D Meek
- Department of Trauma and Orthopaedic surgery, Glasgow University, Glasgow, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK.,Institute of Sports, Health and Exercise, University College Hospital, London, UK
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Stauffer TP, Kim BI, Grant C, Adams SB, Anastasio AT. Robotic Technology in Foot and Ankle Surgery: A Comprehensive Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:686. [PMID: 36679483 PMCID: PMC9864483 DOI: 10.3390/s23020686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/11/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
Recent developments in robotic technologies in the field of orthopaedic surgery have largely been focused on higher volume arthroplasty procedures, with a paucity of attention paid to robotic potential for foot and ankle surgery. The aim of this paper is to summarize past and present developments foot and ankle robotics and describe outcomes associated with these interventions, with specific emphasis on the following topics: translational and preclinical utilization of robotics, deep learning and artificial intelligence modeling in foot and ankle, current applications for robotics in foot and ankle surgery, and therapeutic and orthotic-related utilizations of robotics related to the foot and ankle. Herein, we describe numerous recent robotic advancements across foot and ankle surgery, geared towards optimizing intra-operative performance, improving detection of foot and ankle pathology, understanding ankle kinematics, and rehabilitating post-surgically. Future research should work to incorporate robotics specifically into surgical procedures as other specialties within orthopaedics have done, and to further individualize machinery to patients, with the ultimate goal to improve perioperative and post-operative outcomes.
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Affiliation(s)
| | - Billy I. Kim
- School of Medicine, Duke University, Durham, NC 27710, USA
| | - Caitlin Grant
- School of Medicine, Duke University, Durham, NC 27710, USA
| | - Samuel B. Adams
- Departmen of Orthopaedic Surgery, Duke University, Durham, NC 27710, USA
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Naik A, Smith AD, Shaffer A, Krist DT, Moawad CM, MacInnis BR, Teal K, Hassaneen W, Arnold PM. Evaluating robotic pedicle screw placement against conventional modalities: a systematic review and network meta-analysis. Neurosurg Focus 2022; 52:E10. [PMID: 34973681 DOI: 10.3171/2021.10.focus21509] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/25/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Several approaches have been studied for internal fixation of the spine using pedicle screws (PSs), including CT navigation, 2D and 3D fluoroscopy, freehand, and robotic assistance. Robot-assisted PS placement has been controversial because training requirements, cost, and previously unclear benefits. This meta-analysis compares screw placement accuracy, operative time, intraoperative blood loss, and overall complications of PS insertion using traditional freehand, navigated, and robot-assisted methods. METHODS A systematic review was performed of peer-reviewed articles indexed in several databases between January 2000 and August 2021 comparing ≥ 2 PS insertion methods with ≥ 10 screws per treatment arm. Data were extracted for patient outcomes, including PS placement, misplacement, and accuracy; operative time, overall complications, intraoperative blood loss, postoperative hospital length of stay, postoperative Oswestry Disability Index (ODI) score, and postoperative visual analog scale (VAS) score for back pain. Risk of bias was assessed using the Newcastle-Ottawa score and Cochrane tool. A network meta-analysis (NMA) was performed to estimate PS placement accuracy as the primary outcome. RESULTS Overall, 78 studies consisting of 6262 patients and > 31,909 PSs were included. NMA results showed that robot-assisted and 3D-fluoroscopy PS insertion had the greatest accuracy compared with freehand (p < 0.01 and p < 0.001, respectively), CT navigation (p = 0.02 and p = 0.04, respectively), and 2D fluoroscopy (p < 0.01 and p < 0.01, respectively). The surface under the cumulative ranking (SUCRA) curve method further demonstrated that robot-assisted PS insertion accuracy was superior (S = 0.937). Optimal screw placement was greatest in robot-assisted (S = 0.995) placement, and misplacement was greatest with freehand (S = 0.069) approaches. Robot-assisted placement was favorable for minimizing complications (S = 0.876), while freehand placement had greater odds of complication than robot-assisted (OR 2.49, p < 0.01) and CT-navigation (OR 2.15, p = 0.03) placement. CONCLUSIONS The results of this NMA suggest that robot-assisted PS insertion has advantages, including improved accuracy, optimal placement, and minimized surgical complications, compared with other PS insertion methods. Limitations included overgeneralization of categories and time-dependent effects.
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Affiliation(s)
- Anant Naik
- 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and
| | - Alexander D Smith
- 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and
| | - Annabelle Shaffer
- 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and
| | - David T Krist
- 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and
| | - Christina M Moawad
- 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and
| | - Bailey R MacInnis
- 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and
| | - Kevin Teal
- 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and.,2Department of Neurosurgery, Carle Neuroscience Institute, Carle Foundation Hospital, Urbana, Illinois
| | - Wael Hassaneen
- 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and.,2Department of Neurosurgery, Carle Neuroscience Institute, Carle Foundation Hospital, Urbana, Illinois
| | - Paul M Arnold
- 1Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign; and.,2Department of Neurosurgery, Carle Neuroscience Institute, Carle Foundation Hospital, Urbana, Illinois
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Haddad FS. A year of challenges, but ongoing progress. Bone Joint J 2021; 103-B:1743-1744. [PMID: 34847714 DOI: 10.1302/0301-620x.103b12.bjj-2021-1537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Fares S Haddad
- University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK.,The Bone & Joint Journal , London, UK
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Asokan A, Baawa-Ameyaw J, Kayani B, Radhakrishnan GT, Magan AA, Haddad FS. Nursing considerations for patients undergoing robotic-arm assisted joint replacements. ACTA ACUST UNITED AC 2021; 30:580-587. [PMID: 34037453 DOI: 10.12968/bjon.2021.30.10.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Robotic-arm assisted arthroplasty (RAA) has gained popularity over the past decade because of its ability to provide more accurate implant positioning with less surgical trauma than conventional manual arthroplasty. It has shown better early functional outcomes, less postoperative pain and shorter inpatient stays. A multidisciplinary approach is crucial in improving overall outcomes and ensuring this technology is implemented efficiently and safely, but there is limited published literature on the nursing considerations for managing patients undergoing RAA. This article aims to provide a pragmatic approach for nursing care in the pre-, intra-, and postoperative phases of RAA.
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Affiliation(s)
- Ajay Asokan
- Clinical Fellow, Department of Orthopaedics, University College London Hospitals NHS Foundation Trust, and Department of Orthopaedics, The Princess Grace Hospital, London
| | - Joanna Baawa-Ameyaw
- Clinical Fellow, Department of Orthopaedics, University College London Hospitals NHS Foundation Trust, and Department of Orthopaedics, The Princess Grace Hospital, London
| | - Babar Kayani
- PhD Candidate, Department of Orthopaedics, University College London Hospitals NHS Foundation Trust, and Department of Orthopaedics, The Princess Grace Hospital, London
| | - Ganan T Radhakrishnan
- Clinical Fellow, Department of Orthopaedics, University College London Hospitals NHS Foundation Trust, and Department of Orthopaedics, The Princess Grace Hospital, London
| | - Ahmed A Magan
- Senior Clinical Fellow, Department of Orthopaedics, University College London Hospitals NHS Foundation Trust, and Department of Orthopaedics, The Princess Grace Hospital, London
| | - Fares S Haddad
- Professor of Orthopaedics, Department of Orthopaedics, University College London Hospitals NHS Foundation Trust, and Department of Orthopaedics, The Princess Grace Hospital, London
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Pennington Z, Morgan CD, Uribe JS. Commentary: Present and Future Spinal Robotic and Enabling Technologies. Oper Neurosurg (Hagerstown) 2021; 21:S57-S58. [PMID: 34128063 DOI: 10.1093/ons/opaa405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/23/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Clinton D Morgan
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Haddad FS. High-quality research and technology to the forefront. Bone Joint J 2021; 103-B:1005-1006. [PMID: 34058881 DOI: 10.1302/0301-620x.103b6.bjj-2021-0647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Fares S Haddad
- University College London Hospitals NHS Foundation Trust, London, UK.,The Bone & Joint Journal, London, UK
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Fontalis A, Epinette JA, Thaler M, Zagra L, Khanduja V, Haddad FS. Advances and innovations in total hip arthroplasty. SICOT J 2021; 7:26. [PMID: 33843582 PMCID: PMC8040589 DOI: 10.1051/sicotj/2021025] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/20/2021] [Indexed: 12/12/2022] Open
Abstract
Total hip arthroplasty (THA) has been quoted as one of the most successful and cost-effective procedures in Orthopaedics. The last decade has seen an exponential rise in the number of THAs performed globally and a sharp increase in the percentage of young patients hoping to improve their quality of life and return to physically demanding activities. Hence, it is imperative to review the various applications of technology in total hip arthroplasty for improving outcomes. The development of state-of-the-art robotic technology has enabled more reproducible and accurate acetabular positioning, while long-term data are needed to assess its cost-effectiveness. This opinion piece aims to outline and present the advances and innovations in total hip arthroplasty, from virtual reality and three-dimensional printing to patient-specific instrumentation and dual mobility bearings. This illustrates and reflects the debate that will be at the centre of hip surgery for the next decade.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London NW1 2BU, UK
| | | | - Martin Thaler
- Department of Orthopaedics and Traumatology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan 20161, Italy
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Box 37, Addenbrookes Hospital, Cambridge CB2 0QQ, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London NW1 2BU, UK
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