Robotic arm-assisted versus manual total hip arthroplasty : a systematic review and meta-analysis

Robotic Assistance for Posterior Approach Total Hip Arthroplasty Is Associated With Lower Risk of Revision for Dislocation When Compared to Manual Techniques

BACKGROUND

Robotic-assistance total hip arthroplasty (RA-THA) and computer navigation THA (CN-THA) have been shown to improve accuracy of component positioning compared to manual techniques; however, controversy exists regarding clinical benefit. Moreover, these technologies may expose patients to risks. The purpose of this study is to compare rates of intraoperative fracture and complications requiring reoperation within 1 year for posterior approach RA-THA, CN-THA, and THA with no technology (Manual-THA).

METHODS

In total, 13,802 primary, unilateral, elective, posterior approach THAs (1770 RA-THAs, 3155 CN-THAs, and 8877 Manual-THAs) were performed at a single institution between 2016 and 2020. Intraoperative fractures and reoperations within 1 year of the index procedure were identified. Cohorts were balanced using inverse probability of treatment weight based on age, gender, body mass index, femoral cementation, history of spine fusion, and Charlson Comorbidity Index. Logistic regression was performed to create odds ratios for complications. Additional regression analysis for dislocation was performed, adjusting for dual mobility and femoral head size.

RESULTS

There were no differences in intraoperative fracture and postoperative complication rates between the groups (P = .521). RA-THA had a 0.3 odds ratio (95% confidence interval 0.1-0.9, P = .046) compared to Manual-THA for reoperation due to dislocation. CN-THA had an odds ratio of 3.0 for reoperation due to dislocation (95% confidence interval 0.8-11.3, P = .114) compared to RA-THA. The remaining complication odds ratios, including those for infection, loosening, dehiscence, and "other" were similar between the groups.

CONCLUSION

RA-THA is associated with lower risk of revision for dislocation within 1 year of index surgery, when compared to Manual-THA performed through the posterior approach.

Patient Interest in Robotic Total Joint Arthroplasty Is Exponential: A 10-Year Google Trends Analysis

Background

The use of robotics in arthroplasty continues to increase. Patient demand, patient expectations, and patient-directed marketing by industry and care providers each likely contributes to its increasing popularity. Trends in patient interest have not been well described. We used the online Google Trends tool to analyze trends in national public interest toward robotic and nonrobotic arthroplasty between 2011 and 2021.

Material and methods

Google Trends online was queried for search terms related to nonrobotic hip and knee arthroplasty in addition to robotic hip, robotic knee, and general robotic arthroplasty between January 1, 2011, and December 31, 2021.

Results

Google Trends Data demonstrated a significant linear increase in online searches related to nonrobotic total knee and hip arthroplasty. Online search volume for robotic hip arthroplasty was significant and linear, while that of robotic knee arthroplasty was significant and exponential. When combined, robotic joint arthroplasty demonstrated an exponential trend over the 10-year period. This increase was noted to be statistically significant when compared with nonrobotic arthroplasty search volume.

Conclusion

Our study demonstrates that public interest in robotic total joint arthroplasty has increased significantly from 2011 through 2020. When compared with online search volume for conventional arthroplasty, this increasing growth is statistically significant. Public interest in robotic arthroplasty is anticipated to continue to increase, and care providers should be aware of this trend that impacts patient perceptions and expectations. Despite significant growth in interest for robotic arthroplasty, there is incomplete evidence supporting its use over nonrobotic arthroplasty. Additional high-quality studies are needed to inform provider decision-making and appropriately guide public interest in robot-assisted arthroplasty.

Learning curves in robot-assisted spine surgery: a systematic review and proposal of application to residency curricula

OBJECTIVE

Spine robots have seen increased utilization over the past half decade with the introduction of multiple new systems. Market research expects this expansion to continue over the next half decade at an annual rate of 20%. However, because of the novelty of these devices, there is limited literature on their learning curves and how they should be integrated into residency curricula. With the present review, the authors aimed to address these two points.

METHODS

A systematic review of the published English-language literature on PubMed, Ovid, Scopus, and Web of Science was conducted to identify studies describing the learning curve in spine robotics. Included articles described clinical results in patients using one of the following endpoints: operative time, screw placement time, fluoroscopy usage, and instrumentation accuracy. Systems examined included the Mazor series, the ExcelsiusGPS, and the TiRobot. Learning curves were reported in a qualitative synthesis, given as the mean improvement in the endpoint per case performed or screw placed where possible. All studies were level IV case series with a high risk of reporting bias.

RESULTS

Of 1579 unique articles, 97 underwent full-text review and 21 met the inclusion and exclusion criteria; 62 articles were excluded for not presenting primary data for one of the above-described endpoints. Of the 21 articles, 18 noted the presence of a learning curve in spine robots, which ranged from 3 to 30 cases or 15 to 62 screws. Only 12 articles performed regressions of one of the endpoints (most commonly operative time) as a function of screws placed or cases performed. Among these, increasing experience was associated with a 0.24- to 4.6-minute decrease in operative time per case performed. All but one series described the experience of attending surgeons, not residents.

CONCLUSIONS

Most studies of learning curves with spine robots have found them to be present, with the most common threshold being 20 to 30 cases performed. Unfortunately, all available evidence is level IV data, limited to case series. Given the ability of residency to allow trainees to safely perform these cases under the supervision of experienced senior surgeons, it is argued that a curriculum should be developed for senior-level residents specializing in spine comprising a minimum of 30 performed cases.

[Comparative study of intra- and post-operative inclination and anteversion angles of acetabular cup in robot-assisted total hip arthroplasty]

Objective

To compare the difference in the inclination and anteversion angles of the acetabular cup measured by intraoperative robot-assisted total hip arthroplasty (THA) and postoperative X-ray films and CT imaging.

Methods

The clinical data of 54 patients (54 hips) who underwent robot-assisted THA between May 2020 and December 2020 were retrospectively analyzed. Among them, there were 26 males (26 hips) and 28 females (28 hips), with an average age of 58.4 years (range, 39-71 years). The body mass index was 19.2-29.3 kg/m ², with an average of 25.2 kg/m ². All the patients had their first THA, including 31 cases of osteonecrosis of the femoral head, 12 cases of hip arthritis, 8 cases of femoral neck fracture, and 3 cases of developmental dysplasia of the hip. The anteversion and inclination angles of the acetabular cup were obtained through the surgical data in the robot host system. All patients underwent X-ray and CT scan examination within 2-7 days after operation to obtain the postoperative anteversion and inclination angles of the acetabular cup. According to the concept of "Lewinnek safe zone", the proportion of acetabular in the safe zone intra- and post-operation were compared.

Results

The operation time was 57.8-89.2 minutes, with an average of 68.3 minutes; the intraoperative blood loss was 125.0-450.0 mL, with an average of 204.8 mL. No adverse events such as dislocation of hip joint and infection occurred during hospitalization. The anteversion angle of acetabular cup was (40.8±0.6)° during operation and (41.2±2.8)° after operation, with no significant difference ( t=1.026, P=0.307). The anteversion angle of acetabular cup measured during operation was (17.6±1.4)°, which was significantly smaller than that measured after operation (23.4±3.8)°( t=10.520, P=0.000). According to "Lewinnek safe zone", 54 hips (100%) were in the safety zone during operation, and 16 hips were out of the safety zone, 38 hips were in the safty zone after operation, the ratio of the hips in the safty zone was 70.4%, showing a significant difference ( χ ²=18.783, P=0.000).

Conclusion

Robot-assisted THA can obtain accurate placement of the acetabular cup, but there is a large deviation between the anteversion angle of the acetabular cup in the lateral position during operation and the supine position after operation. Further study is needed to define the intraoperative placement position of the acetabular cup.