Conversion of Hip Arthrodesis Using Robotic Arm Technology

Clinical Outcomes and Complications Following Hip Fusion Conversion to Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

BACKGROUND

Efficacy, clinical outcomes, and complications following hip fusion conversion to total hip arthroplasty (THA) surgery have been explored in several studies with controversial findings and no consensus.

METHODS

Comprehensive search of online databases was performed through December 2022 for prepost clinical trials using MeSH keywords. Harris hip score (HHS), leg length discrepancy (LLD), pain score, and range of motion (ROM) were considered as clinical outcomes along with implant survival and complications. The retrieved studies were assessed for methodologic quality. Weighted mean difference (WMD) with 95% confidence interval (CI) were calculated using random effects meta-analysis taking into account for heterogeneity. Subgroup meta-analysis as well as sensitivity analysis were performed.

RESULTS

Findings of meta-analysis on 34 trials showed that HHS increase after THA (WMD: 42.3; 95% confidence interval (CI): 38 to 47). Subgroup analyses indicated that cementless prosthesis, length of arthrodesis <12 years, age <45 years, and studies with good quality have more HHS improvement. The LLD decreased 21 mm (95% CI: 19 to 24 mm) based on 21 trials. The range of motion (ROM) reached to 89 (95% CI: 84 to 95) for flexion, 32 (95% CI: 27 to 37) for abduction, 25 (95% CI: 21 to 29) for adduction, 29 (95% CI: 25 to 33) for external rotation, and 25 (95% CI: 20 to 31) for internal rotation after surgery. The most common complication was heterotopic ossification (14%).

CONCLUSION

Conversion of an ankylosed hip to THA leads to improved hip function and leg discrepancy with relatively notable rate of complications. Our findings could provide a framework to guide surgeons and decision makers.

Robotic-assisted revision total joint arthroplasty: a state-of-the-art scoping review

Background

During the past decades, robotic-assisted technology has experienced an incredible advancement in the field of total joint arthroplasty (TJA), which demonstrated promise in improving the accuracy and precision of implantation and alignment in both primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, revision TJA remains a technically challenging procedure with issues of large-scale bone defects and damage to nearby anatomical structures. Thus, surgeons are trying to harness the abilities of robotic-assisted technology for revision TJA surgery.

Methods

PubMed, Embase, Cochrane Library, and Google Scholar were comprehensively searched to identify relevant publications that reported the application of robotic-assisted technology in revision TJA.

Results

Overall, ten studies reported the use of the robotic system in revision TJA, including active (ROBODOC) and semi-active (MAKO and NAVIO) systems. One clinical case reported conversion from hip fusion to THA, and three studies reported revision from primary THA to revision THA. Moreover, four studies reported that robotic-assisted technology is helpful in revising unicompartmental knee arthroplasty (UKA) to TKA, and two case reports converted primary TKA to revision TKA. In this study, we present the latest evolvements, applications, and technical obstacles of robotic-assisted technology in the revision of TJA and the current state-of-the-art.

Conclusion

Current available evidence suggests that robotic-assisted technology may help surgeons to reproducibly perform preoperative plans and accurately achieve operative targets during revision TJA. However, concerns remain regarding preoperative metal artifacts, registration techniques, closed software platforms, further bone loss after implant removal, and whether robotic-assisted surgery will improve implant positioning and long-term survivorship.

Revision Total Knee Arthroplasty Using Robotic Arm Technology

Total knee arthroplasty (TKA) is a highly successful operation for the treatment of end-stage osteoarthritis of the knee. Increasing use of computer-assisted and robotic-assisted total joint arthroplasty has been shown to improve component position, with short-term studies demonstrating improved survivability in unicompartmental knee arthroplasty. Robotic-assisted technology has been shown to be helpful in revising unicompartmental knee arthroplasty to TKA, as well as hip fusion to total hip arthroplasty, but few have described revision of a primary TKA. This case report describes the use of robotic-assisted technology in revision TKA. Robotic assistance during revision TKA may improve component alignment and increase prosthesis longevity. Future research is needed to investigate the effects on survivorship and cost.