The Off-Table Technique Increases Operating Room Efficiency in Direct Anterior Hip Replacement

Robotic assistance is associated with improved surgical efficiency during direct anterior total hip arthroplasty

Introduction

The direct anterior (DA) approach allows for earlier mobilization and shorter length-of-stay than traditional total hip arthroplasty (THA) approaches; however, conventional techniques rely on intraoperative fluoroscopy for accurate cup placement. Robotic-assisted THA is an alternative to conventional THA procedures and utilizes preoperative computed tomography (CT) scans and intraoperative mapping for accurate component positioning. The purpose of this study was to evaluate the impact of robotic-assisted DA THA without fluoroscopy on surgical efficiency parameters when compared to conventional DA THA with fluoroscopy.

Methods

There were six cadaver specimens evenly distributed between two orthopaedic surgeons, both with previous experience in conventional and robotic-assisted THA. For each cadaver, conventional DA THA with fluoroscopy was performed on the first hip, and robotic-assisted DA THA without fluoroscopy was performed on the contralateral hip. Total surgical time from skin to trials, acetabular and femoral workflow time, and the number of reamers and broaches used, were recorded for all cases. There were two-sample t-tests performed to assess statistical differences between conventional and robotic-assisted THA data.

Results

Acetabular reaming took longer, on average, for conventional DA THA with fluoroscopy than robotic-assisted DA THA without fluoroscopy (2.4 ± 0.6 versus 0.4 ± 0.2 min; p < 0.001). Surgeons using conventional THA required more acetabular reamers when compared to a single reamer used with robotic-assisted THA (2.67 ± 0.5 versus 1 ± 0; p = 0.001). Total operative time (26.1 ± 7.0 versus 23.2 ± 5.6 min; p = 0.452), acetabular workflow time (6.4 ± 3.1 versus 3.3 ± 1.7 min; p = 0.07), femoral workflow time (6.5 ± 4.8 versus 5.0 ± 1.7 min; p = 0.495), and number of femoral broaches (5.0 ± 1.8 versus 4.3 ± 2.3; p = 0.593) were higher during conventional THA than during robotic-assisted THA.

Discussion

Amidst the changing healthcare environment and focus on identifying and implementing efficiencies, these findings have important consequences for the continued and accelerated use of robotic-assisted THA in primary settings.

'On Table' Versus 'Off Table' Direct Anterior Approach Total Hip Arthroplasty: Is There a Difference?

Background

The purpose of this study was to evaluate whether there were differences in patient-reported outcomes, operative times, satisfaction scores, and complications between patients undergoing total hip arthroplasty (THA) performed through a direct anterior approach on a specialized traction table or a regular operating room table.

Methods

Patients who underwent a direct anterior approach THA on a specialized table or a regular table with a minimum 1-year follow-up were included. Patient-reported outcome measures and THA satisfaction were recorded. Demographics, complications, and operative times (both in-room and surgical time) were evaluated. Three hundred twenty-two patients were included with 217 (67.4%) undergoing anterior THA on the specialized table and 105 (32.6%) on a regular table.

Results

Outcome measures were similar at 4 months and 1 year postoperatively. Average operative time was 87 minutes (range, 50-160) and 90 minutes (range, 35-197) for the specialized table and regular table groups (P = .314). Average total in room time was 123 minutes (range, 87-201) and 120 minutes (range, 62-255) for the specialized table and regular table groups (P = .564). Satisfaction rates between groups did not differ (P = .564). No differences were found in complication rates at 4 months (P = .814) or 1 year (P = .547).

Conclusions

This study shows that the direct anterior approach for THA can be safely and efficiently performed on either a specialized traction table or a regular table. Surgeons should continue to utilize the approach and set-up they are most comfortable with to achieve an optimal outcome for the patient.