Robotic total hip arthroplasty

A high body mass index tilts the pelvis caudally in the lateral decubitus position for total hip arthroplasty

BACKGROUND

Accurate cup placement is essential for obtaining excellent outcomes in total hip arthroplasty (THA). We evaluated the pelvic lateral tilt of the patient (which affects the incline of the acetabular cup in THA) and investigated the factors affecting it.

METHODS

We reviewed the medical records of THA procedures performed at our hospital between October 2015 and January 2021 for which an anteroposterior pelvic radiograph was always taken preoperatively once the patient was placed in the lateral decubitus position. These radiographs were used to measure the lateral pelvic tilt in each case. We analysed whether patient factors (sex, body mass index [BMI], range of motion of abduction or adduction in both hips, surgical history of both hips, and lumbar Cobb angle) influenced the tilt.

RESULTS

We reviewed 363 cases (341 primary, 22 revision). The mean pelvic lateral tilt was 4.1°, and the operated hip was located on the caudal side compared to the unoperated hip. Statistical analyses revealed that the patient BMI and surgical history of the operated and unoperated hips significantly influenced tilt.

CONCLUSIONS

The pelvis in the lateral decubitus position leaned 4.1° to the caudal side, most commonly due to a high BMI. Surgeons should consider this when performing acetabular cup implantation in THA.

Conversion of Hip Arthrodesis Using Robotic Arm Technology

Recent advancements in computer-assisted surgery have led to a renewed interest in robotic-assisted hip arthroplasty. This technology assists with component position which is especially useful in prior trauma or dysplasia cases. We present a case of a surgical hip fusion conversion to total hip arthroplasty with the use of robotic-assisted technology. Enhanced preoperative planning with the ability to manipulate implant position before execution can be invaluable during complex procedures. Further research is warranted before revision cases using computerized navigation systems becomes more prevalent.

Robotic-assisted compared with conventional total hip arthroplasty: systematic review and meta-analysis

BACKGROUND

Robotic-assisted total hip arthroplasty (THA) allows for accurate preoperative planning and component positioning, potentially enhancing implant survival and long-term outcomes. The relative efficacy and safety of robotic-assisted and conventional THA, however, are unclear. This systematic review and meta-analysis compared the safety and efficacy of robotic-assisted and conventional THA.

METHODS

Medline, Embase and the Cochrane Library were comprehensively searched in September 2017 to identify studies comparing the safety and efficacy of robotic-assisted and conventional THA. Seven studies were included. Data of interest were extracted and analysed using Review Manager 5.3.

RESULTS

The seven included studies involved 1516 patients, with 522 undergoing robotic-assisted and 994 undergoing conventional THA. Compared with conventional THA, robotic-assisted THA was associated with longer surgical time (not significant); lower intraoperative complication rates (OR: 0.12, 95% CI: 0.05 to 0.34, p<0.0001 I²); better cup placement, stem placement and global offset and a higher rate of heterotopic ossifications. Functional scores, limb length discrepancy and rates of revision and stress shielding were similar in the two groups. The relative amount of blood loss was unclear.

CONCLUSION

The results of this meta-analysis suggest that robotic-assisted THA has certain advantages over conventional THA, including the results of component positioning and rates of intraoperative complications. Additional comparative studies are required to determine the long-term clinical outcomes of robotic-assisted THA.

Ethical considerations in providing an upper limb exoskeleton device for stroke patients

The health care system needs to face new and advanced medical technologies that can improve the patients' quality of life by replacing lost or decreased functions. In stroke patients, the disabilities that follow cerebral lesions may impair the mandatory daily activities of an independent life. These activities are dependent mostly on the patient's upper limb function so that they can carry out most of the common activities associated with a normal life. Therefore, an upper limb exoskeleton device for stroke patients can contribute a real improvement of quality of their life. The ethical problems that need to be considered are linked to the correct adjustment of the upper limb skills in order to satisfy the patient's expectations, but within physiological limits. The debate regarding the medical devices dedicated to neurorehabilitation is focused on their ability to be beneficial to the patient's life, keeping away damages, injustice, and risks.

The current status and future prospects of computer-assisted hip surgery

The advances in computer assistance technology have allowed detailed three-dimensional preoperative planning and simulation of preoperative plans. The use of a navigation system as an intraoperative assistance tool allows more accurate execution of the preoperative plan, compared to manual operation without assistance of the navigation system. In total hip arthroplasty using CT-based navigation, three-dimensional preoperative planning with computer software allows the surgeon to determine the optimal angle of implant placement at which implant impingement is unlikely to occur in the range of hip joint motion necessary for daily activities of living, and to determine the amount of three-dimensional correction for leg length and offset. With the use of computer navigation for intraoperative assistance, the preoperative plan can be precisely executed. In hip osteotomy using CT-based navigation, the navigation allows three-dimensional preoperative planning, intraoperative confirmation of osteotomy sites, safe performance of osteotomy even under poor visual conditions, and a reduction in exposure doses from intraoperative fluoroscopy. Positions of the tips of chisels can be displayed on the computer monitor during surgery in real time, and staff other than the operator can also be aware of the progress of surgery. Thus, computer navigation also has an educational value. On the other hand, its limitations include the need for placement of trackers, increased radiation exposure from preoperative CT scans, and prolonged operative time. Moreover, because the position of a bone fragment cannot be traced after osteotomy, methods to find its precise position after its movement need to be developed. Despite the need to develop methods for the postoperative evaluation of accuracy for osteotomy, further application and development of these systems are expected in the future.