1
|
Kara GK, Turan K, Eroglu ON, Ozturk C, Ertürer E. Is the Acetabular Cup Orientation Different in Robot-Assisted and Conventional Total Hip Arthroplasty With Right-Handed Surgeons Using an Anterolateral Approach? Cureus 2023; 15:e42335. [PMID: 37614261 PMCID: PMC10443961 DOI: 10.7759/cureus.42335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/25/2023] Open
Abstract
Introduction Total hip arthroplasty (THA) is one of the most successful orthopaedic procedures. Survival rates from 90% at 10 years to 93% at 20 years have been reported in different studies. Differences in implant and patient characteristics can undoubtedly explain some of this variability observed in prosthesis durability, but the effect of surgical technique and implant orientation cannot be ignored. Therefore, many intraoperative methods (anatomic landmarks, intraoperative x-ray, fluoroscopy, navigation, and robotic surgery) have been attempted to avoid acetabular component malpositioning. Although postoperative computed tomography (CT) is accepted as the gold standard for the measurement of acetabular anteversion, it remains controversial in respect of costs and radiation exposure. The aim of this study was to examine how acetabular component orientation was affected in robotic and conventional THA operations performed by two surgeons with right-hand dominance. Material and methods The study included 113 primary THA operations performed on 113 patients between 2017 and 2022 in two groups: (i) robotic THA (Mako, Stryker Corporation, Kalamazoo, Michigan, United States) (55 patients) and (ii) conventional THA (58 patients). The patients comprised 51 males and 62 females. THA was performed on 54 right-side hips and 59 left-side hips. The operations were performed by two orthopaedic surgeons, each with 20 years of arthroplasty experience, on all the patients in the lateral decubitus position with an anterolateral approach. In all the cases, the orientation of the acetabular component was 40° inclination and 20° anteversion. Difficult THA procedures (patients with developmental dysplasia of the hip (DDH), a history of hip surgery, revision THA, defect or deformity of the acetabulum, a history of scoliosis or lumbar posterior surgery, or those requiring proximal femoral osteotomy) were excluded from the study. Using the Liaw and Lewinnek methods, the acetabular component anteversion was measured on the radiographs taken in the optimal position postoperatively and the acetabular cup inclination angles were measured on the pelvis radiographs. The groups were compared using the Kolmogorov-Smirnov, Pearson Chi-square and Mann-Whitney U statistical tests. The limits were accepted as 40±5° for inclination and 20±5° for anteversion. Results No statistically significant difference was determined between the groups in respect of age, gender, or operated side. No statistically significant difference was determined between the optimal acetabular cup inclination angles of the robotic and conventional THA groups (p = 0.79). No statistically significant difference was determined between the optimal acetabular cup anteversion angles of the left and right conventional THA groups. Statistically significantly better results were determined in the robotic group in respect of acetabular cup anteversion (p<0,001). Conclusion The optimal orientation of the acetabular component is a key factor for successful THA. Otherwise, revision surgery is inevitable for reasons such as instability, impingement, or increased wear. The results of this study demonstrated that robotic surgery was superior to the conventional method in the placement of the acetabular component in the desired orientation.
Collapse
Affiliation(s)
| | - Kayhan Turan
- Orthopedics and Traumatology, Atlas University, İstanbul, TUR
| | | | - Cagatay Ozturk
- Orthopedics and Traumatology, Istinye University, Istanbul, TUR
| | - Erden Ertürer
- Orthopedics and Traumatology, Istinye University, İstanbul, TUR
| |
Collapse
|
2
|
Zhang S, Liu Y, Yang M, Ma M, Cao Z, Kong X, Chai W. Robotic-assisted versus manual total hip arthroplasty in obese patients: a retrospective case-control study. J Orthop Surg Res 2022; 17:368. [PMID: 35907875 PMCID: PMC9338672 DOI: 10.1186/s13018-022-03263-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/25/2022] [Indexed: 11/12/2022] Open
Abstract
Aims The objective of this study was to evaluate the accuracy of acetabular cup positioning in the obese patients when using robotic-assisted technology during total hip arthroplasty (THA). Methods Data were retrospectively collected from patients who underwent primary (THA) with a body mass index (BMI) ≥ 28 kg/m2 and ≥ 1 year of follow-up between January 2018 and December 2019. Their demographics, diagnosis, acetabular cup positioning, American Society of Anesthesiologists (ASA) score, Harris Hip Score (HHS), and Forgotten Joint Score (FJS) at the final follow-up were recorded for analysis. Results There were no statistically significant differences between the two groups in height, weight, BMI, ASA score, or preoperative Harris Hip Score (HHS). Also, there was no difference in inclination angle between the two groups (R-THA: 41.29° ± 3.04°; manual THA (M-THA): 40.47° ± 5.46°; P = 0.312). However, the mean anteversion angle was greater in the R-THA group (20.71° ± 1.98° vs. 19.08° ± 4.04°; P < 0.001). Compared to M-THA, R-THA more frequently achieved an acetabular cup angle within 5° of the target (anteversion, 98.1% vs. 78.1% P = 0.001; inclination, 88.5% vs. 53.1%, P < 0.001). The R-THA group was more advantageous in restoring the hip center of rotation (COR) and leg length difference (LLD). There was no statistical difference in postoperative HHS (P = 0.404) or FJS (P = 0.497) between the two groups. Conclusions Compared to manual technique, robotic-assisted technique provided more precise acetabular cup positioning and better leg length restoration for obese patients. The robotic-assisted technique was more advantageous in recovering the center of rotation position and achieved a higher proportion of the acetabular cup placed in the target safety zone. Further studies are needed to confirm the clinical outcomes of surgeries in obese patients using robotic-assisted technology.
Collapse
Affiliation(s)
- Shuai Zhang
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing, China.,Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Yubo Liu
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, China
| | - Minzhi Yang
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, China
| | - Mingyang Ma
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing, China.,Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Zheng Cao
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, China
| | - Xiangpeng Kong
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China. .,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
| | - Wei Chai
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China. .,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
| |
Collapse
|
4
|
Interobserver and Intraobserver Reliabilities of Three-Dimensional Postoperative Evaluation Software in Total Hip Arthroplasty. Adv Orthop 2021; 2021:3705789. [PMID: 34567806 PMCID: PMC8463242 DOI: 10.1155/2021/3705789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In primary and revision total hip arthroplasty, to prevent perioperative complications, the prediction of the optimal implant size is essential. Using three-dimensional computed tomography-based postoperative evaluation software, we explored the accuracy and the precision of measurement of the size, alignment, and position of the prosthetic components after total hip arthroplasty. METHODS Using postoperative evaluation software, the postoperative computed tomography data from 20 hips in 20 patients were evaluated. The component size, alignment, and three-dimensional positioning of the cup and stem were assessed. The concordance rates of the component, repeatability (intraobserver reliability), and reproducibility (interobserver reliability) of postoperative evaluation were calculated. The radiographic inclination and radiographic anteversion of the cup, anteversion, varus-valgus angle, and flexion-extension angles of the stem were measured for alignment. The implant positioning was measured along three axes, namely, X-axis (transverse), Y-axis (sagittal), and Z-axis (longitudinal). RESULTS The concordance rates of all parts are above 94%. The intraobserver and interobserver intraclass correlation coefficients of alignment measurement were very good for both cup (0.879-0.964) and stem (0.973-0.996). The intraobserver and interobserver intraclass correlation coefficients of cup positioning were very good (0.961-0.987) for all axes. The intraobserver and interobserver intraclass correlation coefficients of implant positioning were very good for the stem (0.879-0.995) for all axes. CONCLUSIONS Computed tomography-based postoperative evaluation software was able to evaluate the size and position of total hip implants with high reproducibility.
Collapse
|