1
|
Goldstein K, Tyndall W, Nickol ME, van der Merwe JM. Inclinometer use in primary total hip arthroplasty does not improve acetabular component positioning: a non-randomized control trial. ARTHROPLASTY 2024; 6:41. [PMID: 38965583 PMCID: PMC11229020 DOI: 10.1186/s42836-024-00258-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/26/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Total hip arthroplasty (THA) is a common surgical procedure that aims to relieve pain, improve function, and increase mobility in patients with hip joint pathology. One of the most challenging aspects of THA is to determine the correct angle of the acetabular component's placement. Intraoperative inclinometers have emerged as a promising tool to obtain accurate measurements of the acetabular component's inclination. The primary objective of this study was to evaluate the accuracy and efficacy of using intraoperative inclinometers for THA. METHODS This non-randomized control trial evaluated patients undergoing primary THA. Patients in the inclinometer group had an inclinometer used intraoperatively to measure acetabular component inclination, and patients in the control group had no inclinometer. Inclination and anteversion of the acetabular component were measured on postoperative radiographs. RESULTS A total of 223 patients were included in the study. The mean inclination angle of the acetabular cup was significantly higher in the inclinometer group (43.9° vs. 41.5°, P < 0.001). This difference was not clinically significant. There was no significant difference in anteversion. There were no significant differences in the number of patients within the safe zones for inclination or anteversion, or in the number of patients experiencing a dislocation. No correlation was found between inclinometer measurement and measured acetabular component inclination. Inclinometer use and body mass index (BMI) were the sole statistically significant factors in determining acetabular component inclination. CONCLUSIONS This study indicated no current benefit to inclinometer use during primary THA, as measured by inclination, anteversion, and dislocation rate. However, this might be confounded by subtle variations in patient positioning, which may be a strong area of study in the future.
Collapse
Affiliation(s)
- Kyle Goldstein
- Adult Reconstruction Subdivision, Orthopaedic Division, University of Saskatchewan, Saskatoon, SK, S7K0M5, Canada
| | - Wyatt Tyndall
- Adult Reconstruction Subdivision, Orthopaedic Division, University of Saskatchewan, Saskatoon, SK, S7K0M5, Canada
| | - Michaela E Nickol
- Adult Reconstruction Subdivision, Orthopaedic Division, University of Saskatchewan, Saskatoon, SK, S7K0M5, Canada
| | - Johannes M van der Merwe
- Adult Reconstruction Subdivision, Orthopaedic Division, University of Saskatchewan, Saskatoon, SK, S7K0M5, Canada.
| |
Collapse
|
2
|
Rice SJ, D’Abarno A, Luu HH. Robotic-assisted Total Hip Arthroplasty and Spinopelvic Parameters: A Review. Hip Pelvis 2024; 36:87-100. [PMID: 38825818 PMCID: PMC11162869 DOI: 10.5371/hp.2024.36.2.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 06/04/2024] Open
Abstract
Total hip arthroplasty (THA) is an effective treatment for osteoarthritis, and the popularity of the direct anterior approach has increased due to more rapid recovery and increased stability. Instability, commonly caused by component malposition, remains a significant concern. The dynamic relationship between the pelvis and lumbar spine, deemed spinopelvic motion, is considered an important factor in stability. Various parameters are used in evaluating spinopelvic motion. Understanding spinopelvic motion is critical, and executing a precise plan for positioning the implant can be difficult with manual instrumentation. Robotic and/or navigation systems have been developed in the effort to enhance THA outcomes and for implementing spinopelvic parameters. These systems can be classified into three categories: X-ray/fluoroscopy-based, imageless, and computed tomography (CT)-based. Each system has advantages and limitations. When using CT-based systems, preoperative CT scans are used to assist with preoperative planning and intraoperative execution, providing feedback on implant position and restoration of hip biomechanics within a functional safe zone developed according to each patient's specific spinopelvic parameters. Several studies have demonstrated the accuracy and reproducibility of robotic systems with regard to implant positioning and leg length discrepancy. Some studies have reported better radiographic and clinical outcomes with use of robotic-assisted THA. However, clinical outcomes comparable to those for manual THA have also been reported. Robotic systems offer advantages in terms of accuracy, precision, and potentially reduced rates of dislocation. Additional research, including conduct of randomized controlled trials, will be required in order to evaluate the long-term outcomes and cost-effectiveness of robotic-assisted THA.
Collapse
Affiliation(s)
- Steven J. Rice
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago, Chicago, IL, USA
| | | | - Hue H. Luu
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago, Chicago, IL, USA
| |
Collapse
|
3
|
Sarrel K, Hameed D, Dubin J, Mont MA, Jacofsky DJ, Coppolecchia AB. Understanding economic analysis and cost-effectiveness of CT scan-guided, 3-dimensional, robotic-arm assisted lower extremity arthroplasty: a systematic review. J Comp Eff Res 2024; 13:e230040. [PMID: 38488048 PMCID: PMC11044952 DOI: 10.57264/cer-2023-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 12/21/2023] [Indexed: 03/23/2024] Open
Abstract
Aim: The overall goal of this review was to examine the cost-utility of robotic-arm assisted surgery versus manual surgery. Methods: We performed a systematic review of all health economic studies that compared CT-based robotic-arm assisted unicompartmental knee arthroplasty, total knee arthroplasty and total hip arthroplasty with manual techniques. The papers selected focused on various cost-utility measures. In addition, where appropriate, secondary aims encompassed various clinical outcomes (e.g., readmissions, discharges to subacute care, etc.). Only articles directly comparing CT-based robotic-arm assisted joint arthroplasty with manual joint arthroplasty were included, for a resulting total of 21 reports. Results: Almost all twenty-one studies demonstrated a positive effect of CT scan-guided robotic-assisted joint arthroplasty on health economic outcomes. For studies reporting on 90-day episodes of costs, 10 out of 12 found lower costs in the robotic-arm assisted groups. Conclusion: Robotic-arm assisted joint arthroplasty patients had shorter lengths of stay and cost savings based on their 90-day episodes of care, among other metrics. Payors would likely benefit from encouraging the use of this CT-based robotic technology.
Collapse
Affiliation(s)
- Kara Sarrel
- Department of Orthopaedic Surgery, Northwell Hospital Lenox Hill, New York City, NY 10075, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD 21215, USA
| | - Jeremy Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD 21215, USA
| | - Michael A Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD 21215, USA
| | - David J Jacofsky
- The CORE Institute, Phoenix, AZ 85023, USA
- HOPCo, Phoenix, AZ 85023, USA
| | | |
Collapse
|
4
|
Buchan GBJ, Hecht CJ, Sculco PK, Chen JB, Kamath AF. Improved short-term outcomes for a novel, fluoroscopy-based robotic-assisted total hip arthroplasty system compared to manual technique with fluoroscopic assistance. Arch Orthop Trauma Surg 2024; 144:501-508. [PMID: 37740783 DOI: 10.1007/s00402-023-05061-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/01/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND While robotic-assisted total hip arthroplasty (RA-THA) has been associated with improved accuracy of component placement, the perioperative and early postoperative outcomes of fluoroscopy-based RA-THA systems have yet to be elucidated. METHODS This retrospective cohort analysis included a consecutive series of patients who received manual, fluoroscopy-assisted THA (mTHA) and fluoroscopy-based RA-THA at a single institution. We compared rates of complications within 90 days of surgery, length of hospital stay (LOS), and visual analog scale (VAS) pain scores. RESULTS No differences existed between groups with respect to demographic data or perioperative recovery protocols. The RA-THA cohort had a significantly greater proportion of outpatient surgeries compared to the mTHA cohort (37.4% vs. 3.8%; p < 0.001) and significantly lower LOS (26.0 vs. 39.5 h; p < 0.001). The RA-THA cohort had a smaller 90-day postoperative complication rate compared to the mTHA cohort (0.9% vs. 6.7%; p = 0.029). The RA-THA cohort had significantly lower patient-reported VAS pain scores at 2-week follow-up visits (2.5 vs. 3.3; p = 0.048), but no difference was seen after 6-week follow visits (2.5 vs. 2.8; p = 0.468). CONCLUSION Fluoroscopy-based RA-THA demonstrates low rates of postoperative complications, improved postoperative pain profiles, and shortened LOS when compared to manual, fluoroscopy-assisted THA.
Collapse
Affiliation(s)
- Graham B J Buchan
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Christian J Hecht
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th, New York, NY, 10021, USA
| | - James B Chen
- Mission Orthopaedic Institute, Providence Mission Hospital, Mission Viejo, CA, 92691, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| |
Collapse
|
5
|
Marchand RC, Marchand K, Taylor K, Guerrieo Z, Hameed D, Bains SS, Dubin JA, Sodhi N, Mont MA. Patient-reported and radiographic outcomes of a porous-coated acetabular cup in robotic assisted total hip arthroplasty at 2-year follow up. J Orthop 2023; 46:78-82. [PMID: 37969228 PMCID: PMC10643097 DOI: 10.1016/j.jor.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/14/2023] [Accepted: 10/04/2023] [Indexed: 11/17/2023] Open
Abstract
Introduction Several implant manufacturers have developed ultra-porous metal substrate acetabular components recently. Despite this, data on clinical and radiographic outcomes remain limited. Our study evaluated postoperative patient-reported outcome measures (PROMs) and radiographic analyses in patients fitted with a novel acetabular porous-coated component. Methods A total of 152 consecutive patients underwent a total hip arthroplasty by a single orthopaedic surgeon. All patients underwent surgery utilizing the same CT-scan based robotic-assisted device with the same porous cementless acetabular shell. They received standardized postoperative physical therapy, rehabilitation, and pain protocols. Preoperatively, first postoperative visit, 6-months, 1-year, and 2-years, patients were evaluated based on Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain, physical function, and total scores; 2) Patient-Reported Outcomes Measurement Information System (PROMIS)-10 physical and mental scores; 3) Hip Disability and Osteoarthritis Outcome Score (HOOS)-Jr scores; as well as 4) acetabular component positions and 5) evidence of acetabular component loosening. Results Significant improvements were observed by 6 months in WOMAC pain, physical function, and total scores (p < 0.05), maintained at 1 and 2 years. PROMIS-10 physical scores also improved significantly from preoperative to 6 months postoperative and remained so at 1 and 2 years postoperative (p < 0.05). No significant changes were found in PROMIS-10 mental scores. HOOS-Jr scores significantly improved from preoperative to 6 months postoperative and remained so through 2 years (p < 0.05). At 6 months, slight changes were noted in abduction angle and horizontal and vertical offset. Radiolucencies, initially found in 3 shells, reduced to 1 shell with 2 new radiolucencies by 6 months, and remained stable with no subsequent operative interventions. At 1 year and 2 years, no radiographic abnormalities were noted, including complete resolution of prior radiolucencies as well as stable components. Conclusion This porous cementless acetabular shell, implanted with CT-scan-based robotic-assisted techniques, demonstrated excellent postoperative PROMs at 2 years. Stable radiolucencies suggest good component stability. The early stable clinical and radiographic results suggest promising long-term outcomes with this device. Level of evidence III (retrospective cohort study).
Collapse
Affiliation(s)
- Robert C. Marchand
- South County Orthopaedics, Orthopaedics Rhode Island, Wakefield, RI, USA
| | - Kevin Marchand
- Northwell Health Orthopedics, Lenox Hill Hospital, New York, NY, USA
| | - Kelly Taylor
- South County Orthopaedics, Orthopaedics Rhode Island, Wakefield, RI, USA
| | - Zachary Guerrieo
- South County Orthopaedics, Orthopaedics Rhode Island, Wakefield, RI, USA
| | - Daniel Hameed
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Sandeep S. Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jeremy A. Dubin
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Lenox Hill Hospital Northwell Health, New York, NY, USA
| | - Michael A. Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| |
Collapse
|
6
|
Kim K, Kwon S, Kwon J, Hwang J. A review of robotic-assisted total hip arthroplasty. Biomed Eng Lett 2023; 13:523-535. [PMID: 37872985 PMCID: PMC10590363 DOI: 10.1007/s13534-023-00312-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/02/2023] [Accepted: 08/11/2023] [Indexed: 10/25/2023] Open
Abstract
Total hip arthroplasty (THA) is a successful surgical method for hip replacement but still poses challenges and risks. Robotic-assisted THA (rTHA) using new generation robotic systems has emerged to improve surgical precision and outcomes. The purpose of this paper is to review the literature on rTHA, with a focus on its advantages, such as individualized preoperative planning, intraoperative assistance, and improved accuracy in implantation, especially in complex cases. Additionally, it aims to explore the disadvantages associated with the use of rTHA, including high costs, the learning curve, and prolonged operation time compared to manual THA (mTHA), which are critical drawbacks that require careful consideration and efforts for minimization. Some financial analyses suggest that rTHA may offer cost-effectiveness and reduced postoperative costs compared to mTHA. While technological advancements are expected to reduce technical complications, there are still debates surrounding long-term outcomes. Practical limitations, such as limited availability and accessibility, also warrant attention. Although the development of rTHA shows promise, it is still in its early stages, necessitating critical evaluation and further research to ensure optimal patient benefits.
Collapse
Affiliation(s)
- Kwangkyoun Kim
- Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Konyang University School of Medicine, Daejeon, South Korea
| | - Seungcheol Kwon
- Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Konyang University School of Medicine, Daejeon, South Korea
| | - Junhyuk Kwon
- Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Konyang University School of Medicine, Daejeon, South Korea
| | - Jihyo Hwang
- Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Konyang University School of Medicine, Daejeon, South Korea
| |
Collapse
|
7
|
Buchan GBJ, Hecht CJ, Liu D, Mokete L, Kendoff D, Kamath AF. Improved accuracy of a novel fluoroscopy-based robotically assisted THA system compared to manual THA. J Robot Surg 2023; 17:2073-2079. [PMID: 37209355 DOI: 10.1007/s11701-023-01623-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/14/2023] [Indexed: 05/22/2023]
Abstract
Accurate acetabular cup position remains a persistent challenge in total hip arthroplasty (THA). Studies investigating the early outcomes of robotic-assisted THA (RA-THA) systems have shown improved cup placement compared to manual THA (mTHA) approaches, however, contemporary robotic platforms are reliant on pre-operative CT imaging. The goal of this study was to analyze the accuracy of a novel, fluoroscopy-based RA-THA system compared to an unassisted mTHA approach and determine the effect of the robotic system on operative time. We performed a retrospective cohort analysis on a consecutive series of 198 patients who received mTHA and RA-THA between March 2021 and July 2022. The primary outcome of interest was the accuracy of acetabular component placement, defined by average cup inclination and anteversion. Secondary outcomes included the proportion of acetabular cups positioned within the Lewinnek safe zone, operative time, and overall room time. The RA-THA group demonstrated significantly higher accuracy of acetabular anteversion to target compared to the manual group (18.5 vs. 21.7˚; p < 0.001), and had a significantly greater proportion of acetabular cups placed within the Lewinnek safe zone (81.6 vs. 59.0%; p < 0.001). The RA-THA cohort had longer operative times compared to mTHA group (39.0 vs. 35.3 min; p = 0.003), but no difference was seen in total operating room time (101.2 vs. 101.2 min; p = 0.982). This study demonstrates that the use of a novel, fluoroscopy-based, pin-less THA robotic platform increased the accuracy of acetabular cup placement, including a 22.6% improvement in safe zone placement, compared to mTHA approach, with no increase in overall case time.
Collapse
Affiliation(s)
- Graham B J Buchan
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Christian J Hecht
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - David Liu
- Gold Coast Centre for Bone and Joint Surgery, 14 Sixth Ave, Palm Beach, QLD, 4421, Australia
| | - Lipalo Mokete
- Consultant Orthopaedic Surgeon, Charlotte Maxeke Johannesburg Academic Hospital, Busamed Modderfontein Hospital, Lecture University of the Witwatersand, 4 Cransley Crescent, Linbro Park, Sandton, Johannesburg, 2190, South Africa
| | - Daniel Kendoff
- Chefarzt Zentrum für Orthopädie und Unfallchirurgie, HELIOS Kliniken Berlin-Buch, Schwanebecker Chaussee 25, 13125, Berlin, Germany
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| |
Collapse
|
8
|
Barsoum W, Gregory D, Needham K, Mont M, Sodhi N, Coppolecchia A, Jacofsky D. Advantages of robotic arm-assisted total hip arthroplasty: a 90-day episode-of-care clinical utility and cost analysis. J Comp Eff Res 2023; 12:e220208. [PMID: 37144744 PMCID: PMC10402783 DOI: 10.57264/cer-2022-0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/15/2023] [Indexed: 05/06/2023] Open
Abstract
Aim: Determine the clinical utility and economic differences over a 90-day period between robotic arm-assisted total hip arthroplasty (RATHA) and manual total hip arthroplasty (MTHA). Methods: Leveraging a nationwide commercial payer database, pre-covid THA procedures were identified. Following a 1:5 propensity score match, 1732 RATHA and 8660 MTHA patients were analyzed. Index costs, index lengths of-stay, and 90-day episode-of-care utilization and costs were evaluated. Results: Episode of care costs for RATHA was found to be $1573 lower compared with MTHA (p < 0.0001). Post-index hospital utilization was significantly less likely to occur for RATHA compared with MTHA. Total index costs were also significantly lower for RATHA versus MTHA (p < 0.0001). Conclusion: Index and post-index EOC hospital utilization and costs were lower for RATHA compared with MTHA.
Collapse
Affiliation(s)
- Wael Barsoum
- HOPCo, Phoenix, AZ 85023, USA
- Cleveland Clinic Florida, Weston, FL 33331, USA
| | | | | | - Michael Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA
| | - Nipun Sodhi
- Long Island Jewish Medical Center, Northwell Health, Long Island, NY 11040, USA
| | | | - David Jacofsky
- HOPCo, Phoenix, AZ 85023, USA
- The CORE Institute, Phoenix, AZ 85015, USA
| |
Collapse
|
9
|
Achieving Precise Cup Positioning in Direct Anterior Total Hip Arthroplasty: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020271. [PMID: 36837472 PMCID: PMC9959722 DOI: 10.3390/medicina59020271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 02/01/2023]
Abstract
Malpositioned implants in total hip arthroplasty are associated with impingement, increased wear, and dislocations, thus precise cup positioning is crucial. However, significant deviations between targeted and actually achieved cup positions have been found even in patients operated by experienced surgeons. When aiming for higher accuracy, various methods based on freehand positioning lead by anatomic landmarks, C-arm fluoroscopy, imageless navigation, or robotic-assisted-surgery have been described. There is a constant development of new products aiming to simplify and improve intraoperative guidance. Both the literature and expert opinions on this topic are often quite controversial. This article aims to give an overview of the different methods and systems with their specific advantages and potential pitfalls while also taking a look into the future of cup positioning in anterior hip replacements.
Collapse
|
10
|
Bullock EKC, Brown MJ, Clark G, Plant JGA, Blakeney WG. Robotics in Total Hip Arthroplasty: Current Concepts. J Clin Med 2022; 11:6674. [PMID: 36431151 PMCID: PMC9695933 DOI: 10.3390/jcm11226674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/25/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022] Open
Abstract
This current concepts article reviews the literature pertaining to the use of robot-assisted systems in total hip arthroplasty (THA). The bulk of the literature is regarding the MAKO (currently the most used system worldwide) and the historic ROBODOC robotic systems. There is a paucity of literature available on other systems, with several still in pilot-phase development. Whilst the evidence shows improved radiological outcomes with robotic THA, functional outcomes are equivocal between conventional and robotic techniques. Acceptance of robotic THA worldwide is limited by its accessibility including cost, and by already exceptional results with the conventional technique. It is, however, a rapidly developing area of orthopaedic surgery. This article discusses the history of robotics in THA, current surgical techniques, functional and radiological outcomes, and ongoing avenues for development.
Collapse
Affiliation(s)
- Emily K. C. Bullock
- Department of Orthopaedic Surgery, Royal Perth Hospital, Wellington St., Perth, WA 6000, Australia
| | - Michael J. Brown
- Department of Orthopaedic Surgery, Royal Perth Hospital, Wellington St., Perth, WA 6000, Australia
| | - Gavin Clark
- Department of Orthopaedic Surgery, St John of God Subiaco Hospital, 12 Salvado Road, Subiaco, WA 6008, Australia
| | - James G. A. Plant
- Department of Orthopaedic Surgery, Royal Perth Hospital, Wellington St., Perth, WA 6000, Australia
- Department of Orthopaedic Surgery, St John of God Subiaco Hospital, 12 Salvado Road, Subiaco, WA 6008, Australia
| | - William G. Blakeney
- Department of Orthopaedic Surgery, Royal Perth Hospital, Wellington St., Perth, WA 6000, Australia
- Department of Orthopaedic Surgery, St John of God Subiaco Hospital, 12 Salvado Road, Subiaco, WA 6008, Australia
| |
Collapse
|
11
|
Tuecking LR, Ettinger M, Windhagen H, Savov P. [Market overview: Robotic-assisted arthroplasty : Current robotic systems, learning curve and cost analysis]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:727-738. [PMID: 35945459 DOI: 10.1007/s00132-022-04286-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
Robotic-assisted arthroplasty has been rapidly entering clinical routine in recent years. The leading endoprosthesis manufacturers have all meanwhile placed robotic systems on the market, which, however, differ significantly from one another technically. Current systems are currently classified according to the degree of autonomy (active vs. semi-active vs. passive) and the data/image source (image-based: CT vs. X‑ray, imageless). Some systems already offer the possibility of robotic-assisted or navigated implantation of hip endoprostheses. In the following review article, the currently leading robotic systems will be presented and compared with regard to their characteristics. Furthermore, the analysis of the learning curves for the different systems, currently available cost analysis models and an outlook on future developments and challenges will be given.
Collapse
Affiliation(s)
- Lars-René Tuecking
- Orthopädische Klinik der MHH im Diakovere Annastift, Anna-von-Borries-Str. 1-6, 30625, Hannover, Deutschland.
| | - Max Ettinger
- Orthopädische Klinik der MHH im Diakovere Annastift, Anna-von-Borries-Str. 1-6, 30625, Hannover, Deutschland
| | - Henning Windhagen
- Orthopädische Klinik der MHH im Diakovere Annastift, Anna-von-Borries-Str. 1-6, 30625, Hannover, Deutschland
| | - Peter Savov
- Orthopädische Klinik der MHH im Diakovere Annastift, Anna-von-Borries-Str. 1-6, 30625, Hannover, Deutschland
| |
Collapse
|
12
|
Gregory DA, Coppolecchia A, Scotti DJ, Chen Z, Mont MA, Jacofsky D. A 90-Day Episode-of-Care Analysis Including Computed Tomography Scans of Robotic-Arm Assisted versus Manual Total Knee Arthroplasty. J Knee Surg 2022. [PMID: 35817055 DOI: 10.1055/s-0042-1749083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In this observational, retrospective study, we performed economic analyses between robotic arm-assisted total knee arthroplasty (RATKA) and manual total knee arthroplasty (MTKA). Specifically, we compared: (1) index costs including computed tomography (CT) scans; (2) 90-day postoperative health care utilization, (3) 90-day episode-of-care (EOC) costs, and (4) lengths of stay between CT scan-based robotically-assisted versus MTKAs. A large national database, Blue Health Intelligence (BHI), was used for RATKAs and MTKAs performed between April 1, 2017 and September 30, 2019. Based on strict inclusion-exclusion criteria, with propensity score matching, 4,135 RATKAs and 4,135 MTKAs were identified and analyzed. Index costs to the payer for RATKA patients were found to be less than those for MTKA patients ($29,984 vs. $31,280, p <0.0001). Overall, 90-day EOC costs for RATKA patients were found to be less than that for MTKA patients in the inpatient and outpatient settings. This also holds true for the use of skilled nursing facilities, pharmacies, or other services. In conclusion, the results from our study show that RATKA were associated with lower costs than MTKAs, even when including the cost of CT scans. These results are of marked importance given the emphasis to contain and reduce health care costs.
Collapse
Affiliation(s)
- David A Gregory
- Department of Orthopaedic Surgery, Baker Tilly Virchow Krause LLP, Madison, Wisconsin
| | | | - Dennis J Scotti
- Department of Orthopaedic Surgery, Fairleigh Dickinson University, Teaneck, New Jersey
| | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - David Jacofsky
- Department of Orthopaedic Surgery, The CORE Institute, Phoenix, Arizona
| |
Collapse
|