Robotic-arm assisted total hip arthroplasty results in smaller acetabular cup size in relation to the femoral head size: a matched-pair controlled study

Robotic-assisted Total Hip Arthroplasty and Spinopelvic Parameters: A Review

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.

The Value of Computed Tomography Scan in Three-dimensional Planning and Intraoperative Navigation in Primary Total Hip Arthroplasty

Total hip arthroplasty (THA) is a frequently performed procedure; the objective is restoration of native hip biomechanics and achieving functional range of motion (ROM) through precise positioning of the prosthetic components. Advanced three-dimensional (3D) imaging and computed tomography (CT)-based navigation are valuable tools in both the preoperative planning and intraoperative execution. The aim of this study is to provide a thorough overview on the applications of CT scans in both the preoperative and intraoperative settings of primary THA. Preoperative planning using CT-based 3D imaging enables greater accuracy in prediction of implant sizes, leading to enhancement of surgical workflow with optimization of implant inventory. Surgeons can perform a more thorough assessment of posterior and anterior acetabular wall coverage, acetabular osteophytes, anatomical landmarks, and thus achieve more functional implant positioning. Intraoperative CT-based navigation can facilitate precise execution of the preoperative plan, to attain optimal positioning of the prosthetic components to avoid impingement. Medial reaming can be minimized preserving native bone stock, which can enable restoration of femoral, acetabular, and combined offsets. In addition, it is associated with greater accuracy in leg length adjustment, a critical factor in patients' postoperative satisfaction. Despite the higher costs and radiation exposure, which currently limits its widespread adoption, it offers many benefits, and the increasing interest in robotic surgery has facilitated its integration into routine practice. Conducting additional research on ultra-low-dose CT scans and examining the potential for translation of 3D imaging into improved clinical outcomes will be necessary to warrant its expanded application.

A review of robotic-assisted total hip arthroplasty

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.

Advantages of robotic arm-assisted total hip arthroplasty: a 90-day episode-of-care clinical utility and cost analysis

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.

Downsizing and minimising medialisation of the acetabular component: Novel technique to preserve bone in THA

Standard practice for acetabular component placement in total hip arthroplasty (THA) is to medialise the acetabular component. Bone preservation techniques during primary THA are beneficial for possible future revisions. The goal of this study is to examine the effect of downsizing and minimising medialisation of the acetabular component on bone resection volume. The volume of bone resected during acetabular preparation for different sizes of components was calculated and the volume of bone preserved by downsizing the cup was determined. Minimising medialisation of the acetabular component by 1-3 mm from the true floor was calculated. Absolute values and percentage of bone volume preserved when acetabular components are downsized or less medialised is presented. Downsizing the acetabular component by one size (2 mm) preserves between 2.6 cm³ (size 40 vs 42) and 8.4 cm³ (size 72 vs 74) of bone volume and consistently reduces resected bone volume by at least 35% (range 35.2%-37.5%). Similarly, reducing medialisation of a 56 mm acetabular cup (as an example of a commonly implanted component) by 3 mm reduces bone loss by 5.9 cm³- 44% less bone volume resection. Downsizing and minimising medialisation of the cup in THA substantially preserves bone which may benefit future revision surgeries. Surgeons could consider implanting the smallest acceptable acetabular shell to preserve bone without compromising on head size.

Does acetabular robotic-assisted total hip arthroplasty with femoral navigation improve clinical outcomes at 1-year post-operative? A case-matched propensity score study comparing 98 robotic-assisted versus 98 manual implantation hip arthroplasties

INTRODUCTION

Despite the optimization of implant positioning, the clinical benefit of the use of robotic assistance during THA remains uncertain. In this case-control study (robotic versus manual technique) we made a retrospective short-term comparison of: (1) the functional results, (2) the complications, (3) and the influence of radiological symmetrization of the hips on the functional result.

HYPOTHESIS

The use of a robotic arm improved the functional results of a THA.

MATERIALS AND METHOD

A retrospective case-control study was performed, including patients with unilateral hip osteoarthritis who underwent a robotic arm-assisted THA (THA-R). The controls (THA-C) were matched according to age, sex, body mass index and surgical approach. The Harris (HHS), Oxford (OHS) and Forgotten Joint (FJS) scores were collected preoperatively and 1 year postoperatively. At each review, complications were categorized into minor events, revision surgery with and without implant change. Radiographic analysis was performed on weight-bearing images of the pelvis 3 months postoperatively. The objective of the surgery was symmetrization of the THA in the contralateral healthy hip. For each measured parameter of the hip joint center of rotation (COR), global offset (GO) and articular leg length discrepancy (aLLD), the difference between the two sides corresponding to the delta symmetrization was compared.

RESULTS

Ninety-eight patients were included in the THA-R group and matched to 98 controls in the THA-C group. At 1 year postoperatively, the FJS and OHS scores were statistically higher in the THA-R group, respectively 82.1±22.3 [8.3; 100] and 40.8±8.8 [6; 48] vs. 71.2±27.8 [0; 100] and 38.1±9.7 [12; 48] in the THA-C group (p=0.004 and p=0.043). There was no difference in HHS (THA-R: 85.9±15.8 [31; 100] vs. THA-C: 85.8±13.3 [49-100] (p=0.962)). The implant revision rate at 1 year was significantly higher in the THA-C group (0% vs. 5.1% (p=0.025)). There was no difference in the reoperation without component exchange despite 3 dislocations (3.1%) in the THA-R group (5 (5.1%) vs. 9 (9.2%) (p=0.273)). The rate of abarticular pathologies (ilio-psoas irritation and greater trochanteric bursitis) was higher in the THA-C group (10 (10.8%) vs. 2 (2%) (p=0.016). Robotic acetabular assistance allowed a significantly better restitution of the horizontal position (THA-R: 1mm±4.8 [-11.7; 12.6] vs. THA-C: 4.1mm±7 [-29.6; 28] (p=0.0005)) and vertical COR (THA-R: 0.5mm±3.1 [-6; 8.3] vs. THA-C: 2mm±4.1 [-6; 14.6] (p=0.0068)). Navigated assistance of the femur did not significantly optimize the restitution of the Global Offset (THA-R: +2mm±6.4 [-16.4; 27.6] vs. THA-C: +0.5mm±7 .7 [-34; 30.2] (p=0.145)), or lower limb length (THA-R: +1.1mm±5 [-8.2; 13.5] vs. THA-C: +0.3mm±6 [-14.1; 22.5] (p=0.344). The FJS was statistically correlated with the restoration of the symmetry of the COR and the aLLD. A post-hoc power analysis confirmed sufficient potency (1-β=0.85).

CONCLUSION

Robotic acetabular assistance combined with femoral navigation improves clinical outcomes of THAs with fewer short-term complications. The precision of the positioning of the implants, optimized by the computer-assisted surgery system, is correlated with the missed joint score.

LEVEL OF EVIDENCE

III, retrospective case-control study.

A systematic review on the cost-effectiveness of the computer-assisted orthopedic system

Computer-assisted orthopedic system (CAOS) is rapidly gaining popularity in the field of precision medicine. However, the cost-effectiveness of CAOS has not been well clarified. We performed this review to summarize and assess the cost-effectiveness analyses (CEAs) with regard to CAOS. Publications on CEA in CAOS have been searched in PubMed and CEA Registry up to May 31, 2022. The Quality of Health Economic Studies (QHES) instrument was used to estimate the quality of studies. Relationships between qualities and potential factors were also examined. There were 15 eligible studies in the present review. Twelve studies evaluated CAOS joint arthroplasties and found that CAOS joint arthroplasties were cost-effective compared to manual methods. Three studies focused on spinal surgery, two of which analyzed the cost-effectiveness of CAOS for patients after spinal fusion, with conflicting results. One study demonstrated that CAOS was cost-effective in spinal pedicle screw insertion. The mean QHES score of CEAs included was 86.1. The potential factors had no significant relationship with the quality of studies. Based on available studies, our review reflected that CAOS was cost-effective in the field of joint arthroplasty. While in spinal surgery, the answer was unclear. Current CEAs represent high qualities, and more CEAs are required in the different disciplines of orthopedics where CAOS is employed.

Assessment of Robot-Assisted Mandibular Contouring Surgery in Comparison With Traditional Surgery: A Prospective, Single-Center, Randomized Controlled Trial

BACKGROUND

Few clinical studies on robot-assisted surgery (RAS) for mandibular contouring have been reported.

OBJECTIVES

The aim of this study was to follow the long-term effectiveness and safety of RAS for craniofacial bone surgery.

METHODS

This small-sample, early-phase, prospective, randomized controlled study included patients diagnosed with mandibular deformity requiring mandibular contouring surgery. Patients of both genders aged 18 to 30 years without complicated craniofacial repair defects were enrolled and randomly assigned in a 1:1 ratio by a permuted-block randomized assignments list generated by the study statistician. The primary outcomes were the positioning accuracy and accuracy of the osteotomy plane angle 1 week after surgery. Surgical auxiliary measurement index, patient satisfaction scale, surgical pain scale, perioperative period, and complications at 1 week, 1 month, and 6 months after surgery were also analyzed.

RESULTS

One patient was lost to follow-up, resulting in a total of 14 patients in the traditional surgery group and 15 in the robot-assisted group (mean [standard deviation] age, 22.65 [3.60] years). Among the primary outcomes, there was a significant difference in the positioning accuracy (2.91 mm vs 1.65 mm; P < 0.01) and angle accuracy (13.26º vs 4.85º; P < 0.01) between the 2 groups. Secondary outcomes did not significantly differ.

CONCLUSIONS

Compared to traditional surgery, robot-assisted mandibular contouring surgery showed improved precision in bone shaving, as well as higher safety.

LEVEL OF EVIDENCE: 2

[Application of Mako robot-assisted total hip arthroplasty in developmental dysplasia of the hip]

Objective

To evaluate the early effectiveness and summarize the initial application experiences of Mako robot-assisted total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) in adults.

Methods

Between August 2018 and January 2020, 55 cases of DDH (75 hips) were treated with Mako robot-assisted THA. There were 10 males and 45 females with an average age of 51 years (range, 30-73 years). There were 35 cases of unilateral hip and 20 cases of bilateral hips. The DDH was classified as Crowe type Ⅰin 29 hips, type Ⅱ in 20 hips, type Ⅲ in 6 hips, and type Ⅳ in 20 hips. The modified Harris score was 54.8±16.0, the hip joint range of motion was 90° (80°, 100°), and the leg length discrepancy (LLD) was 22.0 (10.5, 47.0) mm. The preoperative surgical plan was made in the robot system based on the CT data. The reaming and installation of the acetabular cup were completed with the assistance of the robot system. The distance between the rotation center of the hip joint and the teardrop (horizontal distance, vertical distance), inclination angle, and anteversion angle were measured on the pelvic X-ray film to evaluate the position of the acetabular prosthesis. The above indicators were compared with preoperative planning to evaluate the accuracy of robotic-assisted surgery. The modified Harris score, the range of motion, and the LLD were used to evaluate the early effectiveness.

Results

The 75 hips of THAs were completed with the assistance of Mako robots. There was no significant difference in the acetabular inclination angle, the horizontal distance and the vertical distance of the rotation center between the preoperative planning and the postoperative measurement values ( P>0.05); the acetabular anteversion angle was significantly smaller than the postoperative measurement value ( t=-2.482, P=0.015). Four hips located beyond the Lewinnek safety zone, and 71 hips located within the Lewinnek safety zone. All patients followed up 6-24 months (mean, 13 months). All incisions healed by first intention. At last follow-up, the modified Harris score was 85.5±11.2, the hip joint range of motion was 120° (110°, 120°), and the LLD was 3.8 (2.0, 8.1) mm; all improved significantly compared with preoperative ones ( P<0.05). Except for one nerve injury case, there was no other complication.

Conclusion

Mako robot-assisted THA is a safe and effective method for adult DDH, which can optimize the acetabular cup positioning, hip function, and leg length, but the long-term effectiveness needs to be confirmed by further studies.

Robotic-assisted total hip arthroplasty: an economic analysis

Aim: To evaluate 90-day episode-of-care (EOC) resource consumption in robotic-assisted total hip arthroplasty (RATHA) versus manual total hip arthroplasty (mTHA). Methods: THA procedures were identified in Medicare 100% data. After propensity score matching 1:5, 938 RATHA and 4,670 mTHA cases were included. 90-day EOC cost, index costs, length of stay and post-index rehabilitation utilization were assessed. Results: RATHA patients were significantly less likely to have post-index inpatient rehabilitation or skilled nursing facility admissions and used fewer home health agency visits, compared with mTHA patients. Total 90-day EOC costs for RATHA patients were found to be US$785 less than those of mTHA patients (p = 0.0095). Conclusion: RATHA was associated with an overall lower 90-day EOC cost when compared with mTHA. The savings associated with RATHA were driven by reduced utilization and cost of post-index rehabilitation services.

Short-term Clinical Outcomes of Robotic-Arm Assisted Total Hip Arthroplasty: A Pair-Matched Controlled Study

Advances have made robotic assistance a viable option in total hip arthroplasty (THA). However, the clinical outcomes of this procedure relative to manual THA are limited in the literature. This study compared robotic-arm assisted (RAA) THA and manual THA at minimum 2-year follow-up. Data were collected prospectively on all THAs performed from July 2011 to January 2015. Patients were included if they underwent RAA primary THA for idiopathic osteo-arthritis and had minimum follow-up of 2 years. The following patient-reported outcomes were compared: Harris Hip Score (HHS), Forgotten Joint Score (FJS-12), visual analog scale (VAS) pain score, and satisfaction. Postoperative radio-graphs were analyzed for cup inclination, cup version, leg-length discrepancy, and global offset. Robotic-arm assisted THA patients were matched 1:1 with manual THA patients for age, sex, body mass index, and surgical approach. Each study group included 85 patients. There were no significant differences in the demographic factors between the groups. Both HHS and FJS-12 were significantly higher in the RAA group at minimum 2-year follow-up. The VAS score was lower in the RAA group, but this difference was not statistically significant. A significantly higher proportion of patients were in the Lewinnek and Callanan safe zones for cup orientation. There was no difference between the groups in patient satisfaction. Robotic-arm assisted THA yielded improved short-term patient outcomes compared with manual THA and higher likelihood of cup placement in the safe zones. No differences were found regarding VAS scores, patient satisfaction, complication rates, or subsequent revisions between groups. [Orthopedics. 2021;44(2):e236-e242.].

Comparison of Outcomes After Robotic-Assisted or Conventional Total Hip Arthroplasty at a Minimum 2-Year Follow-up: A Systematic Review

BACKGROUND

This systematic review aimed to present an updated analysis of the evidence comparing outcomes between robotic-assisted total hip arthroplasty (robotic THA) and conventional manual total hip arthroplasty (manual THA).

METHODS

A PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) systematic review was performed using the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, and Embase. Controlled studies comparing primary robotic THA and manual THA utilizing patient-reported outcome measures (PROMs) at a minimum follow-up of 2 years were included. We also compared radiographic outcomes, dislocation rates, and revision surgical procedures between groups. The ROBINS-I (Risk of Bias in Non-Randomized Studies - of Interventions) and Cochrane Risk of Bias 2.0 tools were used to assess study quality and risk of bias.

RESULTS

Of 765 studies identified, 7 articles comparing robotic THA with manual THA met inclusion criteria. A total of 658 patients were assessed, 335 of whom underwent robotic THA. The majority of studies found no significant differences (p > 0.05) in PROMs between the 2 techniques. Two low-quality studies (Level III) found significantly better postoperative PROMs favoring robotic THA at 2 years. When assessing radiographic outcomes, 6 studies showed that robotic THA resulted in more consistent and accurate component placement. No differences in postoperative dislocations, complications, or revision rates were found between groups except in 1 study, which found significantly more dislocations and revisions in the robotic THA cohort. Reported operative times were a mean of 12 to 25 minutes longer when using robotic THA.

CONCLUSIONS

The existing literature comparing robotic THA and manual THA is scarce and low-quality, with findings limited by methodological flaws in study design. Although evidence exists to support increased accuracy and reproducibility of THA component placement with robotic THA, this has not been shown to reduce postoperative dislocation and revision rates. Based on the available evidence, functional outcomes are comparable between techniques, and robotic THA appears to be associated with longer operative times. To fully evaluate the utility of robotic THA, additional well-designed, prospective controlled studies with continuous long-term monitoring are required.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Robotic arm-assisted versus manual total hip arthroplasty : a systematic review and meta-analysis

AIMS

The aims of this systematic review were to assess the learning curve of semi-active robotic arm-assisted total hip arthroplasty (rTHA), and to compare the accuracy, patient-reported functional outcomes, complications, and survivorship between rTHA and manual total hip arthroplasty (mTHA).

METHODS

Searches of PubMed, Medline, and Google Scholar were performed in April 2020 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included "robotic", "hip", and "arthroplasty". The criteria for inclusion were published clinical research articles reporting the learning curve for rTHA (robotic arm-assisted only) and those comparing the implantation accuracy, functional outcomes, survivorship, or complications with mTHA.

RESULTS

There were 501 articles initially identified from databases and references. Following full text screening, 17 articles that satisfied the inclusion criteria were included. Four studies reported the learning curve of rTHA, 13 studies reported on implant positioning, five on functional outcomes, ten on complications, and four on survivorship. The meta-analysis showed a significantly greater number of cases of acetabular component placement in the safe zone compared with the mTHA group (95% confidence interval (CI) 4.10 to 7.94; p < 0.001) and that rTHA resulted in a significantly better Harris Hip Score compared to mTHA in the short- to mid-term follow-up (95% CI 0.46 to 5.64; p = 0.020). However, there was no difference in infection rates, dislocation rates, overall complication rates, and survival rates at short-term follow-up.

CONCLUSION

The learning curve of rTHA was between 12 and 35 cases, which was dependent on the assessment goal, such as operating time, accuracy, and team working. Robotic arm-assisted total hip arthroplasty was associated with improved accuracy of component positioning and functional outcome, however no difference in complication rates or survival were observed at short- to mid-term follow-up. Overall, there remains an absence of high-quality level I evidence and cost analysis comparing rTHA and mTHA. Cite this article: Bone Joint J 2021;103-B(6):1009-1020.

Effect of Biomedical Materials in the Implementation of a Long and Healthy Life Policy

This paper is divided into seven main parts. Its purpose is to review the literature to demonstrate the importance of developing bioengineering and global production of biomaterials to care for the level of healthcare in the world. First, the general description of health as a universal human value and assumptions of a long and healthy life policy is presented. The ethical aspects of the mission of medical doctors and dentists were emphasized. The coronavirus, COVID-19, pandemic has had a significant impact on health issues, determining the world’s health situation. The scope of the diseases is given, and specific methods of their prevention are discussed. The next part focuses on bioengineering issues, mainly medical engineering and dental engineering, and the need for doctors to use technical solutions supporting medicine and dentistry, taking into account the current stage Industry 4.0 of the industrial revolution. The concept of Dentistry 4.0 was generally presented, and a general Bioengineering 4.0 approach was suggested. The basics of production management and the quality loop of the product life cycle were analyzed. The general classification of medical devices and biomedical materials necessary for their production was presented. The paper contains an analysis of the synthesis and characterization of biomedical materials supporting medicine and dentistry, emphasizing additive manufacturing methods. Numerous examples of clinical applications supported considerations regarding biomedical materials. The economic conditions for implementing various biomedical materials groups were supported by forecasts for developing global markets for biomaterials, regenerative medicine, and tissue engineering. In the seventh part, recapitulation and final remarks against the background of historical retrospection, it was emphasized that the technological processes of production and processing of biomedical materials and the systematic increase in their global production are a determinant of the implementation of a long and healthy policy.

The Impact of Author Financial Conflicts on Robotic-Assisted Joint Arthroplasty Research

BACKGROUND

Recent studies have suggested clinical superiority with robotic-assisted arthroplasty compared to traditional techniques. However, concerns exist regarding the author's financial conflicts of interest (COI), which may influence research outcomes. This study aimed to determine whether COI relating to robotic-assisted arthroplasty influences the results of published outcomes following total hip (THA), total knee (TKA), and unicompartmental knee arthroplasty (UKA).

METHODS

We performed a systematic review to identify all studies evaluating the use of robotics in THA, TKA, and UKA. An author's financial COI was identified if they reported a relevant disclosure through the American Academy of Orthopedic Surgeons or within the study article. We then queried the Open Payments website to record all payments made from a robotic company in the year prior to publication. Each study was categorized as either favoring robotics (n = 42), neutral (n = 10), or favoring traditional techniques (n = 2). We then compared the number of conflicted authors, journal impact factor, level of evidence, and mean annual industry payment to each author.

RESULTS

Of the 54 studies meeting inclusion criteria, 49 (91%) had an author financial COI. Conflicted studies were more likely to report favorable results of robotics than nonconflicted studies. When compared to studies favoring conventional techniques, those demonstrating favorable robotics outcomes had a higher number of conflicted authors and a higher mean industry payment per author. There was no difference in the level of evidence or journal impact factor.

DISCUSSION

Nearly all studies comparing robotic THA, TKA, and UKA to conventional techniques involve financially conflicted authors. Further studies without COI may provide unbiased results.

Preliminary clinical experience of robot-assisted surgery in treatment with genioplasty

Genioplasty is the main way to treat diseases such as chin asymmetry, dysplasia and overdevelopment, which involve the three-dimensional direction abnormalities of the chin. Since this kind of surgery mainly uses intraoral incisions, the narrow surgical field of intraoral incisions and the surrounding important neurovascular tissues make it easy for complications, to occur during the osteotomy process, which results in greater surgical risks. The first craniofacial-plastic surgical robot (CPSR-I) system is developed to complete the precise positioning and improve the surgeon's force perception ability. The Kalman filtering method is adopted to reduce the interference of sensor signal noise. An adaptive fuzzy control system, which has strong robustness and adaptability to the environment, is designed to improve the stability of robot-assisted surgical operations. To solve the problem of the depth perception, we propose an automatic bone drilling control strategy that combines position and force conditions to ensure that the robot can automatically stop when the bone is penetrated. On the basis of model surgery and animal experiments, preliminary experiments were carried out clinically. Based on the early results of 6 patients, the robot-assisted approach appears to be a safe and effective strategy for genioplasty.

Robotics in total hip arthroplasty: a review of the evolution, application and evidence base

Robotic systems used in orthopaedics have evolved from active systems to semi-active systems.

Early active systems were associated with significant technical and surgical complications, which limited their clinical use.

The new semi-active system Mako has demonstrated promise in overcoming these limitations, with positive early outcomes.

There remains a paucity of data regarding long-term outcomes associated with newer systems such as Mako and TSolution One, which will be important in assessing the applicability of these systems.

Given the already high satisfaction rate of manual THA, further high-quality comparative studies are required utilizing outcome scores that are not limited by high ceiling effects to assess whether robotic systems justify their additional expense.

Cite this article: EFORT Open Rev 2020;5:866-873. DOI: 10.1302/2058-5241.5.200037

Current concepts in robotic total hip arthroplasty

INTRODUCTION

Total hip replacement provides mostly fair functional and clinical results. Many factors play an essential role in hip stability and long-term outcomes. Surgical positioning remains fundamental for obtaining accurate implant fit and prevent hip dislocation or impingement. Different categories of robotic assistance have been established throughout the previous years and all of the technologies target accuracy and reliability to reduce complications, and enhance clinical outcomes.

MATERIALS AND METHODS

An overview is proposed over the principles of robotic assistance in hip arthroplasty surgery. Accuracy, reliability, management of the bone stock, clinical outcomes, constraints and limits of this technology are reported, based on recent literature.

RESULTS

Potential advantages regarding pre-operative planning accuracy, cup positioning, maintenance of the center of rotation, preservation of an adequate bone stock nay clinical short- and mid-term outcomes are balanced with some reported disadvantages and limits like hip anatomical specificity, cost-effectiveness, engineering dependence.

DISCUSSION

The use of robotic-assisted THA presents clear and evident benefits related to accurate implant positioning and maintenance of a minimal bone while allowing. For some authors, an early improvement in functional results and patient's recovery. This technology demonstrated a shorter surgical time and a short learning curve required to optimize its use and this technology presents promising outcomes and results and potential use in routine clinical application but its limitation of use is still present especially the cost of the robot, the need for the presence of an engineer during the surgery, its availability of use in all hospitals as well as the difficulty presented in dysplastic or dysmorphic hip joints.

Robotic-Assisted Acetabular Cup Placement in Severe Intrapelvic Acetabular Protrusio: A Case Report

CASE

We present a patient with a 30-year history of severe intrapelvic acetabular protrusio. As far as we know, this is the first case report on the use of robotic technology in total hip arthroplasty for severe acetabular protrusion. We also discuss the challenges and lessons learned from this technically demanding case.

CONCLUSION

Robotic assistance has its advantages in the accurate templating of the optimal cup dimensions, orientation, and location. However, the surgeon may still need to manually restore the offset because the center of rotation is not re-established and must be mindful of the severity and chronicity of the soft-tissue contractures.

Fully Automatic Robot-Assisted Surgery for Mandibular Angle Split Osteotomy

With the development of computer-assisted surgery, preoperational design is detailed in software. However, it is still a challenge for surgeons to realize the surgical plan in the craniofacial surgery. Robot-assisted surgery has advantages of high accuracy and stability. It is suitable for the high-stress procedures like drilling, milling, and cutting. This study aims to verify the feasibility for automatic drilling without soft tissues in model test based on an industrial robot platform.This study chose the data from digital laboratory in Shanghai 9th People's Hospital. The mandibular was reconstructed in software and surgical plan was also designed. Then, the coordinate data was input to the robot's software and matrix conversion was calculated by 4 marked points. The trajectory generation was calculated by inverse kinematics for target coordinates and robot coordinates. The model was fixed and calibrated for automatic drilling. At last, the accuracy was calculated by optic scanning instrument.The installment and preparation cost 10 minutes, the drilling procedure cost 12 minutes. The outside position error was (1.71 ± 0.16) mm, the inside position error was (1.37 ± 0.28) mm, the orientation error was (3.04 ± 1.02)°. Additionally, a total of 5 beagles were tested, with an accuracy error of (2.78 ± 1.52) mm. No postoperative complications occurred.This is the first study reported for robot-assisted automatic surgery in craniofacial surgery. The result shows it is possible to realize the automatic drilling procedure under the condition of no interference like soft tissues. With the development of artificial intelligence and machine vision, robot-assisted surgery may help surgeons to fulfill more automatic procedures for craniofacial surgery.

Robotic-Arm Assisted Direct Anterior Total Hip Arthroplasty; Improving Implant Accuracy

INTRODUCTION

The aim of this study was to investigate the accuracy of implant position of robotic-arm assisted total hip arthroplasty (THA) via the direct anterior approach (DAA).

MATERIALS AND METHODS

All patients who underwent robotic-arm assisted DAA THA (MAKO Surgical Corp., Ft. Lauderdale, Florida) from November 2018 to January 2020 were prospectively followed up. Pelvis indices (limb length discrepancy, femoral and hip offset, implant inclination, and anteversion), surgical duration, length of stay, and complications were recorded. To further evaluate the accuracy of robotic-arm assisted THA, patients who underwent manual DAA THA by the same surgeon were match-paired with the study group.

RESULTS

Twenty-five patients underwent robotic-arm assisted DAA THR. Limb length discrepancy was restored to 0.1mm (±3.4mm) from 10.0mm (±6.4mm) postoperatively. Preoperatively, the difference in femoral offset was 5.1mm (±5.1mm), and this was corrected to 1.9mm (±6.5mm) postoperatively. Nine cases had target inclination of 40° and mean inclination achieved was 40.7° (±0.9°). Sixteen cases had target inclination of 45° and mean inclination achieved was 45.3° (±1.0°). Mean anteversion was 19.5° (±2.4°). Propensity matched analysis showed that the root mean square errors for manual cup implantation compared to the robotic-arm assisted group was 2.3 times higher for anteversion and 6.3 times higher for inclination. Fourteen (56%) of the cups were within Callanan safe-zone and 18 (72%) within Lewinnek safe-zone in the manual group compared to 18 (72%) and 25 (100%), respectively, in the robotic-arm assisted group.

CONCLUSION

Combining the muscle-sparing technique of DAA with the improved implant placement with the robotic-arm assisted platform is a promising solution to improving THA outcomes.

Current topics in robotic-assisted total hip arthroplasty: a review

Total hip arthroplasty (THA) is among the most successful procedures of modern medicine, yet failures and complications continue to occur, leaving room for improvement. Robotics is a cutting-edge technology that tries to improve joint arthroplasty surgery. There is some evidence that shows that robotic-assisted THA improves implant positioning, but less is known about its effect on clinical outcomes or the rate of complications. This article reviews the literature on robotic-assisted THA to elucidate the history, advantages, disadvantages, and current clinical understanding of this procedure.

Robotics in trauma and orthopaedics

Recent advances and review of literature