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Barakat N, Ramamurti P, Duensing IM, Browne JA. Financial Conflicts of Interest and Industry Funding are Associated With Conclusions Favorable to New Technologies: A Review of Published Economic Analyses in Hip and Knee Arthroplasty. J Arthroplasty 2024; 39:S299-S305.e9. [PMID: 38408713 DOI: 10.1016/j.arth.2024.02.054] [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: 10/28/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND New technologies in hip and knee arthroplasty are commonly evaluated using cost-effectiveness analyses and similar economic assessments. There is a wide variation in the methodology of these studies, introducing the potential for bias. The purpose of this study was to evaluate associations between potential financial conflicts of interest (COI) and the outcomes of economic analyses. We hypothesized that authors' COI and industry funding would be associated with conclusions favorable to a new technology. METHODS Economic analyses making cost-effectiveness or economic implementation claims on patient-specific instrumentation, robotics, and implants used in hip and knee arthroplasty published from 2010 to 2022 were identified. Papers were evaluated to determine if conclusions were favorable to the new technology being studied. Fisher's exact test was utilized to determine the relationship between the presence of COI and an article's conclusions. RESULTS Of 43 eligible articles, 76.7% were cost-effectiveness analyses, 23.2% were cost analyses, and 67.4% of articles had conclusions favorable to a technology. Of the 29 articles with favorable conclusions, 26 had an author with a financial COI (89.7%), and 14 had industry funding (48.3%). Of the 33 articles with a financial COI, 26 (78.8%) had favorable conclusions, and of the 16 articles with industry funding, 14 (87.5%) had favorable conclusions. Fisher's exact test revealed a statistically significant association between an article having favorable conclusions and the presence of an author's COI or industry funding (odds ratio, 13.5; 95% CI [confidence interval], 2.3 to 79.9; P = .003). CONCLUSIONS Financial COIs were present in 79.1% of lower extremity arthroplasty economic analyses on technologies and were associated with an article having conclusions favorable to the new technology. Surgeons and decision-makers should be aware of the variability and assumptions in these studies and the potential bias of the conclusions.
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Affiliation(s)
- Nadim Barakat
- University of Virginia School of Medicine, Charlottesville, Virginia
| | - Pradip Ramamurti
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Ian M Duensing
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - James A Browne
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
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Di Gangi C, Prinos A, Buehring W, Meere PA, Meftah M, Hepinstall MS. Fewer Dislocations After Total Hip Arthroplasty With Robotic Assistance or Fluoroscopic Guidance. J Arthroplasty 2024; 39:S359-S366. [PMID: 39002766 DOI: 10.1016/j.arth.2024.07.002] [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: 12/16/2023] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND Computer navigation and robotic assistance may reduce total hip arthroplasty (THA) dislocations by improving the accuracy and precision of component positioning. We investigated dislocation rates for THAs using conventional techniques, robotic assistance, and computer navigation, while controlling for surgical approach, dual mobility (DM) use, and fluoroscopic guidance. METHODS We reviewed 11,740 primary THAs performed between June 2016 and December 2022, including 5,873 conventional, 1,293 with robotic-arm assistance, and 4,574 with navigation. The approach was posterior in 6,580 (56.0%), anterior in 4,342 (37.0%), and lateral in 818 (7.0%). A DM was used in 10.4%. Fluoroscopy was used in 3,653 cases and only with the anterior approach. Multivariate analyses yielded odds ratios (OR) for dislocation and revision. Additional regression analyses for dislocation were performed for approach and DM. RESULTS Raw dislocation rates were as follows: conventional 1.2%, robotic 0.4%, navigation 0.9%, anterior with fluoroscopy 0.4%, anterior without fluoroscopy 2.3%, posterior 1.3%, and lateral 0.5%. Upon multivariate analysis, use of robotics was found to be associated with significantly reduced dislocation risk compared to conventional (OR: 0.3), as did anterior (OR: 0.6) compared to posterior approach; navigation and lateral approach were not found to be associated with a significant reduction in risk. For the anterior approach, multivariate analysis demonstrated that fluoroscopy significantly reduced dislocation risk (OR: 0.1), while DM, robotics, and navigation were not significant. For the posterior approach, the dislocation risk was lower with robotics than with conventional (OR: 0.2); the use of navigation or DM did not demonstrate a significant reduction in risk. CONCLUSIONS The use of robotics was associated with a reduction in dislocations for this cohort overall. Further, fluoroscopy in the anterior approach and robotic assistance in the posterior approach were both associated with decreased dislocation risk. The role of imageless computer navigation and DM implants requires further study.
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Affiliation(s)
- Catherine Di Gangi
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York
| | - Alana Prinos
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York
| | - Weston Buehring
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York
| | - Patrick A Meere
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York
| | - Morteza Meftah
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York
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Ong CB, Buchan GBJ, Hecht CJ, Kanaji A, Kendoff DO, Kamath AF. Robotic-assisted total hip arthroplasty utilizing a fluoroscopy-guided system produced similar cup accuracy and precision relative to a computerized tomography-based robotic platform. J Robot Surg 2024; 18:273. [PMID: 38949665 DOI: 10.1007/s11701-024-02033-2] [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: 04/23/2024] [Accepted: 06/21/2024] [Indexed: 07/02/2024]
Abstract
Robotic assistance for total hip arthroplasty (THA) has been demonstrated to improve accuracy of acetabular cup placement relative to manual, unassisted technique. The purpose of this investigation was to compare the accuracy and precision between a fluoroscopy-based robotic total hip arthroplasty platform (FL-RTHA) and a computerized tomography-based (CT-RTHA) platform. The study included 98 consecutive FL-RTHA and 159 CT-RTHA procedures performed via direct anterior approach (DAA). All cases were performed for a pre-operative diagnosis of osteoarthritis, avascular necrosis, or rheumatoid arthritis. Primary outcome variables included cup implantation accuracy and precision (variance). Implantation accuracy was calculated as the absolute value of the difference between pre-operative target cup angles (inclination and anteversion) and the same post-operative angles. Percentage placement in the Lewinnek safe zone was also measured for both cohorts. The FL-RTHA and CT-RTHA cohorts demonstrated a 1.2° difference in absolute values for cup inclination accuracy (4.6° ± 3.6 vs. 3.4 ± 2.7; p = 0.005), and no difference in absolute values for cup anteversion accuracy (4.7° ± 4.1 vs. 4.6 ± 3.4; p = 0.991). Cohorts demonstrated similar precision for cup inclination and anteversion placement parameters, as well as equivalent Lewinnek safe zone placement. The use of a fluoroscopy-based robotic assistance platform for primary DAA THA resulted in similar accuracy and precision of acetabular cup placement when compared to a CT-based robotic assistance system.
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Affiliation(s)
- Christian B Ong
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - 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
| | - Arihiko Kanaji
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Daniel O Kendoff
- Chefarzt Zentrum für Orthopädie und Unfallchirurgie, HELIOS Kliniken Berlin-Buch, Schwanebecker Chaussee 25, 13125, Berlin, Germany
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Zhang X, Shen X, Zhang R, Chen M, Ma R, Zhang Z, Zhang H, Yang B, Zhu C. Radiographic evaluation of robot-assisted versus manual total hip arthroplasty: a multicenter randomized controlled trial. J Orthop Traumatol 2024; 25:33. [PMID: 38926175 PMCID: PMC11208392 DOI: 10.1186/s10195-024-00773-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/25/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The effectiveness of robot-assisted surgery remains contentious due to the lack of high-quality randomized controlled trials (RCTs) to elevate the level of evidence. We aimed to evaluate the postoperative radiographic outcomes of robot-assisted (RAS-THA) versus manual (M-THA) total hip arthroplasty. METHODS This multicenter RCT was performed from March 1, 2021 to December 1, 2021. Patients were randomly assigned to routine M-THA or to RAS-THA that used the TRex-RS orthopedic joint surgical navigation system. The primary outcome was to compare the acetabular component orientation, femoral stem alignment, femoral canal fill ratio, and leg length discrepancy between RAS-THA and M-THA using postoperative radiography. Subgroup analyses of the two groups stratified by surgical approach, gender, and BMI were also conducted. RESULTS Seventy-three participants were randomly allocated to the RAS-THA group, while seventy-two participants were assigned to the M-THA group. Compared to the M-THA group, the RAS-THA group exhibited less variability in the preoperative planning of the vertical center of rotation (VCOR; P < 0.001), demonstrated a significant advantage in femoral stem alignment (P = 0.004), and showed pronounced decreases in inequality and in the variability in leg length discrepancy (P < 0.001). There was no significant difference in the Lewinnek safe-zone ratio (P = 0.081) and the femoral canal fill ratio (P > 0.05) between the two groups. Further subgroup analysis also showed that the RAS-THA group had fewer horizontal center of rotation (HCOR) and leg length differences when stratified by surgical approach, gender, and overweight status. CONCLUSION This RCT found that, regardless of the surgical approach, gender, or body mass index, RAS-THA can effectively improve the postoperative VCOR and significantly reduce the variability of leg length difference. RAS-THA should be considered an effective method to enhance surgical precision by achieving less variability in challenging patients with leg length discrepancies. TRIAL REGISTRATION ChiCTR2100044124.
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Affiliation(s)
- Xianzuo Zhang
- Department of Orthopedics, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Xianyue Shen
- Department of Orthopedics, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Rongwei Zhang
- Department of Orthopedics, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Mo Chen
- Department of Orthopedics, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Ruixiang Ma
- Department of Orthopedics, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Zian Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Haining Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
| | - Bo Yang
- Department of Joint Surgery, Weifang People's Hospital, Weifang, Shandong, 261000, People's Republic of China.
| | - Chen Zhu
- Department of Orthopedics, Centre for Leading Medicine and Advanced Technologies of IHM, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China.
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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.
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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
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Prinos A, Buehring W, Di Gangi C, Meere P, Meftah M, Hepinstall M. Robot-Assisted Total Hip Arthroplasty Demonstrates Improved 90-Day Clinical and Patient-Reported Outcomes. Arthroplast Today 2024; 27:101393. [PMID: 39071820 PMCID: PMC11282420 DOI: 10.1016/j.artd.2024.101393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/11/2024] [Accepted: 04/01/2024] [Indexed: 07/30/2024] Open
Abstract
Background The utilization of technology, including robotics and computer navigation, in total hip arthroplasty (THA) has been steadily increasing; however, conflicting data exists regarding its effect on short-term clinical and patient-reported outcomes. Therefore, this study sought to explore the association between different surgical technologies and postoperative outcomes following THA. Methods We retrospectively reviewed 9892 primary THA cases performed by 62 surgeons from a single institution from September 2017 to November 2022. Three cohorts were created based on the utilization of technology: conventional (no technology), navigation, or robotics. Patient demographics, clinical outcomes, and patient-reported outcome measures were collected over the first 90 days following surgery. This data was compared using analysis of variance and multivariate logistic regressions. In total, 4275 conventional, 4510 navigation, and 1107 robotic cases were included in our analyses. Results The robotic cohort achieved a perfect Activity Measure for Post-Acute Care (AM-PAC) score earliest (0.1 days, P < .001). After adjusting for potential confounding variables, use of robotic assistance was associated with greater odds of achieving a perfect AM-PAC score on postoperative day 0 (odds ratio 1.6, P < .001) and greater odds of having length of stay shorter than 24 hours (odds ratio 2.3, P < .001) compared to no technology use in THA. Hip dysfunction and Osteoarthritis Outcome Score, Joint Replacement and Patient-Reported Outcomes Measurement Information System Pain Interference scores showed the greatest improvement in the robotic cohort at both 6 weeks and 3 months following surgery. Conclusions The present study demonstrates favorable clinical and patient-reported outcomes in the first 90 days following surgery for patients undergoing robot-assisted THA compared to conventional and navigation-assisted THA.
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Affiliation(s)
- Alana Prinos
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Weston Buehring
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | | | - Patrick Meere
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Morteza Meftah
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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Lao HD, Liu D, Cheng B, Liu SL, Shuang F, Li H, Li L, Zhou JJ. Personalized digital simulation‑assisted acetabular component implantation in revision hip arthroplasty. Exp Ther Med 2024; 27:180. [PMID: 38515645 PMCID: PMC10952346 DOI: 10.3892/etm.2024.12468] [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: 04/25/2023] [Accepted: 01/24/2024] [Indexed: 03/23/2024] Open
Abstract
The number of artificial total hip revision arthroplasties is increasing yearly in China, and >50% of these cases have acetabular defects. Accurately locating and quantifying the bone defect is one of the current challenges of this surgery. Thus, the objective of the present study was to simulate acetabular implantation with the aid of Mimics 17.0 software (Materialise NV) in patients with loosened acetabular prosthesis, to evaluate the 'ideal acetabular center' and the 'actual acetabular center' to guide the choice of prosthesis and surgical method. From January 2017 to June 2021, the present study included 10 hips from 10 patients [seven men (seven hips) and three women (three hips)]. In all patients, the Mimics software was applied to simulate the dislocation of the femoral prosthesis and acetabular prosthesis implantation before surgery; calculate the height difference between the 'ideal acetabular center' and the 'actual acetabular center' to assess the bone defect; confirm the size of the acetabular prosthesis, abduction angle, anteversion angle and bone coverage of the acetabular cup; and measure the intraoperative bleeding and postoperative follow-up Harris score of the hip joint. After statistical analysis, the present study revealed that digital simulation assistance could improve the accuracy of hip revision acetabular prosthesis implantation, reduce postoperative shortening of the affected limb, especially for surgeons with relatively little experience in hip revision surgery, and greatly reduce the occurrence of complications such as hip dislocation because of poor postoperative prosthesis position.
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Affiliation(s)
- Hong-Da Lao
- Department of Orthopedics, The 908th Hospital of The Joint Logistics Support Force (Great Wall Hospital Affiliated to Nanchang University), Nanchang, Jiangxi 335001, P.R. China
| | - Da Liu
- Department of Orthopedics, General Hospital of Western Theater Command, Chengdu, Sichuan 610038, P.R. China
| | - Bin Cheng
- Second Department of Orthopedics, The 92962 Military Hospital, Guangzhou, Guangdong 510000, P.R. China
| | - Shu-Ling Liu
- Jiangxi Institute of Scientific and Technical Information, Nanchang, Jiangxi 335001, P.R. China
| | - Feng Shuang
- Department of Orthopedics, The 908th Hospital of The Joint Logistics Support Force (Great Wall Hospital Affiliated to Nanchang University), Nanchang, Jiangxi 335001, P.R. China
| | - Hao Li
- Department of Orthopedics, The 908th Hospital of The Joint Logistics Support Force (Great Wall Hospital Affiliated to Nanchang University), Nanchang, Jiangxi 335001, P.R. China
| | - Lei Li
- Department of Orthopedics, The 908th Hospital of The Joint Logistics Support Force (Great Wall Hospital Affiliated to Nanchang University), Nanchang, Jiangxi 335001, P.R. China
| | - Jiang-Jun Zhou
- Department of Orthopedics, The 908th Hospital of The Joint Logistics Support Force (Great Wall Hospital Affiliated to Nanchang University), Nanchang, Jiangxi 335001, P.R. China
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Hecht CJ, Porto JR, Sanghvi PA, Homma Y, Sculco PK, Kamath AF. Contemporary analysis of the learning curve for robotic-assisted total hip arthroplasty emerging technologies. J Robot Surg 2024; 18:160. [PMID: 38578350 DOI: 10.1007/s11701-024-01928-4] [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: 02/27/2024] [Accepted: 03/24/2024] [Indexed: 04/06/2024]
Abstract
Robotic assisted (RA) total hip arthroplasty (THA) offers improved acetabular component placement and radiographic outcomes, but inconsistent assessment methods of its learning curves render the evaluation of adopting novel platforms challenging. Therefore, we conducted a systematic review to assess the learning curve associated with RA-THA, both tracking a surgeon's performance across initial cases and comparing their performance to manual THA (M-THA). PubMed, MEDLINE, EBSCOhost, and Google Scholar were searched on June 16, 2023, to identify studies published between January 1, 2000 and June 16, 2023 (PROSPERO registration: CRD42023437339). The query yielded 655 unique articles, which were screened for eligibility. The final analysis included 11 articles, evaluating 1351 THA procedures. Risk of bias was assessed via the Methodological Index for Nonrandomized Studies (MINORS) tool. The mean MINORS score was 21.3 ± 0.9. RA-THA provided immediate improvements in acetabular component placement accuracy and radiographic outcomes compared to M-THA, with little to no experience required to achieve peak proficiency. A modest learning curve (12-17 cases) was associated with operative time, which was elevated compared to M-THA (+ 9-13 min). RA-THA offers immediate advantages to M-THA for component placement accuracy and radiographic outcomes. Surgeons should expect to experience increased operative times, which become less pronounced or equivalent to M-THA after a modest caseload.
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Affiliation(s)
- Christian J Hecht
- Department of Orthopaedic Surgery, Center for Hip Preservation, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Joshua R Porto
- Department of Orthopaedic Surgery, Center for Hip Preservation, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Parshva A Sanghvi
- Department of Orthopaedic Surgery, Center for Hip Preservation, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organs, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Center for Hip Preservation, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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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.
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MESH Headings
- Humans
- Cost-Benefit Analysis/methods
- Robotic Surgical Procedures/economics
- Robotic Surgical Procedures/methods
- Arthroplasty, Replacement, Hip/economics
- Arthroplasty, Replacement, Hip/methods
- Tomography, X-Ray Computed/economics
- Tomography, X-Ray Computed/methods
- Arthroplasty, Replacement, Knee/economics
- Arthroplasty, Replacement, Knee/methods
- Imaging, Three-Dimensional/economics
- Imaging, Three-Dimensional/methods
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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
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Buchan GBJ, Ong CB, Hecht Ii CJ, DeCook CA, Spencer-Gardner LS, Kamath AF. Use of a fluoroscopy-based robotic-assisted total hip arthroplasty system produced greater improvements in patient-reported outcomes at one year compared to manual, fluoroscopic-assisted technique. Arch Orthop Trauma Surg 2024; 144:1843-1850. [PMID: 38400899 PMCID: PMC10965579 DOI: 10.1007/s00402-024-05230-8] [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: 10/11/2023] [Accepted: 02/15/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION The adoption of new technology should be supported by improvements in patient-reported outcomes (PROMs). The purpose of this study was to assess the one-year PROMs of patients who underwent total hip arthroplasty (THA) using a novel, fluoroscopy-based, robotic-assisted (RA-THA) system when compared to a manual, fluoroscopic-assisted technique (mTHA). MATERIALS AND METHODS A review of 91 consecutive mTHA and 85 consecutive RA-THA via a direct anterior approach was conducted. All cases were performed by the same surgeon at the same institution, for a pre-operative diagnosis of osteoarthritis, avascular necrosis, or rheumatoid arthritis. Outcomes included one-year Veterans RAND-12 (VR-12) Physical/Mental, Hip Disability and Osteoarthritis Outcome (HOOS) Pain/Physical Function/Joint Replacement, and University of California Los Angeles (UCLA) Activity scores, as well as the difference between pre-operative and one-year post-operative PROMs. RESULTS Patients in the RA-THA cohort had lower pre-operative HOOS-JR scores compared to patients in the mTHA cohort (37.0 vs. 43.1; p = 0.031). Cohorts experienced similar one-year post-operative VR-12, HOOS, and UCLA Activity scores. Patients in the RA-THA cohort experienced greater improvements across all pre- and post-operative HOOS scores compared to patients in the mTHA cohort: Pain (+ 54.7 vs. +42.1; p = 0.009), Physical Function (-41.6 vs. -28.7; p = 0.007), and Joint Replacement (+ 46.6 vs. +33.0; p = 0.002). These differences exceeded minimum clinically important difference (MCID). CONCLUSIONS Both manual and robotic cohorts experienced benefit from THA at one-year post-operative. Importantly, the use of a novel, fluoroscopy-based robotic assistance system for primary THA resulted in greater improvements in PROMs at one-year relative to manual technique.
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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 B Ong
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Christian J Hecht Ii
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Charles A DeCook
- Arthritis and Total Joint Specialists, 2000 Howard Farm Drive, Suite 200, Cumming, GA, 30041, USA
| | - Luke S Spencer-Gardner
- Department of Orthopaedic Surgery, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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11
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Khanna V, Sohn G, Khanna S, Ashraf M, Mittal MM, Mounsamy V, Sambandam S. Lower Intraoperative and Immediate Postoperative Complications in Robotic Versus Conventional Primary Total Hip Arthroplasty: A Retrospective Cohort Analysis of Over 360,000 Patients. Cureus 2024; 16:e57726. [PMID: 38711699 PMCID: PMC11073758 DOI: 10.7759/cureus.57726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE Although a trend of an improved alignment with robotic total hip arthroplasty (THA) over conventional methods has surfaced from recent series, it is unknown whether these results translate into meaningful enhancements in postoperative outcomes. To address this lack in the literature, we compared the perioperative morbidity and mortality with robotic and conventional THA in a large national cohort of 367,894 patients. We hypothesized that no significant differences would exist in the outcomes between the two groups. METHODS Records were extracted from 2016-2019 from the National Inpatient Sample (NIS) database Healthcare Cost and Utilization Project which is the largest in-patient database in the United States. From 367,894 THAs, robotics were employed for 7,863 patients. The remaining 360,031 conventional THAs served as controls. The two groups were compared for demographics, admission, and hospital stay details including costs, and mortality and morbidity data including medical and surgical complications. Descriptive statistics were used for demographic data while analytical statistics including t-tests, chi-squared tests, Fischer exact test, and Pearson chi-squared tests were used for perioperative outcomes. Statistical significance was set at p<0.005. RESULTS Demographic distributions between robotic and conventional THA groups displayed similar age and sex characteristics. Shorter mean lengths of stay (1.87 days) were seen in robotic THA versus conventional THA (2.33 days) while higher costs were noted for the former (mean $68,686.71 vs $66,840.39) (p<0.005). Low overall mortality (0.03% robotic, 0.09% conventional) was seen in both groups (p>0.005). Higher comparative incidences of anemia, acute renal failure, and pneumonia were seen in conventional THA (p<0.005) while no significant differences were noted for other complications including myocardial infarction, pulmonary embolism, deep vein thrombosis, and cardiac arrest (p>0.005). Among others, lower dislocation rates, mechanical complications, periprosthetic joint infection, and periprosthetic fractures were seen with robotic THA (p<0.005). Wound complications and superficial infection rates did not differ between the two groups (p>0.005). CONCLUSIONS Evidence has emerged from our results to support more routine adaptation of the robotic option of performing a THA. These can be based on lower local, systemic, and mechanical complications as demonstrated by the present study. Further evaluation of these results in follow-up would help establish the foothold of robotic surgery in total hip replacement in the modern context.
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Affiliation(s)
| | - Garrett Sohn
- Orthopedics, UT Southwestern Medical Center, Dallas, USA
| | - Surya Khanna
- Orthopaedics, Jawaharlal Nehru Medical College, Belagavi, IND
| | - Munis Ashraf
- Orthopedics, Saveetha Medical College and Hospital, Chennai, IND
| | - Mehul M Mittal
- Orthopedics, UT Southwestern Medical Center, Dallas, USA
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12
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Rogers N, Rullán PJ, Pasqualini I, Khan ST, Klika AK, Surace PA, Molloy RM, Piuzzi NS, Bloomfield M. Lower 90-day inpatient readmission and 1-year reoperation in patients undergoing robotic versus manual total hip arthroplasty through an anterior approach. Technol Health Care 2024:THC231646. [PMID: 38393864 DOI: 10.3233/thc-231646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
BACKGROUND The value of robotic-assisted total hip arthroplasty (rTHA) has yet to be determined compared to conventional manual THA (mTHA). OBJECTIVE Evaluate 90-day inpatient readmission rates, rates of reoperation, and clinically significant improvement of patient-reported outcome measures (PROMs) at 1-year in a cohort of patients who underwent mTHA or rTHA through a direct anterior (DA) approach. METHODS A single-surgeon, prospective institutional cohort of 362 patients who underwent primary THA for osteoarthritis via the DA approach between February 2019 and November 2020 were included. Patient demographics, surgical time, discharge disposition, length of stay, acetabular cup size, 90-day inpatient readmission, 1-year reoperation, and 1-year PROMs were collected for 148 manual and 214 robotic THAs, respectively. RESULTS Patients undergoing rTHA had lower 90-day readmission (3.74% vs 9.46%, p= 0.04) and lower 1-year reoperation (0.93% vs 4.73% mTHA, p= 0.04). rTHA acetabular cup sizes were smaller (rTHA median 52, interquartile range [IQR] 50; 54, mTHA median 54, IQR 52; 58, p< 0.001). Surgical time was longer for rTHA (114 minutes vs 101 minutes, p< 0.001). At 1-year post-operatively, there was no difference in any of the PROMs evaluated. CONCLUSION Robotic THA demonstrated lower 90-day readmissions and 1-year reoperation rates than manual THA via the DA approach. PROMs were not significantly different between the two groups at one year.
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13
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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).
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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
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14
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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.
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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
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15
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Borsinger TM, Chandi SK, Puri S, Debbi EM, Blevins JL, Chalmers BP. Total Hip Arthroplasty: An Update on Navigation, Robotics, and Contemporary Advancements. HSS J 2023; 19:478-485. [PMID: 37937097 PMCID: PMC10626925 DOI: 10.1177/15563316231193704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 11/09/2023]
Abstract
While total hip arthroplasty (THA) remains effective for improvement of pain and function in patients with osteoarthritis and avascular necrosis, there remain areas of continued pursuit of excellence, including decreasing rates of dislocation, leg length discrepancy, implant loosening, and infection. This review article covers several bearing surfaces and articulations, computer-assisted navigation and robotic technology, and minimally invasive surgical approaches that have sought to improve such outcomes. Perhaps the most significant improvement to THA implant longevity has been the broad adoption of highly cross-linked polyethylene, with low wear rates. Similarly, navigation and robotic technology has proven to more reproducibly achieve intraoperative component positioning, which has demonstrated clinical benefit with decreased risk of dislocation in a number of studies. Given the projected increase in THA over the coming decades, continued investigation of effective incorporation of technology, soft tissue-sparing approaches, and durable implants is imperative to continued pursuit of improved outcomes in THA.
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Affiliation(s)
- Tracy M Borsinger
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Sonia K Chandi
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Simarjeet Puri
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Eytan M Debbi
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Jason L Blevins
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Brian P Chalmers
- Department of Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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16
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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.
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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.
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17
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Danoff JR, Heimroth J, Willinger M, Trout S, Sodhi N. Surgical Technique: Robotic-Assisted 1.5-Stage Exchange Total Knee Arthroplasty for Periprosthetic Joint Infection. Arthroplast Today 2023; 21:101126. [PMID: 37234598 PMCID: PMC10205596 DOI: 10.1016/j.artd.2023.101126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 01/12/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023] Open
Abstract
A 1.5-stage exchange total knee arthroplasty for periprosthetic joint infection has been described; however, achieving a balanced and well-aligned construct can sometimes be difficult given the bony defects often encountered in these cases. The use of robotic navigation technologies allows for accurate and precise implant placement. This technique report details the utilization of robotic navigation in a 1.5-stage exchange total knee arthroplasty for periprosthetic joint infection and describes the outcome of 6 patients. This technique guide highlights how robotic technology can account for many commonly encountered bone voids, joint line identification, and component orientation, while achieving a balanced and well-aligned knee.
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Affiliation(s)
- Jonathan R. Danoff
- Corresponding author: Department of Orthopaedic Surgery, Northwell Health, North Shore University Hospital, 611 Northern Blvd, Suite 200 Great Neck, NY 11021, USA. Tel.: +1 516 325 7013.
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18
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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.
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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
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19
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Meghpara MM, Goh GS, Magnuson JA, Hozack WJ, Courtney PM, Krueger CA, Krueger CA. The Ability of Robot-Assisted Total Knee Arthroplasty in Matching the Efficiency of Its Conventional Counterpart at an Orthopaedic Specialty Hospital. J Arthroplasty 2023; 38:72-77.e3. [PMID: 35940350 DOI: 10.1016/j.arth.2022.07.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Robot-assisted total knee arthroplasty (RA-TKA) has become a popular technology. Studies have investigated the learning curve for surgeons incorporating RA-TKA into practice, but less is known regarding the change in operative efficiency when introducing RA-TKA into a facility. The purpose of this study was to investigate the effects of RA-TKA on operative and turnover time at an orthopaedic specialty hospital. METHODS A total of 148 cases (74 RA-TKA and 74 conventional TKA [C-TKA]) performed by 2 surgeons with previous robotic experience were identified following the introduction of RA-TKA at our facility. Patient demographics, comorbidities, and operative times (ie, wheels-in to incision, incision to closure, closure to wheels-out, and turnover time) were recorded. Cumulative summation analyses were used to investigate learning curves of factors extraneous to surgeon proficiency with RA-TKA. RESULTS While RA-TKA had a slightly longer set up (3 minutes; range, 12-45), surgical (5 minutes; range, 33-118), and breakdown time (3 minutes; range, 2-7), there was no difference in turnover time between the groups. The learning curve for surgeon A was 6 robotic cases, whereas surgeon B demonstrated no learning curve. There was no identifiable learning curve for turnover time. CONCLUSION There was a mean of 8 minutes of increased time required to perform a RA-TKA compared to C-TKA. However, these small increases for the RA-TKA group for set-up, surgical, and breakdown times are not likely to be clinically relevant compared to the C-TKA. It appears that the RA-TKA technology was able to be incorporated into this specialty hospital with minimal changes to surgical efficiency.
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Affiliation(s)
- Michael M Meghpara
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Justin A Magnuson
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - William J Hozack
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Chad A Krueger
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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20
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Maldonado DR, Glein RM, Annin S, Owens JS, Jimenez AE, Saks BR, Lall AC, Domb BG. Outcomes Following Primary Total Hip Arthroplasty With Concomitant Gluteus Medius Repair Using the Direct Anterior Approach. Orthopedics 2023; 46:39-46. [PMID: 36206516 DOI: 10.3928/01477447-20221003-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Outcomes following total hip arthroplasty (THA) with concomitant gluteus medius (GM) repair using the direct anterior approach (DAA) are scarce. The primary purpose of this study was to report patient-reported outcome measures (PROMs) with 2-year follow-up of patients with osteoarthritis and GM tear who underwent primary THA and GM repair through the DAA. The secondary purpose was to compare these outcomes with a benchmark propensity-matched control group who underwent a DAA THA without GM tear. Patients were eligible if they received a primary THA and GM repair via the DAA between January 2015 and October 2018 and had baseline PROMs with 2-year follow-up. Patients were excluded if they had workers' compensation or were unwilling to participate. PROM subanalysis was performed between patients and a propensity-matched control group with DAA THA without GM tear. Fourteen patients were included in the study, all of whom were female. Significant improvement for all PROMs and high rate of achieving the minimal clinically important difference (MCID) at 2-year follow-up were reported. All patients were propensity-matched to 28 patients for sex, age, and body mass index. Preoperative PROMs between groups were similar, and both groups reported comparable improvement, satisfaction, and MCID achievement at 2-year follow-up. Primary THA with concomitant GM repair using the DAA yielded good functional outcomes and a high rate of MCID achievement at 2-year follow-up. Based on these results, the DAA can be used safely to address symptomatic GM tears during THA. Furthermore, these outcomes were comparable to a propensity-matched control group without GM tear. [Orthopedics. 2023;46(1):39-46.].
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21
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Li H, Zhuang T, Wu W, Gan W, Wu C, Peng S, Huan S, Liu N. A systematic review on the cost-effectiveness of the computer-assisted orthopedic system. HEALTH CARE SCIENCE 2022; 1:173-185. [PMID: 38938554 PMCID: PMC11080830 DOI: 10.1002/hcs2.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/30/2022] [Accepted: 09/14/2022] [Indexed: 06/29/2024]
Abstract
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.
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Affiliation(s)
- Hua Li
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Tengfeng Zhuang
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Wenrui Wu
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Wenyi Gan
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Chongjie Wu
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Sijun Peng
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Songwei Huan
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
| | - Ning Liu
- Department of OrthopaedicsThe First Affiliated Hospital of Jinan UniversityGuangzhouGuangdong ProvinceChina
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22
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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.
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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
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23
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Robotic-Arm-Assisted Total Hip Arthroplasty: A Review of the Workflow, Outcomes and Its Role in Addressing the Challenge of Spinopelvic Imbalance. Medicina (B Aires) 2022; 58:medicina58111616. [DOI: 10.3390/medicina58111616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/27/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022] Open
Abstract
Robotic-arm-assisted total hip arthroplasty (RoTHA) offers the opportunity to improve the implant positioning and restoration of native hip mechanics. The concept of individualised, functional implant positioning and how it relates to spinopelvic imbalance is an important yet rather novel consideration in THA. There is mounting evidence that a significant percentage of dislocations occur within the perceived “safe zones”; hence, in the challenging subset of patients with a stiff spinopelvic construct, it is imperative to employ individualised component positioning based on the patients’ phenotype. Restoring the native centre of rotation, preserving offset, achieving the desired combined anteversion and avoiding leg length inequality are all very important surgeon-controlled variables that have been shown to be associated with postoperative outcomes. The latest version of the software has a feature of virtual range of motion (VROM), which preoperatively identifies potential dynamic causes of impingement that can cause instability. This review presents the workflow of RoTHA, especially focusing on pragmatic solutions to tackle the challenge of spinopelvic imbalance. Furthermore, it presents an overview of the existing evidence concerning RoTHA and touches upon future direction.
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24
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Mahmoud RH, Lizardi JJ, Weinerman J, Vanden Berge DJ, Constantinescu DS, Yakkanti R. Characteristics and trends of the most cited papers in robotic assisted arthroplasty. J Orthop 2022; 34:40-48. [PMID: 36016864 PMCID: PMC9395732 DOI: 10.1016/j.jor.2022.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 07/30/2022] [Indexed: 12/30/2022] Open
Abstract
Purpose To compile and analyze the top 50 most frequently cited articles published on robotic-assisted arthroplasty, allowing clinicians to effectively identify the most influential literature pertaining to this topic. Methods Guidelines set by the Preferred Reporting Items for Systematic Reviews were used as the foundation for data collection and analysis. All papers pertaining to robotic-assisted arthroplasty were retrieved using the Scopus database. Data including: manuscript title, authors, total citation count, level of evidence, journal, publication year, and country of publication was extracted from a final list of articles. Results The top 50 publications regarding robotic assisted arthroplasty were cited a total of 4530 times (including self-citations), with an average total of 91. The years with the most publications in the top 50 were: 2017, 2018, and 2019, producing 7, 6, and 5 papers, respectively. Only 4 papers in the top 50 were published prior to the year 2003. The most common level of evidence was level V, and the most common category was Clinical Outcomes (74%). The United States contributed half of the 50 articles, and Princess Grace Hospital and University of London were the most contributory institutions, each with 6 of the top 50 articles. Conclusion This analysis provides a comprehensive review of the most cited and influential papers in robotic-assisted arthroplasty. Understanding these trends in the literature will ultimately pave the way for physicians and researchers to continue to innovate and research in a targeted manner as they gain an understanding of what has been studied and what remains inadequately explored. Level of evidence 3.
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Affiliation(s)
- Rami H. Mahmoud
- The University of Miami Leonard M. Miller School of Medicine, Department of Education, United States
| | - Juan J. Lizardi
- The University of Miami Leonard M. Miller School of Medicine, Department of Education, United States
| | - Jonathan Weinerman
- The University of Miami Leonard M. Miller School of Medicine, Department of Education, United States
| | | | | | - Ramakanth Yakkanti
- University of Miami Hospital, Department of Orthopaedic Surgery, United States
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25
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Shaw JH, Rahman TM, Wesemann LD, Z Jiang C, G Lindsay-Rivera K, Davis JJ. Comparison of Postoperative Instability and Acetabular Cup Positioning in Robotic-Assisted Versus Traditional Total Hip Arthroplasty. J Arthroplasty 2022; 37:S881-S889. [PMID: 35143923 DOI: 10.1016/j.arth.2022.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/16/2022] [Accepted: 02/01/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Robotic-assisted total hip arthroplasty (R-THA) affords precision yet uncertain clinical benefits. This study compares dislocation rates and related revisions between R-THA and manual total hip arthroplasty (M-THA). Secondarily we evaluated cup position, patient-reported outcome measures (PROMs), and postoperative complications. METHODS A three-surgeon cohort study was conducted on 2247 consecutive patients (1724 M-THA and 523 R-THA) who received a primary THA between January 2014 and June 2020 at a single hospital. Demographics, PROMs, emergency department visits, readmissions, and 90-day complications were collected via the Michigan Arthroplasty Registry Collaborative Quality Initiative. Chart review yielded instability occurrence with an average follow-up of 4 years. Multivariate regression analysis was performed, and a sample of 368 radiographs, including all dislocations, were assessed. RESULTS There were significantly lower rates of dislocation in R-THA (0.6%) vs M-THA (2.5%; Multivariate odds ratio 3.74, P < .046). All cases of unstable R-THA were successfully treated conservatively, whereas 46% of unstable M-THA were revised for recurrent instability. Cup anteversion (25.6° ± 5.4° R-THA vs 20.6° ± 7.6° M-THA) was greater, and cup inclination (42.5° ± 5.3° R-THA vs 47.0° ± 6.7° M-THA) was lower in the R-THA group (P < .05). No significant differences were noted for demographics, PROMs, or other complications (P > .05). CONCLUSION R-THA resulted in less than one-fourth the dislocation rate compared to M-THA and no revision for instability. It was associated with no difference in PROMs or other early complications. The influence of R-THA on stability goes beyond simply cup positioning and deserves further study.
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Affiliation(s)
- Jonathan H Shaw
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI
| | - Tahsin M Rahman
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI
| | - Luke D Wesemann
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI
| | - Charles Z Jiang
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI
| | | | - Jason J Davis
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI
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26
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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.
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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
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27
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Bendich I, Vigdorchik JM, Sharma AK, Mayman DJ, Sculco PK, Anderson C, Della Valle AG, Su EP, Jerabek SA. Robotic Assistance for Posterior Approach Total Hip Arthroplasty Is Associated With Lower Risk of Revision for Dislocation When Compared to Manual Techniques. J Arthroplasty 2022; 37:1124-1129. [PMID: 35124193 DOI: 10.1016/j.arth.2022.01.085] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Robotic-assistance total hip arthroplasty (RA-THA) and computer navigation THA (CN-THA) have been shown to improve accuracy of component positioning compared to manual techniques; however, controversy exists regarding clinical benefit. Moreover, these technologies may expose patients to risks. The purpose of this study is to compare rates of intraoperative fracture and complications requiring reoperation within 1 year for posterior approach RA-THA, CN-THA, and THA with no technology (Manual-THA). METHODS In total, 13,802 primary, unilateral, elective, posterior approach THAs (1770 RA-THAs, 3155 CN-THAs, and 8877 Manual-THAs) were performed at a single institution between 2016 and 2020. Intraoperative fractures and reoperations within 1 year of the index procedure were identified. Cohorts were balanced using inverse probability of treatment weight based on age, gender, body mass index, femoral cementation, history of spine fusion, and Charlson Comorbidity Index. Logistic regression was performed to create odds ratios for complications. Additional regression analysis for dislocation was performed, adjusting for dual mobility and femoral head size. RESULTS There were no differences in intraoperative fracture and postoperative complication rates between the groups (P = .521). RA-THA had a 0.3 odds ratio (95% confidence interval 0.1-0.9, P = .046) compared to Manual-THA for reoperation due to dislocation. CN-THA had an odds ratio of 3.0 for reoperation due to dislocation (95% confidence interval 0.8-11.3, P = .114) compared to RA-THA. The remaining complication odds ratios, including those for infection, loosening, dehiscence, and "other" were similar between the groups. CONCLUSION RA-THA is associated with lower risk of revision for dislocation within 1 year of index surgery, when compared to Manual-THA performed through the posterior approach.
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Affiliation(s)
| | | | | | | | | | | | | | - Edwin P Su
- Hospital for Special Surgery, New York, NY
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28
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Kunze KN, Bovonratwet P, Polce EM, Paul K, Sculco PK. Comparison of Surgical Time, Short-term Adverse Events, and Implant Placement Accuracy Between Manual, Robotic-assisted, and Computer-navigated Total Hip Arthroplasty: A Network Meta-analysis of Randomized Controlled Trials. J Am Acad Orthop Surg Glob Res Rev 2022; 6:e21.00200. [PMID: 35472191 PMCID: PMC10566925 DOI: 10.5435/jaaosglobal-d-21-00200] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 02/12/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Recent years have observed the increasing utilization of robotic-assisted and computer navigation techniques in total hip arthroplasty (THA), given the proposed benefits of enhanced consistency and precision in implant placement. The purpose of this study was to conduct a systematic review of randomized controlled trials (RCTs) to determine whether differences in surgical times, adverse events, and implant positioning existed between manual, robotic-assisted, and computer navigation THA. METHODS PubMed, OVID/MEDLINE, and Cochrane databases were queried for RCTs comparing robotic-assisted versus manual THA and computer navigation versus manual THA at a minimum 1-year follow-up. Frequentist model network meta-analyses with P-scores were conducted to compare revisions, complications, and surgical times among the three treatment groups. A random-effects meta-analysis between computer navigation and manual THAs was conducted to analyze cup positioning because no robotic-assisted THA studies reported this outcome. RESULTS Five RCTs compared robotic-assisted and manual THAs, while seven compared computer navigation and manual THAs. manual THA was associated with significantly reduced surgical time in comparison with computer navigation (mean difference: 23.3 minutes) and robotic-assisted THAs (mean difference: 8.6 minutes; P < 0.001). No difference was observed in the incidence of all-cause complications (computer navigation: 1.7%, manual: 6.6%, and robotic-assisted: 16.2%) or revisions (computer navigation: 1.0%, manual: 1.7%, and robotic-assisted 4.8%) among the three treatment groups based on the network meta-analysis. In three studies that reported acetabular implant positioning, computer navigation had a significantly higher percentage of acetabular cups placed in the Lewinnek "safe zone" compared with manual THA (79% versus 52%; P = 0.02). CONCLUSIONS manual THA results in markedly shorter surgical times and a similar incidence of complications and revisions compared with robotic-assisted and computer navigation THAs, given the sample sizes available for study. However, computer navigation THA led to increased precision in the placement of acetabular implants.
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Affiliation(s)
- Kyle N. Kunze
- From the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Kunze, Dr. Bovonratwet, and Dr. Sculco), University of Wisconsin School of Medicine and Public Health, Madison, WI (Mr. Polce), and the Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL (Ms. Paul)
| | - Patawut Bovonratwet
- From the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Kunze, Dr. Bovonratwet, and Dr. Sculco), University of Wisconsin School of Medicine and Public Health, Madison, WI (Mr. Polce), and the Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL (Ms. Paul)
| | - Evan M. Polce
- From the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Kunze, Dr. Bovonratwet, and Dr. Sculco), University of Wisconsin School of Medicine and Public Health, Madison, WI (Mr. Polce), and the Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL (Ms. Paul)
| | - Katlynn Paul
- From the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Kunze, Dr. Bovonratwet, and Dr. Sculco), University of Wisconsin School of Medicine and Public Health, Madison, WI (Mr. Polce), and the Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL (Ms. Paul)
| | - Peter K. Sculco
- From the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Kunze, Dr. Bovonratwet, and Dr. Sculco), University of Wisconsin School of Medicine and Public Health, Madison, WI (Mr. Polce), and the Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL (Ms. Paul)
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29
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Scott CEH, Clement ND, Davis ET, Haddad FS. Modern total hip arthroplasty: peak of perfection or room for improvement? Bone Joint J 2022; 104-B:189-192. [PMID: 35094584 DOI: 10.1302/0301-620x.104b2.bjj-2022-0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Chloe E H Scott
- Royal Infirmary of Edinburgh, Edinburgh, UK.,The Bone & Joint Journal , London, UK.,Bone & Joint Research , London, UK.,University of Edinburgh, Edinburgh, UK
| | | | | | - Fares S Haddad
- The Bone & Joint Journal , London, UK.,University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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30
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Emara AK, Samuel LT, Acuña AJ, Kuo A, Khlopas A, Kamath AF. Robotic-arm assisted versus manual total hip arthroplasty: Systematic review and meta-analysis of radiographic accuracy. Int J Med Robot 2021; 17:e2332. [PMID: 34528372 DOI: 10.1002/rcs.2332] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/14/2021] [Accepted: 09/14/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND We systematically reviewed the radiological outcomes of studies comparing robotic-assisted (RA-THA) and manual total hip arthroplasty (mTHA). METHODS The PubMed, Embase, and Cochrane databases were queried from 1994-2021 for articles comparing radiographic outcomes between RA-THA and mTHA cohorts. A meta-analysis was conducted whenever sufficient data was present for common outcomes. RESULTS Our analysis included 20 articles reporting on 4140 patients (RA-THA: n = 1228; mTHA: n = 2912). No differences were demonstrated for acetabular inclination or anteversion. However, RA-THA demonstrated higher rates of cup orientation within the Lewinnek and Callanan safe zones, improved femoral stem alignment, and lower global offset difference (GOD) and limb length discrepancy (all p-values <0.05). Superior femoral canal fill and combined offset were seen among RA-THA patients. CONCLUSION Our review found that the use of RA-THA yields superior radiographic outcomes compared to mTHA counterparts. This information can inform healthcare systems considering investing in and implementing these technologies.
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Affiliation(s)
- Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, 44195, USA
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, 44195, USA
| | - Alexander J Acuña
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, 44195, USA
| | - Andy Kuo
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, 44195, USA
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, 44195, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, 44195, USA
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31
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Emara AK, Zhou G, Klika AK, Koroukian SM, Schiltz NK, Higuera-Rueda CA, Molloy RM, Piuzzi NS. Is there increased value in robotic arm-assisted total hip arthroplasty? : a nationwide outcomes, trends, and projections analysis of 4,699,894 cases. Bone Joint J 2021; 103-B:1488-1496. [PMID: 34465149 DOI: 10.1302/0301-620x.103b9.bjj-2020-2411.r1] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS The current study aimed to compare robotic arm-assisted (RA-THA), computer-assisted (CA-THA), and manual (M-THA) total hip arthroplasty regarding in-hospital metrics including length of stay (LOS), discharge disposition, in-hospital complications, and cost of RA-THA versus M-THA and CA-THA versus M-THA, as well as trends in use and uptake over a ten-year period, and future projections of uptake and use of RA-THA and CA-THA. METHODS The National Inpatient Sample was queried for primary THAs (2008 to 2017) which were categorized into RA-THA, CA-THA, and M-THA. Past and projected use, demographic characteristics distribution, income, type of insurance, location, and healthcare setting were compared among the three cohorts. In-hospital complications, LOS, discharge disposition, and in-hospital costs were compared between propensity score-matched cohorts of M-THA versus RA-THA and M-THA versus CA-THA to adjust for baseline characteristics and comorbidities. RESULTS RA-THA and CA-THA did not exhibit any clinically meaningful reduction in mean LOS (RA-THA 2.2 days (SD 1.4) vs 2.3 days (SD 1.8); p < 0.001, and CA-THA 2.5 days (SD 1.9) vs 2.7 days (SD 2.3); p < 0.001, respectively) compared to their respective propensity score-matched M-THA cohorts. RA-THA, but not CA-THA, had similar non-home discharge rates to M-THA (RA-THA 17.4% vs 18.5%; p = 0.205, and 18.7% vs 24.9%; p < 0.001, respectively). Implant-related mechanical complications were lower in RA-THA (RA-THA 0.5% vs M-THA 3.1%; p < 0.001, and CA-THA 1.2% vs M-THA 2.2%; p < 0.001), which was associated with a significantly lower in-hospital dislocation (RA-THA 0.1% vs M-THA 0.8%; p < 0.001). Both RA-THA and CA-THA demonstrated higher mean higher index in-hospital costs (RA-THA $18,416 (SD $8,048) vs M-THA $17,266 (SD $8,396); p < 0.001, and CA-THA $20,295 (SD $8,975) vs M-THA $18,624 (SD $9,226); p < 0.001, respectively). Projections indicate that 23.9% and 3.2% of all THAs conducted in 2025 will be robotic arm- and computer-assisted, respectively. Projections indicated that RA-THA use may overtake M-THA by 2028 (48.3%) and reach 65.8% of all THAs by 2030. CONCLUSION Technology-assisted THA, particularly RA-THA, may provide value by lowering in-hospital early dislocation rates and and other in-hospital metrics compared to M-THA. Higher index-procedure and hospital costs warrant further comprehensive cost analyses to determine the true added value of RA-THA in the episode of care, particularly since we project that one in four THAs in 2025 and two in three THA by 2030 will use RA-THA technology. Cite this article: Bone Joint J 2021;103-B(9):1488-1496.
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Affiliation(s)
- Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Guangjin Zhou
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Siran M Koroukian
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nicholas K Schiltz
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Robert M Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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32
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Remily EA, Nabet A, Sax OC, Douglas SJ, Pervaiz SS, Delanois RE. Impact of Robotic Assisted Surgery on Outcomes in Total Hip Arthroplasty. Arthroplast Today 2021; 9:46-49. [PMID: 33997208 PMCID: PMC8105177 DOI: 10.1016/j.artd.2021.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/24/2021] [Accepted: 04/04/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The introduction of robotic technologies into the field of arthroplasty ushered in promises of increased precision and superior outcomes over conventional methods. However, the effect on outcomes in total hip arthroplasty (THA) remains debatable, particularly when considering the additional financial burden created by the addition of robotics. The purpose of this study is to examine total cost of care, length of stay (LOS), and postoperative complications in robotic-assisted vs conventional THA recipients. MATERIALS AND METHODS A retrospective review of the Mariner database was performed within PearlDiver Technologies for patients undergoing THA from 2010 to 2018 (n = 714,859). Patients with robotic-assisted procedures were matched with patients undergoing conventional THA at a 1:1 ratio based on age, sex, Charlson Comorbidity Index, smoking, and obesity status (n = 4630). LOS, total cost of care, readmission rates, and medical and surgical outcomes were examined. RESULTS Robotic-assisted patients had shorter average LOS (3.4 vs 3.7 days, P = .001). The mean cost for robotic-assisted patients was $1684 and $1759 less at 90 days and 1 year, respectively (both P = .001). Readmission rates were higher for robotic-assisted patients at 1 year (7.8 vs 6.6%; P = .001), while surgical outcomes were not significantly different at all timepoints (all P > .498). Robotic-assisted patients demonstrated significantly higher blood transfusion rates (4.4 vs 3.2%; P = .001). CONCLUSIONS Robotic-assisted THA was associated with minimal decreases in LOS and costs as compared to conventional methods. However, robotics was associated with slightly higher readmissions and blood transfusions.
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Affiliation(s)
- Ethan A. Remily
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Austin Nabet
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Oliver C. Sax
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Scott J. Douglas
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Sahir S. Pervaiz
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Ronald E. Delanois
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
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33
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Fontalis A, Epinette JA, Thaler M, Zagra L, Khanduja V, Haddad FS. Advances and innovations in total hip arthroplasty. SICOT J 2021; 7:26. [PMID: 33843582 PMCID: PMC8040589 DOI: 10.1051/sicotj/2021025] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/20/2021] [Indexed: 12/12/2022] Open
Abstract
Total hip arthroplasty (THA) has been quoted as one of the most successful and cost-effective procedures in Orthopaedics. The last decade has seen an exponential rise in the number of THAs performed globally and a sharp increase in the percentage of young patients hoping to improve their quality of life and return to physically demanding activities. Hence, it is imperative to review the various applications of technology in total hip arthroplasty for improving outcomes. The development of state-of-the-art robotic technology has enabled more reproducible and accurate acetabular positioning, while long-term data are needed to assess its cost-effectiveness. This opinion piece aims to outline and present the advances and innovations in total hip arthroplasty, from virtual reality and three-dimensional printing to patient-specific instrumentation and dual mobility bearings. This illustrates and reflects the debate that will be at the centre of hip surgery for the next decade.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London NW1 2BU, UK
| | | | - Martin Thaler
- Department of Orthopaedics and Traumatology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan 20161, Italy
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Box 37, Addenbrookes Hospital, Cambridge CB2 0QQ, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London NW1 2BU, UK
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Clement ND, Gaston P, Bell A, Simpson P, Macpherson G, Hamilton DF, Patton JT. Robotic arm-assisted versus manual total hip arthroplasty. Bone Joint Res 2021; 10:22-30. [PMID: 33380216 PMCID: PMC7845457 DOI: 10.1302/2046-3758.101.bjr-2020-0161.r1] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIMS The primary aim of this study was to compare the hip-specific functional outcome of robotic assisted total hip arthroplasty (rTHA) with manual total hip arthroplasty (mTHA) in patients with osteoarthritis (OA). Secondary aims were to compare general health improvement, patient satisfaction, and radiological component position and restoration of leg length between rTHA and mTHA. METHODS A total of 40 patients undergoing rTHA were propensity score matched to 80 patients undergoing mTHA for OA. Patients were matched for age, sex, and preoperative function. The Oxford Hip Score (OHS), Forgotten Joint Score (FJS), and EuroQol five-dimension questionnaire (EQ-5D) were collected pre- and postoperatively (mean 10 months (SD 2.2) in rTHA group and 12 months (SD 0.3) in mTHA group). In addition, patient satisfaction was collected postoperatively. Component accuracy was assessed using Lewinnek and Callanan safe zones, and restoration of leg length were assessed radiologically. RESULTS There were no significant differences in the preoperative demographics (p ≥ 0.781) or function (p ≥ 0.383) between the groups. The postoperative OHS (difference 2.5, 95% confidence interval (CI) 0.1 to 4.8; p = 0.038) and FJS (difference 21.1, 95% CI 10.7 to 31.5; p < 0.001) were significantly greater in the rTHA group when compared with the mTHA group. However, only the FJS was clinically significantly greater. There was no difference in the postoperative EQ-5D (difference 0.017, 95% CI -0.042 to 0.077; p = 0.562) between the two groups. No patients were dissatisfied in the rTHA group whereas six were dissatisfied in the mTHA group, but this was not significant (p = 0.176). rTHA was associated with an overall greater rate of component positioning in a safe zone (p ≤ 0.003) and restoration of leg length (p < 0.001). CONCLUSION Patients undergoing rTHA had a greater hip-specific functional outcome when compared to mTHA, which may be related to improved component positioning and restoration of leg length. However, there was no difference in their postoperative generic health or rate of satisfaction. Cite this article: Bone Joint Res 2021;10(1):22-30.
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Affiliation(s)
- Nicholas D. Clement
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Paul Gaston
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
- Spire Murrayfield Hospital, Edinburgh, UK
| | | | - Philip Simpson
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
- Spire Murrayfield Hospital, Edinburgh, UK
| | - Gavin Macpherson
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
- Spire Murrayfield Hospital, Edinburgh, UK
| | - David F. Hamilton
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
- Spire Murrayfield Hospital, Edinburgh, UK
- Department of Orthopaedics, School of Clinical Sciences, Edinburgh, UK
- School of Health and Social Care, Edinburgh Napier University, Ediburgh, UK
| | - James T. Patton
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
- Spire Murrayfield Hospital, Edinburgh, UK
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