[A comparative study of MAKO robotic arm assisted total hip arthroplasty and traditional total hip arthroplasty through posterolateral approach]

[Meta-analysis of leg length discrepancy after robot-assisted and traditional total hip arthroplasty]

OBJECTIVE

To systematically evaluate the difference in leg length discrepancy (LLD) between robot-assisted total hip arthroplasty (THA) and traditional THA.

METHODS

The Cochrane Library, PubMed, Web of Science, EMbase, CNKI, Wanfang, VIP, and CBM databases were searched by computer to collect cohort studies of robot-assisted and traditional THAs from inception to August 11th, 2021. Two researchers independently screened the literature, extracted the data, and evaluated the risk of bias of the included studies. Meta-analysis was performed using RevMan 5.3 software.

RESULTS

A total of 10 high-quality cohort studies were included. The results of Meta-analysis showed that compared with traditional THA, LLD after robot-assisted THA was smaller [ MD=-1.64, 95% CI (-2.25, -1.04), P<0.001], Harris scores at 3 and 12 months after operation were higher [ MD=1.50, 95% CI (0.44, 2.57), P=0.006; MD=7.60, 95% CI (2.51, 12.68), P=0.003]. However, the operative time was longer [ MD=8.36, 95% CI (4.56, 12.17), P<0.000 1], and the postoperative acetabular anteversion angle was larger [ MD=1.91, 95% CI (1.43, 2.40), P<0.001]. There was no significant difference in Harris score at 6 months, amnesia index (Forgotten joint score, FJS), postoperative acetabular abduction angle, and incidence of complication between the two groups ( P>0.05).

CONCLUSION

Robot-assisted THA is superior to traditional THA in postoperative LLD.

[Short-term effectiveness of MAKO robot assisted complex total hip arthroplasty]

OBJECTIVE

To investigate the short-term effectiveness of MAKO robot assisted complex total hip arthroplasty (THA).

METHODS

The clinical data of 15 patients (17 hips) underwent MAKO robot assisted complex THA between May 2020 and June 2021 were analyzed retrospectively. There were 5 males and 10 females with the age ranged from 19 to 70 years (median, 49 years), included 9 cases (9 hips) of developmental dysplasia of the hip (Crowe type Ⅱ in 5 hips, type Ⅲ in 1 hip, and type Ⅳ in 3 hips), 1 case (2 hips) of rheumatoid arthritis, 2 cases (3 hips) of ankylosing spondylitis, 3 cases (3 hips) of secondary arthritis with a history of acetabular fracture and internal fixation. The acetabular cup abduction angle and anteversion angle were measured at 3 months after operation, and compared with those measured by MAKO robot system before and immediately after operation. The femoral offset and leg length discrepancy (LLD) were measured at 3 months after operation, which were compared with those before operation. Harris hip score (HHS) and visual analogue scale (VAS) score were used to evaluate hip function before operation and at 3 months after operation.

RESULTS

All 15 patients (17 hips) completed the operation successfully. The operation time was 75-175 minutes, with an average of 116.3 minutes; the intraoperative blood loss was 100-800 mL, with an average of 381.3 mL. Two patients were not included in the statistics because of intraoperative and postoperative complications, the remaining 13 patients (15 hips) had no serious complication such as vascular and nerve injuries, and 3 patients had intermuscular vein thrombosis. The 13 patients (15 hips) were followed up 3-15 months, with an average of 8 months. At last follow-up, the position of prosthesis did not change and there was no signs of loosening. There was no significant difference in acetabular abduction angle at immediate and 3 months after operation when compared with preoperative one ( P>0.05), and the acetabular anteversion angle was significantly lower than that before operation ( P<0.05). There was no significant difference in acetabular abduction angle and anteversion angle between at immediate and 3 months after operation ( P>0.05). The LLD, offset, HHS score, and VAS score were significantly improved at 3 months after operation when compared with preoperative ones ( P<0.05).

CONCLUSION

MAKO robot assisted complex THA can achieve good short-term effectiveness, improve the hip range of motion, reduce the length difference between bilateral lower limbs, and improve the quality of patients' life.

[Short-term effectiveness of Mako robot-assisted total hip arthroplasty via posterolateral approach]

Objective

To explore the short-term effectiveness of Mako robot-assisted total hip arthroplasty (THA) via posterolateral approach.

Methods

The clinical data of 64 patients (74 hips) treated with Mako robot-assisted THA via posterolateral approach (robot group) between May 2020 and March 2021 were retrospectively analyzed and compared with the clinical data of 52 patients (55 hips) treated with traditional THA via posterolateral approach (control group) in the same period. There was no significant difference in general data such as gender, age, side, body mass index, disease type, and preoperative Harris score between the two groups ( P>0.05). The operation time, intraoperative blood loss, and complications were recorded and compared between the two groups. Acetabular inclination angle, acetabular anteversion angle, and lower limbs discrepancy were measured after operation. At last follow-up, the improvement of hip pain and function was evaluated by visual analogue scale (VAS) score, Harris score, and forgetting joint score (FJS-12).

Results

In the robot group, 3 patients (including 1 patient with acetabular fracture during operation) were converted to routine THA because the pelvic data array placed at the anterior superior iliac spine was loose, resulting in data error and unable to register the acetabulum; the other patients in the two groups completed the operation successfully. The operation time and intraoperative blood loss in the robot group were significantly higher than those in the control group ( P<0.05). All patients were followed up 1-10 months, with an average of 4.6 months. In the robot group, 1 patient with ankylosing spondylitis had acetabular prosthesis loosening at 2 days after operation, underwent surgical revision, and 10 patients had lower limb intermuscular vein thrombosis; in the control group, 1 patient had left hip dislocation and 5 patients had lower extremity intermuscular vein thrombosis; there was no complication such as sciatic nerve injury, incision exudation, and periprosthetic infection in both groups. There was no significant difference in the incidence of complications between the robot group and the control group (17.2% vs.11.5%) ( χ ²=0.732, P=0.392). At last follow-up, the acetabular anteversion angle and FJS-12 score in the robot group were was significantly greater than those in the control group, and the lower limbs discrepancy was significantly less than that in the control group ( P<0.05); there was no significant difference in acetabular inclination angle and VAS score between the two groups ( P>0.05). The Harris scores of the two groups were significantly improved when compared with those before operation ( P<0.05), but there was no significant difference in the difference of pre- and post-operative score between the two groups ( t=1.632, P=0.119).

Conclusion

Compared with traditional surgery, Mako robot-assisted THA can optimize the accuracy and safety of acetabular cup implantation, reduce the length difference of the lower limbs, and has a certain learning curve. Its long-term effectiveness needs further research to confirm.