Illgen Richard L, Bukowski Brandon R, Abiola Rasheed, Anderson Paul, Chughtai Morad, Khlopas Anton, Mont Michael A
Department of Orthopedics and Rehabilitation, The University of Wisconsin School of Medicine and Public Health, UW-Health at The American Center, Madison, Wisconsin.
Department of Orthopaedic Surgery,Cleveland Clinic Cleveland, Ohio.
Surg Technol Int. 2017 Jul 25;30:365-372.
Component malposition in total hip arthroplasty (THA) contributes to instability and early failure. Robotic-assisted total hip arthroplasty (rTHA) utilizes CT-based planning with haptically-guided bone preparation and implant insertion to optimize component position accuracy. This study compared acetabular component position and postoperative complications following manual THA (mTHA) with rTHA.
Consecutive primary THAs performed by one surgeon at three intervals were analyzed in this retrospective cohort study: the initial 100 consecutive manual THAs (mTHA) in clinical practice (year 2000), the last consecutive 100 mTHA before rTHA introduction (year 2011), and the first consecutive 100 rTHA (year 2012). Acetabular abduction (AAB) and anteversion (AAV) angles were measured using validated software. The Lewinnek safe zone was used to define accuracy (AAB 40°±10° and AAV 15°±10°). Comparisons included operative time, estimated blood loss (EBL), infection rate, and dislocation rate.
The rate of acetabular component placement within Lewinnek safe zone was the highest in the rTHA cohort (77%), followed by late mTHA (45%) and early mTHA (30%) (p<0.001). Robotic-assisted THA resulted in an additional 71% improvement in accuracy in the first year of use (p<0.001). Dislocation rate was 5% with early mTHA, 3% in the late mTHA cohort, and 0% in the rTHA cohort within the first two years postoperatively. There were no statistically significant differences in the rate of infection between groups.
Robotic-assisted THA improved acetabular component accuracy and reduced dislocation rates when compared with mTHA. Further study is needed to determine if similar improvements will be noted in larger multicenter studies using alternative surgical approaches.
全髋关节置换术（THA）中组件位置不当会导致不稳定和早期失败。机器人辅助全髋关节置换术（rTHA）利用基于CT的规划以及触觉引导的骨制备和植入物插入来优化组件位置精度。本研究比较了人工全髋关节置换术（mTHA）与机器人辅助全髋关节置换术（rTHA）后髋臼组件位置及术后并发症情况。
在这项回顾性队列研究中，分析了由一名外科医生分三个阶段连续进行的初次全髋关节置换术：临床实践中的最初100例连续人工全髋关节置换术（mTHA，2000年）、引入机器人辅助全髋关节置换术之前的最后100例连续人工全髋关节置换术（mTHA，2011年）以及最初的100例连续机器人辅助全髋关节置换术（rTHA，2012年）。使用经过验证的软件测量髋臼外展（AAB）和前倾角（AAV）。Lewinnek安全区用于定义准确性（AAB 40°±10°和AAV 15°±10°）。比较内容包括手术时间、估计失血量（EBL）、感染率和脱位率。
机器人辅助全髋关节置换术队列中髋臼组件放置在Lewinnek安全区内的比例最高（77%），其次是晚期人工全髋关节置换术（45%）和早期人工全髋关节置换术（30%）（p<0.001）。在使用的第一年，机器人辅助全髋关节置换术在准确性方面额外提高了71%（p<0.001）。术后两年内，早期人工全髋关节置换术的脱位率为5%，晚期人工全髋关节置换术队列中的脱位率为3%，机器人辅助全髋关节置换术队列中的脱位率为0%。各组之间的感染率无统计学显著差异。
与人工全髋关节置换术相比，机器人辅助全髋关节置换术提高了髋臼组件的准确性并降低了脱位率。需要进一步研究以确定在使用替代手术方法的更大规模多中心研究中是否会有类似的改善。
