University College Hospital, London, UK and Princess Grace Hospital, London, UK.
University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK.
Bone Joint J. 2019 Jan;101-B(1_Supple_A):11-18. doi: 10.1302/0301-620X.101B1.BJJ-2018-0377.R1.
The primary objective of this study was to compare accuracy in restoring the native centre of hip rotation in patients undergoing conventional manual total hip arthroplasty (THA) versus robotic-arm assisted THA. Secondary objectives were to determine differences between these treatment techniques for THA in achieving the planned combined offset, component inclination, component version, and leg-length correction.
This prospective cohort study included 50 patients undergoing conventional manual THA and 25 patients receiving robotic-arm assisted THA. Patients undergoing conventional manual THA and robotic-arm assisted THA were well matched for age (mean age, 69.4 years (sd 5.2) vs 67.5 years (sd 5.8) (p = 0.25); body mass index (27.4 kg/m (sd 2.1) vs 26.9 kg/m (sd 2.2); p = 0.39); and laterality of surgery (right = 28, left = 22 vs right = 12, left = 13; p = 0.78). All operative procedures were undertaken by a single surgeon using the posterior approach. Two independent blinded observers recorded all radiological outcomes of interest using plain radiographs.
The correlation coefficient was 0.92 (95% confidence interval (CI) 0.88 to 0.95) for intraobserver agreement and 0.88 (95% CI 0.82 to 0.94) for interobserver agreement in all study outcomes. Robotic THA was associated with improved accuracy in restoring the native horizontal (p < 0.001) and vertical (p < 0.001) centres of rotation, and improved preservation of the patient's native combined offset (p < 0.001) compared with conventional THA. Robotic THA improved accuracy in positioning of the acetabular component within the combined safe zones of inclination and anteversion described by Lewinnek et al (p = 0.02) and Callanan et al (p = 0.01) compared with conventional THA. There was no difference between the two treatment groups in achieving the planned leg-length correction (p = 0.10).
Robotic-arm assisted THA was associated with improved accuracy in restoring the native centre of rotation, better preservation of the combined offset, and more precise acetabular component positioning within the safe zones of inclination and anteversion compared with conventional manual THA.
本研究的主要目的是比较传统手动全髋关节置换术（THA）与机器人辅助 THA 术在恢复髋关节旋转中心的准确性。次要目的是确定这两种治疗技术在实现计划的联合偏移、组件倾斜度、组件版本和下肢长度矫正方面的差异。
这项前瞻性队列研究纳入了 50 例接受传统手动 THA 和 25 例接受机器人辅助 THA 的患者。接受传统手动 THA 和机器人辅助 THA 的患者在年龄（平均年龄，69.4 岁（标准差 5.2）比 67.5 岁（标准差 5.8）（p=0.25）；体重指数（27.4kg/m（标准差 2.1）比 26.9kg/m（标准差 2.2）（p=0.39）；手术的侧别（右侧=28，左侧=22 比右侧=12，左侧=13（p=0.78）方面匹配良好。所有手术操作均由同一位外科医生采用后路进行。两名独立的盲法观察者使用平片记录所有感兴趣的影像学结果。
在所有研究结果中，观察者内一致性的相关系数为 0.92（95%置信区间（CI）为 0.88 至 0.95），观察者间一致性的相关系数为 0.88（95%CI 为 0.82 至 0.94）。与传统 THA 相比，机器人 THA 术在恢复髋关节旋转的原始水平（p<0.001）和垂直（p<0.001）中心方面更准确，并且更好地保留了患者的原始联合偏移（p<0.001）。与传统 THA 相比，机器人 THA 术在髋臼组件的定位方面更加准确，符合 Lewinnek 等人（p=0.02）和 Callanan 等人（p=0.01）描述的髋臼组件倾斜和前倾角的组合安全区。两组患者在实现计划的下肢长度矫正方面无差异（p=0.10）。
与传统手动 THA 相比，机器人辅助 THA 术在恢复髋关节旋转中心的准确性、更好地保留联合偏移以及更精确地在髋臼组件的倾斜和前倾角的安全区内定位方面具有优势。
