Department of Orthopaedic Surgery, Singapore General Hospital, Outram, Singapore.
Surg Technol Int. 2020 May 20;38:347-352. doi: 10.52198/21.STI.38.OS1368.
The aim of this study was to investigate the accuracy of implant position of robotic-arm assisted total hip arthroplasty (THA) via the direct anterior approach (DAA).
All patients who underwent robotic-arm assisted DAA THA (MAKO Surgical Corp., Ft. Lauderdale, Florida) from November 2018 to January 2020 were prospectively followed up. Pelvis indices (limb length discrepancy, femoral and hip offset, implant inclination, and anteversion), surgical duration, length of stay, and complications were recorded. To further evaluate the accuracy of robotic-arm assisted THA, patients who underwent manual DAA THA by the same surgeon were match-paired with the study group.
Twenty-five patients underwent robotic-arm assisted DAA THR. Limb length discrepancy was restored to 0.1mm (±3.4mm) from 10.0mm (±6.4mm) postoperatively. Preoperatively, the difference in femoral offset was 5.1mm (±5.1mm), and this was corrected to 1.9mm (±6.5mm) postoperatively. Nine cases had target inclination of 40° and mean inclination achieved was 40.7° (±0.9°). Sixteen cases had target inclination of 45° and mean inclination achieved was 45.3° (±1.0°). Mean anteversion was 19.5° (±2.4°). Propensity matched analysis showed that the root mean square errors for manual cup implantation compared to the robotic-arm assisted group was 2.3 times higher for anteversion and 6.3 times higher for inclination. Fourteen (56%) of the cups were within Callanan safe-zone and 18 (72%) within Lewinnek safe-zone in the manual group compared to 18 (72%) and 25 (100%), respectively, in the robotic-arm assisted group.
Combining the muscle-sparing technique of DAA with the improved implant placement with the robotic-arm assisted platform is a promising solution to improving THA outcomes.
本研究旨在探讨机器人辅助直接前入路（DAA）全髋关节置换术（THA）中植入物位置的准确性。
前瞻性随访 2018 年 11 月至 2020 年 1 月期间接受机器人辅助 DAA THA（MAKO Surgical Corp.，佛罗里达州劳德代尔堡）的所有患者。记录骨盆指数（肢体长度差异、股骨和髋关节偏移、植入物倾斜和前倾角）、手术时间、住院时间和并发症。为了进一步评估机器人辅助 THA 的准确性，将同一术者进行的手动 DAA THA 患者与研究组进行配对。
25 例患者接受了机器人辅助 DAA THR。术后肢体长度差异从 10.0mm（±6.4mm）恢复至 0.1mm（±3.4mm）。术前股骨偏移差值为 5.1mm（±5.1mm），术后矫正至 1.9mm（±6.5mm）。9 例目标倾斜度为 40°，实际达到的倾斜度为 40.7°（±0.9°）。16 例目标倾斜度为 45°，实际达到的倾斜度为 45.3°（±1.0°）。平均前倾角为 19.5°（±2.4°）。倾向性匹配分析显示，与机器人辅助组相比，手动杯植入的均方根误差在倾斜角方面高出 2.3 倍，在倾斜角方面高出 6.3 倍。手动组 14 例（56%）杯在 Callanan 安全区内，18 例（72%）在 Lewinnek 安全区内，而机器人辅助组分别为 18 例（72%）和 25 例（100%）。
将 DAA 的肌肉保护技术与机器人辅助平台改善植入物放置相结合，是改善 THA 结果的一种有前途的方法。
