Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
Gold Coast Centre for Bone and Joint Surgery, 14 Sixth Ave, Palm Beach, QLD, 4421, Australia.
J Robot Surg. 2023 Oct;17(5):2073-2079. doi: 10.1007/s11701-023-01623-w. Epub 2023 May 20.
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.
在全髋关节置换术（THA）中，准确的髋臼杯位置仍然是一个持续存在的挑战。研究表明，与手动 THA（mTHA）方法相比，机器人辅助 THA（RA-THA）系统在早期结果方面有所改善，然而，当代机器人平台依赖于术前 CT 成像。本研究旨在分析一种新型基于透视的 RA-THA 系统与非辅助 mTHA 方法的准确性，并确定机器人系统对手术时间的影响。我们对 2021 年 3 月至 2022 年 7 月期间连续接受 mTHA 和 RA-THA 的 198 例患者进行了回顾性队列分析。主要研究结果是髋臼组件位置的准确性，定义为髋臼杯平均倾斜度和前倾角。次要结果包括髋臼杯位于 Lewinnek 安全区的比例、手术时间和总手术室时间。与手动组相比，RA-THA 组髋臼前倾角的准确性明显更高（18.5 度对 21.7 度；p<0.001），髋臼杯位于 Lewinnek 安全区的比例明显更高（81.6%对 59.0%；p<0.001）。与 mTHA 组相比，RA-THA 组的手术时间明显更长（39.0 分钟对 35.3 分钟；p=0.003），但总手术室时间无差异（101.2 分钟对 101.2 分钟；p=0.982）。本研究表明，与 mTHA 方法相比，使用一种新型基于透视的、无销钉的 THA 机器人平台提高了髋臼杯位置的准确性，包括安全区位置的 22.6%的改善，而不会增加整体手术时间。
