Caba Melanie, O'Neill Christina, Nessler Joseph, Frye Benjamin, Scholl Laura, Sequira Sean B, Mont Michael A
Stryker Orthopaedics, Mahwah, NJ, USA.
St. Cloud Orthopedics, Sartell, MN, USA.
J Orthop. 2024 Jun 21;59:86-89. doi: 10.1016/j.jor.2024.06.027. eCollection 2025 Jan.
The direct anterior (DA) approach allows for earlier mobilization and shorter length-of-stay than traditional total hip arthroplasty (THA) approaches; however, conventional techniques rely on intraoperative fluoroscopy for accurate cup placement. Robotic-assisted THA is an alternative to conventional THA procedures and utilizes preoperative computed tomography (CT) scans and intraoperative mapping for accurate component positioning. The purpose of this study was to evaluate the impact of robotic-assisted DA THA without fluoroscopy on surgical efficiency parameters when compared to conventional DA THA with fluoroscopy.
There were six cadaver specimens evenly distributed between two orthopaedic surgeons, both with previous experience in conventional and robotic-assisted THA. For each cadaver, conventional DA THA with fluoroscopy was performed on the first hip, and robotic-assisted DA THA without fluoroscopy was performed on the contralateral hip. Total surgical time from skin to trials, acetabular and femoral workflow time, and the number of reamers and broaches used, were recorded for all cases. There were two-sample -tests performed to assess statistical differences between conventional and robotic-assisted THA data.
Acetabular reaming took longer, on average, for conventional DA THA with fluoroscopy than robotic-assisted DA THA without fluoroscopy (2.4 ± 0.6 versus 0.4 ± 0.2 min; < 0.001). Surgeons using conventional THA required more acetabular reamers when compared to a single reamer used with robotic-assisted THA (2.67 ± 0.5 versus 1 ± 0; = 0.001). Total operative time (26.1 ± 7.0 versus 23.2 ± 5.6 min; = 0.452), acetabular workflow time (6.4 ± 3.1 versus 3.3 ± 1.7 min; = 0.07), femoral workflow time (6.5 ± 4.8 versus 5.0 ± 1.7 min; = 0.495), and number of femoral broaches (5.0 ± 1.8 versus 4.3 ± 2.3; = 0.593) were higher during conventional THA than during robotic-assisted THA.
Amidst the changing healthcare environment and focus on identifying and implementing efficiencies, these findings have important consequences for the continued and accelerated use of robotic-assisted THA in primary settings.
与传统全髋关节置换术（THA）相比，直接前路（DA）入路可使患者更早活动且住院时间更短；然而，传统技术依靠术中透视来精确放置髋臼杯。机器人辅助THA是传统THA手术的一种替代方法，它利用术前计算机断层扫描（CT）和术中映射来精确放置假体组件。本研究的目的是评估与使用透视的传统DA THA相比，不使用透视的机器人辅助DA THA对手术效率参数的影响。
六个尸体标本平均分配给两位骨科医生，他们都有传统和机器人辅助THA的经验。对于每个尸体，在第一个髋关节上进行使用透视的传统DA THA，在对侧髋关节上进行不使用透视的机器人辅助DA THA。记录所有病例从皮肤切开到试验、髋臼和股骨操作流程的总手术时间，以及使用的扩孔钻和拉刀数量。进行双样本检验以评估传统和机器人辅助THA数据之间的统计学差异。
使用透视的传统DA THA的髋臼扩孔平均比不使用透视的机器人辅助DA THA花费更长时间（2.4±0.6分钟对0.4±0.2分钟；P<0.001）。与机器人辅助THA使用单个扩孔钻相比，使用传统THA的外科医生需要更多的髋臼扩孔钻（2.67±0.5对1±0；P = 0.001）。传统THA期间的总手术时间（26.1±7.0分钟对23.2±5.6分钟；P = 0.452）、髋臼操作流程时间（6.4±3.1分钟对3.3±1.7分钟；P = 0.07）、股骨操作流程时间（6.5±4.8分钟对5.0±1.7分钟；P = 0.495）以及股骨拉刀数量（5.0±1.8对4.3±2.3；P = 0.593）均高于机器人辅助THA期间。
在不断变化的医疗环境以及关注识别和提高效率的背景下，这些发现对于机器人辅助THA在初次手术中的持续和加速应用具有重要意义。
