Singh Ashish, Kumar Purushotam, Kalyan Kanukuntla, Gundalli Akash Chandrashekar, Mane Sudhir Shankar, Swarnkar Himanshu, Singh Lavanya
Anup Institute of Orthopaedics & Rehabilitation, G75-77, P.C. Colony, Kankarbagh, Patna, Bihar, 800020, India.
The Hazeley Academy, Emperor Drive, Hazeley, Milton Keynes, MK8 0PT, United Kingdom.
SICOT J. 2024;10:57. doi: 10.1051/sicotj/2024057. Epub 2024 Dec 20.
Robot-assisted instrumentation during total hip arthroplasty (THA) has the potential to improve acetabular cup positioning. This study aimed to evaluate the precision of robotic-arm-assisted THA (rTHA) and assess whether the system can provide accurate cup positioning comparable to conventional THA (cTHA).
A single-center prospective cohort study consisting of 151 patients who underwent THA (108 rTHA and 43 cTHA). The robotically assisted system was used to match the postoperative computed tomography (CT) image of the pelvis with the planned and intraoperative anatomical landmarks. The cTHA cohort underwent hip replacement using the standard manual procedure, with acetabular component locations assessed during and after surgery.
The rTHA cohort was significantly younger, but no other significant differences were found between the two cohorts in preoperative baseline data. In rTHA cohort, the planned inclination (40.0 ± 0.3°) closely matched the intraoperative (40.2 ± 2.7°; p = 0.54) and postoperative (40.7 ± 4.0°; p = 0.07) measurements. However, anteversion showed a significant increase from planned (19.4 ± 1.5°) to postoperative CT scan (28.7 ± 7.0°; p < 0.001). There was evidence of proportional bias in the measurements (p < 0.001). In the cTHA cohort, the mean inclination (43.1 ± 5.1°) did not show any significant change between the preoperative plans and postoperative assessments (p = 0.12); however, there was a remarkable change in the mean anteversion (17.6 ± 6.4°) between postoperative measurements and the preoperative plans (p < 0.001). The average anteversion in the preoperative plans did not differ remarkably between the rTHA and cTHA cohorts. However, the average inclination was substantially different between the two cohorts (p < 0.001). Both groups had no significant differences in the proportion of cups outside the referenced safe zones.
The results suggest that while robotic-assisted guidance ensures consistent cup inclination, there may be more variability in achieving the planned anteversion, which warrants further investigation into the factors influencing postoperative changes in acetabular orientation.
全髋关节置换术（THA）期间的机器人辅助器械操作有可能改善髋臼杯的定位。本研究旨在评估机器人手臂辅助THA（rTHA）的精度，并评估该系统能否提供与传统THA（cTHA）相当的准确杯定位。
一项单中心前瞻性队列研究，纳入了151例行THA的患者（108例rTHA和43例cTHA）。使用机器人辅助系统将骨盆的术后计算机断层扫描（CT）图像与计划的和术中的解剖标志进行匹配。cTHA队列采用标准手动程序进行髋关节置换，在手术期间和术后评估髋臼组件的位置。
rTHA队列患者明显更年轻，但两组术前基线数据无其他显著差异。在rTHA队列中，计划倾斜度（40.0±0.3°）与术中（40.2±2.7°；p=0.54）和术后（40.7±4.0°；p=0.07）测量值密切匹配。然而，前倾角从计划的（19.4±1.5°）到术后CT扫描时显著增加（28.7±7.0°；p<0.001）。测量中有比例偏差的证据（p<0.001）。在cTHA队列中，平均倾斜度（43.1±5.1°）在术前计划和术后评估之间没有显示出任何显著变化（p=0.12）；然而，术后测量值与术前计划之间的平均前倾角（17.6±6.4°）有显著变化（p<0.001）。术前计划中的平均前倾角在rTHA和cTHA队列之间没有显著差异。然而，两组之间的平均倾斜度有显著差异（p<0.001）。两组在参考安全区之外的髋臼杯比例没有显著差异。
结果表明，虽然机器人辅助引导可确保髋臼杯倾斜度一致，但在实现计划的前倾角方面可能存在更多变异性，这值得进一步研究影响髋臼方向术后变化的因素。
