Bertugli Enrico, Marcovigi Andrea, Grandi Gianluca, Catani Fabio
Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Modena, Italy.
Arch Orthop Trauma Surg. 2025 May 15;145(1):295. doi: 10.1007/s00402-025-05911-y.
The main goal of this study was to compare patient outcomes following robotic-arm assisted THA (RTHA) using the direct lateral approach (DLA) and the posterior-lateral approach (PLA) by analysing the clinical and radiographical data.
203 consecutive patients diagnosed with end stage hip osteoarthritis underwent RTHA at the same orthopaedic centre between 2015 and 2019. Patients were divided in two groups based on the surgical approach where 95 patients received PLA and 108 received DLA. All patients were assessed pre-operatively and at minimum 3-year follow-up using Harris Hip Score (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). A radiographic evaluation was performed for every patient to assess the incidence of heterotopic ossification (HO).
Patients in the PLA cohort had higher scores in the post-operative WOMAC when compared to the DLA group (PLA: 96.2 ± 8.2 vs. DLA: 93.6 ± 10.3, p = 0.05). There was no statistical difference in the post-op HHS (PLA 86.3 ± 7 vs. DLA: 86.3 ± 9.5, p = 0.97). Accurate component positioning was achieved according to the pre-operative planning in both groups. There were no cases of dislocation. We found a significantly higher incidence of HO in the DLA group (59.3%) compared to the PLA group (12.6%). However, this difference was not associated with a poorer clinical outcome.
Current controversy still persists regarding the surgical approach without clear evidence about which one is more appropriate. Nowadays, it seems that surgeons' skill and experience to perform an approach are still more relevant than the choice of the approach. Both PLA and DLA represent valid surgical options for performing RTHA, yielding excellent clinical outcomes without clear evidence of superiority of one approach over the other.
本研究的主要目的是通过分析临床和影像学数据，比较采用直接外侧入路（DLA）和后外侧入路（PLA）的机器人手臂辅助全髋关节置换术（RTHA）后的患者预后。
2015年至2019年期间，203例连续诊断为终末期髋关节骨关节炎的患者在同一骨科中心接受了RTHA。根据手术入路将患者分为两组，其中95例患者接受PLA，108例接受DLA。所有患者在术前以及至少3年的随访中使用Harris髋关节评分（HHS）和西安大略和麦克马斯特大学骨关节炎指数（WOMAC）进行评估。对每位患者进行影像学评估，以评估异位骨化（HO）的发生率。
与DLA组相比，PLA队列中的患者术后WOMAC评分更高（PLA：96.2±8.2 vs. DLA：93.6±10.3, p = 0.05）。术后HHS无统计学差异（PLA 86.3±7 vs. DLA：86.3±9.5, p = 0.97）。两组均根据术前规划实现了假体的准确放置。无脱位病例。我们发现DLA组的HO发生率（59.3%）显著高于PLA组（12.6%）。然而，这种差异与较差的临床结果无关。
目前关于手术入路仍存在争议，尚无明确证据表明哪种入路更合适。如今，似乎外科医生实施某种入路的技能和经验比入路的选择更为重要。PLA和DLA都是进行RTHA的有效手术选择，均可产生优异的临床结果，且没有明确证据表明一种入路优于另一种入路。
