Tachibana Tetsuya, Katagiri Hiroki, Watanabe Toshifumi, Saito Ryusuke, Jinno Tetsuya
Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, JPN.
Department of Joint Surgery and Sports Medicine, Institute of Science Tokyo, Tokyo, JPN.
Cureus. 2025 Jul 5;17(7):e87358. doi: 10.7759/cureus.87358. eCollection 2025 Jul.
The risk of insufficiency fractures at the iliac crest following pin insertion during robot-assisted total hip arthroplasty (THA) is unknown, as there have been very few reports on this complication. Here, we report two cases of insufficiency fractures of the contralateral iliac crest following robot-assisted THA using the Mako system (Stryker Orthopaedics, Mahwah, NJ, USA). Both patients underwent left THA using the anterolateral supine approach, and three threaded bone pins (4.0 mm diameter) were inserted into the right iliac crest for pelvic array fixation. In case one, all three pins achieved bicortical fixation. In case two, one pin demonstrated long transcortical fixation with the outer cortex of the ilium, another was inserted into soft tissue, and the third pin was fixed monocortically. Postoperatively, both patients were discharged without pain or radiographic evidence of fracture; however, contralateral iliac pain developed approximately four weeks postoperatively without trauma. Insufficiency fractures of the iliac crest at the pin insertion sites were confirmed by plain radiography. Bone union was observed within three to six months of conservative treatment in both cases, with T-cane ambulation and no weight-bearing restrictions. These cases suggest that both bicortical and transcortical pin fixation to the iliac crest may cause insufficiency fractures of the iliac bone. This report highlights the need for increasing awareness of insufficiency fractures associated with pin insertion in robot-assisted THA.
机器人辅助全髋关节置换术（THA）过程中在髂嵴处插入钢针后发生不全骨折的风险尚不清楚，因为关于这种并发症的报道非常少。在此，我们报告两例使用Mako系统（美国新泽西州马哈瓦市史赛克骨科公司）进行机器人辅助THA后对侧髂嵴发生不全骨折的病例。两名患者均采用仰卧位前外侧入路进行左侧THA，并在右侧髂嵴插入三根螺纹骨针（直径4.0毫米）用于骨盆阵列固定。病例一中，三根钢针均实现了双皮质固定。病例二中，一根钢针在髂骨外皮质处实现了长距离穿皮质固定，另一根插入了软组织，第三根钢针为单皮质固定。术后，两名患者均无疼痛或骨折的影像学证据出院；然而，术后约四周，在无外伤的情况下出现了对侧髂嵴疼痛。通过X线平片证实了髂嵴钢针插入部位发生了不全骨折。两例患者在保守治疗三到六个月内均观察到骨愈合，使用丁字拐行走且无负重限制。这些病例表明，髂嵴的双皮质和穿皮质钢针固定均可能导致髂骨不全骨折。本报告强调了提高对机器人辅助THA中与钢针插入相关的不全骨折认识的必要性。
