Robotics in Total Hip Arthroplasty: Current Concepts
Abstract
:1. Introduction
2. History
3. Current Role
Stages of Robotic Total Hip Arthroplasty
4. Outcomes and Current Controversies
4.1. Radiological Outcomes
4.1.1. Accuracy of Implant Placement
4.1.2. Heterotopic Ossification (HO)
4.1.3. Leg Length Discrepancy (LLD)
4.2. Functional Outcomes
4.3. Complications
4.3.1. Infection
4.3.2. Blood Loss
4.3.3. Operative Time
4.3.4. Learning Curve
4.3.5. Dislocation and Revision Rates
4.3.6. Radiation Exposure
4.3.7. Cost
5. A Look to the Future
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Author | Year | Design | Robot Type | Evidence |
---|---|---|---|---|
Bukowski et al. [44] | 2016 | Retrospective | MAKO | rTHA reduced blood loss vs. cTHA (374 +/− 133 mL vs. 423 +/− 186 mL, p = 0.035) |
Chen et al. [15] | 2018 | Systematic review and meta-analysis | No significant difference in surgical time rTHA vs. cTHA (however, favoured cTHA) Higher HO rate post rTHA (32/142 rTHA vs. 18/133 cTHA, p = 0.04) | |
Chen et al. [32] | 2021 | Review | rTHA more accurate acetabular cup placement Equivocal functional scores rTHA vs. cTHA at 5 years Equivocal blood loss rTHA vs. cTHA | |
Clement et al. [37] | 2021 | Propensity score-matched prospective | MAKO | rTHA significantly superior restoration of leg length (2.3 mm greater rTHA vs. 3.6 mm cTHA) rTHA–significantly higher OHS (2.5 points) and FJS (21.1 points) with FJS having clinical significance |
Domb et al. [39] | 2015 | Retrospective | MAKO | Comparable LLD rates rTHA vs. cTHA (97% <10 mm, no significant difference rTHA vs. cTHA) |
Domb et al. [40] | 2020 | Propensity score-matched retrospective | MAKO | rTHA higher HHS, FJS and VR-12 Physical (all significant) No significant difference in revision rates over 5 years |
Emara et al. [31] | 2021 | Systematic review and meta-analysis | rTHA superior acetabular cup positioning (significant) rTHA significantly lower LLD vs. cTHA (−0.33 mm vs. −1.24 mm) | |
Han et al. [33] | 2019 | Systematic review and meta-analysis | No significant difference in development of HO rTHA vs. cTHA No difference rTHA vs. cTHA in HHS, WOMAC, Merle D’Aubigne scores post-operatively (none reaching significance) | |
Illgen et al. [43] | 2017 | Retrospective | MAKO | rTHA vs. cTHA no difference in infection rates |
Kamara et al. [48] | 2017 | Retrospective | MAKO | rTHA competency achieved after 10 procedures |
Kayani et al. [49] | 2021 | Prospective | MAKO | rTHA competency achieved after 12 procedures |
Kirchner et al. [55] | 2021 | Retrospective | Not specified | rTHA higher cost (USD $20,046 vs. cTHA USD $18,258), despite shorter hospital LOS |
Kolodychuk et al. [50] | 2021 | Prospective | Not specified | rTHA mitigated learning curve, with no significant difference in radiological outcomes and operative time between new and experienced surgeons |
Kumar et al. [38] | 2021 | Systematic review and meta-analysis | rTHA reduced LLD vs. cTHA (mean difference 1.44 mm, p = 0.01) rTHA longer operative time (mean difference 19.48 min, p = 0.02) No significant difference in dislocation and revision rates rTHA vs. cTHA | |
Lim et al. [45] | 2015 | Prospective | ROBODOC | No significant difference in blood loss (rTHA 1010cc vs. cTHA 895cc) |
Maldonado et al. [54] | 2021 | Computer simulation | rTHA significant cost reduction, saving USD 945 per public patient, and USD 1810 for private patients | |
Ng et al. [46] | 2021 | Systematic review and meta-analysis | Learning curve to rTHA competency 12–35 patients | |
Nishihara et al. [41] | 2006 | Prospective | ORTHODOC ISS | Equivocal time to walking 500 m, rTHA > cTHA number of patients walking 6 blocks in 13 days (significant) Equivocal Merle d’Aubigne hip score 3 months post-operatively (rTHA 15.8 vs. cTHA 15.3, insignificant), rTHA significantly improved scores on the same scale at 2 years (rTHA 17.4 vs. 17.1) |
Pierce et al. [53] | 2022 | Propensity score-matched retrospective | Not specified | rTHA overall lower 90-day cost (assessing index procedure, hospital LOS and rehabilitation) averaging USD 785 less per patient. |
Redmond et al. [47] | 2015 | Retrospective | MAKO | Significantly lower risk of malpositioned acetabular cup (103/105 in Lewinnek’s safe zone, and 99/105 in Callanan’s safe zone) and a shorter operating time with the final 70 rTHA cases, which reached significance. |
Samuel et al. [42] | 2021 | Systematic review | No significant difference in functional outcomes, and between MAKO and ROBODOC No significant difference in infection rates Equivocal dislocation and revision rates rTHA vs. cTHA | |
Schulz et al. [8] | 2007 | Prospective | ROBODOC | rTHA higher intraoperative blood loss and transfusion requirement |
Tarwala et al. [24] | 2011 | Review | rTHA 3x increase in radiation exposure due to pre-operative planning CT scan |
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Bullock, E.K.C.; Brown, M.J.; Clark, G.; Plant, J.G.A.; Blakeney, W.G. Robotics in Total Hip Arthroplasty: Current Concepts. J. Clin. Med. 2022, 11, 6674. https://doi.org/10.3390/jcm11226674
Bullock EKC, Brown MJ, Clark G, Plant JGA, Blakeney WG. Robotics in Total Hip Arthroplasty: Current Concepts. Journal of Clinical Medicine. 2022; 11(22):6674. https://doi.org/10.3390/jcm11226674
Chicago/Turabian StyleBullock, Emily K. C., Michael J. Brown, Gavin Clark, James G. A. Plant, and William G. Blakeney. 2022. "Robotics in Total Hip Arthroplasty: Current Concepts" Journal of Clinical Medicine 11, no. 22: 6674. https://doi.org/10.3390/jcm11226674
APA StyleBullock, E. K. C., Brown, M. J., Clark, G., Plant, J. G. A., & Blakeney, W. G. (2022). Robotics in Total Hip Arthroplasty: Current Concepts. Journal of Clinical Medicine, 11(22), 6674. https://doi.org/10.3390/jcm11226674