RESUMEN
Robotic-assisted total hip arthroplasty (THA) is a recent platform introduced to decrease the risk of malpositioned components. The goals of this study were to determine whether intraoperative data on robotic-assisted THA acetabular component position accurately predict postoperative radiographic acetabular component position and to determine whether intraoperative data on robotic-assisted THA leg length and offset accurately predict postoperative radiographic leg length and offset data. In 146 patients, pre- and postoperative radiographs and intraoperative component measurements were reported for acetabular inclination, anteversion, leg length change, and offset change. Component position obtained by the robotic system and radiographic data were compared with subgroup analysis for the posterior and direct anterior approaches. The average difference between groups was 3.3°±3.1° for inclination, 2.9°±2.3° for anteversion, 3.0±2.3 mm for leg length change, and 4.0±3.1 mm for change in global offset. Correlation between the robotic system and postoperative radiographs was within 10° for 95.9% of cases for inclination and 99.3% for anteversion. Posterior approach correlation was within 10° for 97.1% of cases for inclination and 100% for anteversion. Anterior approach correlation was within 10° for 92.7% of cases for inclination and 97.6% for anteversion. Intraoperative data on component position obtained from the robotic system compared well with radiographic data on component position. Surgeons must remain vigilant to ensure outliers related to robotic system malfunction do not occur. [Orthopedics. 2016; 39(3):193-199.].
Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera , Osteoartritis de la Cadera/cirugía , Robótica/métodos , Acetábulo/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/diagnóstico , Periodo Posoperatorio , Estudios Prospectivos , Reproducibilidad de los Resultados , Tomografía Computarizada por Rayos XRESUMEN
The purpose of this multi-surgeon study was to assess and compare the accuracy of acetabular component placement, leg length discrepancy (LLD), and global offset difference (GOD) between six different surgical techniques and modes of guidance in total hip arthroplasty (THA). A total of 1980 THAs met inclusion criteria. Robotic- and navigation-guided techniques were more consistent than other techniques in placing the acetabular cup into Lewinnek's safe zone (P<0.005 and P<0.05, respectively). Robotic-guided surgery was more consistent than other techniques in placing the acetabular component within Callanan's safe zone (P<0.005). No statistically significant differences were found between groups in the frequency of patients with excessive LLD. Clinically significant differences between groups were not found in the frequency of patients with excessive GOD. Level of Evidence: IV.
Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera , Diferencia de Longitud de las Piernas/epidemiología , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos , Acetábulo/cirugía , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Femenino , Humanos , Illinois/epidemiología , Diferencia de Longitud de las Piernas/etiología , Persona de Mediana Edad , Estudios Retrospectivos , Robótica , Resultado del TratamientoRESUMEN
Obese populations present challenges for acetabular cup placement during total hip arthroplasty (THA). This study examines the accuracy of acetabular cup inclination and version in the obese patient with robotic-assisted computer navigation. A total of 105 patients underwent robotic-assisted computer navigation THA with a posterior approach. Groups were divided on body mass index (BMI, kg/m(2)) of <30, 30-35, and >35. There was no statistical difference between the BMI <30 (n=59), BMI 30-35 (n=34) and BMI >35 (n=12) groups for acetabular inclination (P=0.43) or version (P=0.95). Robotic-assisted computer navigation provided accurate and reproducible placement of the acetabular cup within safe zones for inclination and version in the obese patient.
Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera , Obesidad/complicaciones , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos , Acetábulo/diagnóstico por imagen , Anciano , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/cirugía , Radiografía , Robótica , Cirugía Asistida por ComputadorRESUMEN
There are no reports examining the learning curve during the adoption of robotic assisted THA. The purpose of this study was to examine the learning curve of robotic assisted THA as measured by component position, operative time, and complications. The first 105 robotic-assisted THAs performed by a single surgeon were divided into three groups based on the order of surgery. Component position, operative time, intra-operative technical problems, and intra-operative complications were recorded. There was a decreased risk of acetabular component malpositioning with experience (P<0.05). Operative time appeared to decrease with increasing surgical experience (P<0.05). A learning curve was observed, as a decreased incidence of acetabular component outliers and decreased operative time were noted with increased experience.