Robotik in der Endoprothetik - Neue OP-Unterstützungssysteme

Zusammenfassung

Der Einsatz robotischer Unterstützungssysteme findet seit den 1990er-Jahren zunehmend Anwendung in der Endoprothetik. Durch höhere Präzision und Reproduzierbarkeit sollen Komplikationen reduziert und funktionelle Ergebnisse sowie Standzeiten verbessert werden. Die meisten aktuell verfügbaren Systeme sind bildgeführt und erfordern eine entsprechende präoperative Planung. Bei anderen Systemen erfolgt die Erfassung der Anatomie und die Planung der Prothese erst intraoperativ. In der Knieendoprothetik konnte durch robotische Technik eine verbesserte Gelenkausrichtung erzielt werden. Bei Hüftendoprothesen zeigte sich eine Verringerung von Abweichungen bei der Pfannenpositionierung. Diese Resultate zeigten sich unabhängig von der Erfahrung des Operateurs, sodass besonders Operateure mit geringerer Fallzahl von dem Einsatz robotischer Unterstützungssysteme profitieren könnten. Jedoch steht dem allerdings eine verlängerte Operationszeit gegenüber. Zudem wirft die Technik u.a. Fragen bez. der Kosteneffizienz und des Managements intraoperativer Komplikationen auf. Ob es durch künstliche Intelligenz langfristig tatsächlich möglich sein wird, die Ergebnisse ohnehin bereits sehr erfolgreicher Operationen noch weiter zu verbessern, bleibt abzuwarten. In jedem Fall liegt die Verantwortung für das Gelingen der Operation doch stets beim Operateur.

Abstract

The use of robotic-assisted joint arthroplasty surgeries has increased over the past decades. It promises higher precision and reproducibility. Thereby it aims to reduce complications and improve functional outcomes and implant survival. Most currently available systems are image-guided and correspondingly require preoperative planning, while other systems generate the anatomic data intraoperatively. In total- and uni-compartmental knee arthroplasties, robotic technology has been associated with improved joint alignment. For total hip arthroplasties, a reduction of deviations in cup positioning was demonstrated. Precision of implant position was independent from surgeon’s experience in robotic-assisted joint replacement. Therefore, especially surgeons with low case numbers could benefit from its use. However, robotic-assisted surgery appears to be associated with longer duration of surgery and aspects such as cost-effectiveness, and management of intraoperative complications need to be addressed. In terms of functional outcomes and implant survival, robotic assisted and manually implanted arthroplasties seem equivalent. Therefore, it remains to be seen whether the combination of growing datasets and artificial intelligence will, on the long run, further improve the results of procedures that are already very successful. In any case, the ultimate responsibility for the success of the operation lies with the surgeon.

Schlüsselwörter

Robotische Unterstützungssysteme - künstliche Intelligenz - Endoprothetik - unikondylärer Kniegelenksersatz

Keywords

robotic-assisted surgery - total joint replacement - unicompartmental knee replacement - artificial intelligence

Publikationsverlauf

Artikel online veröffentlicht:
30. Mai 2022

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