Does Robotic-Assisted Total Hip Arthroplasty Improve Accuracy of Cup Positioning?

Abstract

Acetabular component malpositioning is a frequent cause of complications in total hip arthroplasty including instability, increased wear, osteolysis, impingement, and revision surgery. Recently, robotics and navigation have been introduced to improve cup positioning in total hip arthroplasty. The purpose of this study was to compare the accuracy of postoperative acetabular component positioning using MAKO robotic-assisted versus manual acetabular component placement. A consecutive series of 100 total hip replacements were performed in 100 patients. The first 50 were performed using manual techniques, while the second 50 were performed using MAKO-guided acetabular component placement. Postoperative anteroposterior pelvis radiographs were used to determine the postoperative anteversion and inclination of the cup relative to the goal of 15 and 45°, respectively. In the manual group, the average anteversion and inclination was 14.3 and 44.2°, respectively, with 28% within 5° and 82% within 10° of the goal alignment, respectively. In the robotic group, the average anteversion and inclination was 15.1 and 45.6°, respectively, with 54 and 88% within 5 and 10° of the goal alignment, respectively. This equated to a statistically significant improvement in the number of acetabular components placed within 5° of the target alignment with the use of robotic guidance (p = 0.0142). From the authors' study, they were able to demonstrate a significant improvement in acetabular component alignment with the use of robotic techniques. Additional studies are needed to demonstrate improvement in clinical outcomes as a result of improved accuracy and precision of acetabular component placement.

Keywords

primary THA - robotic-assisted THA - acetabular component alignment - anteversion - inclination

• References

• 1 Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 1978; 60 (02) 217-220
• 2 Callanan MC, Jarrett B, Bragdon CR. , et al. The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res 2011; 469 (02) 319-329
• 3 Biedermann R, Tonin A, Krismer M, Rachbauer F, Eibl G, Stöckl B. Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component. J Bone Joint Surg Br 2005; 87 (06) 762-769 Review
• 4 Ali Khan MA, Brakenbury PH, Reynolds IS. Dislocation following total hip replacement. J Bone Joint Surg Br 1981; 63-B [phone]
• 5 Kennedy JG, Rogers WB, Soffe KE, Sullivan RJ, Griffen DG, Sheehan LJ. Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration. J Arthroplasty 1998; 13 (05) 530-534
• 6 Del Schutte Jr H, Lipman AJ, Bannar SM, Livermore JT, Ilstrup D, Morrey BF. Effects of acetabular abduction on cup wear rates in total hip arthroplasty. J Arthroplasty 1998; 13 (06) 621-626
• 7 D'Lima DD, Urquhart AG, Buehler KO, Walker RH, Colwell Jr CW. The effect of the orientation of the acetabular and femoral components on the range of motion of the hip at different head-neck ratios. J Bone Joint Surg Am 2000; 82 (03) 315-321
• 8 Barrack RL, Krempec JA, Clohisy JC. , et al. Accuracy of acetabular component position in hip arthroplasty. J Bone Joint Surg Am 2013; 95 (19) 1760-1768
• 9 Abdel MP, von Roth P, Jennings MT, Hanssen AD, Pagnano MW. What safe zone? The vast majority of dislocated THAs are within the Lewinnek Safe Zone for acetabular component position. Clin Orthop Relat Res 2016; 474 (02) 386-391
• 10 Kanawade V, Dorr LD, Banks SA, Zhang Z, Wan Z. Precision of robotic guided instrumentation for acetabular component positioning. J Arthroplasty 2015; 30 (03) 392-397
• 11 Elson L, Dounchis J, Illgen R. , et al. Precision of acetabular cup placement in robotic integrated total hip arthroplasty. Hip Int 2015; 25 (06) 531-536
• 12 Nodzo SR, Chang CC, Carroll KM. , et al. Intraoperative placement of total hip arthroplasty components with robotic-arm assisted technology correlates with postoperative implant position: a CT-based study. Bone Joint J 2018; 100-B (10) 1303-1309
• 13 Redmond JM, Gupta A, Hammarstedt JE, Petrakos A, Stake CE, Domb BG. Accuracy of component placement in robotic-assisted total hip arthroplasty. Orthopedics 2016; 39 (03) 193-199
• 14 Elmallah RK, Cherian JJ, Jauregui JJ, Padden DA, Harwin SF, Mont MA. Robotic-arm assisted surgery in total hip arthroplasty. Surg Technol Int 2015; 26: 283-288
• 15 Nho JH, Lee YK, Kim HJ, Ha YC, Suh YS, Koo KH. Reliability and validity of measuring version of the acetabular component. J Bone Joint Surg Br 2012; 94 (01) 32-36
• 16 Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am 2018; 100 (17) 1455-1460
• 17 Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 2005; 87 (07) 1487-1497
• 18 Gwam CU, Mistry JB, Mohamed NS. , et al. Current epidemiology of revision total hip arthroplasty in the United States: national inpatient sample 2009 to 2013. J Arthroplasty 2017; 32 (07) 2088-2092
• 19 Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 2009; 91 (01) 128-133
• 20 Gupta A, Redmond JM, Hammarstedt JE, Petrakos AE, Vemula SP, Domb BG. Does robotic-assisted computer navigation affect acetabular cup positioning in total hip arthroplasty in the obese patient? A comparison study. J Arthroplasty 2015; 30 (12) 2204-2207
• 21 Kajino Y, Kabata T, Maeda T, Iwai S, Kuroda K, Tsuchiya H. Does degree of the pelvic deformity affect the accuracy of computed tomography-based hip navigation?. J Arthroplasty 2012; 27 (09) 1651-1657
• 22 Tsutsui T, Goto T, Wada K, Takasago T, Hamada D, Sairyo K. Efficacy of a computed tomography-based navigation system for placement of the acetabular component in total hip arthroplasty for developmental dysplasia of the hip. J Orthop Surg (Hong Kong) 2017; 25 (03) 2309499017727954
• 23 Zhang YZ, Chen B, Lu S. , et al. Preliminary application of computer-assisted patient-specific acetabular navigational template for total hip arthroplasty in adult single development dysplasia of the hip. Int J Med Robot 2011; 7 (04) 469-474
• 24 Domb BG, El Bitar YF, Sadik AY, Stake CE, Botser IB. Comparison of robotic-assisted and conventional acetabular cup placement in THA: a matched-pair controlled study. Clin Orthop Relat Res 2014; 472 (01) 329-336
• 25 Domb BG, Redmond JM, Louis SS. , et al. Accuracy of component positioning in 1980 total hip arthroplasties: a comparative analysis by surgical technique and mode of guidance. J Arthroplasty 2015; 30 (12) 2208-2218
• 26 Illgen RNd, Bukowski BR, Abiola R, Anderson P, Chughtai M, Khlopas A, Mont MA. Robotic-assisted total hip arthroplasty: outcomes at minimum two-year follow-up. Surg Technol Int 2017; 30: 365-372
• 27 Bukowski BR, Anderson P, Khlopas A, Chughtai M, Mont MA, Illgen II RL. Improved functional outcomes with robotic compared with manual total hip arthroplasty. Surg Technol Int 2016; 29: 303-308