BackgroundRobotic-assisted total hip arthroplasty (THA) allows for accurate preoperative planning and component positioning, potentially enhancing implant survival and long-term outcomes. The relative efficacy and safety of robotic-assisted and conventional THA, however, are unclear. This systematic review and meta-analysis compared the safety and efficacy of robotic-assisted and conventional THA.MethodsMedline, Embase and the Cochrane Library were comprehensively searched in September 2017 to identify studies comparing the safety and efficacy of robotic-assisted and conventional THA. Seven studies were included. Data of interest were extracted and analysed using Review Manager 5.3.ResultsThe seven included studies involved 1516 patients, with 522 undergoing robotic-assisted and 994 undergoing conventional THA. Compared with conventional THA, robotic-assisted THA was associated with longer surgical time (not significant); lower intraoperative complication rates (OR: 0.12, 95% CI: 0.05 to 0.34, p<0.0001 I2); better cup placement, stem placement and global offset and a higher rate of heterotopic ossifications. Functional scores, limb length discrepancy and rates of revision and stress shielding were similar in the two groups. The relative amount of blood loss was unclear.ConclusionThe results of this meta-analysis suggest that robotic-assisted THA has certain advantages over conventional THA, including the results of component positioning and rates of intraoperative complications. Additional comparative studies are required to determine the long-term clinical outcomes of robotic-assisted THA.

The maintenance of a constant ATP level (‘set-point’) is a vital homeostatic function shared by eukaryotic cells. In particular, mammalian myocardium exquisitely safeguards its ATP set-point despite 10-fold fluctuations in cardiac workload. However, the exact mechanisms underlying this regulation of ATP homeostasis remain elusive. Here we show mitochondrial flashes (mitoflashes), recently discovered dynamic activity of mitochondria, play an essential role for the auto-regulation of ATP set-point in the heart. Specifically, mitoflashes negatively regulate ATP production in isolated respiring mitochondria and, their activity waxes and wanes to counteract the ATP supply-demand imbalance caused by superfluous substrate and altered workload in cardiomyocytes. Moreover, manipulating mitoflash activity is sufficient to inversely shift the otherwise stable ATP set-point. Mechanistically, the Bcl-xL-regulated proton leakage through F1Fo-ATP synthase appears to mediate the coupling between mitoflash production and ATP set-point regulation. These findings indicate mitoflashes appear to constitute a digital auto-regulator for ATP homeostasis in the heart.DOI: http://dx.doi.org/10.7554/eLife.23908.001

Within limitations of the present systematic review, GFSFE with simultaneous implant placement can achieve satisfactory mean ISR of 97.9% ± 0.02%.