Instability After Total Hip Arthroplasty and the Role of Advanced and Robotic Technology

Flick, Travis R.; Ross, Bailey J.; Sherman, William F.

doi:10.1016/j.ocl.2021.03.001

Cited by 10 publications

(5 citation statements)

References 98 publications

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“…The success of traditional THA depends largely on the precision of implant placement, which requires extensive surgical experience [ 3 ]. Furthermore, with the widespread adoption of THA, the number of patients requiring hip revision due to dislocations, impingement, pelvic osteolysis, acetabular displacement, polyethylene wear, and unequal leg length is increasing, seriously affecting patient satisfaction and quality of life [ 4 ]. Compared with Conventional THA (CoTHA), several studies have shown that robot-assisted THA (RaTHA) can improve the accuracy of implant placement, achieve equal leg length, enhance hip offset, decreases in length of stay and costs, but may increase the readmissions and blood transfusions [ 5 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

The learning curve of a novel seven-axis robot-assisted total hip arthroplasty system: a randomized controlled trial

Sun,

Lu,

Xiao

et al. 2024

BMC Musculoskelet Disord

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Bacground The aim of this study was to assess the learning curve of a novel seven-axis robot-assisted total hip arthroplasty (RaTHA) system. Methods A total of 59 patients who underwent unilateral total hip arthroplasty at our institution from June 2022 to September 2022 were prospectively included in the study. In this randomized controlled clinical trial, robot-assisted THA (RaTHA) and Conventional THA (CoTHA) were performed using cumulative sum (CUSUM) analysis to evaluate the learning curve of the RaTHA system. The demographic data, preopera1tive clinical data, duration of operation, postoperative Harris Hip Score (HHS), postoperative Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, and duration of operation between the learning stage and the proficiency stage of the RaTHA group were compared between the two groups. Results The average duration of operation of the RaTHA group was increased by 34.73 min compared with the CoTHA group (104.26 ± 19.33 vs. 69.53 ± 18.38 min, p < 0.01). The learning curve of the RaTHA system can be divided into learning stage and proficiency stage, and the former consists of the first 13 cases by CUSUM analysis. In the RaTHA group, the duration of operation decreased by 29.75 min in the proficiency stage compared to the learning stage (121.12 ± 12.84 vs.91.37 ± 12.92, p < 0.01). Conclusions This study demonstrated that the surgical team required a learning curve of 13 cases to become proficient using the RaTHA system. The duration of operation, total blood loss, and drainage gradually shortened (decreased) with the learning curve stage, and the differences were statistically significant. Trial registration Number: ChiCTR2200061630, Date: 29/06/2022.

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Section: Introductionmentioning

confidence: 99%

The learning curve of a novel seven-axis robot-assisted total hip arthroplasty system: a randomized controlled trial

Sun,

Lu,

Xiao

et al. 2024

BMC Musculoskelet Disord

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“…It is difficult to perform accurate manual prosthesis positioning and implantation. Consequently, aseptic loosening, dislocation, leg length discrepancy (LLD), wear to the prosthesis surface, in addition to other problems, remain to be solved [3,4]. This often leads to early revision surgery, affecting the quality of life for patients and also imposes an additional financial burden.…”

Section: Introductionmentioning

confidence: 99%

Precise acetabular positioning, discrepancy in leg length, and hip offset using a new seven-axis robot-assisted total hip arthroplasty system requires no learning curve: a retrospective study

et al. 2023

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Objective The purpose of the present study was to determine the learning curve for a novel seven-axis robot-assisted total hip arthroplasty (RA-THA) system, and to explore whether it was able to provide greater accuracy in acetabular cup positioning, superior leg length discrepancy (LLD), and hip offset than conventional methods. Methods A total of 160 patients in which unilateral THA was performed in the second affiliated Hospital of Xi'an Jiaotong University from July 2021 to September 2022 were studied. The first 80 patients underwent robot-assisted THA, while conventional THA was performed on the subsequent 80 by the same team of experienced surgeons. The learning curve for the RA-THA system was evaluated using cumulative sum (CUSUM) analysis. The demographic data, preoperative clinical data, duration of surgery, postoperative Harris hip score (HHS) and postoperative radiographic data from patients that had conventional THA were compared. Results The 80 patients who underwent primary unilateral RA-THA comprised 42 males and 38 females and were followed up for 12 weeks. Using analysis by CUSUM, the learning curve of the RA-THA system could be divided into learning and proficiency phases, the former of which consisted of the first 17 cases. There was no significant difference between the learning and proficiency phases in terms of LLD, hip offset, or accuracy of acetabular prosthesis position in the RA-THA groups. The proportion of acetabular prostheses located in the Lewinnek safe zone was 90.5% in the proficiency group and 77.5% in the conventional group, respectively, a difference that was statistically significant (P < 0.05). The absolute error between target angle and postoperative measured angle of anteversion was statistically significant in the proficiency group and the conventional group((P < 0.05). Postoperative acetabular anteversion and LLD were 19.96 ± 5.68° and 6.00 (5.00) mm in the proficiency group, respectively, and 17.84 ± 6.81° and 8.09 (4.33) mm using conventional surgery, respectively (anteversion: P = 0.049; LLD: P < 0.001). Conclusions The surgical team required a learning curve of 17 cases using the RA-THA system to become proficient. There was no learning curve for other parameters, namely LLD, hip offset, or accuracy of acetabular prosthesis positioning. During the proficiency phase, the RA system was superior to conventional THA for control of leg length and accuracy of acetabular cup placement.

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“…Several modifiable and nonmodifiable risk factors should be considered prior to undertaking hip arthroplasty. Modifiable risk factors include tobacco, alcohol use, and obesity [15,16]. Modern hip arthroplasty utilizing press fit implants relies on Femoral offset and subsequent abductor moment arm [13].…”

Section: Risk Factorsmentioning

confidence: 99%

Instability in Total Hip Arthroplasty

Panwar¹,

Cutter²,

Holmboe³

et al. 2023

Arthroplasty - Advanced Techniques and Future Perspectives

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Total hip arthroplasty (THA) is becoming one of the most frequently sought-after surgeries in orthopedics. As the techniques and implants continue to evolve, the stability of the prosthesis is always at the forefront of the surgeon’s mind. Multiple factors contribute to implant stability and there are many intraoperative decisions that can be made by the surgeon to increase stability. Techniques including approaches, adjusting length, adjusting offset, as well as implant choices can dictate stability in THA. There are multiple options that exist including different liners and constraint. One non modifiable variable which surgeons often struggle with is the spinopelvic relationship which can also affect stability post operatively. These factors include lumbar arthritis, variable pelvic tilt, and others that can make a routine approach to a total hip unsuccessful and increase the risk of post-operative complications. Ultimately there are many things to consider when approaching THA in patients, especially in the setting of abnormal pathology.

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Instability After Total Hip Arthroplasty and the Role of Advanced and Robotic Technology

Cited by 10 publications

References 98 publications

The learning curve of a novel seven-axis robot-assisted total hip arthroplasty system: a randomized controlled trial

The learning curve of a novel seven-axis robot-assisted total hip arthroplasty system: a randomized controlled trial

Precise acetabular positioning, discrepancy in leg length, and hip offset using a new seven-axis robot-assisted total hip arthroplasty system requires no learning curve: a retrospective study

Instability in Total Hip Arthroplasty

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