Does robotic-assisted computer navigation improve acetabular cup positioning in total hip arthroplasty for Crowe III/IV hip dysplasia? A propensity score case-match analysis

AbstractAcetabular 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.

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Minimum 5-Year Outcomes of Robotic-assisted Primary Total Hip Arthroplasty With a Nested Comparison Against Manual Primary Total Hip Arthroplasty: A Propensity Score–Matched Study

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/jaaos-d-19-00328 ◽

2020 ◽

Vol 28 (20) ◽

pp. 847-856 ◽

Cited By ~ 2

Author(s):

Benjamin G. Domb ◽

Jeffrey W. Chen ◽

Ajay C. Lall ◽

Itay Perets ◽

David R. Maldonado

Keyword(s):

Total Hip Arthroplasty ◽

Propensity Score ◽

Hip Arthroplasty ◽

Robotic Assisted ◽

Total Hip ◽

Matched Study ◽

Primary Total Hip Arthroplasty

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Comparison of Three-Dimensional Planning-Assisted and Conventional Acetabular Cup Positioning in Total Hip Arthroplasty

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.n.00753 ◽

2016 ◽

Vol 98 (2) ◽

pp. 108-116 ◽

Cited By ~ 28

Author(s):

Elhadi Sariali ◽

Nadia Boukhelifa ◽

Yves Catonne ◽

Hugues Pascal Moussellard

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Three Dimensional ◽

Acetabular Cup ◽

Total Hip ◽

Cup Positioning

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Randomised Controlled Trial Comparing two Methods of Acetabular Cup Positioning during Total Hip Arthroplasty

Hip International ◽

10.1177/112070000701700303 ◽

2007 ◽

Vol 17 (3) ◽

pp. 137-142 ◽

Cited By ~ 5

Author(s):

P.-A. Vendittoli ◽

M. Ganapathi ◽

N. Duval ◽

P. Lavoie ◽

A. Roy ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Reference Points ◽

Abduction Angle ◽

Anatomical Landmarks ◽

Acetabular Cup ◽

Total Hip ◽

Increased Risk ◽

Visuospatial Perception ◽

Cup Positioning

Background Acetabular cup positioning is an important technical aspect in total hip arthroplasty. Most surgeons estimate cup abduction angle during surgery with the insertion rod position according to the patient's body anatomical landmarks or other reference points in the operating room. High acetabular component abduction angle is associated with an increased risk of dislocation, premature polyethylene wear and osteolysis. Method To evaluate the potential benefits of a new technique for vertical acetabular cup positioning, 100 acetabular cups were randomised to be inserted with or without an inclinometer. Abduction angles were measured on postoperative radiographs by 2 evaluators blind to the treatment group. Results Of the cups, 57% (27/47) were positioned within the desirable abduction angle range of 40°–49° with the inclinometer, compared with 50% (27/53) by visuospatial perception (p=0.454). The proportion of cups positioned outside a safe angle range of 30°–55° was low in both groups: 6% (3/47) for the inclinometer group versus 4% (2/53) for the visuospatial perception group (p=0.536). Conclusion The use of an inclinometer did not significantly improve the acetabular cup abduction angle obtained by our group of surgeons when compared with visuospatial perception. Newer techniques such as navigation may be useful in further optimising cup positioning and reducing the outliers.

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Accuracy of Image-less Navigation for Functional Cup Positioning in Total Hip Arthroplasty

10.29007/3lbz ◽

2019 ◽

Author(s):

Morteza Meftah ◽

Vinnay Siddappa ◽

Jeffery Muir ◽

Peter White

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Weight Bearing ◽

Safe Zone ◽

Computer Assisted ◽

Acetabular Cup ◽

Assisted Navigation ◽

Total Hip ◽

Significant Difference ◽

Cup Positioning

Computer-assisted navigation has the potential to improve the accuracy of cup positioning during total hip arthroplasty (THA) and prevent leg length discrepancy (LLD). The purpose of this study was to compare acetabular cup position and post- operative LLD after primary THA using posterolateral approach. Between August 2016 to December 2017, 57 THAs using imageless navigation were matched with 57 THA without navigation, based on age, gender and BMI. Post-operative weight-bearing radiographs were assessed using for anteversion, inclination and LLD. Goal for functional cup placement was 40° inclination and 20° anteversion based on preoperative weight bearing pelvic images. Functional LLD was measured as compared to pre- operative radiographs and contralateral side. Proportion of cups within Lewinnek’s safe zone, proximity to a pre-operative target of and the LLD >5 mm was assessed. The mean age was 54.9 ± 9.6 years (30 – 72) and 57.6 ± 12.5 years (20 – 85) in control and navigated groups, respectively. Mean cup orientation in the navigated group was 20.6°± 3.3° (17 - 25) of anteversion and 41.9°± 4.8° (30 - 51) of inclination, vs. 25.0°± 11.1° (10 - 31) and 45.7°± 8.7° (29 – 55) in control group, where were statistically significant (p=0.005 and p=0.0001), respectively. In the navigated group, significantly more acetabular cups were placed within Lewinnek’s safe zone (anteversion: 78% vs. 47%, p=0.005; inclination: 92% vs. 67%, p=0.002). There was no significant difference in mean LLD in navigation and control groups (3.1 ± 1.5 mm vs. 4.6 ± 3.4 mm, p=0.36), although fewer LLDs >5 mm were reported in the navigated group (7.1%) than in controls (31.4%, p=0.007). The use of this image-less computer-assisted navigation improved the accuracy with which acetabular cup components were placed and may represent an important method for limiting post-operative complications related to cup malpositioning and LLD.

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