Adoption of Robotic Arm-Assisted Total Hip Arthroplasty Results in Reliable Clinical and Radiographic Outcomes at Minimum Two-Year Follow Up

2021 ◽  
Author(s):  
Matthew Hepinstall ◽  
Harrison Zucker ◽  
Chelsea Matzko ◽  
Morteza Meftah ◽  
Michael Mont
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Case Series ◽  
Robotic Arm ◽  
Complication Rates ◽  
Total Hip ◽  
Surgical Assistance ◽  
Published Evidence

Introduction: Longevity and success of total hip arthroplasty (THA) is largely dependent on component positioning. While use of robotic platforms can improve this positioning, published evidence on its clinical benefits is limited. Therefore, the aim of this study was to assess the clinical outcomes of THA with robotic surgical assistance. Materials and Methods: We conducted an analysis of robotic arm-assisted primary THAs performed by a single surgeon utilizing a posterior approach. A total of 99 patients (107 cases) who had a minimum two-year follow up were identified. Their mean age was 61 years (range, 33 to 84 years), and their mean body mass index was 30.5 kg/m2 (range, 18.5 to 49.1 kg/m2). There were 56% female patients and primary osteoarthritis was the principal hip diagnosis in 88.8%. Operative times, lengths of hospital stay, and discharge dispositions were recorded, along with any complications. Modified Harris Hip Scores (HHS) were calculated to quantify clinical outcomes. Results: Mean postoperative increases in HHS at 2- to 5.7-year follow up was 33 points (range, 6 to 77 points). There were no complications attributable to the use of robotic assistance. Surgical-site complications were rare; one case underwent a revision for prosthetic joint infection (0.93%) but there were no dislocations, periprosthetic fractures, or cases of mechanical implant loosening. There was no evidence of progressive radiolucencies or radiographic failure. Discussion: Robotic arm-assisted THA resulted in low complication rates at minimum two-year follow up, with clinical outcomes comparable to those reported with manual surgery.1–4 The haptically-guided acetabular bone preparation enabled reliable cementless acetabular fixation and there were no adverse events related to the use of the robot. Dislocations were avoided in this case series. Randomized controlled clinical trials are needed to compare manual to robotic surgery and to investigate whether the precision found with this functional planning will reliably reduce the incidence of dislocations.

Robotic arm-assisted versus manual total hip arthroplasty

2021 ◽  
Vol 103-B (6) ◽  
pp. 1009-1020 ◽  
Author(s):  
Nathan Ng ◽  
Paul Gaston ◽  
Philip M. Simpson ◽  
Gavin J. Macpherson ◽  
James T. Patton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Hip Arthroplasty ◽  
Learning Curve ◽  
Hip Arthroplasty ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Robotic Arm ◽  
Complication Rates ◽  
Total Hip

Aims The aims of this systematic review were to assess the learning curve of semi-active robotic arm-assisted total hip arthroplasty (rTHA), and to compare the accuracy, patient-reported functional outcomes, complications, and survivorship between rTHA and manual total hip arthroplasty (mTHA). Methods Searches of PubMed, Medline, and Google Scholar were performed in April 2020 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included “robotic”, “hip”, and “arthroplasty”. The criteria for inclusion were published clinical research articles reporting the learning curve for rTHA (robotic arm-assisted only) and those comparing the implantation accuracy, functional outcomes, survivorship, or complications with mTHA. Results There were 501 articles initially identified from databases and references. Following full text screening, 17 articles that satisfied the inclusion criteria were included. Four studies reported the learning curve of rTHA, 13 studies reported on implant positioning, five on functional outcomes, ten on complications, and four on survivorship. The meta-analysis showed a significantly greater number of cases of acetabular component placement in the safe zone compared with the mTHA group (95% confidence interval (CI) 4.10 to 7.94; p < 0.001) and that rTHA resulted in a significantly better Harris Hip Score compared to mTHA in the short- to mid-term follow-up (95% CI 0.46 to 5.64; p = 0.020). However, there was no difference in infection rates, dislocation rates, overall complication rates, and survival rates at short-term follow-up. Conclusion The learning curve of rTHA was between 12 and 35 cases, which was dependent on the assessment goal, such as operating time, accuracy, and team working. Robotic arm-assisted total hip arthroplasty was associated with improved accuracy of component positioning and functional outcome, however no difference in complication rates or survival were observed at short- to mid-term follow-up. Overall, there remains an absence of high-quality level I evidence and cost analysis comparing rTHA and mTHA. Cite this article: Bone Joint J 2021;103-B(6):1009–1020.

Excellent Clinical and Radiographic Outcomes with Direct Superior Total Hip Arthroplasty with a Minimum of Two-Year Follow Up

2021 ◽  
Author(s):  
Moritz Sharabianlou ◽  
Prerna Arora ◽  
Derek Amanatullah
Keyword(s):  
Total Hip Arthroplasty ◽  
Functional Recovery ◽  
Hip Arthroplasty ◽  
Case Series ◽  
Harris Hip Score ◽  
Timed Up And Go ◽  
Total Hip ◽  
Radiologic Evaluation ◽  
Superior Approach

This study aims to establish the midterm safety and performance for the direct superior approach to minimally invasive surgery total hip arthroplasty (MIS-THA). We used a unicentric, single-surgeon, retrospective, consecutive case series analysis of the first 40 patients who received primary unilateral direct superior MIS-THA. Special attention was given to functional recovery by measuring Harris Hip Score (HHS) and timed-up-and-go (TUG) with a mean follow up of 2.2 ± 0.4 years. A radiologic evaluation was performed. HHS and TUG improved significantly at three months and one year (p < 0.001). All components were placed within the Lewinnek safe zone with no change position or signs of loosening at two years. With a minimum of two years of follow up, the direct superior approach appears to be safe without any obvious or consistent postoperative complications—clinically or radiographically—with excellent functional recovery. Additionally, our subgroup analysis supported no late learning curve effect.

scholarly journals Ten-year comparison of two different techniques for femoral bone cavity preparation—broaching versus compaction in patients with cementless total hip arthroplasty

2021 ◽  
Vol 2 (12) ◽  
pp. 1035-1042
Author(s):  
Maciej Okowinski ◽  
Mette Holm Hjorth ◽  
Sebastian Breddam Mosegaard ◽  
Jonathan Hugo Jürgens-Lahnstein ◽  
Stig Storgaard Jakobsen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Femoral Bone ◽  
Total Hip ◽  
Stem Subsidence ◽  
Femur Fractures

Aims Femoral bone preparation using compaction technique has been shown to preserve bone and improve implant fixation in animal models. No long-term clinical outcomes are available. There are no significant long-term differences between compaction and broaching techniques for primary total hip arthroplasty (THA) in terms of migration, clinical, and radiological outcomes. Methods A total of 28 patients received one-stage bilateral primary THA with cementless femoral stems (56 hips). They were randomized to compaction on one femur and broaching on the contralateral femur. Overall, 13 patients were lost to the ten-year follow-up leaving 30 hips to be evaluated in terms of stem migration (using radiostereometry), radiological changes, Harris Hip Score, Oxford Hip Score, and complications. Results Over a mean follow-up period of 10.6 years, the mean stem subsidence was similar between groups, with a mean of -1.20 mm (95% confidence interval (CI) -2.28 to -0.12) in the broaching group and a mean of -0.73 mm (95% CI -1.65 to 0.20) in the compaction group (p = 0.07). The long-term migration patterns of all stems were similar. The clinical and radiological outcomes were similar between groups. There were two intraoperative fractures in the compaction group that were fixed with cable wire and healed without complications. No stems were revised. Conclusion Similar stem subsidence and radiological and clinical outcomes were identified after the use of compaction and broaching techniques of the femur at long-term follow-up. Only the compaction group had intraoperative periprosthetic femur fractures, but there were no long-term consequences of these. Cite this article: Bone Jt Open 2021;2(12):1035–1042.

Outcomes and survivorship after conversion of failed hip hemiarthroplasty to total hip arthroplasty

2019 ◽  
pp. 112070001989142 ◽  
Author(s):  
Nana O Sarpong ◽  
Matthew J Grosso ◽  
Akshay Lakra ◽  
Carl L Herndon ◽  
Emma Jennings ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Total Hip Arthroplasty ◽  
Femoral Component ◽  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Complication Rates ◽  
Conversion Surgery ◽  
Total Hip ◽  
Estimated Blood Loss

Background: Arthroplasty is the treatment of choice for elderly patients with displaced femoral neck fractures. When compared to total hip arthroplasty (THA), higher revision rates have been reported for hemiarthroplasty (HA). Conversion of failed HA to THA can be complex, especially in the elderly population at risk for revision surgery complications. We report a single institution’s experience with conversion of failed HA to THA at mid-term follow-up. Methods: We identified patients converted from failed HA to THA from 2006 to 2016. Clinical data including indication for index and conversion surgery, maintenance or revision of femoral component during conversion, operative time, estimated blood loss, postoperative complications, and need for revision surgery were collected. Descriptive statistics were analysed in SPSS. Results: The cohort included 21 men and 39 women (mean age of 74.5 years). The mean follow-up after conversion HA to THA was 2.8 years. During conversion surgery, the femoral component was revised in 75.0% and retained in 25.0% of cases. After conversion HA to THA, the rate of major complications and re-revision at 2 years was 11.7% and 10.0%, respectively. Femoral revision versus retention did not affect complication rates (11.1% vs. 6.7%; p = 0.31) or re-revision rates (8.9% vs. 13.3%; p = 1.0). Conclusions: In this high-risk population, mid-term follow-up demonstrated tolerable complication and re-revision rates, the majority of which were for instability. We observed high rates of femoral component revision during conversion THA, although this did not increase the likelihood of postoperative complications or need for future surgery.

scholarly journals Vitamin E highly cross-linked polyethylene reduces mid-term wear in primary total hip replacement: a meta-analysis and systematic review of randomized clinical trials using radiostereometric analysis

2021 ◽  
Vol 6 (9) ◽  
pp. 759-770
Author(s):  
Zeng Li ◽  
Shuai Xiang ◽  
Cuijiao Wu ◽  
Yingzhen Wang ◽  
Xisheng Weng
Keyword(s):  
Clinical Trials ◽  
Vitamin E ◽  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Wear Properties ◽  
Total Hip

Vitamin E incorporation into highly cross-linked polyethylene (HXLPE) has been introduced to improve wear resistance, and vitamin E incorporated HXLPE (VEPE) has been used in total hip arthroplasty. The aim of this meta-analysis was to investigate the wear properties of VEPE in clinical practice by synthesizing the data provided in randomized clinical trials. The effects on implant stability, functional outcomes and revision rate of VEPE were also compared with those of HXPLE or ultra-high molecular weight polyethylene (UHMWPE). Literature searches were conducted on 1 January 2020 using MEDLINE, EMBASE, Cochrane and ClinicalTrials.gov databases. Randomized controlled trials (RCTs) comparing the aforementioned parameters between VEPE and standard HXPLE/UHMWPE liners were included. Methodological quality and the bias of the included studies were analysed. Meta-analyses were performed using the Review Manager software. Nine RCTs met the eligibility criteria and were included. At early and mid-term follow-up, the vertical penetration and the total penetration of the femoral head were both significantly reduced in the VEPE group. The steady state wear rate of the VEPE group was also remarkably lower. However, at two-year follow-up, significantly increased cup migration was observed in the VEPE group. Moreover, the mid-term clinical outcomes of the VEPE group were worse, while the total revision rates between the two groups were not significantly different. The limited number of included studies may compromise our conclusion regarding clinical outcomes of the VEPE bearing surface. More RCTs with longer follow-up periods are needed to further investigate the effects of VEPE in total hip arthroplasty. Cite this article: EFORT Open Rev 2021;6:759-770. DOI: 10.1302/2058-5241.6.200072

scholarly journals Early Postoperative Clinical Outcomes of Robotic Arm-Assisted Vs. Image-Based Navigated Total Hip Arthroplasty

2020 ◽  
Author(s):  
Nao Shibanuma ◽  
Kazunari Ishida ◽  
Tomoyuki Matsumoto ◽  
Koji Takayama ◽  
Yutaro Sanada ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Robotic Arm ◽  
Harris Hip Score ◽  
Surgical Time ◽  
Total Hip ◽  
Radiographic Parameters ◽  
Significant Difference

Abstract Background The purpose of this study was to compare the clinical outcomes of total hip arthroplasty (THA) using computer navigation systems (nTHA) and those of robotic arm-assisted THA (rTHA).Methods Thirty prospective subjects who underwent rTHA were clinically compared with 30 subjects who underwent nTHA. Clinical data (the surgical time, intraoperative blood loss, length of hospital stay, pain severity, number of days to independent walking, and Harris Hip Score (HHS) at discharge) and radiographic parameters (the inclination and anteversion angles) were statistically compared between the two groups. Results The surgical time, number of days to independent walking, and postoperative pain were significantly reduced in the rTHA group than in the nTHA group. The rTHA group showed a significantly higher postoperative HHS than did the nTHA group. No statistically significant difference was observed in radiographic parameters between the groups.Conclusion The surgical time, postoperative pain, and number of days to independent walking were significantly shorter, and the HHS at discharge was significantly higher in the rTHA group than in the nTHA group. Thus, as compared to nTHA, rTHA improved early clinical outcomes.

A follow-up study of hip arthroplasty in patients with chronic renal failure on dialysis

2020 ◽  
Author(s):  
Sang Min Lee ◽  
Kuen Tak Suh ◽  
Won Chul Shin ◽  
Young Kwang Oh ◽  
Seung Hun Woo
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Bipolar Hemiarthroplasty ◽  
Acetabular Cup ◽  
Total Hip ◽  
The Mean

Abstract Background Although hip arthroplasty has become increasingly common, its radiological and clinical outcomes in chronic renal failure patients remain unclear. This study analyzed the outcomes of hip arthroplasty in patients with chronic renal failure undergoing dialysis. Methods Of 2,364 hips undergoing total hip arthroplasty or bipolar hemiarthroplasty between January 2003 and December 2017, data pertaining of 37 hips of patients with chronic renal failure undergoing dialysis (16 men, 21 women) were retrospectively examined. We analyzed the radiological and clinical outcomes of hip arthroplasty, as well as the occurrence of local and general complications (particularly the time of their occurrence) during follow-up and their association with dialysis duration. Results The mean patient age was 60.6 ± 13.5 years, and the mean follow-up duration was 36.6 ± 27.2 months. The mean T-value indicating bone mineral density was -2.62 ± 1.15, with osteoporosis noted in 20 cases. Except for 1 case with infection-induced change in acetabular cup tilt, all cases of total hip arthroplasty with cementless acetabular cup implant exhibited excellent radiographic outcomes. The cementless proximally coated femoral stem was used in all 25 cases of total hip arthroplasty and 7 out of 12 cases of bipolar hemiarthroplasty. Changes in the alignment of femoral stems, subsidence, osteolysis, and loosening were not observed. On clinical assessment, 33 patients received an “excellent” or “good” Harris hip score. Within 1 year postoperatively, complications developed in 18 patients, and some patients exhibited more than 1 complication. More than 1 year after surgery, general complications developed in 12 patients; however, no patient experienced local complications.Conclusions Hip arthroplasty in chronic renal failure patients on dialysis showed excellent radiological and satisfactory clinical outcomes; however, it may be associated with various postoperative complications. Therefore, meticulous preoperative treatment planning and overall postoperative management are required to reduce the risk of complications.

Total hip arthroplasty using highly cross-linked polyethylene in patients aged 50 years and younger

2021 ◽  
Vol 103-B (7 Supple B) ◽  
pp. 78-83 ◽  
Author(s):  
Gordon G. Roedel ◽  
Beau J. Kildow ◽  
Daniel S. Sveom ◽  
Kevin L. Garvin
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Hip Arthroplasty ◽  
Polyethylene Wear ◽  
Prognostic Significance ◽  
Head Size ◽  
Linear Wear ◽  
Total Hip ◽  
Radiolucent Lines

Aims Highly cross-linked polyethylene (HXLPE) has greatly improved the durability of total hip arthroplasty (THA) in young patients because of its improved wear characteristics. Few studies have followed this population into the second decade, and therefore the purpose of this investigation was to evaluate the clinical outcome for THA patients 50 years of age and younger at a minimum of 15 years postoperatively. The second purpose was to evaluate the radiological findings secondary to wear or mechanical failure of the implant. Methods Between October 1999 and December 2005, 105 THAs were performed in 95 patients (53 female, 42 male) aged 50 years and younger (mean 42 years (20 to 50)). There were 87 patients (96 hips) that were followed for a minimum of 15 years (mean 17.3 years (15 to 21)) for analysis. Posterior approach was used with cementless fixation with a median head size of 28 mm. HXLPE was the acetabular bearing for all hips. Radiographs were evaluated for polyethylene wear, radiolucent lines, and osteolysis. Results Clinical outcomes showed significant improvement of mean Harris Hip Scores from 52.8 (SD 13.5) preoperatively to 94.8 (SD 7.6) postoperatively. One hip was revised for recurrent instability, and there were no infections. No hips were revised for mechanical loosening or osteolysis. Mean polyethylene linear wear was 0.04 mm/year and volumetric wear was 6.22 mm3/year, with no significant differences between head size or material. Osteolysis was not present in any of the hips. Conclusion The use of HXLPE in THA for patients aged 50 years and younger has performed exceptionally well without evidence of significant wear causing mechanical loosening or necessitating revision. The radiolucent lines of the acetabular component must be followed to determine the prognostic significance. This investigation represents the longest clinical follow-up of a large, consecutive cohort of patients aged 50 years or younger with THA using HXLPE. This long-term analysis found negligible polyethylene wear, no incidence of aseptic loosening, and excellent clinical outcomes at and beyond 15 years of follow-up. Cite this article: Bone Joint J 2021;103-B(7 Supple B):78–83.

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