Robotic-assisted Total Hip Arthroplasty in Patients with Developmental Dysplasia of the Hip

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2024 Feb 15

PMID 38358516

Authors

Shuai Zhang

Mingyang Ma

Xiangpeng Kong

Yonggang Zhou

Jiying Chen

Wei Chai

Affiliations

Soon will be listed here.

Abstract

Purposes: Due to the morphological diversity of deformities, technical difficulties, improperly designed components, and so on, THA remains a challenging task in dysplastic hips, especially in highly dislocated hips. The purpose of this study was to comprehensively evaluate the clinical outcomes of robot-assisted THA in patients with DDH through a large cohort study, including the precision of acetabular cup positioning, indicators of inflammatory response, indicators of muscle damage, and complications.

Methods: We retrospectively analyzed patients with DDH who underwent THA in our prospectively constructed joint registry between August 2018 and August 2022. Finally, 147 manual THAs and 147 robotic-assisted THAs were included in the final analysis. Patient demographics, indicators of inflammation, indicators of muscle damage, operative time, Harris hip scores (HHS), and forgotten joint score (FJS) were recorded for analysis. The precision of the positioning of the acetabular component was assessed with plain radiographs.

Results: In the Crowe II/III groups, the reconstructed center of rotation (COR) in the robotic-assisted group was closer to the anatomical COR with less variation than the manual group (absolute horizontal distances of COR 3.5 ± 2.8 vs. 5.4 ± 4.9 mm, p < 0.05; absolute vertical distances of COR 6.4 ± 4.1 vs. 11.7 ± 8.2 mm, p = 0.001). For all Crowe subtypes, the robotic-assisted THA significantly increased the proportion of acetabular cups located in the safety zone within 5° (all p < 0.05). Interleukin-6 and creatine kinase levels were slightly lower and significantly different in the robotic-assisted group at three days postoperatively (all p < 0.05).

Conclusions: Compared to the manual technique, the robot-assisted technique improved the precision and reproducibility of acetabular component positioning, particularly in DDH patients with Crowe types II/III. The robotic-assisted technique did not increase operative time, bleeding, complications, or revision rates, and had a slighter early inflammatory response and muscle damage.

Citing Articles

Morphological and bone defect mapping analysis of true acetabulum in Crowe type IV hip dysplasia.

Yang Y, Chen D, Zhang B, Li Q, Hu L, Ma Y J Orthop Surg Res. 2024; 19(1):888.

PMID: 39734190 PMC: 11684270. DOI: 10.1186/s13018-024-05389-1.

Clinical Study on the Effects of Total Hip Arthroplasty Assisted by Virtual Planning Combined With Intraoperative Navigation Templates.

Zhu H, Wu J, Cheng K, Yan H, Liang J, Long Y Orthop Surg. 2024; 17(3):831-840.

PMID: 39725844 PMC: 11872358. DOI: 10.1111/os.14335.

Chiropractic rehabilitation in accelerated rehabilitation after total hip arthroplasty for Crowe type IV hip dysplasia.

Deng G, Tan Z, Chen R, Fu R, Shu Y, Jiang W Medicine (Baltimore). 2024; 103(30):e39117.

PMID: 39058838 PMC: 11272372. DOI: 10.1097/MD.0000000000039117.

Why robot-assisted total hip arthroplasty aborted: Chinese experience of four hundred and twenty nine consecutive cases.

An H, Cao Z, Zhang S, Yang M, Kong X, Chai W Int Orthop. 2024; 48(9):2359-2365.

PMID: 39012414 DOI: 10.1007/s00264-024-06250-0.

How useful are indirect radiographic measurements of hip instability in borderline hip dysplasia? An MRI-based comparison to a healthy cohort.

Andronic O, Germann C, Jud L, Imhoff F, Frohlich S, Scherr J Int Orthop. 2024; 48(8):2007-2015.

PMID: 38684549 PMC: 11246315. DOI: 10.1007/s00264-024-06202-8.

References

Chai W, Xu C, Guo R, Kong X, Fu J, Tang P . 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. Int Orthop. 2022; 46(4):769-777. DOI: 10.1007/s00264-021-05232-w. View

LLOYD-ROBERTS G . Osteoarthritis of the hip; a study of the clinical pathology. J Bone Joint Surg Br. 1955; 37-B(1):8-47. DOI: 10.1302/0301-620X.37B1.8. View

Argenson J, Ryembault E, Flecher X, Brassart N, Parratte S, Aubaniac J . Three-dimensional anatomy of the hip in osteoarthritis after developmental dysplasia. J Bone Joint Surg Br. 2005; 87(9):1192-6. DOI: 10.1302/0301-620X.87B9.15928. View

Argenson J, Flecher X, Parratte S, Aubaniac J . Anatomy of the dysplastic hip and consequences for total hip arthroplasty. Clin Orthop Relat Res. 2007; 465:40-5. DOI: 10.1097/BLO.0b013e3181576052. View

Sanchez-Sotelo J, Berry D, Trousdale R, Cabanela M . Surgical treatment of developmental dysplasia of the hip in adults: II. Arthroplasty options. J Am Acad Orthop Surg. 2002; 10(5):334-44. DOI: 10.5435/00124635-200209000-00005. View

Zhou Y, Shao H, Huang Y, Deng W, Yang D, Bian T . Does robotic assisted technology improve the accuracy of acetabular component positioning in patients with DDH?. J Orthop Surg (Hong Kong). 2021; 29(2):23094990211025325. DOI: 10.1177/23094990211025325. View

Hepinstall M, Mota F, Naylor B, Coden G, Muthusamy N, Salem H . Robotic-Assisted Total Hip Arthroplasty in Patients Who Have Developmental Hip Dysplasia. Surg Technol Int. 2021; 39:338-347. View

Vigdorchik J, Sharma A, Aggarwal V, Carroll K, Jerabek S . The Use of Robotic-Assisted Total Hip Arthroplasty in Developmental Dysplasia of the Hip. Arthroplast Today. 2020; 6(4):770-776. PMC: 7490591. DOI: 10.1016/j.artd.2020.07.022. View

Ranawat C, Dorr L, INGLIS A . Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. J Bone Joint Surg Am. 1980; 62(7):1059-65. View

10.

Kong X, Chai W, Chen J, Yan C, Shi L, Wang Y . Intraoperative monitoring of the femoral and sciatic nerves in total hip arthroplasty with high-riding developmental dysplasia. Bone Joint J. 2019; 101-B(11):1438-1446. DOI: 10.1302/0301-620X.101B11.BJJ-2019-0341.R2. View

11.

Zhang S, Liu Y, Yang M, Ma M, Cao Z, Kong X . Robotic-assisted versus manual total hip arthroplasty in obese patients: a retrospective case-control study. J Orthop Surg Res. 2022; 17(1):368. PMC: 9338672. DOI: 10.1186/s13018-022-03263-6. View

12.

Ovre S, Sandvik L, Madsen J, Roise O . Comparison of distribution, agreement and correlation between the original and modified Merle d'Aubigné-Postel Score and the Harris Hip Score after acetabular fracture treatment: moderate agreement, high ceiling effect and excellent correlation in.... Acta Orthop. 2006; 76(6):796-802. DOI: 10.1080/17453670510045390. View

13.

Gross J . Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983; 58(3):277-80. DOI: 10.1097/00000542-198303000-00016. View

14.

Domb B, El Bitar Y, Sadik A, Stake C, Botser I . Comparison of robotic-assisted and conventional acetabular cup placement in THA: a matched-pair controlled study. Clin Orthop Relat Res. 2013; 472(1):329-36. PMC: 3889439. DOI: 10.1007/s11999-013-3253-7. View

15.

Lewinnek G, Lewis J, Tarr R, COMPERE C, Zimmerman J . Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978; 60(2):217-20. View

16.

Callanan M, Jarrett B, Bragdon C, Zurakowski D, Rubash H, Freiberg A . The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res. 2010; 469(2):319-29. PMC: 3018230. DOI: 10.1007/s11999-010-1487-1. View

17.

Reina N, Putman S, Desmarchelier R, Sari Ali E, Chiron P, Ollivier M . Can a target zone safer than Lewinnek's safe zone be defined to prevent instability of total hip arthroplasties? Case-control study of 56 dislocated THA and 93 matched controls. Orthop Traumatol Surg Res. 2017; 103(5):657-661. DOI: 10.1016/j.otsr.2017.05.015. View

18.

Biedermann R, Tonin A, Krismer M, Rachbauer F, Eibl G, Stockl 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(6):762-9. DOI: 10.1302/0301-620X.87B6.14745. View

19.

Coulomb R, Cascales V, Haignere V, Bauzou F, Kouyoumdjian P . Does acetabular robotic-assisted total hip arthroplasty with femoral navigation improve clinical outcomes at 1-year post-operative? A case-matched propensity score study comparing 98 robotic-assisted versus 98 manual implantation hip arthroplasties. Orthop Traumatol Surg Res. 2022; 109(1):103477. DOI: 10.1016/j.otsr.2022.103477. View

20.

Grammatopoulos G, Alvand A, Monk A, Mellon S, Pandit H, Rees J . Surgeons' Accuracy in Achieving Their Desired Acetabular Component Orientation. J Bone Joint Surg Am. 2016; 98(17):e72. DOI: 10.2106/JBJS.15.01080. View