A comparative study of MAKO robotic arm assisted total hip arthroplasty and traditional total hip arthroplasty through posterolateral approach_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 CUI Keze , GUO Xiang , CHEN Yuanliang , ZHONG Haibo , HAN Guibin , LIU Yiheng

Orthopaedic Center, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou Hainan, 570208, P.R.China;

Corresponding author：

CUI Keze, Email: kezecui@163.com

Keywords：

Total hip arthroplasty; MAKO robot; posterolateral approach; function recovery

DOI：

10.7507/1002-1892.201911077

Video：

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Objective To investigate the efficacy of total hip arthroplasty (THA) assisted by the MAKO robotic arm via posterolateral approach.Methods The clinical data of 70 patients treated with THA via posterolateral approach between March 2017 and March 2019 who met the selection criteria were retrospectively analyzed. According to different treatment methods, the patients were divided into two groups, 35 were treated with MAKO robotic arm assisted THA (MAKO group) and 35 with traditional THA (THA group). There was no significant difference in gender, age, body mass index, disease duration, etiology, perioperative time, preoperative activity of daily living (ADL) scale index, American Society of Anesthesiologists (ASA) classification, walking ability, comorbidities, hemoglobin, and other general data between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, postoperative acetabular abduction and anteversion angles, postoperative length difference of bilateral lower limbs, and proportions of intraoperative blood transfusion, immediate postoperative loading, wound drainage time more than 2 days, and complications were recorded and compared between the two groups. According to the X-ray films at 6 months after operation, the reduction quality was judged. The forgotten joint score, Harris score, and proportions of independent walking and ADL index increased were used to evaluate the function recovery of patients.Results Patients in both groups were followed up 6-18 months, with an average of 8 months. There was no significant difference (P>0.05) between the two groups in operation time, intraoperative blood loss, hospital stay, acetabular abduction and anteversion angles, and length difference of both lower limbs at 6 months after operation. There was no significant difference in the proportions of intraoperative blood transfusion, immediate postoperative loading, and wound drainage time more than 2 days between the two group (P>0.05). X-ray reexamination at 6 months after operation showed that there was no significant difference in the reduction quality between the two groups (Z=4.191, P=0.123). Postoperative complications occurred in 7 patients (20.0%) in the MAKO group and 10 patients (28.6%) in the THA group, showing no significant difference in the incidence of complications between the two groups (χ²=2.121, P=0.224). Two patients (5.7%) in the MAKO group and 4 patients (11.4%) in the THA group underwent revision within 6 months, showing no significant difference in the revision rate between the two groups (χ²=0.729, P=0.673). At 3 and 6 months after operation, the proportions of independent walking and ADL index increased showed no significant difference between the two groups (P>0.05). Harris scores in both groups improved significantly when compared with preoperative scores (P<0.05); there was no significant difference in the forgotten joint scores and Harris scores between the two groups (P>0.05).Conclusion Compared with traditional THA, MAKO robotic arm assisted THA has longer operation time and more intraoperative blood loss, but it has the advantages of accurate positioning and simple operation, and there is no significant difference in short-term postoperative function recovery.

Citation： CUI Keze, GUO Xiang, CHEN Yuanliang, ZHONG Haibo, HAN Guibin, LIU Yiheng. A comparative study of MAKO robotic arm assisted total hip arthroplasty and traditional total hip arthroplasty through posterolateral approach. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(7): 883-888. doi: 10.7507/1002-1892.201911077 Copy

1.	Konan S, Duncan CP. Total hip arthroplasty in patients with neuromuscular imbalance. Bone Joint J, 2018, 100-B(1 Supple A): 17-21.
2.	Murayama T, Ohnishi H, Mori T, et al. A novel non-invasive mechanical technique of cup and stem placement and leg length adjustment in total hip arthroplasty for dysplastic hips. Int Orthop, 2015, 39(6): 1057-1064.
3.	Schultz K, Ewbank ML, Pandit HG. Changing practice for hip arthroplasty and its implications. Br J Nurs, 2017, 26(22): 1238-1244.
4.	Hassan DM, Johnston GH, Dust WN, et al. Radiographic calculation of anteversion in acetabular prostheses. J Arthroplasty, 1995, 10(3): 369-372.
5.	Barrack RL, Krempec JA, Clohisy JC, et al. Accuracy of acetabular component position in hip arthroplasty. J Bone Joint Surg (Am), 2013, 95(19): 1760-1768.
6.	Domb BG, El Bitar YF, Sadik AY, et al. Comparison of robotic-assisted and conventional acetabular cup placement in THA: a matched-pair controlled study. Clin Orthop Relat Res, 2014, 472(1): 329-336.
7.	Pivec R, Johnson AJ, Mears SC, et al. Hip arthroplasty. Lancet, 2012, 380(9855): 1768-1777.
8.	Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
9.	Weeden SH, Paprosky WG, Bowling JW. The early dislocation rate in primary total hip arthroplasty following the posterior approach with posterior soft-tissue repair. J Arthroplasty, 2003, 18(6): 709-713.
10.	Ng VY, Kean JR, Glassman AH. Limb-length discrepancy after hip arthroplasty. J Bone Joint Surg (Am), 2013, 95(15): 1426-1436.
11.	Siebel T, Käfer W. Klinisches outcome nach roboter-assistierter versus konventionell implantierter hüftendoprothetik: Prospektive, kontrollierte untersuchung von 71 patienten. Z Orthop Ihre Grenzgeb, 2005, 143(4): 391-398.
12.	Bukowski BR, Anderson P, Khlopas A, et al. Improved functional outcomes with robotic compared with manual total hip arthroplasty. Surg Technol Int, 2016, 29: 303-308.
13.	Bargar WL, Parise CA, Hankins A, et al. Fourteen year follow-up of randomized clinical trials of active robotic-assisted total hip arthroplasty. J Arthroplasty, 2018, 33(3): 810-814.
14.	Honl M, Dierk O, Gauck C, et al. Comparison of robotic-assisted and manual implantation of a primary total hip replacement. A prospective study. J Bone Joint Surg (Am), 2003, 85(8): 1470-1478.
15.	Zawadsky MW, Paulus MC, Murray PJ, et al. Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. J Arthroplasty, 2014, 29(6): 1256-1260.
16.	Redmond JM, Gupta A, Hammarstedt JE, et al. The learning curve associated with robotic-assisted total hip arthroplasty. J Arthroplasty, 2015, 30(1): 50-54.
17.	Kamara E, Robinson J, Bas MA, et al. Adoption of robotic vs fluoroscopic guidance in total hip arthroplasty: Is acetabular positioning improved in the learning curve? J Arthroplasty, 2017, 32(1): 125-130.

1. Konan S, Duncan CP. Total hip arthroplasty in patients with neuromuscular imbalance. Bone Joint J, 2018, 100-B(1 Supple A): 17-21.
2. Murayama T, Ohnishi H, Mori T, et al. A novel non-invasive mechanical technique of cup and stem placement and leg length adjustment in total hip arthroplasty for dysplastic hips. Int Orthop, 2015, 39(6): 1057-1064.
3. Schultz K, Ewbank ML, Pandit HG. Changing practice for hip arthroplasty and its implications. Br J Nurs, 2017, 26(22): 1238-1244.
4. Hassan DM, Johnston GH, Dust WN, et al. Radiographic calculation of anteversion in acetabular prostheses. J Arthroplasty, 1995, 10(3): 369-372.
5. Barrack RL, Krempec JA, Clohisy JC, et al. Accuracy of acetabular component position in hip arthroplasty. J Bone Joint Surg (Am), 2013, 95(19): 1760-1768.
6. Domb BG, El Bitar YF, Sadik AY, et al. Comparison of robotic-assisted and conventional acetabular cup placement in THA: a matched-pair controlled study. Clin Orthop Relat Res, 2014, 472(1): 329-336.
7. Pivec R, Johnson AJ, Mears SC, et al. Hip arthroplasty. Lancet, 2012, 380(9855): 1768-1777.
8. Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
9. Weeden SH, Paprosky WG, Bowling JW. The early dislocation rate in primary total hip arthroplasty following the posterior approach with posterior soft-tissue repair. J Arthroplasty, 2003, 18(6): 709-713.
10. Ng VY, Kean JR, Glassman AH. Limb-length discrepancy after hip arthroplasty. J Bone Joint Surg (Am), 2013, 95(15): 1426-1436.
11. Siebel T, Käfer W. Klinisches outcome nach roboter-assistierter versus konventionell implantierter hüftendoprothetik: Prospektive, kontrollierte untersuchung von 71 patienten. Z Orthop Ihre Grenzgeb, 2005, 143(4): 391-398.
12. Bukowski BR, Anderson P, Khlopas A, et al. Improved functional outcomes with robotic compared with manual total hip arthroplasty. Surg Technol Int, 2016, 29: 303-308.
13. Bargar WL, Parise CA, Hankins A, et al. Fourteen year follow-up of randomized clinical trials of active robotic-assisted total hip arthroplasty. J Arthroplasty, 2018, 33(3): 810-814.
14. Honl M, Dierk O, Gauck C, et al. Comparison of robotic-assisted and manual implantation of a primary total hip replacement. A prospective study. J Bone Joint Surg (Am), 2003, 85(8): 1470-1478.
15. Zawadsky MW, Paulus MC, Murray PJ, et al. Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. J Arthroplasty, 2014, 29(6): 1256-1260.
16. Redmond JM, Gupta A, Hammarstedt JE, et al. The learning curve associated with robotic-assisted total hip arthroplasty. J Arthroplasty, 2015, 30(1): 50-54.
17. Kamara E, Robinson J, Bas MA, et al. Adoption of robotic vs fluoroscopic guidance in total hip arthroplasty: Is acetabular positioning improved in the learning curve? J Arthroplasty, 2017, 32(1): 125-130.

Chinese Journal of Reparative and Reconstructive Surgery

A comparative study of MAKO robotic arm assisted total hip arthroplasty and traditional total hip arthroplasty through posterolateral approach

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