Application of Mako robot-assisted total hip arthroplasty in developmental dysplasia of the hip_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Gujun ^1,2 , MA Mingyang ^1,3,4 , ZHANG Shuai ^1,3,4 , LIU Yubo ^1,3,5 ,  KONG Xiangpeng ^1,3 ,  CHAI Wei ^1,3

1. Senior Department of Orthopedics, the Fourth Medical Centre of Chinese PLA General Hospital, Beijing, 100048, P.R.China;
2. Department of Orthopedics, Huludao Central Hospital, Huludao Liaoning, 125001, P.R.China;
3. National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, 100048, P.R.China;
4. Medical School of Chinese PLA, Beijing, 100853, P.R.China;
5. School of Medicine, Nankai University, Tianjin, 300000, P.R.China;

Corresponding author：

KONG Xiangpeng, Email: 18810999609@163.com; CHAI Wei, Email: chaiwei301@163.com

Keywords：

Robot-assisted total hip arthroplasty; Mako robot; developmental dysplasia of the hip; adult

DOI：

10.7507/1002-1892.202105013

Video：

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Objective To evaluate the early effectiveness and summarize the initial application experiences of Mako robot-assisted total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) in adults. Methods Between August 2018 and January 2020, 55 cases of DDH (75 hips) were treated with Mako robot-assisted THA. There were 10 males and 45 females with an average age of 51 years (range, 30-73 years). There were 35 cases of unilateral hip and 20 cases of bilateral hips. The DDH was classified as Crowe type Ⅰin 29 hips, type Ⅱ in 20 hips, type Ⅲ in 6 hips, and type Ⅳ in 20 hips. The modified Harris score was 54.8±16.0, the hip joint range of motion was 90° (80°, 100°), and the leg length discrepancy (LLD) was 22.0 (10.5, 47.0) mm. The preoperative surgical plan was made in the robot system based on the CT data. The reaming and installation of the acetabular cup were completed with the assistance of the robot system. The distance between the rotation center of the hip joint and the teardrop (horizontal distance, vertical distance), inclination angle, and anteversion angle were measured on the pelvic X-ray film to evaluate the position of the acetabular prosthesis. The above indicators were compared with preoperative planning to evaluate the accuracy of robotic-assisted surgery. The modified Harris score, the range of motion, and the LLD were used to evaluate the early effectiveness. Results The 75 hips of THAs were completed with the assistance of Mako robots. There was no significant difference in the acetabular inclination angle, the horizontal distance and the vertical distance of the rotation center between the preoperative planning and the postoperative measurement values (P>0.05); the acetabular anteversion angle was significantly smaller than the postoperative measurement value (t=–2.482, P=0.015). Four hips located beyond the Lewinnek safety zone, and 71 hips located within the Lewinnek safety zone. All patients followed up 6-24 months (mean, 13 months). All incisions healed by first intention. At last follow-up, the modified Harris score was 85.5±11.2, the hip joint range of motion was 120° (110°, 120°), and the LLD was 3.8 (2.0, 8.1) mm; all improved significantly compared with preoperative ones (P<0.05). Except for one nerve injury case, there was no other complication. Conclusion Mako robot-assisted THA is a safe and effective method for adult DDH, which can optimize the acetabular cup positioning, hip function, and leg length, but the long-term effectiveness needs to be confirmed by further studies.

Citation： XU Gujun, MA Mingyang, ZHANG Shuai, LIU Yubo, KONG Xiangpeng, CHAI Wei. Application of Mako robot-assisted total hip arthroplasty in developmental dysplasia of the hip. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(10): 1233-1239. doi: 10.7507/1002-1892.202105013 Copy

1.	Caton J, Prudhon JL. Over 25 years survival after Charnley’s total hip arthroplasty. Int Orthop, 2011, 35(2): 185-188.
2.	Carter AH, Sheehan EC, Mortazavi SM, et al. Revision for recurrent instability: what are the predictors of failure? J Arthroplasty, 2011, 26(6 Suppl): 46-52.
3.	Mohan Kumar EG, Yathisha Kumar GM, Noorudheen M. Challenges and outcome of total hip arthroplasty in patients with developmental dysplasia of the hip: a clinical series with a spectrum of disease manifestation and technical notes. International Journal of Research in Orthopaedics, 2018, 4(2). doi: 10.18203/issn.2455-4510.IntJResOrthop20180689.
4.	van Bosse H, Wedge JH, Babyn P. How are dysplastic hips different? A three-dimensional CT study. Clin Orthop Relat Res, 2015, 473(5): 1712-1723.
5.	Nodzo SR, Chang CC, Carroll KM, et al. Intraoperative placement of total hip arthroplasty components with robotic-arm assisted technology correlates with postoperative implant position: a CT-based study. Bone Joint J, 2018, 100-B(10): 1303-1309.
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.	Chai W, Kong X, Yang M, et al. Robot-assisted total hip arthroplasty for arthrodesed hips. Ther Clin Risk Manag, 2020, 16: 357-368.
8.	郭人文, 柴伟, 李想, 等. 机器人辅助在股骨头坏死全髋关节置换术中的应用. 中华骨科杂志, 2020, 40(13): 819-827.
9.	Chai W, Guo RW, Puah KL, et al. Use of robotic-arm assisted technique in complex primary total hip arthroplasty. Orthop Surg, 2020, 12(2): 686-691.
10.	宋平, 孔祥朋, 李想, 等. 机器人辅助全髋关节置换术在伴有髋臼内固定的患者中的应用. 中华外科杂志, 2020, 58(12): 947-950.
11.	Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
12.	Biedermann R, Tonin A, Krismer M, et al. 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): 762-769.
13.	Grammatopoulos G, Alvand A, Monk AP, et al. Surgeons’ accuracy in achieving their desired acetabular component orientation. J Bone Joint Surg (Am), 2016, 98(17): e72. doi: 10.2106/JBJS.15.01080.
14.	Callanan MC, Jarrett B, Bragdon CR, et al. The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res, 2011, 469(2): 319-329.
15.	Kanawade V, Dorr LD, Banks SA, et al. Precision of robotic guided instrumentation for acetabular component positioning. J Arthroplasty, 2015, 30(3): 392-397.
16.	Domb BG, Redmond JM, Louis SS, et al. Accuracy of component positioning in 1980 total hip arthroplasties: A comparative analysis by surgical technique and mode of guidance. J Arthroplasty, 2015, 30(12): 2208-2218.
17.	Sakellariou VI, Christodoulou M, Sasalos G, et al. Reconstruction of the acetabulum in developmental dysplasia of the hip in total hip replacement. Arch Bone Jt Surg, 2014, 2(3): 130-136.
18.	Tarwala R, Dorr LD. Robotic assisted total hip arthroplasty using the MAKO platform. Curr Rev Musculoskelet Med, 2011, 4(3): 151-156.
19.	Wang L, Trousdale RT, Ai S, et al. Dislocation after total hip arthroplasty among patients with developmental dysplasia of the hip. J Arthroplasty, 2012, 27(5): 764-769.
20.	Suarez-Ahedo C, Gui C, Martin TJ, et al. Robotic-arm assisted total hip arthroplasty results in smaller acetabular cup size in relation to the femoral head size: a matched-pair controlled study. Hip Int, 2017, 27(2): 147-152.
21.	Sariali E, Klouche S, Mouttet A, et al. The effect of femoral offset modification on gait after total hip arthroplasty. Acta Orthop, 2014, 85(2): 123-127.
22.	El Bitar YF, Jackson TJ, Lindner D, et al. Predictive value of robotic-assisted total hip arthroplasty. Orthopedics, 2015, 38(1): e31-e37.
23.	Tsai TY, Dimitriou D, Li JS, et al. Does haptic robot-assisted total hip arthroplasty better restore native acetabular and femoral anatomy? Int J Med Robot, 2016, 12(2): 288-295.
24.	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.
25.	Bargar WL, Bauer A, Börner M. Primary and revision total hip replacement using the Robodoc system. Clin Orthop Relat Res, 1998, (354): 82-91.
26.	Kayani B, Konan S, Ayuob A, et al. The current role of robotics in total hip arthroplasty. EFORT Open Rev, 2019, 4(11): 618-625.
27.	Kong X, Yang M, Jerabek S, et al. A retrospective study comparing a single surgeon’s experience on manual versus robot-assisted total hip arthroplasty after the learning curve of the latter procedure—A cohort study. Int J Surg, 2020, 77: 174-180.
28.	Perets I, Walsh JP, Mu BH, et al. Short-term clinical outcomes of robotic-arm assisted total hip arthroplasty: A pair-matched controlled study. Orthopedics, 2021, 44(2): e236-e242.

1. Caton J, Prudhon JL. Over 25 years survival after Charnley’s total hip arthroplasty. Int Orthop, 2011, 35(2): 185-188.
2. Carter AH, Sheehan EC, Mortazavi SM, et al. Revision for recurrent instability: what are the predictors of failure? J Arthroplasty, 2011, 26(6 Suppl): 46-52.
3. Mohan Kumar EG, Yathisha Kumar GM, Noorudheen M. Challenges and outcome of total hip arthroplasty in patients with developmental dysplasia of the hip: a clinical series with a spectrum of disease manifestation and technical notes. International Journal of Research in Orthopaedics, 2018, 4(2). doi: 10.18203/issn.2455-4510.IntJResOrthop20180689.
4. van Bosse H, Wedge JH, Babyn P. How are dysplastic hips different? A three-dimensional CT study. Clin Orthop Relat Res, 2015, 473(5): 1712-1723.
5. Nodzo SR, Chang CC, Carroll KM, et al. Intraoperative placement of total hip arthroplasty components with robotic-arm assisted technology correlates with postoperative implant position: a CT-based study. Bone Joint J, 2018, 100-B(10): 1303-1309.
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. Chai W, Kong X, Yang M, et al. Robot-assisted total hip arthroplasty for arthrodesed hips. Ther Clin Risk Manag, 2020, 16: 357-368.
8. 郭人文, 柴伟, 李想, 等. 机器人辅助在股骨头坏死全髋关节置换术中的应用. 中华骨科杂志, 2020, 40(13): 819-827.
9. Chai W, Guo RW, Puah KL, et al. Use of robotic-arm assisted technique in complex primary total hip arthroplasty. Orthop Surg, 2020, 12(2): 686-691.
10. 宋平, 孔祥朋, 李想, 等. 机器人辅助全髋关节置换术在伴有髋臼内固定的患者中的应用. 中华外科杂志, 2020, 58(12): 947-950.
11. Lewinnek GE, Lewis JL, Tarr R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg (Am), 1978, 60(2): 217-220.
12. Biedermann R, Tonin A, Krismer M, et al. 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): 762-769.
13. Grammatopoulos G, Alvand A, Monk AP, et al. Surgeons’ accuracy in achieving their desired acetabular component orientation. J Bone Joint Surg (Am), 2016, 98(17): e72. doi: 10.2106/JBJS.15.01080.
14. Callanan MC, Jarrett B, Bragdon CR, et al. The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res, 2011, 469(2): 319-329.
15. Kanawade V, Dorr LD, Banks SA, et al. Precision of robotic guided instrumentation for acetabular component positioning. J Arthroplasty, 2015, 30(3): 392-397.
16. Domb BG, Redmond JM, Louis SS, et al. Accuracy of component positioning in 1980 total hip arthroplasties: A comparative analysis by surgical technique and mode of guidance. J Arthroplasty, 2015, 30(12): 2208-2218.
17. Sakellariou VI, Christodoulou M, Sasalos G, et al. Reconstruction of the acetabulum in developmental dysplasia of the hip in total hip replacement. Arch Bone Jt Surg, 2014, 2(3): 130-136.
18. Tarwala R, Dorr LD. Robotic assisted total hip arthroplasty using the MAKO platform. Curr Rev Musculoskelet Med, 2011, 4(3): 151-156.
19. Wang L, Trousdale RT, Ai S, et al. Dislocation after total hip arthroplasty among patients with developmental dysplasia of the hip. J Arthroplasty, 2012, 27(5): 764-769.
20. Suarez-Ahedo C, Gui C, Martin TJ, et al. Robotic-arm assisted total hip arthroplasty results in smaller acetabular cup size in relation to the femoral head size: a matched-pair controlled study. Hip Int, 2017, 27(2): 147-152.
21. Sariali E, Klouche S, Mouttet A, et al. The effect of femoral offset modification on gait after total hip arthroplasty. Acta Orthop, 2014, 85(2): 123-127.
22. El Bitar YF, Jackson TJ, Lindner D, et al. Predictive value of robotic-assisted total hip arthroplasty. Orthopedics, 2015, 38(1): e31-e37.
23. Tsai TY, Dimitriou D, Li JS, et al. Does haptic robot-assisted total hip arthroplasty better restore native acetabular and femoral anatomy? Int J Med Robot, 2016, 12(2): 288-295.
24. 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.
25. Bargar WL, Bauer A, Börner M. Primary and revision total hip replacement using the Robodoc system. Clin Orthop Relat Res, 1998, (354): 82-91.
26. Kayani B, Konan S, Ayuob A, et al. The current role of robotics in total hip arthroplasty. EFORT Open Rev, 2019, 4(11): 618-625.
27. Kong X, Yang M, Jerabek S, et al. A retrospective study comparing a single surgeon’s experience on manual versus robot-assisted total hip arthroplasty after the learning curve of the latter procedure—A cohort study. Int J Surg, 2020, 77: 174-180.
28. Perets I, Walsh JP, Mu BH, et al. Short-term clinical outcomes of robotic-arm assisted total hip arthroplasty: A pair-matched controlled study. Orthopedics, 2021, 44(2): e236-e242.

Chinese Journal of Reparative and Reconstructive Surgery

Application of Mako robot-assisted total hip arthroplasty in developmental dysplasia of the hip

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