Early effectiveness of robot-assisted total hip arthroplasty via direct superior approach_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Ji , WANG Xingshan , YANG Dejin ,  ZHOU Yixin

Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, 100035, P.R.China;

Corresponding author：

ZHOU Yixin, Email: orthoyixin@yahoo.com

Keywords：

Robot-assisted total hip arthroplasty; Mako robot; direct superior approach; total hip arthroplasty; minimally invasive surgery

DOI：

10.7507/1002-1892.202105115

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Objective To evaluate the early effectiveness of the robot-assisted total hip arthroplasty (THA) via direct superior approach (DSA).Methods Between March 2021 and April 2021, 11 patients (11 hips) were treated with a robot-assisted THA via DSA. There were 7 males and 4 females, with an average age of 55 years (range, 26-73 years). There were 5 patients of osteoarthritis secondary to hip dysplasia and 6 patients of osteonecrosis of femoral head. Preoperative hip Harris score was 55.8±6.3. The operation time, volume of blood loss, length of incision, postoperative blood transfusion and hospital stay, and the incidence of surgical complications were recorded. The visual analogue scale (VAS) score and Harris score were used to evaluate hip joint pain and function. The leg length discrepancy (LLD) was measured on the X-ray films. The inclination angle and anteversion angle of the acetabular component were also measured, and the difference between the planned and actual values were compared.Results One THA was performed via conventional posterolateral approach finally because of poor exposure. The rest of 10 THAs were performed with assistance of robotic arm via DSA. The average operation time was 89 minutes (range, 65-120 minutes); the average length of incision was 10.5 cm (range, 9-13 cm); and the average blood loss was 400 mL (range, 110-740 mL). One patient was given a blood transfusion for 2 unit. All incisions healed by first intention and no neurovascular injury, deep vein thrombosis, or fracture occurred. The length of hospital stay after operation was 2-6 days (mean, 4.4 days). The duration of follow-up was 1-3 months (mean, 2.1 months). The VAS score was 0 in 9 patients and 2 in 1 patient at the day of discharge. At last follow-up, the hip Harris score was 84.9±6.7, showing significant difference when compared with that before operation (t=−8.717, P=0.000). The inclination and anteversion angles were (37.4±2.0)° and (17.1±4.5)°, respectively, and there was no significant difference when compared with the planned values [(38.2±1.6)°, (16.6±3.7)°] (t=1.809, P=0.104; t=–1.103, P=0.299). The LLD ranged from –2 to 4 mm. No complication such as dislocation, aseptic loosening, or periprosthetic joint infection occurred. Conclusion The robot-assisted THA via DSA has encouraged early effectiveness.

Citation： ZHANG Ji, WANG Xingshan, YANG Dejin, ZHOU Yixin. Early effectiveness of robot-assisted total hip arthroplasty via direct superior approach. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(10): 1240-1245. doi: 10.7507/1002-1892.202105115 Copy

1.	Roger DJ, Hill D. Minimally invasive total hip arthroplasty using a transpiriformis approach: a preliminary report. Clin Orthop Relat Res, 2012, 470(8): 2227-2234.
2.	Ezzibdeh RM, Barrett AA, Arora P, et al. Learning curve for the direct superior approach to total hip arthroplasty. Orthopedics, 2020, 43(4): e237-e243.
3.	Duijnisveld BJ, van den Hout JAAM, Wagenmakers R, et al. No learning curve of the direct superior approach in total hip arthroplasty. Orthop Surg, 2020, 12(3): 852-860.
4.	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.
5.	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.
6.	Redmond JM, Gupta A, Hammarstedt JE, et al. Accuracy of component placement in robotic-assisted total hip arthroplasty. Orthopedics, 2016, 39(3): 193-199.
7.	Illgen RL, Bukowski BR, Abiola R, et al. Robotic-assisted total hip arthroplasty: outcomes at minimum two-year follow-up. Surg Technol Int, 2017, 30: 365-372.
8.	Xu S, Bernardo LIC, Yew AKS, et al. Robotic-arm assisted direct anterior total hip arthroplasty; Improving implant accuracy. Surg Technol Int, 2020, 38: sti38/1368. doi: 10.52198/21.STI.38.OS1368.
9.	Perazzini P, Trevisan M, Sembenini P, et al. The Mako^TM robotic arm-assisted total hip arthroplasty using direct anterior approach: surgical technique, skills and pitfals. Acta Biomed, 2020, 91(4-S): 21-30.
10.	Bourke DL, Smith TC. Estimating allowable hemodilution. Anesthesiology, 1974, 41(6): 609-612.
11.	Yoo JI, Cha YH, Kim KJ, et al. Gait analysis after total hip arthroplasty using direct anterior approach versus anterolateral approach: a systematic review and meta-analysis. BMC Musculoskelet Disord, 2019, 20(1): 63. doi: 10.1186/s12891-019-2450-2.
12.	Yang XT, Huang HF, Sun L, et al. Direct anterior approach versus posterolateral approach in total hip arthroplasty: A systematic review and meta-analysis of randomized cntrolled studies. Orthop Surg, 2020, 12(4): 1065-1073.
13.	Ulivi M, Orlandini L, Vitale JA, et al. Direct superior approach versus posterolateral approach in total hip arthroplasty: a randomized controlled trial on early outcomes on gait, risk of fall, clinical and self-reported measurements. Acta Orthop, 2021, 92(3): 274-279.
14.	Klasan A, Neri T, Oberkircher L, et al. Complications after direct anterior versus Watson-Jones approach in total hip arthroplasty: results from a matched pair analysis on 1408 patients. BMC Musculoskelet Disord, 2019, 20(1): 77. doi: 10.1186/s12891-019-2463-x.
15.	Hadley CJ, Grossman EL, Mont MA, et al. Robotic-assisted versus manually implanted total hip arthroplasty: A clinical and radiographic comparison. Surg Technol Int, 2020, 37: 371-376.
16.	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.
17.	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.
18.	Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty, 2013, 28(9): 1634-1638.
19.	Zhao HY, Kang PD, Xia YY, et al. Comparison of early functional recovery after total hip arthroplasty using a direct anterior or posterolateral approach: A randomized controlled trial. J Arthroplasty, 2017, 32(11): 3421-3428.
20.	Herndon CL, Drummond N, Sarpong NO, et al. Direct anterior versus mini-anterolateral approach for primary total hip arthroplasty: early postoperative outcomes and complications. Arthroplast Today, 2020, 6(2): 257-261.
21.	Moerenhout K, Derome P, Laflamme GY, et al. Direct anterior versus posterior approach for total hip arthroplasty: a multicentre, prospective, randomized clinical trial. Can J Surg, 2020, 63(5): E412-E417.

1. Roger DJ, Hill D. Minimally invasive total hip arthroplasty using a transpiriformis approach: a preliminary report. Clin Orthop Relat Res, 2012, 470(8): 2227-2234.
2. Ezzibdeh RM, Barrett AA, Arora P, et al. Learning curve for the direct superior approach to total hip arthroplasty. Orthopedics, 2020, 43(4): e237-e243.
3. Duijnisveld BJ, van den Hout JAAM, Wagenmakers R, et al. No learning curve of the direct superior approach in total hip arthroplasty. Orthop Surg, 2020, 12(3): 852-860.
4. 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.
5. 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.
6. Redmond JM, Gupta A, Hammarstedt JE, et al. Accuracy of component placement in robotic-assisted total hip arthroplasty. Orthopedics, 2016, 39(3): 193-199.
7. Illgen RL, Bukowski BR, Abiola R, et al. Robotic-assisted total hip arthroplasty: outcomes at minimum two-year follow-up. Surg Technol Int, 2017, 30: 365-372.
8. Xu S, Bernardo LIC, Yew AKS, et al. Robotic-arm assisted direct anterior total hip arthroplasty; Improving implant accuracy. Surg Technol Int, 2020, 38: sti38/1368. doi: 10.52198/21.STI.38.OS1368.
9. Perazzini P, Trevisan M, Sembenini P, et al. The Mako^TM robotic arm-assisted total hip arthroplasty using direct anterior approach: surgical technique, skills and pitfals. Acta Biomed, 2020, 91(4-S): 21-30.
10. Bourke DL, Smith TC. Estimating allowable hemodilution. Anesthesiology, 1974, 41(6): 609-612.
11. Yoo JI, Cha YH, Kim KJ, et al. Gait analysis after total hip arthroplasty using direct anterior approach versus anterolateral approach: a systematic review and meta-analysis. BMC Musculoskelet Disord, 2019, 20(1): 63. doi: 10.1186/s12891-019-2450-2.
12. Yang XT, Huang HF, Sun L, et al. Direct anterior approach versus posterolateral approach in total hip arthroplasty: A systematic review and meta-analysis of randomized cntrolled studies. Orthop Surg, 2020, 12(4): 1065-1073.
13. Ulivi M, Orlandini L, Vitale JA, et al. Direct superior approach versus posterolateral approach in total hip arthroplasty: a randomized controlled trial on early outcomes on gait, risk of fall, clinical and self-reported measurements. Acta Orthop, 2021, 92(3): 274-279.
14. Klasan A, Neri T, Oberkircher L, et al. Complications after direct anterior versus Watson-Jones approach in total hip arthroplasty: results from a matched pair analysis on 1408 patients. BMC Musculoskelet Disord, 2019, 20(1): 77. doi: 10.1186/s12891-019-2463-x.
15. Hadley CJ, Grossman EL, Mont MA, et al. Robotic-assisted versus manually implanted total hip arthroplasty: A clinical and radiographic comparison. Surg Technol Int, 2020, 37: 371-376.
16. 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.
17. 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.
18. Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty, 2013, 28(9): 1634-1638.
19. Zhao HY, Kang PD, Xia YY, et al. Comparison of early functional recovery after total hip arthroplasty using a direct anterior or posterolateral approach: A randomized controlled trial. J Arthroplasty, 2017, 32(11): 3421-3428.
20. Herndon CL, Drummond N, Sarpong NO, et al. Direct anterior versus mini-anterolateral approach for primary total hip arthroplasty: early postoperative outcomes and complications. Arthroplast Today, 2020, 6(2): 257-261.
21. Moerenhout K, Derome P, Laflamme GY, et al. Direct anterior versus posterior approach for total hip arthroplasty: a multicentre, prospective, randomized clinical trial. Can J Surg, 2020, 63(5): E412-E417.

Chinese Journal of Reparative and Reconstructive Surgery

Early effectiveness of robot-assisted total hip arthroplasty via direct superior approach

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