ObjectiveTo evaluate the early effectiveness of the robot-assisted total hip arthroplasty (THA) via direct superior approach (DSA).MethodsBetween 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.ResultsOne 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. ConclusionThe robot-assisted THA via DSA has encouraged early effectiveness.
【Abstract】 Objective To investigate the surgical technique and the cl inical results of total knee arthroplasty (TKA)in treating end-stage gonarthrosis combined with valgus knee deformity. Methods Between November 1998 and October2010, 64 patients (72 knees) with end-stage gonarthrosis combined with valgus knee deformity underwent TKA by a medialparapatellar approach. Of the 64 patients, 18 were male and 46 were female with an average age of 62.5 years (range, 23-82 years),including 44 cases (49 knees) of osteoarthritis, 17 cases (20 knees) of rheumatoid arthritis, 2 cases (2 knees) of haemophilicarthritis, and 1 case (1 knee) of post-traumatic arthritis. Bilateral knees were involved in 8 cases, and single knee in 56 cases. Theflexion and extension range of motion (ROM) of the knee joint was (82.2 ± 28.7)°; the femur-tibia angle (FTA) was (18.0 ± 5.8)°;according to Knee Society Score (KSS) criterion, the preoperative cl inical score was 31.2 ± 10.1 and functional score was37.3 ± 9.0. According to Krackow’s classification, there were 65 knees of type I and 7 knees of type II. By medial parapatellarapproach, conventional osteotomy and Ranawat soft tissue release were performed in all cases. Prosthesis of preserved posteriorcruciate l igament were used in 7 cases (7 knees), posterior stabil ize prosthesis in 54 cases (60 knees), constrained prosthesisin 4 cases (5 knees). Results Incisions healed by first intention in all cases. Peroneal nerve palsy occurred in 1 patient withhaemophilic arthritis, severe valgus deformity (FTA was 41°), and flexion contracture (20°), which was cured after 1 year ofconservative treatment. Revison surgery was performed in 1 case of deep infection at 2 years after surgery. All the patients werefollowed up 4.9 years on average (range, 1-13 years). At last follow-up, the FTA was (7.0 ± 2.5)°, showing significant differencewhen compared with preoperative value (t=15.502, P=0.000). The KSS cl inical score was 83.0 ± 6.6 and functional score was85.1 ± 10.5, the flexion and extension ROM of the knee joint was (106.1 ± 17.0)°, all showing significant differences whencompared with preoperative values (P lt; 0.05). Five patients had 12-15° valgus knee deformity, but the function of the affectknees were good. Conclusion TKA is an effective way for the patients with end-stage gonarthrosis combined with valgusknee deformity by medial parapatellar approach combined with conventional osteotomy and Ranawat soft tissue release. Thecorrection of deformity and improvement of joint function can be achieved significantly. The cl inical result is satisfactory.