Fluoroscopy-based robotics in total hip arthroplasty mitigates laterality-based differences in acetabular cup placement when compared to the manual, fluoroscopic- assisted technique

Issue title: Special Section: Future Arthroplasty

Guest editors: Mustafa Citak

Article type: Research Article

Authors: Ong, Christian B.^a | Buchan, Graham B.J.^a | Hecht II, Christian J.^a | Homma, Yasuhiro^{b; c} | Harmon, Daniel J.^a | Kendoff, Daniel O.^d | Petterwood, Joshua^{e; f} | Kamath, Atul F.^{a; *}

Affiliations: [a] Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA | [b] Department of Medicine for Orthopaedics and Motor Organs, Juntendo University Graduate School of Medicine, Tokyo, Japan | [c] Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan | [d] Chefarzt Zentrum für Orthopädie und Unfallchirurgie, HELIOS Kliniken Berlin-Buch, Berlin, Germany | [e] Department of Orthopaedics, Royal Hobart Hospital, Hobart, TAS, Australia | [f] Department of Orthopaedics, Calvary Hospital, Hobart, TAS, Australia

Correspondence: [*] Corresponding author: Atul F. Kamath, MD, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. Tel.: +1 216 444 2606; E-mail: kamatha@ccf.org.

Abstract: BACKGROUND: Robotic assistance in total hip arthroplasty (RA-THA) has been shown to minimize laterality-based differences in acetabular cup positioning. OBJECTIVE: To determine if the use of a novel, fluoroscopy-based RA-THA system mitigates differences in acetabular cup placement between left (L) and right (R) side hip procedures, when compared to manual, fluoroscopic-assisted technique. METHODS: We conducted a retrospective review of 106 consecutive mTHA (40 L/66 R) and 102 RA-THA (48 L/54 R) primary direct anterior approach procedures. All cases were performed by a single right-hand-dominant surgeon, for a pre-operative diagnosis of osteoarthritis, avascular necrosis, or rheumatoid arthritis. Outcomes included acetabular cup inclination and anteversion, and the proportion of cups within the Lewinnek safe-zone. RESULTS: The average inclination of mTHA L cases was smaller than that of mTHA R cases (41.10∘± 7.38 vs. 43.97∘± 6.27; p= 0.04). For RA-THA, L and R cup angles were similar. There were fewer overall mTHA hips within the Lewinnek safe-zone compared to RA-THA (0.59 vs. 0.78; p= 0.003), as well as fewer mTHA R cases than RA-THA R cases (0.59 vs. 0.80; p= 0.03) within safe zone. CONCLUSION: Use of a novel, fluoroscopy-based robotic system mitigates laterality-based differences in acetabular cup placement that were observed in a manual, fluoroscopic-assisted cohort.

Keywords: Arthroplasty, hip, acetabulum, robotic-assisted surgery, functional laterality

DOI: 10.3233/THC-231126

Journal: Technology and Health Care, vol. 32, no. 5, pp. 3693-3701, 2024