Clinical Orthopaedics and Related Research®

, Volume 472, Issue 1, pp 329–336 | Cite as

Comparison of Robotic-assisted and Conventional Acetabular Cup Placement in THA: A Matched-pair Controlled Study

  • Benjamin G. Domb
  • Youssef F. El Bitar
  • Adam Y. Sadik
  • Christine E. Stake
  • Itamar B. Botser
Clinical Research

Abstract

Background

Improper acetabular component orientation in THA has been associated with increased dislocation rates, component impingement, bearing surface wear, and a greater likelihood of revision. Therefore, any reasonable steps to improve acetabular component orientation should be considered and explored.

Questions/purposes

We therefore sought to compare THA with a robotic-assisted posterior approach with manual alignment techniques through a posterior approach, using a matched-pair controlled study design, to assess whether the use of the robot made it more likely for the acetabular cup to be positioned in the safe zones described by Lewinnek et al. and Callanan et al.

Methods

Between September 2008 and September 2012, 160 THAs were performed by the senior surgeon. Sixty-two patients (38.8%) underwent THA using a conventional posterior approach, 69 (43.1%) underwent robotic-assisted THA using the posterior approach, and 29 (18.1%) underwent radiographic-guided anterior-approach THAs. From September 2008 to June 2011, all patients were offered anterior or posterior approaches regardless of BMI and anatomy. Since introduction of the robot in June 2011, all THAs were performed using the robotic technique through the posterior approach, unless a patient specifically requested otherwise. The radiographic cup positioning of the robotic-assisted THAs was compared with a matched-pair control group of conventional THAs performed by the same surgeon through the same posterior approach. The safe zone (inclination, 30°–50°; anteversion, 5°–25°) described by Lewinnek et al. and the modified safe zone (inclination, 30°–45°; anteversion, 5°–25°) of Callanan et al. were used for cup placement assessment. Matching criteria were gender, age ± 5 years, and (BMI) ± 7 units. After exclusions, a total of 50 THAs were included in each group. Strong interobserver and intraobserver correlations were found for all radiographic measurements (r > 0.82; p < 0.001).

Results

One hundred percent (50/50) of the robotic-assisted THAs were within the safe zone described by Lewinnek et al. compared with 80% (40/50) of the conventional THAs (p = 0.001). Ninety-two percent (46/50) of robotic-assisted THAs were within the modified safe zone described by Callanan et al. compared with 62% (31/50) of conventional THAs p (p = 0.001). The odds ratios for an implanted cup out of the safe zones of Lewinnek et al. and Callanan et al. were zero and 0.142, respectively (95% CI, 0.044, 0.457).

Conclusions

Use of the robot allowed for improvement in placement of the cup in both safe zones, an important parameter that plays a significant role in long-term success of THA. However, whether the radiographic improvements we observed will translate into clinical benefits for patients—such as reductions in component impingement, acetabular wear, and prosthetic dislocations, or in terms of improved longevity—remains unproven.

Level of Evidence

Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Notes

Acknowledgments

We thank Zachary Finley BA, Ryan Baise BS, Jennifer C. Stone MA, and Anthony P. Trenga BA for assistance with data collection and analysis and literature review.

References

  1. 1.
    Ali Khan MA, Brakenbury PH, Reynolds IS. Dislocation following total hip replacement. J Bone Joint Surg Br. 1981;63:214–218.PubMedGoogle Scholar
  2. 2.
    Archbold HA, Mockford B, Molloy D, McConway J, Ogonda L, Beverland D. The transverse acetabular ligament: an aid to orientation of the acetabular component during primary total hip replacement: a preliminary study of 1000 cases investigating postoperative stability. J Bone Joint Surg Br. 2006;88:883–886.PubMedCrossRefGoogle Scholar
  3. 3.
    Beverland D. The transverse acetabular ligament: optimizing version. Orthopedics. 2010;33:631.PubMedGoogle Scholar
  4. 4.
    Biedermann R, Tonin A, Krismer M, Rachbauer F, Eibl G, Stockl B. Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component. J Bone Joint Surg Br. 2005;87:762–769.PubMedCrossRefGoogle Scholar
  5. 5.
    Callanan MC, Jarrett B, Bragdon CR, Zurakowski D, Rubash HE, Freiberg AA, Malchau H. The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res. 2011;469:319–329.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    De Haan R, Pattyn C, Gill HS, Murray DW, Campbell PA, De Smet K. Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. J Bone Joint Surg Br. 2008;90:1291–1297.PubMedCrossRefGoogle Scholar
  7. 7.
    Digioia AM 3rd, Jaramaz B, Plakseychuk AY, Moody JE Jr, Nikou C, Labarca RS, Levison TJ, Picard F. Comparison of a mechanical acetabular alignment guide with computer placement of the socket. J Arthroplasty. 2002;17:359–364.PubMedCrossRefGoogle Scholar
  8. 8.
    Dorr LD. Acetabular cup position: the imperative of getting it right. Orthopedics. 2008;31:898–899.PubMedCrossRefGoogle Scholar
  9. 9.
    Dorr LD, Malik A, Dastane M, Wan Z. Combined anteversion technique for total hip arthroplasty. Clin Orthop Relat Res. 2009;467:119–127.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Epstein NJ, Woolson ST, Giori NJ. Acetabular component positioning using the transverse acetabular ligament: can you find it and does it help? Clin Orthop Relat Res. 2011;469:412–416.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Gallo J, Havranek V, Zapletalova J. Risk factors for accelerated polyethylene wear and osteolysis in ABG I total hip arthroplasty. Int Orthop. 2010;34:19–26.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Ha YC, Yoo JJ, Lee YK, Kim JY, Koo KH. Acetabular component positioning using anatomic landmarks of the acetabulum. Clin Orthop Relat Res. 2012;470:3515–3523.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Haaker RG, Tiedjen K, Ottersbach A, Rubenthaler F, Stockheim M, Stiehl JB. Comparison of conventional versus computer-navigated acetabular component insertion. J Arthroplasty. 2007;22:151–159.PubMedCrossRefGoogle Scholar
  14. 14.
    Hassan DM, Johnston GH, Dust WN, Watson G, Dolovich AT. Accuracy of intraoperative assessment of acetabular prosthesis placement. J Arthroplasty. 1998;13:80–84.PubMedCrossRefGoogle Scholar
  15. 15.
    Hohmann E, Bryant A, Tetsworth K. A comparison between imageless navigated and manual freehand technique acetabular cup placement in total hip arthroplasty. J Arthroplasty. 2011;26:1078–1082.PubMedCrossRefGoogle Scholar
  16. 16.
    Jaramaz B, DiGioia AM 3rd, Blackwell M, Nikou C. Computer assisted measurement of cup placement in total hip replacement. Clin Orthop Relat Res. 1998;354:70–81.PubMedCrossRefGoogle Scholar
  17. 17.
    Jolles BM, Genoud P, Hoffmeyer P. Computer-assisted cup placement techniques in total hip arthroplasty improve accuracy of placement. Clin Orthop Relat Res. 2004;426:174–179.PubMedCrossRefGoogle Scholar
  18. 18.
    Kalteis T, Handel M, Bathis H, Perlick L, Tingart M, Grifka J. Imageless navigation for insertion of the acetabular component in total hip arthroplasty: is it as accurate as CT-based navigation? J Bone Joint Surg Br. 2006;88:163–167.PubMedCrossRefGoogle Scholar
  19. 19.
    Kalteis T, Handel M, Herold T, Perlick L, Baethis H, Grifka J. Greater accuracy in positioning of the acetabular cup by using an image-free navigation system. Int Orthop. 2005;29:272–276.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Kalteis T, Sendtner E, Beverland D, Archbold PA, Hube R, Schuster T, Renkawitz T, Grifka J. The role of the transverse acetabular ligament for acetabular component orientation in total hip replacement: an analysis of acetabular component position and range of movement using navigation software. J Bone Joint Surg Br. 2011;93:1021–1026.PubMedCrossRefGoogle Scholar
  21. 21.
    Kennedy JG, Rogers WB, Soffe KE, Sullivan RJ, Griffen DG, Sheehan LJ. Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration. J Arthroplasty. 1998;13:530–534.PubMedCrossRefGoogle Scholar
  22. 22.
    Kumar PG, Kirmani SJ, Humberg H, Kavarthapu V, Li P. Reproducibility and accuracy of templating uncemented THA with digital radiographic and digital TraumaCad templating software. Orthopedics. 2009;32:815.PubMedGoogle Scholar
  23. 23.
    Kummer FJ, Shah S, Iyer S, DiCesare PE. The effect of acetabular cup orientations on limiting hip rotation. J Arthroplasty. 1999;14:509–513.PubMedCrossRefGoogle Scholar
  24. 24.
    Leenders T, Vandevelde D, Mahieu G, Nuyts R. Reduction in variability of acetabular cup abduction using computer assisted surgery: a prospective and randomized study. Comput Aided Surg. 2002;7:99–106.PubMedCrossRefGoogle Scholar
  25. 25.
    Leslie IJ, Williams S, Isaac G, Ingham E, Fisher J. High cup angle and microseparation increase the wear of hip surface replacements. Clin Orthop Relat Res. 2009;467:2259–2265.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978;60:217–220.PubMedGoogle Scholar
  27. 27.
    McCollum DE, Gray WJ. Dislocation after total hip arthroplasty: causes and prevention. Clin Orthop Relat Res. 1990;261:159–170.PubMedGoogle Scholar
  28. 28.
    Morrey BF. Difficult complications after hip joint replacement: dislocation. Clin Orthop Relat Res. 1997;344:179–187.PubMedGoogle Scholar
  29. 29.
    Murphy SB, Ecker TM. Evaluation of a new leg length measurement algorithm in hip arthroplasty. Clin Orthop Relat Res. 2007;463:85–89.PubMedGoogle Scholar
  30. 30.
    Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg Br. 1993;75:228–232.PubMedGoogle Scholar
  31. 31.
    Parratte S, Argenson JN. Validation and usefulness of a computer-assisted cup-positioning system in total hip arthroplasty: a prospective, randomized, controlled study. J Bone Joint Surg Am. 2007;89:494–499.PubMedCrossRefGoogle Scholar
  32. 32.
    Saxler G, Marx A, Vandevelde D, Langlotz U, Tannast M, Wiese M, Michaelis U, Kemper G, Grutzner PA, Steffen R, von Knoch M, Holland-Letz T, Bernsmann K. The accuracy of free-hand cup positioning: a CT based measurement of cup placement in 105 total hip arthroplasties. Int Orthop. 2004;28:198–201.PubMedCentralPubMedGoogle Scholar
  33. 33.
    Shon WY, Baldini T, Peterson MG, Wright TM, Salvati EA. Impingement in total hip arthroplasty a study of retrieved acetabular components. J Arthroplasty. 2005;20:427–435.PubMedCrossRefGoogle Scholar
  34. 34.
    Siebenrock KA, Kalbermatten DF, Ganz R. Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers. Clin Orthop Relat Res. 2003;407:241–248.PubMedCrossRefGoogle Scholar
  35. 35.
    Steinberg EL, Shasha N, Menahem A, Dekel S. Preoperative planning of total hip replacement using the TraumaCad system. Arch Orthop Trauma Surg. 2010;130:1429–1432.PubMedCrossRefGoogle Scholar
  36. 36.
    Wan Z, Malik A, Jaramaz B, Chao L, Dorr LD. Imaging and navigation measurement of acetabular component position in THA. Clin Orthop Relat Res. 2009;467:32–42.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Westacott DJ, McArthur J, King RJ, Foguet P. Assessment of cup orientation in hip resurfacing: a comparison of TraumaCad and computed tomography. J Orthop Surg Res. 2013;8:8.PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Widmer KH, Zurfluh B. Compliant positioning of total hip components for optimal range of motion. J Orthop Res. 2004;22:815–821.PubMedCrossRefGoogle Scholar
  39. 39.
    Woo RY, Morrey BF. Dislocations after total hip arthroplasty. J Bone Joint Surg Am. 1982;64:1295–1306.PubMedGoogle Scholar
  40. 40.
    Yamaguchi M, Akisue T, Bauer TW, Hashimoto Y. The spatial location of impingement in total hip arthroplasty. J Arthroplasty. 2000;15:305–313.PubMedCrossRefGoogle Scholar
  41. 41.
    Ybinger T, Kumpan W, Hoffart HE, Muschalik B, Bullmann W, Zweymuller K. Accuracy of navigation-assisted acetabular component positioning studied by computed tomography measurements: methods and results. J Arthroplasty. 2007;22:812–817.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Benjamin G. Domb
    • 1
    • 2
    • 3
    • 4
  • Youssef F. El Bitar
    • 1
  • Adam Y. Sadik
    • 1
  • Christine E. Stake
    • 1
    • 2
  • Itamar B. Botser
    • 1
  1. 1.American Hip InstituteChicagoUSA
  2. 2.Hinsdale OrthopaedicsHinsdaleUSA
  3. 3.Loyola University Stritch School of MedicineChicagoUSA
  4. 4.American Hip Institute in ChicagoHinsdale OrthopedicsWestmontUSA

Personalised recommendations