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Improved accuracy of a novel fluoroscopy-based robotically assisted THA system compared to manual THA

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Abstract

Accurate acetabular cup position remains a persistent challenge in total hip arthroplasty (THA). Studies investigating the early outcomes of robotic-assisted THA (RA-THA) systems have shown improved cup placement compared to manual THA (mTHA) approaches, however, contemporary robotic platforms are reliant on pre-operative CT imaging. The goal of this study was to analyze the accuracy of a novel, fluoroscopy-based RA-THA system compared to an unassisted mTHA approach and determine the effect of the robotic system on operative time. We performed a retrospective cohort analysis on a consecutive series of 198 patients who received mTHA and RA-THA between March 2021 and July 2022. The primary outcome of interest was the accuracy of acetabular component placement, defined by average cup inclination and anteversion. Secondary outcomes included the proportion of acetabular cups positioned within the Lewinnek safe zone, operative time, and overall room time. The RA-THA group demonstrated significantly higher accuracy of acetabular anteversion to target compared to the manual group (18.5 vs. 21.7˚; p < 0.001), and had a significantly greater proportion of acetabular cups placed within the Lewinnek safe zone (81.6 vs. 59.0%; p < 0.001). The RA-THA cohort had longer operative times compared to mTHA group (39.0 vs. 35.3 min; p = 0.003), but no difference was seen in total operating room time (101.2 vs. 101.2 min; p = 0.982). This study demonstrates that the use of a novel, fluoroscopy-based, pin-less THA robotic platform increased the accuracy of acetabular cup placement, including a 22.6% improvement in safe zone placement, compared to mTHA approach, with no increase in overall case time.

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Data availability

The data used to support the findings of this study are available from the corresponding author upon request.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Graham B. J. Buchan, Christian J. Hecht II & Atul F. Kamath

  2. Gold Coast Centre for Bone and Joint Surgery, 14 Sixth Ave, Palm Beach, QLD, 4421, Australia

    David Liu

  3. Consultant Orthopaedic Surgeon, Charlotte Maxeke Johannesburg Academic Hospital, Busamed Modderfontein Hospital, Lecture University of the Witwatersand, 4 Cransley Crescent, Linbro Park, Sandton, Johannesburg, 2190, South Africa

    Lipalo Mokete

  4. Chefarzt Zentrum für Orthopädie und Unfallchirurgie, HELIOS Kliniken Berlin-Buch, Schwanebecker Chaussee 25, 13125, Berlin, Germany

    Daniel Kendoff

Authors
  1. Graham B. J. Buchan
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  2. Christian J. Hecht II
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  3. David Liu
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  4. Lipalo Mokete
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  6. Atul F. Kamath
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by GBJB and CJH. The first draft of the manuscript was written by GBJB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Atul F. Kamath.

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Conflict of interest

GBJB and CJH declare they have no competing interests. DK serves on the speakers’ bureau and receives royalties from Zimmer Biomet. DL serves on the speakers’ bureau, is a paid consultant, and receives royalties and research support from Zimmer Biomet. LM is a paid consultant and receives research support from Zimmer Biomet. AFK serves on the speakers’ bureau, is a paid consultant, and owns stock or stock options in Zimmer Biomet.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Cleveland Clinic Foundation Institutional Review Board (June 3rd, 2022/ No. 22-528).

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Buchan, G.B.J., Hecht, C.J., Liu, D. et al. Improved accuracy of a novel fluoroscopy-based robotically assisted THA system compared to manual THA. J Robotic Surg 17, 2073–2079 (2023). https://doi.org/10.1007/s11701-023-01623-w

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  • DOI: https://doi.org/10.1007/s11701-023-01623-w

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