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Image-based robotic-assisted total hip arthroplasty through direct anterior approach allows a better orientation of the acetabular cup and a better restitution of the centre of rotation than a conventional procedure

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Abstract

Purpose

The aim was to investigate the contribution of robotics assisted total hip arthroplasty (THA) through direct anterior approach (DAA) in improving radiographic precision, functional results and complications.

Methods

This retrospective study compared 100 primary conventional THA (cTHA) to 50 primary robotic THA (rTHA) through DAA. All cups were placed with the objective of having no anterior overhang while respecting the safe zones (SZ). Radiographic analysis included cup inclination and anteversion, vertical and horizontal changes of the rotation centre (ΔVCOR, ΔHCOR), acetabular and femoral offset. SZ were 30–50° of inclination and 10–30° of anteversion. Outliers were defined as medial displacement of the COR > 5 mm, vertical displacement of the COR > 3 mm superiorly. Harris hip score (HHS) and complications were compared at one year of follow-up.

Results

The robotic cups were better oriented with 98% in the global SZ versus 68% in the cTHA group (p = 0.0002). The COR was on average better restored in the robotic group in both the horizontal and vertical planes (Δ HCOR =  − 5.0 ± 5.0 vs − 3.4 ± 4.9, p = 0.03; Δ VCOR = 1.6 ± 3.3 vs 0.2 ± 2.7, p = 0.04). There were fewer outliers in the rTHA group concerning VCOR (28% versus 10%, p = 0.03). There was no significant difference in HHS and complication rate at one year.

Conclusion

The use of robotics for THA by DAA provided an advantage in controlling the orientation of the cup and the restoration of its rotation centre. Thanks to the 3D planning on CT scan, it allowed to respect the thresholds while avoiding the anterior overhangs.

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Centre of Excellence, Lyon, France

    Constant Foissey, Cécile Batailler, Benoit Coulin & Sébastien Lustig

  2. Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France

    Cécile Batailler & Sébastien Lustig

  3. 2 Rue de L’École de Médecine, France - Laboratoire de Mécanique Et Génie Civile (LMGC), CNRS-UM1, Centre Hospitalo-Universitaire de Nîmes, Rue du Pr. Robert Debré, 30029 Nîmes, France - Université Montpellier 1, 860 Rue de St-Priest, 34090, Montpellier, France

    Rémy Coulomb & Pascal Kouyoumdjian

  4. Department of Trauma and Orthopaedics Surgery, University College Hospital, London, UK

    Dia Eldean Giebaly

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  1. Constant Foissey
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Contributions

Constant Foissey: study design, data collection, statistical analysis, literature review and manuscript writing. Cécile Batailler: study design, manuscript editing. Remy Coulomb: study design, manuscript editing. Dia Eldean Giebaly: manuscript editing. Benoit Coulin: data collection. Sébastien Lustig: study design, supervision, literature review and manuscript editing. Pascal Kouyoumdjian: study design, supervision, literature review and manuscript editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Constant Foissey.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Advisory Committee on Research Information Processing in the Field of Health (CCTIRS) approved this study on June 4, 2015 under number 15–430. For this type of study formal consent is not required.

Conflict of interest

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. CF, CB, RC and DEG declare that they have no conflict of interest. ES: Consultant for Corin. SL: Consultant for Stryker, Smith Nephew, Heraeus, Depuy Synthes; Institutional research support from Groupe Lepine, Amplitude; Editorial Board for Journal of Bone and Joint Surgery (Am), PK: Consultant for Stryker and for Lepine.

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Foissey, C., Batailler, C., Coulomb, R. et al. Image-based robotic-assisted total hip arthroplasty through direct anterior approach allows a better orientation of the acetabular cup and a better restitution of the centre of rotation than a conventional procedure. International Orthopaedics (SICOT) 47, 691–699 (2023). https://doi.org/10.1007/s00264-022-05624-6

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