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Robotic-assisted total hip arthroplasty in patients with developmental dysplasia of the hip

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Abstract

Purposes

Due to the morphological diversity of deformities, technical difficulties, improperly designed components, and so on, THA remains a challenging task in dysplastic hips, especially in highly dislocated hips. The purpose of this study was to comprehensively evaluate the clinical outcomes of robot-assisted THA in patients with DDH through a large cohort study, including the precision of acetabular cup positioning, indicators of inflammatory response, indicators of muscle damage, and complications.

Methods

We retrospectively analyzed patients with DDH who underwent THA in our prospectively constructed joint registry between August 2018 and August 2022. Finally, 147 manual THAs and 147 robotic-assisted THAs were included in the final analysis. Patient demographics, indicators of inflammation, indicators of muscle damage, operative time, Harris hip scores (HHS), and forgotten joint score (FJS) were recorded for analysis. The precision of the positioning of the acetabular component was assessed with plain radiographs.

Results

In the Crowe II/III groups, the reconstructed center of rotation (COR) in the robotic-assisted group was closer to the anatomical COR with less variation than the manual group (absolute horizontal distances of COR 3.5 ± 2.8 vs. 5.4 ± 4.9 mm, p < 0.05; absolute vertical distances of COR 6.4 ± 4.1 vs. 11.7 ± 8.2 mm, p = 0.001). For all Crowe subtypes, the robotic-assisted THA significantly increased the proportion of acetabular cups located in the safety zone within 5° (all p < 0.05). Interleukin-6 and creatine kinase levels were slightly lower and significantly different in the robotic-assisted group at three days postoperatively (all p < 0.05).

Conclusions

Compared to the manual technique, the robot-assisted technique improved the precision and reproducibility of acetabular component positioning, particularly in DDH patients with Crowe types II/III. The robotic-assisted technique did not increase operative time, bleeding, complications, or revision rates, and had a slighter early inflammatory response and muscle damage.

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Data availability

All data generated or analyzed during this study are included in this published article.

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Funding

National Natural Science Foundation of China Joint Key Program (U22A20355)

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Author notes

  1. Shuai Zhang and Mingyang Ma contributed equally to this work and were considered co-first authors.

Authors and Affiliations

  1. Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China

    Shuai Zhang, Mingyang Ma, Xiangpeng Kong, Yonggang Zhou, Jiying Chen & Wei Chai

  2. Department of Orthopedics, the 969th Hospital of the PLA joint Logisitcs Support Force, No. 51 Aimin street, Xincheng District, Huhehaote, China

    Shuai Zhang

  3. National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China

    Shuai Zhang, Mingyang Ma, Xiangpeng Kong, Yonggang Zhou, Jiying Chen & Wei Chai

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  1. Shuai Zhang
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Contributions

Shuai Zhang and Mingyang Ma: primarily responsible for all computational analyses in the article and the drafting of the manuscript. Shuai Zhang and Mingyang Ma are the co-first authors of this article. Yonggang Zhou, Jiying Chen, and Wei Chai: primarily responsible for oversight of the research project, including all data acquisition and analysis, and manuscript preparation and approval. Yonggang Zhou, Jiying Chen, and Wei Chai contributed to this work equally, and both of them were co-corresponding author. Xiangpeng Kong: revised the manuscript and helped perform the analysis with constructive discussions. All authors have read and approved the final submitted manuscript.

Corresponding authors

Correspondence to Mingyang Ma, Yonggang Zhou, Jiying Chen or Wei Chai.

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This study was approved by the ethics committee of hospital and was carried out in accordance with the Declaration of Helsinki of the World Medical Association. All enrolled patients provided written informed consent.

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Zhang, S., Ma, M., Kong, X. et al. Robotic-assisted total hip arthroplasty in patients with developmental dysplasia of the hip. International Orthopaedics (SICOT) 48, 1189–1199 (2024). https://doi.org/10.1007/s00264-024-06115-6

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