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Robot-assisted versus conventional percutaneous sacroiliac screw fixation for posterior pelvic ring injuries: a systematic review and meta-analysis

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Abstract

Purpose

Robot-assisted pelvic screw fixation is a new technology with promising benefits on intraoperative outcomes for patients with posterior pelvic ring injuries. We aim to compare robot-assisted pelvic screw fixation to the traditional fluoroscopy-assisted technique with regards to intraoperative and postoperative outcomes.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used along with a search of electronic information to identify all studies comparing the outcomes of robot-assisted versus conventional screw fixation in patients with posterior pelvic ring injuries. Primary outcomes included operative duration (minutes), intraoperative bleeding (mL), fluoroscopy exposure and intraoperative drilling frequency. Secondary outcome measures included Majeed score, healing time (minutes) and rate (%), postoperative complications, screw positioning, incision length (cm) and guide wire insertion times (minutes). The random effects model was used for analysis.

Results

Four observational studies including a total of 294 patients were identified. There was a significant difference between robot-assisted and conventional groups in terms of operative duration (MD = − 24.66, p < 0.05), intraoperative bleeding (MD = − 10.37, P < 0.05), fluoroscopy exposure (MD = − 2.15, P < 0.05) and intraoperative drilling frequency (MD = − 2.42, P =  < 0.05). For secondary outcomes, no significant difference was seen in Majeed score, healing time and rate and postoperative complications. The robot-assisted group had better screw positioning, smaller incision length, and shorter anaesthesia and guide wire insertion times.

Conclusions

Robot-assisted fixation has superior intraoperative outcomes compared to conventional fixation. Further studies are needed to look at postoperative outcomes as there is no significant difference in postoperative prognosis between the techniques.

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Data availability

The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

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Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

Author information

Authors and Affiliations

  1. School of Medicine, University of Manchester, Oxford Road, Manchester, M13 9PL, UK

    Abdulrahman Al-Naseem & Abdelrahman Sallam

  2. School of Medicine, University of Liverpool, Liverpool, UK

    Ahmed Gonnah

  3. School of Medicine, King’s College London, London, UK

    Omar Masoud

  4. Department of Neurosurgery, Division of Spine, Duke University Medical Centre, Durham, USA

    Muhammad M. Abd-El-Barr

  5. Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA

    Ilyas S. Aleem

Authors
  1. Abdulrahman Al-Naseem
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  2. Abdelrahman Sallam
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  3. Ahmed Gonnah
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  4. Omar Masoud
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  5. Muhammad M. Abd-El-Barr
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  6. Ilyas S. Aleem
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Contributions

AN is the first author of this paper. Study concept and design was by AN. AN and AS were involved in analysis and interpretation of data. OM and AG took part in data acquisition. MAB and IA took part in supervision. All authors contributed to drafting the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Abdulrahman Al-Naseem.

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The author(s) declared that they have no competing interests.

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Appendices

Appendix 1

See Table

Table 5 Abbreviation list
Full size table

5

Appendix 2

Search criteria

(Computer-assisted) AND (robo-) AND (fractur-).

(iliosacral) AND (computer-assisted) AND (fractur-).

(iliosacral) AND (computer-navigated) AND (fractur-).

(iliosacral) AND (robo-).

(lumbopelvic) AND (robo-).

(machin-) AND (pelvi-) AND (fractur-).

(pelvi-) AND (computer-assisted) AND (fractur-).

(pelvi-) AND (computer-navigated) AND (fractur-).

(Pelvi-) AND (robo-) AND (fractur-).

(percutaneous) AND (sacroiliac) AND (scre-).

(robo-) AND (posterior) AND (ring).

(sacr) AND (fracture) AND ((computer- assisted) OR (computer assisted) OR (robo-) OR (computer-navigated) OR (computer navigated)).

(sacroiliac) AND (computer-navigated) AND (fractur-).

(Sacroiliac) AND (robo-).

(screw) AND (pelvi-) AND (robo-).

(screws) AND (pelvi-) AND (robo-).

(ROBOT)

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Al-Naseem, A., Sallam, A., Gonnah, A. et al. Robot-assisted versus conventional percutaneous sacroiliac screw fixation for posterior pelvic ring injuries: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 33, 9–20 (2023). https://doi.org/10.1007/s00590-021-03167-x

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