Adoption of Robotic vs Fluoroscopic Guidance in Total Hip Arthroplasty: Is Acetabular Positioning Improved in the Learning Curve?

Kamara, Eli; Robinson, Jonathon; Bas, Marcel A.; Rodríguez, José A.; Hepinstall, Matthew S.

doi:10.1016/j.arth.2016.06.039

Cited by 96 publications

(78 citation statements)

References 33 publications

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“…As previously noted [25,38], there is a documented learning curve associated with adopting the DAA for THA. Although not the focus of the present study, we hypothesize that the elimination of fluoroscopy during the operation may have more of an effect for less experienced surgeons undertaking these operations, and our results may not apply as directly to that clinical situation.…”

Section: Discussionmentioning

confidence: 83%

“…Optimal positioning of prosthetic components is necessary to successfully achieve the goals of THA, including re-establishment of femoral offset [2,17], restoration of hip biomechanics [18,19], improvement in postoperative stability [20,21], reduction in bearing wear [20,22], and reproduction of appropriate leg lengths [19,23]. In an attempt to optimize component positioning, a number of techniques have been developed, including the utilization of newer technology, such as robotics, computer navigation, and patient-specific positioning systems [24][25][26][27][28].…”

Section: Introductionmentioning

confidence: 99%

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Does the use of intraoperative fluoroscopy improve postoperative radiographic component positioning and implant size in total hip arthroplasty utilizing a direct anterior approach?

et al. 2020

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Background: The direct anterior approach (DAA) for total hip arthroplasty (THA) has gained recent popularity, with 1 purported benefit being access to intraoperative fluoroscopy. However, there are limited data demonstrating improved component position with the use of intraoperative fluoroscopy. The aim of this study is to compare radiographic implant positioning on 2 consecutive cohorts of patients undergoing DAA THA performed by 1 surgeon either utilizing intraoperative fluoroscopy or not. We hypothesized that there would be no relevant radiographic differences between the cohorts. Methods: Forty-two consecutive patients underwent DAA THA utilizing fluoroscopy (IFC), and 42 consecutive patients then underwent DAA THA without fluoroscopy (NFC). Using preoperative pelvis radiographs and 6-week postoperative pelvis radiographs, acetabular anteversion, inclination, femoral offset, and templated component sizes vs final intraoperatively selected sizes were recorded and compared between cohorts. Results: Acetabular inclination was 45.0 for IFC and 45.6 for NFC (P ¼ .629). Femoral offset difference preoperatively and postoperatively was 0.8 mm for IFC and 1.3 mm for NFC (P ¼ .734). Number of hips within the so-called safe zone was 32 for IFC and 33 for NFC (P ¼ .794). These all demonstrated no significant difference between the cohorts. However, acetabular anteversion was 13.7 for IFC and 11.2 for NFC (P ¼ .02). Conclusions: In this limited series, the routine use of intraoperative fluoroscopy did not improve implant positioning or sizing. This may be surgeon-specific or due to the result of the use of acetabular landmarks to guide placement of the components without fluoroscopy.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Does the use of intraoperative fluoroscopy improve postoperative radiographic component positioning and implant size in total hip arthroplasty utilizing a direct anterior approach?

et al. 2020

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“…The DAA is currently gaining popularity for its association with improved postoperative outcomes such as decreased length of stay, patient-reported pain, postoperative resource utilization, risk of re-operation, and faster return of physical function and mobility [6-7]. Correct component positioning via the DAA is predominantly reported utilizing C-arm fluoroscopy [8], which can reduce variability in acetabular component positioning and improve implant placement with respect to the surgeon’s targeted position [8]. However, risks include musculoskeletal injury resulting from the prolonged use of heavy lead aprons [9], increased risk of infection as the C-arm is carted into the sterile field [10], and cumulative surgeon radiation exposure [11].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Acetabular Component Positioning Using Computer-assisted Navigation in Direct Anterior Total Hip Arthroplasty

Bradley¹,

Benson²,

Muir³

2019

Cureus

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Background Appropriate component positioning in total hip arthroplasty (THA) is imperative for long-term survivorship. C-arm fluoroscopy provides visual guidance in the direct anterior approach (DAA), but it is limited by qualitative properties. Conversely, imageless computer-assisted navigation systems (CAS) provide surgeons with intraoperative, three-dimensional (3D) quantitative measurements for cup position, although the accuracy of such systems has not been extensively addressed in the DAA. We evaluated the ability of an imageless CAS to deliver measurements for acetabular cup position with accuracy in the DAA. Materials and methods A retrospective analysis of 69 primary THA procedures was conducted. Acetabular cup position measurements (anteversion and inclination) obtained intraoperatively by imageless navigation were compared to standard, postoperative anteroposterior pelvic radiographic measurements. Statistical comparisons were made using the Bland-Altman technique. Results The mean difference between device and radiographic measurements for anteversion was 3.4° (standard deviation (SD): 4.1°; absolute mean difference (ABS): 4.2°), and 4.0° for inclination (SD: 3.6°; ABS: 4.3°). Bland-Altman analysis demonstrated excellent agreement; 93% (64/69) and 97% (67/69) of anteversion pairings fell within the statistical and clinical limits of agreement, whereas 94% (65/69) and 100% (69/69) of inclination pairings were within the statistical and clinical limits, respectively. Conclusions Measurements obtained intraoperatively for acetabular cup position using imageless navigation in the DAA are agreeable with the current clinical standard.

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“…Even more importantly, surgeons are aware of potential legal implications for component position inaccuracy as these complications represent the bulk of legal cases following THA. Many studies have demonstrated that surgeries using computer-assisted surgery (CAS) technologies have statistically improved accuracy to ensure leg length, cup position, and stability [8, 9].…”

Section: Introductionmentioning

confidence: 99%

Periprosthetic Fracture of Greater Trochanter in Total Hip Replacement Stemming from Pin Site Placement in Navigation-Assisted Surgery

Brozovich

Lionberger

2019

Case Reports in Orthopedics

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Surgeons are looking to use computer computer-assisted surgery (CAS) in total hip arthroplasty (THA) in order to quantify leg length measurement, angular cup placement, and enhance stability to provide enhanced accuracy in implant placement. As a result, CAS in THA is gaining popularity. This technology employs the use of pins and provides the surgeon with real-time feedback on positioning intraoperatively. Previous total knee arthroplasty (TKA) literature has reported pin-associated complications such as infections, neuropraxia, and suture abscess. To our knowledge, there have been reports of tibial stress fracture after CAS TKA, but this is the first report of a pin causing fracture of the greater trochanter leading to dislocation in THA. Further studies may be warranted to optimize pin placement for trackers to prevent fractures of the greater trochanter.

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Adoption of Robotic vs Fluoroscopic Guidance in Total Hip Arthroplasty: Is Acetabular Positioning Improved in the Learning Curve?

Cited by 96 publications

References 33 publications

Does the use of intraoperative fluoroscopy improve postoperative radiographic component positioning and implant size in total hip arthroplasty utilizing a direct anterior approach?

Does the use of intraoperative fluoroscopy improve postoperative radiographic component positioning and implant size in total hip arthroplasty utilizing a direct anterior approach?

Accuracy of Acetabular Component Positioning Using Computer-assisted Navigation in Direct Anterior Total Hip Arthroplasty

Periprosthetic Fracture of Greater Trochanter in Total Hip Replacement Stemming from Pin Site Placement in Navigation-Assisted Surgery

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