Effect of robotic milling on periprosthetic bone remodeling

Abstract

ABSTRACT:The ROBODOC system has provided better fit and fill of the stem and less destruction of the bony architecture than with manual surgery. These benefits might affect femoral periprosthetic bone remodeling. We evaluated the effects of robotic milling in cementless total hip arthroplasty (THA) in a longitudinal 24-month follow-up study using dual energy X-ray absorptiometry (DEXA) and plain radiographs of 29 patients (31 hips) after ROBODOC THA and 24 patients (27 hips) after manual THA with the same stem design. To minimize the influence of other factors on bone remodeling, only female osteoarthritis patients, who had no drugs that might affect bone metabolism were enrolled. Significantly less bone loss occurred at the proximal periprosthetic areas in the ROBODOC group. In zone 1, the decrease was 15.5 versus 29.9% using conventional rasping; in zone 7, the loss was 17.0% with ROBODOC compared to 30.5% with conventional rasping (p < 0.05). On radiographs, endosteal spot welds in the proximal medial portion were more pronounced in the ROBODOC group (48 vs. 11% in the conventional group, p < 0.05). Our results suggest that robotic milling is effective in facilitating proximal load transfer around the femoral component and minimizing bone loss after cementless THA. ß

A Comparison between Robotic-assisted and Manual Implantation of Cementless Total Hip Arthroplasty

“…This result was consistent with a previous comparison dual-energy xray absorptiometry (DEXA) study of 2-year followup data between two groups [13]. This tendency of stress shielding was more prominent 5 years postoperatively on the radiographs.…”

Long-term Periprosthetic Remodeling in THA Shows Structural Preservation

“…It would be inappropriate to make generalizations about the particular implant used in this study or even to make greater conclusions regarding all uncemented femoral prostheses. However, the overall changes documented in this study reflect general trends that have been documented in the literature by shorter followup periods [2,4,9,18,19] ( Table 4). Evaluating longitudinal changes in bone mineral density with DEXA can be problematic.…”

Robotic-assisted total hip arthroplasty: a critical appraisal

“…[7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Twelve of the 15 articles were clinical studies. In these 12 studies, a total of 682 patients underwent THA using ROBODOC ® and 50 patients underwent THA using MAKOplasty ® .…”

“…The combined mean follow-up time for all studies was 26.35 months (range, 1-67). [7][8][9][10][11][12][13]15,[17][18][19]21 The remaining three studies were cadaveric studies, where a total of 15 cadavers had components placed with the ROBODOC ® and 6 cadavers had components placed using the MAKOplasty ® .…”

“…7,8 Proponents of robotic-assisted THA argue that despite the increased cost and complication rate, better long-term results and more accurate component positioning have been seen with roboticassisted THA. [9][10][11][12][13][14][15][16][17] The purpose of this study was to analyze two different US Food and Drug Administration (FDA) approved robotic devices that are currently used in primary THA. We evaluated 1) accuracy of component placement, 2) reproducibility of the procedure, 3) limb alignment 4) clinical outcomes of THA, 5) and complications associated with robotic-assisted THA.…”