Robotics and Navigation as Learning Tools for Fellows Training in Hip Arthroplasty

Abstract

Introduction: The association between implant malpositioning and complications has been repeatedly demonstrated. Recently, technological advancements have allowed for more consistent implant placement. Beyond this obvious application, these technologies may also serve as a learning tool. Thus, the aim of this study was to evaluate the accuracy of fellows' estimation of implant positioning using a robotic system. Methods: Data were prospectively collected for all patients undergoing total hip arthroplasty between September 2019 and December 2019. The fellow was blinded to the robotic system. Before reaming and broaching by the senior surgeon, the fellow was asked to place the reamer at 40° of cup inclination and 20° of version. The resulting values were recorded before the true measurements were revealed. A similar process was followed for femoral broaching. Results: The mean difference between the estimated and actual cup inclination and version was 7.24° (P = 0.060) and 4.81° (P = 0.031), respectively. The mean difference in broach version was 7.00° (P = 0.159). Without the robotic system, 43.47% and 69.57% of patients would have had the cup placed outside of the safe zones described by Lewinnek and Callanan, respectively. Conclusion: The estimated anteversion of the acetabular implant was found to be markedly different from its actual anteversion. A considerable portion of the cups would have been positioned outside of the Lewinnek and Callanan “safe zones” provided that the implants would have been manually positioned. The use of robotic or navigation systems may provide useful learning tools for fellows in training to understand their own inaccuracies in estimated implant position and hence refine their abilities.

Total Hip Arthroplasty with Robotic Arm Assistance for Precise Cup Positioning: A Case‐Control Study

“…A study reported that in the absence of a robotic system, cups were placed beyond the bounds of the safe zone as defined by Lewinnek and Callanan in approximately 43.47% and 69.57% of patients, respectively 25 . An effective way to improve the implant placement accuracy during THA is to tailor the implants to the patient's anatomy 30 .…”

“…We have shown that the robot-assisted implantation of the acetabular cup could get more accurate anteversion, a more reasonable LLD, and a higher proportion of the prosthesis position in the Lewinnek's safe zone. Robot-assisted THA surgery has been a reliable surgical technique in recent years 13,[24][25][26][27] . Ilmen et al reported that robotic-assisted THA improved acetabular component accuracy compared with conventional THA.…”

Technology-Assisted Hip and Knee Arthroplasty in Orthopaedic Residency Training: A National Survey

“…18 They reported a notable difference between estimated and actual cup version but no notable differences between estimated and actual cup inclination or femoral broach position. 18 In another recent study, Deckey et al 19 suggested that robotic technology can potentially be useful as a learning tool for residents by allowing for visual preoperative case planning and providing intraoperative feedback to trainees through real-time evaluation of soft-tissue balancing in TKAs. The authors noted, however, that training in robotics should not compromise the acquisition of surgical skills needed for manual procedures.…”

“…18,19 A recent study compared intraoperative orthopaedic fellow estimations of acetabular reamer and femoral broach placement with real-time actual positioning as measured by a robotic system. 18 They reported a notable difference between estimated and actual cup version but no notable differences between estimated and actual cup inclination or femoral broach position. 18 In another recent study, Deckey et al 19 suggested that robotic technology can potentially be useful as a learning tool for residents by allowing for visual preoperative case planning and providing intraoperative feedback to trainees through real-time evaluation of soft-tissue balancing in TKAs.…”

“…[11][12][13] The perceptions toward technology among fellowship trained arthroplasty surgeons and, interestingly, the general public have been evaluated in recently published studies. [14][15][16][17] Although several studies have introduced the concept of TA-TJA as a learning tool for orthopaedic trainees, [18][19][20] no studies to date have specifically examined the extent to which TA-TJA has been incorporated into orthopaedic residency training or trainee perceptions toward these technologies. Certain training programs, geographic regions, or populations may use TA-TJA at different rates, which may lead to considerable variation in resident experience and opinions toward new technology.…”