TiRobot‐Assisted Percutaneous Cannulated Screw Fixation in the Treatment of Femoral Neck Fractures: A Minimum 2‐Year Follow‐up of 50 Patients

Abstract

Objective To assess the long‐term clinical efficacy of TiRobot‐assisted percutaneous cannulated screw fixation in the treatment of femoral neck fractures. Methods This retrospective study included 50 patients with unilateral femoral neck fractures who were treated with TiRobot‐assisted percutaneous cannulated screw fixation from September 2017 to May 2018. After at least 2 years of follow‐up, the results of treatment, including operation duration, frequency of fluoroscopy use, intraoperative bleeding, hospital stay, medical expense, screw placement accuracy, rate of fracture healing and necrosis of the femoral head, and Harris hip scores at the last follow up, were recorded and compared with those of 83 matched patients who underwent conventional manual positioning surgery. Results The TiRobot group had longer operation duration (83.3 ± 31.2 min vs 44.1 ± 14.8 min) and higher medical expenses (28,407.1 ± 7498.0 yuan vs 22,672.3 ± 4130.3 yuan) than the conventional group. The TiRobot group had significantly less intraoperative bleeding (11.3 ± 7.3 mL vs 51.6 ± 40.4 mL) and shorter hospital stay (8.6 ± 2.8 days vs 11.1 ± 3.41 days) than the conventional group. Screw parallelism (1.32° ± 1.85° vs 2.54° ± 2.99° on anteroposterior radiograph; 1.42° ± 2.25° vs 3.09° ± 3.63° on lateral radiograph) and distance between screws (58.44 ± 10.52 mm vs 39.69 ± 12.17 mm) were significantly improved. No significant difference was found between the two groups in terms of the use of fluoroscopy (40.1 ± 28.5 times vs 38.6 ± 21.0 times) and Harris hip scores at the last follow‐up (93.2 ± 10.3 points vs 88.4 ± 11.9 points). Two cannulated screws penetrated the femoral head during manual insertion in the conventional group but not in the TiRobot group. The rate of nonunion and necrosis of the femoral head in the TiRobot group was reduced compared with that in the conventional group (0 vs 7.2%; 6.0% vs 24.1%). Conclusion TiRobot‐assisted percutaneous cannulated screw fixation of femoral neck fractures is accurate and minimally invasive and helps in reducing late complications, particularly necrosis of the femoral head and nonunion of fractures.

Robot-Assisted Versus Conventional Freehand Fluoroscopy-Guided Percutaneous Screw Fixation in Femoral Neck Fractures: A Systematic Review and Meta-analysis

“…Duan et al [ 13 ] was a prospective cohort study, while He et al [ 14 ] and Wan et al [ 15 ] were the only randomized control trials. Wang et al (2019) [ 16 ] and Zhu et al (2021) [ 17 ] were the largest studies with 128 and 133 patients each compared to the other studies that had a number of included patients in the range of 3-60. The studies aimed to assess the efficacy and safety of the included studies looking mainly at intraoperative outcomes.…”

“…Overall, robot-assisted fixation is associated with fewer complications. The incidence of avascular necrosis is significantly greater in the conventional group compared to the robot-assisted group in Wang et al [ 16 ], He et al [ 14 ], and Zhu et al [ 17 ]. No significant differences were seen between the groups in other studies.…”

“…No significant differences were seen between the groups in other studies. According to Duan et al [ 13 ] and Zhu et al [ 17 ], the robot-assisted group was less likely to have femoral head penetration. No significant differences were seen between the groups in other studies.…”

“…No episodes of infection or neurovascular injury were reported in any of the five studies. Zhu et al [ 17 ] found that patients without comorbidities undergoing robot-assisted femoral neck fracture fixation have a statistically significant shorter postoperative hospital stay.…”

Feasibility and accuracy of orthopaedic surgical robot system for intraoperative navigation to locate bone tunnel in anterior cruciate ligament reconstruction

“…In recent years, robotic arms have been increasingly used in orthopaedic surgery to improve surgical accuracy, and reduce complications and radiation exposure to doctors 12 . Many studies have reported that TiRobot (TINAVI Medical Technologies Co., Ltd.), which is an orthopaedic surgical robotic system, has shown greater accuracy than conventional procedures in spinal surgery, helping to achieve good long‐term clinical efficacy in the treatment of femoral neck fractures 13,14 . The TiRobot orthopaedic surgical robot system uses intraoperative three‐dimensional CT reconstruction to display bony markers in the target area, using infrared tracking reference markers attached to the patient to carry out real‐time positioning of the surgical area, and the robotic arm to guide the operation path 15 .…”