Which way forward? Comparing radiological outcomes using three different surgical approaches in robotic assisted total hip arthroplasty

ABSTRACT

Objectives

To assess the accuracy and precision of acetabular component placement in robot-assisted surgery total hip arthroplasty (RAS-THA) using three different approaches.

Methods

This study is a secondary analysis from a multicenter, randomized controlled trial comparing the Trex RS Hip 1.0 robot navigation system across different surgical approaches. It involved 145 patients treated at three Chinese medical centers from June 2021 to July 2022. Patients with end-stage joint disease were randomly assigned to either the RAS or control group. Acetabular component positioning was evaluated radiographically, and registration accuracy was measured using Root Mean Square Error (RMSE).

Results

The overall RMSE was 0.72 mm (SD = 0.24 mm), indicating consistent accuracy regardless of surgical approach. Significant variations in anteversion were noted across groups (p = 0.001). Lateral RAS-THA showed enhanced precision. The RAS Direct Anterior Approach (DAA) group had the least deviation in the rotation center’s horizontal distance (0.89 ± 1.14 mm, p = 0.0014) and minimal leg length discrepancy (2.41 ± 1.17 mm). The RAS DAA approach also produced more consistent results.

Conclusion

Robotic assistance in THA, especially via the DAA approach, enhances the accuracy and precision of acetabular component positioning. Consistent registration accuracy across various surgical approaches confirms the reliability of these methods for THA.

Clinical trial registration

www.clinicaltrials.gov identifier is ChiCTR2100044124.

KEYWORDS:

• Robot-assisted surgery
• total hip arthroplasty
• acetabular component positioning
• direct anterior approach
• radiographic evaluation

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Availability of data and material

The data supporting the findings of this study are available within the article and its supplementary materials. Additional datasets generated during and/or analyzed during the current study are available are available from the corresponding author on reasonable request.

Code availability (software application or custom code)

All analyses were conducted using R (version [4.1.3]). Specific scripts and commands used in the analysis are available upon request.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Authors’ contributions

ZX contributed to the conception and design of the work, acquisition of data, and drafting the article. SX played a key role in analyzing and interpreting the data and revising the manuscript critically for important intellectual content. AM was involved in the acquisition of data and drafting the manuscript. ZZ and ZH provided substantial contributions to the conception of the work and revised it critically for important intellectual content. YB contributed to the interpretation of data and provided the final approval of the version to be published. ZC was responsible for the conception and design of the study, revising the manuscript critically for important intellectual content, and final approval of the version to be published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Acknowledgments

We extend our sincere gratitude to Chen Wei and Li Hongqing from Shanghai Longwell Corporation for their invaluable assistance in the mechanical operation of the robotic arm used in our study. Their expertise and support were instrumental in the successful execution of our experiments.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17434440.2024.2334932.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China [Grant No. 82202672], the Key Research and Development Program of Anhui Province [No. 2022e07020017], China Postdoctoral Science Foundation Grant [2022M723049] and the Joint Fund for Medical Artificial Intelligence [MAI2022C002].