Robotic-assisted THA may alter preoperative plan for cup position
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Key takeaways:
- Changes in the preoperative plan for cup position occurred in 78% of patients who underwent THA with robotic-assistance software.
- This study focused on intraoperative planning from a surgeon’s perspective.
Published results showed total hip arthroplasty performed with robotic-assistance software that incorporates pelvic tilt and virtual range of motion may change the preoperative plan for cup position and deviate from traditional safe zones.
“The growing utilization of robotic assistance for primary THA is projected to continue. However, despite its proliferation, there remains skepticism regarding the utility of cost-effectiveness of implementing these technologies at scale,” Scott M. LaValva, MD, orthopedic surgery resident at Hospital for Special Surgery, told Healio. “Our study adds value in that it demonstrates the substantial influence of preoperative planning afforded by the three-dimensional modeling and virtual impingement assessment from the latest robotic THA software with the ultimate goal to avoid hip instability.”
LaValva and colleagues reviewed data from 105 patients who underwent THA with the Mako Total Hip 4.0 system (Mako Surgical Corp., Stryker), which incorporates pelvic tilt and virtual range of motion for impingement modeling. Researchers considered the percentage of patients who underwent changes to the preoperative plan for cup position after incorporating data from the software as the primary outcome measure.
Results showed 78% of cases had changes in the preoperative plan for cup position from the default of 40° of inclination and 20° anteversion.
When separated into groups by preoperative spinopelvic mobility, LaValva and colleagues found 64% of patients were considered normal, 27% were stiff and 9% were hypermobile. According to results, 78% of cases in all cohorts deviated from the 40° inclination and 20° anteversion target. Researchers evaluated the proportion of cases within the Lewinnek and Callanan safe zones based on spinopelvic mobility and found 19% of patients in the normal group, 39% of patients in the stiff group and 10% of patients in the hypermobile group were planned outside of both zones.
“The utilization of the latest version of robotic-assisted THA software led to deviations from traditional, default cup targets (40° of abduction, 20° of anteversion) in more than three out of four cases,” LaValva said. “This suggests that the information gleaned from the software — specifically the three-dimensional modeling and virtual range of motion impingement assessment — prompts surgeons to alter their planned cup position in the majority of cases to allow for greater impingement-free range of motion. However, it is critical to acknowledge that the focus of our study was intraoperative planning from a surgeon’s perspective and not evaluating mid[term] or long-term clinical outcomes of robotic-assisted THA.”
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