Total hip arthroplasty (THA) has been and continues to be the gold standard for treatment of end-stage osteoarthritis. With each year, implant characteristics are evolving to increase patient-reported outcomes and decrease complications. Data were prospectively collected on patients who underwent THA with Corin-type implants (both cup and stem) and THA using Stryker implants between June 2011 and July 2016. A 1:1 propensity match was performed using the following 5 covariates: age, body mass index, gender, Charlson score and smoking status. Surgical outcomes were assessed at minimum 2-year follow-up using the Forgotten Joint Score (FJS), Harris Hip Score (HHS), Veterans RAND 12-item physical and mental health survey, Short Form 12 physical and mental health survey, Visual Analog Score (VAS), and patient satisfaction. The exclusion criteria were previous hip condition/surgery, workers compensation, or were unwilling.Background
Methods
Primary robotic-arm assisted total hip arthroplasty (THA) yields more accurate and reproducible acetabular cup placement, nonetheless, data is scarce in terms of outcomes. The purpose of the present study was to report on patient-reported outcomes (PROMs) in a large group of patients who underwent robotic-arm assisted THA. The authors hypothesized that (1) patients who underwent robotic-arm assisted primary THA would achieve favorable and significant improvement in PROMs, (2) an accurate and reproducible acetabular cup placement with respect to the defined SafeZones would be obtained, and (3) a low rate of THA dislocation would be observed. Prospectively collected data were retrospectively reviewed between April 2012 to May 2017. Primary THA using Mako Robotic-Arm [Mako Surgical Corp. (Stryker), Fort Lauderdale, FL, USA] with minimum two-year follow-up for the Harris Hip Score (HHS) and the Forgotten Joint Score-12 (FJS-12) were included. Exclusion criteria were: bodymass index (BMI) > 40 kg/m2, age < 21-year old, worker's compensation, or unwilling to participate. Visual analog scale (VAS) for pain and patient satisfaction were obtained. Intraoperative measurements for leg-length, global offset, acetabular inclination and version were documented.Introduction
Methods
To compare the acetabular component size relative to the patient's native femoral head size between conventional THA (CTHA) approach and robotic-guided THA (RGTHA) to infer which of these techniques preserves more acetabular bone. Patients were included if they had primary osteoarthritis (OA) and underwent total hip replacement between June 2008 and March 2014. Patients were excluded if they had missing or rotated postoperative anteroposterior radiographs. RGTHA patients were matched to a control group of CTHA patients, in terms of pre-operative native femoral head size, age, gender, body mass index (BMI) and approach. Acetabular cup size relative to femoral head size was used as a surrogate for amount of bone resected. We compared the groups according to two measures describing acetabular cup diameter (c) in relation to femoral head diameter (f): (1) c-f, the difference between cup diameter and femoral head diameter and (2) (c-f)/f, the same difference as a fraction of femoral head diameter.Purposes
Methods
Outpatient total hip arthroplasty (THA) has remained controversial and challenging. Traditional hospital stays following total joint arthroplasty were substantial and resulted in increased rates of morbidity, significant pain, and severe restriction in mobility. Advancements in the surgical approach, anesthetic regimens, and the initiation of rapid rehabilitation protocols have had an impact on the length of recovery following elective THA. Still, very few studies have specifically outlined outpatient hip arthroplasty and, thus far, none have addressed the use of robotic-arm navigation in outpatient THA. This article describes in detail the technique used to perform outpatient THA with the use of robotic-arm assistance. We believe that outpatient THA using robotic-arm assistance in combination with tissue-preserving surgery, multi-modal pain and nausea management, early rehabilitation, and stringent patient selection yields a suitable alternative to inpatient joint replacement.
Accurate component placement in total hip arthroplasty (THA) improves post-operative stability and reduces wear and aseptic loosening. Methods for achieving accurate stem placement have not been as extensively studied as cup placement. The purpose of this study is to determine how consistently femoral stem version can be corrected to an ideal of 15 +/− 5 degrees using robotic guidance. Furthermore, the study aims to identify other factors related to approach and patient demographics, which may influence the degree of correction obtained.Introduction
Objectives
We present to you a match-controlled study assessing co-existing arthroscopic findings during hip arthroscopy in patients with an intraoperative diagnosis of a central acetabular osteophyte (CAO). We feel that this manuscript is both pertinent and timely. Recent literature has described the entity of central acetabular impingement, in which an osteophyte of the cotyloid fossa impinges against the superomedial femoral head and fovea. The technique for central acetabular decompression has also been described to treat this entity. The primary purpose of this study was to report the prevalence of femoral head articular damage in a matched cohort of patients with and without central acetabular osteophyte (CAO) that was identified during hip arthroscopy. A secondary purpose was to identify the rates of co-existing intraarticular pathology in both patient groups. Intraoperative data was collected prospectively on all patients undergoing hip arthroscopy at our institution between February 2008 to March 2015,. The inclusion criteria for this study were the presence of a CAO identified during hip arthroscopy for a labral tear and/or femoroacetabular impingement (FAI). Exclusion criteria were revision surgeries, Tönnis grade 1 and higher, and previous hip conditions such as Legg-Calves-Perthes disease, avascular necrosis, and prior surgical intervention. The matched cohort control group was selected based on gender, age within 5 years, body mass index (BMI), and workers' compensation claim, on a 1:3 ratio to patients who underwent hip arthroscopy for a labral tear and/or FAI and did not have a CAO. The CAO group consisted of 126 patients, which were matched to 378 patients in the control group. The grades of femoral and acetabular chondral damage were significantly different between the two groups (p<0.01). This study showed that patients with CAO had a significantly higher prevalence of femoral and acetabular chondral damage, size of articular defects on both surfaces and the prevalence of LT tears compared to matched controls.
We present a prospective two-year follow-up study of 1038 hip arthroscopies performed at a high volume tertiary referral centre for hip preservation. We feel that this manuscript is both pertinent and timely due to the advances in the field of hip preservation. We used four validated patient-reported outcome (PRO) scores along with the visual analog scale (VAS) and patient satisfaction scores to assess preoperative and postoperative outcomes in all patients undergoing hip arthroscopy. We divided the entire cohort into patients undergoing primary and revision hip arthroscopies. We found a statistically significant improvement from preoperative to two-year postoperative PRO scores in the two subgroups. We also found a significant difference in the PRO scores at three months, one year, and two years postoperatively between the primary and revision subgroups. The revision subgroup had inferior VAS and patient satisfaction compared to the primary subgroup, however these results were not significant. The conversion to total hip arthroplasty/hip resurfacing (THA/HR) was 5.6% and 11.2% in the primary and revision subgroups, respectively. This resulted in a relative risk of 2.0 for conversion to THA/HR in the revision subgroup. We had a complication rate of 5.3 (only 0.5% of which were considered major) which was similar to that reported in the literature for hip arthroscopy. The primary purpose was to perform a survival analysis in a large mixed cohort of patients undergoing hip arthroscopy at a high volume tertiary referral centre for hip preservation with minimum two-year follow-up. The secondary purpose was to compare clinical outcomes of primary versus revision hip arthroscopy. From February 2008 to June 2012, data were prospectively collected on all patients undergoing primary or revision hip arthroscopy. Patients were assessed pre- and post-operatively with modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sport Specific Subscales (HOS-SSS). Pain was estimated on the visual analog scale (VAS). Patient satisfaction was measured on a scale from 0 to 10. There were a total of 1155 arthroscopies performed, including 1040 primary arthroscopies (926 patients) and 115 revision arthroscopies (106 patients). Of these, 931 primary arthroscopies (89.5%) in 824 patients (89.0%) and 107 revision arthroscopies (93.0%) in 97 patients (91.5%), were available for follow-up and included in our study. The mean change in patient reported outcome (PRO) scores at two-year follow-up in the primary subgroup was 17.4 for mHHS, 19.7 for HOS-ADL, 23.8 for HOS-SSS, 21.3 for NAHS, and −3.0 for VAS. The mean change in PRO scores at two-year follow-up in the revision subgroup was 13.4, 10.9, 16.1, 15.4, and −2.7, respectively. All scores improved significantly compared to pre-operatively (p<0.001). PRO scores were higher at all time points for the primary subgroup compared to the revision subgroup (p<0.05). Satisfaction was 7.7 and 7.2 for primary and revision subgroups, respectively. Of 931 primary arthroscopies, 52 (5.6%) underwent THA/HR. Of 107 revision arthroscopies, 12 (11.2%) underwent THA/HR. The relative risk of a THA/HR was 2.0 after revision procedures compared to primary procedures. The overall complication rate was 5.3%. Hip arthroscopy showed significant improvement in all PRO, VAS, and satisfaction scores at two years postoperatively. Primary arthroscopy patients showed greater PRO scores and a trend towards greater VAS compared to the revision subgroup. The relative risk of a THA/HR was 2.0 after revision procedures compared to primary procedures.
Robotics assisted surgery are tools that provide successful biomechanical reconstruction of the hip. We compare the accuracy of cup placement in the safe zones described by Lewinnek et al. and Callanan et al., leg length discrepancy (LLD) and global offset (GO) measurement in total hip arthroplasty (THA) using five diferent image guided techniques performed by six diferent surgeons. Between June 2008 and April 2014, 2330 THRs were performed by six different surgeons. Ninety-three (4.69%) patients underwent robotic-assisted THA anterior approach, 135 (6.8%) had robotic-assisted THA posterior approach, 942 (47.5%) patients underwent fluoroscopic guided THA anterior approach, 708 (35.7%) had THA without guidance using posterior approach, 43 (2.1%) patients underwent navigation-guided anterior approach and 59 (2.9%) patients underwent radiographic-guided posterior approach THAs (Figure 1).Background
Methods
Preservation of acetabular bone during primary total hip arthroplasty (THA) is important, because proper stability of cementless acetabular cup during primary THA depends largely on the amount of bone stock left after acetabular reaming. Eccentric or excessive acetabular reaming can cause soft tissue impingement, loosening, altered center of rotation, bone-to-bone impingement, intraoperative periprosthetic fracture, and other complications. Furthermore, loss of bone stock during primary THA may adversely affect subsequent revision THA. We sought to compare the conventional THA (CTHA) approach to robotic-guided THA (RGTHA) to determine which of these techniques preserves more acetabular bone, as interpreted from the size of the acetabular component compared with the size of the native femoral head.Background
Questions/Purposes
Preservation of acetabular bone during primary total hip arthroplasty (THA) is important, because proper stability of cementless acetabular cup during primary THA depends largely on the amount of bone stock left after acetabular reaming. Eccentric or excessive acetabular reaming can cause soft tissue impingement, loosening, altered centre of rotation, bone-to-bone impingement, intra-operative periprosthetic fracture, and other complications. Furthermore, loss of bone stock during primary THA may adversely affect subsequent revision THA. The purpose of this study was to compare preservation of acetabular bone stock between conventional THA (CTHA) vs. robotic-guided THA (RGTHA). We hypothesised that RGTHA would allow more precise reaming, leading to use of smaller cups and greater preservation of bone stock.Background
Questions/Purposes
Lewinnek et al described a safe zone of acetabular component placement in Total Hip Arthroplasty (THA) to reduce complications. Callanan Between June 2008 and April 2014, 2330 THRs were performed by six different surgeons. Post-operative radiographic images were retrospectively reviewed and measured using TraumaCad® software to determine cup placement, LLD, and GOD.Introduction
Methods
Component positioning in total hip arthroplasty (THA) is critical to achieve optimal patient outcomes. Recent literature has shown acetabular component positioning may be inaccurate using traditional techniques. Robotic-assisted THA is a recent platform introduced to decrease the risk of malpositioned components. However, to date, a paucity of data is available comparing the intra-operative component position generated by the navigation system to post-operative radiographs. The purpose of this study was to compare the component position measurements of a navigation system, used during robotic-assisted THA, to component position measurements obtained on post-operative radiographs.Background
Purpose
Pre-operative and postoperative analgesia in total hip arthroplasty (THA) involves multimodal analgesia using differing classes of drugs and varying introductions of these agents. Postoperative opioid-related events can slow recovery and increase patients' length of stay. Long-acting local anesthetics can reduce early postoperative pain at the surgical site, potentiating a decrease of opioid intervention needed postoperatively. Decreasing opioid use while maintaining adequate pain control could reduce opioid-related events, increase patient time to first ambulation and decrease length of stay. The purpose of this study was to compare liposomal bupivacaine to bupivacaine for postoperative analgesia. Between November 2012 and February 2013, 57 consecutive patients that underwent THA and hip resurfacing received either an intraoperative injection of liposomal bupivacaine or bupivacaine alone. All patients received a combination of medications prior to the procedure including celecoxib 400 mg by mouth, pregabalin 75 mg by mouth and 1gm of intravenous acetaminophen. The study group received 20 cc of liposomal bupivacaine, combined with 40 cc 0.25% bupivacaine with epinephrine and 20 cc of normal saline. The control group received 60 ml of 0.25% bupivacaine with epinephrine. Data was prospectively collected including average visual analog pain scale (VAS), opioid consumption, time to first ambulation, hospital length of stay measured by days, and post-operative opioid-related adverse drug events.Background
Methods
Several recent reports have documented high frequency of malpositioned acetabular components, even amongst high volume arthroplasty surgeons. Robotic assisted total hip arthroplasty (THA) has the potential to improve component positioning; however, to our knowledge there are no reports examining the learning curve during the adoption of robotic assisted THA. The purpose of this study was to examine the learning curve of robotic assisted THA as measured by component position, operative time, intra-operative technical problems, and complications.Background
Purpose
Total hip arthroplasty (THA) has been proven to be successful in achieving adequate pain relief and favorable outcomes in patients suffering from hip osteoarthritis (OA). However, leg length discrepancy (LLD) is still a significant cause of morbidities such as nerve damage, low back pain and abnormal gait. Despite most of the reported values of LLD in the literature being within the acceptable threshold of < 10 mm, some patients still report dissatisfaction, leading to litigation against orthopedic surgeons. However, lower extremity lengthening is sometimes necessary to achieve adequate hip joint stability and prevent dislocations. The purpose of this study was to compare LLD in patients undergoing THA using three different techniques: conventional anterior-approach THA (ATHA), conventional posterior-approach THA (PTHA), and robotic-assisted posterior-approach THA (RTHA) using the MAKO™ robotic hip system. All cases of RTHA, ATHA and PTHA that were performed by the senior surgeon between Sep 2008 and Dec 2012 were reviewed. Patients included in this study had a primary diagnosis of hip osteoarthritis, with available and proper post-operative antero-posterior pelvis radiographs. All radiographs were calibrated and measurements done twice by two blinded observers.Background:
Materials and Methods:
Acetabular cup positioning1, 2, leg length discrepancy3 and global offset4 are important parameters associated with outcomes following total hip arthroplasty (THA). Deviation from an accepted range of values for each of these parameters can lead to significant complications including nerve injury, low back pain, abnormal gait, increased dislocation rate, and bearing surface wear. The primary purpose of this study was to assess whether the use of the MAKO™ robotic hip system is reliable in predicting post-operative radiographic measurements of cup inclination, cup anteversion, leg length change, and global offset change in THA. All robotic-assisted THAs performed using the MAKO™ system between June 2011 and Dec 2012 were reviewed. A single surgeon performed all cases through a mini-posterior approach. The intra-operative measurements of cup inclination and anteversion angles, leg length change, and global offset change recorded by the MAKO™ system were compared to the post-operative radiographic measurements.Background:
Materials and Methods:
Improper acetabular component orientation has been shown to negatively affect the outcome of total hip arthroplasty through increasing dislocation rates, component impingement, bearing surface wear, and the rate of revision surgeries. The “Safe Zone” was defined by Lewinnek et al. in 1978 as 5 to 25 degrees of cup version and 30 to 50 degrees of cup inclination. Later, the inclination “Safe Zone” values were modified to 30 to 45 degrees. The primary purpose of this study was to assess whether the use of Mako robotic hip system improves cup positioning when compared to traditional THR.Introduction
Objectives
