Abstract
Combined acetabular and femoral anteversion (CA) of the hip following total hip arthroplasty (THA) is critical to the hip function and longevity of the components. However, no study has been reported on the accuracy in restoration of CA of the hip after operation using robotic assistance and conventional free-hand techniques. The purpose of this study was to evaluate if using robotic assistance in THA can better restore native CA than a free-hand technique.
Twenty three unilateral THA patients participated in this study. Twelve of them underwent a robotic-arm assisted THA (RIO® Robotic Arm Interactive Orthopedic System, Stryker Mako., Fort Lauderdale, FL, USA) and eleven received a free-hand THA. Subject specific 3D models of both implanted and non-implanted hips were reconstructed using post-operative CT scans. The anteversion and inclination of the native acetabulum and implanted cup were measured and compared. To determine the differences of the femoral anteversion between sides, the non-implanted native femur was mirrored and aligned with the remaining femur of the implanted side using an iterative closest point algorithm. The angle between the native femoral neck axis and the prosthesis neck axis in transverse plane was measured as the change in femoral anteversion following THA. The sum of the changes of the acetabular and femoral anteversion was defined as the change of CA after THA. A Wilcoxon signed rank test was performed to test if the anteversion of the navigation and free-hand THAs were different from the contralateral native hips (α = 0.05).
The acetabular anteversion were 22.0°±7.4°, 35.9°±6.5° and 32.6°±22.6° for the native hips, robotic assisted THAs and free-hand THAs, respectively, and the corresponding values of the acetabular inclinations were 52.0°±2.9°, 35.4°±4.4° and 43.1°±7.1°. The acetabular anteversion was increased by 12.2°±11.1° (p=0.005) and 12.5°±20.0° (p=0.102) for the robotic assisted and the free-hand THAs. The femoral anteversion was increased by 6.3°±10.5° (p=0.077) and 11.0°±13.4° (p=0.014) for the robotic assisted and free-hand THAs, respectively. The CA were significantly increased by 18.5°±11.7° (p<0.001) and 23.5°±26.5° (p=0.019) for the robotic assisted and the free-hand THAs. The changes of the CA of the free-hand THAs varied in a larger range than those of the robotic assisted THAs.
This study is the first to evaluate the changes in acetabular and femoral anteversions of the hips after robotic assisted and free-hand THAs using the contralateral native hip as a control. The results demonstrate that both the navigation and free-hand THAs significantly increased the CA compared to the contralateral native hips, but the changes of the robotic assisted THAs (18.5°±11.7°) were smaller and varied less than those of the free-hand THAs (23.5°±26.5°). These data suggest that the robotic assisted THA can better restore the native hip CAs with higher repeatability than the free-hand technique. Further studies are needed to investigate the effects of the hip anteversion changes on the in-vivo function of the hip and the long-term outcomes in THA patients.
