Robotics in Total Hip Replacement Benjamin G. Domb, M.D. Medical - - PowerPoint PPT Presentation

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Robotics in Total Hip Replacement Benjamin G. Domb, M.D. Medical - - PowerPoint PPT Presentation

Apr 02, 2023 32 likes •313 views

Robotics in Total Hip Replacement Benjamin G. Domb, M.D. Medical Director, American Hip Institute Clinical Assistant Professor, Loyola University Head Team Physician, Chicago Sky, WNBA Hinsdale Orthopaedics Disclosures American Hip

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Hinsdale Orthopaedics

Robotics in Total Hip Replacement

Benjamin G. Domb, M.D.

Medical Director, American Hip Institute Clinical Assistant Professor, Loyola University Head Team Physician, Chicago Sky, WNBA

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Hinsdale Orthopaedics

Disclosures

  • American Hip Institutea, AANA Learning

Center Committeea, Adventist Hinsdale Hospitalb, Arthroscopy Journala, Amplitudec, Arthrexb,c,d, ATIb, Bregb, DJO Globald, Medactab,c, Orthomericad, Pacirab,c, Strykerb,c

  • a – boardmember; b – research support; c – consulting; d – royalty; e - stockholder
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Hinsdale Orthopaedics

Does measuring leg lengths help achieve even leg lengths??

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Hinsdale Orthopaedics

Does measuring leg lengths help achieve even leg lengths??

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Hinsdale Orthopaedics

Arguments Against Robotics

  • “I’ve been doing it this way for 30 years”
  • “My results are great”
  • “I don’t need no stinking robot”
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Hinsdale Orthopaedics

Considering Something New

  • Our humility is our

greatest asset

  • There is
  • pportunity to

improve!

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Hinsdale Orthopaedics

Robotics: Potential Advantages

  • More information!
  • Preoperative 3D planning
  • Intraoperative robotic accuracy
  • Navigated confirmation of positioning
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Hinsdale Orthopaedics

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Hinsdale Orthopaedics

Traditional Challenges in THR

  • Hip dislocation – one of most

significant complications in THA

  • Leg length discrepancy -- primary

cause of litigation following THA in US

  • Edge loading  liner fracture, wear

leading to osteolysis, impingement leading to prosthetic loosening etc.

  • Restoration of 3D relationship between

femur and pelvis

(Philips, JBJS Am 2003) (Bozic, JBJS Am 2009)

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Hinsdale Orthopaedics

Challenges in THR: The Plot Thickens

  • X-rays and fluoro are 2D
  • Traditionally, we have judged accuracy with X-rays
  • 2D perspective of a 3D object can be deceptive
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Hinsdale Orthopaedics

Goals of Robotics

  • 3D virtual pre-op implant planning
  • Haptic Guidance
  • Combined Version
  • Hip Length
  • Hip Offset
  • Navigation
  • Neck cut
  • Femoral version
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Hinsdale Orthopaedics

A Higher Goal: Creating a “Normal” Hip

  • Normal muscle tension and

vectors make a THR feel like a normal hip

  • Depends on spacial relationship

between femur and pelvis …in 3 dimensions!

  • Beyond combined version
  • Beyond length and offset
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Hinsdale Orthopaedics

Effect of Femoral Version on Gluteus Medius Force Vector

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Hinsdale Orthopaedics

Cup Positioning

  • Callanan et al:
  • 47% within combined

safe zone

  • 79% within

anteversion safe zone

  • 62% within inclination

safe zone

Callanan et al, CORR, 2011

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Hinsdale Orthopaedics

Cup Placement Using Freehand Technique vs. Mako Robotic Guidance: A Prospective Matched-Pair Controlled Comparison Domb et al, CORR 2013

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Hinsdale Orthopaedics

Methods

  • 33 Robotic THA
  • 33 Conventional

THA

  • Matched groups
  • Single surgeon
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Hinsdale Orthopaedics

X-Ray Measurements

2 Blinded Observers

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Hinsdale Orthopaedics

Results

Robotic THA Conventional THA

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Hinsdale Orthopaedics

Safe Zone Results - Callanan

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Hinsdale Orthopaedics

0.2 0.4 0.6 0.8 1 Mako Anterior Mako Posterior Fluoroscopic Traditional X-ray Total Fraction in Safe Zone Technique Inside Lewinnek Safe Zone Inside Callanan Safe Zone

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Hinsdale Orthopaedics

Lewinnek and Callanan safe zones

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Hinsdale Orthopaedics

  • “All 3 techniques are effective in

achieving accuracy in LLD”

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Hinsdale Orthopaedics

  • “100% of robotic leg length changes…

were within 10 mm of radiographic measurements”

  • “Robotic-assisted THA showed good

predictive value… for measurements of leg length change”

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Hinsdale Orthopaedics

Robotic vs. Non-Robotic THR: Patient-Reported Outcomes in a Matched-Pair Comparison

  • Robotic – significantly higher HHS and FJS
  • No difference in rate of complications or

subsequent revisions

  • - Domb et al, under review
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Hinsdale Orthopaedics

Summary

  • Eliminate outliers
  • Reproduce native 3D

relationship between femur and pelvis

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Hinsdale Orthopaedics

Implant Positioning: Does a Robot Help?

  • More information
  • Cup position
  • Femoral version – native and

component

  • Length and offset pre and post
  • Preoperative 3D virtual

planning

  • Robotic execution
  • Navigational confirmation
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Hinsdale Orthopaedics

Does a better tool make you more accurate?

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Hinsdale Orthopaedics

Thank You

www.AmericanHipInstitute.org