PRACTICE PEARLS: Robotics in Hip Replacement

    Yesterday, we looked at the use of robotics in unicompartmental and total knee arthroplasty. Today, find out what faculty at past ICJR meetings had to say about some of the issues – pro and con – with the use of robotic technology for total hip arthroplasty.

    Case Example: Robotics in Total Hip Arthroplasty
    William L. Bargar, MD

    Using robotics in total hip arthroplasty (THA) as the case example of adopting new technology, William L. Bargar, MD, from Sutter General Hospital in Sacramento, California, reviews the challenges of evidence-based medicine and the type of studies that can realistically be expected prior to adoption.

    Multiple studies have shown that robotics is superior to manual techniques with regard to component sizing, orientation, and fit in THA. What has not been shown is how these values relate to outcome, Dr. Bargar says.

    Click the image above to watch Dr. Bargar’s presentation.

    Robotic Guidance in Anterior Approach THR
    Benjamin G. Domb, MD

    One of the most important aspects of total hip arthroplasty (THA) is component placement, as it affects outcomes and complication rates, and there is always room for improvement, says Benjamin G. Domb, MD, from Hinsdale Orthopaedics & American Hip Institute in Westmont, Illinois.

    In this presentation, Dr. Domb discusses the current challenges in THA and emphasizes the importance of restoring the spatial relationship between femur and pelvis in 3 dimensions.

    The goal of robotics is to assist the surgeon in accurately executing this 3D preoperative plan, and Dr. Domb reviews his research showing how robotics can eliminate outliers in cup placement.

    Click the image above to watch Dr. Domb’s presentation.

    Robotic THA – Coming to a Hospital Near You?
    Jonathan M. Vigdorchik, MD

    Many new technologies are available for total hip arthroplasty (THA), but do they address actual problems and are they worth the cost?

    Jonathan M. Vigdorchik, MD, from NYU Langone Medical Center – Hospital for Joint Diseases in New York, reviews the current problems encountered in THA, such as component positioning issues and leg length discrepancy, and then discusses whether these problems can be properly addressed using new technologies.

    He concludes that yes, robotic technology can help make component positioning more accurate and reduce leg length discrepancy, but cost may be an issue. Only time will tell if robotic technology can provide better outcomes and implant longevity with decreased complications in a cost-effective manner.

    Click the image above to watch Dr. Vigdorchik’s presentation.

    Navigation and Robotics
    Douglas E. Padgett, MD

    Robotic total hip arthroplasty (THA) surgery is not necessarily minimally invasive, says Douglas E. Padgett, MD, from Hospital for Special Surgery in New York. The surgeon needs an extensile exposure to translate the femur out of the way and make room for the robotic arm.

    In this presentation, Dr. Padgett uses a surgical video to illustrate the preoperative planning and intraoperative steps necessary for performing a THA using robotics.

    In Dr. Padgett’s experience, robotics has been accurate and he has been happy with leg length and offset, especially in thin hyper-mobile women and other difficult patients.

    Click the image above to watch Dr. Padgett’s presentation.

    Why Consider Robotics in THA
    Mark W. Pagnano, MD

    Use of robotics in total hip arthroplasty (THA) has been shown to improve the precision of bone preparation and implant positioning, and the 3D planning may improve the ability to restore limb length and offset in a reproducible way.

    But Mark W. Pagnano, MD, from Mayo Clinic in Rochester, Minnesota, believes we are still in the infancy of routinely using this technology in THA.

    In this presentation, he reviews the current literature and concludes that robotics can improve implant positioning in THA, but until we know the ideal component position, we will not be able to harness the precision of robotics to make a meaningful difference in outcomes.

    Click the image above to watch Dr. Pagnano’s presentation.