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Review
. 2022 Nov 9;58(11):1616.
doi: 10.3390/medicina58111616.

Robotic-Arm-Assisted Total Hip Arthroplasty: A Review of the Workflow, Outcomes and Its Role in Addressing the Challenge of Spinopelvic Imbalance

Andrew Ogilvie  1 , Woo Jae Kim  1 , Rhody David Asirvatham  1 , Andreas Fontalis  1 , Pierre Putzeys  2 , Fares S Haddad  1
Affiliations
Review

Robotic-Arm-Assisted Total Hip Arthroplasty: A Review of the Workflow, Outcomes and Its Role in Addressing the Challenge of Spinopelvic Imbalance

Andrew Ogilvie et al. Medicina (Kaunas). .

Abstract

Robotic-arm-assisted total hip arthroplasty (RoTHA) offers the opportunity to improve the implant positioning and restoration of native hip mechanics. The concept of individualised, functional implant positioning and how it relates to spinopelvic imbalance is an important yet rather novel consideration in THA. There is mounting evidence that a significant percentage of dislocations occur within the perceived "safe zones"; hence, in the challenging subset of patients with a stiff spinopelvic construct, it is imperative to employ individualised component positioning based on the patients' phenotype. Restoring the native centre of rotation, preserving offset, achieving the desired combined anteversion and avoiding leg length inequality are all very important surgeon-controlled variables that have been shown to be associated with postoperative outcomes. The latest version of the software has a feature of virtual range of motion (VROM), which preoperatively identifies potential dynamic causes of impingement that can cause instability. This review presents the workflow of RoTHA, especially focusing on pragmatic solutions to tackle the challenge of spinopelvic imbalance. Furthermore, it presents an overview of the existing evidence concerning RoTHA and touches upon future direction.

Keywords: functional component positioning; impingement; robotic-arm assistance; spinal pathology; spinopelvic imbalance; stiffness; total hip arthroplasty; virtual range of motion.

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Conflict of interest statement

F.S.H. receives royalties/licenses, consultancy fees, and also payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Smith & Nephew, Corin, MatOrtho, and Stryker. F.S.H. is also Editor-in-Chief of The Bone & Joint Journal. P.P. is a consultant for STRYKER and designer Surgeon and Consultant for IN2Bones. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
(a) Calculation of the sacral slope with sitting X-ray on the left (28 degrees) and (b) standing X-ray on the right (40 degrees). This signifies normal change from upright to sitting position as the difference is 12 (between 11 and 29).
Figure 2
Figure 2
Annotated standing lateral lumbar spine xray defining the different spinopelvic parameters. Lumbar Lordosis (LL): the angle between superior end plates of L1 and S1; Sacral Slope (SS): the angle between a horizontal line and superior end plate of S1; Pelvic Tilt (PT): the angle between a vertical line and a line from femoral head (yellow circle) to midpoint of sacral endplate; Pelvic Incidence (PI): the angle between a line from the femoral head centre to midpoint of sacral endplate and a line perpendicular to the sacral end plate at its midpoint.
Figure 3
Figure 3
Evaluation of 3D bony coverage of the acetabular cup and careful planning in relation to restoring the native centre of rotation. (a) Sagittal. (b) Transverse. (c) Coronal.
Figure 3
Figure 3
Evaluation of 3D bony coverage of the acetabular cup and careful planning in relation to restoring the native centre of rotation. (a) Sagittal. (b) Transverse. (c) Coronal.
Figure 4
Figure 4
Preoperative screenshot showing planned femoral osteotomy with green line, femoral centre of rotation with green dot at tip of implant, planned leg length and combined offset changes at bottom right of screen and calculated femoral version just above.
Figure 5
Figure 5
Intraoperative screenshot showing the actual cup position compared to the pre-operative plan. Leg length and combined offset changes are also displayed.
Figure 6
Figure 6
(a) AP pelvis radiograph; (b) standing lateral lumbar radiograph showing sacral slope of 25 degrees; (c) sitting lumbar radiograph showing sacral slope of 19 degrees.
Figure 7
Figure 7
Native femoral version is −6 degrees (yellow circle).
Figure 8
Figure 8
Bone-on-bone and implant-on-bone impingement in the postero-superior region of the acetabulum (in red) in deep flexion/external rotation.
Figure 9
Figure 9
Correction of femoral retroversion from native −6 degrees to +16 degrees with the implant on the (a) robotic software (yellow circle) and (b) intraoperatively (yellow lines).
Figure 10
Figure 10
VROM in flexion with new femoral broach version of 16 degrees with no further evidence of impingement.
Figure 11
Figure 11
(a) VROM in extension with no obvious impingement. (b) VROM in extension (yellow circle) with subtraction of the implant showing a small area of anterior impingement (red area indicated by yellow arrow).
Figure 11
Figure 11
(a) VROM in extension with no obvious impingement. (b) VROM in extension (yellow circle) with subtraction of the implant showing a small area of anterior impingement (red area indicated by yellow arrow).
Figure 12
Figure 12
(a) Robotic software showing anticipated post-operative X-ray incorporating planned changes in leg length and offset. (b) Post-operative X-ray.
See this image and copyright information in PMC

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