Accuracy of cup position following robot-assisted total hip arthroplasty may be associated with surgical approach and pelvic tilt

Shinya Hayashi,Tomoyuki Kamenaga,Naoki Nakano,Ryosuke Kuroda,Kazunari Ishida,Yuichi Kuroda,Nao Shibanuma,Tomoyuki Matsumoto,Shingo Hashimoto

doi:10.1038/s41598-021-86849-0

Shinya Hayashi, Tomoyuki Kamenaga + Show 7 more

Open Access

https://doi.org/10.1038/s41598-021-86849-0

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Journal: Scientific Reports	Publication Date: Apr 7, 2021
Citations: 8	License type: open-access

Affiliation: Kobe University, Kobe Kaisei Hospital

Abstract

This study aimed to investigate the accuracy of cup placement and determine the predictive risk factors for inaccurate cup positioning in robot-assisted total hip arthroplasty (THA). We retrospectively analyzed 115 patients who underwent robot-assisted THA between August 2018 and November 2019. Acetabular cup alignment and three-dimensional (3D) position were measured using pre- or postoperative computed tomography (CT) data. Absolute differences in cup inclination, anteversion, and 3D position were assessed, and their relation to preoperative factors was evaluated. The average measurement of the absolute differences was 1.8° ± 2.0° (inclination) and 1.9° ± 2.3° (anteversion). The average absolute difference in the 3D cup position was 1.1 ± 1.2 mm (coronal plane) and 0.9 ± 1.0 mm (axial plane). Multivariate analysis revealed that a posterior pelvic tilt [odds ratio (OR, 1.1; 95% confidence interval (CI), 1.00–1.23] and anterior surgical approach (OR, 5.1; 95% CI, 1.69–15.38) were predictive factors for inaccurate cup positioning with robot-assisted THA. This is the first study to demonstrate the predictive risk factors (posterior pelvic tilt and anterior surgical approach) for inaccurate cup position in robot-assisted THA.

Highlights

This study aimed to investigate the accuracy of cup placement and determine the predictive risk factors for inaccurate cup positioning in robot-assisted total hip arthroplasty (THA)
Acetabular cup positioning is important for early and long-term outcomes of total hip arthroplasty (THA), and malposition is recognized as a risk factor for postoperative complications, such as impingement, dislocation, and accelerated polyethylene wear, after T HA1–3
We believe that several predictive risk factors for inaccurate cup positioning may exist

Summary

Introduction

This study aimed to investigate the accuracy of cup placement and determine the predictive risk factors for inaccurate cup positioning in robot-assisted total hip arthroplasty (THA). Multivariate analysis revealed that a posterior pelvic tilt [odds ratio (OR, 1.1; 95% confidence interval (CI), 1.00–1.23] and anterior surgical approach (OR, 5.1; 95% CI, 1.69–15.38) were predictive factors for inaccurate cup positioning with robot-assisted THA. The factors included patient characteristics comprising body mass index (BMI)5, age6, gender[6], and primary diagnosis for THA7 or surgery including the performing surgeon’s experience[6], the surgical approach[8], and the prosthetic components[9] To resolve this difficulty, various techniques, such as manual guides, intraoperative landmarks, intraoperative X-ray or fluoroscopy, computer navigation, and robotics, were developed to improve the accuracy and precision of acetabular cup positioning in T HA10.

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