Learning curve and short-term clinical outcomes of Mako robotic-assisted direct anterior approach total hip arthroplasty

Abstract

Objective: To explore the learning curve and short-term clinical outcomes of Mako robotic-assisted direct anterior approach total hip arthroplasty (THA). Methods: The preoperative basic data, surgical information and postoperative rehabilitation of 50 patients who underwent Mako robotic-assisted THA for hip diseases in Department of Orthopedic Surgery of the 6th People's Hospital Affiliated to Shanghai Jiao Tong University from December 2018 to December 2020 were analyzed retrospectively, included operation time, intraoperative blood loss, postoperative complications, postoperative imaging parameters (abduction angle, anteversion angle, lower limb length difference, eccentricity difference) and postoperative hip joint Harris score (hip Harris score, HHS). There were 16 males and 34 females, with a mean age of 50-79(67±10) years. The postoperative clinical results of Mako robotic-assisted total hip arthroplasty was analyzed. A cumulative sum analysis (CUSUM) was performed on the operation time (OT). The CUSUM learning curve was modeled by curve fitting and R² was used to testify the goodness. The different phase of the learning curve was compared with several observation indicators. Results: All patients were followed up for more than 6 months. Two patients had poor wound healing and 5 patients had symptoms of lateral femoral cutaneous nerve injury, which disappeared within 1-2 months. No serious complications such as dislocation, aseptic loosening, periprosthetic infection or revision occurred in all the patients. The average operation time was (81±16) min, and the intraoperative blood loss was (456±84) ml. The average Harris hip score at the last follow-up was 88.6±2.5. The radiological evaluation showed that the positions of the acetabular cups were all in the Lewinnnek safety zone; the limb length discrepancy was (0.15±0.50) cm, the offset was (-0.11±0.72) cm. The OT decreased with the accumulation of the cases. The CUSUM learning curve was best modeled as cubic curve,the fitting curve reached the top at the 19th case. As a cut-off point, the 19th point divided the learing curve into two phases. There were statistical differences in OT, pelvic array installation time, acetabular registration time, acetabular reaming time (all P<0.05), but there was no significant differences in Harris hip score, acetabular prosthesis anteversion angle and abduction angle between the two groups (all P>0.05). Conclusions: The learning curve of Mako robot-assisted DAA-THA is about 19 cases. Mako robot-assisted DAA-THA can ensure the accuracy of prosthetic placement and the safety of the operation during the learning curve, and the short-term clinical results after surgery is excellent.