Robot-assisted total hip replacement in primary and revision cases

Abstract

Cementless total hip replacement is the standard indication in robot-assisted orthopedic surgery. The communication between the surgeon and the computer system distinguishes robot-assisted surgery from conventional total hip replacement surgery. This communication begins with the establishment of a preoperative plan by the surgeon on the Orthodoc computer workstation. Although this planning process is guided by a menu, it requires a thorough analysis of the patient's anatomy by the surgeon. The next crucial step during robot-assisted surgery is registration, which is the matching of the virtual world and the real world by the robot. During registration, the surgeon assists the robot by guiding it either to fiducial markers (pins) or surface points at the femoral neck. Once registration is completed, the surgeon has to connect the patient's bone to the robot and provide access for the end-effector to the bone. The latter step sometimes requires scrupulous soft tissue management. Failure to provide access to the bone will lead to force-freezes, interruptions of the reaming, and ultimately, to prolongation of the procedure. The use of the robot in revision cases requires special attention to the quality of the bone to prevent fractures during positioning and fixation. If the surgeon complies with the routines of the computer, the robot will transfer the preoperative plan with highest accuracy.