Haptically guided robotic technology in total hip arthroplasty: A cadaveric investigation

• Published in: Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine Journal of engineering in medicine, 2013-03, Vol.227 (3), p.302-309
• Main Authors: Nawabi, Danyal H, Conditt, Michael A, Ranawat, Amar S, Dunbar, Nicholas J, Jones, Jennifer, Banks, Scott, Padgett, Douglas E
• Format: Article
• Language: English
• Subjects: Acetabulum - anatomy & histology; Acetabulum - diagnostic imaging; Acetabulum - surgery; Arthroplasty, Replacement, Hip - instrumentation; Arthroplasty, Replacement, Hip - methods; Biomedical materials; Cadaver; Comparative analysis; Equalization; Failure; Hip - diagnostic imaging; Hip - surgery; Hip joint; Humans; Imaging, Three-Dimensional - methods; Implantation; Joint surgery; Orientation; Placement; Reproducibility of Results; Robotics; Robotics - instrumentation; Robotics - methods; Surgery, Computer-Assisted - instrumentation; Surgery, Computer-Assisted - methods; Surgical implants; Tomography; Tomography, X-Ray Computed - methods; Touch; Transplants & implants
• ISSN: 0954-4119; 2041-3033
• DOI: 10.1177/0954411912468540

The longevity of total hip arthroplasty (THA) continues to improve with advancements in design and bearing materials. However, the incidence of dislocation and impingement-related failures continue to rise, with the inability of the surgeon to achieve optimal component orientation cited as a cause. Computer-assistance has been shown to increase the accuracy of component orientation and robotic-assistance has been developed to translate this advantage into precise surgical execution. We sought to validate a haptically-guided robotic arm system in performing THA with the aim of comparing the accuracy of robotic-assisted acetabular cup placement to manual placement. We implanted 12 acetabular components in 6 cadaveric pelvises comparing robotic-assistance on one side with manual implantation on the other. We measured planned and actual center of rotation (COR), cup position, leg-length equalization and offset for each THA using computed tomography and the robotic platform. The root-mean-square (RMS) error for the robotic-assisted system was within 3° for cup placement and within 1mm for leg-length equalization and offset when compared to computed tomography. The robotic-assisted system was significantly more accurate than manual implantation in reproducing the COR and cup orientation, as determined by a preoperative plan. The RMS error for manual implantation compared to robotic-assistance was 5 times higher for cup inclination and 3.4 times higher for cup anteversion (p