Robotics in Total Hip Replacement Benjamin G. Domb, M.D. Medical - PowerPoint PPT Presentation

Robotics in Total Hip Replacement Benjamin G. Domb, M.D. Medical Director, American Hip Institute Clinical Assistant Professor, Loyola University Head Team Physician, Chicago Sky, WNBA Hinsdale Orthopaedics

Disclosures • American Hip Institute a , AANA Learning Center Committee a , Adventist Hinsdale Hospital b , Arthroscopy Journal a , Amplitude c , Arthrex b,c,d , ATI b , Breg b , DJO Global d , Medacta b,c , Orthomerica d , Pacira b,c , Stryker b,c a – boardmember; b – research support; c – consulting; d – royalty; e - stockholder • Hinsdale Orthopaedics

Does measuring leg lengths help achieve even leg lengths?? Hinsdale Orthopaedics

Does measuring leg lengths help achieve even leg lengths?? Hinsdale Orthopaedics

Arguments Against Robotics • “I’ve been doing it this way for 30 years” • “My results are great” • “I don’t need no stinking robot” Hinsdale Orthopaedics

Considering Something New • Our humility is our greatest asset • There is opportunity to improve! Hinsdale Orthopaedics

Robotics: Potential Advantages • More information! • Preoperative 3D planning • Intraoperative robotic accuracy • Navigated confirmation of positioning Hinsdale Orthopaedics

Hinsdale Orthopaedics

Traditional Challenges in THR • Hip dislocation – one of most significant complications in THA • Leg length discrepancy -- primary cause of litigation following THA in US • Edge loading  liner fracture, wear leading to osteolysis, impingement leading to prosthetic loosening etc. • Restoration of 3D relationship between femur and pelvis (Philips, JBJS Am 2003) (Bozic, JBJS Am 2009) Hinsdale Orthopaedics

Challenges in THR: The Plot Thickens • X-rays and fluoro are 2D • Traditionally, we have judged accuracy with X-rays • 2D perspective of a 3D object can be deceptive Hinsdale Orthopaedics

Goals of Robotics • 3D virtual pre-op implant planning • Haptic Guidance • Combined Version • Hip Length • Hip Offset • Navigation • Neck cut • Femoral version Hinsdale Orthopaedics

A Higher Goal: Creating a “Normal” Hip • Normal muscle tension and vectors make a THR feel like a normal hip • Depends on spacial relationship between femur and pelvis …in 3 dimensions! • Beyond combined version • Beyond length and offset Hinsdale Orthopaedics

Effect of Femoral Version on Gluteus Medius Force Vector Hinsdale Orthopaedics

Cup Positioning • Callanan et al: o 47% within combined safe zone  79% within anteversion safe zone  62% within inclination safe zone Callanan et al, CORR, 2011 Hinsdale Orthopaedics

Cup Placement Using Freehand Technique vs. Mako Robotic Guidance: A Prospective Matched-Pair Controlled Comparison Domb et al, CORR 2013 Hinsdale Orthopaedics

Methods • 33 Robotic THA • 33 Conventional THA • Matched groups • Single surgeon Hinsdale Orthopaedics

X-Ray Measurements 2 Blinded Observers Hinsdale Orthopaedics

Results Robotic THA Conventional THA Hinsdale Orthopaedics

Safe Zone Results - Callanan Hinsdale Orthopaedics

1 Fraction in Safe Zone 0.8 Inside Lewinnek 0.6 Safe Zone 0.4 Inside Callanan Safe 0.2 Zone 0 Mako Mako Fluoroscopic Traditional X-ray Total Anterior Posterior Technique Hinsdale Orthopaedics

Lewinnek and Callanan safe zones Hinsdale Orthopaedics

• “All 3 techniques are effective in achieving accuracy in LLD” Hinsdale Orthopaedics

• “100% of robotic leg length changes… were within 10 mm of radiographic measurements” • “Robotic-assisted THA showed good predictive value… for measurements of leg length change” Hinsdale Orthopaedics

Robotic vs. Non-Robotic THR: Patient-Reported Outcomes in a Matched-Pair Comparison Robotic – significantly higher HHS and FJS • No difference in rate of complications or • subsequent revisions Hinsdale -- Domb et al, under review Orthopaedics

Summary • Eliminate outliers • Reproduce native 3D relationship between femur and pelvis Hinsdale Orthopaedics

Implant Positioning: Does a Robot Help? • More information o Cup position o Femoral version – native and component o Length and offset pre and post • Preoperative 3D virtual planning • Robotic execution • Navigational confirmation Hinsdale Orthopaedics

Does a better tool make you more accurate? Hinsdale Orthopaedics

Thank You www.AmericanHipInstitute.org Hinsdale Orthopaedics