| Background:Total hip arthroplasty(THA)is an effective method for treating end-stage hip joint diseases,which can significantly improve patients’ pain symptoms and restore hip physiological function.Previous studies have reported that THA has an extremely high implant survival rate and patient satisfaction.Nevertheless,various complications caused by poor placement and angle of prosthesis installation are one of the main factors leading to a decrease in postoperative satisfaction among patients.With the continuous progress of technology and the improvement of surgical requirements,Robotic arm assisted total hip arthroplasty(RATHA)has been widely used in clinical practice,which can improve the accuracy and repeatability of prosthesis implantation,reduce postoperative complications,and achieve good imaging results.However,there is currently no consensus on the application and clinical efficacy evaluation of RATHA in different types of hip joint diseases.Purpose:This study evaluated and analyzed RATHA from the following three aspects by collecting patient basic information,preoperative and postoperative laboratory examination data and imaging data,as well as hip joint function scores and complications during follow-up:(1)accuracy evaluation of RATHA surgery;(2)Analysis of the safety and early clinical efficacy of RATHA;(3)Analysis of differences in the performance of RATHA surgery in different types of hip joint diseases.Methods:This study is a prospective study.Inclusion criteria:(1)Diagnosed with developmental dysplasia of the hip(DDH)(Crowe phase I-III)or osteonecrosis of the femoral head(ONFH),initial total hip arthroplasty;(2)Grouping according to diagnosis and surgical procedure;(3)The operation is performed by the same primary surgeon;(4)Case control study.Exclusion criteria:(1)Have a history of mental illness,or poor adherence to treatment;(2)Missing imaging data;(3)With concomitant lower extremity fractures;(4)Loss to follow-up;(5)Hip instability or abnormal gait due to neuromuscular insufficiency.According to the inclusion and exclusion criteria,the study included a total of 105 patients who underwent total hip arthroplasty due to DDH or ONFH in the Laoshan Joint Surgery Ward of Qingdao University Affiliated Hospital from January 2021 to December2021.Among them,there were 42 patients in the RATHA group(13 in the RATHA-DDH group and 29 in the RATHA-ONFH group)and 63 patients in the traditional THA group.Observation indicators:(1)Accuracy evaluation of RATHA surgery: Record the relevant parameters such as preoperative planning of the patient’s prosthetic model,prosthetic angle,lower limb length difference,and hip joint eccentricity difference,and compare them with the actual prosthetic model used during surgery and the relevant parameters measured by postoperative imaging.Evaluate the matching degree of the actual prosthetic model with preoperative planning and the accuracy of executing preoperative planning.(2)Safety and early clinical efficacy of RATHA: Record patient’s basic information,preoperative and postoperative laboratory examination data and imaging data,hip joint function scores and complications during follow-up,and analyze the safety and early clinical efficacy of RATHA.(3)Analysis of differences in the performance of RATHA surgery in different types of hip joint diseases: recording the patient’s basic information,preoperative planning,postoperative imaging data,hip joint function scores and complications during follow-up,and comparing and evaluating the surgical effects of using RATHA to treat DDH and ONFH hip diseases.Results:(1)The preoperative planning of RATHA can achieve a high degree of matching with the actual prosthetic models used during surgery,which can better execute its surgical plan.The accuracy of RATHA acetabular prosthesis planning is 83.33%,and the accuracy of femoral stem prosthesis planning is 78.57%.Compared with the preoperative plan,the abduction angle of the acetabular prosthesis after RATHA was(42.24 ± 0.65)°,the average absolute error(MAE)was 3.97 °,the anteversion angle of the acetabular prosthesis was(13.59 ± 0.73)°,and the MAE was 3.62 °.The preoperative planned lower limb length difference was(6.40 ± 1.14)mm,the postoperative measured lower limb length difference was(3.79 ± 0.62)mm,and the MAE was 5.49 mm.The preoperative planned hip joint eccentricity difference was(4.93 ± 0.54)mm,the postoperative measured hip joint eccentricity difference was(4.95 ± 0.54)mm,and the MAE was 6.70 mm.Compared with preoperative planning,76.19% of patients had acetabular abduction angle errors of less than 5 °,83.33% had acetabular anteversion angle errors of less than 5 °,71.43% had lower limb length differences of less than 5mm,and 61.90% had postoperative hip joint eccentricity errors of less than 5mm.The placement rate of acetabular prostheses in the Lewinnek safety zone and Callan safety zone in RATHA patients after surgery was 90.48% and 71.43%,respectively.(2)Compared with traditional THA,there was no significant statistical difference in patient basic information(P>0.05).The operating time of RATHA was(98.81 ± 15.45)minutes,which was significantly longer than that of traditional THA(66.89 ± 5.66)minutes(P<0.001),but did not increase the risk of infection and blood loss in the perioperative period(P>0.05).The difference in lower limb length is(3.79 ± 2.72)mm,which is smaller than the traditional THA(7.44 ± 3.91)mm(P<0.001).The placement rates of acetabular implants in the Lewinnek and Callan safety zones were 90.5% and71.4% in the RATHA group,while the placement rates in the two safety zones were93.7% and 69.8% in the traditional THA group,respectively.There was no statistically significant difference between the groups(P>0.05).The Harris hip joint function scores of the two groups of patients at 3 months and 6 months after surgery were significantly improved compared to before surgery,and there was no significant statistical difference between the two groups(P>0.05).Compared with the traditional THA group at 6 months after surgery and before surgery,the improved scores of patients in the RATHA group were(37.14 ± 5.35)points and(36.56 ± 5.36)points,respectively.There was no statistically significant difference between the groups(t=0.389,P=0.698).The WOMAC osteoarthritis index of the two groups of patients at 3 months and 6 months after surgery was significantly improved compared to before surgery,and there was no significant statistical difference between the two groups(P>0.05).Compared with the traditional THA group patients 6 months after surgery and before surgery,the improvement values of the scores in the RATHA group patients were(46.62 ± 9.87)points and(46.22 ± 11.35)points,respectively.There was no statistically significant difference between the groups(t=0.136,P=0.892).The forgetting joint scores of the two groups of patients showed an upward trend at 3 months and 6 months after surgery,and there was no statistically significant difference between the groups(P>0.05).(3)Except for the higher proportion of women in the RATHA-DDH group(P=0.03),there was no significant statistical difference in basic information between the RATHA DDH group and the RATHA-ONFH group(P>0.05).There were no significant statistical differences between the two groups in terms of surgical time,postoperative prosthesis angle,difference between postoperative prosthesis angle and preoperative planning,postoperative lower limb length difference,and hip joint eccentricity difference(P>0.05).The placement rate of acetabular implants in the Lewinnek safety zone was 90.9% in the RATHA-DDH group and 89.7% in the RATHA-ONFH group,with no statistically significant difference between the groups(P=0.906).The proportion of acetabular prosthesis angles in the Callan safety zone was 84.6% in the RATHA-DDH group,while the proportion in the RATHA-ONFH group was 65.52%.There was no statistically significant difference between the groups(P=0.205).The Harris hip joint function scores of the two groups of patients at 3 months and 6 months after surgery were significantly improved compared to before surgery,and there was no significant statistical difference between the two groups(P>0.05).The improvement values of the RATHA-DDH group and the RATHA-ONFH group at 6 months after surgery were(36.23 ± 5.13)points and(37.14 ± 5.81)points,respectively,with no statistically significant difference(t=0.484,P=0.616).The WOMAC osteoarthritis index of the two groups of patients at 3 months and 6 months after surgery was significantly improved compared to before surgery,and there was no significant statistical difference between the two groups(P>0.05).The improvement values of the RATHA-DDH group and the RATHA-ONFH group at 6months after surgery were(48.62 ± 11.84)points and(45.72 ± 8.94)points,respectively,with no statistically significant difference(t=0.875,P=0.387).The forgetting joint scores of the two groups of patients showed an upward trend at 3 months and 6 months after surgery,and there was no statistically significant difference between the groups(P>0.05).Conclusion:The RATHA surgery has a high accuracy in predicting acetabular and femoral stem prostheses,and completing surgical plans.Its preoperative planning has certain reference value,and the surgeon can benefit from it.Compared to traditional THA,RATHA is safe and reliable.Although the surgical time is prolonged,it does not increase the risk of infection,blood loss,and complications for patients during the perioperative period.Moreover,the difference in lower limb length is smaller,which is beneficial for restoring the physiological structure of the hip joint.In terms of early recovery of hip joint function,there was no significant statistical difference between RATHA and traditional THA.RATHA is stable and reliable,and there is no significant difference in surgical efficacy when treating different types of hip joint diseases. |
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