Robotic-Assisted Total Hip Arthroplasty Provides Greater Implant Placement Accuracy and Lower Complication Rates, but Not Superior Clinical Results Compared to the Conventional Manual Approach: A Systematic Review and Meta-Analysis.

IF 3.4 2区 医学 Q1 ORTHOPEDICS
Alessandro Bensa, Gherardo Pagliazzi, Antonio Miele, Guglielmo Schiavon, Marco Cuzzolin, Giuseppe Filardo
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引用次数: 0

Abstract

Background: Accurate component placement plays a critical role in the outcome of total hip arthroplasty (THA). Robotic-assisted THA (R-THA) has emerged as an option to optimize this aspect compared to the conventional manual THA (C-THA). The aim of this meta-analysis was to analyze the studies comparing R-THA and C-THA. The hypothesis was that the use of robotic technology could improve component positioning, but this advantage may not translate into clinically relevant benefits.

Methods: The literature search was conducted on three databases (PubMed, Cochrane Library, and Web of Science) in January 2024. The screening process and analysis were conducted separately by two independent observers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The inclusion criteria were comparative studies, English language, no time limitation, and focusing on the comparison of R-THA and C-THA. Among the 1,883 articles retrieved, 38 studies (10,055 patients) were included. The meta-analysis covered radiological outcomes, clinical outcomes, perioperative parameters, complications, and revisions. The quality of each article was assessed using the "Downs and Black's checklist for measuring quality".

Results: Robotic THA provided superior radiological results compared to C-THA in terms of acetabular cup placement within the Lewinnek safe zone (P < 0.01) and horizontal change of the rotation center (P = 0.03). No statistically significant difference was obtained in terms of clinical scores between the two approaches, including Harris Hip Score, Western Ontario and McMaster Universities Arthritis Index, Forgotten Joint Score, and Merle d'Aubigné Hip Score. Robotic THA showed longer operative time (P < 0.01), but lower complication rates (P = 0.04). No difference was obtained in terms of intraoperative blood loss and revision rates.

Conclusions: The results of this meta-analysis suggest that R-THA can provide more accurate cup placement and better restoration of the native hip anatomy while reducing complication rates compared to C-THA. However, these benefits did not translate into clinical differences in terms of patient-reported outcomes between the two approaches, and R-THA required longer operative time. While the overall results suggest some benefits with the robotic technology, future studies should investigate if further technical improvements will translate into clinically relevant benefits for patients undergoing THA.

与传统人工方法相比,机器人辅助全髋关节置换术提供更高的植入物放置准确性和更低的并发症发生率,但没有更好的临床结果:一项系统回顾和荟萃分析。
背景:准确的假体放置对全髋关节置换术(THA)的疗效起着至关重要的作用。与传统的人工THA (C-THA)相比,机器人辅助THA (R-THA)已经成为优化这方面的一种选择。本荟萃分析的目的是分析比较R-THA和C-THA的研究。假设使用机器人技术可以改善部件定位,但这种优势可能不会转化为临床相关的益处。方法:于2024年1月在PubMed、Cochrane Library、Web of Science三个数据库进行文献检索。筛选过程和分析由两名独立观察员根据系统评价和荟萃分析(PRISMA)指南的首选报告项目分别进行。纳入标准为比较研究、英语语言、无时间限制、以R-THA和C-THA比较为主。在检索到的1883篇文章中,纳入了38项研究(10055例患者)。荟萃分析包括放射学结果、临床结果、围手术期参数、并发症和修订。每篇文章的质量都是用“Downs和Black的质量测量清单”来评估的。结果:与C-THA相比,机器人THA在Lewinnek安全区内髋臼杯放置位置(P < 0.01)和旋转中心水平变化(P = 0.03)方面的放射学结果优于C-THA。两种方法的临床评分包括Harris髋关节评分、Western Ontario and McMaster Universities Arthritis Index、Forgotten Joint Score和Merle d’aubign髋关节评分,差异无统计学意义。机器人THA手术时间较长(P < 0.01),并发症发生率较低(P = 0.04)。术中出血量和翻修率无差异。结论:本荟萃分析的结果表明,与C-THA相比,R-THA可以提供更准确的罩杯放置,更好地恢复髋关节原解剖结构,同时减少并发症发生率。然而,就两种入路患者报告的结果而言,这些益处并没有转化为临床差异,R-THA需要更长的手术时间。虽然总体结果表明机器人技术有一些好处,但未来的研究应该调查进一步的技术改进是否会转化为THA患者的临床相关益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Arthroplasty
Journal of Arthroplasty 医学-整形外科
CiteScore
7.00
自引率
20.00%
发文量
734
审稿时长
48 days
期刊介绍: The Journal of Arthroplasty brings together the clinical and scientific foundations for joint replacement. This peer-reviewed journal publishes original research and manuscripts of the highest quality from all areas relating to joint replacement or the treatment of its complications, including those dealing with clinical series and experience, prosthetic design, biomechanics, biomaterials, metallurgy, biologic response to arthroplasty materials in vivo and in vitro.
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