Comparison of Robotic-assisted and Conventional Acetabular Cup Placement in THA: A Matched-pair Controlled Study Robot-assisted primary cementless total hip arthroplasty with a short femoral stem: a prospective randomized short-term outcome study. Robot-assisted primary cementless total hip arthroplasty with a short femoral stem: a prospective randomized short-term outcome study A Comparison between Robotic-assisted and Manual Implantation of Cementless Total Hip Arthroplasty Robot‐assisted total hip arthroplasty: Clinical outcomes and complication rate Achieving Accurate Ligament Balancing Using Robotic-Assisted Unicompartmental Knee Arthroplasty Early experiences with robot-assisted total knee arthroplasty using the DigiMatch™ ROBODOC® surgical system. [Clinical outcome following robotic assisted versus conventional total hip arthroplasty: a controlled and prospective study of seventy-one patients]. Robot-assisted total knee arthroplasty accurately restores the joint line and mechanical axis. A prospective randomised study. Effect of robotic milling on periprosthetic bone remodeling. Comparison of robotic-assisted and conventional manual implantation of a primary total knee arthroplasty. Comparison of robot-assisted and conventional total knee arthroplasty: A controlled cadaver study using multiparameter quantitative three-dimensional CT assessment of alignment Comparison of robotic-assisted and manual implantation of a primary total hip replacement. A prospective study. Reduction in variability of acetabular cup abduction using computer assisted surgery: a prospective and randomized study. Robot-assisted Total Knee Arthroplasty Robotic-assisted total knee arthroplasty may lead to improvement in quality-of-life measures: a 2-year follow-up of a prospective randomized trial Preliminary application of computer-assisted patient-specific acetabular navigational template for total hip arthroplasty in adult single development dysplasia of the hip. Robotic-assisted TKA Reduces Postoperative Alignment Outliers and Improves Gap Balance Compared to Conventional TKA Technique and first clinical results of robot-assisted total knee replacement. Accuracy of Robot-Assisted Placement of Lumbar and Sacral Pedicle Screws: A Prospective Randomized Comparison to Conventional Freehand Screw Implantation Robot-assisted spine surgery: feasibility study through a prospective case-matched analysis Thirteen-year wear rate comparison of highly crosslinked and conventional polyethylene in total hip arthroplasty: long-term follow-up of a prospective randomized controlled trial A comparison of total hip resurfacing and total hip arthroplasty - patients and outcomes.
Background Improper acetabular component orientation in THA has been associated with increased dislocation rates , component impingement , bearing surface wear , and a greater likelihood of revision . Therefore , any reasonable steps to improve acetabular component orientation should be considered and explored . Questions / purpose sWe therefore sought to compare THA with a robotic-assisted posterior approach with manual alignment techniques through a posterior approach , using a matched-pair controlled study design , to assess whether the use of the robot made it more likely for the acetabular cup to be positioned in the safe zones described by Lewinnek et al. and Callanan et al. Methods Between September 2008 and September 2012 , 160 THAs were performed by the senior surgeon . Sixty-two patients ( 38.8 % ) underwent THA using a conventional posterior approach , 69 ( 43.1 % ) underwent robotic-assisted THA using the posterior approach , and 29 ( 18.1 % ) underwent radiographic-guided anterior-approach THAs .  From September 2008 to June 2011 , all patients were offered anterior or posterior approaches regardless of BMI and anatomy . Since introduction of the robot in June 2011 , all THAs were performed using the robotic technique through the posterior approach , unless a patient specifically requested otherwise . The radiographic cup positioning of the robotic-assisted THAs was compared with a matched-pair control group of conventional THAs performed by the same surgeon through the same posterior approach . The safe zone ( inclination , 30 ° –50 ° ; anteversion , 5 ° –25 ° ) described by Lewinnek et al. and the modified safe zone ( inclination , 30 ° –45 ° ; anteversion , 5 ° –25 ° ) of Callanan et al. were used for cup placement assessment . Matching criteria were gender , age ± 5 years , and ( BMI ) ± 7 units . After exclusions , a total of 50 THAs were included in each group . Strong interobserver and intraobserver correlations were found for all radiographic measurements ( r > 0.82 ; p < 0.001 ) . Results One hundred percent ( 50/50 ) of the robotic-assisted THAs were within the safe zone described by Lewinnek et al. compared with 80 % ( 40/50 ) of the conventional THAs ( p = 0.001 ) . Ninety-two percent ( 46/50 ) of robotic-assisted THAs were within the modified safe zone described by Callanan et al. compared with 62 % ( 31/50 ) of conventional THAs p ( p = 0.001 ) . The odds ratios for an implanted cup out of the safe zones of Lewinnek et al. and Callanan et al. were zero and 0.142 , respectively ( 95 % CI , 0.044 , 0.457 ) . Conclusions Use of the robot allowed for improvement in placement of the cup in both safe zones , an important parameter that plays a significant role in long-term success of THA . However , whether the radiographic improvements we observed will translate into clinical benefits for patients —such as reductions in component impingement , acetabular wear , and prosthetic dislocations , or in terms of improved longevity — remains unproven . Level of Evidence Level III , therapeutic study . See the Instructions for Authors for a complete description of levels of evidence BACKGROUND Recently , two topical issues in total hip arthroplasty ( THA ) have been robot-assisted surgery and use of a short stem . The purpose of this study was to evaluate the effects of robotic milling on the accuracy of short femoral stem positioning and on the short-term clinical outcome in THA using a prospect i ve , r and omized design . METHODS We r and omized 54 patients into two groups , either robotic milling group or manual rasping group .  The patients were assessed clinical ly and radiographically at 8 weeks , 5 months , 12 months , and 24 months . RESULTS Robotic milling group had a significantly longer operation time , requiring on average 8.9 min for registration and 11.2 min for milling . On the other h and , robotic milling group showed superior results in terms of stem alignment and leg length e quality . Two intraoperative femoral fractures occurred only in manual rasping group . Harris hip scores and WOMAC scores at 24 months postoperatively were similar in both groups . No complications including stem loosening , infection , nerve palsy , or dislocation were encountered in either group during the follow-up period . CONCLUSIONS The present study suggested that robot-assisted short stem THA could increase the accuracy of stem alignment , improve leg length e quality , and help reduce the risk of intraoperative femoral fracture as compared with manual rasping . However , the clinical outcome scores did not differ between the two groups at the time of short-term follow-up . Long-term follow-up is needed to determine whether there will be a long-term clinical relevance of robot-assisted implantation of short femoral stems in THA Abstract Background : Recently , two topical issues in total hip arthroplasty ( THA ) have been robot-assisted surgery and use of a short stem . The purpose of this study was to evaluate the effects of robotic milling on the accuracy of short femoral stem positioning and on the short-term clinical outcome in THA using a prospect i ve , r and omized design . Methods : We r and omized 54 patients into two groups , either robotic milling group or manual rasping group .  The patients were assessed clinical ly and radiographically at 8 weeks , 5 months , 12 months , and 24 months . Results : Robotic milling group had a significantly longer operation time , requiring on average 8.9 min for registration and 11.2 min for milling . On the other h and , robotic milling group showed superior results in terms of stem alignment and leg length e quality . Two intraoperative femoral fractures occurred only in manual rasping group . Harris hip scores and WOMAC scores at 24 months postoperatively were similar in both groups . No complications including stem loosening , infection , nerve palsy , or dislocation were encountered in either group during the follow-up period . Conclusions : The present study suggested that robot-assisted short stem THA could increase the accuracy of stem alignment , improve leg length e quality , and help reduce the risk of intraoperative femoral fracture as compared with manual rasping . However , the clinical outcome scores did not differ between the two groups at the time of short-term follow-up . Long-term follow-up is needed to determine whether there will be a long-term clinical relevance of robot-assisted implantation of short femoral stems in THA Background The benefits of robotic techniques for implanting femoral components during THA are still controversial . Questions / Purpose sThe purpose of this study was to prospect ively compare the results and complications of robotic-assisted and h and -rasping stem implantation techniques . Method The minimum followup was 5 years ( mean , 67 months ; range , 60–85 months ) . One hundred forty-six primary THAs on 130 patients were included in this study .  Robot-assisted primary THA was performed on 75 hips and a h and -rasping technique was used on 71 hips . Results At 2 and 3 years postoperatively , the Japanese Orthopaedic Association ( JOA ) clinical score was slightly better in the robotic-assisted group . At 5 years followup , however , the differences were not significant . Postoperative limb lengths of the robotic-milling group had significantly less variance than the h and -rasping group . At 2 years postoperatively , there was significantly more stress shielding of the proximal femur in the h and -rasping group ; this difference was more significant 5 years postoperatively . Conclusions Substantially more precise implant positioning seems to have led to less variance in limb-length ine quality and less stress shielding of the proximal femur 5 years postoperatively . Level of Evidence Level II , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence BACKGROUND The purpose of this study was to report minimum 2-year outcomes and complications for robotic-arm-assisted total hip arthroplasty ( THA )  . METHODS Data were prospect ively collected and retrospectively review ed between June 2011 and April 2014 . Inclusion criteria were primary robotic-arm-assisted THAs treating idiopathic osteoarthritis with ≥ 2-year follow-up .  Demographics , operating time , complications , 2-year outcome scores and satisfaction , and subsequent surgeries were recorded . RESULTS There were 181 cases eligible for inclusion , of which 162 ( 89.5 % ) had minimum 2-year follow-up . At the latest follow-up , the mean visual analogue scale was 0.7 , satisfaction was 9.3 , Harris hip score was 91.1 and forgotten joint score was 83.1 . Six ( 3.7 % ) intraoperative complications and six ( 3.7 % ) postoperative complications were reported . No leg length discrepancies ( LLDs ) or dislocations were reported . CONCLUSIONS Robotic-arm-assisted THA demonstrates favourable short-term outcomes and does not result in a higher complication rate compared to non-robotic THA as reported by the literature Unicompartmental knee arthroplasty ( UKA ) allows replacement of a single compartment in patients with limited disease . However , UKA is technically challenging and relies on accurate component positioning and restoration of natural knee kinematics . This study examined the accuracy of dynamic , real-time ligament balancing  using a robotic-assisted UKA system . Surgical data obtained from the computer system were prospect ively collected from 51 patients ( 52 knees ) undergoing robotic-assisted medial UKA by a single surgeon .  Dynamic ligament balancing of the knee was obtained under valgus stress prior to component implantation and then compared to final ligament balance with the components in place . Ligament balancing was accurate up to 0.53 mm compared to the preoperative plan , with 83 % of cases within 1 mm at 0 ° , 30 ° , 60 ° , 90 ° , and 110 ° of flexion . Ligamentous laxity of 1.31 ± 0.13 mm at 30 ° of flexion was corrected successfully to 0.78 ± 0.17 mm ( P < 0.05 ) . Robotic-assisted UKA allows accurate and precise reproduction of a surgical balance plan using dynamic , real-time soft-tissue balancing to help restore natural knee kinematics , potentially improving implant survival and functional outcomes INTRODUCTION The use of robotics in total knee arthroplasty ( TKA ) has been shown to minimise human error , as well as improve the accuracy and precision of component implantation and mechanical axis alignment . The present study aim ed to demonstrate that robot-assisted TKA using ROBODOC ® is safe and capable of producing a consistent and accurate postoperative mechanical axis . METHODS We prospect ively recruited 27 consecutive patients who underwent robot-assisted TKA between May and December 2012 . Two patients were excluded from the study due to intraoperative technical problems with the robot .  Long-leg radiography and computed tomography were performed prior to surgery , and used for mechanical axis measurements and component sizing . DigiMatch ™ ROBODOC ® Surgical System software version 4.3.6 ( Curexo Technology Corp , Fremont , CA , USA ) was used in all cases to perform bone cuts in accordance with the preoperative plan . RESULTS The postoperative coronal mechanical alignment was within 3 degrees , with a mean alignment of -0.4 ± 1.7 degrees , confirming the accuracy of the preoperative surgical plan and bone cuts . The mean operating time was 96 ± 15 min , and preoperative planning yielded 100 % implant sizing accuracy . CONCLUSION Robotics has the potential to enable surgeons to consistently attain ideal postoperative alignment . The use of bone movement monitors and an integrated navigation system enhances the safety profile of ROBODOC ® by minimising errors . However , the role of the surgeon in TKA is still vital , as the surgeon is ultimately in charge of planning the surgery , its execution and ensuring soft tissue balance during TKA AIM Robotic assisted total hip arthroplasty  remains controversial , since wider exposure of the proximal femur and placement of the leg in maximal hip adduction and external rotation using a rigid leg-holder apparatus may impair significantly the hip abductors . Consequently , it is the purpose of this study to analyse and report both clinical outcome and hip abductor function following robotic assisted versus conventional total hip arthroplasty . MATERIAL AND METHODS 36 robotic-assisted ( CASPAR , Orto-Maquet , Rastatt , Germany ) and 35 conventional cementless total hip arthroplasties  were followed on average for 18 months regarding incidence of complications , Harris hip score , the scoring system according to Merle d'Aubigné and Postel , hip abductor function ( using a spring-balance ) , and incidence of Trendelenburg 's sign ( according to the Kuhfuss-classification ) . Statistical analysis was performed in case of continuous data using the t test and the Mann-Whitney test , respectively , and in case of categorical data using Fisher 's exact test and the chi-squared test , respectively . The level of significance was set as p < 0.05 . RESULTS Average duration of surgery ( CASPAR : 100.6 min ; conventional : 51.5 min ; p < 0.0001 ) as well as average loss of haemoglobin ( CASPAR : 4.5 mg/dL ; conventional : 3.3 mg/dL ; p = 0.0002 ) differed significantly , whereas the incidence of complications ( CASPAR : two dislocations , one sciatic paresis , one deep infection ; conventional : one dislocation , two fissures ) , revision rate ( CASPAR : 5.6 % ; conventional : 2.9 % ) , and incidence of heterotopic ossifications ( CASPAR : 30.6 % ; conventional : 17.1 % ) was comparable following both procedures ( p > 0.05 ) . Improvement of the Harris hip score also was comparable in both groups ( CASPAR : 40.9 to 86.1 points ; conventional : 39.5 to 88.0 points ; p = 0.21 ) , whereas improvement of the score according to Merle d'Aubigné and Postel was significantly greater following the manual procedure ( CASPAR : 10.1 to 16.0 points ; conventional : 8.3 to 16.6 points ; p < 0.0001 ) . Differences between the two groups were also significant regarding hip abductor function ( CASPAR : 76.1 % ; conventional : 93.8 % of the contralateral hip ; p < 0.0001 ) and incidence of Trendelenburg 's sign ( CASPAR : 61.1 % ; conventional : 25.7 % ; p = 0.0014 ) . CONCLUSION The significant functional impairment following robotic assisted THA should be taken critically into consideration prior to initiating such procedure Robot-assisted Total Knee Arthroplasty ( TKA ) improves the accuracy and precision of component implantation and mechanical axis ( MA ) alignment . Joint-line restoration in robot-assisted TKA is not widely described and joint-line deviation of>5 mm results in mid-flexion instability and poor outcomes . We prospect ively r and omised 60 patients into two groups : 31 patients ( robot-assisted ) , 29 patients ( conventional ) .  No MA outliers ( > ±3 ° from neutral ) or notching was noted in the robot-assisted group as compared with 19.4 % ( P=0.049 ) and 10.3 % ( P=0.238 ) respectively in the conventional group . The robot-assisted group had 3.23 % joint-line outliers ( > 5 mm ) as compared to 20.6 % in the conventional group ( P=0.049 ) . Robot-assisted TKA produces similar short-term clinical outcomes when compared to conventional methods with reduction of MA alignment and joint-line deviation outliers The ROBODOC system has provided better fit and fill of the stem and less destruction of the bony architecture than with manual surgery . These benefits might affect femoral periprosthetic bone remodeling . We evaluated the effects of robotic milling in cementless total hip arthroplasty ( THA ) in a longitudinal 24-month follow-up study using dual energy X-ray absorptiometry ( DEXA ) and plain radiographs of 29 patients ( 31 hips ) after ROBODOC THA and 24 patients ( 27 hips ) after manual THA with the same stem design . To minimize the influence of other factors on bone remodeling , only female osteoarthritis patients , who had no drugs that might affect bone metabolism were enrolled . Significantly less bone loss occurred at the proximal periprosthetic areas in the ROBODOC group . In zone 1 , the decrease was 15.5 versus 29.9 % using conventional rasping ; in zone 7 , the loss was 17.0 % with ROBODOC compared to 30.5 % with conventional rasping ( p < 0.05 ) . On radiographs , endosteal spot welds in the proximal medial portion were more pronounced in the ROBODOC group ( 48 vs. 11 % in the conventional group , p < 0.05 ) . Our results suggest that robotic milling is effective in facilitating proximal load transfer around the femoral component and minimizing bone loss after cementless THA This study was aim ed to compare robotic-assisted implantation of a total knee arthroplasty with conventional manual implantation . We controlled , r and omized , and review ed 72 patients for total knee arthroplasty assigned to undergo either conventional manual implantation ( excluding navigation-assisted implantation cases ) of a Zimmer LPS prosthesis ( Zimmer , Warsaw , Ind ) ( 30 patients : group 1 ) or robotic-assisted implantation of such a prosthesis ( 32 patients : group 2 ) . The femoral flexion angle ( gamma angle ) and tibial angle ( delta angle ) in the lateral x-ray of group 1 were 4.19 + /- 3.28 degrees and 89.7 + /- 1.7 degrees , and those of group 2 were 0.17 + /- 0.65 degrees and 85.5 + /- 0.92 degrees . The major complications were from improper small skin incision during a constraint attempt of minimally invasive surgery and during bulk fixation frame pins insertion . Robotic-assisted technology had definite advantages in terms of preoperative planning , accuracy of the intraoperative procedure , and postoperative follow-up , especially in the femoral flexion angle ( gamma angle ) and tibial flexion angle ( delta angle ) in the lateral x-ray , and in the femoral flexion angle ( alpha angle ) in the anteroposterior x-ray . But a disadvantage was the high complication rate in early stage Introduction : A functional total knee replacement has to be well aligned , which implies that it should lie along the mechanical axis and in the correct axial and rotational planes . Incorrect alignment will lead to abnormal wear , early mechanical loosening , and patellofemoral problems . There has been increased interest of late in total knee arthroplasty with robotic assistance . This study was conducted to determine whether robot-assisted total knee arthroplasty is superior to the conventional surgical method with regard to the precision of implant positioning . Material s and Methods : Twenty knee replacements , comprising ten robot-assisted procedures and ten conventional operations , were performed on ten cadavers . Two experienced surgeons performed the surgeries . Both procedures on each cadaver were performed by the same surgeon . The choice of which procedure was to be performed first was r and omized . Following implantation of the prosthesis , the mechanical axis deviation , femoral coronal angle , tibial coronal angle , femoral sagittal angle , tibial sagittal angle , and femoral rotational alignment were measured via 3D CT scanning . These variables were then compared with the preoperatively planned values . Results : In the knees that underwent robot-assisted surgery , the mechanical axis deviation ranged from −1.94 ° to 2.13 ° ( mean : −0.21 ° ) , the femoral coronal angle from 88.08 ° to 90.99 ° ( mean : 89.81 ° ) , the tibial coronal angle from 89.01 ° to 92.36 ° ( mean : 90.42 ° ) , the tibial sagittal angle from 81.72 ° to 86.24 ° ( mean : 83.20 ° ) , and the femoral rotational alignment from 0.02 ° to 1.15 ° ( mean : 0.52 ° ) in relation to the transepicondylar axis . In the knees that underwent conventional surgery  , the mechanical axis deviation ranged from −3.19 ° to 3.84 ° ( mean : −0.48 ° ) , the femoral coronal angle from 88.36 ° to 92.29 ° ( mean : 90.50 ° ) , the tibial coronal angle from 88.15 ° to 91.51 ° ( mean : 89.83 ° ) , the tibial sagittal angle from 80.06 ° to 87.34 ° ( mean : 84.50 ° ) , and the femoral rotational alignment from 0.32 ° to 4.13 ° ( mean : 2.76 ° ) in relation to the transepicondylar axis . In the conventional knee replacement group , there were two instances of outliers outside the range of 3 ° varus/valgus for the mechanical axis deviation . The robot-assisted knee replacements showed significantly superior femoral rotational alignment results compared with conventional surgery ( p = 0.006 ) . There was no statistically significant difference between robot-assisted and conventional total knee arthroplasty with regard to the other variables . All the measurements showed high intra-observer and inter-observer reliability . Conclusion : Robot-assisted total knee arthroplasty showed excellent precision in the sagittal and coronal planes of the 3D CT scan . In particular , the robot-assisted technique showed better accuracy in femoral rotational alignment compared to the conventional surgery , despite the fact that the surgeons who performed the operations were more experienced and familiar with the conventional method than with robot-assisted surgery . It can thus be concluded that robot-assisted total knee arthroplasty is superior to conventional total knee arthroplasty BACKGROUND Robotic-assisted total hip replacement  has become a common method of implantation , especially in Europe . It frequently has been postulated that robotic reaming would result in an improved clinical outcome due to the better fit of the prosthesis , but that has never been demonstrated in a prospect i ve study , to our knowledge . The purpose of this study was to compare robotic-assisted implantation of a total hip replacement with conventional manual implantation . METHODS One hundred and fifty-four patients scheduled for total hip replacement were r and omly assigned to undergo either conventional manual implantation of an S-ROM prosthesis ( eighty patients ) or robotic-assisted implantation of such a prosthesis ( seventy-four patients ) . The five-axis ROBODOC was used for the robotic-assisted procedures . Preoperatively as well as at three , six , twelve , and twenty-four months after surgery , the scores according to the Harris and Merle d'Aubigné systems and the Mayo clinical score were determined . Radiographs made at these intervals were analyzed for evidence of loosening , prosthetic alignment , and heterotopic ossification . RESULTS Thirteen ( 18 % ) of the seventy-four attempted robotic implantations had to be converted to manual implantations as a result of failure of the system . The duration of the robotic procedures  was longer than that of the manual procedures ( mean and st and ard deviation,107.1 + /- 29.1 compared with 82.4 + /- 23.4 minutes , p < 0.001 ) . Limb-length e quality ( mean discrepancy , 0.18 + /- 0.30 compared with 0.96 + /- 0.93 cm , p < 0.001 ) and varus-valgus orientation of the stem ( mean angle between the femur and the shaft of the prosthesis , 0.34 degrees + /- 0.67 degrees compared with 0.84 degrees + /- 1.23 degrees , p < 0.001 ) were better after the robotic procedures . At six months , slightly more heterotopic ossification was seen in the group treated with robotic implantation . The group treated with robotic implantation had a better Mayo clinical score at six and twelve months and a better Harris score at twelve months ; however , by twenty-four months , no difference was found between the groups with regard to any of the three scores . Dislocation was more frequent in the group treated with robotic implantation : it occurred in eleven of the sixty-one patients in that group compared with three of eighty in the other group ( p < 0.001 ) . Recurrent dislocation and pronounced limping were indications for revision surgery in eight of the sixty-one patients treated with robotic implantation compared with none of the seventy-eight ( excluding two with revision for infection ) treated with manual insertion ( p < 0.001 ) . Rupture of the gluteus medius tendon was observed during all of the revision operations . CONCLUSIONS The robotic-assisted technology had advantages in terms of preoperative planning and the accuracy of the intraoperative procedure . Disadvantages were the high revision rate ; the amount of muscle damage , which we believe was responsible for the higher dislocation rate ; and the longer duration of surgery . This technology must be further developed before its widespread usage can be justified Optimal orientation of the acetabular component of a  total hip prosthesis  is an important factor in determining the early and long-term result of a  total hip arthroplasty ( THA ) . Conventional positioning of the cup component is usually done using a free-h and method , or with the help of a mechanical acetabular alignment guide . However , these methods have proven to be inaccurate , and a great variation in orientation of the cup is found postoperatively . In this study , we wished to determine if the variability of the abduction angle of acetabular cups could be reduced with the use of computer navigation . The abduction angles of the acetabular components of three groups of 50 THAs were assessed . In the first group , a free-h and method was used to position the cup component . This group was operated in the period before we started using computer navigation for hip surgery . In the second group , CT-based computer navigation was used to plan and help position the cup . The third group consisted of 50 THA cases in which a free-h and method was used to position the cup , although these procedures were performed in the period after we had begun using the Computer Assisted Surgery ( CAS ) system . The variability in cup abduction angle was assessed in all three groups and compared . There was a significant reduction in variability in the CAS group compared to the first group . There was also a reduction in variability in the CAS group compared to the third group , although this was not statistically significant . It is concluded that the use of computer navigation helped the surgeon to place the cup component with less variability of the abduction angle , and , more importantly , we found that no cups were placed in the more extreme positions ( outliers ) Increasing evidence suggests performing  total knee arthroplasty  using computer navigation can lead to more accurate surgical positioning of the components and knee alignment compared to a conventional operating technique without computer assistance . The use of robotic technology could theoretically take this accuracy one level further because it uses navigation in combination with ultimate mechanical precision , which could eliminate or reduce the inevitable margin of error during mechanical preparation of the bony cuts of total knee arthroplasty by the surgeon . We prospect ively followed 25 consecutive cases using an active surgical robot . The minimum followup was 5.1 years ( mean , 5.5 years ; range , 5.1 - 5.8 years ) . Our results demonstrate excellent implant positioning and alignment was achieved within the 1 ° error of neutral alignment in all three planes in all cases . Despite this technical precision , the excessive operating time required for the robotic implantation , the technical complexity of the system , and the extremely high operational costs have led us to ab and on this procedure and direct our interest more toward smart semiactive robotic systems . Level of Evidence : Level IV , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence Purpose Despite reduction in radiological outliers in previous r and omized trials comparing robotic-assisted versus conventional total knee arthroplasty ( TKA ) , no differences in short-term functional outcomes were observed . The aim of this study was to determine whether there was improvement in functional outcomes and quality -of-life ( QoL ) measures between robotic-assisted and conventional TKA . Methods All 60 knees ( 31 robotic-assisted ; 29 conventional ) from a previous r and omized trial were available for analysis . Differences in range of motion , Knee Society ( KSS ) knee and function scores , Oxford Knee scores ( OKS ) , SF-36 subscale and summative ( physical PCS/mental component scores MCS ) were analysed . In addition , patient satisfaction , fulfilment of expectations and the proportion attaining a minimum clinical ly important difference ( MCID ) in KSS , OKS and SF-36 were studied . Results Both robotic-assisted and conventional TKA displayed significant improvements in majority of the functional outcome scores at 2 years . Despite having a higher rate of complications , the robotic-assisted group displayed a trend towards higher scores in SF-36 QoL measures , with significant differences in SF-36 vitality ( p = 0.03 ) , role emotional ( p = 0.02 ) and a larger proportion of patients achieving SF-36 vitality MCID ( 48.4 vs 13.8 % , p = 0.009 ) . No significant differences in KSS , OKS or satisfaction/expectation rates were noted . ConclusionS ubtle improvements in patient QoL measures were observed in robotic-assisted TKA when compared to conventional TKA . This finding suggests that QoL measures may be more sensitive and clinical ly important than surgeon-driven objective scores in detecting subtle functional improvements in  robotic-assisted TKA  patients .Level of evidence II BACKGROUND The considerable variation in anatomical abnormalities of hip joints associated with different types of developmental dysplasia of hip ( DDH ) makes reconstruction in total hip arthroplasty ( THA ) difficult . It is desirable to create patient-specific design s for THA procedures . In the cases of adult single DDH , an accuracy-improved method has been developed for acetabular cup prosthesis implantation of hip arthroplasty . METHODS From October 2007 to November 2008 , 22 patients with single DDH ( according to the Crowe st and ard , all dysplasia hips were classified as type I ) were scanned with spiral CT pre-operatively . These patients scheduled for THA were r and omly assigned to undergo either conventional THA ( control group , n = 11 ) or navigation template implantation ( NT group , n = 11 ) . In the NT group , three-dimensional ( 3D ) CT pelvis image data were transferred to a computer workstation and 3D models of the hip were reconstructed using the Mimics software . The 3D models were then processed by the Imageware software . In brief , a template that best fitted the location and shape of the acetabular cup was ' reversely ' built from the 3D model , the rotation centre of the pathological hip determined by mirroring that of the healthy site , and a guiding hole in the template was then design ed . The navigational templates were manufactured using a rapid prototyping machine . These navigation templates guide acetabular component placement . RESULTS Based on the predetermined abduction angle 45 ° and anteversion angle 18 ° , after 1 year follow-up , the NT group showed significantly smaller differences ( 1.6 ° ± 0.4 ° , 1.9 ° ± 1.1 ° ) from the predetermined angles than those in the control group ( 5.8 ° ± 2.9 ° , 3.9 ° ± 2.5 ° ) ( P < 0.05 ) . CONCLUSIONS The template design s facilitated accurate placement of acetabular components in dysplasia of acetabulum . The hip 's center of rotation in DDH could be established using computer-aided design , which provides a useful method for the accurate location of prosthesis with a low cost-performance ratio without excessive technical workload on the surgical team Background Several studies have shown mechanical alignment influences the outcome of TKA . Robotic systems have been developed to improve the precision and accuracy of achieving component position and mechanical alignment . Questions / purpose sWe determined whether robotic-assisted implantation for TKA ( 1 ) improved clinical outcome ; ( 2 ) improved mechanical axis alignment and implant inclination in the coronal and sagittal planes ; ( 3 ) improved the balance ( flexion and extension gaps ) ; and ( 4 ) reduced complications , postoperative drainage , and operative time when compared to conventionally implanted TKA over an intermediate-term ( minimum 3-year ) followup period . Methods We prospect ively r and omized 100 patients who underwent unilateral TKA into one of two groups : 50 using a robotic-assisted procedure and 50 using conventional manual techniques .  Outcome variables considered were postoperative ROM , WOMAC scores , Hospital for Special Surgery ( HSS ) knee scores , mechanical axis alignment , flexion/extension gap balance , complications , postoperative drainage , and operative time . Minimum followup was 41 months ( mean , 65 months ; range , 41–81 months ) . Results There were no differences in postoperative ROM , WOMAC scores , and HSS knee scores . The robotic-assisted group result ed in no mechanical axis outliers ( > ± 3 ° from neutral ) compared to 24 % in the conventional group . There were fewer robotic-assisted knees where the flexion gap exceeded the extension gap by 2 mm . The robotic-assisted procedures took an average of 25 minutes longer than the conventional procedures but had less postoperative blood drainage . There were no differences in complications between groups . Conclusions Robotic-assisted TKA appears to reduce the number of mechanical axis alignment outliers and improve the ability to achieve flexion-extension gap balance , without any differences in clinical scores or complications when compared to conventional manual techniques . Level of Evidence Level I , therapeutic study . See Instructions for Authors for a complete description of levels of evidence Total knee replacement ( TKR ) is a common procedure for treatment of severe gonarthrosis  , but the outcome may be unsatisfactory due to primary malalignment of the prosthetic components . In order to improve precision and accuracy of this surgical procedure , a commercial robotic surgical system ( CASPAR ) has been adapted to assist the surgeon in the preoperative planning and intraoperative execution of TKR . So far , 70 patients with idiopathic gonarthrosis were successfully treated with a robot-assisted technique in our institution . No major adverse events related to the use of the robotic system have been observed . The mean difference between preoperatively planned and postoperatively achieved tibiofemoral alignment was 0.8 degrees ( 0 - 4.1 degrees ) in the robotic group vs. 2.6 degrees ( 0 - 7 degrees ) in a manually operated historical control group of 50 patients . A clear advantage of robot-assisted TKR seems to be the ability to execute a highly precise preoperative plan based on computed tomography ( CT ) scans . Due to better alignment of the prosthetic components and improved bone-implant fit , implant loosening is anticipated to be diminished which may be most evident in non-cemented prostheses . Current disadvantages such as the need for placement of fiducial markers , increased operating times and higher overall costs have to be resolved in the future Study Design . Single-center prospect i ve r and omized controlled study . Objective . To evaluate the accuracy of  robot-assisted ( RO ) implantation of lumbar/sacral pedicle screws  in comparison with the freeh and ( FH ) conventional technique . Summary of Background Data . SpineAssist is a miniature robot for the implantation of thoracic , lumbar , and sacral pedicle screws . The system , studied in cadaver and cohort studies , revealed a high accuracy , so far . A direct comparison of the robot assistance with the FH technique is missing . Methods . Patients requiring mono- or bisegmental lumbar or lumbosacral stabilization were r and omized in a 1:1 ratio to FH or RO pedicle screw implantation .  Instrumentation was performed using fluoroscopic guidance ( FH ) or robot assistance . The primary end point screw position was assessed by a postoperative computed tomography , and screw position was classified ( A : no cortical violation ; B : cortical breach < 2 mm ; C : ≥2 mm to < 4 mm ; D : ≥4 mm to < 6 mm ; E : ≥6 mm ) . Secondary end points as radiation exposure , duration of surgery/planning , and hospital stay were assessed . Results . A total of 298 pedicle screws were implanted in 60 patients ( FH , 152 ; RO , 146 ) . Ninety-three percent had good positions ( A or B ) in FH , and 85 % in RO . Preparation time in the operating room ( OR ) , overall OR time , and intraoperative radiation time were not different for both groups . Surgical time for screw placement was significantly shorter for FH ( 84 minutes ) than for RO ( 95 minutes ) . Ten RO screws required an intraoperative conversion to the FH . One FH screw needed a secondary revision . Conclusion . In this study , the accuracy of the conventional FH technique was superior to the RO technique . Most malpositioned screws of the RO group showed a lateral deviation . Attachment of the robot to the spine seems a vulnerable aspect potentially leading to screw malposition as well as slipping of the implantation cannula at the screw entrance point Purpose While image guidance and neuronavigation have enabled a more accurate placement of pedicle implants , they can inconvenience the surgeon . Robot-assisted placement of pedicle screws appears to overcome these disadvantages . However , recent data concerning the superiority of currently available robots in assisting spinal surgeons are conflicting . The aim of our study was to evaluate the percentage of accurately placed pedicle screws , inserted using a new robotic-guidance system . Method 20 Patients were operated on successively by the same surgeon using robotic assistance ( ROSA ™ , Medtech ) ( Rosa group 10 patients , n = 40 screws ) or by the freeh and conventional technique ( Freeh and group 10 patients , n = 50 screws ) . Patient characteristics as well as the duration of the operation and of exposure to X rays were recorded . Results The mean age of patients in each group ( RG and FHG ) was 63 years . Mean BMI and operating time among the RG and FHG were , respectively , 26 and 27 kg/m2 , and 187 and 119 min . Accurate placement of the implant ( score A and B of the Gertzbein Robbins classification ) was achieved in 97.3 % of patients in the RG ( n = 36 ) and in 92 % of those in the FHG ( n = 50 ) . Four implants in the RG were placed manually following failed robotic assistance . Conclusion We report a higher rate of precision with robotic as compared to the FH technique . Providing assistance by permanently monitoring the patient ’s movements , this image-guided tool helps more accurately pinpoint the pedicle entry point and control the trajectory . Limitations of the study include its small sized and non-r and omized sample . Nevertheless , these preliminary results are encouraging for the development of new robotic techniques for spinal surgery Background The purpose of this study was to report the radiographic wear rates from a previous r and omized controlled trial of first-generation highly crosslinked versus conventional polyethylene in  total hip arthroplasty ( THA ) at a minimum of 13 years ’ follow-up . Methods Patients returned for radiographic imaging and radiostereometric analysis ( RSA ) .  Radiographs were review ed for the presence of osteolysis or component loosening . Femoral head penetration ( which includes both wear and creep ) was measured using RSA . We compared Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , 12-Item Short Form Health Survey ( SF-12 ) and Harris Hip Scores ( HHS ) with preoperative values . Results There was 1 revision in each group . There was no difference in WOMAC , SF-12 , or HHS outcome scores  between the highly crosslinked and conventional polyethylene groups ( all p ≥ 0.13 ) . Wear rate was lower with crosslinked polyethylene than conventional polyethylene ( 0.04 ± 0.02 mm/year v. 0.08 ± 0.03 mm/year , p = 0.007 ) . Conclusion First-generation crosslinked polyethylene demonstrates greater wear resistance  than conventional polyethylene after 13 years of implantation . Crosslinked polyethylene continues to outperform conventional polyethylene into the second decade of implantation A comparison of pertinent preoperative and postoperative data relative to total hip resurfacing versus total hip arthroplasty ( THA ) would assist in evaluating current perceptions in outcome . We compared 50 consecutive metal-metal resurfacing replacements in 50 patients with 44 consecutive conventional total hip arthroplasties in 35 patients , who were implanted during the same time period , by the same surgeon , and followed prospect ively for 2 to 4 years . The patients undergoing hip resurfacing were 62 % male , 9 years younger , and 3.2 inches taller , with a lower mean body mass index and American Society of Anesthesiologists ( ASA ) grade than patients undergoing total hip arthroplasty .  Preoperatively , patients undergoing resurfacing had a lower Harris hip score ( 46 vs 52 points ) , more pain , higher UCLA ( University of California at Los Angeles ) activity scores ( 4.2 vs 3.6 ) , and better range of motion . Surgical time for resurfacing was 18 % longer , but there was less total blood loss and fewer transfusions . Postoperatively , there was no difference in Harris hip score ( 97 vs 96 ) . Patients undergoing resurfacing had higher function , Short Form-12 physical activity scores , and UCLA activity scores , but also a higher incidence of slight or mild pain . There were no differences in postoperative range of motion or dislocation ( one each ) . The preoperative characteristics and general health status of the average patient undergoing resurfacing are more favorable than that of the average patient undergoing conventional total hip arthroplasty . Caution should be applied in attributing differences in outcomes directly to the arthroplasty technology
Conclusion The results of this meta- analysis suggest that robotic-assisted THA has certain advantages over conventional THA , including the results of component positioning and rates of intraoperative complications .
Background Robotic-assisted total hip arthroplasty ( THA ) allows for accurate preoperative planning and component positioning , potentially enhancing implant survival and long-term outcomes .
The relative efficacy and safety of robotic-assisted and conventional THA , however , are unclear .
This systematic review and meta- analysis compared the safety and efficacy of robotic-assisted and conventional THA .