2.1.patients
A total of 64 patients meeting the criteria were selected from November 2022 to February 2023 at the hospital affiliated with the corresponding author. Among them, 32 cases underwent domestically manufactured robot-assisted THA (robot group), and 32 cases underwent traditional THA (conventional surgery group). The surgical protocol of this study was approved by the Ethics Committee of the 920th Hospital of the People's Liberation Army (Ethics Number: 2024-010-01), and all patients provided informed consent for the surgery. All 64 patients were diagnosed with DDH preoperatively, comprising 15 males and 49 females, with a mean age of (42.23 ± 11.71) years. There were 28 left hip involvements and 36 right hip involvements. According to the Crowe classification, there were 3 cases of Type I, 25 cases of Type II, 29 cases of Type III, and 7 cases of Type IV (Table 1). The average follow-up time was (12.3 ± 0.21) months for all patients. Preoperative Harris Hip Score (HHS), Visual Analog Scale (VAS), leg length discrepancy (LLD), functional outcome (FO), and hemoglobin levels were recorded for both groups (Table 2). The robot group underwent surgery using a domestically manufactured robotic surgical system (Longwell Robot, Shanghai Longhui Medical Technology Co., Ltd.) (Fig. 1) and the same brand of prostheses (J-Med prostheses, J-Med Shanghai Medical International Trading Co., Ltd.). The conventional surgery group utilized traditional hip arthroplasty instruments and the same brand of prostheses. Both surgeries were performed by the same orthopedic surgeon who had received training in orthopedic robotics and obtained the operation permit. Preoperative thin-layer CT images were imported into the system to generate 3D models for preoperative planning, including determining the prosthesis type and true acetabular position (Fig. 1), as well as the femoral stem type and implantation position, aiming for optimal alignment, prosthesis position, and postoperative limb length equality.
Inclusion criteria: (1) Patients diagnosed with Developmental Dysplasia of the Hip; (2) Age between 25 and 65 years; (3) Robot-assisted THA performed domestically; (4) Traditional manual THA performed; (5) Kellgren-Lawrence Grade I osteoarthritis present; (6) Absence of severe underlying diseases or infectious diseases, and overall good health status; (7) Availability of standard postoperative pelvic X-rays and complete medical records.
Exclusion criteria: (1) Incomplete clinical data or postoperative X-rays not meeting the predefined standards; (2) Patients without Developmental Dysplasia of the Hip; (3) History of previous surgical treatment on the affected hip joint; (4) Presence of severe underlying diseases or infectious diseases, and poor general health condition.
Table 1
Baseline table of patient preoperative data
Sports Event | Robotics Team | Traditional Group | P |
---|
Sex (male: female) | 6:26 | 9:23 | 0.376 |
Surgical limb (left:right) | 13:19 | 15:17 | 0.614 |
Age (years) | 44.16 ± 11.28 | 40.31 ± 12 | 0.192 |
BMI(kg/m2) | 21.44 ± 1.3 | 21.28 ± 1.39 | 0.644 |
CROWE Typing | | | |
I | 1 | 2 | |
II | 13 | 12 | |
III | 15 | 14 | |
IV | 3 | 4 | |
Table 2
Patient preoperative scores table
Preoperative Indicators | Robotics Team | Traditional Group | P |
---|
Harris Score | 56.56 ± 3.52 | 55.09 ± 3.67 | 0.107 |
VAS | 7 ± 0.8 | 7.03 ± 0.78 | 0.875 |
FO | 29.03 ± 6.87 | 30.84 ± 6.46 | 0.281 |
LLD | 12.5 ± 8.61 | 12.12 ± 6.59 | 0.845 |
Hemoglobin | 140.5 ± 15.1 | 140.75 ± 14.1 | 0.946 |
2.2 Surgical Procedure for the Robot Group:
All patients underwent general anesthesia and were positioned in the lateral decubitus position for surgery. After positioning the robotic arm and identification system, robotic arm registration was conducted, and two fixation pins and acetabular side identification targets were affixed to the iliac crest. A marker screw was secured anterior to the greater trochanter, and the femoral side identification target was installed (Fig. 2A). Rough and fine registrations were conducted on the femoral side to verify the planned osteotomy line with the actual intraoperative situation (Fig. 2B). After removing the femoral head, the acetabulum was exposed, and rough and fine registrations were conducted on both the inner and outer margins of the acetabulum. The matched acetabulum was attached to the robotic arm, and according to the preoperative planning angle, the acetabulum was initially reamed using a smaller reamer to prepare the true acetabular position, followed by reaming with the planned reamer size. Depending on preoperative assessment of acetabular stability and intraoperative bone quality around the trial socket, a decision was made whether to utilize acetabular screws for additional fixation. An awl was mounted on the robotic arm to assist in creating the acetabular opening, followed by femoral reaming. Real-time implantation data and related angles were displayed on the screen to assess joint stability, limb length discrepancy (LLD), and implant planning position. Once satisfactory, the trial components were removed. The femoral implant was attached to the robotic arm (Fig. 2D), and terminal verification was conducted. The femoral stem implant was then hammered into the pre-planned position using the robotic arm, and the femoral head implant was relocated. After irrigation and injection of a cocktail into the surrounding soft tissues, all layers were sutured, and sterile dressings were applied.
2.3 Statistical analysis
Evaluation of Clinical Function Scores and Imaging Evaluation Indicators in 64 Patients Preoperatively and at 1-Year Follow-Up: Clinical function scores and imaging evaluation indicators, including Harris Hip Score (HHS)[13], Forgotten Joint Score (FJS), visual analogue scale (VAS), leg length discrepancy (LLD), acetabular cup anteversion angle, abduction angle, femoral offset (FO), center of rotation (COR), acetabular inclination angle, operation time, preoperative, and postoperative hemoglobin levels, were assessed preoperatively and at the final 1-year follow-up. Statistical analysis was performed using SPSS 26.0 software. Measurement data are presented as (X ± s), and independent sample t-tests were used for continuous data, while chi-square tests were used for categorical data. A significance level of P < 0.05 was considered statistically significant.