Robotic Hip Replacement Surgery

Robotic hip replacement surgery is a surgery that is performed to replace a patient’s hip, after suffering from arthritis or anther condition which has led to a degenerative joint disease within their hip. The surgery itself is performed by a surgeon with the assistance of a robot with a built in computer system that allows for more precise calculations of where bony cuts need to be made in order to remove the arthritis fully from the patients hip. It also allows a slightly smaller incision size and slightly more conservative tissue dissection due to the highly precise nature of the robotic assistant. The vast majority of patients who suffer from hip osteoarthritis will be candidates to have robotic-assisted hip surgery. The indications for this are essentially the same as normal hip replacement surgery that is not assisted by a robot. Pain in the hip that is frequent, severe and debilitating. Ideally the patient should also have a full assessment by an orthopedic surgeon including an examination and assessment of plain-film radiographs. Provided that the patient’s examination and plain-film radiographs demonstrate degenerative joint disease and the patient’s symptoms coincide with this, that patient will be considered a candidate for a hip replacement.

The only contraindication to a patient receiving a hip replacement from procedure that uses robotic assistant would be severely abnormal anatomy or any other severe deformity that precludes the use of the sophisticated computer-navigating software.

The actual implants used in robotic hip replacement surgery are identical to the implants that are used in hip replacement surgeries that are not assisted by a robot. The way the equipment differs is that, rather than have the surgeon make bony cuts by hand using visual estimates, there is a sophisticated computer-navigation software built into the robot that allows the computer to build a 3D picture of the patient’s hip at the time of the surgery, based on information input into it by the surgeon. Once this 3D picture has been constructed, the robot can then calculate the best positions to make the bony cuts necessary to remove the arthritis from the hip. This includes the depths, angle and exact position on the bone of the necessary cuts.

Unlike with knee arthritis there are, unfortunately, very few effective nonoperative treatment modalities of patients with advanced degenerative joint disease of the hip. Although physical therapy is beneficial in some patients, not all will respond to it. Use of gait aids such as a cane or walkers is an option for some patients, but not all. Joint injections can be performed, however, these usually involve the patient going to see an interventional radiologist who will use imaging techniques to identify exactly where the hip joint is before injecting it. It is not able to be done in the orthopedic surgeons office in the same way a knee injection is. As such, if the patient is experiencing hip pain then a complete and thorough assessment by an orthopedic surgeon is usually the best step – they will also be able to counsel you with regards to your treatment options or whether you are unlikely to benefit from nonoperative treatment modalities of your hip condition.

The vast majority of hip arthritis patients would be good candidates for robotic hip replacement surgery. The only patients who would not be suitable for a hip surgery that is assisted by a robot would be those with severely abnormal anatomy or some of the other severe deformity that may preclude the computer navigation software from building an accurate picture of the 3D anatomy in this type of patient.

The procedure of replacing a patient’s hip using robotic assistance is broadly similar in terms of the surgical approach and equipment that is used. The procedure will involve bringing in a robot to calculate the position and depth of the bony cuts necessary in order to complete the surgery successfully. The robot itself does not complete the entire surgery and is under the control of the surgeon the entire time. The parts of the procedure such as closure of tissue planes and closure of the skin incision are still up to the surgeon to do on his/her own.

Due to the fact that robotic-assisted surgery is relatively new technological advancement in the field of orthopedic surgery, there is not a great deal of long-term followup literature to guide us as to whether there are significant benefits in the long term for patients who have their hips or knees replaced using robotic-assisted techniques. There are some early studies to suggest that, in terms of their accuracy with regards to the bony cuts made and the implant positions subsequent to the cuts being made are improved with the aid of a robot, but at this stage we simply do not know if there is any other major advantage or whether in 20 years time patients will be faring significantly better than those who have had hip replacements without the use of a robot. With that being said, there is certainly no data to suggest that hip replacements performed with the assistance of robot are any less successful than other hip replacement patients, that is to say that success rates are likely to be in the order of 95% to 98%.

The risks of hip replacement surgery are virtually the same whether assisted by a robot or assisted by humans. Risks such as periprosthetic infection, neurovascular injury, leg length discrepancy, dislocation, heart attack, blood clot and stroke are all still important risks that the patient needs to be made aware of. There is some suggestion that due to the smaller incision used and more precise tissue dissection in robotic assisted surgery that there is decreased blood loss when using a robot to assist in hip replacement surgery, although this is yet to be proven with a high quality and scientifically robust research studies.

Recovering from a hip replacement that has been performed with the assistance of a robot is no different from recovering from any other type of hip replacement. Although some surgeons believe that robotic hip replacement surgery patients recover quicker due to the smaller amount of dissection that these patients usually undergo and therefore the smaller of the insult to the surrounding muscle tissue, this is yet to be proved with any high quality or scientifically robust research studies. In any case, your recovery should follow the same path of any other hip replacement patient and that postoperative pain should subside within two weeks, with your ability to weight bear being essentially immediate and usually postop day 1 for most people. By around 6 weeks, your pain should be significantly improved and the strength in your hip should be increasing with continued physiotherapy and regular exercise. By 3 months, most patients have fully recovered from hip replacement and are close to their baseline (although this may be slightly longer in more elderly patients).

The most important exercise to regularly undertake is walking given that this uses a complex series of muscular contractions at different times during the gait cycle, it is important that all of these muscles get a regular workout in order for the patient to be able to walk normally and without pain. Your physical therapist may recommend different exercises depending on the surgical approach that was used to complete a hip replacement (for example, if you received a lateral approach then they will request you work on abductor strengthening exercises such as clamshells or active abduction against the wall).

You may be instructed to follow hip precautions, which include no active adduction and no flexion beyond 90 degrees for a period of up to 3 months. Not all hip replacement patients are given these restrictions and this will largely be dictated by the surgical approach used to perform in hip replacement. If you have any questions or concerns, consult your physical therapist or your orthopedic surgeon.

As with any new technology, there is an increased cost to using a robot to assist with your total hip replacement. Because it is an emerging technology, there is high variability in health insurance company policies and whether robotic hip surgery is covered. If you have any concerns with regards to what your policy will and will not cover, speak to your provider directly or consult with one of our orthopedic surgeons and they will discuss your options with you and would be happy to find a satisfactory solution to any of your hip replacement questions.

Given that most patients who suffer from hip arthritis and who would like to pursue a hip replacement as a treatment option would likely be candidates for robotic-assisted hip replacement surgery, it is something that you can ask your orthopedic surgeon or healthcare provider about. We will be happy to discuss the possibility of you receiving a hip replacement assisted by a robotic device and answer any questions or concerns you have with regards to this particular treatment option.