Hip and knee replacement surgeries have transformed the treatment of arthritis. Hip replacement is a surgery to replace the diseased parts of the hip joint with metal and plastic parts. The prosthetic parts duplicate the function of the natural, healthy joint. The procedure also involves balancing the muscular forces acting around the joint. 

Traditionally, the surgery has been performed from behind known as the posterior approach. The more recent approach from the front, known as the anterior approach utilizes less soft tissue dissection. It also promises a faster recovery with a decreased hospital stay. The surgery can also be performed from the side known as the lateral approach.

Regardless of approach, all surgical techniques, however, require accurate placement and positioning of the implant. The benefits of robotic-assisted hip replacement help the surgeon in achieving precision in anterior Hip replacement. 

Hip pain may be caused by conditions such as osteoarthritis, post-traumatic arthritis, inflammatory arthritis, or hip dysplasia. The pain which is not relieved by conservative management, are candidates who can benefit from hip replacement surgery. 

Conservative treatment options include physical therapy, medications, cortisone injections. Arthritis is a progressively worsening joint disease requiring joint replacement surgery sooner or later.

Total hip replacement involves access to the hip joint and removal of diseased/arthritic bone. A prosthetic acetabular cup is placed in the pelvis socket with a specialized plastic over it to reduce friction. The cup may be further stabilized using metal screws. The upper part of the thigh bone is replaced with a prosthetic stem over which a prosthetic head it’s placed.

The metal part is made of titanium, cobalt-chromium alloy, stainless steel or ceramic. The plastic used is a high-grade polyethylene which is introduced between the head and the cup. The metal parts are either fixed using special acrylic bone cement or press-fit into the bone. Press-fit allows the bone to grow onto the implant surface.

Surgical Considerations

Patient needs, skill, and expertise of the operating surgeon are important factors for successful outcomes of any surgery. Hip replacement surgery with robotic assistance offers the benefits of accurate implant placement. Accurate implant positioning leads to excellent outcomes and an expedited recovery. 

Placement of Hip Implants

The biomechanics of the Hip joint warrant accurate positioning of the implant. This is necessary for the prosthetic joint to duplicate both the mobility and stability of the natural joint. Every patient has slightly different anatomy of the joint. 

Hip joint requiring a different positioning of the complements. Inaccurate placement leads to impingement, dislocation, reduced lifespan of implant, leg length discrepancies, or failure. 

Bone preservation

Total hip arthroplasty requires the removal of diseased bone to make a place for the prosthetic implant. Removal of more than required bone leads to loss of bone stock for subsequent surgery and reduced stability for components. 

Approach 

The anterior or posterior approach to the hip joint may be used depending on various patient factors. The anterior approach involves an incision in front of the Hip joint. The approach allows for muscles and tendons to be separated instead of cutting through them. The traditional approaches utilize cutting of the muscles to access the hip joint. 

The patients also enjoy expedited recovery and return to activities they enjoy. They enjoy early weight-bearing with fewer hip precautions like lying on back with a pillow in between the legs. However, in the long run, the outcome is similar in both approaches.

Robotic-Assisted Surgery

CT scans of the patient’s hip are taken several weeks before the surgery which is uploaded to the robotic system. The CT scan images are then used to generate 3D models of the patient’s hip. The data is used to determine the accurate anatomy of the patient’s hip to guide the orthopedic surgeon intraoperatively.

The 3D models are used to create a customized surgical plan which has been individualized according to the patient’s anatomy. During the surgery, the surgeon uses the robotic system to generate anatomical guides in the patient’s hip. The System then guides the surgeon for accurate placement of the implant position removing only the diseased bone.

The robotic arm does not perform the surgical procedure or make independent decisions. The surgeon uses the robotic arms guidance making decisions intraoperatively. The surgeon remains in control of the system and can modify the guidelines of the system intraoperatively.

Benefits

Compared to traditional surgical techniques, hip replacement assisted by robotic system offers several benefits:

  • Precise alignment and placement of the implant components based on the patient’s unique anatomy. 
  • Removal of only diseased bone and preservation of bone stock. 
  • Reduced blood loss during the surgery. 
  • Duplication of the biomechanics of the hip joint leading to the feeling of a natural hip. 
  • Decreased rate of complications such as hip dislocation or leg length discrepancy.

Complications

As with any hip replacement, there are potential complications that are discussed by the operating surgeon. There may be medical complications such as heart attack, stroke, urinary tract infections or pneumonia. 

There may be intraoperative complications such as fractures, shortening, imbalance, nerve damage or blood vessel damage. During the few weeks after the surgery, there is an increased risk of blood clots in the leg, infection or dislocation. 

In the following months, the patient may complain of persistent pain, dislocation or stiffness. In the long run, there may be loosening of the implant or the plastic component.

Summary

Robotic hip replacement is an excellent option for the relief of hip pain when indicated. Precise placement of components with a personalized surgical plan ensures the best outcomes of surgery and an expedited recovery. 

Patients return to their previous activities sooner with a pain-free and natural feeling hip joint. Robotic innovations in other fields outside the operating room are making giant leaps. Similarly, the robotic assistance in hip replacement offers precise surgical techniques that can be duplicated in every surgery.

 

My name is Dr. Suhirad Khokhar, and am an orthopaedic surgeon. I completed my MBBS(Bachelor of Medicine & Bachelor of Surgery) at Govt. Medical College, Patiala, India.

I specialize in musculoskeletal disorders and their management, and have personally approved of and written this content.