Cleveland Clinic is among the first medical centers in the U.S. to perform revision hip arthroplasty with robot assistance. The surgery, which took place this spring, is the nation’s second to incorporate a novel CT-based robotic-arm system (Mako SmartRobotics™).
While using robotic platforms for joint replacement is common at Cleveland Clinic, only recently have technological advances made it possible for hip revision.
“Most robotic platforms rely on imaging, and imaging joint prostheses is different than imaging native bone,” says Peter Surace, MD, the orthopaedic surgeon who performed the first robot-assisted hip revision at Cleveland Clinic. “The new technology allows us to use CT scans to plan around previous hip implants, accounting for elements such as the femoral stem and acetabular component. It has a high degree of fidelity in registering periprosthetic bone as well.”
Conventional vs. robot-assisted procedures
Compared with conventional surgery, robot-assisted hip revision requires less manual assessment and guesswork, says Dr. Surace.
“Conventionally, hip surgeons manually ream for a large socket and determine where to place screws — which involves drilling and measuring and hoping the screws are affixed to good bone,” he says. “If we need an acetabular augment, we put that in manually. After the acetabulum, we ream to get what we think is good fixation with the femur. We determine leg length and offset based on intraoperative feel.”
With the robotic platform, those steps are precisely planned ahead of time, in 3D, using digital measurements based on CT scans of the patient’s anatomy.
“There’s no ambiguity about where the cup goes or what size cup will fit into the defect,” Dr. Surace says. “You can measure how long the screws should be and plan their trajectories to make sure they go through the cup and into good bone. You can plan for and prepare an augment, if needed. Although you don’t ream the femur with the robotic platform, you can determine stem size and, at the end of the case, get an accurate measurement of leg length and offset as opposed to trying to do it by feel on the table or with rough estimates.”
Image Credit: Cleveland Clinic / Stryker
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