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 Robotic Anterior Total Hip Arthroplasty

What is Robotic Anterior Total Hip Arthroplasty?

Robotic anterior total hip arthroplasty is a minimally invasive surgical procedure that involves the use of a specialized robotic system to remove the damaged parts of a hip joint and replace them with an artificial prosthesis or implant from an anterior approach rather than a traditional total hip arthroplasty approach.

During a traditional hip replacement, your surgeon operates from the side of the hip, whereas in a direct anterior approach, your surgeon operates from the front of the hip. Another difference is in the length of the incision. Traditional hip replacement may require a 10- to 12-inch incision, while the incision used in the direct anterior approach maybe 3 to 4 inches in length.

Accurate placement and alignment of the hip implant are crucial in total hip arthroplasty surgery. Robotic anterior total hip arthroplasty system utilizes a CT scan of the patient’s hip to generate a 3-D model of their pelvis and femur. This aids the surgeon in planning the surgery. The three-dimensional pre-surgical planning provides the surgeon with real-time visual, tactile and auditory feedback to facilitate optimal joint resurfacing and implant positioning. Such optimal placement can result in a more natural hip motion following surgery, which can be difficult to achieve with traditional surgical techniques.

Anatomy of the Hip

The hip joint is one of the body's largest weight-bearing joints and is the point where the thighbone (femur) and pelvis (acetabulum) join. It is a ball-and-socket joint in which the head of the femur forms the ball, and the pelvic acetabulum forms the socket. The joint surface is covered by smooth articular cartilage that cushions and enables smooth movement of the joint. The bones are held together by bands of tissue called ligaments that provide stability to the joint.

Indications for Robotic Anterior Total Hip Arthroplasty

Some of the indications for robotic anterior total hip arthroplasty include:

  • Treatment of arthritic conditions, such as osteoarthritis and rheumatoid arthritis of the hip joint
  • Dislocation of the hip joint
  • Severe hip joint fracture or trauma 
  • Failed total hip replacement surgery
  • Severe hip joint pain that limits your activities of daily living, such as walking or climbing stairs
  • Failure to obtain pain relief from medications, injections, physical therapy or other conservative treatments

Preparation for Robotic Anterior Total Hip Arthroplasty

In general, preoperative preparation for robotic anterior total hip arthroplasty will involve the following steps:

  • A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could threaten the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking.
  • You may need to refrain from supplements or medications such as blood thinners or anti-inflammatories for a week or two prior to surgery.
  • You should refrain from alcohol or tobacco at least a week before surgery.
  • You should not consume solids or liquids at least 8 hours prior to surgery.
  • Arrange for someone to drive you home after surgery.
  • A written consent will be obtained from you after the surgical procedure has been explained in detail.

Procedure for Robotic Anterior Total Hip Arthroplasty

The surgical procedure is performed under regional or general anesthesia. The robotic system consists of a surgeon's console, robotic arms, a high-performance vision system, and special surgical instruments. A computed tomography (CT) scan is taken before the surgery to create a 3D model of the affected hip joint. During surgery, the information provided by the CT scan is interpreted by the robotic system and guides your surgeon with the procedure. The 3D camera provides your surgeon with a magnified view of the operating area. Your surgeon sits at a console and controls the movement of the robotic arms holding the special surgical instruments. The movements of your surgeon’s hands are translated by the robotic system into precise movements of the miniaturized instruments that are held by the robotic arms. The enhanced vision and superior control of the micro-instruments improve the precision of the surgery. This accuracy helps repair the damaged joint and optimally position the prosthetic implant while ensuring minimal injury to neighboring tissues. The implant is tested for range of motion and the soft tissues and skin are closed over the new hip joint with sutures.

Postoperative Care and Instructions

In general, postoperative care instructions and recovery after robotic anterior total hip arthroplasty will involve the following steps:

  • You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
  • You may need to stay in the hospital for a day or two before discharge to home.
  • You may notice pain, swelling, and discomfort in the hip area. Pain and anti-inflammatory medications are provided as needed.
  • Antibiotics are also prescribed to address the risk of surgery-related infection.
  • You will be placed on assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
  • Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
  • Refrain from smoking as it can hinder the healing process.
  • Eating a healthy diet rich in vitamin D is strongly advised to promote healing and a faster recovery.
  • Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. Gradual increase in activities over a period of time is recommended.
  • An individualized physical therapy protocol will be designed to help strengthen hip muscles and optimize hip function.
  • Most patients are able to resume their normal activities in 3 to 4 weeks after surgery; however, return to sports may take at least 6 months or longer.
  • Refrain from driving until you are fully fit and receive your doctor’s consent.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Benefits of Robotic Anterior Total Hip Arthroplasty

There are several advantages of robotic anterior total hip arthroplasty over traditional hip replacement surgery, including:

  • Smaller incisions leading to reduced scarring
  • Minimal blood loss
  • Less postoperative pain
  • Shorter hospital stays and recovery period 
  • Quicker return to daily normal activities
  • Precise placement of the hip implant with a reduced risk of hip dislocation
  • Improved safety and reduced risk of injury to adjacent tissues
  • Increased longevity of the implant

Risks and Complications

Robotic anterior total hip arthroplasty is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:

  • Damage to nerves and blood vessels
  • Leg-length discrepancy
  • Fracture
  • Infection
  • Bleeding
  • Postoperative pain
  • Deep vein thrombosis or blood clots
  • Dislocations (rarely)
  • Implant wear and loosening
  • Anesthetic/allergic reactions