Robotic Hip Replacement

Introduction

Robotic hip surgery is an advancement to a traditional hip surgery by using a robotic system to perform the surgery. The robotic system functions as an extension of the surgeon's hands and eyes.

The advantages of robotic hip surgery include:

A computed tomography (CT) scan is ordered before the surgery to create a 3D model of the hip joint. This is fed into the system, which is used to accurately guide your surgeon during the surgery.
A 3D camera is used to provide your surgeon with a magnified view of the operating site.
The procedure is performed minimally invasively, through 2 to 3 small incisions.

This facilitates:

Shorter hospital stays
Fewer post-surgical complications such as implant wear, dislocation and impingement (rubbing of the bones)
Reduced pain, scarring and minimal blood loss
Faster recovery and return to regular activities

Although the surgery is performed by the surgeon, the robot ensures that each movement is made precisely, thus greatly improving the accuracy of the surgery. This accuracy helps:

Repair the damaged joint
Optimally position the prosthetic implants for a more natural feeling joint after surgery
Ensures minimal injury to neighboring tissues

Many studies have indicated greater precision of the robotic system than when a surgery is performed by hand. Robotic surgery improves the position and alignment of instruments and implants, thereby improving clinical outcomes.

Indications

The hip is a ball and socket joint made up of the femur (thigh bone) and pelvic bone. The ball-shaped head of the femur articulates with the socket-shaped acetabulum of the pelvic bone to form the hip joint. The smooth movement of the hip is facilitated by the spongy cartilage tissue that lines the articular surfaces. This joint is further stabilized by the labrum (tissue that lines the outer rim of the acetabulum to provide a tight fit of the joint), and other soft tissues and muscles. Many injuries and diseases to the hip can cause pain and disability and may require surgery.

With precision being a major requirement to regain the smooth movement as close to the normal hip as possible, your surgeon may suggest robotic hip surgery to treat your damaged hip. You may be a candidate for robotic hip surgery if:

Conservative hip treatments do not provide relief
Osteoarthritis (OA)
Post-traumatic arthritis
Rheumatoid arthritis (RA)
Avascular necrosis (AVN)
Hip dysplasia

Procedure

The robotic system is primarily used to perform hip arthroplasty, a surgery that involves the partial or complete replacement of the diseased or injured joints of the hip with metal and plastic implants.

If you are a candidate for robotic hip surgery, your surgeon will order a detailed CT scan of your hip joint. This information is fed into a computer system, which creates a virtual 3D model of your unique hip structure. This model helps your surgeon decide on an individualized surgical plan by calculating the exact size of the implants to be used and the precise position that these implants should be inserted to provide the most optimal outcome.

On the day of surgery, you will be prepped and the procedure will be performed through small incisions made on your hip joint. Your surgeon controls the movement of the robotic arms, which hold the surgical instruments.

The first stage to the procedure is called the registration process, where a tracker is placed on your hip to track the position of the hip. This is matched with the virtual model created earlier from your CT scan. Following registration, your surgeon will be guided visually and will be provided measurements on a real-time basis.

Throughout the surgery, the system provides dynamic information to enhance accuracy of the procedure, and auditory, visual and tactile feedback so that your surgeon follows the surgical plan precisely. Using the robotic arms, your surgeon prepares and shapes the acetabulum to receive the metal cup component. The robotic arm is guided to place the acetabular implant in the perfect orientation and depth. Next, the femoral head and neck are prepared. The femoral component is accurately inserted into the femur. The two components are brought together. Your surgeon then confirms with the system for the accuracy of the size and alignment of the prosthesis.

Post-procedure care

One or two days after robotic hip surgery you will be encouraged to get out of bed to improve blood circulation. You will be given crutches, walker or a cane for support until you can bear your body's complete weight on your hips.

When you are ready to go home, your therapist will teach you ways to accommodate to your daily life as you recover such as rearranging your house so that you can have things within your reach and avoid unnecessary movement. Get plenty of rest, but ensure that you move about frequently with support, gradually increasing your level of activity. In about 6 to 8 weeks you will be able to resume light activities. Meanwhile, you will be introduced to muscle strengthening and mobility exercises. Your physical therapist will design a special exercise regime that will help you recover faster.

Depending on your response to the treatment and rehabilitation, your surgeon will decide when you will be able to drive, return to work and perform low-impact aerobic exercises such as walking and swimming.

Risks and Complications

Robotic hip surgery is suggested because of its success in outcomes. However, as with all surgical procedures, robotic hip surgery may be also associated with certain risks and complications. Some of these include: