Robot-yardımlı ve konvansiyonel total kalça artroplastisinde komponent yerleşiminin karşılaştırılması

Year 2020, Volume: 4 Issue: 4, 276 - 280, 01.04.2020

Yusuf Onur Kızılay , Murat Kezer

https://doi.org/10.28982/josam.656702

Abstract

Amaç: Total kalça artroplastisinde protez komponentlerinin uygun olarak yerleştirilmemesi istenmeyen sonuçlara ve komplikasyonlara yol açabilmektedir. Son 20 yılda protez komponentlerinin daha doğru yerleştirilebilmesi için robotik sistemler total kalça artroplastisinde kullanılmaya başlanmıştır. Buna rağmen literatürde robotik sistemlerin uygun protez komponent yerleşimine sebep olduğuna dair kısıtlı sayıda yayın bulunmaktadır. Bu sebeple mevcut çalışmada robot-yardımlı ve konvansiyonel total kalça artroplastisinde komponent yerleşiminin doğruluğu karşılaştırılmaya çalışılmıştır.
Yöntemler: Mevcut retrospektif kohort çalışmasında, 44 hastaya robot-yardımlı total kalça artroplastisi (RYA), 60 hastaya ise konvansiyonel total kalça artroplastisi (KTKA) uygulandı. Tüm vakalar primer artroplasti vakasıydı. Ameliyat sonrası kontrollerde ayakta basarak çekilen bacak uzunluk grafilerinde asetabuler inklinasyon, anteversiyon ve bacak uzunluk farkı ölçümleri yapıldı. Bu sonuçlar her iki grup arasında karşılaştırıldı.
Bulgular: Amaçlanan inklinasyondan ortalama sapma KTKA grubunda 8o, RYA grubunda 4,7o idi ve aradaki fark istatistiksel olarak anlamlıydı (P=0,023). Asetabuler inklinasyon parametresinde KTKA grubundaki hastaların %72’si Lewinnek tarafından tanımlanan güvenli aralıkta bulunurken RYA grubundaki hastaların %94’ü aynı güvenli aralıkta yer aldı. Amaçlanan anteversiyondan ortalama sapma KTKA grubunda 6,7o iken, bu değer RYA grubunda 5,6o idi. İki grup arasındaki fark istatistiksel açıdan anlamlı değildi (P=0,209). Ortalama bacak uzunluk farkı KTKA grubunda 8 mm iken bu değer RYA grubunda 6mm idi. Bacak uzunluk parametresi bakımından iki grup arasında istatiksel açıdan anlamlı fark bulunamadı (P=0,238).
Sonuç: Çalışmamızda konservatif kalça artroplastisi ile karşılaştırıldığında robot-yardımlı total kalça artroplastisi ile daha tutarlı asetabuler komponent yerleşimi elde edildi. Buna ek olarak robotik cerrahi grubunda daha fazla oranda hasta Lewinnek tarafından tarif edilen güvenli aralıkta yer aldı. 

Keywords

Total kalça artroplastisi, Robot-yardımlı, Komponent pozisyonu

Comparison of component positioning in robot-assisted and conventional total hip arthroplasty

Abstract

Aim: For primary total hip arthroplasty, many authors reported that inappropriate component positioning may lead to unfavorable results and complications. In the last two decades, robotic systems were developed to improve component positioning in total hip arthroplasty. However, there are few reports in the literature concerning its efficacy. In this study, we aimed to compare the accuracy of component positioning between robot-assisted and conventional total hip arthroplasty.
Methods: In this retrospective cohort study, forty-four patients were operated using robot-assisted surgery (RAS), and 60 patients were operated using primary conventional manual arthroplasty (CMA). Measurements were done in standing orthogonal antero-posterior x-ray (AP) views to evaluate acetabular inclination, anteversion, and leg length discrepancy. Results were compared between RAS and CMA groups.
Results: The average deviation from desired acetabular inclination was 8o in the CMA group, 4.7o in the RAS group, between which the difference was statistically significant (P=0.023). Concerning acetabular inclination, 72% of the patients in the CMA group remained in the safe zone described by Lewinnek while 94% of the patients in the RAS group remained in the same safe zone. The mean deviation from desired anteversion was 6.7o in the CMA group and 5.6o in the RAS group. The difference between two groups was not significant (P=0.209). The two groups were similar in terms of leg length discrepancy (P=0.238).
Conclusion: We achieved more consistent acetabular component positioning with robot-assisted total hip arthroplasty compared with conventional total hip arthroplasty. Thus, more patients remained within Lewinnek’s safe zone in the robot-assisted surgery group.

Keywords

Total hip arthroplasty, Robotic-assisted, Component positioning

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