10 - Does robotic-arm assisted total hip arthroplasty impact the surgical team experience?

Description:

Introduction: The direct-anterior approach (DAA) has become increasingly adopted to minimize soft tissue damage, especially for outpatient total hip arthroplasties (THA). This approach, however, often requires the use of fluoroscopy for visualization which may pose risks to surgeons and OR staff including radiation and unintended effects of protective lead gear. Utilization of CT-based robotic-arm assisted total hip arthroplasty (RA-THA) also continues to increase and offers potential benefits to patients such as reduced dislocations, decreased length of stay, and improved outcomes compared to manual THA. The use of RA-THA may help surgeons and staff using DAA in the OR by reducing, if not eliminating, fluoroscopy use. This abstract evaluates the impact of a DAA with CT-based RA-THA on surgeon and OR staff, compared to a DAA with fluoroscopic-guided conventional or manual total hip arthroplasty (C-THA).

Methods: A review of available literature was performed to understand the impact of RA-THA using the DAA compared to fluoroscopy-guided C-THA using the DAA on surgeon and OR staff experience including ergonomics, fluoroscopy use, and efficiency.

Results: Studies comparing CT-based RA-THA and fluoroscopy-guided C-THA using the DAA were identified. In a comparison of surgeon health metrics, RA-THA was associated with a significantly reduced heart rate and stress levels during acetabular reaming and preparation, respectively, compared to C-THA. When surveyed, surgeons reported RA-THA to be less physically and mentally demanding compared to C-THA in a cadaveric setting. This was likely due to elimination of fluoroscopy and lead vest use. In another study, among two experienced surgeons, C-THA cases required an average of 21 fluoroscopic shots, resulting in 700 mrem of intraoperative radiation exposure. In contrast, RA-THA eliminated the need for intraoperative fluoroscopy, avoiding the risk of radiation exposure and its potential harmful cumulative effects to the surgeon and the surgical team. Furthermore, a retrospective review of 6,541 patients found RA-THA had a 4.0- to 5.0-fold shorter mean fluoroscopy time and a 6.5-fold smaller mean radiation dose compared to computer-navigated THA and C-THA. In a learning curve study comparing 53 C-THA cases and 36 RA-THA cases, the surgeon reached operating times similar to C-THA after 15 cases and eliminated fluoroscopy use after 17 cases. Published efficiency workflow techniques for RA-THA using the DAA have demonstrated surgeries can consistently be completed in under 60 minutes without fluoroscopy

Discussion: Studies have shown that CT-based RA-THA using the DAA reduced surgeon physical and mental demand, may reduce, if not eliminate, fluoroscopy use, and enabled workflow efficiency compared to fluoroscopy-guided C-THA using the DAA. Future studies should continue to evaluate the impact of robotic-assisted surgery on the surgeon and OR staff.