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Title: [Application of Mako robot-assisted total hip arthroplasty in developmental dysplasia of the hip].
Author: Xu G, Ma M, Zhang S, Liu Y, Kong X, Chai W.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2021 Oct 15; 35(10):1233-1239. PubMed ID: 34651474.
Abstract:
OBJECTIVE: To evaluate the early effectiveness and summarize the initial application experiences of Mako robot-assisted total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) in adults. METHODS: Between August 2018 and January 2020, 55 cases of DDH (75 hips) were treated with Mako robot-assisted THA. There were 10 males and 45 females with an average age of 51 years (range, 30-73 years). There were 35 cases of unilateral hip and 20 cases of bilateral hips. The DDH was classified as Crowe type Ⅰin 29 hips, type Ⅱ in 20 hips, type Ⅲ in 6 hips, and type Ⅳ in 20 hips. The modified Harris score was 54.8±16.0, the hip joint range of motion was 90° (80°, 100°), and the leg length discrepancy (LLD) was 22.0 (10.5, 47.0) mm. The preoperative surgical plan was made in the robot system based on the CT data. The reaming and installation of the acetabular cup were completed with the assistance of the robot system. The distance between the rotation center of the hip joint and the teardrop (horizontal distance, vertical distance), inclination angle, and anteversion angle were measured on the pelvic X-ray film to evaluate the position of the acetabular prosthesis. The above indicators were compared with preoperative planning to evaluate the accuracy of robotic-assisted surgery. The modified Harris score, the range of motion, and the LLD were used to evaluate the early effectiveness. RESULTS: The 75 hips of THAs were completed with the assistance of Mako robots. There was no significant difference in the acetabular inclination angle, the horizontal distance and the vertical distance of the rotation center between the preoperative planning and the postoperative measurement values ( P>0.05); the acetabular anteversion angle was significantly smaller than the postoperative measurement value ( t=-2.482, P=0.015). Four hips located beyond the Lewinnek safety zone, and 71 hips located within the Lewinnek safety zone. All patients followed up 6-24 months (mean, 13 months). All incisions healed by first intention. At last follow-up, the modified Harris score was 85.5±11.2, the hip joint range of motion was 120° (110°, 120°), and the LLD was 3.8 (2.0, 8.1) mm; all improved significantly compared with preoperative ones ( P<0.05). Except for one nerve injury case, there was no other complication. CONCLUSION: Mako robot-assisted THA is a safe and effective method for adult DDH, which can optimize the acetabular cup positioning, hip function, and leg length, but the long-term effectiveness needs to be confirmed by further studies. 目的: 探讨 Mako 机器人辅助人工全髋关节置换术（total hip arthroplasty，THA）治疗成人发育性髋关节发育不良（developmental dysplasia of the hip，DDH）早期疗效，总结初步应用经验。. 方法: 2018 年 8 月—2020 年 1 月，采用 Mako 机器人辅助 THA 治疗 55 例（75 髋）DDH。男 10 例，女 45 例；年龄 30～73 岁，平均 51 岁。单髋 35 例，双髋 20 例。DDH 分型：Crowe Ⅰ型 29 髋，Ⅱ型 20 髋，Ⅲ型 6 髋，Ⅳ型 20 髋。改良 Harris 评分为（54.8±16.0）分，髋关节活动度为 90°（80°，100°），双下肢长度差为 22.0（10.5，47.0）mm。术前基于 CT 数据于机器人系统中制定手术计划；术中在机器人辅助下完成髋臼磨锉和臼杯安装。术后于骨盆正位 X 线片上测量髋关节旋转中心在水平方向和垂直方向与泪滴距离（水平距离、垂直距离）、外展角及前倾角，评价髋臼假体位置；并将上述指标与术前规划比较，评估机器人辅助手术的准确性。以髋关节改良 Harris 评分、关节活动度以及双下肢长度差评价早期疗效。. 结果: 75 髋 THA 均在 Mako 机器人辅助下完成。术前规划髋臼外展角、髋关节旋转中心水平距离及垂直距离与术后测量值比较，差异均无统计学意义（ P>0.05）；髋臼前倾角小于术后测量值（ t=−2.482， P=0.015）。其中 4 髋位于 Lewinnek 安全区以外，71 髋位于 Lewinnek 安全区以内。患者均获随访，随访时间 6～24 个月，平均 13 个月。切口均Ⅰ期愈合。末次随访时改良 Harris 评分为（85.5±11.2）分，髋关节活动度为 120°（110°，120°），双下肢长度差为 3.8 （2.0，8.1）mm，均较术前明显改善（ P<0.05）。除 1 例出现术侧下肢感觉障碍外，随访期间无其他 THA 相关并发症发生。. 结论: Mako 机器人辅助 THA 治疗 DDH 是一种安全有效的手术方法，在髋臼假体定位、改善功能及调整肢体长度方面具有优势，远期疗效有待进一步随访观察。.

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