Evaluation of an Initial Robotic-Assisted Direct Anterior Approach Cohort Receiving a New Short Metaphyseal Filling Collared Femoral Implant.

Abstract

Background: Shorter, metaphyseal-filling collared stems have become popular with the direct anterior approach (DAA), based on their ease of broaching and insertion through less invasive surgical exposures. To aid with the DAA, robotic-assisted technology provides three-dimensional computed tomography (CT) preoperative planning and intraoperative guidance to accurately assess stem version. With other femoral stems, this has been shown to provide more accurate implant planning and improved patient outcomes. The purpose of this study was to understand femoral stem placement predictability and patient outcomes for a newly designed metaphyseal-filling collared stem system through a DAA in combination with a robotic-assisted system during a single surgeon's initial cases.

Materials and methods: A single high-volume surgeon, experienced with robotic-assisted DAA total hip arthroplasty (THA), adopted the use of a metaphyseal-filling collared stem. Intraoperative data and patient outcomes up to six months postoperative were collected prospectively during the surgeon's first 123 cases. Student's t-tests (α=0.05) were used for statistical comparisons. Intraoperative and radiographic assessments were performed for all 123 cases.

Results: The estimated version with neck-cut view of the robotic-assisted system was 13.81 ± 3.81°. The final version measurement captured with the robotic-assisted system was 16.56 ± 6.61°. The difference between the estimated version and robotic-assisted measured version was, on average, 2.68 ± 5.7° (p<0.001). The femoral stem sat at the level of the calcar in all but five cases. There were no intraoperative or postoperative periprosthetic fractures. Patients reported significant improvements in reduced Hip dysfunction and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR), Patient-Reported Outcomes Measurement Information System (PROMIS 10), and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores throughout their six-month recovery process with no patients reporting a periprosthetic joint infection, fracture, or dislocation.

Conclusion: The use of a metaphyseal-filling collared stem with robotic-assisted DAA resulted in adequate stem version when assessed visually and with CT scan assessments. Version estimation values were improved upon over visual assessments when using the robotic system that maps out the proximal femur and the improvement was also demonstrated when compared to the prior literature. This may also be related to the stem's collar providing a visual guide during stem placement posterior fill of this triple-tapered stem design. Although further follow up is needed to assess longer-term outcomes, at six months postoperatively, patients had significant improvements in patient-reported outcomes with all patients reporting minimal to no restrictions with their THA.