Robot-assisted percutaneous cannulated screw fixation in the treatment of slipped capital femoral epiphysis.

Abstract

Purpose: To investigate robot-assisted percutaneous cannulated screw fixation for treating slipped capital femoral epiphysis, including acute, chronic, and acute-on-chronic slips. Our study included all stable and unstable slips.

Methods: Thirty-one children with unilateral SCFE were treated from October 2019 to October 2021. All 31 patients were followed up for 12-36 months, with an average follow-up time of 24.56 ± 6.73 months. The femoral epiphysis was fixed with a percutaneous cannulated screw assisted by a surgical robot.

Results: All 31 femoral head epiphyses underwent successful fixation in one attempt. The average operation time and bleeding were 98.25 ± 15.13 min and 21.65 ± 11.25 ml, respectively. The average distance between the actual and planned entry points was 1.13 ± 0.58 mm and 0.91 ± 0.72 mm in the anteroposterior (AP) and lateral views, respectively. The actual insertion trajectory deviated from the planned position by 3.61 ± 1.34° and 2.33 ± 1.32° in the AP and lateral views, respectively. The average fluoroscopy time was 6.56 ± 3.23 times per screw. The Non-Arthritic Hip Score improved from 28.53 ± 9.17 preoperatively to 67.34 ± 6.21 at the last follow-up (P < 0.05), and the Harris hip score improved from 46.47 ± 15.34 to 89.63 ± 7.52 (P < 0.05). The wounds healed without avascular necrosis or chondrolysis of the femoral head.

Conclusion: Robot-assisted percutaneous cannulated screw fixation is effective for treating pediatric SCFE. Screw fixation was accurate and safe, and clinical outcomes were satisfactory.

Level of evidence: Level 4, Case Series.