Comparison of the surgical efficacy of robot-assisted and freehand nail placement in the treatment of sarcopenia combined with femoral neck fractures younger than 65 years

Objective

There is limited research on the effectiveness of orthopedic robot-assisted treatment for sarcopenia combined with femoral neck fractures (FNF) in clinical settings. This study aimed to compare the clinical outcomes of orthopedic robot-assisted screw placement with traditional manual screw placement for treating sarcopenia combined with FNF.

Methods

The retrospective study included patients with FNF under the age of 65 who were admitted to the Department of Orthopedics at XX Hospital Affiliated to XX University between January 2019 and March 2022 and underwent internal fixation with cannulated screws. Grip strength of the dominant hand was measured, and the skeletal muscle index (SMI) was calculated based on the muscle tissue area at the level of the 12th thoracic vertebrae on chest CT divided by height squared. Sarcopenia was diagnosed when SMI was below 42.6 cm²/m² for men or 30.6 cm²/m² for women. Patients were then grouped based on whether they underwent orthopedic robot-assisted surgery, as the robot-assisted (RA) group or the freehand (FH) group. Follow-up evaluations over 24–36 months included various parameters such as operation time, blood loss, X-ray shots, number of needle drilling, cannulated nail parallelism, C-reactive protein (CRP) levels, time to weight-bearing, perioperative infection, VAS (visual analogue scale) scores at 1 and 6 months post-surgery, Harris hip score at 6 months post-surgery, and incidence of nonunions and femoral head necrosis within 24 months post-surgery.

Results

A total of 127 participants were enrolled in this study, with 46 individuals in the RG group and 81 in the FG group. Across both groups, factors such as gender, age, SMI, injury sides, Garden classifications, intraoperative blood loss, preoperative CRP, and VAS scores at 6 months post-surgery did not show statistically significant differences (p > 0.05). The RA group exhibited shorter operation time, fewer intraoperative X-ray shots, less needle drilling, and lower postoperative CRP levels compared to the FH group. The VAS score of the RA group was lower one month after surgery, whereas the Harris score was higher six months post-surgery (p < 0.05). The parallel angle of the hollow screws in the RA group was superior to that in the FH screw placement group, with an earlier time to bear weight on the ground post-surgery (p < 0.05). There were no statistically significant differences in incision infection, femoral neck nonunion (within 9 months after surgery), and patient satisfaction between the two groups (p > 0.05). Furthermore, the rate of femoral head necrosis after fracture within 2 years in the RA group was lower compared to the FH screw placement group, with statistically significant differences (p < 0.05).