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Equivalent radiation exposure with robotic total hip replacement using a novel, fluoroscopic-guided (CT-free) system: case–control study versus manual technique

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A Correction to this article was published on 15 April 2023

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Abstract

Accurate and precise positioning of the acetabular cup remains a prevalent challenge in total hip arthroplasty (THA). Robotic assistance for THA has increased over the past decade due to the potential to improve the accuracy of implant placement. However, a common criticism of existing robotic systems is the requirement for preoperative computerized tomography (CT) scans. This additional imaging increases patient radiation exposure, as well as cost, and requires pin placement during surgery. The goal of this study was to analyze the radiation burden associated with a novel, CT-free robotic THA system compared to an unassisted manual THA approach (n = 100/arm). On average, the study cohort had a higher number of fluoroscopic images captured (7.5 vs. 4.3 images; p < 0.001), radiation dose (3.0 vs. 1.0 mGy; p < 0.001), and a longer duration of radiation exposure (18.8 vs. 6.3 s; p < 0.001), per procedure, than the control group. Additionally, no learning curve was detected by CUSUM analysis with respect to the number of fluoroscopic images taken during the adoption of the robotic THA system. While statistically significant, in comparison to published literature, the radiation exposure of the CT-free robotic THA system was comparable to that of unassisted manual THA approach and less than that of CT-based robotic approaches. Thus, the novel CT-free robotic system likely poses no clinically significant increase in radiation exposure to the patient compared to manual approaches.

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Funding

The authors declare that no funds, grants, or other support was received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    Graham Buchan, Christian Ong, Christian Hecht & Atul F. Kamath

  2. Advanced Orthopaedics and Sports Medicine a Division of OrthoLoneStar, Houston, TX, USA

    Thomas J. Tanous

  3. Orthopedic and Sports Medicine Center of St. Joseph, St. Joseph, MO, USA

    Blake Peterson

  4. Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Edobashi, Tsu City, Mie, Japan

    Akihiko Hasegawa

Authors
  1. Graham Buchan
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  2. Christian Ong
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  3. Christian Hecht
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  4. Thomas J. Tanous
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  5. Blake Peterson
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  6. Akihiko Hasegawa
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  7. Atul F. Kamath
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by GB and CH. The first draft of the manuscript was written by GB and CO, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Atul F. Kamath.

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Conflict of interest

Graham Buchan, Christian Ong, Christian Hecht, and Akihiko Hasegawa declare they have no financial interests. Thomas Tanous and Blake Peterson serve on the Zimmer Biomet speaker’s bureau. Blake Peterson and Atul Kamath serve as consultants for Zimmer Biomet.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Cleveland Clinic Foundation Institutional Review Board (June 3rd, 2022/ No. 22–528).

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Buchan, G., Ong, C., Hecht, C. et al. Equivalent radiation exposure with robotic total hip replacement using a novel, fluoroscopic-guided (CT-free) system: case–control study versus manual technique. J Robotic Surg 17, 1561–1567 (2023). https://doi.org/10.1007/s11701-023-01554-6

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  • DOI: https://doi.org/10.1007/s11701-023-01554-6

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