Talk with Dr. Morton about Robotic Hip Replacements

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Talk with Dr. Morton about Robotic Hip Replacements

  • Board-certified, Fellowship Trained  Surgeon in Robotic Hip Replacements
  • First Robotic Hip Replacement Performed in Hawaii by Dr. Morton
  • Anterior Hip Replacement Expert – Soft tissue sparing, smaller incisions
  • Robotic-Assistance – More accurate implant positioning
  • No Posterior Hip Precautions – The traditional approaches require patients to avoid internally rotating the hip, or bending the hip past 90 degrees. This can be very limiting for patients during their recovery phase.
  • Faster and Easier Recovery – Without posterior hip precautions and less pain after surgery, recovery is much faster
  • Most Surgeries Are Same-Day, Outpatient surgeries– Many patients are able to go home on the day of surgery
  • Lower Risk of Hip Dislocation – More accurate positioning of implants during surgery allow for a lower risk of hip dislocation
  • Equal Leg Lengths – Leg length discrepancy after surgery, especially in Hawaii (where people wear slippers or walk barefoot on the beach), can be a big deal. Intra-operative x-rays performed during the anterior hip surgery allow for more accurate placement of implants and avoid leg length issues.
Robotic Hip Replacement Rosa

Robotic Hip Replacement

Robotic-Assisted Anterior Hip Replacement with Rosa is a new system that provides many advantages over traditional approaches.

Advantages to the Rosa robotic hip replacement system include:

  • Minimally invasive techniques with smaller incisions
  • Robotic system designed to use the Anterior approach
  • Improved accuracy of component positioning
  • Lower risk of hip dislocation
  • Efficient system, lower operating room time
  • Accelerated recovery time due to minimal trauma to muscles, tendons, and nerves
  • Patient-specific planning
  • Lower radiation exposure
  • Designed specifically for the Anterior Approach

Anyone who is a candidate for a hip replacement is a candidate for a robotic hip replacement. It is not limited to any age group or type of patient.

Rosa Robotic Hip Replacement with Impactor

Content

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Who is a Candidate for a Robotic Hip Replacement?
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Minimally Invasive Approach
Robotic Advantages
Before Your Hip Replacement
Surgery
Recovery
Summary
Frequently Asked Questions

Who is a Candidate for a Robotic Hip Replacement?

You may be a candidate for a hip replacement if you have experienced:

  • Pain that prevents you from sleeping
  • Pain or Stiffness after a long period of sitting
  • Hip pain limiting you from the activities that you love
  • Difficulty getting up from a seated position or climbing in and out of a bathtub

You may want to discuss some non-operative treatment strategies with your doctor before proceeding. When non-operative treatment fails, you may be a candidate for a hip replacement.

Osteoarthritis

Hip osteoarthritis is the most common cause of hip pain.  Osteoarthritis is the wear and tear of the cartilage around the joint. Cartilage in the joint is the smooth protective surface on the ends of the bone that prevents the bone from rubbing together.  Once the cartilage is worn away, the ends of the bone rub together and this can become painful. Often, basic activities such as walking, sitting, and even laying down can become painful.

Other causes of hip pain include osteonecrosis (loss of blood supply to the hip joint, causing dead bone), trauma, and rheumatoid arthritis.

Minimally Invasive Approach

The Rosa Hip Replacement approach is a minimally invasive procedure that takes advantage of the anterior approach utilizing a 3-to-6 inch incision in the front of the leg directly over the hip joint, compared to the traditional 8-to-12 inch incision on the side.

In addition, this approach allows the preservation of your muscles and soft tissue without detaching any of the muscles as in some of the traditional approaches. This approach helps with the faster recovery time following hip replacement surgery.

Anterior Hip Incision Size
  • Soft Tissue Sparing – Anterior approach avoids cutting the muscle, as it follows the natural path between the muscles.
  • Smaller Incisions – Anterior approach to the hip is much closer to the hip joint, allowing for a smaller incision.
  • Less Pain – Many patients do complain of pain on the day of surgery, and may not require more than Tylenol for pain control.
  • No Posterior Hip Precautions – The traditional approaches require patients to avoid internally rotating the hip, or bending the hip past 90 degrees. This can be very limiting for patients during their recovery phase.
  • Faster and Easier Recovery – Without posterior hip precautions and less pain after surgery, recovery is much faster
  • Early Discharge From Hospital – Many patients are able to go home on the day of surgery
  • Lower Risk of Hip Dislocation – More accurate positioning of implants during surgery allow for a lower risk of hip dislocation
  • Equal Leg Lengths – Leg length discrepancy after surgery, especially in Hawaii (where people wear slippers or walk barefoot on the beach), can be a big deal. Intra-operative x-rays performed during the anterior hip surgery allow for more accurate placement of implants and avoid leg length issues.
  • No CT-scan or pins – Unlike many other robotic hip platforms, no CT scan or extra-incisional pin sites are required to perform a robotic total hip.
  • Anterior Hip Benefit – Designed specifically for the Anterior Approach

Advantages of Using a Robot During Your Hip Replacement

72%

A survey in 2016 evaluated perceptions about robotic-assisted surgery: 72% of respondents felt that robotic-assisted surgery is Faster, Safer, Less Painful or Provided Better Results than conventional minimally invasive surgery.

  1. Boys, J. A., Alicuben, E. T., DeMeester, M. J., Worrell, S. G., Oh, D.S., Hagen, J. A., & DeMeester, S. R. (2016). Public perceptions on robotic surgery, hospitals with robots, and surgeons that use them. Surgical endoscopy, 30(4), 1310–1316. 2016.

Several studies demonstrate improved patient-reported outcomes following Robotic Hip Replacement vs Conventional Hip Replacements

  1. Clement ND, Gaston P, Bell A, et al. Robotic arm-assisted versus manual total hip arthroplasty. Bone & Joint Research. 2021 Jan;10(1):22-30. DOI: 10.1302/2046-3758.101.bjr-2020-0161.r1. PMID: 33380216; PMCID: PMC7845457.
  2. Shibanuma N, Ishida K, Matsumoto T, Takayama K, Sanada Y, Kurosaka M, Kuroda R, Hayashi S. Early postoperative clinical recovery of robotic arm-assisted vs. image-based navigated Total hip Arthroplasty. BMC Musculoskelet Disord. 2021 Mar 29;22(1):314. doi: 10.1186/s12891-021-04162-3. PMID: 33781263; PMCID: PMC8008585.
  3. Bukowski BR, Anderson P, Khlopas A, Chughtai M, Mont MA, Illgen RL 2nd. Improved Functional Outcomes with Robotic Compared with Manual Total Hip Arthroplasty. Surg Technol Int. 2016 Oct 26;29:303-308. PMID: 27728953.
  4. Ng N, Gaston P, Simpson PM, Macpherson GJ, Patton JT, Clement ND. Robotic arm-assisted versus manual total hip arthroplasty : a systematic review and meta-analysis. Bone Joint J. 2021 Jun;103-B(6):1009-1020. doi: 10.1302/0301-620X.103B6.BJJ-2020-1856.R1. PMID: 34058875.
300%

Hip Dislocation is one of the leading causes for revision and can increase hospital costs by up to 300% when compared to routine total hip replacement.

  1. Hailer N P, Weiss R J, Stark A, Kärrholm J. The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis: an analysis of 78,098 operations in the Swedish Hip Arthroplasty Register. Acta Orthop 2012; 83 (5): 442-8
  2. Kostensalo I, Junnila M, Virolainen P, Remes V, Matilainen M, Vahlberg T, Pulkkinen P, Eskelinen A, Mäkelä KT. Effect of femoral head size on risk of revision for dislocation after total hip arthroplasty: a population-based analysis of 42,379 primary procedures from the Finnish Arthroplasty Register. Acta Orthop 2013; 84 (4): 342-7
  3. Gwam CU, Mistry JB, Mohamed NS, Thomas M, Bigart KC, Mont MA, et al. Current epidemiology of revision total hip arthroplasty in the United States: National Inpatient Sample 2009 to 2013. J Arthroplasty 2017;32:2088e9
  4. Abdel MP, Cross MB, Yasen AT, Haddad FS. The functional and financial impact of isolated and recurrent dislocation after total hip arthroplasty. Bone Joint J 2015;97:1046e9.
  5. Sanchez-Sotelo J, Haidukewych GJ, Boberg CJ. Hospital cost of dislocation after primary total hip arthroplasty. J Bone Joint Surg 2006;88:290.
100%

A 2021 study showed that 100% of hips studied with the Rosa Hip Platform are within the Lewinnek and Callanan Safe zones, reducing the chance for hip dislocation.

Compared to 73% performed with traditional instrumentation.

Cup Orientation Rosa

Scatterplots of traditional (top) vs robotic (bottom) cases within the Lewinnek and Callanan safe zones. The acetabular component orientation is reproducible (with fewer outliers) in the robotic group compared to the manual group (p=0.002), demonstrating improved accuracy of component positioning.

  1. Kamath AF, Durbhakula SM, Pickering T, Cafferky NL, Murray TG, Wind Jr. MA, Méthot S. Improved Accuracy and Fewer Outliers with a Novel CT-free Robotic THA System in Matchedpair Analysis with Manual THA. Journal of Robotic Surgery. 2021 Oct 28. doi: 10.1007/s11701-021-01315-3. Epub ahead of print. PMID: 34709535

Advantages of Using a Robot During Your Hip Replacement

72%
300%
100%

A survey in 2016 evaluated perceptions about robotic-assisted surgery: 72% of respondents felt that robotic-assisted surgery is Faster, Safer, Less Painful or Provided Better Results than conventional minimally invasive surgery.

  1. Boys, J. A., Alicuben, E. T., DeMeester, M. J., Worrell, S. G., Oh, D.S., Hagen, J. A., & DeMeester, S. R. (2016). Public perceptions on robotic surgery, hospitals with robots, and surgeons that use them. Surgical endoscopy, 30(4), 1310–1316. 2016.

Several studies demonstrate improved patient-reported outcomes following Robotic Hip Replacement vs Conventional Hip Replacements

  1. Clement ND, Gaston P, Bell A, et al. Robotic arm-assisted versus manual total hip arthroplasty. Bone & Joint Research. 2021 Jan;10(1):22-30. DOI: 10.1302/2046-3758.101.bjr-2020-0161.r1. PMID: 33380216; PMCID: PMC7845457.
  2. Shibanuma N, Ishida K, Matsumoto T, Takayama K, Sanada Y, Kurosaka M, Kuroda R, Hayashi S. Early postoperative clinical recovery of robotic arm-assisted vs. image-based navigated Total hip Arthroplasty. BMC Musculoskelet Disord. 2021 Mar 29;22(1):314. doi: 10.1186/s12891-021-04162-3. PMID: 33781263; PMCID: PMC8008585.
  3. Bukowski BR, Anderson P, Khlopas A, Chughtai M, Mont MA, Illgen RL 2nd. Improved Functional Outcomes with Robotic Compared with Manual Total Hip Arthroplasty. Surg Technol Int. 2016 Oct 26;29:303-308. PMID: 27728953.
  4. Ng N, Gaston P, Simpson PM, Macpherson GJ, Patton JT, Clement ND. Robotic arm-assisted versus manual total hip arthroplasty : a systematic review and meta-analysis. Bone Joint J. 2021 Jun;103-B(6):1009-1020. doi: 10.1302/0301-620X.103B6.BJJ-2020-1856.R1. PMID: 34058875.

Hip Dislocation is one of the leading causes for revision and can increase hospital costs by up to 300% when compared to routine total hip replacement.

  1. Hailer N P, Weiss R J, Stark A, Kärrholm J. The risk of revision due to dislocation after total hip arthroplasty depends on surgical approach, femoral head size, sex, and primary diagnosis: an analysis of 78,098 operations in the Swedish Hip Arthroplasty Register. Acta Orthop 2012; 83 (5): 442-8
  2. Kostensalo I, Junnila M, Virolainen P, Remes V, Matilainen M, Vahlberg T, Pulkkinen P, Eskelinen A, Mäkelä KT. Effect of femoral head size on risk of revision for dislocation after total hip arthroplasty: a population-based analysis of 42,379 primary procedures from the Finnish Arthroplasty Register. Acta Orthop 2013; 84 (4): 342-7
  3. Gwam CU, Mistry JB, Mohamed NS, Thomas M, Bigart KC, Mont MA, et al. Current epidemiology of revision total hip arthroplasty in the United States: National Inpatient Sample 2009 to 2013. J Arthroplasty 2017;32:2088e9
  4. Abdel MP, Cross MB, Yasen AT, Haddad FS. The functional and financial impact of isolated and recurrent dislocation after total hip arthroplasty. Bone Joint J 2015;97:1046e9.
  5. Sanchez-Sotelo J, Haidukewych GJ, Boberg CJ. Hospital cost of dislocation after primary total hip arthroplasty. J Bone Joint Surg 2006;88:290.

A 2021 study showed that 100% of hips studied with the Rosa Hip Platform are within the Lewinnek and Callanan Safe zones, reducing the chance for hip dislocation.

Compared to 73% performed with traditional instrumentation.

Cup Orientation Rosa

Scatterplots of traditional (top) vs robotic (bottom) cases within the Lewinnek and Callanan safe zones. The acetabular component orientation is reproducible (with fewer outliers) in the robotic group compared to the manual group (p=0.002), demonstrating improved accuracy of component positioning.

  1. Kamath AF, Durbhakula SM, Pickering T, Cafferky NL, Murray TG, Wind Jr. MA, Méthot S. Improved Accuracy and Fewer Outliers with a Novel CT-free Robotic THA System in Matchedpair Analysis with Manual THA. Journal of Robotic Surgery. 2021 Oct 28. doi: 10.1007/s11701-021-01315-3. Epub ahead of print. PMID: 34709535
Improved Accuracy Of All parameters for Total Hips with Robotic Surgery

2021 Cadavaeric study comparing Rosa Hip to conventional instruments demonstrated:

  • Component positioning significantly more accurate and more reproducible, with fewer outliers
  • Leg length discrepancy significantly more reproducible, with fewer outliers (easier to achieve goal leg lengths following surgery)
  1. Kamath AF, Durbhakula SM, Pickering T, Cafferky NL, Murray TG, Wind Jr. MA, Méthot S. Improved Accuracy and Fewer Outliers with a Novel CT-free Robotic THA