Robotic Hip Replacement

What Is Robotic Total Hip Replacement?

Total Hip Replacement (THR): This surgery involves removing the worn or damaged surfaces of both the socket (acetabulum) and the ball (femoral head) of the hip joint and replacing them with artificial joint (prosthesis) components made of metal, ceramic, and specialized durable polyethylene (plastic) materials.

Robotic Total Hip Replacement: This is the performance of this surgery with the assistance of a specialized robotic system. The most important point to emphasize is that the robot does not perform the surgery itself. The robotic system is a sophisticated tool controlled by the surgeon that assists in the following areas:

• Precise 3D Planning: Before surgery, a three-dimensional digital model of the patient’s hip joint is typically created using Computed Tomography (CT) scanning. On this model, the surgeon plans the size of the prosthesis components (socket and ball/stem), the angles at which they will be placed (inclination, anteversion), their position, leg length, and the joint’s offset (distance from the center) with millimeter precision, tailored to the patient’s own anatomy.
• Precise Surgical Execution: During surgery, the robotic arm guides or constrains the special instruments in the surgeon’s hand (usually the reamer used to prepare the socket) or the bone-cutting guides directly, ensuring they precisely match the pre-planned plan. This allows bone preparation and reaming of the prosthesis socket to be carried out with the planned precision.

Goal: By ensuring the prosthesis components are positioned in the manner best suited, most accurate, and most reproducible for the patient’s anatomy and biomechanics, the aim is to enable more natural joint function, increase stability, and potentially extend the lifespan of the prosthesis.

Potential Advantages of Robotic Hip Replacement

The potential benefits that robotic surgery may offer compared to traditional hip replacement methods are as follows:

• More Accurate Prosthesis Placement: Correct placement of the angle and orientation (version) of the acetabular cup, in particular, is critical for the longevity and function of the prosthesis. Robotic systems can help achieve these planned angles with greater precision during surgery.
• Achieving Optimal Biomechanics: Correct positioning of the prosthesis components can result in an outcome closer to the patient’s natural hip mechanics. This can translate into a more balanced gait, better function, and less abnormal loading on the soft tissues surrounding the joint.
• Reduced Dislocation Risk (?): One of the most significant complications after hip replacement is dislocation of the prosthesis. It is known that correct angular placement of the prosthesis components (especially the socket) reduces the risk of dislocation. It is thought that the precision provided by robotic surgery may further reduce this risk, but the evidence on this subject is still accumulating.
• More Accurate Leg Length and Offset Adjustment: Thanks to preoperative planning and intraoperative measurements, it may be possible to reduce the risk of leg length discrepancy and more accurately restore the hip’s natural offset (the distance from the center of the femoral head to the body’s center).
• Potentially Less Invasive: Some robotic systems and surgical approaches may theoretically offer the potential for smaller incisions or less muscle damage, although this depends more on the surgical approach itself.

Important Note: High-quality scientific studies are still ongoing regarding the extent to which these potential advantages of robotic surgery translate into long-term clinical outcomes (better pain control, higher function, longer prosthesis lifespan).

How Does Robotic Hip Replacement Surgery Work?

A typical robotic hip replacement surgery process includes the following steps:

1. Preoperative Planning: A CT scan of the patient’s hip is taken, and this data is used to create a 3D model in specialized software. The surgeon virtually plans the size, placement, and angles of the prosthesis on this model (a “virtual surgery”).
2. Intraoperative Registration: In the operating room, small trackers are temporarily attached to the patient’s pelvis and/or femur. The robotic system’s camera detects these trackers to determine the exact position of the patient’s bones in space and matches this with the previously created virtual plan.
3. Robot-Assisted Bone Preparation: Using the robotic arm, or guided by the robotic system, the surgeon first performs bone reaming for the acetabulum (socket) at the planned size and angle. The robotic system helps the surgeon keep the instrument in the correct position and stay within the planned boundaries (through haptic feedback or motion restriction). Some systems can also assist with preparation of the femur (thigh bone).
4. Prosthesis Placement: After the bone surfaces are prepared, the surgeon inserts the trial prosthesis components and then the permanent prosthesis components (socket, head, stem). Feedback on alignment and position control may be obtained from the robotic system during placement.
5. Final Checks and Closure: After checking the joint’s stability, range of motion, and leg length, the wound is closed in the standard manner.

It should be remembered that the robot is merely a high-precision assistant. Control, decision-making, and execution at every stage of the surgery remain entirely in the surgeon’s hands.

Who Is a Suitable Candidate for Robotic Hip Replacement?

In general, most patients who are suitable candidates for traditional total hip replacement surgery may also be candidates for the robotic method. Robotic surgery may be particularly considered in the following situations:

• Patients with significant abnormalities or deformities in hip anatomy.
• Those who have previously undergone hip surgery.
• Young or active patients for whom maximum precision in prosthesis placement and biomechanical restoration is the goal.
• Patients concerned about dislocation risk or leg length discrepancy.

However, robotic surgery may not be necessary or the best option for every patient or every hip problem. The decision is made by evaluating the patient’s condition, the surgeon’s experience and preference, and the hospital’s facilities.

Robotic vs. Traditional Hip Replacement: A Comparison

• Key Difference: Robotic surgery aims to offer greater precision and reproducibility in the placement of prosthesis components through 3D planning and robotic arm guidance. In the traditional method, the surgeon performs planning and execution based on his or her own experience, observations, and mechanical guides.
• Surgeon Experience: In both methods, the key to success is the surgeon’s knowledge, skill, and experience. The results of traditional hip replacement surgery performed by an experienced surgeon are also highly successful.
• Long-Term Outcomes: The 15-20-year-plus survival rates of traditional total hip replacements are already very high. Definitive evidence that robotic surgery significantly increases these long-term survival rates is still emerging. Research is ongoing.
• Other Factors: Robotic surgery can sometimes require a slightly longer operating time, and the use of the technology may add extra costs.

Risks and Recovery Process

• Risks: The risks of robotic hip replacement surgery are largely the same as those of traditional total hip replacement surgery:
  
  • Infection (superficial or deep prosthetic infection)
  • Blood clots (DVT) and clots traveling to the lungs (Pulmonary Embolism – PE)
  • Prosthesis dislocation
  • Leg length discrepancy
  • Periprosthetic fracture (during or after surgery)
  • Nerve or blood vessel damage
  • Loosening or wear of the prosthesis (in the long term)
  • Anesthesia risks. Specific to robotic surgery, there may be minor additional risks such as pain, infection, or, very rarely, fracture at the sites where tracker pins are placed.
• Recovery Process: Robotic surgery does not fundamentally change the postoperative recovery process or rehabilitation protocol. The recovery process is the same as with traditional prosthesis:
  
  • Early Mobilization: The patient is usually stood up and started walking (with a walker or crutches) on the day of surgery or the following day.
  • Hospital Stay: Usually lasts a few days.
  • Physical Therapy: Very important. It begins in the hospital and continues for months after discharge. The goal is to regain joint range of motion, increase muscle strength, restore a normal walking pattern, and safely return to daily activities.
  • Timeline: Full recovery and complete return to normal activities usually takes 3 to 6 months, although this period may be longer for some patients.

The goal of robotic surgery is not to shorten the recovery process, but rather to optimize prosthesis placement in order to enhance long-term function and durability.

Robotic Hip Replacement in Ankara and Prof. Dr. Murat Bozkurt’s Approach

Robotic hip replacement technology is also offered to patients at advanced orthopedic centers in Ankara. As a physician who follows the most current, evidence-based treatment methods in hip replacement surgery, Prof. Dr. Murat Bozkurt evaluates the potential benefits and place of robotic surgery as follows:

• Using Technology in the Right Place: He views robotic surgery as a valuable tool for increasing precision, particularly in situations where prosthesis position is critical, in complex anatomies, or in revision (second) surgeries.
• Comprehensive Planning: Using the 3D planning capability offered by the robotic system, he aims to plan critical parameters such as leg length, offset, and component orientation in the most ideal, patient-specific way for each patient.
• Individualized Approach: He is aware that robotic surgery may not be necessary or the best option for every patient. In line with the patient’s condition, anatomy, and expectations, he decides together with the patient which of the traditional or robotic methods is most appropriate.
• Priority of Surgeon Experience: Regardless of which technology is used, he believes that the foundation of a successful hip replacement surgery is the surgeon’s experience, knowledge, careful surgical technique, and appropriate patient management.

Prof. Dr. Bozkurt aims to help his patients undergoing hip replacement surgery in Ankara, whether by the robotic or traditional method, achieve a pain-free and functional life by providing the highest quality surgical care.

Robotic total hip replacement is an advanced technology that offers potential benefits by increasing surgical precision. However, it should not be forgotten that the most important factors for a successful outcome are proper patient selection, the surgeon’s experience, and a comprehensive postoperative rehabilitation program. If you are considering hip replacement surgery in Ankara, you can consult Prof. Dr. Murat Bozkurt to determine the most suitable treatment method for you.

For detailed information and appointments, you can contact Prof. Dr. Murat Bozkurt at 0312 502 70 74.