A Detailed analysis of Time taken in Robotic Surgery for Total Hip Replacement Arthroplasty and comparison with computer assisted navigation in Total Hip Replacement Arthroplasty

The accuracy of implantation using navigation and robotic hip replacement (THR) has been proven and accepted. Time taken for the use of technology, has been one of the major factors quoted by many surgeons for not using it. Aim was to analyse the time taken during different steps of the procedure and identify which part needs further improvement. Secondary aim was to compare the time with computer navigation technology. 20 total joint replacements were carried out with MAKO robotic system using extended software version, which includes both acetabular and femoral guidance. The times of different surgical steps were noted. After the incision was made, and joint exposed the trackers for the pelvis and femur were then inserted, tightened and verification pins inserted. Femoral registration matching was started at 15 minutes (SD5.4 Range7-22). Femoral Neck Cut level was made at 22.5 minutes (SD4.5 Range15-29). It took mean 7.5 minutes to match the femoral anatomy to preop CT scan anatomy. Pelvic registration matching was done at 42.4 minutes (SD5.9 Range33-50). It took average 8.4 minutes to match pelvic anatomy. Bone reaming was with robotic arm at 50.8minutes (SD5.5 Range40-57). The cup was impacted at 56.2 minutes (SD5.2 Range45-60). Cementing stem added 14 minutes. The navigation hip replacement surgery took mean 60 minutes in uncemented and 72minutes for cemented stems. Robotic technique took 10 minutes longer. There is room for improvement in two main modifiable steps. Total registration matching time which took 16 minutes and using a uncemented stem. Should time constraint supersede accuracy achievable with technology?