Original Article
Comparison Between Hand Rasping and Robotic Milling for Stem Implantation in Cementless Total Hip Arthroplasty

https://doi.org/10.1016/j.arth.2006.01.001Get rights and content

Abstract

We evaluated the effects of conventional hand rasping and robotic milling on the clinical and radiographic results of cementless total hip arthroplasty, with the same computed tomography (CT)–based 3-dimensional preoperative planning using a ROBODOC workstation (Integrated Surgical Systems, Davis, Calif). The robotic milling group consisted of 78 hips, and the hand-rasping group 78 hips. The radiographic findings from the preoperative planning and postoperative CT data were evaluated using the most accurate CT images reconstructed by the ROBODOC workstation. The robotic milling group showed significant superior Merle D'Aubigne hip score at 2 years. In the robotic milling group, there were no intraoperative femoral fractures, and a radiographically superior implant fit was obtained. Hand rasping had the potential to cause intraoperative femoral fractures, undersizing of the stem, unexpectedly higher vertical seating, and unexpected femoral anteversion causing inferior implant fit.

Section snippets

Materials and Methods

From September 2000 to September 2002, a total of 156 primary cementless THAs were performed on 140 patients at our 2 institutions. The indications were good bone quality (Dorr type A or B) [13] and Crowe class I, II, or III (0%-100% subluxation of the hip) [14]. Patients with poor bone quality (Dorr type C) were excluded because of the need for use of cement. Patients with Crowe class IV (>100% subluxation of the hip) were excluded because of the need for subtrochanteric osteotomy to be

Results

One patient of the robotic milling group was lost at the final follow-up. Four patients of the hand-rasping group were lost at the final follow-up. One patient (2 hips) of the hand-rasping group died with lung cancer during follow-up period. Complete clinical follow-up including evaluation on the 2-year postoperative radiograph was available for 77 hips in the robotic milling group and 72 hips in the hand-rasping group. Radiographic evaluation using reconstructed CT images obtained

Discussion

In the present study, we compared the clinical effectiveness of robotic milling and hand rasping. There was no significant difference in the Merle D'Aubigne hip score between the 2 groups at 3 months. These findings are consistent with the reports of Bargar et al [7] and Honl et al [12]. There were no significant differences in thigh pain or the time required to gain the ability to walk more than 6 blocks without a cane. However, the number of patients who gained the ability to walk more than 6

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  • Cited by (0)

    No benefits or funds were received in support of the study.

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