Discussion
scoliosis, low back pain, THA
SCOLIOSIS, COMPLICATIONS, POSTOPERATIVE COMPLICATIONS
In this prospective randomized clinical controlled trial, the purpose was to investigate the impact of preoperative planning and intraoperative decision-making caused by rTHA. Our results show that compared with cTHA, rTHA reduces leg length difference in lower limbs, and shows similar predictive effects of the size and position of the prosthesis as the experienced orthopedic surgeons, which reflects the relatively strong ability in preoperative planning and intraoperative decision-making.An inaccurate size of the prosthesis can lead to serious intraoperative and postoperative complications and may even lead to the failure of THA [The placement of prostheses in traditional THA mainly depends on the experience of the operators. We assume that the placement of acetabular prostheses can be better guided by rTHA. In our results, we use the angular difference of the acetabular cup between the actual and predicted values to comprehensively reflect the ability of preoperative planning and intraoperative decision-making of our robot. Our results show that the inclination/anteversion differences contained a similar trend, that is, rTHA is more often located in groups (< 6°), while cTHA is more widely distributed across all four groups. This implies that the actual angles deviate more from the planned angles in cTHA, suggesting that rTHA can reduce the placement error of the prosthesis and make the prosthesis reach the desired position as much as possible. Accurate matching between the prosthesis and the patient can be realized in three-dimensional view intraoperatively, and the error caused by the measuring instrument and the human can be effectively reduced. The robotic system can identify the surgical situation accurately, adjust in a timely manner, and finally make correct intraoperative decision-making during the operation.The ideal leg length difference after THA is less than 1 cm, while conversely, it will lead to a series of complications, such as scoliosis, low back pain, and worn prostheses [The study has some limitations. First, as a prospective study, this trial selected only 60 patients, a small number of cases, and requires a larger sample to obtain clearer results. Second, although the robot planning navigation system was compared with the traditional X-ray template, this trial did not use a 3D template as a control. Third, CT scanning was performed by a robot planning navigation system before the operation, whose radiation dose and economic cost increase compared with the control group. Fourth, although there was no significant difference in BMI between the two groups, the closeness to significant difference may introduce some bias. Fifth, while the surgeons made efforts to adhere to the initial plan during the surgical procedure, it is possible that adjustments were made to the implant positions based on intraoperative findings and considerations, for both groups. This could introduce a slight margin of error in the experiment. Sixth, during preoperative planning, the rTHA group utilized anatomical inclination/anteversion angles for their planning, while the cTHA group used radiographic inclination/anteversion angles. This difference in approach is a result of the designed system differences and introduces potential bias to the experiment.