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Robotic Surgery in Professional Athletes

Dr. Domb performs a variety of minimally invasive hip procedures. For patients with a history of osteoarthritis of the hip, he may recommend minimally invasive robotic hip replacement. Robotic-assisted hip replacement has several advantages compared to traditional hip surgery. The robotic systems consist of a robotic arm extension and software that is designed to customize your hip replacement to your anatomy. The surgery is performed by your surgeon, who uses the robotic system to ensure that each movement is made with the greatest amount of precision.

Prior to robotic-guided hip replacement, a computed tomography (CT) scan is performed to create a 3D model of your pelvis. This CT scan is integrated into the robotic software and is used to accurately guide your surgeon during the surgery.

The advantages of robotic hip surgery include:

  • Minimally invasive.
    • The surgery is completed with the use of a 3-inch incision in most cases.
    • Surgery is done between the muscles without cutting any of the major muscles or tendons of the hip.
  • Improved accuracy.
    • Fewer post-surgical complications such as implant wear, dislocation and impingement.
    • Reduced pain, scarring, and minimal blood loss.
    • Faster recovery and return to regular activities.
    • Optimal positioning of the prosthetic implants for a more natural feeling joint after surgery.

Many studies have indicated greater precision with the use of robotic-guidance in comparison to surgery that is performed by hand, with the goal of improving clinical outcomes. Dr. Domb and the American Hip Institute & Orthopedic Specialists have published results demonstrating improved accuracy using robotics.

Comparison of robotic-assisted and conventional acetabular cup placement in THA: a matched-pair controlled study.

The hip is a ball and socket joint made up of the femur (thigh bone) and pelvic bone. The ball-shaped head of the femur fits within the socket-shaped acetabulum of the pelvic bone to form the hip joint. Smooth movement of the hip is facilitated by the shape of the ball and socket and the presence of cartilage tissue.

Regaining smooth movement of the hip and improving hip pain are priorities in those who require hip replacement surgery. Your surgeon may suggest robotic-assisted hip replacement surgery to treat your damaged hip.

Common indications for robotic hip surgery are:

Hip replacement surgery is indicated in select patients with diseased or injured structures of the hip. Most often, hip replacement is indicated in patients with osteoarthritis of the hip. Surgery involves removal of arthritis or damaged cartilage and replacement of the hip structures with metal, ceramic, and hard plastic (polyethylene) implants.

If you are a candidate for robotic hip surgery, your surgeon will order a detailed CT scan of your hip joint prior to surgery. This CT scan is integrated into the robotic software and a virtual 3D model of your unique hip structure is created. This model helps your surgeon decide on an individualized surgical plan by calculating the exact size of the implants to be used and the precise position that these implants should be inserted. This provides you the most optimal outcome.

On the day of surgery, you will meet several members of the surgical team including nurses, assistive staff, and anesthesiologists. You will be positioned in the operating room and your hip prepared prior to surgery. The procedure is performed through a small incision on the thigh. Throughout the surgery your surgeon controls the movement of the robotic arm, which assists with accuracy in placement of the implant.

The first stage of robotic-guided total hip replacement is hip registration. During this process, a sensor is placed on the pelvis to track the position of the hip. This is matched with the virtual 3D pelvic model created earlier from your CT scan. Following registration your surgeon will be guided visually and will be provided measurements of your unique anatomy on a real-time basis.

Throughout the surgery, the robotic system also provides dynamic information to enhance accuracy of the procedure, and auditory, visual and tactile feedback so that your surgeon follows the surgical plan precisely. Using the robotic system, your surgeon prepares and shapes the acetabulum (cup) to receive the metal cup implant. The robotic arm assists in placing the implant in the perfect orientation and depth. After the acetabulum is prepared, the femoral head (ball) and neck are prepared and the femoral implant is accurately inserted into the femur. The two components are then brought together and your surgeon confirms accuracy of the size and alignment of the prosthesis.

Hip Replacement

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Robotic-guided total hip replacement can be completed as an outpatient procedure (home following surgery the same day) in select patients, or as a short hospitalization (typically 1 day). The evening of surgery you will be out of bed and walking. You will be encouraged to bear weight on both legs as soon as possible with the use of crutches, a walker, or a cane for support until you feel fully comfortable.

Following surgery, it is very important to get plenty of rest, eat a nutritious diet, and keep well hydrated. A therapist will teach you ways to accommodate to your daily life as you recover from your surgery. The therapist will discuss items such as rearranging your home and exercises to help strengthen the hip. Over the course of several weeks, your activity level will gradually increase. Your physical therapist will help with this and will design a special exercise regimen that will help you recover faster and get back to recreational activities that you enjoy. Most patients are able to resume light activities about 6 weeks after surgery without assistance.

Robotic-assisted hip replacement surgery has a high success rate with positive patient outcomes. However, as with all surgical procedures, robotic hip surgery also has potential risks and complications. Some risks of surgery include:

  • Bleeding
  • Infection
  • Blood clot formation (DVT or PE)
  • Allergy to anesthesia
  • Pain
  • Wear of hip implants
  • Bone formation in soft tissues (heterotopic ossification)
  • Dislocation

Your surgeon will discuss with you the risks and benefits of the procedure, based on your medical history and unique situation. Surgery is only recommended if benefits outweigh the potential risks.