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      Is Open Access

      Evidence for robots

      1 , * , 1


      EDP Sciences

      Robots, Orthopaedics, Hip, Knee, Arthroplasty

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          Robots have been successfully used in commercial industry and have enabled humans to perform tasks which are repetitive, dangerous and requiring extreme force. Their role has evolved and now includes many aspects of surgery to improve safety and precision. Orthopaedic surgery is largely performed on bones which are rigid immobile structures which can easily be performed by robots with great precision. Robots have been designed for use in orthopaedic surgery including joint arthroplasty and spine surgery. Experimental studies have been published evaluating the role of robots in arthroscopy and trauma surgery. In this article, we will review the incorporation of robots in orthopaedic surgery looking into the evidence in their use.

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          Most cited references 37

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          A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery.

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            Clinical acceptance and accuracy assessment of spinal implants guided with SpineAssist surgical robot: retrospective study.

            Retrospective, multicenter study of robotically-guided spinal implant insertions. Clinical acceptance of the implants was assessed by intraoperative radiograph, and when available, postoperative computed tomography (CT) scans were used to determine placement accuracy. To verify the clinical acceptance and accuracy of robotically-guided spinal implants and compare to those of unguided free-hand procedures. SpineAssist surgical robot has been used to guide implants and guide-wires to predefined locations in the spine. SpineAssist which, to the best of the authors' knowledge, is currently the sole robot providing surgical assistance in positioning tools in the spine, guided over 840 cases in 14 hospitals, between June 2005 and June 2009. Clinical acceptance of 3271 pedicle screws and guide-wires inserted in 635 reported cases was assessed by intraoperative fluoroscopy, where placement accuracy of 646 pedicle screws inserted in 139 patients was measured using postoperative CT scans. Screw placements were found to be clinically acceptable in 98% of the cases when intraoperatively assessed by fluoroscopic images. Measurements derived from postoperative CT scans demonstrated that 98.3% of the screws fell within the safe zone, where 89.3% were completely within the pedicle and 9% breached the pedicle by up to 2 mm. The remaining 1.4% of the screws breached between 2 and 4 mm, while only 2 screws (0.3%) deviated by more than 4 mm from the pedicle wall. Neurologic deficits were observed in 4 cases yet, following revisions, no permanent nerve damage was encountered, in contrast to the 0.6% to 5% of neurologic damage reported in the literature. SpineAssist offers enhanced performance in spinal surgery when compared to free-hand surgeries, by increasing placement accuracy and reducing neurologic risks. In addition, 49% of the cases reported herein used a percutaneous approach, highlighting the contribution of SpineAssist in procedures without anatomic landmarks.
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              Comparison of robotic-assisted and conventional acetabular cup placement in THA: a matched-pair controlled study.

              Improper acetabular component orientation in THA has been associated with increased dislocation rates, component impingement, bearing surface wear, and a greater likelihood of revision. Therefore, any reasonable steps to improve acetabular component orientation should be considered and explored.

                Author and article information

                SICOT J
                SICOT J
                EDP Sciences
                25 May 2017
                : 3
                : ( publisher-idID: sicotj/2017/01 )
                [1 ] Imperial College Healthcare NHS Trust London W2 1NY UK
                Author notes
                [* ]Corresponding author: shenoy.ravi@ 123456gmail.com
                sicotj160178 10.1051/sicotj/2017020
                © The Authors, published by EDP Sciences, 2017

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 3, Tables: 0, Equations: 0, References: 36, Pages: 6
                Lower Limb
                Special Issue: "Computer Assisted Orthopaedic Surgery - Current State and Impact" Guest Editor: A. Adhikari
                Review Article

                robots, arthroplasty, knee, hip, orthopaedics


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