PROMs in Total Hip Arthroplasty: A Comparison between Robotic Mako Assisted Versus Manual Technique

Study Purpose: The purpose of this observational study is to evaluate the degree of satisfaction and improvement in quality of life through PROMs (Patient Related Outcome Measures), which were administered to patients who underwent Total Hip Arthroplasty (THA) by robotic-arm assisted technique (RIO®, MAKO Surgical Corporation). These data were then compared to a sample of patients operated on by standard manual technique. Both groups were operated on by the same surgical team, in the same hospital, and were subjected to the same recommendation and rehabilitation protocols. Surgeries were performed from November 2017 to March 2019 at a hospital in Asl Toscana Sudest. Endpoint of our study is to verify the rate of improvement – which is assumed to be stable one year after surgery – and how the satisfaction rate increases over time. Another aim is to determine – through the use of Forgotten Joint Score questionnaires and the satisfaction scale – whether there is a difference between arthroplasty operated on by standard manual technique vs robotic-assisted method one year after surgery. Method: Patients who undergone robotic-assisted surgery were evaluated before surgery, at discharge, 1, 4 and 12 months after surgery. 70 robotic-assisted THA patients were studied for a whole year, while 31 standard-technique THA patients were evaluated only 12 months after surgery. PROMs post-surgical evaluations occurred during follow-up visits by orthopedists and physiotherapists. Harris Hip Score (HHs), Oxford Hip score (OHS), EQol VAS (Dimension Visual Analogue Scale), LiKert satisfaction scales were used. Likert scale was administered only 4 and 12 months after (no significant results before this time). The Forgotten Joint Scale (FJS) and the satisfaction scale were administered 1 year after surgery both in robotic-assisted and standard manual THA patients (70 robotic-assisted THA vs 31 standard THA). They were operated on in the same period by the same surgical team, with the presence of a senior surgeon, and were subjected to the same rehabilitation protocols by the same team of physiotherapists.Results: 70 robotic-assisted THA were analyzed (30 l, 40r), with a mean age of 63, 76 years. The average hospital stay in acute care settings was 3.07 days. 40 patients then continued in the rehabilitation department after discharge for further 2.98 days. HHs scale gave a value of 54, 94±14, 71 before surgery and 98, 63±2, 54 one year after surgery. OHS scale reported a value of 21, 27±9, 24 before surgery and 47±2, 06 one year after surgery. The EqolVas scale had a value of 56, 23±20, 04 before surgery and 81, 25±15, 84 one year after. 4 months after surgery, the satisfaction rate was 4, 67±0, 61 and 12 months later was 4, 77±0, 54. The FJS scale in 70 robotic-operated patients had a value of 86, 24±21, 1 and it has been compared to a group of 31 standard-operated patients, whose values were 87, 02±16, 57 and P=0,86. 12 months after surgery, the satisfaction rate for robotic-operated patients was 4, 77±0, 54 and 4, 47±0, 83 and P<0, 05 for standard-operated patients, thus statistically significant. Conclusion: Patients undergoing hip arthroplasty surgery all have a high level of expectations and clinical outcomes are very satisfactory, while knee replacements have more limitations and less appreciable results. Some studies regarding THA report more favorable short-to-medium-term outcomes, fewer transfusions, and fewer days of hospital stay by the use of the roboticassisted technique, when compared to the standard manual surgery. Differences in function and quality of life after 1 year from the two types of surgery tend to decrease, although in our study the satisfaction rate of the robotic-assisted surgeries was statistically significant compared to the standard manual technique. Furthermore, it has been noticed that the rate of functional improvement, well-being, satisfaction and quality of life increases over time after surgery. At the first year of follow-up, no statistically significant differences are shown between the robotic-assisted and standard sample concerning the FJS scale.