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What is ROSA Robotic-Assisted Anterior Hip Replacement?

ROSA robotic-assisted anterior hip replacement is a surgical procedure in which the worn out or damaged parts of the hip joint are removed and replaced with artificial hip components called prostheses or implants using an anterior hip approach with the help of a robotic system called ROSA, which stands for Robotic Surgical Assistant.

ROSA - developed by Zimmer Biomet - enables surgeons to carry out hip replacement surgeries with greater precision and a higher standard of care. The ROSA robotic system utilizes real-time information and assists surgeons with the precise placement of the implants based on a person’s unique hip anatomy.

ROSA robotic-assisted anterior hip replacement is a minimally invasive hip replacement surgery that utilizes a 3- to 6-inch incision on the front of your hip (anterior approach) rather than an 8- to 12-inch incision on the side of your hip as in a traditional hip replacement procedure. This surgery enables your surgeon to preserve much of the muscle tissue that holds your joint tight, thereby reducing the risk of dislocation post surgery.

Anatomy of the Hip

The hip joint is one of the body's largest weight-bearing joints and is the point where the thighbone (femur) and pelvis (acetabulum) join. It is a ball-and-socket joint in which the head of the femur forms the ball, and the pelvic acetabulum forms the socket. The joint surface is covered by smooth articular cartilage that cushions and enables smooth movement of the joint. The bones are held together by bands of tissue called ligaments that provide stability to the joint.

Indications for ROSA Robotic-Assisted Anterior Hip Replacement

The ROSA robotic-assisted anterior hip replacement is commonly indicated for individuals with early-to-mid-stage osteoarthritis of the hip exhibiting symptoms such as pain, swelling, and locking that are not amenable to conservative treatment. Osteoarthritis is a degenerative joint disease that causes breakdown and eventual loss of cartilage in the joint making the bones rub against each other leading to painful movement.

In general, your surgeon may recommend ROSA robotic system for the treatment of the following hip conditions, such as:

  • Treatment of arthritic conditions, such as osteoarthritis and rheumatoid arthritis of the hip joint
  • Severe hip joint fracture or trauma 
  • Failed total hip replacement
  • Malpositioning of the acetabular component
  • Dislocation of the joint
  • Impingement of the prosthesis
  • Aseptic loosening of the prosthesis
  • Periprosthetic osteolysis
  • Polyethene liner wear of the implant
  • Prosthetic joint infection

Preparation for ROSA Robotic-Assisted Anterior Hip Replacement

The preoperative preparation is similar to the most hip joint replacement procedures. But contrary to traditional techniques, the ROSA system utilizes a series of X-rays to generate 3D images of an individual’s unique hip anatomy. These 3D images enable the surgeon to design a personalized plan based on the specifics of an individual’s hip anatomy prior to performing joint replacement surgery.

In addition, preparation for ROSA robotic-assisted anterior hip replacement may involve the following steps:

  • A review of your medical history and a physical examination are performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications, vitamins, or supplements that you are taking or any conditions you have such as heart or lung disease.
  • You may be asked to avoid medications such as blood thinners, aspirin, or anti-inflammatories for a specific period prior to surgery.
  • You should refrain from alcohol or tobacco at least a few days prior to the surgery and several days after as it can hinder the healing process.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • You need to arrange for someone to drive you home after surgery.
  • Signed informed consent will be obtained from you after the pros and cons of the surgery have been explained in detail.

Procedure for ROSA Robotic-Assisted Anterior Hip Replacement

In general, the ROSA robotic-assisted anterior hip replacement procedure using the ROSA system is similar to that of a traditional hip replacement procedure but performed with the help of a robotic assistant in an anterior approach. The robotic system does not perform the procedure on its own. The surgery is performed entirely by your surgeon by prompting the robotic hands as per the personalized plan developed by your surgeon. The ROSA system is only an additional tool to guide your surgeon and ensure greater accuracy in the placement of the hip implants. It cannot replace the skills of your experienced surgeon.

The ROSA robotic-assisted anterior hip replacement surgery is done under general anesthesia with you appropriately placed on the operating table. A surgical cut is made over the hip from the front (anterior approach) to expose the hip joint. The ROSA system functions like a high-tech GPS system utilizing optical trackers and a mini-camera to determine the exact position of the hip in space. In addition to providing robotic assistance to guide accurate acetabular component orientation, as well as intra-operative assessment of leg length and offset, the application allows surgeons to create a personalized surgical plan with the use of ONE Planner™ Hip. The robotic system makes adjustments even with the slightest movement ensuring the surgical plan designed by your surgeon is carried out without any changes and with a high degree of precision. Throughout the procedure, your surgeon is provided with real-time data by the ROSA system, which enhances your surgeon’s skill enabling accurate placement of the hip implant. Once the surgery is completed, the incision is closed with sutures and covered with a sterile dressing.

Postoperative Care and Recovery

Recovery is fairly quick as it is a minimally invasive procedure. In general, postoperative care and recovery after ROSA robotic-assisted anterior hip replacement procedure involve the following:

  • You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
  • Most patients may need to stay in the hospital for 2 to 3 days before being discharged home.
  • You may notice pain, swelling, and discomfort in the hip area. Pain and anti-inflammatory medications are provided as needed for comfort.
  • Antibiotics are also prescribed to address the risk of surgery-related infection.
  • You will be placed on assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
  • Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
  • Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. A gradual increase in activities over a period of time is recommended.
  • An individualized physical therapy protocol will be designed to help strengthen hip muscles and optimize hip function once you are off crutches.
  • Most patients are able to resume their normal activities in 3 to 4 weeks after surgery; however, returning to sports or high-intensity activities may take at least 6 months or longer.
  • You should refrain from driving until you are fully fit and receive your doctor’s consent.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Benefits of ROSA Robotic-assisted Anterior Hip Replacement

Being a minimally invasive procedure, the ROSA robotic-assisted anterior hip replacement surgery offers the following benefits:

  • Smaller incisions
  • Shorter operative time
  • Minimal blood loss
  • Shorter hospital stay
  • Less postoperative pain
  • Minimal soft-tissue trauma
  • Less scarring
  • Quicker recovery
  • Quicker return to normal activities
  • Lower risk of dislocation
  • Precise placement of the implant
  • Increased longevity of the implant
  • Increased stability of the hip

Risks and Complications

ROSA robotic-assisted hip replacement surgery is a relatively safe procedure; however, as with any surgery, there are risks and complications that can occur, such as:

  • Pain
  • Bleeding
  • Infection
  • Damage to surrounding soft tissues
  • Stiffness or instability in the hip
  • Allergic/anesthetic reactions
  • Blood clots or deep vein thrombosis (DVT)
  • Leg length inequality
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