What are the six degree-of-freedom errors of a robotically-machined femoral cavity in total hip arthroplasty and are they clinically important? An in-vitro study

Errors during a robot-assisted THA may result in a femoral cavity with position and orientation different than planned. This can lead to a femoral component placement that inaccurately sets a patient's femoral anteversion (FA), femoral offset (FO), and vertical offset (VO). The objectives of this study were to determine the position and orientation errors of robotically-machined femoral cavities in six degrees of freedom and to determine how position and orientation errors translate into errors in the setting of FA, FO, and VO. After creating preoperative plans, robot-assisted THAs were performed on twelve cadaveric specimens. The position and orientation of the machined cavities were compared to those of the planned cavities to determine the errors in six degrees of freedom. Placement of femoral components into the machined cavities was simulated, and the differences in FA, FO, and VO between the simulated and planned component placement were computed. While bias (i.e. mean error) occurred for three of six degrees of freedom in femoral cavities machined by a robotic system, the root mean squared errors (RMSEs) when the placement of femoral component was simulated were limited to 1.9° for FA, 1.0 mm for FO, and 2.1 mm for VO and were clinically unimportant.