Aims The primary objective of this study was to develop a validated classification system for assessing iatrogenic bone trauma and soft-tissue injury during total hip arthroplasty (THA). The secondary objective was to compare macroscopic bone trauma and soft-tissues injury in conventional THA (CO THA) versus robotic arm-assisted THA (RO THA) using this classification system. Methods This study included 30 CO THAs versus 30 RO THAs performed by a single surgeon. Intraoperative photographs of the osseous acetabulum and periacetabular soft-tissues were obtained prior to implantation of the acetabular component, which were used to develop the proposed classification system. Interobserver and intraobserver variabilities of the proposed classification system were assessed. Results The BOne trauma and Soft-Tissue Injury classification system in total Hip arthroplasty (BOSTI Hip) grades osseous acetabular trauma and periarticular muscle damage during THA. The classification system has an interclass correlation coefficient of 0.90 (95% CI 0.86 to 0.93) for interobserver agreement and 0.89 (95% CI 0.84 to 0.93) for intraobserver agreement. RO THA was associated with improved BOSTI Hip scores (p = 0.002) and more pristine osseous surfaces in the anterior superior (p = 0.001) and posterior superior (p < 0.001) acetabular quadrants compared with CO THA. There were no differences between the groups in relation to injury to the gluteus medius (p = 0.084), obturator internus (p = 0.241), piriformis (p = 0.081), superior gamellus (p = 0.116), inferior gamellus (p = 0.132), quadratus femoris (p = 0.208), and vastus lateralis (p = 0.135), but overall combined muscle injury was reduced in RO THA compared with CO THA (p = 0.023). Discussion The proposed BOSTI Hip classification provides a reproducible grading system for stratifying iatrogenic bone trauma and soft-tissue injury during THA. RO THA was associated with improved BOSTI Hip scores, more pristine osseous acetabular surfaces, and reduced combined periarticular muscle injury compared with CO THA. Further research is required to understand if these intraoperative findings translate to differences in clinical outcomes between the treatment groups.

中文翻译：

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全髋关节置换术 （BOSTI Hip） 中的骨外伤和软组织损伤分类系统。


目的 本研究的主要目的是开发一个经过验证的分类系统，用于评估全髋关节置换术 （THA） 期间的医源性骨创伤和软组织损伤。次要目的是使用该分类系统比较传统 THA （CO THA） 与机械臂辅助 THA （RO THA） 中的肉眼可见的骨创伤和软组织损伤。方法 本研究包括 30 例 CO THA 与由一名外科医生进行的 30 例 RO THA 对比。在植入髋臼组件之前获得骨髋臼和髋臼周围软组织的术中照片，用于开发拟议的分类系统。评估了所提出的分类系统的观察者间和观察者内变异性。结果 全髋关节置换术 （BOSTI Hip） 中的 BOne 创伤和软组织损伤分类系统对 THA 期间的骨性髋臼创伤和关节周围肌肉损伤进行分级。该分类系统的观察者间一致性的类间相关系数为 0.90 （95% CI 0.86 至 0.93），观察者内部一致性的类别间相关系数为 0.89 （95% CI 0.84 至 0.93）。与 CO THA 相比，RO THA 与 BOSTI 髋关节评分改善 （p = 0.002） 和前上 （p =0.001） 和后上 （p < 0.001） 髋臼象限更原始的骨表面相关。两组之间在臀中肌损伤 （p = 0.084）、闭孔内肌 （p = 0.241）、梨状肌 （p = 0.081）、上甘毛 （p = 0.116）、下甘毛 （p = 0.132）、股方肌 （p = 0.208） 和股外侧肌 （p = 0.135） 方面没有差异，但与 CO THA 相比，RO THA 的总体联合肌肉损伤减少 （p = 0.023）。 讨论 拟议的 BOSTI 髋关节分类为 THA 期间医源性骨创伤和软组织损伤的分层提供了一个可重复的分级系统。与 CO THA 相比，RO THA 与 BOSTI 髋关节评分改善、骨髋臼表面更原始以及关节周围联合肌肉损伤减少相关。需要进一步的研究来了解这些术中发现是否转化为治疗组之间临床结局的差异。