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Background:The use of computer navigation has been shown to produce more accurate cup positioning when compared with non-navigated total hip arthroplasty (THA), but so far there is only limited evidence to show its effect on clinical outcomes. The present study analyzed data from the Australian Orthopaedic Association National Joint Replacement Registry to assess the impact of computer navigation on the rates of all-cause revision and revision for dislocation following THA.Methods:Data for all non-navigated and navigated primary THAs performed for osteoarthritis in Australia from January 1, 2009, to December 31, 2019, were examined to assess the rate of revision. We analyzed the effects of navigation on rate, reason, and type of revision. Hazard ratios (HRs) from Cox proportional hazard models, adjusted for age, sex, and head size, were utilized. Because of known prosthesis-specific differences in outcomes, we performed a further analysis of the 5 acetabular and femoral component combinations most commonly used with navigation.Results:Computer navigation was utilized in 6,912 primary THAs for osteoarthritis, with the use of navigation increasing from 1.9% in 2009 to 4.4% of all primary THAs performed in 2019. There was no difference in the rate of all-cause revision between navigated and non-navigated THAs looking at the entire group. There was a lower rate of revision for dislocation in the navigation THA cohort. The cumulative percent revision for dislocation at 10 years was 0.4% (95% confidence interval [CI], 0.2% to 0.6%) for navigated compared with 0.8% (95% CI, 0.8% to 0.9%) for non-navigated THAs (HR adjusted for age, sex, and head size, 0.46; 95% CI, 0.29 to 0.74; p = 0.002). In the 5 component combinations most commonly used with navigation, the rate of all-cause revision was significantly lower when these components were navigated compared with non-navigated. The cumulative percent revision at 10 years for these 5 prostheses combined was 2.4% (95% CI, 1.6% to 3.4%) for navigated compared with 4.2% (95% CI, 4.0% to 4.5%) for non-navigated THAs (HR, 0.64; 95% CI, 0.48 to 0.86; p = 0.003).Conclusions:This study showed that the use of computer navigation was associated with a reduced rate of revision for dislocation following THA. Furthermore, in the component combinations most commonly used with navigation there was also a reduction in the rate of all-cause revision.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Patients undergoing knee joint replacement (KJR) are at high risk of postoperative venous thromboembolism (VTE), but data on the time trends of VTE rate in this population are sparse. In this analysis of the German nationwide inpatient sample, we included all hospitalizations for elective primary KJR in Germany 2005–2016. Overall, 1,804,496 hospitalized patients with elective primary KJR (65.1% women, 70.0 years [IQR 63.0–76.0]) were included in the analysis. During hospitalization, VTE was documented in 23,297 (1.3%) patients. Total numbers of primary KJR increased from 129,832 in 2005 to 167,881 in 2016 (β-(slope)-estimate 1,978 [95% CI 1,951 to 2,004], P < 0.001). In-hospital VTE decreased from 2,429 (1.9% of all hospitalizations for KJR) to 1,548 (0.9%) cases (β-estimate − 0.77 [95% CI − 0.81 to − 0.72], P < 0.001), and in-hospital death rate from 0.14% (184 deaths) to 0.09% (146 deaths) (β-estimate − 0.44 deaths per year [95% CI − 0.59 to − 0.30], P < 0.001). Infections during hospitalization were associated with a higher VTE risk. VTE events were independently associated with in-hospital death (OR 20.86 [95% CI 18.78–23.15], P < 0.001). Annual number of KJR performed in Germany increased by almost 30% between 2005 and 2016. In parallel, in-hospital VTE rates decreased from 1.9 to 0.9%. Perioperative infections were associated with higher risk for VTE. Patients who developed VTE had a 21-fold increased risk of in-hospital death.

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