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Background: Prior work suggests that computer-assisted navigation improves acetabular component position during primary total hip arthroplasty (THA). However, it is not known whether this translates to improvements in clinical outcomes. The purpose of this study was to test for associations between navigation use and the risk of dislocation, aseptic revision of the acetabular component, aseptic revision of the femoral component, aseptic revision of either component, and acute periprosthetic joint infection (PJI). Methods: This was a retrospective cohort study, conducted using the 100% Medicare Part A claims data set. Inclusion criteria were an age of ≥65 years and primary THA for osteoarthritis. First, the association between navigation use and patient and hospital characteristics was assessed. Second, while controlling for these characteristics, multivariate regression was used to test for the association of navigation use and the outcomes listed above. Results: A total of 803,732 primary THA procedures were identified; 14,540 (1.81%) involved the use of navigation. Navigation use was associated with younger age, other/unknown race, the Western census region, higher socioeconomic status, lower Charlson Comorbidity Index, shorter length of stay, private hospitals, teaching hospitals, and larger hospitals (p < 0.05 for each). Navigation use was associated with a lower rate of dislocation (1.00% versus 1.70% for no navigation; adjusted hazard ratio [HR] = 0.69; 95% confidence interval [CI] = 0.58 to 0.82; p < 0.001) and aseptic revision of the acetabular component (1.03% versus 1.55%; adjusted HR = 0.75; 95% CI = 0.64 to 0.88; p < 0.001). Navigation was not associated with aseptic revision of the femoral component (1.54% versus 1.87%; p = 0.064), aseptic revision of either component (1.91% versus 2.31%; p = 0.077), acute PJI at 6 weeks (0.34% versus 0.45%; p = 0.121), or acute PJI at 90 days (0.50% versus 0.66%; p = 0.458). Conclusions: The findings of this study suggest that navigation is associated with reductions in the rates of dislocation and aseptic acetabular revision following primary THA. However, these results should be interpreted carefully in the setting of potential confounding by unmeasured variables, such as surgeon volume, family support, and patient compliance. Causality cannot be inferred until further prospective trials can vet this technology. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Aims Tranexamic acid (TXA) is proven to reduce blood loss following total knee arthroplasty (TKA), but there are limited data on the impact of similar dosing regimens in revision TKA. The purpose of this multicentre randomized clinical trial was to determine the optimal regimen to maximize the blood-sparing properties of TXA in revision TKA. Patients and Methods From six-centres, 233 revision TKAs were randomized to one of four regimens: 1 g of intravenous (IV) TXA given prior to the skin incision, a double-dose regimen of 1 g IV TXA given both prior to skin incision and at time of wound closure, a combination of 1 g IV TXA given prior to skin incision and 1 g of intraoperative topical TXA, or three doses of 1950 mg oral TXA given two hours preoperatively, six hours postoperatively, and on the morning of postoperative day one. Randomization was performed based on the type of revision procedure to ensure equivalent distribution among groups. Power analysis determined that 40 patients per group were necessary to identify a 1 g/dl difference in the reduction of haemoglobin postoperatively between groups with an alpha of 0.05 and power of 0.80. Per-protocol analysis involved regression analysis and two one-sided t-tests for equivalence. Results In total, one patient withdrew, five did not undergo surgery, 16 were screening failures, and 25 did not receive the assigned treatment, leaving 186 patients for analysis. There was no significant difference in haemoglobin reduction among treatments (2.8 g/dl for single-dose IV TXA, 2.6 g/dl for double-dose IV TXA, 2.6 g/dl for combined IV/topical TXA, 2.9 g/dl for oral TXA; p = 0.38). Similarly, calculated blood loss (p = 0.65) and transfusion rates (p = 0.95) were not significantly different between groups. Equivalence testing assuming a 1 g/dl difference in haemoglobin change as clinically relevant showed that all possible pairings were statistically equivalent. Conclusion Despite the higher risk of blood loss in revision TKA, all TXA regimens tested had equivalent blood-sparing properties. Surgeons should consider using the lowest effective dose and least costly TXA regimen in revision TKA. Cite this article: Bone Joint J 2019;101-B(Supple 7):10–16

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