Computer-Assisted Navigation Is Associated with Reductions in the Rates of Dislocation and Acetabular Component Revision Following Primary Total Hip Arthroplasty

Abstract

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.

Trends and patient factors associated with technology-assisted total hip arthroplasty in the United States from 2005 to 2014

“…In our study, patients who underwent TA-THA had no differences in age or medical comorbidities, as measured by ECI, compared to those who underwent conventional THA. Our findings differ from what Bohl et al [22] showed, which was that patients who underwent THA with computer-assisted navigation tended to be younger and with fewer medical comorbidities. We attribute these differences to the fact that Bohl et al used the Medicare Part A claims data set and included only Medicare patients 65 years old, whereas we included all insurance payers for patients of all ages.…”

“…In addition, patients from higher income quartiles were found to have an increased likelihood of undergoing TA-THA. These findings are similar to what Bohl et al [22] found in their study and suggest a potential disparity in the utilization of TA-THA based on socioeconomic factors. Although large, prospective randomized controlled trials are needed to determine if TA-THA results in improved clinical outcome measures, the socioeconomic differences presented here warrant further investigation to eliminate any inequitable distribution of a new surgical technology.…”

“…We found no differences in the likelihood of undergoing TA-THA based on hospital size or type. These findings are similar to what Antonios et al showed in their analysis of TA-TKA but differ from Bohl et al in their retrospective study of THA with computer- assisted navigation [22,34]. Specifically, Bohl et al [22] showed that large, teaching medical centers had increased utilization of computer-assisted navigation.…”

“…Previous studies have demonstrated that TA-THA improves the precision and accuracy of acetabular component positioning compared to conventional THA [15][16][17][18][19][20][21]. However, it is unclear whether the use of TA-THA results in improved long-term clinical outcomes and decreased postoperative complications compared to conventional THA [19][20][21][22][23][24][25]. Furthermore, purchasing any computerassisted navigation or robotic-assistance systems requires not only a significant initial financial investment but also a routine maintenance fee and disposable instrument cost [12,14,26].…”

“…However, whether TA-THA results in meaningful improvement in clinical outcomes compared to conventional THA remains unclear. Bohl et al [22] recently showed decreased dislocation and acetabular component revision rates in their retrospective study of 14,540 patients who underwent THA with computer-assisted navigation. Conversely, other studies, including 2 randomized trials by Lass et al and Parratte et al, have found no clinically significant differences in patient-reported outcomes or revision surgery rates between TA-THA and conventional THA [19][20][21][23][24][25].…”