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Singh V, et al. Effect of intraoperative use of technology on patient reported outcomes following total hip arthroplasty. Presented at: International Society for Technology in Arthroplasty New Early Career Webinar Series; Nov. 20-21, 2020.
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Navigation, robotics may not improve functional outcomes vs conventional THA
Published by:
Singh V, et al. Effect of intraoperative use of technology on patient reported outcomes following total hip arthroplasty. Presented at: International Society for Technology in Arthroplasty New Early Career Webinar Series; Nov. 20-21, 2020.
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Results from the International Society for Technology in Arthroplasty New Early Career Webinar Series showed use of navigation and robotics in total hip arthroplasty may not improve functional outcomes compared with conventional THA.
Joshua C. Rozell, MD, and colleagues categorized 1,960 patients who underwent primary elective THA during a 4-year period into groups based on whether navigation (n=896), robotics (n=135) or standard instrumentation (n=929) was used during the procedure. Rozell noted all patients completed a patient-reported outcome measure questionnaire.
“The forgotten joint score was collected at 3 months, 1 year and 2 years, respectively, for all groups,” Rozell said in his presentation. “Hip disability and osteoarthritis outcome score joint replacement, or HOOS Jr., was collected preoperatively and at 3 months and 1-year follow-up.”
Rozell noted patients who underwent manual THA had the longest length of stay, while patients who underwent THA with robotics had the longest surgical time. The groups had no statistically significant differences for all cause 90-day readmission or revision, according to Rozell. He added the groups also had no differences in forgotten joint score at 3 months or 1 year, as well as no differences in HOOS Jr. preoperatively or at 3 months.
“However, 2-year [forgotten joint score] FJS score varied significantly between groups, with manual implantation scoring the highest at 2-year follow-up,” Rozell said. “The same trend was seen in the 1-year HOOS Jr. scores, with manual implantation scoring the highest at 1 year.”
At 1- and 2-year follow-up, Rozell noted a statistically significant difference in mean improvement in the FJS between the groups, with the largest changes seen among patients in the conventional THA group.
“Mean improvements in HOOS Jr. scores were statistically significant between the groups and, again, were largest for patients who underwent conventional THA,” Rozell said. “However, these differences did not exceed the mean clinically important difference.”
Perspective
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Henry Finn, MD
There are two main advantages to using computer navigated surgery during a primary THA. One is positioning of the acetabular component using the latest generation of the technology called real intelligence, which uses the experience of a surgeon working with the computer navigated system for accurate and precise preparation of bone to accept the hip replacement implants for proper placement, as well as perfect balance of the soft tissue. In traditional THA, malpositioning the acetabular component continues to challenge most orthopedic surgeons and can lead to dislocation and accelerated wear of the hip.
The second advantage to computer navigated surgery comes with leg length evaluation without the use of fluoroscopic X-ray. This saves time and minimizes potential contamination and eliminates radiation exposure. Leg length discrepancy remains the main reason most patients file lawsuits against their surgeon.
This study looks at a 2-year period, but it seems logical that computer navigated surgeries will bring fewer complications, such as dislocations, as well as better wear of the articulating bearing.
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