Reduced postoperative morbidity in computer-navigated total knee arthroplasty: A retrospective comparison of 225,123 cases

Webb, Matthew L.; Hutchison, Catherine E.; Sloan, Matthew; Scanlon, Christopher M.; Lee, Gwo-Chin; Sheth, Neil P.

doi:10.1016/j.knee.2020.12.015

Cited by 11 publications

(5 citation statements)

References 37 publications

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“…To our knowledge, this is the largest study to compare operative times for patients undergoing TA-TKA and U-TKA. Prior studies have shown that TA-TKA and U-TKA have similar operative times, and not surprisingly, we found that mean operative times did not significantly differ between the matched TA-TKA and U-TKA cohorts [ 8 , 10 , 25 , 27 , 28 ]. Although these data support existing findings, operators using technology must register bony landmarks, interpret intraoperative data, and adjust component positions accordingly.…”

Section: Discussionsupporting

confidence: 71%

“…With the introduction of technology-assisted total knee arthroplasty (TA-TKA), orthopedic surgeons may now achieve increased accuracy and precision in the placement of TKA components [ 3 , 4 ]. Despite this, there is no consensus on whether TA-TKA confers superior clinical outcomes as compared with conventional unassisted techniques [ 5 – 10 ]. Therefore, larger and more comprehensive studies are required to detect meaningful clinical benefits of using advanced technologies.…”

Section: Introductionmentioning

confidence: 99%

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A comparison of utilization and short-term complications of technology-assisted versus conventional total knee arthroplasty

Simcox

Singh

Oakley

et al. 2022

Knee Surg & Relat Res

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Background While technology-assisted total knee arthroplasty (TA-TKA) improves implant positioning, whether it confers improved clinical outcomes remains inconclusive. We sought to examine national TA-TKA utilization trends and to compare outcomes between TA-TKA and unassisted TKA (U-TKA). Methods Patients who underwent primary, elective TKA from 2010 to 2018 were identified using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Demographic, perioperative, and 30-day outcomes were collected. Patients were stratified on the basis of whether they underwent TA-TKA, which included computer navigation and robotics, or U-TKA. The proportion of patients undergoing TKA using TA-TKA was calculated. One-to-one propensity-score matching paired patients undergoing TA-TKA or U-TKA. Independent samples t-tests and Mann–Whitney U tests were used to compare continuous variables, and chi-squared tests were used to compare categorical variables. Results Of the 402,284 TKA patients, 10,429 (2.6%) cases were performed using TA-TKA. Comparing the unmatched TA-TKA and U-TKA groups, race (p < 0.001), smoking status (p = 0.050), baseline functional status (p < 0.001), and body mass index (BMI) (p < 0.001) significantly differed. Propensity-score matching yielded 8633 TA-TKA and U-TKA pairs. The TA-TKA cohort had shorter hospital length of stay (LOS) (2.7 ± 2.5 versus 2.8 ± 1.9 days, p = 0.017) but similar operative times (92.4 ± 33.4 versus 92.6 ± 39.8 min, p = 0.670). Compared with the U-TKA group, the TA-TKA group had lower major complication (7.6% versus 9.4%, p < 0.001) and transfusion (3.9% versus 5.1%, p < 0.001) rates and higher rates of discharge to home (73.9% versus 70.4%, p < 0.001). Reoperation and readmission rates did not significantly differ between groups. Conclusions TA-TKA utilization remains low among orthopedic surgeons. Compared with U-TKA, TA-TKA yielded improved perioperative and 30-day outcomes. Nonetheless, surgeons must consider the benefits and drawbacks of TA-TKA when determining the proper surgical technique and technology for each patient. Level III evidence Retrospective cohort study.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

A comparison of utilization and short-term complications of technology-assisted versus conventional total knee arthroplasty

Simcox

Singh

Oakley

et al. 2022

Knee Surg & Relat Res

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“…The current literature with respect to length of stay in orthopedic-based operations is ambiguous. 8,9,12,13 Our study thus highlights the necessity of further research to elucidate the aid of computer-aided navigation in improving surgical outcomes. As computer-aided navigation becomes more widely used in spine surgery, the number of patients who undergo cervical fusion surgery with computer-aided navigation should increase.…”

Section: Discussionmentioning

confidence: 75%

“…These similarities in readmission rates and length of stay indicate that computer-aided navigation use in PCF surgeries is not statistically significant. The current literature with respect to length of stay in orthopedic-based operations is ambiguous 8,9,12,13. Our study thus highlights the necessity of further research to elucidate the aid of computer-aided navigation in improving surgical outcomes.…”

Section: Discussionmentioning

confidence: 88%

The Impact of Computer-Assisted Navigation on Charges and Readmission in Patients Undergoing Posterior Cervical Fusion Surgery

Tang

Dominy

Arvind

et al. 2022

Clinical Spine Surgery: A Spine Publication

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Objective: The aim was to evaluate cost and outcomes associated with navigation use on posterior cervical fusion (PCF) surgery patients.Summary of Background Data: Computer-assisted navigation systems demonstrate comparable outcomes with hardware placement and procedural speed compared with traditional techniques. Innovations in technology continue to improve surgeons' performance in complicated procedures, causing need to analyze the impact on patient care. Methods:The 2016 NRD was queried for patients with PCF surgery ICD-10 codes. Cost and readmission rates were compared with and without navigation. Nonelective cases and patients below 18 years of age were excluded. Univariate analysis on demographics, surgical data, and total charges was performed. Lastly, multivariate analysis was performed to assess navigation's impact on cost and postoperative outcomes.Results: A total of 11,834 patients were identified, with 137 (1.2%) patients undergoing surgery with navigation and 11,697 (98.8%) patients without. Average total charge was $131,939.47 and $141,270.1 for the non-navigation and navigation cohorts, respectively (P = 0.349). Thirty-day and 90-day readmission rates were not significantly lower in patients who received navigation versus those that did not (P = 0.087). This remained insignificant after adjusting for several variables, age above 65, sex, medicare status, mental health history, and comorbidities. The model adjusting for demographic and comorbidities maintained insignificant results of navigation being associated with decreased 30-day and 90-day readmissions (P = 0.079).Conclusions: Navigation use in PCF surgery was not associated with increased cost, and patients operated on with navigation did not significantly have increased routine discharge or decreased 90-day readmission. As a result, future studies must continue to evaluate the cost-benefit of navigation use for cervical fusion surgery.

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“…Hospital and surgeon volume is also known to be related to patient outcomes following THA and TKA, but these data are often not available in administrative claims databases and thus cannot be accounted for. Our review of the literature identified studies in which computer-assisted (9 studies) and/or robotic-assisted technology (11 studies) was evaluated with use of large databases, and none reported surgeon or hospital-specific volume (Table I) 18-33 .…”

mentioning

confidence: 99%

Analysis of New Orthopaedic Technologies in Large Database Research

Callaghan

DeMik

Carender

et al. 2022

Journal of Bone and Joint Surgery

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Reduced postoperative morbidity in computer-navigated total knee arthroplasty: A retrospective comparison of 225,123 cases

Cited by 11 publications

References 37 publications

A comparison of utilization and short-term complications of technology-assisted versus conventional total knee arthroplasty

A comparison of utilization and short-term complications of technology-assisted versus conventional total knee arthroplasty

The Impact of Computer-Assisted Navigation on Charges and Readmission in Patients Undergoing Posterior Cervical Fusion Surgery

Analysis of New Orthopaedic Technologies in Large Database Research

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