Robotics Versus Navigation Versus Conventional Total Hip Arthroplasty: Does the Use of Technology Yield Superior Outcomes?

Singh, Vivek; Realyvasquez, John; Simcox, Trevor; Rozell, Joshua C.; Schwarzkopf, Ran; Davidovitch, Roy I.

doi:10.1016/j.arth.2021.02.074

Cited by 63 publications

(50 citation statements)

References 33 publications

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“…The Forgotten Joint Score-12 (FJS-12) 21 is a PROM that asks questions about a patient’s awareness of their joints in daily life. As these PROMs and many others have been used in the postoperative evaluation of THA, 22,23 previous studies on the long-term outcomes following PAO have yet to examine PROMs, such as OHS and FJS-12, in detail as the primary outcome. In addition, the distribution, characteristics, success threshold, and determinants of favourable PROMs results remain unclear.…”

Section: Introductionmentioning

confidence: 99%

20-year hip survivorship and patient-reported outcome measures after transpositional osteotomy of the acetabulum for dysplastic hips

Nakashima

Ishibashi

Kitamura

et al. 2022

The Bone & Joint Journal

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Aims Although periacetabular osteotomies are widely used for the treatment of symptomatic dysplastic hips, long-term surgical outcomes and patient-reported outcome measures (PROMs) are still unclear. Accordingly, we assessed hip survival and PROMs at 20 years after transpositional osteotomy of the acetabulum (TOA). Methods A total of 172 hips in 159 patients who underwent TOA were followed up at a mean of 21.02 years (16.6 to 24.6) postoperatively. Kaplan-Meier analysis was used to assess survivorship with an endpoint of total hip arthroplasty (THA). PROMs included the visual analogue scale (VAS) Satisfaction, VAS Pain, Oxford Hip Score (OHS), and Forgotten Joint Score-12 (FJS-12). Thresholds for favourable outcomes for OHS (≥ 42) and FJS-12 (≥ 51) were obtained using the receiver operating characteristic curve with VAS Satisfaction ≥ 50 and VAS Pain < 20 as anchors. Results THA was performed on 37 hips (21.5%) by the latest follow-up. Kaplan-Meier analysis indicated that the hip survival rate at 20 years was 79.7% (95% confidence interval (CI) 73.7 to 86.3). Multivariate analysis showed that preoperative Tönnis grade significantly influenced hip survival. Tönnis grades 0, 1, and 2 were associated with 20-year survival rates of 93.3% (95% CI 84.8 to 100), 86.7% (95% CI 79.8 to 94.3), and 54.8% (95% CI 41.5 to 72.3), respectively. More than 60% of the patients exhibited favourable PROMs. An advanced Tönnis grade at the latest follow-up and a higher BMI were both significantly associated with unfavourable OHS, but not with other PROMs. Conclusion This study demonstrated the durability of TOA for hips with Tönnis grades 0 to 1 at 20 years. While the presence of advanced osteoarthritis and higher BMI was associated with lower hip functions (OHS), it was not necessarily associated with worse patient satisfaction and joint awareness. Cite this article: Bone Joint J 2022;104-B(7):767–774.

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Section: Introductionmentioning

confidence: 99%

20-year hip survivorship and patient-reported outcome measures after transpositional osteotomy of the acetabulum for dysplastic hips

Nakashima

Ishibashi

Kitamura

et al. 2022

The Bone & Joint Journal

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“…To date, this is the largest study to examine differences in surgical time between TA-THA and U-THA. Although previous studies yielded mixed results as to whether TA-THA is associated with increased surgical time, 5,6,20,[30][31][32] we unsurprisingly found that the mean surgical time for TA-THA was markedly greater than that of U-THA by approximately 10 minutes. This result is likely clinically meaningful, especially in the context of high-volume adult reconstruction hip surgeons, and most likely manifests from registering bony landmarks, interpreting intraoperative data, and adjusting implant positions accordingly.…”

Section: Discussionmentioning

confidence: 53%

“…In the existing literature, the association between TA-THA and shorter LOS is unclear. Although several studies support this finding, 6,8,28,33 an NIS database analysis consisting of patients undergoing THA from 2005 to 2014 found no association. 16 In our analysis, patients in the TA-THA cohort were more likely to be discharged home as compared with the U-THA cohort, which is consistent with the prior literature.…”

Section: Discussionmentioning

confidence: 95%

“…It is unclear whether improved positioning translates into improved clinical outcomes, whether certain subsets of patients benefit from intraoperative technology over conventional techniques, and whether there is improvement in long-term implant survivorship with the use of advanced technology during surgery. 6,9,12,25–27…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] Despite the obvious advantages of TA-THA, there is no consensus in the literature as to whether TA-THA confers short-term or long-term clinical improvements in outcomes over unassisted techniques. [6][7][8][9][10][11][12][13] Thus, longer-term studies are required to detect any substantial and meaningful clinical benefits of the use of advanced technology.…”

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confidence: 99%

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Comparison of Utilization and Short-term Complications Between Technology-assisted and Conventional Total Hip Arthroplasty

Simcox

Singh

Oakley

et al. 2022

J Am Acad Orthop Surg

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Introduction: Although technology-assisted total hip arthroplasty (TA-THA) may improve implant positioning, it remains unknown whether TA-THA confers improved clinical outcomes. We sought to examine national TA-THA utilization trends and compare clinical outcomes between TA-THA and unassisted THA (U-THA). Methods: Patients who underwent primary, elective THA from 2010 to 2018 were identified using the American College of Surgeons National Surgical Quality Improvement Program database. Demographic, perioperative, and 30-day outcomes were queried and collected. Patients were stratified based on whether they underwent TA-THA, which included computer navigation or robotics, and U-THA. Propensity score matching paired patients undergoing TA-THA or U-THA on a 1:1 basis. Results: Of the 238,755 THA patients, 3,149 cases (1.3%) were done using TA-THA. Comparing the unmatched TA-THA and U-THA groups, race distribution (P , 0.001) and baseline functional status (P , 0.001) differed. Propensity score matching yielded 2,335 TA-THA and U-THA pairs. Perioperatively, the TA-THA cohort had longer mean surgical times (101.0 6 34.0 versus 91.9 6 38.8 minutes, P , 0.001), but lower transfusion rates (5.7% versus 7.8%, P = 0.005). As compared with the U-THA group, the TA-THA group had a shorter mean hospital length of stay (2.0 6 1.1 versus 2.5 6 2.0 days, P , 0.001) and a higher proportion of patients discharged home (85.8% versus 75.7%, P , 0.001). Notably, the TA-THA cohort had higher readmission rates (3.8% versus 2.4%, P , 0.001). Major complication and revision surgery rates did not markedly differ between groups. Discussion: TA-THA utilization rates remain low among orthopaedic surgeons. As compared with U-THA, TA-THA yield mixed perioperative and 30-day outcomes. Surgeons must consider the clinical benefits and drawbacks of TA-THA when determining the proper surgical

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Use of a fluoroscopy‐based robotic‐assisted total hip arthroplasty system resulted in greater improvements in hip‐specific outcome measures at one‐year compared to a CT‐based robotic‐assisted system

Ong,

Buchan,

Hecht

et al. 2024

Robotics Computer Surgery

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BackgroundThe purpose of this study was to compare one‐year patient reported outcome measures between a novel fluoroscopy‐based robotic‐assisted (FL‐RTHA) system and an existing computerised tomography‐based robotic assisted (CT‐RTHA) system.MethodsA review of 85 consecutive FL‐RTHA and 125 consecutive CT‐RTHA was conducted. Outcomes included one‐year post‐operative Veterans RAND‐12 (VR‐12) Physical (PCS)/Mental (MCS), Hip Disability and Osteoarthritis Outcome (HOOS) Pain/Physical Function (PS)/Joint replacement, and University of California Los Angeles (UCLA) Activity scores.ResultsThe FL‐RTHA cohort had lower pre‐operative VR‐12 PCS, HOOS Pain, HOOS‐PS, HOOS‐JR, and UCLA Activity scores compared with patients in the CT‐RTHA cohort. The FL‐RTHA cohort reported greater improvements in HOOS‐PS scores (−41.54 vs. −36.55; p = 0.028) than the CT‐RTHA cohort. Both cohorts experienced similar rates of major post‐operative complications, and had similar radiographic outcomes.ConclusionsUse of the fluoroscopy‐based robotic system resulted in greater improvements in HOOS‐PS in one‐year relative to the CT‐based robotic technique.

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Robotics Versus Navigation Versus Conventional Total Hip Arthroplasty: Does the Use of Technology Yield Superior Outcomes?

Cited by 63 publications

References 33 publications

20-year hip survivorship and patient-reported outcome measures after transpositional osteotomy of the acetabulum for dysplastic hips

20-year hip survivorship and patient-reported outcome measures after transpositional osteotomy of the acetabulum for dysplastic hips

Comparison of Utilization and Short-term Complications Between Technology-assisted and Conventional Total Hip Arthroplasty

Use of a fluoroscopy‐based robotic‐assisted total hip arthroplasty system resulted in greater improvements in hip‐specific outcome measures at one‐year compared to a CT‐based robotic‐assisted system

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