International orthopaedics · 2026
Five-year implant-related complication rates of total hip arthroplasty performed for osteonecrosis were not improved by robotic-assisted or computer-navigated techniques.
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Becker Nils, Kim Lucas Y, Rubin Lee E, Grauer Jonathan N, Wiznia Daniel H
Аннотация
BACKGROUND: Osteonecrosis of the femoral head (ONFH) is associated with hip deformity and variable bone quality compared with osteoarthritis (OA). We hypothesised that robotic and navigation-assisted total hip replacement (rTHA, nTHA, together referred to as r-nTHA) might have benefits for this indication.
METHODS: A national administrative database was used to identify THA patients diagnosed with ONFH or OA. The use of r-nTHA versus manual THA (mTHA) was trended and compared by indication. In THA for ONFH patients, cases with rTHA or nTHA were separately matched to mTHA 1:4 by age, sex, Elixhauser comorbidity index, and surgery year. The 90-day medical adverse events were assessed relative to mTHA. Five-year implant-related complications were compared for those with laterality indicators.
RESULTS: The utilisation of r-nTHA for ONFH was similar to that for OA until 2021, and lagged behind in 2022 (17.8% versus 23.1%, p = 0.0217). After matching and relative to mTHA, rTHA showed higher odds ratios (OR) for transfusions (OR = 2.67) and readmissions (OR = 2.14), whereas nTHA demonstrated lower OR for adverse events and emergency department visits (ORs 0.48 to 0.67) (p < 0.001 for each). The five-year odds of each of the assessed implant-related complications was comparable between both rTHA and nTHA relative to mTHA.
CONCLUSIONS: As implant-related complications were similar between rTHA, nTHA, and mTHA at midterm follow-up, the current study does not provide clear evidence favouring routine use of the technology-assistance over mTHA for ONFH, although cost-effectiveness, surgeon experience, and the potential for increased accuracy in component positioning in anatomically complex cases were not assessed. Prospective studies accounting for ONFH aetiology and disease severity are needed before definitive recommendations can be made. The association of some 90-day outcomes with r-nTHA may be correlated with the pathologies associated with ONFH.
METHODS: A national administrative database was used to identify THA patients diagnosed with ONFH or OA. The use of r-nTHA versus manual THA (mTHA) was trended and compared by indication. In THA for ONFH patients, cases with rTHA or nTHA were separately matched to mTHA 1:4 by age, sex, Elixhauser comorbidity index, and surgery year. The 90-day medical adverse events were assessed relative to mTHA. Five-year implant-related complications were compared for those with laterality indicators.
RESULTS: The utilisation of r-nTHA for ONFH was similar to that for OA until 2021, and lagged behind in 2022 (17.8% versus 23.1%, p = 0.0217). After matching and relative to mTHA, rTHA showed higher odds ratios (OR) for transfusions (OR = 2.67) and readmissions (OR = 2.14), whereas nTHA demonstrated lower OR for adverse events and emergency department visits (ORs 0.48 to 0.67) (p < 0.001 for each). The five-year odds of each of the assessed implant-related complications was comparable between both rTHA and nTHA relative to mTHA.
CONCLUSIONS: As implant-related complications were similar between rTHA, nTHA, and mTHA at midterm follow-up, the current study does not provide clear evidence favouring routine use of the technology-assistance over mTHA for ONFH, although cost-effectiveness, surgeon experience, and the potential for increased accuracy in component positioning in anatomically complex cases were not assessed. Prospective studies accounting for ONFH aetiology and disease severity are needed before definitive recommendations can be made. The association of some 90-day outcomes with r-nTHA may be correlated with the pathologies associated with ONFH.