Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Exponent, Inc., Philadelphia, Pennsylvania.
J Bone Joint Surg Am. 2019 Feb 6;101(3):250-256. doi: 10.2106/JBJS.18.00108.
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).
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.
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).
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.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
先前的研究表明，计算机辅助导航可改善初次全髋关节置换术（THA）中的髋臼部件位置。但是，尚不清楚这是否可以改善临床结果。本研究的目的是检验导航使用与脱位风险、髋臼部件无菌翻修、股骨部件无菌翻修、任何部件无菌翻修以及急性假体周围关节感染（PJI）之间的关联。
这是一项回顾性队列研究，使用了 100%的 Medicare Part A 索赔数据集进行。纳入标准为年龄≥65 岁且初次行 THA 治疗骨关节炎。首先，评估导航使用与患者和医院特征之间的关联。其次，在控制这些特征的同时，使用多变量回归来检验导航使用与上述结果之间的关联。
共确定了 803732 例初次 THA 手术；其中 14540 例（1.81%）涉及导航使用。导航使用与年龄较小、其他/未知种族、西部普查区、较高的社会经济地位、较低的 Charlson 合并症指数、较短的住院时间、私立医院、教学医院和较大的医院有关（p <0.05）。与未使用导航相比，导航使用与脱位率较低相关（1.00%比 1.70%；调整后的危害比[HR] = 0.69；95%置信区间[CI] = 0.58 至 0.82；p <0.001）和髋臼部件无菌翻修率较低（1.03%比 1.55%；调整后的 HR = 0.75；95%CI = 0.64 至 0.88；p <0.001）。导航与股骨部件无菌翻修（1.54%比 1.87%；p = 0.064）、任何部件无菌翻修（1.91%比 2.31%；p = 0.077）、6 周时急性 PJI（0.34%比 0.45%；p = 0.121）或 90 天时急性 PJI（0.50%比 0.66%；p = 0.458）无相关性。
本研究的结果表明，导航与初次 THA 后脱位率和无菌髋臼翻修率的降低有关。但是，在存在未测量变量（例如手术医生的数量、家庭支持和患者的依从性）混杂的情况下，这些结果应谨慎解释。在可以对该技术进行进一步前瞻性试验验证之前，不能推断因果关系。
治疗性 III 级。有关证据水平的完整描述，请参见《作者说明》。
