Davis Edward T, McKinney Kerren D, Kamali Amir, Kuljaca Selena, Pagkalos Joseph
The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom.
Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.
JB JS Open Access. 2021 Jul 28;6(3). doi: 10.2106/JBJS.OA.21.00006. eCollection 2021 Jul-Sep.
Computer-assisted total hip arthroplasty (THA) is known to improve implantation precision, but clinical data demonstrating an improvement in survivorship and patient-reported outcome measures (PROMs) are lacking. Our aim was to compare the risk of revision, PROMs, and patient satisfaction between cohorts who underwent THA with and without the use of computer guidance.
We used the data set and linked PROM data of the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man. Our sample included THAs performed for osteoarthritis using cementless acetabular components from a single manufacturer (cementless and hybrid THAs). An additional analysis was performed limiting the sample size to cementless-only THAs. The primary end point was revision (any component) for any reason. Kaplan-Meier survivorship analysis and an adjusted Cox proportional-hazards model were used.
There were 41,683 non-computer-guided and 871 (2%) computer-guided cases included in our analysis of the cementless and hybrid group. There were 943 revisions in the non-computer-guided group and 7 in the computer-guided group. The cumulative revision rate at 10 years was 3.88% (95% confidence interval [CI]: 3.59% to 4.18%) for the non-computer-guided group and 1.06% (95% CI: 0.45% to 2.76%) for the computer-guided group. The Cox proportional-hazards model yielded a hazard ratio of 0.45 (95% CI: 0.21 to 0.96; p = 0.038). In the analysis of the cementless-only group, the cumulative revision rate at 10 years was 3.99% (95% CI: 3.62% to 4.38%) and 1.20% (95% CI: 0.52% to 3.12%) for the 2 groups, respectively. The Cox proportional-hazards model yielded a hazard ratio of 0.47 (95% CI: 0.22 to 1.01; p = 0.053). There was no significant difference in the 6-month Oxford Hip Score, the EuroQol-5 Dimension (EQ-5D) and EQ-VAS (Visual Analogue Scale) scores, and patient-reported success rates. Patient satisfaction (single-item satisfaction outcome measure) was higher in the computer-guided group, but this finding was limited by a reduced number of responses.
In our analysis, the use of computer-guided surgery was associated with a lower rate of revision at mean follow-up of 5.6 years. This finding was upheld when the sample was restricted to cementless-only THAs. Causality cannot be inferred in view of the observational nature of the study, and additional studies are recommended to validate these findings.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
已知计算机辅助全髋关节置换术（THA）可提高植入精度，但缺乏能证明其可提高生存率及患者报告结局指标（PROMs）的临床数据。我们的目的是比较使用和不使用计算机辅助进行THA的队列之间的翻修风险、PROMs及患者满意度。
我们使用了英格兰、威尔士、北爱尔兰和马恩岛国家关节注册中心的数据集及相关的PROM数据。我们的样本包括使用单一制造商的非骨水泥髋臼组件（非骨水泥和混合型THA）治疗骨关节炎的THA。另外进行了一项分析，将样本量限制为仅非骨水泥THA。主要终点是因任何原因进行的翻修（任何组件）。采用Kaplan-Meier生存分析和校正的Cox比例风险模型。
在我们对非骨水泥和混合型组的分析中，包括41683例非计算机辅助和871例（2%）计算机辅助病例。非计算机辅助组有943例翻修，计算机辅助组有7例。非计算机辅助组10年的累积翻修率为3.88%（95%置信区间[CI]：3.59%至4.18%），计算机辅助组为1.06%（95%CI：0.45%至2.76%）。Cox比例风险模型得出的风险比为0.45（95%CI：0.21至0.96；p = 0.038）。在仅非骨水泥组的分析中，两组10年的累积翻修率分别为3.99%（95%CI：3.62%至4.38%）和1.20%（95%CI：0.52%至3.12%）。Cox比例风险模型得出的风险比为0.47（95%CI：0.22至1.01；p = 0.053）。6个月的牛津髋关节评分、欧洲五维健康量表（EQ-5D）和EQ视觉模拟量表（VAS）评分以及患者报告的成功率没有显著差异。计算机辅助组的患者满意度（单项满意度结局指标）较高，但这一发现因回复数量减少而受到限制。
在我们的分析中，在平均5.6年的随访中，使用计算机辅助手术与较低的翻修率相关。当样本仅限于仅非骨水泥THA时，这一发现仍然成立。鉴于该研究的观察性本质不能推断因果关系，建议进行更多研究以验证这些发现。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
