From the Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY (Dr. Kunze, Dr. Bovonratwet, and Dr. Sculco), University of Wisconsin School of Medicine and Public Health, Madison, WI (Mr. Polce), and the Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL (Ms. Paul).
J Am Acad Orthop Surg Glob Res Rev. 2022 Apr 1;6(4):e21.00200. doi: 10.5435/JAAOSGlobal-D-21-00200.
Recent years have observed the increasing utilization of robotic-assisted and computer navigation techniques in total hip arthroplasty (THA), given the proposed benefits of enhanced consistency and precision in implant placement. The purpose of this study was to conduct a systematic review of randomized controlled trials (RCTs) to determine whether differences in surgical times, adverse events, and implant positioning existed between manual, robotic-assisted, and computer navigation THA.
PubMed, OVID/MEDLINE, and Cochrane databases were queried for RCTs comparing robotic-assisted versus manual THA and computer navigation versus manual THA at a minimum 1-year follow-up. Frequentist model network meta-analyses with P-scores were conducted to compare revisions, complications, and surgical times among the three treatment groups. A random-effects meta-analysis between computer navigation and manual THAs was conducted to analyze cup positioning because no robotic-assisted THA studies reported this outcome.
Five RCTs compared robotic-assisted and manual THAs, while seven compared computer navigation and manual THAs. manual THA was associated with significantly reduced surgical time in comparison with computer navigation (mean difference: 23.3 minutes) and robotic-assisted THAs (mean difference: 8.6 minutes; P < 0.001). No difference was observed in the incidence of all-cause complications (computer navigation: 1.7%, manual: 6.6%, and robotic-assisted: 16.2%) or revisions (computer navigation: 1.0%, manual: 1.7%, and robotic-assisted 4.8%) among the three treatment groups based on the network meta-analysis. In three studies that reported acetabular implant positioning, computer navigation had a significantly higher percentage of acetabular cups placed in the Lewinnek "safe zone" compared with manual THA (79% versus 52%; P = 0.02).
manual THA results in markedly shorter surgical times and a similar incidence of complications and revisions compared with robotic-assisted and computer navigation THAs, given the sample sizes available for study. However, computer navigation THA led to increased precision in the placement of acetabular implants.
近年来，随着机器人辅助和计算机导航技术在全髋关节置换术（THA）中应用的增加，人们提出了增强植入物放置一致性和精确性的好处。本研究旨在对随机对照试验（RCT）进行系统评价，以确定手动、机器人辅助和计算机导航 THA 之间手术时间、不良事件和植入物定位是否存在差异。
检索 PubMed、OVID/MEDLINE 和 Cochrane 数据库，以比较至少 1 年随访的机器人辅助与手动 THA 以及计算机导航与手动 THA 的 RCT。采用 P 评分进行频率主义模型网络荟萃分析，比较三组治疗中翻修、并发症和手术时间的差异。由于没有机器人辅助 THA 研究报告此结果，因此对计算机导航与手动 THA 进行了随机效应荟萃分析以分析杯定位。
五项 RCT 比较了机器人辅助与手动 THA，七项 RCT 比较了计算机导航与手动 THA。与计算机导航（平均差异：23.3 分钟）和机器人辅助 THA（平均差异：8.6 分钟；P<0.001）相比，手动 THA 手术时间显著缩短。基于网络荟萃分析，三组治疗中所有原因并发症的发生率（计算机导航：1.7%，手动：6.6%，机器人辅助：16.2%）或翻修率（计算机导航：1.0%，手动：1.7%，机器人辅助：4.8%）无差异。在三项报告髋臼植入物定位的研究中，计算机导航髋臼杯放置在 Lewinnek“安全区”的比例明显高于手动 THA（79%对 52%；P=0.02）。
鉴于可用于研究的样本量，与机器人辅助和计算机导航 THA 相比，手动 THA 可显著缩短手术时间，且并发症和翻修的发生率相似。然而，计算机导航 THA 提高了髋臼植入物放置的精度。
