Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.
Biostatistics Core, Research Administration, Hospital for Special Surgery, New York, NY.
J Bone Joint Surg Am. 2024 Apr 3;106(7):582-589. doi: 10.2106/JBJS.23.00289. Epub 2024 Feb 7.
The use of computer navigation or robotic assistance during primary total hip arthroplasty (THA) has yielded numerous benefits due to more accurate component positioning. The utilization of these tools is generally associated with longer operative times and also necessitates additional surgical equipment and personnel in the operating room. Thus, the aim of this study was to evaluate the impact of technology assistance on periprosthetic joint infection (PJI) after primary THA.
We retrospectively reviewed the records for 12,726 patients who had undergone primary THA at a single high-volume institution between 2018 and 2021. Patients were stratified by surgical technique (conventional THA, computer-navigated THA [CN-THA], or robotic-assisted THA [RA-THA]) and were matched 1:1 with use of propensity score matching. Univariate and logistic regression analyses were performed to compare the rates of PJI within 90 days postoperatively between the cohorts.
After propensity score matching, there were 4,006 patients in the THA versus RA-THA analysis (2,003 in each group) and 5,288 patients in the THA versus CN-THA analysis (2,644 in each group). CN-THA (p < 0.001) and RA-THA (p < 0.001) were associated with longer operative times compared with conventional THA by 3 and 11 minutes, respectively. The rates of PJI after conventional THA (0.2% to 0.4%) were similar to those after CN-THA (0.4%) and RA-THA (0.4%). On the basis of logistic regression, the development of PJI was not associated with the use of computer navigation (odds ratio [OR], 1.8 [95% confidence interval (CI), 0.7 to 5.3]; p = 0.232) or robotic assistance (OR, 0.9 [95% CI, 0.3 to 2.3]; p = 0.808).
Despite longer operative times associated with the use of computer navigation and robotic assistance, the use of these tools was not associated with an increased risk of PJI within 90 days after surgery.
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
在初次全髋关节置换术（THA）中使用计算机导航或机器人辅助技术，由于能够更精确地定位假体，因此带来了许多益处。这些工具的使用通常与手术时间延长有关，并且还需要在手术室中增加额外的手术设备和人员。因此，本研究旨在评估初次 THA 后技术辅助对假体周围关节感染（PJI）的影响。
我们回顾性分析了 2018 年至 2021 年期间在一家高容量机构接受初次 THA 的 12726 例患者的记录。根据手术技术（常规 THA、计算机导航 THA [CN-THA]或机器人辅助 THA [RA-THA]）对患者进行分层，并使用倾向评分匹配进行 1:1 配对。使用单变量和逻辑回归分析比较两组术后 90 天内 PJI 的发生率。
在进行倾向评分匹配后，THA 与 RA-THA 分析中有 4006 例患者（每组 2003 例），THA 与 CN-THA 分析中有 5288 例患者（每组 2644 例）。与常规 THA 相比，CN-THA（p<0.001）和 RA-THA（p<0.001）的手术时间分别延长了 3 分钟和 11 分钟。常规 THA（0.2%至 0.4%）、CN-THA（0.4%）和 RA-THA（0.4%）后 PJI 的发生率相似。基于逻辑回归，PJI 的发生与计算机导航的使用无关（比值比 [OR]，1.8 [95%置信区间（CI），0.7 至 5.3]；p=0.232）或机器人辅助（OR，0.9 [95%CI，0.3 至 2.3]；p=0.808）。
尽管计算机导航和机器人辅助使用相关的手术时间延长，但这些工具的使用与术后 90 天内 PJI 的风险增加无关。
治疗性 III 级。请参阅作者说明以获取完整的证据水平描述。
