Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA.
Hip Int. 2024 Sep;34(5):578-587. doi: 10.1177/11207000241241797. Epub 2024 Apr 2.
Total hip arthroplasty (THA) using computer-assisted navigation (N-THA) and robot-assisted surgery (RA-THA) has been increasingly adopted to improve implant positioning and offset/leg-length restoration. Whether clinically meaningful differences in patient-reported outcomes (PROMs) compared to conventional THA (C-THA) are achieved with intraoperative technology has not been established. This systematic review aimed to assess whether published relative PROM improvements with technology use in THA achieved minimal clinically important differences (MCIDs).
PubMed/MEDLINE/Cochrane Library were systematically reviewed for studies comparing PROMs for primary N-THA or RA-THA with C-THA as the control group. Relative improvement differences between groups were compared to established MCID values. Reported clinical and radiographic differences were assessed. Review of N-THA and RA-THA literature yielded 6 ( 2580) and 10 ( 2786) studies, respectively, for analyses.
Statistically significant improvements in postoperative PROM scores were reported in 2/6 (33.3%) studies comparing N-THA with C-THA, though only 1 (16.7%) reported clinically significant relative improvements. Statistically significant improvements in postoperative PROMs were reported in 6/10 (60.0%) studies comparing RA-THA and C-THA, though none reported clinically significant relative improvements. Improved radiographic outcomes for N-THA and RA-THA were reported in 83.3% and 70.0% of studies, respectively. Only 1 study reported a significant improvement in revision rates with RA-THA as compared to C-THA.
Reported PROM scores in studies comparing N-THA or RA-THA to C-THA often do not achieve clinically significant relative improvements. Future studies reporting PROMs should be interpreted in the context of validated MCID values to accurately establish the clinical impact of intraoperative technology.
全髋关节置换术（THA）使用计算机辅助导航（N-THA）和机器人辅助手术（RA-THA）已经越来越多地被采用，以改善植入物的定位和偏移/腿长的恢复。使用术中技术与传统 THA（C-THA）相比，在患者报告的结果（PROM）方面是否达到临床有意义的差异尚未确定。本系统评价旨在评估在 THA 中使用技术是否发表了相对 PROM 改善，达到了最小临床重要差异（MCID）。
系统地检索了 PubMed/MEDLINE/Cochrane 图书馆，以比较 N-THA 或 RA-THA 的 PROM 与 C-THA 作为对照组的研究。比较组间的相对改善差异与既定的 MCID 值。评估了报告的临床和放射学差异。对 N-THA 和 RA-THA 文献的回顾分别产生了 6（2580）和 10（2786）项研究进行分析。
与 C-THA 相比，2/6（33.3%）的 N-THA 研究报告了术后 PROM 评分的统计学显著改善，但只有 1（16.7%）报告了具有临床意义的相对改善。与 C-THA 相比，6/10（60.0%）的 RA-THA 研究报告了术后 PROM 评分的统计学显著改善，但均未报告具有临床意义的相对改善。分别有 83.3%和 70.0%的研究报告了 N-THA 和 RA-THA 的影像学改善。只有 1 项研究报告 RA-THA 与 C-THA 相比，翻修率有显著改善。
与 C-THA 相比，比较 N-THA 或 RA-THA 的研究报告的 PROM 评分往往没有达到具有临床意义的相对改善。报告 PROM 的未来研究应结合验证的 MCID 值进行解释，以准确确定术中技术的临床影响。
