Chung Cedric, Bin Hazzaa Ibrahim, Hakim Raja, Zywiel Michael G
Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, University of Toronto, Toronto, Ontario Canada.
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada.
Arthroplast Today. 2024 Mar 29;27:101361. doi: 10.1016/j.artd.2024.101361. eCollection 2024 Jun.
Many techniques and technologies exist for the intraoperative assessment of component positioning, leg lengths, and offset in total hip arthroplasty, but with limited comparative data. We conducted a systematic review of the available literature to evaluate the range of techniques and technologies for the intraoperative assessment of component position as well as leg lengths and offset in terms of accuracy, precision, surgical time, cost, and relationship to clinical outcomes.
A comprehensive search of the Embase and Medline databases from 1974 to 2023 was performed. We included controlled or comparative prospective clinical studies. Cochrane's risk-of-bias tool for randomized trials and Risk of Bias in Non-Randomized Studies - of Interventions tools were used by 2 independent reviewers to evaluate each study for risk of bias. We conducted both qualitative and quantitative analyses of the studies included. However, a meta-analysis was deemed not to be feasible due to heterogeneity.
Our review included 25 studies with 52 intraoperative techniques and technologies. Mechanical guides and computerized navigation were most frequently evaluated in the included studies. Computerized navigation systems consistently showed the greatest accuracy and precision across all measures, at the cost of longer mean operative time. In contrast, freehand techniques demonstrated the poorest accuracy and precision. Insufficient data were found to reach any meaningful conclusions in terms of differences in overall surgical cost or clinical outcomes.
Evidence shows that computerized navigation systems are most accurate and precise in positioning components during total hip arthroplasty. Further research is needed to determine their health and economic impact and whether the accuracy and precision of navigated techniques are justified in terms of clinical outcomes.
在全髋关节置换术中，存在多种用于术中评估假体位置、腿长和偏移的技术，但比较数据有限。我们对现有文献进行了系统综述，以评估用于术中评估假体位置以及腿长和偏移的技术范围，包括准确性、精确性、手术时间、成本以及与临床结果的关系。
对1974年至2023年的Embase和Medline数据库进行了全面检索。我们纳入了对照或比较性前瞻性临床研究。由2名独立评审员使用Cochrane随机试验偏倚风险工具和非随机研究干预偏倚风险工具来评估每项研究的偏倚风险。我们对纳入的研究进行了定性和定量分析。然而，由于异质性，荟萃分析被认为不可行。
我们的综述纳入了25项研究，涉及52种术中技术。机械导向器和计算机导航在纳入的研究中评估最为频繁。计算机导航系统在所有测量指标上始终显示出最高的准确性和精确性，但平均手术时间较长。相比之下，徒手技术的准确性和精确性最差。在总体手术成本或临床结果差异方面，未发现足够的数据得出任何有意义的结论。
证据表明，计算机导航系统在全髋关节置换术中定位假体时最为准确和精确。需要进一步研究以确定其对健康和经济的影响，以及导航技术的准确性和精确性在临床结果方面是否合理。
