Shen Tony S, Cheng Ryan, Chiu Yu-Fen, McLawhorn Alexander S, Figgie Mark P, Westrich Geoffrey H
Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA.
Department of Biostatistics, Hospital for Special Surgery, New York, New York, USA.
Bone Jt Open. 2024 Aug 23;5(8):715-720. doi: 10.1302/2633-1462.58.BJO-2024-0061.R1.
Implant waste during total hip arthroplasty (THA) represents a significant cost to the USA healthcare system. While studies have explored methods to improve THA cost-effectiveness, the literature comparing the proportions of implant waste by intraoperative technology used during THA is limited. The aims of this study were to: 1) examine whether the use of enabling technologies during THA results in a smaller proportion of wasted implants compared to navigation-guided and conventional manual THA; 2) determine the proportion of wasted implants by implant type; and 3) examine the effects of surgeon experience on rates of implant waste by technology used.
We identified 104,420 implants either implanted or wasted during 18,329 primary THAs performed on 16,724 patients between January 2018 and June 2022 at our institution. THAs were separated by technology used: robotic-assisted (n = 4,171), imageless navigation (n = 6,887), and manual (n = 7,721). The primary outcome of interest was the rate of implant waste during primary THA.
Robotic-assisted THA resulted in a lower proportion (1.5%) of implant waste compared to navigation-guided THA (2.0%) and manual THA (1.9%) (all p < 0.001). Both navigated and manual THA were more likely to waste acetabular shells (odds ratio (OR) 4.5 vs 3.1) and polyethylene liners (OR 2.2 vs 2.0) compared to robotic-assisted THA after adjusting for demographic and perioperative factors, such as surgeon experience (p < 0.001). While implant waste decreased with increasing experience for procedures performed manually (p < 0.001) or with navigation (p < 0.001), waste rates for robotic-assisted THA did not differ based on surgical experience.
Robotic-assisted THAs wasted a smaller proportion of acetabular shells and polyethylene liners than navigation-guided and manual THAs. Individual implant waste rates vary depending on the type of technology used intraoperatively. Future studies on implant waste during THA should examine reasons for non-implantation in order to better understand and develop methods for cost-saving.
全髋关节置换术（THA）中的植入物浪费对美国医疗系统来说是一项巨大的成本。虽然已有研究探索了提高THA成本效益的方法，但比较THA术中所使用技术的植入物浪费比例的文献有限。本研究的目的是：1）研究与导航引导和传统手动THA相比，THA期间使用辅助技术是否会使植入物浪费的比例更小；2）确定按植入物类型划分的浪费植入物的比例；3）研究外科医生经验对按所使用技术划分的植入物浪费率的影响。
我们确定了2018年1月至2022年6月期间在我们机构对16724例患者进行 的18329例初次THA中植入或浪费的104420个植入物。THA按所使用的技术分类：机器人辅助（n = 4171）、无图像导航（n = 6887）和手动（n = 7721）。感兴趣的主要结果是初次THA期间的植入物浪费率。
与导航引导THA（2.0%）和手动THA（1.9%）相比，机器人辅助THA导致的植入物浪费比例更低（1.5%）（所有p < 0.001）。在调整了人口统计学和围手术期因素（如外科医生经验）后，与机器人辅助THA相比，导航和手动THA浪费髋臼杯（优势比（OR）为4.5对3.1）和聚乙烯衬垫（OR为2.2对2.0）的可能性更大（p < 0.001）。虽然手动操作（p < 0.001）或使用导航（p < 0.001）的手术中，植入物浪费随着经验增加而减少，但机器人辅助THA的浪费率不因手术经验而异。
与导航引导和手动THA相比，机器人辅助THA浪费的髋臼杯和聚乙烯衬垫比例更小。单个植入物的浪费率因术中使用的技术类型而异。未来关于THA期间植入物浪费的研究应检查未植入的原因，以便更好地理解并开发节省成本的方法。
