Robotic and navigation technology in hip surgery don’t raise infection risk, study finds

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For total hip arthroplasty (THA) patients, use of robotic-assisted surgery and surgical navigation techniques are not associated with an increased risk of periprosthetic joint infection (PJI), a study suggests. Journal of Bone and Joint Surgery. The journal is published by Wolters Kluwer in the Lippincott Portfolio.

Computer navigation (CN) and robotic assistance (RA) do not alter the risk of PJI after total hip replacement surgery, Alberto V. Curley, MD, and colleagues at the Hospital for Special Surgery, New York, according to new research.

Can CN and RA risk increase during hip replacement?

Computer navigation and robotic assistance are increasingly used during THA. These technologies have shown beneficial effects, including more accurate component positioning and less risk of operative instability. However, “[I]Whether t use remains unknown [CN and RA] leading to improved long-term functional outcomes or implant longevity,” according to the authors.

The use of CN and RA requires the presence of additional equipment and personnel in the operating room, and is associated with longer operating times. Together, these factors may increase the risk of surgical-site contamination and PJI, a major cause of implant failure after THA.

Dr. Carley and colleagues analyzed the hospital experiences of nearly 13,000 patients who underwent primary THA between 2018 and 2021. During this time, CN was used during THA in 21% of patients and RA in 16%. The remaining 63% of patients underwent conventional THA without CN or RA.

Similarly low rates of PJI, with or without new technology

Using a technique called probability-score matching, the researchers identified groups of patients with similar risk factors undergoing THA using conventional methods or RA (2,003 patients in each group) or CN (2,664 patients in each group). Ninety-day rates of PJI were compared between groups with adjustment for other factors.

Both techniques were associated with a small increase in operative time compared with conventional THA: two minutes longer with CN and 11 minutes longer with RA. Previous studies have raised concerns that longer surgery times may increase the risk of complications.

However, in the new study, the incidence of PJI was similar between groups: 0.4% for both CN and RA compared with rates of 0.2% and 0.4% for their respective propensity-matched conventional THA cohort. In adjusted analysis, there was no significant difference in PJI risk.

“Although computer navigation and robotic assistance are currently used in a minority of THA procedures, increased use of such technologies appears inevitable in the coming decades,” the researchers wrote. Their study adds new evidence that, in matched groups of patients with similar characteristics, the risks of PJI are comparable with or without the use of CN or RA.

The authors noted some limitations of the study—notably the overall low rate of PJI in their specialized, high-volume orthopedic surgery center. Dr. Curley and co-authors concluded: “Although the long-term clinical, functional, and implant-longevity outcomes associated with the use of computer navigation or robotic assistance remain to be elucidated, the results of the present study are reassuring regarding the risk of infection.”

Source:

Journal Reference:

Lavalva, SM, etc (2024). Robotics and navigation do not affect the risk of periprosthetic joint infection after primary total hip arthroplasty. Journal of Bone and Joint Surgery. doi.org/10.2106/jbjs.23.00289.



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