According to a study published in The Journal of Bone & Joint Surgery, patients undergoing total hip arthroplasty (THA) using robotic surgery and navigational techniques do not have an increased risk of periprosthetic joint infection (PJI). The journal is published in the Wolters Kluwer Lippincott portfolio.
New research from Alberto V. Carli, MD, and colleagues at the Hospital for Special Surgery in New York, indicates that computer navigation (CN) and robotic assistance (RA) do not influence the risk of PJI after total hip arthroplasty.
Could CN and RA Increase the Risk During Hip Arthroplasty?
Computer navigation and robotic assistance are increasingly being used in THA procedures. These technologies have shown positive effects, including more accurate positioning of components and a lower risk of postoperative instability. However, there is uncertainty whether the use of CN and RA leads to improved long-term functional outcomes or implant longevity,“ the authors noted.
The use of CN and RA requires additional equipment and personnel in the operating room, and is associated with longer surgical times. These factors combined could lead to an increased risk of contamination of the surgical site and PJI, a major cause of implant failure after THA.
Dr. Carli and colleagues analyzed their hospital’s experience with nearly 13,000 patients who underwent primary THA between 2018 and 2021. During this time, CN was used in 21% of patients and RA in 16% of patients, while the remaining 63% received conventional THA without CN or RA.
Similar Low PJI Rates, With or Without New Technologies
Using a technique called propensity score matching, the researchers identified groups of patients with similar risk factors who underwent THA with conventional methods or using RA (2,003 patients in each group) or CN (2,664 patients in each group). The 90-day rates of PJI were compared between the groups, taking other factors into account.
Both technologies were associated with a slight increase in surgical time compared to conventional THA: two minutes longer with CN and 11 minutes longer with RA. Earlier studies have expressed concerns that longer surgical times could lead to an increased risk of complications.
However, in the new study, the incidence of PJI was similar in the groups: 0.4% for both CN and RA, compared to rates of 0.2% and 0.4% for the respective propensity-matched conventional THA cohorts. In adjusted analyses, there were no significant differences in PJI risk.
„While computer navigation and robotic assistance are currently used in a minority of THA procedures, the increased use of this technology seems inevitable in the coming decades,“ the researchers wrote. „Our study provides new evidence that in matched groups of patients with similar characteristics, the risk of PJI is comparable, with or without the use of CN or RA.“
The authors note some limitations of the study, particularly the overall low PJI rate in their specialized, high-volume orthopedic surgery center. Dr. Carli and co-authors conclude, „While the long-term clinical, functional, and implant longevity results related to the use of computer navigation or robotic assistance still need to be clarified, the results of the present study are reassuring with regard to the risk of postoperative infection.“
LaValva, SM, et al. (2024). Robotics and navigation have no impact on the risk of periprosthetic joint infection after primary total hip arthroplasty. The Journal of Bone and Joint Surgery. doi.org/10.2106/jbjs.23.00289.