Comparison of Utilization and Short-Term Complications Between Technology-Assisted and Conventional Total Hip Arthroplasty

Trevor Simcox, MD; Vivek Singh, MD, MPH; Christian T. Oakley, BS; Jan A. Koenig, MD; Ran Schwarzkopf, MD, MSc; Joshua C. Rozell, MD

Disclosures

J Am Acad Orthop Surg. 2022;30(8):e673-e682.

Abstract and Introduction

Abstract

Introduction: Although technology-assisted total hip arthroplasty (TA-THA) may improve implant positioning, it remains unknown whether TA-THA confers improved clinical outcomes. We sought to examine national TA-THA utilization trends and compare clinical outcomes between TA-THA and unassisted THA (U-THA).

Methods: Patients who underwent primary, elective THA from 2010 to 2018 were identified using the American College of Surgeons National Surgical Quality Improvement Program database. Demographic, perioperative, and 30-day outcomes were queried and collected. Patients were stratified based on whether they underwent TA-THA, which included computer navigation or robotics, and U-THA. Propensity score matching paired patients undergoing TA-THA or U-THA on a 1:1 basis.

Results: Of the 238,755 THA patients, 3,149 cases (1.3%) were done using TA-THA. Comparing the unmatched TA-THA and U-THA groups, race distribution (P < 0.001) and baseline functional status (P < 0.001) differed. Propensity score matching yielded 2,335 TA-THA and U-THA pairs. Perioperatively, the TA-THA cohort had longer mean surgical times (101.0 ± 34.0 versus 91.9 ± 38.8 minutes, P < 0.001), but lower transfusion rates (5.7% versus 7.8%, P= 0.005). As compared with the U-THA group, the TA-THA group had a shorter mean hospital length of stay (2.0 ± 1.1 versus 2.5 ± 2.0 days,

Abstract and Introduction
Methods
Results
Discussion
References

Table 1. Baseline Characteristic of Unmatched and Matched Patient Cohorts
Patient Characteristic	Unmatched Cohorts			Matched Cohorts
Patient Characteristic	U-THA (n = 235,606)	TA-THA (n = 3,149)	P-value	U-THA (n = 2,335)	TA-THA (n = 2,335)	P-value
Sex	—	—	0.355	—	—	0.516
Male	106,990 (45.4%)	1,400 (44.4%)	—	1,342 (57.5%)	1,320 (56.5%)	—
Female	128,,541 (54.6%)	1747 (55.5%)	—	993 (42.5%)	1,015 (43.5%)	—
Age category	—	—	0.406	—	—	0.958
18–49	19,918 (8.5%)	270 (8.6%)	0.803	140 (6.0%)	139 (6.0%)	—
50–59	51,641 (21.9%)	667 (21.2%)	0.328	491 (21.0%)	498 (21.3%)	—
60–69	81,226 (34.5%)	1,073 (34.1%)	0.653	841 (36.0%)	839 (35.9%)	—
70–79	58,736 (24.9%)	831 (26.4%)	0.057	630 (27.0%)	639 (27.4%)	—
80–89	22,470 (9.5%)	289 (9.2%)	0.501	229 (9.8%)	218 (9.3%)	—
90+	1,291 (5.5%)	13 (0.4%)	0.308	4 (0.2%)	2 (0.1%)	—
Race	—	—	<0.001	—	—	0.417
Unknown	34,352 (14.6%)	97 (3.1%)	n/a	73 (3.1%)	52 (2.2%)	—
White	172,210 (73.1%)	2,523 (80.1%)	<0.001	2,121 (90.8%)	2,139 (91.6%)	—
Hispanic	6,645 (2.8%)	143 (4.5%)	<0.001	37 (1.6%)	41 (1.8%)	—
Native American or Pacific Islander	1,447 (0.6%)	13 (0.7%)	0.15	0	0	—
Black/African American	17,720 (7.5%)	339 (10.8%)	<0.001	99 (4.2%)	97 (4.2%)	—
Asian	3,232 (1.4%)	34 (1.1%)	0.161	5 (0.2%)	6 (0.3%)	—
Smoking status (within 1 yr)	—	—	0.290	—	—	0.433
Yes	30,225 (12.8%)	384 (12.2%)	—	165 (7.1%)	179 (7.7%)	—
No	205,381 (87.2%)	2,765 (87.8%)	—	2,170 (92.9%)	2,156 (92.3%)	—
Functional status	—	—	0.002	—	—	0.591
Independent	230,343 (97.8%)	3,060 (97.2%)	0.003	2,314 (99.1%)	2,307 (98.8%)	—
Partially dependent	4,263 (1.8%)	81 (2.6%)	0.01	20 (0.9%)	27 (1.2%)	—
Totally dependent	180 (0.0%)	5 (0.2%)	0.6	0	0	—
Unknown	820 (0.3%)	3 (0.0%)	n/a	1 (0.0%)	1 (0.0%)	—
ASA classification	—	—	0.458	—	—	0.791
1—No disturbance	9,245 (3.9%)	121 (3.8%)	0.815	83 (3.6%)	78 (3.3%)	—
2—Mild disturbance	125,598 (53.3%)	1717 (54.5%)	0.174	1,384 (59.3%)	1,372 (58.8%)	—
3—Severe disturbance	96,158 (40.8%)	1,263 (40.1%)	0.424	858 (36.7%)	871 (37.3%)	—
4+	4,309 (1.8%)	46 (1.5%)	0.13	10 (0.4%)	13 (0.6%)	—
None assigned	0	2 (0.0%)	n/a	0	1 (0.0%)	—
BMI	30.18 (±6.64)	30.05 (±6.05)	0.232	29.62 (±5.60)	29.69 (±5.59)	0.656
5 - mFI score	0.036 (±0.084)	0.037 (±0.083)	0.343	0.028 (±0.073)	0.027 (±0.070)	0.0486

ASA = American Society of Anesthesiologists, BMI = body mass index, mFI = modified frailty index, TA-THA = technology-assisted total hip arthroplasty, U-THA = unassisted THA
Bold terms denote that the value is significantly different in subset analysis.

Table 2. Comparison of Perioperative Variables Between Matched Unassisted and Technology-assisted Cohorts Full Size Table
	U-THA (n = 2,335)	TA-THA (n = 2,335)	P-value
Surgical time (min)	91.9 (±38.8)	101.0 (±33.96)	<0.001
LOS (d)	2.49 (±2.02)	1.98 (±1.10)	<0.001
Discharge destination	—	—	<0.001
Home	1768 (75.7%)	2004 (85.8%)	<0.001
Unskilled facility	0 (0.0%)	1 (0.0%)	0.317
Rehab/skilled nursing facility	466 (20.0%)	279 (11.9%)	<0.001
Expired/Hospice	1 (0.0%)	2 (0.1%)	0.549
Other/AMA	6 (0.3%)	3 (0.1%)	0.317
Unknown	94 (4.0%)	46 (2.0%)	<0.001
Major complication	250 (10.7%)	230 (9.9%)	0.360
Any wound complication	9 (0.4%)	5 (0.2%)	0.301
Periprosthetic infection	7 (0.3%)	4 (0.2%)	0.548
Transfusion	183 (7.8%)	134 (5.7%)	0.005
Systemic infection	10 (0.4%)	16 (0.7%)	0.247
DVT/PE	9 (0.4%)	11 (0.5%)	0.823
Cardiac	2 (0.1%)	4 (0.2%)	0.687
Respiratory	8 (0.3%)	5 (0.2%)	0.581
Neurologic	1 (0.0%)	2 (0.1%)	0.625
Renal	0 (0.0%)	1 (0.0%)	0.317
Revision surgeries	35 (1.5%)	50 (2.1%)	0.125
Unrelated operation	5 (0.2%)	14 (0.6%)	0.036
Periprosthetic fracture	9 (0.4%)	8 (0.3%)	0.841
Superficial irrigation and débridement	6 (0.3%)	6 (0.3%)	1.000
Periprosthetic infection	9 (0.4%)	14 (0.6%)	0.317
Implant complication or dislocation	4 (0.2%)	8 (0.3%)	0.230
Other operation related to THA	2 (0.1%)	0 (0.0%)	0.162
Readmissions	57 (2.4%)	88 (3.8%)	0.011
Unspecified	8 (0.3%)	14 (0.6%)	0.194
Gastrointestinal	3 (0.1%)	13 (0.6%)	0.012
Cardiac	3 (0.1%)	4 (0.2%)	0.689
Pulmonary	7 (0.3%)	8 (0.3%)	0.764
Hematologic	1 (0.0%)	2 (0.1%)	0.549
Other medical diagnosis	6 (0.3%)	8 (0.3%)	0.617
Unrelated musculoskeletal diagnosis	3 (0.1%)	1 (0.0%)	0.317
Periprosthetic fracture	7 (0.3%)	6 (0.3%)	0.764
Superficial surgical site infection	10 (0.4%)	9 (0.4%)	0.841
Periprosthetic infection	8 (0.3%)	12 (0.5%)	0.368
Unspecified THA complication or dislocation	1 (0.0%)	11 (0.5%)	0.004
Mortality	2 (0.1%)	3 (0.1%)	0.655

All bold entries are statistically significant (p<0.05). DVT = deep vein thrombosis, LOS = length of stay, PE = pulmonary embolism, TA-THA = technology-assisted total hip arthroplasty, U-THA = unassisted THA