Robotic tech in hip surgery lowers infection risk. Study finds no increased risk of infection with computer navigation and robotic assistance in total hip arthroplasty. Learn more in The Journal of Bone & Joint Surgery.
Robotic-Assisted Surgery and Surgical Navigation
Recent research published in The Journal of Bone & Joint Surgery suggests that the use of robotic-assisted surgery and surgical navigation techniques does not increase the risk of periprosthetic joint infection (PJI) in patients undergoing total hip arthroplasty (THA). This study, conducted by Alberto V. Carli, MD, and colleagues at the Hospital for Special Surgery in New York, found that computer navigation (CN) and robotic assistance (RA) do not alter the risk of PJI after total hip replacement surgery.
The Impact of Computer Navigation and Robotic Assistance on PJI Risk
The use of computer navigation and robotic assistance is becoming more common in THA, and these technologies have demonstrated benefits such as more accurate component positioning and a lower risk of postoperative instability. However, there has been uncertainty about whether the use of CN and RA leads to better long-term functional outcomes or implant longevity. Furthermore, the presence of additional equipment and personnel, coupled with longer operating times associated with CN and RA, has raised concerns about a potential increased risk of surgical-site contamination and PJI.
The Study: Analyzing PJI Risk in Patients Undergoing THA
Dr. Carli and his colleagues analyzed data from nearly 13,000 patients who underwent primary THA between 2018 and 2021 at their hospital. During this time, CN was used in 21% of patients and RA in 16%, while the remaining 63% underwent conventional THA without CN or RA.
Comparing PJI Rates: CN, RA, and Conventional THA
Using a technique called propensity-score matching, the researchers identified patient groups with similar risk factors undergoing THA by conventional methods or with the use of RA (2,003 patients in each group) or CN (2,664 patients in each group). They compared the 90-day rates of PJI between these groups and found that both technologies were associated with slightly longer operative times compared to conventional THA: two minutes longer with CN and 11 minutes longer with RA.
PJI Risk: CN and RA vs. Conventional THA
Despite the longer operating times, the incidence of PJI was similar among groups, with rates of 0.4% for both CN and RA, compared to rates of 0.2% and 0.4% for the respective propensity-matched conventional THA cohorts. After adjusting for other factors, the researchers found no significant differences in PJI risk.
Looking Ahead: The Role of CN and RA in THA
The researchers noted that while CN and RA are currently used in a minority of THA procedures, the increased use of such technology in the future appears inevitable. Their study provides new evidence that in matched groups of patients with similar characteristics, the risks of PJI are comparable, whether CN or RA is used or not. However, they acknowledged some limitations of the study, including the overall low rate of PJI at their specialized, high-volume orthopedic surgery center.
Conclusion: Reassurance Regarding PJI Risk
Dr. Carli and his coauthors concluded that while the long-term clinical, functional, and implant-longevity outcomes associated with the use of computer navigation or robotic assistance remain to be fully understood, the findings of the present study are reassuring with respect to the risk of infection.
