Robotic and navigation technology in hip surgery do not increase risk of infection, study finds

Robotic and navigation technology in hip surgery do not increase risk of infection, study finds

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

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

Can CN and RA increase risks during hip replacement?

Computer navigation and robotic assistance are increasingly used during THA. These technologies have shown beneficial effects, including more accurate positioning of components and a lower risk of postoperative instability. However, “[I]remains unknown if the use of [CN and RA] leads to an improvement in 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 has been associated with longer operating times. Together, these factors may lead to an increased risk of surgical site contamination and PJI, a major cause of implant failure after THA.

Dr. Carli and colleagues analyzed their hospital’s experience with nearly 13,000 patients undergoing 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.

Likewise low rates of PJI, with or without new technologies

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

Both technologies were associated with small increases in operative times compared with conventional THA: two minutes longer with CN and 11 minutes longer with RA. Previous studies have raised concerns that longer surgical times may lead to increased 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 the respective trend-matched conventional THA groups. In adjusted analyses, there were no significant differences in the risk of PJI.

“Although computer navigation and robotic assistance are currently used in a minority of THA procedures, increased use of such technology appears to be 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 note several study limitations—particularly including the overall low rate of PJI in their high-volume orthopedic surgery specialty center. Dr. Carli and coauthors conclude: “While the long-term clinical, functional, and implant longevity outcomes associated with the use of computer navigation or robotic assistance remain to be elucidated, the findings of this study are reassuring regarding the risk of infection.”


Journal reference:

LaValva, SM, et al. (2024). Robotics and navigation do not affect the risk of periprosthetic joint infection after primary total hip arthroplasty. Journal of Bone and Joint Surgery.

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