No Benefit After THA Performed With Computer-assisted Cup Placement: 10-year Results of a Randomized Controlled Study

Area of Science:

• Orthopedic Surgery
• Medical Technology
• Biomedical Engineering

Background:

• Computer-assisted surgery (CAS) aims to enhance functional outcomes and reduce complications like dislocation and wear in total hip arthroplasty (THA).
• While radiographic benefits of CAS for implant positioning are documented, clinical significance for patient perception remains unclear.

Purpose of the Study:

• To evaluate if THA using CAS improves 10-year patient-reported outcomes, reduces acetabular polyethylene wear, and increases survivorship.
• Hypothesized that CAS would lead to superior long-term clinical results compared to conventional THA techniques.

Main Methods:

• A randomized controlled trial involving 60 patients undergoing THA, comparing CAS with conventional cup placement.
• Patients were assessed at 10-year follow-up using validated questionnaires (SF-12, Harris hip score, Hip injury and Osteoarthritis Outcome Score).
• Acetabular wear was measured radiographically, and complications and survivorship were compared between the CAS and control groups.

Main Results:

• No significant differences were observed in Harris hip scores between the CAS and conventional THA groups at 10 years (95.3 vs. 96.2 points).
• Acetabular linear wear rates were comparable between groups, with no statistically significant difference at the 10-year mark.
• Survivorship free from aseptic loosening was 100% in both groups, indicating no difference in long-term implant stability.

Conclusions:

• Computer-assisted surgery for cup placement in THA does not appear to offer substantial advantages in function, wear, or survivorship at 10 years.
• Given the increased costs and operative time associated with CAS, its continued use in THA requires justification through identification of clinically relevant benefits.