Computer-assisted total hip arthroplasty reduces early complications based on Japanese nationwide medical claims data
Hidetatsu Tanaka1, Kunio Tarasawa2, Yu Mori3
1Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan. hidetatsu.tanaka.c7@tohoku.ac.jp.
Insights
Computer-assisted total hip arthroplasty (CA-THA) reduces dislocation, infection, and reoperation risks but increases periprosthetic fracture risk compared to manual THA. Further research is needed for optimal patient selection.
Area of Science:
- Orthopedic Surgery
- Medical Technology
- Health Informatics
Background:
- Computer-assisted (CA) surgery is increasingly used in total hip arthroplasty (THA) to improve implant positioning.
- Evidence comparing CA-THA to manual THA (M-THA) regarding postoperative complications is limited.
- This study investigates the association between CA-THA and early complications using a large Japanese database.
Purpose of the Study:
- To evaluate the impact of CA-THA versus M-THA on early postoperative complications.
- To analyze complication rates including surgical issues, medical issues, and mortality.
- To provide data for refining patient selection and indications for CA-THA.
Main Methods:
- Analysis of 336,624 THA cases from the Japanese Diagnosis Procedure Combination (DPC) database (Dec 2011-Mar 2023).
- Comparison between 94,557 CA-THA cases and 242,067 M-THA cases.
- One-to-one propensity score matching to control for patient demographics and comorbidities, analyzing 93,887 matched pairs.
Main Results:
- CA-THA showed lower odds of dislocation (OR 0.667), infection (OR 0.763), and re-operation (OR 0.822) compared to M-THA.
- CA-THA was associated with higher odds of periprosthetic fracture (OR 1.301).
- No significant differences were observed in medical complications or in-hospital mortality between the two groups.
Conclusions:
- CA-THA is linked to decreased risks of dislocation, infection, and reoperation in THA.
- An increased risk of periprosthetic fracture is associated with CA-THA.
- Further research is recommended to establish optimal indications and patient selection criteria for CA-THA.
Introduction:
Computer-assisted (CA) surgery is increasingly adopted in total hip arthroplasty (THA) to enhance implant positioning accuracy. However, robust evidence regarding its impact on postoperative complications compared with manual THA (M-THA) remains limited. This study evaluated the association between CA-THA and early postoperative complications using a large Japanese database.
Materials And Methods:
We analyzed 336,624 THA cases recorded in the Japanese Diagnosis Procedure Combination (DPC) database between December 2011 and March 2023. Of these, 242,067 underwent M-THA and 94,557 underwent CA-THA. One-to-one propensity score matching was performed to adjust for age, sex, body mass index, comorbidities, and diagnosis. Outcomes included surgical complications, medical complications, and in-hospital mortality.
Results:
After matching, 93,887 patient pairs were analyzed. Compared with M-THA, CA-THA was associated with lower odds of dislocation (OR 0.667, 95% CI 0.556-0.786, p < 0.001), infection (OR 0.763, 95% CI 0.687-0.848, p < 0.001), and re-operation (OR 0.822, 95% CI 0.732-0.922, p < 0.001), but higher odds of periprosthetic fracture (OR 1.301, 95% CI 1.118-1.514, p < 0.001). No significant differences were found in medical complications or mortality.
Conclusions:
In this nationwide cohort, CA-THA was associated with reduced risks of dislocation, infection, and reoperation, but an increased risk of periprosthetic fracture compared with M-THA. Further research should clarify optimal indications and refine patient selection criteria for CA-THA. In this nationwide cohort, CA-THA was associated with reduced risks of dislocation, infection, and reoperation, but an increased risk of periprosthetic fracture compared with M-THA. Further research should clarify optimal indications and refine patient selection criteria for CA-THA.
