Is Technology in Hip Surgery Safe from Infection Risk?

A recent study has been published in The Journal of Bone & Joint Surgery which suggests that the use of robotic-assisted surgery and surgical navigation techniques in total hip arthroplasty (THA) does not increase the risk of periprosthetic joint infection (PJI). The research, conducted by Alberto V. Carli, MD, and colleagues from the Hospital for Special Surgery in New York, analysed nearly 13,000 patients who underwent primary THA between 2018 and 2021. The study found that computer navigation (CN) and robotic assistance (RA) did not alter the risk of PJI in comparison to conventional THA.

The increasing use of CN and RA in THA is due to their beneficial effects, such as more accurate component positioning and a lower risk of postoperative instability. However, there was uncertainty about whether the use of these technologies leads to an improvement in long-term functional outcomes or implant longevity. Additionally, the presence of additional equipment and personnel in the operating room during CN and RA procedures has been linked to longer operating times, raising concerns about an increased risk of surgical-site contamination and PJI.

The researchers employed a technique called propensity-score matching to identify groups of patients with similar risk factors undergoing THA with or without the use of RA or CN. The study revealed that both CN and RA were associated with small increases in operative times, with CN being two minutes longer and RA being 11 minutes longer compared to conventional THA. However, despite these longer operating times, the incidence of PJI was similar among groups.

The researchers acknowledged some limitations of the study, including the overall low rate of PJI at their specialized, high-volume orthopedic surgery center. However, they concluded that their findings are reassuring with respect to the risk of infection associated with the use of CN or RA.

The study provides valuable insights for the future use of technology in hip replacement surgeries. Despite the concerns about prolonged operative times and potential risks of contamination, the research suggests that the risks of PJI are comparable with or without the use of CN or RA. This evidence is particularly important as computer navigation and robotic assistance are expected to become increasingly prevalent in THA procedures in the coming decades.

This research not only contributes to the field of orthopaedic surgery but also has implications for the broader landscape of surgical technology. As more healthcare facilities and surgical teams consider incorporating CN and RA into their procedures, the study’s findings can help guide decision-making and provide reassurance about the safety of these technologies.

In conclusion, the study offers valuable insights into the safety of robotic and navigation technology in hip surgeries. It addresses the concerns about potential infection risks associated with the use of CN and RA and provides reassurance based on the analysis of a large patient cohort. As technology continues to play a crucial role in modern healthcare, the findings of this study are significant for the future of surgical procedures and patient safety.

Source:
LaValva, S. M., et al. (2024). Robotics and Navigation Do Not Affect the Risk of Periprosthetic Joint Infection Following Primary Total Hip Arthroplasty. The Journal of Bone and Joint Surgery. doi.org/10.2106/jbjs.23.00289.