All Enabling Technology Is Not Created Equal: Comparing Outcomes of Computer-Assisted Fluoroscopic Navigation Versus Robotic-Assisted Total Hip Arthroplasty

Abstract

Background: Computer-assisted fluoroscopic navigation and robotic technologies aim to optimize implant placement and alignment in primary total hip arthroplasty (THA) to improve patient outcomes. This study uses a retrospective hospital billing database covering 1,300 hospitals to compare the clinical and economic effect of these technologies.

Methods: The study compared patients undergoing THA with robotic versus computer-assisted fluoroscopic navigation technologies between January 1, 2016, and September 30, 2021, using the Premier Healthcare Database. Primary outcomes were operating room time and readmission rates. Secondary outcomes were length of stay, discharge status, revision rates within 90- and 365-day follow-up, and hospital costs. Baseline covariate differences between the two cohorts were balanced using fine stratification methodology and analyzed using generalized linear models. A sensitivity analysis was conducted using the nearest neighbor matching as the covariate balancing technique.

Results: The cohorts included 4,378 fluoroscopically navigated THA and 10,423 robotic-assisted THA procedures with 90-day follow-up. Operating room time was markedly lower with fluoroscopic navigation compared with robotic-assisted technology (137.74 vs. 156.00 minutes; P < 0.001). Hip-related readmission rates were markedly lower (P < 0.001) for fluoroscopic navigation for both 90- and 365-day follow-up, by 43% and 40% respectively, compared with robotic-assisted technology. Results showed increased discharge ratio to home/home health, reduced length of stay, and lower hospital costs for fluoroscopic navigation compared with robotic-assisted technology. Revision rates were similar for both cohorts.

Conclusion: Using computer-assisted fluoroscopic navigation in THA was associated with markedly lower operating room time and readmission rates while also having improved healthcare outcomes and costs compared with robotic-assisted technology.