(BSPOT14) All Enabling Technology is not created equal: comparing outcomes of computer assisted fluoroscopic hip navigation versus robotic-assisted total hip arthroplasty

Background: Computer-assisted navigation techniques and robotic-assisted surgeries are used to plan and optimize component placement and alignment in total hip arthroplasty (THA) and utilization of these enabling technologies is increasing. To our knowledge, there are no studies to date that have compared the clinical and economic impact of computer tomography (CT) planned robotic-assisted versus fluoroscopy-based navigation THA.

Objectives: Our objective was to understand the differences in health resource utilization for computer-assisted fluoroscopic navigation and robotic-assisted THA.

Methods: The study compared patients undergoing THA with robotic versus fluoroscopic navigation technologies between January 1, 2016-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 and hospital costs. Covariates included age, gender, race, marital status, payer type and comorbidities of patients as well as hospital bed size, location, and teaching status. Baseline covariate differences between the two cohorts were balanced using fine stratification methodology and analyzed using generalized linear models. A total of 80 strata were created. A nearest neighbor matching with 1:5 variable matching and 0.2 caliper was employed as a sensitivity analysis.

Results: The cohorts included 4,378 fluoroscopically navigated THA and 10,423 robotic-assisted THA patients with 90-day follow-up. Operating room time was significantly lower with fluoroscopic navigation compared to robotic technology (137 vs. 156 minutes). Hip-related readmission rates were significantly lower for fluoroscopic navigation for both 90- and 365-day follow-up, by 43% and 40% respectively, compared to robotic technology. Results showed increased discharge ratio to home/home health, reduced length of stay and lower hospital costs for fluoroscopic navigation compared to robotic technology. Revision rates were similar for both cohorts. The findings from sensitivity analysis consistently replicated the results obtained using the fine stratification approach.

Conclusions: The use of computer-assisted fluoroscopic navigation in THA demonstrated significantly lower operating room time and readmission rates while also having improved healthcare outcomes and costs compared to robotic technology. The fine stratification method preserved all patient data, allowing for the inclusion of outlier patients and yielding more representative outcomes whereas matching usually leads to better balance at the expense of generalizability to all patient data. The results were consistent across both balancing techniques.