Computer Navigation vs Conventional Total Hip Arthroplasty: A Medicare Database Analysis

Background: Computer-assisted surgery (CAS) is applied to total hip arthroplasty (THA) in an attempt to optimize implant positioning. The effect of CAS on postoperative complications after THA remains unknown. Our study aims to assess the change in complication rates when CAS is used in THA. Methods: The Medicare database was studied from 2005 to 2012. All THAs performed with CAS were identified. A total of 64,944 THAs were identified, including 5412 CAS-THAs and 59,532 conventional THAs. Medical and surgical adverse events were collected at various time points. Results: CAS-THA was not associated with a decreased rate of dislocation at 30 days (1.0% vs 1.2%; odds ratio [OR], 1.14; P =.310), 90 days (1.1% vs 1.4%; OR, 1.23; P =.090), or 2 years (2.3% vs 2.3%; OR, 1.01; P =.931). CAS-THA was associated with a significantly higher rate of periprosthetic fracture at 30 days (0.4% vs 0.6%; OR, 1.46; P =.040) as well as revision THA at 30 days (1.0% vs 1.4%; OR, 1.43; P =.003) and 90 days (1.2% vs 1.7%; OR, 1.42; P <.002) when compared to conventional THA. CAS-THA was associated with a significantly lower rate of deep vein thrombosis and pulmonary embolism when compared to conventional THA at all time points (P <.05). Conclusion: Administrative coding data fail to demonstrate any clinically significant reduction in short-term adverse events with CAS-THA. Further study is warranted to evaluate whether the purported benefits of CAS result in a reduction of the adverse events after THA.