Abstract：
BACKGROUND: Computer navigation and robotic assistance may reduce total hip arthroplasty (THA) dislocations by improving the accuracy and precision of component positioning. We investigated dislocation rates for THAs using conventional techniques, robotic assistance, and computer navigation, while controlling for surgical approach, dual mobility (DM) use, and fluoroscopic guidance.
METHODS: We reviewed 11,740 primary THAs performed between June 2016 and December 2022, including 5,873 conventional, 1,293 with robotic-arm assistance, and 4,574 with navigation. The approach was posterior in 6,580 (56.0%), anterior in 4,342 (37.0%), and lateral in 818 (7.0%). A DM was used in 10.4%. Fluoroscopy was used in 3,653 cases and only with the anterior approach. Multivariate analyses yielded odds ratios (OR) for dislocation and revision. Additional regression analyses for dislocation were performed for approach and DM.
RESULTS: Raw dislocation rates were as follows: conventional 1.2%, robotic 0.4%, navigation 0.9%, anterior with fluoroscopy 0.4%, anterior without fluoroscopy 2.3%, posterior 1.3%, and lateral 0.5%. Upon multivariate analysis, use of robotics was found to be associated with significantly reduced dislocation risk compared to conventional (OR: 0.3), as did anterior (OR: 0.6) compared to posterior approach; navigation and lateral approach were not found to be associated with a significant reduction in risk. For the anterior approach, multivariate analysis demonstrated that fluoroscopy significantly reduced dislocation risk (OR: 0.1), while DM, robotics, and navigation were not significant. For the posterior approach, the dislocation risk was lower with robotics than with conventional (OR: 0.2); the use of navigation or DM did not demonstrate a significant reduction in risk.
CONCLUSIONS: The use of robotics was associated with a reduction in dislocations for this cohort overall. Further, fluoroscopy in the anterior approach and robotic assistance in the posterior approach were both associated with decreased dislocation risk. The role of imageless computer navigation and DM implants requires further study.
METHODS: We reviewed 11,740 primary THAs performed between June 2016 and December 2022, including 5,873 conventional, 1,293 with robotic-arm assistance, and 4,574 with navigation. The approach was posterior in 6,580 (56.0%), anterior in 4,342 (37.0%), and lateral in 818 (7.0%). A DM was used in 10.4%. Fluoroscopy was used in 3,653 cases and only with the anterior approach. Multivariate analyses yielded odds ratios (OR) for dislocation and revision. Additional regression analyses for dislocation were performed for approach and DM.
RESULTS: Raw dislocation rates were as follows: conventional 1.2%, robotic 0.4%, navigation 0.9%, anterior with fluoroscopy 0.4%, anterior without fluoroscopy 2.3%, posterior 1.3%, and lateral 0.5%. Upon multivariate analysis, use of robotics was found to be associated with significantly reduced dislocation risk compared to conventional (OR: 0.3), as did anterior (OR: 0.6) compared to posterior approach; navigation and lateral approach were not found to be associated with a significant reduction in risk. For the anterior approach, multivariate analysis demonstrated that fluoroscopy significantly reduced dislocation risk (OR: 0.1), while DM, robotics, and navigation were not significant. For the posterior approach, the dislocation risk was lower with robotics than with conventional (OR: 0.2); the use of navigation or DM did not demonstrate a significant reduction in risk.
CONCLUSIONS: The use of robotics was associated with a reduction in dislocations for this cohort overall. Further, fluoroscopy in the anterior approach and robotic assistance in the posterior approach were both associated with decreased dislocation risk. The role of imageless computer navigation and DM implants requires further study.
摘要：
背景：计算机导航和机器人辅助可以通过提高组件定位的准确性和精度来减少全髋关节置换术（THA）脱位。我们使用常规技术研究了THA的位错率，机器人辅助,和计算机导航，在控制手术入路的同时，双移动性(DM)使用，和透视指导。
方法：我们回顾了2016年6月至2022年12月期间进行的11,740次主要THA，包括5,873次常规，1,293个机器人手臂辅助，和4,574导航。在6,580（56.0％）中，入路向后，前4342例(37.0%)，和横向818（7.0%）。双迁移率占10.4%。透视3653例,只有前路。多变量分析得出脱位和翻修的比值比（OR）。对入路和DM进行了其他位错回归分析。
结果：原始位错率为：常规1.2%，机器人0.4%，导航0.9%，前路透视术0.4%，前路无透视2.3%，后面的1.3%，和横向0.5%。经过多变量分析，与传统技术相比，机器人的使用被发现与显著降低的脱位风险相关（OR：0.3），与后路相比,前路(OR:0.6);未发现导航和外侧入路与风险显著降低相关.对于前路，多变量分析显示透视显着降低了脱位风险（OR：0.1），而DM,机器人,导航并不重要。对于后路，机器人技术的脱位风险低于常规技术(OR:0.2);导航或DM的使用未显示风险显著降低.
结论：机器人的使用与该队列整体脱位的减少有关。Further,前路透视和后路机器人辅助均与脱位风险降低相关.无图像计算机导航和DM植入物的作用需要进一步研究。
方法：我们回顾了2016年6月至2022年12月期间进行的11,740次主要THA，包括5,873次常规，1,293个机器人手臂辅助，和4,574导航。在6,580（56.0％）中，入路向后，前4342例(37.0%)，和横向818（7.0%）。双迁移率占10.4%。透视3653例,只有前路。多变量分析得出脱位和翻修的比值比（OR）。对入路和DM进行了其他位错回归分析。
结果：原始位错率为：常规1.2%，机器人0.4%，导航0.9%，前路透视术0.4%，前路无透视2.3%，后面的1.3%，和横向0.5%。经过多变量分析，与传统技术相比，机器人的使用被发现与显著降低的脱位风险相关（OR：0.3），与后路相比,前路(OR:0.6);未发现导航和外侧入路与风险显著降低相关.对于前路，多变量分析显示透视显着降低了脱位风险（OR：0.1），而DM,机器人,导航并不重要。对于后路，机器人技术的脱位风险低于常规技术(OR:0.2);导航或DM的使用未显示风险显著降低.
结论：机器人的使用与该队列整体脱位的减少有关。Further,前路透视和后路机器人辅助均与脱位风险降低相关.无图像计算机导航和DM植入物的作用需要进一步研究。
