Evidence-based computer-navigated total hip arthroplasty: an updated analysis of randomized controlled trials

Abstract

Background: Total hip arthroplasty (THA) has evolved over the years to be a reliable, reproducible, and successful orthopedic procedure. Nowadays, THA is increasingly performed on patients using less invasive, tissue-preserving techniques. Accordingly, the use of computer navigation in total joint arthroplasty has become more prevalent. However, there is still lack of high-quality evidence to verify the most effective technique for THA.

Methods: A search was conducted in PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases. Clinical trials published from 1966 to Feb 2012 that assess conventional techniques THA or computer-navigated techniques THA for placing the acetabular component. The main outcome measures included abduction angles, anteversion angles, percentage of acetabular outliers, operation time, decrease in Hb/24 h, and wound secretion/48 h.

Results: The pooled analysis across all studies showed a significant difference in anteversion angles and acetabular outliers (difference -0.22, 95% CI -0.67, 0.24; p = 0.346, I (2) = 71.9%) and (difference 8.34, 95% CI 4.15, 16.74; p = 0.000, I (2) = 0.0%). However, no significant difference in abduction angle and decrease in Hb/24 h (difference -0.22, 95% CI -0.67, 0.24; p = 0.346, I (2) = 71.9%) and (difference 0.03, 95% CI -0.36, 0.41; p = 0.888, I (2) = 0.0%). For the operation time, computer-navigated THA was longer (difference -0.73, 95% CI -1.32, -0.15; p = 0.014, I (2) = 74.4%).

Conclusions: This meta-analysis demonstrated computer-navigated THA was a more favorable method for placing the acetabular component and decreased the number of acetabular cups implanted outside the desired range of alignment. More high-quality RCTs were needed to support the evidence.