A new study from Connecticut Orthopaedics found that using fluoroscopic navigation in the OR cuts 18 minutes, on average, from total hip arthroplasty (THA) cases as compared with robotic assist THA cases. Furthermore, says the research team, fluoroscopic navigation also reduced readmission rates at both the 90- and 365-day follow up periods.
The study, “All Enabling Technology Is Not Created Equal: Comparing Outcomes of Computer-Assisted Fluoroscopic Navigation Versus Robotic-Assisted Total Hip Arthroplasty,” appears in the December 2024 edition of the Journal of the American Academy of Orthopaedic Surgeons: Global Research and Reviews.
According to study co-author Jenna Bernstein, M.D., an orthopedic surgeon at Connecticut Orthopaedics, “Technology is becoming more ubiquitous within total hip arthroplasty (THA) surgery, and with that comes more choices in what kinds of technology to use.”
“There have been very few comparisons between types of technology in hip replacement surgery, with most of the comparison being between technology (all grouped together) and manual. Because of this, we wanted to compare two of the most common types of technologies used in hip replacement—robotic arm and fluoroscopic navigation—in the hope that it can help surgeons to choose which makes the most sense for their practice.”
The authors conducted this retrospective cohort study using data from the nationally representative Premier Healthcare Database, which includes data from 1,300 hospitals. A total of 4,378 fluoroscopically navigated THA and 10,423 robotic-assisted THA procedures with 90-day follow-up were included in the study.
The researchers discovered that OR time was markedly lower with fluoroscopic navigation compared with robotic-assisted technology (137.74 vs. 156.00 minutes).
Hip-related readmission rates were markedly lower for fluoroscopic navigation for both 90- and 365-day follow-up, by 43% and 40% respectively, compared with robotic-assisted technology.
The research team also found an increased discharge ratio to home/home health, reduced length of stay, and lower hospital costs for fluoroscopic navigation compared with robotic-assisted technology. The team noted a slight reduction in length of stay (by 8%) and a 29% reduction in discharge to skilled nursing facilities; they also found a 10% reduction in 90-day hip-related costs (mean difference: -$2,005).
Take another look at technology?
“I believe the most important result shows that fluoroscopic navigation has lower surgical time and cost, while at least having as good outcomes, if not better,” explained Dr. Bernstein to OTW. “The reason this is important is that cost and increased surgical time are two of the most common reasons surgeons cite for not using technology. Hopefully, this result shows surgeons that isn’t the case with all technology.”
OTW asked Dr. Bernstein why fluoroscopic cases would be more likely to be discharged to the home?
“My only additional thought is that fluoroscopic navigation may be an easier technology to use in an outpatient setting, and so this might shorten the overall time to discharge,” she said.
When OTW mentioned the trend of younger surgeons almost expecting robots in the OR, she commented, “That isn’t the case at this point with hip replacement surgery. Possibly in knee replacement, but not in hips. In hip replacement, most surgeons, including young surgeons, are still not using a robotic arm, but many are looking for additive technology that can make their surgeries more accurate. This study reinforces that using fluoroscopic navigation is as good of a technology as robotic arm, if not better. The key is to present all of the options to surgeons so they can choose what is the best option for themselves and their patients.”
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