Comparison of Implant Placement Accuracy Between Manual, Robot-Assisted, Computer-Navigated, Augmented Reality Navigated, Patient-Specific Instrumentation, and Accelerometer Navigated Total Hip Arthroplasty: A Systematic Review and Network Meta-Analysis.

IF 1.7 Q2 SURGERY

JBJS Reviews Pub Date : 2024-11-05 eCollection Date: 2024-11-01 DOI:10.2106/JBJS.RVW.24.00120

Takanori Miura, Norio Yamamoto, Akihiro Shiroshita, Takahiro Tsuge, Akihiro Saitsu, Junya Yoshitani, Shuri Nakao, Ken Takami

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引用次数: 0

Abstract

Background: Malpositioning of the acetabular cup during total hip arthroplasty (THA) can lead to complications. Robotic surgery and navigation techniques aim to address this issue, but there is limited evidence regarding which method can achieve better clinical outcomes. Therefore, this network meta-analysis (NMA) aimed to compare the efficacy of various navigation methods.

Methods: This NMA of prospective randomized controlled trials compared robot-assisted systems (RAS), computer-assisted navigation systems (CAS), augmented reality-based portable navigation (AR), patient-specific instrumentation (PSI), portable accelerometer-based navigation (PN), and conventional methods (C) for THA procedures. We searched MEDLINE, EMBASE, Cochrane, Central Register of Controlled Trials, International Clinical Trials Platform Search Portal, and ClinicalTrials.gov. databases. The primary outcomes included revision surgery and postoperative clinical scores, and the secondary outcomes encompassed cup placement accuracy, acetabular cup placement outliers from the Lewinnek safe zone, surgical time, and complications. We used a Bayesian random-effects NMA, and confidence of evidence was assessed using confidence in NMA.

Results: We identified 45 studies including 2,122 patients. We did not find large differences in revision surgery, clinical outcome scores, cup inclination, or anteversion angle accuracy among the modalities. AR, CAS, and PSI exhibited a lower risk of outliers from safe zones than C. In addition, RAS and CAS had a longer surgical time than C.

Conclusions: Robotic and navigation tools did not reduce the revision risk or enhance clinical outcomes. AR, CAS, PSI, and PN may decrease the risk of cup placement outliers in safe zones. However, the cup placement accuracy was equivalent, and the surgical time may be longer in RAS and CAS than in C.

Level of evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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人工、机器人辅助、计算机导航、增强现实导航、患者专用仪器和加速计导航全髋关节置换术的植入物放置准确性比较：系统回顾与网络元分析》。

背景：在全髋关节置换术（THA）中，髋臼杯的错位会导致并发症。机器人手术和导航技术旨在解决这一问题，但关于哪种方法能取得更好的临床效果，目前证据有限。因此，本网络荟萃分析（NMA）旨在比较各种导航方法的疗效：这项前瞻性随机对照试验的网络荟萃分析比较了机器人辅助系统（RAS）、计算机辅助导航系统（CAS）、基于增强现实的便携式导航（AR）、患者特异性仪器（PSI）、基于加速度计的便携式导航（PN）和THA手术的传统方法（C）。我们检索了 MEDLINE、EMBASE、Cochrane、对照试验中央注册、国际临床试验平台搜索门户和 ClinicalTrials.gov 等数据库。主要研究结果包括翻修手术和术后临床评分，次要研究结果包括髋臼杯置入准确性、髋臼杯置入Lewinnek安全区异常值、手术时间和并发症。我们采用了贝叶斯随机效应NMA，并使用NMA置信度评估证据的可信度：结果：我们确定了45项研究，包括2122名患者。我们没有发现各种方式在翻修手术、临床结果评分、杯倾角或内翻角准确性方面存在很大差异。此外，RAS和CAS的手术时间比CAS长：结论：机器人和导航工具并未降低翻修风险或提高临床效果。AR、CAS、PSI和PN可降低安全区杯置入异常的风险。然而，置杯准确性相当，RAS和CAS的手术时间可能比CAS长：有关证据级别的完整描述，请参阅 "作者须知"。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JBJS Reviews SURGERY-

CiteScore

4.40

自引率

4.30%

发文量

132

期刊介绍： JBJS Reviews is an innovative review journal from the publishers of The Journal of Bone & Joint Surgery. This continuously published online journal provides comprehensive, objective, and authoritative review articles written by recognized experts in the field. Edited by Thomas A. Einhorn, MD, and a distinguished Editorial Board, each issue of JBJS Reviews, updates the orthopaedic community on important topics in a concise, time-saving manner, providing expert insights into orthopaedic research and clinical experience. Comprehensive reviews, special features, and integrated CME provide orthopaedic surgeons with valuable perspectives on surgical practice and the latest advances in the field within twelve subspecialty areas: Basic Science, Education & Training, Elbow, Ethics, Foot & Ankle, Hand & Wrist, Hip, Infection, Knee, Oncology, Pediatrics, Pain Management, Rehabilitation, Shoulder, Spine, Sports Medicine, Trauma.