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.

Autor:	Miura T; Department of Orthopaedic Surgery, Matsuda Hospital, Sendai, Japan.; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan., Yamamoto N; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.; Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.; Department of Orthopedic Surgery, Hashimoto Hospital, Mitoyo, Japan., Shiroshita A; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.; Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee., Tsuge T; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.; Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.; Department of Rehabilitation, Kurashiki Medical Center, Kurashiki, Japan., Saitsu A; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.; R & D Division of Career Education for Medical Professionals, Medical Education Center, Jichi Medical University, Shimotsuke, Japan.; Department of Orthopaedics Surgery, Jichi Medical University, Shimotsuke, Japan., Yoshitani J; Department of Orthopedic Surgery, Suzu General Hospital, Suzu, Japan., Nakao S; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan.; Division of Rehabilitation Medicine, Shimane University Hospital, Izumo, Japan., Takami K; School of Public Health, University of California, Berkeley, Berkeley, California.
Jazyk:	angličtina
Zdroj:	JBJS reviews [JBJS Rev] 2024 Nov 05; Vol. 12 (11). Date of Electronic Publication: 2024 Nov 05 (Print Publication: 2024).
DOI:	e24.00120
Abstrakt:	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. Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B164). (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)
Databáze:	MEDLINE
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