Computer-assisted total hip arthroplasty reduces early complications based on Japanese nationwide medical claims data
Hidetatsu Tanaka, Kunio Tarasawa, Yu Mori, Hiroaki Kurishima, Hiroki Kawamata, Kiyohide Fushimi, Kenji Fujimori, Toshimi Aizawa
Abstract
INTRODUCTION: Computer-assisted (CA) surgery is increasingly adopted in total hip arthroplasty (THA) to enhance implant positioning accuracy. However, robust evidence regarding its impact on postoperative complications compared with manual THA (M-THA) remains limited. This study evaluated the association between CA-THA and early postoperative complications using a large Japanese database. MATERIALS AND METHODS: We analyzed 336,624 THA cases recorded in the Japanese Diagnosis Procedure Combination (DPC) database between December 2011 and March 2023. Of these, 242,067 underwent M-THA and 94,557 underwent CA-THA. One-to-one propensity score matching was performed to adjust for age, sex, body mass index, comorbidities, and diagnosis. Outcomes included surgical complications, medical complications, and in-hospital mortality. RESULTS: After matching, 93,887 patient pairs were analyzed. Compared with M-THA, CA-THA was associated with lower odds of dislocation (OR 0.667, 95% CI 0.556-0.786, p < 0.001), infection (OR 0.763, 95% CI 0.687-0.848, p < 0.001), and re-operation (OR 0.822, 95% CI 0.732-0.922, p < 0.001), but higher odds of periprosthetic fracture (OR 1.301, 95% CI 1.118-1.514, p < 0.001). No significant differences were found in medical complications or mortality. CONCLUSIONS: In this nationwide cohort, CA-THA was associated with reduced risks of dislocation, infection, and reoperation, but an increased risk of periprosthetic fracture compared with M-THA. Further research should clarify optimal indications and refine patient selection criteria for CA-THA. In this nationwide cohort, CA-THA was associated with reduced risks of dislocation, infection, and reoperation, but an increased risk of periprosthetic fracture compared with M-THA. Further research should clarify optimal indications and refine patient selection criteria for CA-THA.