Patient Clinical Outcomes and Healthcare Resource Utilization Using a Computer-Assisted Fluoroscopy-Based Navigation System with Anterior Approach Compared to Posterior Approach Manual Surgery for Total Hip Arthroplasty

Introduction: Clinical outcomes and healthcare resource utilization were compared for patients undergoing primary total hip arthroplasty (THA) with direct anterior approach (DAA) using computer-assisted fluoroscopy-based navigation technology (fTHA) vs. posterior approach manual surgery (mTHA). Materials and Methods: A pre/post analysis reviewed electronic medical records from a single surgeon at a US critical access hospital from 2014-2022; fTHA began in October of 2015. The primary outcome was a patient-reported outcome measure (PROM) for pain and the secondary outcome was procedure time. Exploratory outcomes were hospital length of stay (LOS), 30-day readmissions and complications, and changes in disability and osteoarthritis. Results: Among 485 patients (mean [standard deviation (SD)] age 67.1 [10.6] years, 52.8% female), 390 (80.4%) received fTHA and 95 (19.6%) received mTHA. In unadjusted analyses, mTHA patients had greater mean (SD) pain (4.2 [2.0] vs. 3.0 [2.2]; p<0.001), procedure time (65.6 [12.6] vs. 61.1 [16.2] minutes; p=0.013), and LOS (mean [SD]: 1.9 [0.8] vs. 1.3 [1.1] days and median 2.0 vs. 1.0 days). No readmission occurred with fTHA whereas readmission for mTHA was 3.2%. fTHA also showed a reduced complication rate vs. mTHA (0.5% vs. 10.5%). Hip Disability and Osteoarthritis Outcome Score changes were the same, with an average increase of 24.4 [19.9]. Multivariate analyses found mTHA had 1.3 times higher pain intensity PROM (p<0.001), similar procedure time (p=0.103), and 1.6 times longer hospital LOS (p<0.001) compared to fTHA. Conclusions: Using a computer-assisted fluoroscopy-based navigation technology with DAA may facilitate a statistically significant reduction in pain and procedure time.