JBJS - 2026-04-20 - Journal Article
Technology Assistance Mitigates the Volume-Dependent Risk of Hip Dislocation Following Total Hip Arthroplasty.
Iyer A, Telang SS, Culler MC, Yun AG, Oakes DA, Lieberman JR, Heckmann ND
Topics
Key Takeaway
Low-volume surgeons using technology assistance achieved a 90-day dislocation rate of 0.48% versus 0.42% for high-volume surgeons using conventional instrumentation (p=0.510, aOR 1.062), effectively eliminating the volume-dependent dislocation risk.
Summary Depth
Choose how much analysis to show on this article page.
Summary
This study asked whether technology assistance (robotic or navigation, ≥90% use rate) could close the dislocation gap between low-volume (<109 cases/year) and high-volume (≥109 cases/year) THA surgeons using the Premier Healthcare Database (2016–2023). LV-TA surgeons achieved a 90-day dislocation rate of 0.48% versus 0.42% for HV-CI surgeons, a non-significant difference (p=0.510). After mixed-effects modeling controlling for confounders, the adjusted odds ratio was 1.062 (95% CI 0.677–1.668), confirming equivalence.
Key Limitation
The LV-TA cohort (n=5,447) is 35-fold smaller than the HV-CI cohort (n=190,550), creating substantial imbalance that limits the precision of subgroup comparisons and may underpowered detection of rare adverse events beyond dislocation.
Original Abstract
BACKGROUND
Lower surgeon case-volume has been associated with a greater risk of postoperative complications such as dislocation following total hip arthroplasty (THA). However, robotic assistance and computer navigation may mitigate the volume-dependent risk of instability. This study sought to compare dislocation rates between lower-volume surgeons performing technology-assisted (TA) THAs and higher-volume surgeons utilizing conventional instrumentation (CI).
METHODS
The Premier Healthcare Database was queried to identify adult patients who underwent primary elective THA from 2016 to 2023. Surgeons with <10% technology use formed the CI group, and surgeons with ≥90% technology use formed the TA group. These groups were further subdivided into higher-volume (HV) and lower-volume (LV) on the basis of surgeon annual case-volume, using a previously validated threshold of 109 cases/year. Mixed-effects modeling was used to compare the 90-day risk of dislocation between patients treated by low-volume surgeons using TA (LV-TA group) and high-volume surgeons using CI (HV-CI group).
RESULTS
A total of 669,098 patients undergoing THA were identified. Of these, 5,447 patients were treated by LV-TA surgeons and 190,550, by HV-CI surgeons. Notably, LV-TA surgeons achieved a similar rate of dislocation compared with HV-CI surgeons (0.48% versus 0.42%, p = 0.510). After controlling for confounding factors, the risk of dislocation remained comparable between LV-TA and HV-CI surgeons (adjusted odds ratio: 1.062, 95% confidence interval: 0.677 to 1.668, p = 0.793).
CONCLUSIONS
Surgeons with a lower case-volume who used technology assistance achieved a rate of dislocation similar to that of surgeons with a higher case-volume who used conventional instrumentation. These findings demonstrate that technology assistance, including computer navigation and robotic assistance, may attenuate the association between surgeon case-volume and dislocation risk following primary THA.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.