Abstract
Introduction
Hip and knee joint replacement is nowadays one of the most common surgeries in Germany. The frequency of peri- and post-operative complications varies depending on the study. Since 2001, every hospital in Germany is required to report any peri- and post-operative complication to an external institute for quality control. The purpose of this study was to evaluate the published data of these institutes and to differentiate between the rate of peri- and early postoperative complications of conventional and computer navigated surgical procedures. The hypothesis of the study was that there is no increase in the rate of peri- and early post-operative complications as a result of the navigated surgical procedure.
Materials and Methods
A retrospective analysis of the data on primary total knee and hip replacements between 2004 and 2012 were conducted. The share of navigated procedures, additional operating time due to navigation, the peri- and early post-operative surgical and general rates of complications and the comparison of patient population (age, sex and ASA-classification) were subject of the analysis.
Results
Overall, the number of implanted knee endoprostheses rose from 110.000 in 2004 to 133.000 in 2012, including a doubling in the share of the navigated knee endoprostheses from 6.8% to 11.2%. Additional operative time for the implantation of knee prostheses decreased from initially 20 min. to 11.3 min. The rate of patients with at least one surgical intra and post-operative surgical complication decreased nearly 50.0% both, conventional and computer-navigated total knee arthroplasty. Focusing solely on the rate of general post-operative complications, a decrease from 5.9 % (conventional) or 4.7% (navigated) to 2.9%, respectively, was observed.
In the area of hip prostheses, the total number increased from 138.000 (2004) to 152.500 (2012), with a relatively stable share of navigated prostheses from 1.63% to 1.4%. Additional operative time in case of the navigation decreased from 14.8 min. to 5.3 min. The rate of patients with at least one surgical intra or post-operative complication showed a decrease from 5.0% to 3.0% for both. The rate of post-operative general complications with navigated prostheses showed a higher drop in percentage points from 4.5% to 1.85% than with non-navigated prostheses, which decreased from 5.0% to 3.0%.
Discussion
Despite high expertise and having used navigation for years, still very few endoprostheses are navigated. However, through a regular application of the navigation, a significant reduction of the operational time was accomplished in knee and hip replacement. The analysis did not show an increase in either peri- or early post-operative appearance of complications.
