Computer Navigation in Revision Total Joint Arthroplasty: National Utilization and Comparative Mid-Term Outcomes

Background Computer navigation (CN), with or without the use of robotics, is increasingly utilized in primary total joint arthroplasty (TJA). Although evidence supporting its clinical benefit remains limited, its role in the revision setting is even less defined. This study evaluates national utilization trends and compares 2-year implant-related complications of CN and conventional revision total hip (rTHA) and knee arthroplasty (rTKA). Methods A national claims database was queried for CN and conventional rTHA and rTKA procedures from 2010 to 2021. Two-year implant-related complications, including aseptic loosening, instability/dislocation, periprosthetic fracture, and need for re-revision, were assessed. CN and conventional cohorts were 1:1 case-control matched by demographic and clinical variables. Descriptive statistics and univariate analyses were used for comparisons. Results In total, 1,676 CN and 171,591 conventional rTKA and rTHA patients were included, with a mean of 65 years, 59% female sex, and a mean CCI of 1.8. After matching, 1,292 patients remained in each group, with similar demographics. CN use in revision procedures rose from 0.5% in 2010 to over 2% in 2021 representing a more than 250% increase. At 2 years, CN and conventional rTKA cohorts showed similar rates of aseptic loosening (2.0% vs 2.7%, p=0.347), dislocation (2.0% vs 1.9%, p=1.000), periprosthetic fracture (0.9% vs 0.2%, p=0.114), and re-revision (8.9% vs 8.7%, p=0.958). Likewise, in the rTHA cohort, no significant differences were observed in aseptic loosening (2.2% vs 1.3%, p=0.299), dislocation (1.9% vs 4.0%, p=0.202), periprosthetic fracture (1.6% vs 1.6%, p=1.000), or re-revision rates (11.1% vs 10.9%, p=0.835). Conclusions Although still infrequently used in the revision setting, CN TJA has seen a steady rise in utilization over the past decade. Matched cohort analyses demonstrate similar 2-year implant-related complication rates compared to conventional techniques. Further research is warranted to assess its long-term safety and efficacy in complex arthroplasty.