Abstract
BACKGROUND: Total hip replacement (THR) can be performed conventionally or with the assistance of computer guidance systems. We aimed to compare the risk of revision for all-causes and dislocation, and differences in Oxford Hip Score (OHS) and health-related quality of life (EQ-5D-3L) following primary THR performed conventionally versus with the assistance of computer guidance systems. METHODS: We performed an observational study using National Joint Registry data. Adult patients who underwent primary THR for osteoarthritis between 2003 and 2020 were included. The co-primary analyses were revision for all-causes and dislocation. Secondary analyses were differences in OHS and EQ-5D-3L. Weights based on propensity scores were generated. Cox proportional hazards and generalised linear models were used to assess outcomes of revision, OHS, and EQ-5D-3L. Effective sample sizes (ESS) were computed. RESULTS: Risk of revision for all-causes comparing computer guided and conventional THR were similar (HR 0.947, 95% CI 0.698–1.283, p = 0.726, ESS 7235). However, sensitivity analysis restricting to the five most commonly used combination of prosthesis brands demonstrated reduced revision risk in favour of computer guidance (HR 0.446, 95% CI 0.231–0.858, p = 0.016, ESS 3993). There was no difference in revision for dislocation between groups (HR 0.929, 95% CI 0.512–1.688, p = 0.810, ESS 7235). Compared to conventional THR, the use of computer guidance increased OHS by 0.931 (95% CI 0.308–1.554, p = 0.003, ESS 2112) however there were no differences in EQ-5D-3L (0.007, 95% CI −0.008–0.023, p = 0.356, ESS 2929). Incidence of intra-operative complications was significantly fewer during computer guided THR (0.51% versus 0.96%, p = 0.006). CONCLUSIONS: There were no differences in revision for all-causes and dislocation between computer guided and conventional THR. However, sensitivity analysis considering only the five most commonly used prosthesis brands demonstrated a reduced risk of revision for all-causes favouring computer guided THR. Furthermore, computer guidance was associated with a significant but minimal improvement in OHS and a lower risk of intra-operative complications, without differences in EQ-5D-3L. Although these findings suggest potential for computer guided THR to improve implant survivorship and reduce intra-operative complications, they require cautious interpretation given the limitations inherent to observational study designs and registry based analyses. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00590-025-04622-9.