Computer-Assisted Fluoroscopic Navigation Is Cost Effective Compared to Robotic-Assisted and Manual Surgery in Total Hip Arthroplasty

6 pages•Published: January 5, 2026

Jenna Bernstein, Jean-Baptiste Trouiller, Mina Kabiri and William Hamilton

Abstract

Total hip arthroplasty (THA) is among the most common surgeries for hip osteoarthritis. Besides the conventional manual technique (mTHA), alternatives such as computer-assisted fluoroscopic navigation (cTHA) and robotic-assisted solutions (rTHA) are available for THA. We aimed to estimate the cost-utility of cTHA compared to rTHA and mTHA in patients undergoing THA from the US healthcare system perspective.
A Markov model was developed to compare costs and utilities of cTHA vs. mTHA, and cTHA vs. rTHA over a 1-year time horizon. Health states were defined based on the occurrence of readmissions with/without revisions due to fracture, dislocation, infection and hip pain. Utilities were presented in quality-adjusted life years (QALYs). Costs included length of stay, operative time and readmissions/revisions. The incremental cost-effectiveness ratio (ICER) was estimated as incremental cost per QALY change for each pairwise comparison. Inputs were drawn from published literature.
cTHA was associated with a slight QALY gain of 0.001, and estimated savings of $1,595 and $949 per patient compared to rTHA and mTHA, respectively. Results indicated that cTHA was the ‘dominant’ strategy, i.e. reducing costs and slightly increasing QALYs, compared to both alternatives. Probabilistic sensitivity analysis indicated that cTHA was cost saving in 100% of the 1,000 simulations compared to both rTHA and mTHA.
Using computer-assisted fluoroscopic navigation in THA showed cost savings and a slight improvement in quality of life compared to robotic-assisted and manual THA. Results suggest that computer-assisted fluoroscopic navigation is the preferred strategy for THA mainly due to downstream cost savings by reductions in OR time and readmissions/revisions rates.

Keyphrases: computer assisted navigation, cost effectiveness, cost utility, fluoroscopic navigation, tha, total hip arthroplasty

In: Joshua William Giles and Aziliz Guezou-Philippe (editors). Proceedings of The 25th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery, vol 8, pages 38-43.

Links:	https://easychair.org/publications/paper/gbDm
	https://doi.org/10.29007/ntv8

BibTeX entry

@inproceedings{CAOS2025:Computer_Assisted_Fluoroscopic_Navigation,
  author    = {Jenna Bernstein and Jean-Baptiste Trouiller and Mina Kabiri and William Hamilton},
  title     = {Computer-Assisted Fluoroscopic Navigation Is Cost Effective Compared to Robotic-Assisted and Manual Surgery in Total Hip Arthroplasty},
  booktitle = {Proceedings of The 25th Annual Meeting of the International Society for Computer Assisted Orthopaedic Surgery},
  editor    = {Joshua William Giles and Aziliz Guezou-Philippe},
  series    = {EPiC Series in Health Sciences},
  volume    = {8},
  publisher = {EasyChair},
  bibsource = {EasyChair, https://easychair.org},
  issn      = {2398-5305},
  url       = {/publications/paper/gbDm},
  doi       = {10.29007/ntv8},
  pages     = {38-43},
  year      = {2026}}

Download PDF Open PDF in browser