Navigation-guided elective primary total hip arthroplasty is associated with reduced 90-day readmission and early revision at increased index cost: a national analysis

Abstract

Navigation-guided total hip arthroplasty (THA) has been increasingly adopted to improve implant positioning and early outcomes; however, its population-level clinical and economic impact remains uncertain. Using the Nationwide Readmissions Database (NRD) (2020–2022), elective primary THA performed on hospital day 0 was identified in this study. Navigation-guided cases were compared with conventional THA. A 1:5 propensity score–matched cohort was constructed adjusting for demographics, payer, comorbidities, calendar year, and hospital characteristics. Primary outcomes included index hospitalization complications and 90-day readmission with readmission-associated procedural escalation. Readmission resource utilization and modeled 100-case episode-of-care costs were assessed. Among 366,375 elective THA procedures, navigation use increased from 2.9% (2020) to 4.3% (2022). In the matched cohort ( n  = 77,214), navigation was associated with shorter length of stay and lower rates of intraoperative fracture, blood loss anemia, acute kidney injury, and hip dislocation (all p  < 0.01). Ninety-day readmission was lower with navigation (3.6% vs. 4.9%; odds ratio 0.72, 95% confidence interval 0.65–0.79), as were early revision and reoperation events. However, index hospitalization charges were higher (+$15,384 per case), and a modeled episode-of-care analysis did not demonstrate cost offset within 90 days. Navigation-guided elective THA was associated with improved short-term outcomes but higher upfront charges. Because the NRD does not capture surgical approach, implant positioning, implant-specific details, surgeon volume, or longer-term outcomes, these findings should be interpreted as hypothesis-generating associations rather than definitive evidence of a causal technology effect.