Navigated non-image-based positioning of the acetabulum during total hip replacement (original) (raw)
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HIP International, 2011
Malpositioning of the acetabular component in total hip arthroplasty (THA) increases the risk of dislocation, reduces the range of motion and may contribute to bearing surface wear. During computer assisted navigation, the anterior pelvic plane is registered intraoperatively by percutaneous palpation, but this may be unreliable. The aim of our study was to evaluate the reliability of imageless navigation in acetabular positioning employing data acquisition in the supine position and surgery in the lateral position (‘flip technique’). We report 24 patients affected by primary osteoarthritis undergoing THA in which implants were placed with a conventional free-hand technique using the acetabular transverse ligament for cup orientation. For imageless navigation we used Orthopilot-Aesculap software. All patients had a postoperative computed tomography (CT) scan at three months, using previously validated dedicated software for cup orientation. Data collected using navigation software we...
Medicina
Background and Objectives: Intraoperative fluoroscopy can be used to increase the accuracy of the acetabular component positioning during total hip arthroplasty. However, given the three-dimensional nature of cup positioning, it can be difficult to accurately assess inclination and anteversion angles based on two-dimensional imaging. The purpose of this study is to validate a novel method for calculating the 3D orientation of the acetabular cup from 2D fluoroscopic imaging. Materials and Methods: An acetabular cup was implanted into a radio-opaque pelvis model in nine positions sequentially, and the inclination and anteversion angles were collected in each position using two methods: (1) a coordinate measurement machine (CMM) was used to establish a digitalized anatomical coordinate frame based on pelvic landmarks of the cadaveric specimen, and the 3D position of the cup was then expressed with respect to the anatomical planes; (2) AP radiographic images were collected, and a mathem...
Medicina
Background and Objectives: Even after the ‘death’ of Lewinnek’s safe zone, the orientation of the prosthetic cup in total hip arthroplasty is crucial for success. Accurate cup placement can be achieved with surgical navigation systems. The literature lacks study cohorts with large numbers of hips because postoperative computer tomography is required for the reproducible evaluation of the acetabular component position. To overcome this limitation, we used a validated software program, HipMatch, to accurately assess the cup orientation based on an anterior-posterior pelvic X-ray. The aim of this study were to (1) determine the intraoperative ‘individual adjustment’ of the cup positioning compared to the widely suggested target values of 40° of inclination and 15° of anteversion, and evaluate the (2) ‘accuracy’, (3) ‘precision’, and (4) robustness, regarding systematic errors, of an image-free navigation system in routine clinical use. Material and Methods: We performed a retrospective...
Anterior Mechanical Navigation Device is as Accurate as Lateral Device for Hip Socket Position
EPiC Series in Health Sciences
Objectives: In total hip arthroplasty (THA), accurate acetabular component position promotes prosthetic hip joint stability and longevity, and minimizes polyethylene wear. Image-based mechanical navigation is known to improve accuracy and reproducibility of accurate cup position intraoperatively via the posterior approach and the superior capsular approach. The purpose of this study was to assess the accuracy of acetabular component position using image-based mechanical navigation via the direct anterior approach (DAA). Methods: We prospectively followed 96 patients who underwent THA with one fellowship-trained arthroplasty surgeon over a nine-month period. Thirty-three patients underwent DAA THA with the anterior HipXpert device (Group 1), and 63 patients underwent posterior approach THA with the lateral HipXpert mechanical navigation device, serving as an operative control group (Group 2). Standard postoperative plain film radiographic measurements of acetabular component inclinat...
Validation of navigation assisted cup placement in total hip arthroplasty
International Orthopaedics
Purpose Computer navigation has the potential to provide precise intraoperative knowledge to the surgeon. Previous studies with navigation have confirmed its function for improved component position but few studies have reported the accuracy and precision of navigation system in clinical use. With this study we propose to evaluate the efficacy of navigation in guiding cup placement. Methods Fifty-six patients undergoing primary total hip arthroplasty were prospectively included in this study. Stryker imageless navigation system which is accurate to 0.5° was used in all cases. Intraoperative data was collected for the acetabular component position using navigation for the freehand cup placement and the final cup placement done using navigation. Postoperative evaluation of component position was done with computed tomography (CT) and the deviation from intraoperative freehand and navigation values were calculated. Results The mean inclination of the freehand reading was 39.5° (range, 20°–58°), mean version of freehand reading was 10.7° (−6°– 27°), and the mean navigation reading was 43.2° (37°–49°) for inclination and 13.0° (−8° – 24°) for version. On postoperative CT scan analysis the mean inclination was 45.3° (34°–56°) and mean version was 15.1° (4°–25°). The deviation of the freehand inclination from the post operative CT scan reading was 11.4° (1°–30°) and the version deviated by a mean of 10.8° (2°–26°). The deviation of the navigation reading from the CT scan reading had a mean of 5.3° (1°–13°) for inclination and 5.6° (1°–17°) for version. Conclusion The accuracy of the navigation system over conventional freehand cup placement is validated by this study.