Imageless navigation total hip arthroplasty - an evaluation of operative time (original) (raw)
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The Journal of Arthroplasty, 2009
Acetabular orientation affects the success of total hip arthroplasty. Computer-assisted navigation systems may reduce positional errors. Total hip arthroplasty results were analyzed using an imageless navigation system. We hypothesized that reliability and accuracy would improve. One hundred forty-nine total hip arthroplasties were performed using minimally invasive surgical techniques in 3 cohorts: manual (n = 53), initial navigation cases (n = 49), navigation second series (n = 47). Manual patients' cup orientation variation from desired range was −19°to +18°anteversion (SD, 9.1°), −11°to +25°abduction (SD, 6.7°). Navigation variation from desired was −18°to +15°(SD, 7.3°) in group 1 and −15°to +9°(SD, 5.9°) in group 2 in anteversion and −15°to +13°(SD, 6.1°) in group 1 and −15°t o +11°(SD, 4.7°) in group 2 in abduction. Results were statistically significant. There were significant differences for operating room time and estimated blood loss, but not incision size or body mass index. Navigation provided controlled, reproducible acetabular alignment; but a learning curve existed in terms of accuracy, estimated blood loss, and operating room time.
Introduction: Optimal outcomes in total hip arthroplasty are dependent on appropriate placement of femoral and acetabular components, with technological advances providing a platform for guiding component placement to reduce the risk of malpositioned components during surgery. This study will validate the intraoperative data captured using a handheld imageless THA navigation system against postoperative measurements of acetabular inclination, anteversion, leg length, and femoral offset on CT radiographs. Methods and analysis: This is a prospective observational cohort study conducted within a single-centre, single-surgeon private practice. Data will be collected for 35 consecutive patients (>18years) undergoing elective THA surgery, from the research registry established at the surgeon's practice. The primary outcome is the agreement between intraoperative component positioning data captured by the navigation system compared to postoperative measurements using computed tomogr...
The International Journal of Medical Robotics and Computer Assisted Surgery
Background: Total hip arthroplasty (THA) is named the most successful surgical procedure of the twentieth century. To remain a success in the twenty-first century THA should meet the higher demands of patients and society with regard to technical and functional outcome, costs and implant survival. To meet these demands optimal acetabular cup positioning is necessary. An imageless navigation system (NAV) might prevent malpositioning of the acetabular cup in THA. The aim of this study has been to compare the precision and accuracy of the anteversion and inclination of the acetabular cup position after NAV implantation and after freehand implantation of THA. Methods: A systematic review and meta-analysis was conducted to assess the precision (variance) and accuracy (deviation from the target) from all available high-quality randomised control trials to date. Results: Six out of seven studies concluded a statistically significant difference in precision in anteversion between the NAV group and the freehand group. Five out of seven studies concluded a statistically significant difference in precision in inclination. There is a significantly better accuracy for the NAV group than for the freehand group for anteversion (p = 0.002) and for inclination (p = 0.01). Conclusion: This study showed that NAV placement is more precise and has an improved accuracy for anteversion and inclination than freehand placement of the acetabular cup. However, there is a lack of evidence to support an improved functional outcome and a reduction of complications and revisions.
Journal of Bone and Joint Surgery - British Volume, 2009
The computed neck-shaft angle and the size of the femoral component were recorded in 100 consecutive hip resurfacings using imageless computer-navigation and compared with the angle measured before operation and with actual component implanted. The reliability of the registration was further analysed using ten cadaver femora. The mean absolute difference between the measured and navigated neck-shaft angle was 16.3° (0° to 52°). Navigation underestimated the measured neck-shaft angle in 38 patients and the correct implant size in 11. Registration of the cadaver femora tended to overestimate the correct implant size and provided a low level of repeatability in computing the neck-shaft angle.
Applying computer-assisted navigation techniques to total hip and knee arthroplasty
American journal of orthopedics (Belle Mead, N.J.)
Appropriate implant alignment is a major goal of total joint arthroplasty. Obtaining appropriate alignment typically involves making intraoperative decisions in response to visual and tactile feedback. Integrated computer-based systems provide the option of continuous real-time feedback and offer the potential to decrease intraoperative errors while enhancing the surgical learning experience. Computer-assisted orthopedic surgery helps the surgeon perform both intraoperative and postoperative technical audits of implant alignment. Improving implant alignment can be correlated with improved long-term clinical outcomes. However, despite emerging data, many surgeons remain wary of computer-assisted orthopedic surgery.
Clinical Validation of Computer-Assisted Navigation in Total Hip Arthroplasty
Advances in Orthopedics, 2011
A CT-based navigation system is helpful to evaluate the reamer shaft and the impactor position/orientation during unilateral total hip arthroplasty (THA). The main objective of this study is to determine the accuracy of the Navitrack system by measuring the implant's true anteversion and inclination, based on pre-and postoperative CT scans (n = 9 patients). The secondary objective is to evaluate the clinical validity of measurements based on postop anteroposterior (AP) radiographs for determining the cup orientation. Postop CT-scan reconstructions and postop planar radiographs showed no significant differences in orientation compared to peroperative angles, suggesting a clinical validity of the system. Postoperative AP radiographs normally used in clinic are acceptable to determine the cup orientation, and small angular errors may originate from the patient position on the table.
Accuracy of Computer-Navigated Total Hip Arthroplasty
The Journal of Arthroplasty, 2012
Proper acetabular cup orientation is essential in total hip arthroplasty. The purpose of this study was to evaluate the accuracy of a particular imageless computer navigation system in determining cup position. Thirty-nine computer-navigated total hip arthroplasty intraoperative measurements of cup abduction and anteversion were compared with those from follow-up radiographs. Sensitivity, specificity, accuracy, prevalence-adjusted positive value (PPV), and negative predictive value were calculated for both navigation and radiographs. Navigation measurements had high specificity and PPV when assessing cup abduction and anteversion (specificity N90%, PPV N94%). In contrast, the system was not very effective in detecting suboptimal cup position (sensitivity abduction, 50%; anteversion, 33%). Intraoperative navigation readings in the safe zone have high probability of indicating correct placement. However, confirmation of suboptimal cup position intraoperatively requires additional diagnostic methods.
A hybrid CT-free navigation system for total hip arthroplasty
Computer Aided Surgery, 2002
Objective: T o design and evaluate a novel CT-free image-guided surgical navigation system for assisting placement of both acetabular and femoral components in total hip arthroplasty (THA). Materials and Methods: The methodology in this paper is conceptually based on our previous work on CT-free cup placement. For femoral component placement, two patient-specific reference coordinate systems are first defined: One for the pelvis, based on the so-called anterior pelvic plane (APP) concept, and one for the femur, using the center of the femoral head, the posterior condylar tangential line, and the medullary canal axis of the proximal femur. A hybrid method is used for the associated landmark acquisition, which involves percutaneous point-based digitization and bi-planar landmark reconstruction using multiple registered fluoroscopy images. The following clinical parameters are computed in real time: cup inclination and anteversion, antetorsion and vadvalgus of the stem, lateralization, and change in leg length for complete THA. In addition, instrument actions such as reaming, impaction, and rasping are visualized for the surgeon by superimposing virtual instrument representations onto the fluoroscopic images. Results: A laboratory study of computer-assisted measurement of antetorsion and v a d valgus, change in leg length, and lateralization for femoral stem placement demonstrated the high precision of the proposed navigation system. Compared with CT-based measurement, mean deviations of 1.0", 0.6", 0.7 mm, and 1.7 mm were found for antetorsion, d v a l g u s , change in leg length, and lateralization, respectively, with standard deviations of 0.5", 0.5", 0.6 mm, and 0.7 mm, respectively. A pilot clinical evaluation showed that THA could benefit from this newly developed CT-free hybrid system. Conclusions: The proposed CT-free hybrid system promises to increase the accuracy and reliability of "HA surgery. Comp Aid Surg 7:129-145 (2002). Kq wordc navigation; total hip arthroplasty ("HA); stem placement; CT-free; fluoroscopy; computer assisted surgery (CAS) @to02 Wilq-Liss, Inc.
Less outliers in pinless navigation compared with conventional surgery in total knee arthroplasty
Knee Surgery, Sports Traumatology, Arthroscopy, 2013
The aim of this study was to investigate the effectiveness of a new pinless navigation system (Brain-LAB Ò VectorVision Ò Knee 2.5 Navigation System) as an intra-operative alignment check in total knee arthroplasty using conventional cutting jigs. Methods 200 patients who underwent total knee arthroplasty using conventional technique or pinless navigation by a senior surgeon were included in the study and prospectively followed up. Intra-operative readings from the pinless navigation system were recorded, and post-operative long limb radiographic films were taken. The accepted values for normal alignment were 180 ± 3°for Hip-Knee-Ankle Angle and 90 ± 3°for Coronal Femoral-Component Angle or Coronal Tibia-Component Angle. Results There was no difference in the duration of surgery. The mean Coronal Femoral-Component Angle was 89.8 ± 2.0°and 91.3 ± 2.3°in the pinless navigation and conventional group, respectively (p \ 0.001). For Hip-Knee-Ankle Angle, the proportion of outliers was 10 % in the pinless navigation group compared to 26 % in the conventional group (p = 0.005). For Coronal Femoral-Component Angle and Coronal Tibia-Component Angle, the proportion of outliers was 7 and 4 %, respectively, in the pinless navigation group, compared to 22 and 19 % in the conventional group (p = 0.004 and p = 0.001, respectively). The measurements of Coronal Femoral-Component Angle and Coronal Tibia-Component Angle on post-operative radiographic films were similar to intra-operative readings. Conclusions This study showed that pinless navigation is an effective tool for reducing the proportion of outliers, without significantly increasing the duration of surgery. The authors recommend its use in total knee arthroplasty using conventional cutting jigs. Level of evidence III.