Computer-assisted navigation as a diagnostic tool in revision total hip arthroplasty: A case report

Abstract

Revision total hip arthroplasty is a costly procedure accounting for approximately 14% of all hip arthroplasties. Compounding the cost considerations is the potential for serious injury to the patient when removing existing components. Such injury can result in not only increased morbidity but also dramatically increased costs. The use of computer-assisted navigation in revision total hip arthroplasty, while relatively uncommon, offers surgeons the ability to measure component position and orientation intraoperatively, thus allowing them the opportunity to modify their surgical plan, with the potential for decreasing both costs and iatrogenic injury. Here, we report a case of revision total hip arthroplasty where the use of computer-assisted navigation as a diagnostic tool allowed for intraoperative alterations in surgical plan and resulted in improved post-operative outcomes.

Intraoperative measurement of acetabular component position using imageless navigation during revision total hip arthroplasty

“…This has been demonstrated in 2 case reports where data provided by the navigation tool were integral to intraoperative decision-making regarding cup revision versus retention. 19,20 We observed a higher discrepancy between navigationrecorded and CT-measured values in our study (5.2º [SD 4.0º] for inclination and 4.8º [SD 5.4º] for anteversion) in comparison with previous studies involving navigated primary THA. Ybinger and colleagues reported on 37 navigated primary THAs and noted the mean difference between navigation and CT measurements to be 3.5º (SD 4.4º) for inclination and 6.5º (SD 7.3º) for anteversion.…”

“…This has been demonstrated in 2 case reports where data provided by the navigation tool were integral to intraoperative decision-making regarding cup revision versus retention. 19 , 20…”

Use of Imageless Navigation in the Conversion of Hip Fusion to Total Hip Arthroplasty

“…With an arthroplasty procedure on the contralateral side pending, the use of navigation on the arthrodesis side allowed us to prepare the leg such that, following the contralateral THA procedure, the patient would be left with equalised leg lengths and minimal if any leg length discrepancy. This ability to closely monitor leg length and accurately equalise leg lengths has been noted in other conditions where substantial leg length discrepancies of >3 cm exist, e.g., Legg-Calve-Perthes disease [ 10 ], although to our knowledge, this is the first documented use of navigation in a hip fusion takedown procedure.…”

“…While careful pre-operative planning may mitigate these concerns, more advanced technologies such as computer-assisted navigation provide more accurate information and may offer a more reliable avenue for improved patient outcomes. The technology we utilise during THA has been demonstrated to be safe and accurate in clinical studies [ 6 , 7 ], as well as in assisting with challenging cases such as Legg-Calve-Perthes disease [ 8 ] and complex revision THA [ 9 , 10 ]. As such, surgeons may find benefit in leveraging the ability of navigation to provide accurate, real-time data to improve acetabular and femoral component positioning in arthrodesis conversion.…”

Computer-Assisted Navigation for Complex Revision of Unstable Total Hip Replacement in a Patient With Post-traumatic Arthritis

“…In another example, CAN was used to identify the acetabulum and femoral neck cut level after a patient was converted from a hip arthrodesis to a THA [ 26 ]. CAN may also be used as a diagnostic tool to help identify malpositioning of previously placed components [ 27 ]. In cases of osteopetrosis where the femoral canal may be absent, CAN may be useful with femoral canal preparation and implant placement [ 28 ].…”