Efficacy of a computed tomography-based navigation system for placement of the acetabular component in total hip arthroplasty for developmental dysplasia of the hip

Tsutsui, Takahiko; Goto, Tomohiro; Wada, Keizo; Takasago, Tomoya; Hamada, Daisuke; Sairyo, Koichi

doi:10.1177/2309499017727954

Cited by 25 publications

(16 citation statements)

References 26 publications

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“…11,19 With CT-based navigation, the absolute value of the inclination error was 1.2–2.5°, and the anteversion error was 1.0–2.3°. 12–15 With imageless navigation, the inclination error was 1.6–3.7°, and the anteversion error was 2.9–6.5°. 20–23 Although inferior to the accuracy of CT-based navigation, an inclination error of 3.1° and an anteversion error of 2.8° were achieved with portable navigation; therefore, the same level of accuracy as conventional imageless navigation was achieved.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of accuracy of cup position using portable navigation versus alignment guide in total hip arthroplasty in supine position

et al. 2020

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Background: Accelerometer-based portable navigation systems in supine total hip arthroplasty (THA) have been developed, but there are no reports on the accuracy of cup placement. We aimed to investigate and compare the accuracy of the accelerometer-based portable navigation system versus the acetabular alignment guide placed on the pelvis in THA using the direct anterior approach (DAA). Both devices tracked changes in the pelvic position. Methods: In this single-centre, retrospective study, we reviewed 115 hips in 113 patients who underwent primary THA via the DAA using an accelerometer-based portable navigation system in the supine position (portable navigation group) and 106 hips in 101 patients who underwent THA using an acetabular alignment guide (alignment guide group) as controls. Hips were evaluated postoperatively using computed tomography to measure cup orientation. The accuracy of cup orientation was compared between the 2 groups. Results: Absolute values of inclination error were 3.1° ± 2.2° and 2.9° ± 2.3° ( p = 0.708) in the portable navigation and alignment guide groups and those of anteversion error were 2.8° ± 2.3° and 3.7° ± 2.7°, respectively ( p = 0.005). The number of cups placed within 10° of error was 98.3% and 96.2% in the portable navigation and alignment guide groups, respectively ( p = 0.304). The portable navigation group had significantly more hips (72.2%) placed within a 5° margin of error than did the alignment guide group (56.6%) ( p = 0.016). Conclusion: High accuracy in cup placement was achieved using accelerometer-based portable navigation in supine THA. Using a navigation system may contribute to improved long-term outcomes.

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Section: Discussionmentioning

confidence: 99%

“…It is important to place the cup with accuracy and reproducibility, and there are various devices used for this purpose. Computed tomography (CT)-based navigation has extremely high precision and good long-term outcomes; 11–15 however, it is associated with high costs and is not well established.…”

Section: Introductionmentioning

confidence: 99%

Comparison of accuracy of cup position using portable navigation versus alignment guide in total hip arthroplasty in supine position

et al. 2020

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“…poor component positioning or fixation due to a nonhemispherically prepared socket. Robotic and navigated THA has the potential to be very helpful in cases involving patient obesity, 20 pelvic deformity, and dysplasia, [21][22][23] which have all traditionally presented significant challenges for THA surgeons.…”

Section: Discussionmentioning

confidence: 99%

Does Robotic-Assisted Total Hip Arthroplasty Improve Accuracy of Cup Positioning?

et al. 2019

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Acetabular component malpositioning is a frequent cause of complications in total hip arthroplasty including instability, increased wear, osteolysis, impingement, and revision surgery. Recently, robotics and navigation have been introduced to improve cup positioning in total hip arthroplasty. The purpose of this study was to compare the accuracy of postoperative acetabular component positioning using MAKO robotic-assisted versus manual acetabular component placement. A consecutive series of 100 total hip replacements were performed in 100 patients. The first 50 were performed using manual techniques, while the second 50 were performed using MAKO-guided acetabular component placement. Postoperative anteroposterior pelvis radiographs were used to determine the postoperative anteversion and inclination of the cup relative to the goal of 15 and 45°, respectively. In the manual group, the average anteversion and inclination was 14.3 and 44.2°, respectively, with 28% within 5° and 82% within 10° of the goal alignment, respectively. In the robotic group, the average anteversion and inclination was 15.1 and 45.6°, respectively, with 54 and 88% within 5 and 10° of the goal alignment, respectively. This equated to a statistically significant improvement in the number of acetabular components placed within 5° of the target alignment with the use of robotic guidance (p = 0.0142). From the authors' study, they were able to demonstrate a significant improvement in acetabular component alignment with the use of robotic techniques. Additional studies are needed to demonstrate improvement in clinical outcomes as a result of improved accuracy and precision of acetabular component placement.

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“…High accuracy and reproducibility of cup implantation can be achieved by using a navigation system for cup alignment and positioning even in severe hip dysplasia. 14,15 Detailed 3D preoperative planning and accurate cup placement in individual cases can prevent elevation of the hip centre height more than necessary and avoid lateralised placement of the cup. Moreover, it has been suggested that a hip centre height less than 35 mm above the inter-teardrop line is acceptable from the perspective of postoperative range of motion and less than 30 mm from the standpoint of hip abductor strength in high-hip centre reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Postoperative radiographic evaluation and simulation study for optimal cup placement in high-hip centre total hip arthroplasty

et al. 2019

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Background: Achieving favourable outcomes in high-hip centre reconstruction in hip dysplasia requires the optimal cup height and size, which can provide sufficient bone coverage for stable cup fixation that fits the anteroposterior acetabular rim without increasing the cup height more than necessary. Methods: We retrospectively reviewed 214 patients who underwent primary total hip arthroplasty (THA) and identified 30 hips with Crowe II ( n = 15) or III ( n = 15) developmental dysplasia of the hip (DDH). We measured the cup-centre-edge angle (cup-CE) and the vertical and horizontal distances from the teardrop. In a simulation study, we examined the cup-CE and optimal cup size by changing the cup height in 5-mm increments over a distance of 15–40 mm above the inter-teardrop line using a 3-dimensional template system. Results: Postoperative radiographic evaluation revealed a mean cup-CE of 19.9° in Crowe II hips and 15.2° in Crowe III hips; the respective mean vertical distances were 26.6 mm and 27.6 mm ( p = 0.511). There was no evidence of cup loosening or lateralisation at a minimum of 7 years (7–11 years) follow-up. Simulation showed that the hip centre needed to be elevated to 20 mm to acquire a cup-CE of more than 0°. More than 10° of cup-CE could be expected by elevating the hip centre to 25 mm in both Crowe II and III. Conclusions: Even in severe DDH, a high-hip centre positioned approximately 25 mm superior to the inter-teardrop line was sufficient to achieve optimal bone coverage, which could lead to more secure cup fixation.

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Efficacy of a computed tomography-based navigation system for placement of the acetabular component in total hip arthroplasty for developmental dysplasia of the hip

Abstract: THA using a CT-based navigation system achieved quite high accuracy of cup alignment angles and spatial cup positioning in primary THA for patients with DDH.

Cited by 25 publications

References 26 publications

Comparison of accuracy of cup position using portable navigation versus alignment guide in total hip arthroplasty in supine position

Comparison of accuracy of cup position using portable navigation versus alignment guide in total hip arthroplasty in supine position

Does Robotic-Assisted Total Hip Arthroplasty Improve Accuracy of Cup Positioning?

Postoperative radiographic evaluation and simulation study for optimal cup placement in high-hip centre total hip arthroplasty

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