Fluoroscopy and Imageless Navigation Enable an Equivalent Reconstruction of Leg Length and Global and Femoral Offset in THA

Weber, Markus; Woerner, Michael; Springorum, R.; Sendtner, Ernst; Hapfelmeier, Alexander; Grifka, Joachim; Renkawitz, Tobias

doi:10.1007/s11999-014-3740-5

Cited by 47 publications

(42 citation statements)

References 4 publications

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“…Consequently, each of the corresponding hypotheses was tested on a Bonferroni-adjusted, two-sided 5%/2 = 2.5% significance level. Owing to the lack of data regarding psoas impingement, we used previous results of navigationguided biomechanical leg length and offset reconstruction and conservatively set the effect size to 0.6 [24]. Based on these considerations, a sample size of 45 in each group achieved a power of 80% using two-sample t-tests (nQuery Advisor 7.0; Statistical Solutions Ltd, Cork, Ireland).…”

Section: Methodsmentioning

confidence: 99%

“…Thus, observation of a cup overhang above the anterior acetabular rim as commonly performed during THA might be compromised. In contrast, imageless navigation systems without the need for preoperative or intraoperative image acquisition and exposure to radiation have been reported to increase precision in positioning the acetabular component, achieve leg length and offset reconstruction, and prevent impingement [19,24]. The current study is a reanalysis of data from a randomized controlled trial [19].…”

Section: Introductionmentioning

confidence: 97%

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Navigation is Equal to Estimation by Eye and Palpation in Preventing Psoas Impingement in THA

Weber

Woerner

Messmer

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Iliopsoas tendon impingement is one possible reason for persistent groin pain and diminished functional outcome after THA. So far, estimation by eye and palpation is the standard procedure to intraoperatively assess the distance of the cup to the anterior rim. However, novel technologies such as imageless navigation enable intraoperative measurements of the cup in relation to the psoas tendon and bony landmarks. Questions/purposes We asked whether psoas impingement (1) can be reduced using imageless navigation compared with the standard technique and (2) is associated with specific patient characteristics. Furthermore, we investigated (3) if anterior cup protrusion (overhang) is associated with lower outcome scores for pain and function.Methods The current study is a reanalysis of data from a randomized controlled trial evaluating navigation for THA; 135 patients were randomized for surgery with or without the use of imageless navigation. The risk for anterior protrusion of the cup above the acetabular rim and thus potential psoas impingement, defined as an overhang of the cup above the anterior acetabular rim as measured on postoperative CT, was either controlled with the help of navigation or standard control by eye and palpation intraoperatively. Postoperatively, the anterior protrusion of the cup above the acetabular rim was measured on three-dimensional (3-D) CT by a blinded, external institute. In addition to patient-related outcome measures, the Harris hip score, Hip disability and Osteoarthritis Outcome Score, and EuroQol were obtained 1 year postoperatively. Altogether 123 data sets were available for primary analysis and 115 were available for 1-year followup. Results There was no difference, with the numbers available, between the navigated and the control groups in terms of the mean distance of the cup below the anterosuperior acetabular rim (3.9 mm; À5.3 to 12.6 mm versus 4.4 mm; À7.9 to 13.7 mm; p = 0.72) or the anteroinferior acetabular rim (4.7 mm; À6.2 to 14.8 mm versus 4.2 mm; À7.1 to 16.3 mm; p = 0.29). There was no difference, with the numbers available, in terms of the proportion of cups with anterior overhang (7%, four of 57 versus, 15%, 10 of 66; p = 0.16), respectively. After controlling for potential confounding variables such as cup inclination, cup size, patient age, BMI, stage of arthritis, and length of skin incision, we found cup anteversion (hazard ratio [HR], 0.87; 95% CI, 0.81-0.93; p \ 0.001) and female sex (HR, 3.88; 95% CI, 1.01-14.93; p = 0.049) were associated with a propensity to potential psoas impingement. With the numbers available, there were no differences observed in

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Navigation is Equal to Estimation by Eye and Palpation in Preventing Psoas Impingement in THA

Weber

Woerner

Messmer

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…Most studies that entail a comparison to conventional implantation show similar values with respect to leg length equalisation and the reconstruction of the offset. 13 Meta-analyses comparing navigation and freehand positioning were only able to show an improved accuracy of the implant positioning and a reduction in the number of outliers. 51, 52 In the debate about the practicality of navigation in primary total hip arthroplasty, it is not only purely biomechanical sophistication with statistically significant differences that needs to be discussed – its significance in terms of clinical outcome as well as subjective patient satisfaction is more critical.…”

Section: Limitations and Criticisms Of Navigationmentioning

confidence: 99%

“…40 The same was seen in another study, in which the global or femoral offset was able to be reconstructed within 8 mm in 98% of cases. 13 …”

Section: Acetabular and Femoral Offsetmentioning

confidence: 99%

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What do we get from navigation in primary THA?

et al. 2016

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Navigation in primary total hip arthroplasty has a history of over 20 years. During this process, imageless computer navigation can be particularly helpful in optimally restoring the hip’s biomechanics. This involves the accurate placement of the acetabular component with the determination of the anteversion and abduction, whereby the navigated femur-first technique also allows for a calculation of the combined anteversion. Additional critical parameters such as the reconstruction of the rotation centre, as well as the femoral and acetabular offset, can also be optimally adjusted. Last but not least, an intra-operative evaluation and equalisation of the leg length is possible.Nonetheless, the disadvantages of this surgical technique in terms of the high costs in the acquisition and preservation of the necessary devices, as well as the longer operation time, must be taken into account. However, economic aspects are not the only thing preventing widespread use of the navigation technique. Determining the plane of reference (APP) for the optimal orientation of the implants is based on palpation of the bony landmarks – and this is influenced by the thickness of the soft tissue layer. Furthermore, the experience of the surgeon constitutes a variable that influences the accuracy of navigation.In summary, hip navigation certainly offers an interesting technique for the optimisation of total hip arthroplasty with reconstruction of proper biomechanics. At the same time, there is currently a lack of high-quality randomised controlled long-term trials that evaluate the clinical advantage for the patients, together with cost utility and survival rates.Cite this article: Renner L, Janz V, Perka C, Wassilew GI. What do we get from navigation in primary THA? EFORT Open Rev 2016;1:205-210. 10.1302/2058-5241.1.000034.

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A review of computer‐assisted orthopaedic surgery systems

Wang

Shang

et al. 2020

Robotics Computer Surgery

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Background: Computer-assisted orthopaedic surgery systems have great potential, but no review has focused on computer-assisted surgery systems for the spine, hip, and knee. Methods: A systematic search was performed in Web of Science and PubMed. We searched the literature on computer-assisted orthopaedic surgery systems from 2008 to the present and focused on three aspects of systems: training, planning, and intraoperative navigation. Results and discussion: In this review study, we reviewed 34 surgical training systems, 31 surgical planning systems, and 41 surgical navigation systems. The functions and characteristics of the surgical systems were compared and analysed, and the current concerns about and the impact of the surgical systems on doctors and surgery were clarified. Conclusion: Computer-assisted orthopaedic surgery systems are still in the development stage. Future surgical training systems should include synthetic models with patient anatomy. Surgical planning systems with automatic planning should be developed, and surgical navigation systems with multimodal fusion, robotic assistance and imaging should be developed.

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Fluoroscopy and Imageless Navigation Enable an Equivalent Reconstruction of Leg Length and Global and Femoral Offset in THA

Abstract: Intraoperative fluoroscopy and imageless navigation seem equivalent in accuracy and precision to reconstruct leg length and global and femoral offset during MIS THA with the patient in the lateral decubitus position.

Cited by 47 publications

References 4 publications

Navigation is Equal to Estimation by Eye and Palpation in Preventing Psoas Impingement in THA

Navigation is Equal to Estimation by Eye and Palpation in Preventing Psoas Impingement in THA

What do we get from navigation in primary THA?

A review of computer‐assisted orthopaedic surgery systems

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