Use of a novel imageless navigation system reduced fluoroscopy exposure and improved acetabular positioning in anterior approach total hip arthroplasty: a case–control study

Ong, Christian; Chiu, Yu-Fen; Premkumar, Ajay; Valle, Alejandro González Della

doi:10.1007/s00402-022-04520-3

Cited by 11 publications

(4 citation statements)

References 27 publications

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“…Although cost-analyses are multifactorial, surgical time is one component that has been studied in imageless navigation. A study by Ong et al 39 found that there was no difference in surgical time between fluoroscopy and navigated cases in THA with mean surgical times of 89.54 6 14.60 minutes and 82.69 6 11.70 minutes, respectively. However, there is still a need for future studies investigating the cost-effectiveness of imageless navigation and fluoroscopy in THA.…”

Section: Discussionmentioning

confidence: 97%

Fluoroscopy Versus Imageless Optical Navigation in Direct Anterior Approach Total Hip Arthroplasty

Manzo,

Lex,

Rodriguez-Elizalde

et al. 2023

J Am Acad Orthop Surg

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Background: Utilization of the direct anterior approach (DAA) for total hip arthroplasty (THA) has risen in popularity. Accurate implant placement is a critical factor that influences patient outcomes. The goal of this study was to compare the accuracy and precision of fluoroscopy with imageless optical navigation in DAA THA. Methods: This was a cohort study of 640 consecutive primary DAA THAs performed with intraoperative fluoroscopy (n = 300 patients) or imageless optical navigation (n = 304 patients). Accuracy was compared by measuring acetabular cup inclination, anteversion, and leg-length discrepancy (LLD). The proportion of implants placed within the Lewinnek safe zone and those placed within a more precise target of 40 ± 5° inclination and 20 ± 5° anteversion was evaluated. Results: According to the Lewinnek criteria, there was no difference in the percentage of implants placed within both inclination and anteversion targets (fluoroscopy: 90.3%; navigation: 88.8%, P = 0.519). Using the more precise targets, navigation increased the implants positioned correctly for both inclination and anteversion (fluoroscopy: 50.3%; navigation: 65.6%, P < 0.001). Navigation increased the proportion of implants positioned within the target anteversion zone (fluoroscopy: 71.3%; navigation: 83.8%, P < 0.001) but not inclination (fluoroscopy: 71.9%; navigation: 76.9%, P = 0.147). The mean LLD was higher with the use of fluoroscopy compared with navigation (5.5 mm, standard deviation: 4.1; 4.6 mm, SD: 3.4, P < 0.005). No difference in dislocation rate was observed (P = 0.643). Conclusion: Both fluoroscopy and imageless optical navigation demonstrated accurate acetabular implant positioning during DAA THA. Navigation was more precise and associated with improved acetabular anteversion placement and restoration of LLD. Navigation is an accurate alternative to fluoroscopy with decreased radiation exposure.

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Section: Discussionmentioning

confidence: 97%

Fluoroscopy Versus Imageless Optical Navigation in Direct Anterior Approach Total Hip Arthroplasty

Manzo,

Lex,

Rodriguez-Elizalde

et al. 2023

J Am Acad Orthop Surg

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“…Imageless navigation systems can reduce fluoroscopy exposure time and showed more cups with inclination within the safe zone and a reduced number of outliers compared to non-navigated THA (OrthoPilot ® , B. Braun Aesculap, Tuttlingen, GER and Naviswiss Hip miniature imageless navigation platform, Naviswiss AG, Bruss, CHE) [ 87 , 88 ]. Comparing navigation derived intraoperative angles (Stryker Navigation System, Stryker, Kalamazoo, MI, USA) to postoperative CT scans, the cups were placed within a maximum deviation of 10° in 97% for inclination and 77% for abduction [ 89 ].…”

Section: Discussionmentioning

confidence: 99%

Achieving Precise Cup Positioning in Direct Anterior Total Hip Arthroplasty: A Narrative Review

Streck

Boettner

2023

Medicina

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Malpositioned implants in total hip arthroplasty are associated with impingement, increased wear, and dislocations, thus precise cup positioning is crucial. However, significant deviations between targeted and actually achieved cup positions have been found even in patients operated by experienced surgeons. When aiming for higher accuracy, various methods based on freehand positioning lead by anatomic landmarks, C-arm fluoroscopy, imageless navigation, or robotic-assisted-surgery have been described. There is a constant development of new products aiming to simplify and improve intraoperative guidance. Both the literature and expert opinions on this topic are often quite controversial. This article aims to give an overview of the different methods and systems with their specific advantages and potential pitfalls while also taking a look into the future of cup positioning in anterior hip replacements.

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“…The Naviswiss (Naviswiss AG, Brugg, Switzerland) is a portable imageless navigation device equipped with an infrared stereo camera and an inertial measurement unit to facilitate implant positioning intraoperatively. The accuracy of the system has been reported with a <3°mean absolute error for cup inclination and anteversion when tested in the supine position via an anterolateral THA approach (Hasegawa et al, 2022), and <3.5°for cup orientation using a direct anterior THA approach with fluoroscopy (Ong et al, 2022). However, clinical data for the system has not been reported in Australia, and there is a dearth of information regarding femoral offset and leg length discrepancy.…”

Section: Introductionmentioning

confidence: 99%

CT validation of intraoperative imageless navigation (Naviswiss) for component positioning accuracy in primary total hip arthroplasty in supine patient position: A prospective observational cohort study in a single-surgeon practice

Scholes¹,

Ireland²,

Schwaegli

2023

Preprint

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The aim of this study was to report on the validity of the Naviswiss handheld image-free navigation device for accurate measurement of THA component positioning intraoperatively, in comparison with the three-dimensional (3D) reconstruction of computed tomography (CT) images as gold standard. Methods: A series of patients presenting to a single-surgeon clinic with end-stage hip osteoarthritis received primary hip arthroplasty with anterolateral muscle-sparing surgical approach in the supine position. Imageless navigation was applied during the procedure with bone-mounted trackers applied to the greater trochanter and ASIS. Patients underwent routine CT scans before and after surgery and these were analysed using three-dimensional reconstruction to generate cup orientation, offset and leg length changes which were compared to the intraoperative measurements provided by the navigation system. Estimates of agreement between the intraoperative and image-derived measurements were assessed with and without correction for bias and declared cases with potential measurement issues. Results: The mean difference between intraoperative and postoperative CT measurements was within 2° for angular measurements and 2mm for leg length. Absolute differences for the two indices were within 5° and 4mm. Mean bias was 1.9 - 3.6° underestimation for cup orientation and up to 2mm overestimation for leg length change, but absolute thresholds of 10° and 10mm were not exceeded by 95% limits of agreement (LOA), especially after correction for bias. Four cases (12%) were declared intraoperatively for issues with fixation on the greater trochanter. Inclusion of these cases generated acceptable accuracy overall and their omission failed to improve between-case variability in accuracy or LOA for both offset and leg length. Conclusions: The accuracy of the Naviswiss system applied during primary THA in supine patient position and anterolateral surgical approach falls within clinically acceptable recommendations for acetabular cup placement, femoral offset and length length. With refinements to surgical technique to adapt to the navigation hardware, the system could be further improved with regression-based bias correction.

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Use of a novel imageless navigation system reduced fluoroscopy exposure and improved acetabular positioning in anterior approach total hip arthroplasty: a case–control study

Cited by 11 publications

References 27 publications

Fluoroscopy Versus Imageless Optical Navigation in Direct Anterior Approach Total Hip Arthroplasty

Fluoroscopy Versus Imageless Optical Navigation in Direct Anterior Approach Total Hip Arthroplasty

Achieving Precise Cup Positioning in Direct Anterior Total Hip Arthroplasty: A Narrative Review

CT validation of intraoperative imageless navigation (Naviswiss) for component positioning accuracy in primary total hip arthroplasty in supine patient position: A prospective observational cohort study in a single-surgeon practice

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