Imageless Navigation Accurately Measures Component Orientation during Total Hip Arthroplasty: A Comparison with Postoperative Radiographs

2019 ◽  
Vol 03 (01) ◽  
pp. 053-058 ◽  
Author(s):  
Wayne Paprosky ◽  
Jeffrey Muir ◽  
Jennifer Sostak
Keyword(s):  
Revision Surgery ◽  
Surgical Navigation ◽  
Absolute Difference ◽  
Computer Assisted ◽  
Leg Length ◽  
Acetabular Cup ◽  
Mean Absolute Difference ◽  
Assisted Navigation ◽  
Navigation Tool ◽  
The Mean

AbstractAccurate placement of acetabular components during total hip arthroplasty (THA) is paramount in ensuring long-term stability. Current methods for monitoring cup position and leg length intraoperatively are lacking due to susceptibility to inaccuracy or prohibitive cost. The purpose of this study was to evaluate the ability of an imageless surgical navigation tool to accurately measure acetabular cup inclination and leg length differential during THA. The authors retrospectively reviewed the medical records of patients who underwent primary or revision THA (posterolateral approach) at their facility with the assistance of computer-assisted navigation between February 2016 and March 2017. Pre- and postoperative radiographs were analyzed for leg length discrepancies and acetabular cup inclination. Radiographic values were compared with intraoperative values provided by the surgical navigation tool. The mean difference between inclination as measured from radiographs (44.4 ± 5.9 degrees) and navigation (43.0 ± 4.4 degrees) was −1.4 ± 4.6 degrees (mean absolute difference: 3.8 ± 2.8 degrees). Seventy-seven percent (48/62) of navigation measurements were within 5 degrees of radiographs. The mean difference between radiographic (7.39 ± 5.67 mm) and navigation (7.44 ± 4.81 mm) measurements of leg length differential was 0.29 ± 4.20 mm (mean absolute difference: 3.20 ± 2.69 mm). Navigation tool measurements were within 5 mm of radiographic values in 85% (39/46) of cases. At 90 days, idiopathic dislocation requiring revision surgery occurred in one patient (1.2%) with one additional patient (1.2%) requiring revision surgery due to a traumatic injury (fall). Computer-assisted navigation provided accurate intraoperative data regarding inclination and changes in leg length and was associated with a low rate of dislocation and revision surgery at 90-day follow-up.

scholarly journals Trends In Cup Position Utilizing Computer-Assisted Navigation During Total Hip Arthroplasty

10.29007/jn8x ◽  
2019 ◽  
Author(s):  
Rachel Mays ◽  
Jessica Benson ◽  
Jeffrey Muir ◽  
Peter White ◽  
Morteza Meftah
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Lateral Approach ◽  
Computer Assisted ◽  
Acetabular Cup ◽  
Assisted Navigation ◽  
Total Hip ◽  
Current Mass ◽  
The Mean ◽  
Cup Position

Proper positioning of the acetabular cup deters dislocation after total hip arthroplasty (THA). The concept of a safe zone (SZ) for acetabular component placement was first characterized by Lewinnek et al. and furthered by Callanan et al. The SZ concept remains widely utilized and accepted in contemporary THA practice; however, components positioned in this SZ still dislocate. This study sought to characterize current mass trends in cup position identified across a large study sample of THA procedures completed by multiple surgeons. This retrospective, observational study reviewed acetabular cup position in 1,236 patients who underwent THA using computer-assisted navigation between July 2015 and November 2017. The overall mean cup position of all recorded cases was 21.8° (±7.7°, 95% CI = 6.7°, 36.9°) of anteversion and 40.9° (±6.5°, 95% CI = 28.1°, 53.7°) of inclination. For both anteversion and inclination, 65.5% (809/1236) of acetabular cup components were within the Lewinnek SZ and 58.4% (722/1236) were within the Callanan SZ. Acetabular cups were placed a mean of 6.8° of anteversion (posterior/lateral approach: 7.0°, anterior approach: 5.6°) higher than the Lewinnek and Callanan SZs whereas inclination was positioned 0.9° higher than the reported Lewinnek SZ and 3.4° higher than the Callanan SZ. Our data shows that while the majority of acetabular cups were placed within the traditional SZs, the mean anteversion orientation is considerably higher than those suggested by the Lewinnek and Callanan SZs. The implications of this observation warrant further investigation.

scholarly journals Minimal Increase in Total Hip Arthroplasty Surgical Procedural Time with the Use of a Novel Surgical Navigation Tool

2018 ◽  
Vol 12 (1) ◽  
pp. 389-395 ◽  
Author(s):  
Alexander Christ ◽  
Danielle Ponzio ◽  
Michael Pitta ◽  
Kaitlin Carroll ◽  
Jeffrey M. Muir ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Navigation ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Total Hip ◽  
Navigation Tool ◽  
Significant Difference ◽  
Procedural Time ◽  
The Impact

Background: Computer-assisted navigation has proven effective at improving the accuracy of component placement during Total Hip Arthroplasty (THA); however, the material costs, line-of-site issues and potential for significant time increases have limited their widespread use. Objective: The purpose of this study was to investigate the impact of an imageless navigation device on surgical time, when compared with standard mechanical guides. Methods: We retrospectively reviewed prospectively collected data from 61 consecutive primary unilateral THA cases (posterior approach) performed by a single surgeon. Procedural time (incision to closure) for THA performed with (intervention) or without (control) a computer-assisted navigation system was compared. In the intervention group, the additional time associated with the use of the device was recorded. Mean times were compared using independent samples t-tests with statistical significance set a priori at p<0.05. Results: There was no statistically significant difference between procedural time in the intervention and control groups (102.3±28.3 mins vs. 99.1±14.7 mins, p=0.60). The installation and use of the navigation device accounted for an average of 2.9 mins (SD: 1.6) per procedure, of which device-related setup performed prior to skin incision accounted for 1.1 mins (SD: 1.1) and intra-operative tasks accounted for 1.6 mins (SD: 1.2). Conclusion: In this series of 61 consecutive THAs performed by a single surgeon, the set-up and hands-on utilization of a novel surgical navigation tool required an additional 2.9 minutes per case. We suggest that the intraoperative benefits of this novel computer-assisted navigation platform outweigh the minimal operative time spent using this technology.

scholarly journals Periacetabular Osteotomy Performed with Imageless Computer-Assisted Navigation: Case Report

2019 ◽  
Vol 2 (1-3) ◽  
pp. 33-39
Author(s):  
Atul F. Kamath ◽  
Rachel R. Mays
Keyword(s):  
Surgical Navigation ◽  
Periacetabular Osteotomy ◽  
Computer Navigation ◽  
Developmental Dysplasia ◽  
Computer Assisted ◽  
Developmental Hip Dysplasia ◽  
Assisted Navigation ◽  
First Case ◽  
Acetabular Fragment ◽  
Pao Surgery

Periacetabular osteotomy (PAO) is an effective surgical treatment for developmental hip dysplasia. The goal of PAO is to reorient the acetabulum to increase acetabular coverage of the femoral head, as well as to reduce contact pressures within the hip joint. The primary challenge of PAO is to accurately achieve the desired acetabular fragment orientation, while maximizing containment and congruency. As key parts of the procedure are performed out of direct field of view of the surgeon, combined with this challenge of precise spatial orientation, there is a potential role for technologies such as surgical navigation. Adjunctive technology may provide information on the orientation of repositioned acetabulum and may offer a useful assist in performing PAO. Here, we present a case of developmental dysplasia of the hip treated via PAO with the addition of an imageless computer navigation device. Surgery was successful, and, at 3 months after procedure, the patient was progressing well. To our best knowledge, this is the first case using imageless computer-assisted navigation in PAO surgery.

Computer-assisted navigation is beneficial both in primary and revision surgery with modular rotating-hinge knee arthroplasty

2014 ◽  
Vol 24 (1) ◽  
pp. 64-73 ◽  
Author(s):  
Björn G. Ochs ◽  
Anna J. Schreiner ◽  
Peter M. de Zwart ◽  
Ulrich Stöckle ◽  
Christoph Emanuel Gonser
Keyword(s):  
Knee Arthroplasty ◽  
Revision Surgery ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Rotating Hinge ◽  
Rotating Hinge Knee

Computer Assisted Navigation Systems for Hip and Knee Reconstructive Surgery: Evaluation of Traditional Surgical Technique

2001 ◽  
Author(s):  
Anthony M. DiGioia ◽  
Frederic Picard ◽  
Branislav Jaramaz ◽  
David Sell ◽  
James C. Moody ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Patient Outcomes ◽  
Reconstructive Surgery ◽  
Surgical Navigation ◽  
Surgical Techniques ◽  
Measurement Tool ◽  
Computer Assisted ◽  
Navigation Systems ◽  
Assisted Navigation ◽  
Surgical Navigation System

Abstract In this paper we describe a surgical navigation system named HipNav (Hip-Navigation) for THR and KneeNav (Knee-Navigation) for TKR with an emphasis on using these systems as a real time intraoperative measurement tool (these enabling technologies are the surgical toolbox of the future). This approach will permit the direct comparison of patient outcomes with measurable surgical techniques.

scholarly journals Modifying the sternopleural hair pattern in Drosophila by selection

1961 ◽  
Vol 2 (1) ◽  
pp. 158-160 ◽  
Author(s):  
E. C. R. Reeve
Keyword(s):  
Drosophila Melanogaster ◽  
Inbred Lines ◽  
The Other ◽  
Absolute Difference ◽  
Mean Absolute Difference ◽  
Quantitative Characters ◽  
Genetic Behaviour ◽  
The Mean ◽  
Left Right Asymmetry ◽  
Two Sides

Two apparently very similar quantitative characters, the numbers of hairs on the sternopleural region and on the abdominal sternites of Drosophila melanogaster, show unexpected differences in their genetic behaviour. In particular, the amount of left-right asymmetry of the sternopleurals (i.e. the mean absolute difference in numbers of hairs on the two sides of the fly) tends to decline when inbred lines are intercrossed, and can be both increased and decreased by straightforward selection; the corresponding index for the sternite hairs—the uncorrelated variance between two sternites, or the mean absolute difference between the numbers of hairs on each—appears, on the other hand, to be susceptible neither to selection nor to change when inbred lines are crossed (Mather, 1953; Reeve & Robertson, 1954; Reeve, 1959).

scholarly journals Accuracy of Image-less Navigation for Functional Cup Positioning in Total Hip Arthroplasty

10.29007/3lbz ◽  
2019 ◽  
Author(s):  
Morteza Meftah ◽  
Vinnay Siddappa ◽  
Jeffery Muir ◽  
Peter White
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Weight Bearing ◽  
Safe Zone ◽  
Computer Assisted ◽  
Acetabular Cup ◽  
Assisted Navigation ◽  
Total Hip ◽  
Significant Difference ◽  
Cup Positioning

Computer-assisted navigation has the potential to improve the accuracy of cup positioning during total hip arthroplasty (THA) and prevent leg length discrepancy (LLD). The purpose of this study was to compare acetabular cup position and post- operative LLD after primary THA using posterolateral approach. Between August 2016 to December 2017, 57 THAs using imageless navigation were matched with 57 THA without navigation, based on age, gender and BMI. Post-operative weight-bearing radiographs were assessed using for anteversion, inclination and LLD. Goal for functional cup placement was 40° inclination and 20° anteversion based on preoperative weight bearing pelvic images. Functional LLD was measured as compared to pre- operative radiographs and contralateral side. Proportion of cups within Lewinnek’s safe zone, proximity to a pre-operative target of and the LLD &gt;5 mm was assessed. The mean age was 54.9 ± 9.6 years (30 – 72) and 57.6 ± 12.5 years (20 – 85) in control and navigated groups, respectively. Mean cup orientation in the navigated group was 20.6°± 3.3° (17 - 25) of anteversion and 41.9°± 4.8° (30 - 51) of inclination, vs. 25.0°± 11.1° (10 - 31) and 45.7°± 8.7° (29 – 55) in control group, where were statistically significant (p=0.005 and p=0.0001), respectively. In the navigated group, significantly more acetabular cups were placed within Lewinnek’s safe zone (anteversion: 78% vs. 47%, p=0.005; inclination: 92% vs. 67%, p=0.002). There was no significant difference in mean LLD in navigation and control groups (3.1 ± 1.5 mm vs. 4.6 ± 3.4 mm, p=0.36), although fewer LLDs &gt;5 mm were reported in the navigated group (7.1%) than in controls (31.4%, p=0.007). The use of this image-less computer-assisted navigation improved the accuracy with which acetabular cup components were placed and may represent an important method for limiting post-operative complications related to cup malpositioning and LLD.

Double-tapered conical taper in primary and revision surgery: rationale and short-term follow-up

2018 ◽  
Vol 28 (2_suppl) ◽  
pp. 73-77
Author(s):  
Loris Perticarini ◽  
Mario Mosconi ◽  
Marta Medetti ◽  
Laura Caliogna ◽  
Francesco M Benazzo
Keyword(s):  
Revision Surgery ◽  
Developmental Dysplasia ◽  
Modular System ◽  
Harris Hip Score ◽  
Metastatic Tumour ◽  
Leg Length ◽  
Short Term ◽  
Femoral Shortening ◽  
The Mean

Background: The new double-conical tapered stem is a novel cementless modular system, which is indicated for both primary and revision surgeries. It has been designed with different angles at the proximal (5°) and distal sections (1° 36’) in order to obtain optimal fixation by proximal and distal fit and fill of the femoral canal. Aim: The aim of this prospective study was to evaluate the short-term clinical and radiographic outcomes of primary and revision hip surgery with the new double-conical stem. Methods: 61 stems were implanted (December 2013 to September 2016) in 42 cases of primary and in 19 cases of revision surgery. The mean age of patients was 64.7 (17–94; standard deviation [SD] 21.9) years. Results: The mean body mass index of the patients was 24.6 (17–34.6). In 3 cases of developmental dysplasia of the hip we performed femoral shortening osteotomy. The mean follow-up was 26 (8–40) months. 3 patients died due to causes unrelated to surgery. Postoperative complications included 3 hip dislocations, 2 infections and 1 case of stem explant for metastatic tumour. For all other cases, at the last follow-up radiographs showed no loosening, no radiolucent lines nor subsidence. The mean Harris Hip Score significantly improved from 45 (range 35–58) preoperatively to 87 (range 75–94). Leg length discrepancy was found in 10% of cases but never >1 cm. Conclusions: Radiographic analysis showed the bone-stem contact full at 2 levels of taper. The double-tapered prosthetic stem can therefore be usefully employed both in primary and in revision surgeries.

Reliability of Cup Position in Navigated Tha in the Lateral Decubitus Position Using the ‘Flip Technique’

2011 ◽  
Vol 21 (6) ◽  
pp. 700-705 ◽  
Author(s):  
Alessandro Carcangiu ◽  
Carmelo D'Arrigo ◽  
Domenico Topa ◽  
Raffaella Alonzo ◽  
Attilio Speranza ◽  
...  
Keyword(s):  
Supine Position ◽  
Lateral Decubitus Position ◽  
Computer Assisted ◽  
Orientation Data ◽  
Assisted Navigation ◽  
Imageless Navigation ◽  
Significant Difference ◽  
Lateral Decubitus ◽  
The Mean ◽  
Navigation Software

Malpositioning of the acetabular component in total hip arthroplasty (THA) increases the risk of dislocation, reduces the range of motion and may contribute to bearing surface wear. During computer assisted navigation, the anterior pelvic plane is registered intraoperatively by percutaneous palpation, but this may be unreliable. The aim of our study was to evaluate the reliability of imageless navigation in acetabular positioning employing data acquisition in the supine position and surgery in the lateral position (‘flip technique’). We report 24 patients affected by primary osteoarthritis undergoing THA in which implants were placed with a conventional free-hand technique using the acetabular transverse ligament for cup orientation. For imageless navigation we used Orthopilot-Aesculap software. All patients had a postoperative computed tomography (CT) scan at three months, using previously validated dedicated software for cup orientation. Data collected using navigation software were compared with CT measurements. The mean acetabular inclination and anteversion recorded intra-operatively using navigation software were respectively 41°5’ (SD: 9.61) and 9°5’ (SD: 4.01) respectively. The mean inclination and anteversion calculated post-operatively by the CT based image software were 44°2’ (SD 5.83) and 14°4’ (SD 6.42) respectively. There was a statistically significant difference between the anteversion values (p=0.04). Therefore, the acquisition of parameters in the supine position with surgery performed in the lateral decubitus position creates unreliable data concerning cup anteversion using an imageless navigation system, and therefore the ‘flip technique’ cannot be recommended.

scholarly journals Predictability of implants size in Robotic Surgery for Total Knee and hip Replacement Arthroplasty

10.29007/wn1n ◽  
2020 ◽  
Author(s):  
Kamal Deep ◽  
Frederic Picard ◽  
Shoaib Iqbal
Keyword(s):  
Robotic Surgery ◽  
Hip Replacement ◽  
Computer Assisted ◽  
Acetabular Cup ◽  
Joint Replacements ◽  
Assisted Navigation ◽  
Replacement Arthroplasty ◽  
Implant Size ◽  
Operative Planning ◽  
Total Knee

Accuracy of implantation using computer assisted navigation and robotic total knee replacement arthroplasty (TKR) and total hip replacement (THR) has been proven. Templating the pre-operative radiographs has become standard. This gives an insight into the pre op planning and the sizes most likely to be used. This helps to reduce the inventory for storage of implants and cost. While the templating of radiographs has been helpful, implant sizes prediction remains less than desirable. Aim of present study was to look at the predictability of implant sizes in CT planning for robotic surgery. 30 MAKO robotic joint replacements were performed (15TKR/15THR) with pre op CT scans for implant size. For TKR, the sizes used were mean 5 in femur and tibia (SD1 and range 3-7). In tibia, size used was same as predicted. In the femur in two cases the size was reduced by one to balance the gaps. Insert thickness was increased by one size in 4 cases. For THR, the acetabular cup, femur, head diameter and offset were predicted 100%. The neck length had to be changed in some cases by up to two sizes. for balance/stability. In conclusion the CT scan pre-operative planning for MAKO robotic knee joint replacement can predict 100% times the size of tibia, within one size of femur and insert for TKR. These figures are better than published predictability of templates of plain radiographs where implant size was predicted 42% for femoral and 37% acetabular components while 87% of the femoral components and 78% of the acetabular cups were accurate within one size up and down.

Sign in / Sign up

Export Citation Format

Share Document