Accuracy of imageless navigation for functional cup positioning and restoration of leg length in total hip arthroplasty: a matched comparative analysis

Equalization of biomechanical differences is a major goal in total hip arthroplasty (THA). In the current study we compared the accuracy of restoring leg length and offset using imageless navigation with an osseous fixed pin to a femoral pinless device in 97 minimally invasive THAs through an anterolateral approach in the lateral decubitus position. Leg length and offset differences were evaluated on magnification-corrected radiographs by a blinded observer. A postoperative mean difference of -0.9 mm (95% CI -2.8 mm to 1.1 mm, p = 0.38) between pinless navigation and navigation with a fixed pin was observed for leg length and that of -2.4 mm (95% CI -3.9 mm to -0.9 mm, p = 0.002) was observed for offset, respectively. The number of patients with a residual difference below 5 mm after THA was higher if using a fixed pin than in pinless navigation for both leg length (98.2%, 54/55 to 50.0%, 21/42, p < 0.001) and offset (100.0%, 55/55 to 71.4%, 30/42, p < 0.001). Imageless navigation is a feasible method in intraoperative control of leg length and offset in minimally invasive THA. The use of pins fixed to the bone has a higher precision than pinless devices. This trial is registered with DRKS00000739.

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Validity of intraoperative imageless navigation (Naviswiss) for component positioning accuracy in primary total hip arthroplasty: protocol for a prospective observational cohort study in a single-surgeon practice

BMJ Open ◽

10.1136/bmjopen-2020-037126 ◽

2020 ◽

Vol 10 (10) ◽

pp. e037126

Author(s):

Nalan Ektas ◽

Corey Scholes ◽

Alejandro M Ruiz ◽

John Ireland

Keyword(s):

Cohort Study ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Navigation System ◽

Observational Cohort Study ◽

Prospective Observational Cohort Study ◽

Leg Length ◽

Total Hip ◽

Imageless Navigation ◽

Observational Cohort

IntroductionOptimal outcomes in total hip arthroplasty (THA) are dependent on appropriate placement of femoral and acetabular components, with technological advances providing a platform for guiding component placement to reduce the risk of malpositioned components during surgery. This study will validate the intraoperative data captured using a handheld imageless THA navigation system against postoperative measurements of acetabular inclination, acetabular version, leg length and femoral offset on CT radiographs.Methods and analysisThis is a prospective observational cohort study conducted within a single-centre, single-surgeon private practice. Data will be collected for 35 consecutive patients (>18 years) undergoing elective THA surgery, from the research registry established at the surgeon’s practice. The primary outcome is the agreement between intraoperative component positioning data captured by the navigation system compared with postoperative measurements using CT. A total of ten CT scans will be reassessed for interobserver and intraobserver reliability. The influence of patient and surgical factors on the accuracy of component position will also be examined with multivariable linear regression.Ethics and disseminationEthics approval for this study was provided through a certified ethics committee (Bellberry HREC approval number 2017-07-499). The results of this study will be disseminated through peer-reviewed journals and conference presentations.Trial RegistrationAustralian and New Zealand Clinical Trials Registry (ANZCTR) Trial ID: ACTRN12620000089932.

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Cup Positioning in Primary Total Hip Arthroplasty Using an Imageless Navigation Device: Is There a Learning Curve?

Orthopedics ◽

10.3928/01477447-20090915-52 ◽

2009 ◽

Vol 32 (10/SUPPLEMENT) ◽

pp. 14-17 ◽

Cited By ~ 12

Author(s):

Fritz Thorey ◽

Phillip Klages ◽

Matthias Lerch ◽

Thilo Flörkemeier ◽

Henning Windhagen ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Learning Curve ◽

Hip Arthroplasty ◽

Total Hip ◽

Imageless Navigation ◽

Cup Positioning ◽

Primary Total Hip Arthroplasty

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Imageless Navigation Improves Intraoperative Monitoring of Leg Length Changes during Total Hip Arthroplasty for Legg-Calve-Perthes Disease: Two Case Reports

Case Reports in Orthopedics ◽

10.1155/2018/4362367 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Ritesh R. Shah ◽

Varsha Gobin ◽

Jeffrey M. Muir

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Case Reports ◽

Assistive Technologies ◽

Perthes Disease ◽

Computer Assisted ◽

Leg Length ◽

Total Hip ◽

Imageless Navigation ◽

Length Changes

Legg-Calve-Perthes disease is a rare condition characterized by avascular necrosis and malformation of the femoral head. For many patients, total hip arthroplasty (THA) is the only viable treatment option; however, there are challenges associated with THA in this population, primarily the equalization of leg lengths. Here, we present two cases of Legg-Calve-Perthes disease treated via total hip arthroplasty with the assistance of an imageless, computer-assisted navigation device. In each case, the device provided intraoperative data on leg length in real time, allowing for improved accuracy of component placement. Postoperative leg lengths were confirmed to be equalized in each case using radiographs. These cases are, to our knowledge, the first such cases using imageless navigation during THA and demonstrate the benefits of such assistive technologies in challenging cases such as Legg-Calve-Perthes disease.

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Peak Active Hip Flexion Following Navigated Total Hip Arthroplasty.

10.29007/z9fd ◽

2019 ◽

Author(s):

Hollie Leonard ◽

Alistair Ewen ◽

Kamal Deep

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Soft Tissues ◽

Biomechanical Analysis ◽

Range Of Movement ◽

Total Hip ◽

Imageless Navigation ◽

Male Patients ◽

Hip Flexion ◽

Cup Positioning

The importance of accurate cup positioning during total hip arthroplasty (THA) to minimise post- operative complications has been well defined. However it remains unclear if following navigated THA there is a relationship between the active range of movement, the inclination and anteversion of the implant, and the theoretical range of movement as measured intra-operatively using imageless navigation. Fifteen male patients undergoing primary THA using the Orthopilot (Aesculap AG, Tuttlingen, Germany) imageless navigation system were recruited. The Orthopilot system flexion value was recorded. Three months post-THA patients underwent 3D biomechanical analysis (Vicon Motion Systems, Oxford, UK) during which patients performed a standing active hip flexion movement and a sitting task. Inclination and anteversion calculated according to Pradhan’s formula were taken from post-operative radiographs. There was no observed correlation with the theoretical hip flexion and the standing peak active or sitting peak hip flexion values in this series. However, Orthopilot flexion considers only the interaction of the implant components and not the soft tissues surrounding the hip joint which may limit clinical flexion. There does not appear to be any relationship between the inclination and anteversion angles and the range of movement observed post- operatively during a standing active hip flexion task and sitting task. It was observed that peak active hip flexion between the operated and non-operated limbs was not significantly different at three months, which indicates a good level of symmetry at this time point.

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The current role of robotics in total hip arthroplasty

EFORT Open Reviews ◽

10.1302/2058-5241.4.180088 ◽

2019 ◽

Vol 4 (11) ◽

pp. 618-625 ◽

Cited By ~ 4

Author(s):

Babar Kayani ◽

Sujith Konan ◽

Atif Ayuob ◽

Salamah Ayyad ◽

Fares S. Haddad

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Functional Outcomes ◽

Learning Curves ◽

Leg Length ◽

Acetabular Cup ◽

Total Hip ◽

Implant Survivorship ◽

Improved Accuracy ◽

Cup Positioning

Robotic total hip arthroplasty (THA) improves accuracy in achieving the planned acetabular cup positioning compared to conventional manual THA. Robotic THA improves precision and reduces outliers in restoring the planned centre of hip rotation compared to conventional manual THA. Improved accuracy in restoring hip biomechanics and acetabular cup positioning in robotic THA have not translated to any differences in early functional outcomes, correction of leg-length discrepancy, or postoperative complications compared to conventional manual THA. Limitations of robotic THA include substantive installation costs, additional radiation exposure, steep learning curves for gaining surgical proficiency, and compatibility of the robotic technology with a limited number of implant designs. Further higher quality studies are required to compare differences in conventional versus robotic THA in relation to long-term functional outcomes, implant survivorship, time to revision surgery, and cost-effectiveness. Cite this article: EFORT Open Rev 2019;4:618-625. DOI: 10.1302/2058-5241.4.180088

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Which one is more affected by navigation-assisted cup positioning in total hip arthroplasty: Anteversion or inclination? A retrospective matched-pair cohort study in Asian physique

Journal of Orthopaedic Surgery ◽

10.1177/2309499018780755 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901878075 ◽

Cited By ~ 3

Author(s):

Kwang Jun Oh ◽

Byung Kag Kim ◽

Myung Il Jo ◽

Byung Mun Ahn

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Matched Pair ◽

Mean Deviation ◽

Acetabular Cup ◽

Total Hip ◽

Imageless Navigation ◽

Significant Difference ◽

Matching Criteria ◽

Cup Positioning

Introduction: The purpose of this study was to compare acetabular cup positioning using an imageless navigation-assisted total hip arthroplasty (THA) to a case-matched control group using the conventional technique in Asian physique. Methods: Case matching controlled study using retrospectively collected data for THAs was done. Matching criteria were gender, age ± 5 years, and body mass index ± 5 kg/m2. Thirty patients who had navigation THAs were manually matched to a conventional group of 30 patients. After measuring anteversion and inclination on 3-D CT, final cup anteversion was calculated using the mathematical formula (anteversion = arctan [tan (anatomic anteversion) × sin (inclination)]). Results: No significant difference was observed between mean inclination ( p = 0.420), anteversion ( p = 0.697), and the mean deviation from 15° for anteversion ( p = 0.649). However, there was a statistical significant difference for mean deviation from 40° for inclination ( p = 0.027). There was a significant difference in the percentage of correctly placed acetabular cup in safe zones with inclination ( p = 0.039). Conclusions: Although soft tissue overlying the pubic tubercle interfered with registration of the bony landmark and thereby induced inaccuracy of anteversion angles in the navigation group, the use of imageless navigation-assisted technique increases the placement within the safe zone for inclination and enhances the accuracy and the precision of inclination of the acetabular cup relative to the conventional THA rather than anteversion. This finding may be due to the effect of the patient’s physique on the anterior pelvic plane (APP)-based reference system of imageless navigation.

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Value of 3D Preoperative Planning for Primary Total Hip Arthroplasty Based on Biplanar Weightbearing Radiographs

BioMed Research International ◽

10.1155/2019/1932191 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Y. Knafo ◽

F. Houfani ◽

B. Zaharia ◽

F. Egrise ◽

I. Clerc-Urmès ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Preoperative Planning ◽

Femoral Stem ◽

Leg Length ◽

Femoral Offset ◽

Postoperative Result ◽

Total Hip ◽

Planning Software ◽

Navigated Surgery

Two-dimensional (2D) planning on standard radiographs for total hip arthroplasty may not be sufficiently accurate to predict implant sizing or restore leg length and femoral offset, whereas 3D planning avoids magnification and projection errors. Furthermore, weightbearing measures are not available with computed tomography (CT) and leg length and offset are rarely checked postoperatively using any imaging modality. Navigation can usually achieve a surgical plan precisely, but the choice of that plan remains key, which is best guided by preoperative planning. The study objectives were therefore to (1) evaluate the accuracy of stem/cup size prediction using dedicated 3D planning software based on biplanar radiographic imaging under weightbearing and (2) compare the preplanned leg length and femoral offset with the postoperative result. This single-centre, single-surgeon prospective study consisted of a cohort of 33 patients operated on over 24 months. The routine clinical workflow consisted of preoperative biplanar weightbearing imaging, 3D surgical planning, navigated surgery to execute the plan, and postoperative biplanar imaging to verify the radiological outcomes in 3D weightbearing. 3D planning was performed with the dedicated hipEOS® planning software to determine stem and cup size and position, plus 3D anatomical and functional parameters, in particular variations in leg length and femoral offset. Component size planning accuracy was 94% (31/33) within one size for the femoral stem and 100% (33/33) within one size for the acetabular cup. There were no significant differences between planned versus implanted femoral stem size or planned versus measured changes in leg length or offset. Cup size did differ significantly, tending towards implanting one size larger when there was a difference. Biplanar radiographs plus hipEOS planning software showed good reliability for predicting implant size, leg length, and femoral offset and postoperatively provided a check on the navigated surgery. Compared to previous studies, the predictive results were better than 2D planning on conventional radiography and equal to 3D planning on CT images, with lower radiation dose, and in the weightbearing position.

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Staged reconstruction of unilateral neglected hip dislocation through total hip arthroplasty and subsequent intramedullary femoral lengthening

International Orthopaedics ◽

10.1007/s00264-021-05099-x ◽

2021 ◽

Author(s):

Bjoern Vogt ◽

Christoph Theil ◽

Georg Gosheger ◽

Adrien Frommer ◽

Burkhard Moellenbeck ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Plate Fixation ◽

Hip Dislocation ◽

Leg Length ◽

Total Hip ◽

Femoral Lengthening ◽

Shortening Osteotomy ◽

Successful Approach ◽

Staged Reconstruction

Abstract Background and purpose Total hip arthroplasty (THA) is a successful approach to treat unilateral symptomatic neglected hip dislocation (NHD). However, the extensive leg length discrepancy (LLD) can hereby only be partially corrected. In case of residual LLD of more than 2 cm, subsequent femoral lengthening can be considered. Patients/material/methods Retrospective analysis of clinical data and radiographs of five patients (age 38.1 (28–51) years) with unilateral NHD who underwent THA with (n = 3) or without (n = 2) subtrochanteric shortening osteotomy (SSO) and secondary intramedullary femoral lengthening through a retrograde magnetically-driven lengthening nail (follow-up 18.4 (15–27) months). Results LLD was 51.0 (45–60) mm before and 37.0 (30–45) mm after THA. Delayed bone union at one SSO site healed after revision with autologous bone grafting and plate fixation. Subsequent lengthening led to leg length equalisation in all patients. Complete consolidation was documented in all lengthened segments. Conclusion Staged reconstruction via THA and secondary femoral lengthening can successfully be used to reconstruct the hip joint and equalise LLD. The specific anatomical conditions have to be taken into consideration when planning treatment, and patients ought to be closely monitored.

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