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Defining the Learning Period of a Novel Imageless Navigation System for Posterior Approach Total Hip Arthroplasty: Analysis of Surgical Time and Accuracy

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Abstract

Introduction

The use of imageless navigation in total hip arthroplasty (THA) is frequently associated with prolonged surgical times, predominantly during the learning period. The purpose of the present study was to characterize the learning period of a novel imageless navigation system, specifically as it related to surgical time and acetabular navigation accuracy.

Materials and Methods

This was a retrospective observational study of a consecutive group of 158 patients who underwent primary unilateral THA for osteoarthritis by a team headed by a single surgeon. All procedures used an imageless navigation system to measure acetabular cup inclination and anteversion angles, referencing a generic sagittal and frontal plane. Navigation accuracy was determined by assessing differences between intraoperative inclination and anteversion values and those obtained from standardized 6-week follow-up radiographs. Operative time and navigation accuracy were assessed by plotting moving averages of 7 consecutive cases. The learning period was defined using Mann–Kendall trend analyses, student t-tests and nonlinear regression modeling based on surgical time and navigation accuracy. Alpha error was 0.05.

Results

The average surgical time was 67.3 min (SD:9.2) (range 45–95). The average navigation accuracy for inclination was 0.01° (SD:4.2) (range − 10 to 10), and that for anteversion was − 4.9° (SD:3.8) (range − 14 to 5). Average surgical time and navigation accuracy were similar between the first and final cases in the series with no learning period detected.

Conclusions

There was no discernible learning period effect on surgical time or system measurement accuracy during the early phases of adoption for this imageless navigation system.

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Data availability

The data that support the findings of this study are available upon reasonable request from the corresponding author. The data are not publicly available due to privacy orethical restrictions.

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Acknowledgements

We would like to thank Patrick Fritz, Morgan Thomson and Miroslava Rangel for their valuable assistance with data collection and analysis. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This study was partially funded by the generous donations of Mr. Kim Davis and Mr. Baryn Futa.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This study was partially funded by the generous donations of Mr. Kim Davis and Mr. Baryn Futa.

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Authors and Affiliations

  1. The Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Christian B. Ong, Justin M. Ong, Jacqueline Grubel, Ajay Premkumar, Gwo-Chin Lee & Alejandro Gonzalez Della Valle

  2. The Department of Biostatistics, Hospital for Special Surgery, New York, NY, USA

    Yu-Fen Chiu

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  1. Christian B. Ong
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Contributions

CBO: Study conceptualization; data curation; investigation; methodology; project administration; resources; validation; visualization; writing—original draft/review and editing. JMO: Data curation; investigation; writing—original draft/review and editing. Y-FC: Conceptualization; data curation; formal analysis; methodology; software; validation; visualization. JG: Data curation; project administration; resources; writing—review and editing. AP: Data curation; project administration; resources; writing—review and editing. G-CL: Conceptualization; investigation; methodology; project administration; supervision; writing—review and editing. AGDV: Conceptualization; funding acquisition; investigation; methodology; project administration; supervision; writing—review and editing.

Corresponding author

Correspondence to Alejandro Gonzalez Della Valle.

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Conflict of interest

Author A.G.D.V. is a paid consultant for, and owns stock or stock options in Naviswiss.

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A waiver of informed consent was obtained to collect patient health information.

Institutional Ethical Committee Approval (For All Human Studies)

This study received both Institutional Review Board and Ethical Committee approval.

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Ong, C.B., Ong, J.M., Grubel, J. et al. Defining the Learning Period of a Novel Imageless Navigation System for Posterior Approach Total Hip Arthroplasty: Analysis of Surgical Time and Accuracy. JOIO 58, 121–126 (2024). https://doi.org/10.1007/s43465-023-01060-9

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  • DOI: https://doi.org/10.1007/s43465-023-01060-9

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