International Orthopaedics

, Volume 36, Issue 1, pp 17–22 | Cite as

Validation of navigation assisted cup placement in total hip arthroplasty

  • M. Ajith Kumar
  • M. Shantharam Shetty
  • Kanthi G. Kiran
  • Abhishek R. Kini
Original Paper

Abstract

Purpose

Computer navigation has the potential to provide precise intraoperative knowledge to the surgeon. Previous studies with navigation have confirmed its function for improved component position but few studies have reported the accuracy and precision of navigation system in clinical use. With this study we propose to evaluate the efficacy of navigation in guiding cup placement.

Methods

Fifty-six patients undergoing primary total hip arthroplasty were prospectively included in this study. Stryker imageless navigation system which is accurate to 0.5° was used in all cases. Intraoperative data was collected for the acetabular component position using navigation for the freehand cup placement and the final cup placement done using navigation. Postoperative evaluation of component position was done with computed tomography (CT) and the deviation from intraoperative freehand and navigation values were calculated.

Results

The mean inclination of the freehand reading was 39.5° (range, 20°–58°), mean version of freehand reading was 10.7° (−6°– 27°), and the mean navigation reading was 43.2° (37°–49°) for inclination and 13.0° (−8° – 24°) for version. On postoperative CT scan analysis the mean inclination was 45.3° (34°–56°) and mean version was 15.1° (4°–25°). The deviation of the freehand inclination from the post operative CT scan reading was 11.4° (1°–30°) and the version deviated by a mean of 10.8° (2°–26°). The deviation of the navigation reading from the CT scan reading had a mean of 5.3° (1°–13°) for inclination and 5.6° (1°–17°) for version.

Conclusion

The accuracy of the navigation system over conventional freehand cup placement is validated by this study.

Notes

Acknowledgement

We would like to thank Ms. Neevan D’souza, Lecturer of Statistics, Department of PSM, Yenopoya Medical College, Mangalore for her assistance in this study.

References

  1. 1.
    Digioia AM 3rd, Jaramaz B, Plakseychuk AY, Moody JE, Nikou C, Labarca RS, Levison TJ, Picard F (2002) Comparison of a mechanical acetabular alignment guide with computer placement of the socket. J Arthroplasty 17:359–364PubMedCrossRefGoogle Scholar
  2. 2.
    Barrack RL, Lavernia C, Ries M, Thornberry R, Tozakoglou E (2001) Virtual reality computer animation of the effect of component position and design on stability after total hip arthroplasty. Orthop Clin North Am 32:569–577, viiPubMedCrossRefGoogle Scholar
  3. 3.
    Charnley J, Cupic Z (1973) The nine and ten year results of the low friction arthroplasty of the hip. Clin Orthop Relat Res 95:9–25PubMedGoogle Scholar
  4. 4.
    D’Lima DD, Urquhart AG, Buehler KO, Walker RH, Colwell CW Jr (2000) The effect of the orientation of the acetabular and femoral components on the range of motion of the hip at different head-neck ratios. J Bone Joint Surg Am 82:315–321PubMedGoogle Scholar
  5. 5.
    Scifert CF, Brown TD, Pedersen DR, Callaghan JJ (1998) A finite element analysis of factors influencing total hip dislocation. Clin Orthop Relat Res 355:152–162PubMedCrossRefGoogle Scholar
  6. 6.
    Yamaguchi M, Akisue T, Bauer TW, Hashimoto Y (2000) The spatial location of impingement in total hip arthroplasty. J Arthroplasty 15:305–313PubMedCrossRefGoogle Scholar
  7. 7.
    Jaramaz B, DiGioia AM 3rd, Blackwell M, Nikou C (1998) Computer assisted measurement of cup placement in total hip replacement. Clin Orthop Relat Res 354:70–81PubMedCrossRefGoogle Scholar
  8. 8.
    Tannast M, Langlotz U, Siebenrock KA, Wiese M, Bernsmann K, Langlotz F (2005) Anatomic referencing of cup orientation in total hip arthroplasty. Clin Orthop Relat Res 436:144–150PubMedCrossRefGoogle Scholar
  9. 9.
    Jolles BM, Genoud P, Hoffmeyer P (2004) Computer-assisted cup placement techniques in total hip arthroplasty improve accuracy of placement. Clin Orthop Relat Res 426:174–179PubMedCrossRefGoogle Scholar
  10. 10.
    Kalteis T, Handel M, Herold T, Perlick L, Baethis H, Grifka J (2005) Greater accuracy in positioning of the acetabular cup by using an image-free navigation system. Int Orthop 29:272–276PubMedCrossRefGoogle Scholar
  11. 11.
    Leenders T, Vandevelde D, Mahieu G, Nuyts R (2002) Reduction in variability of acetabular cup abduction using computer assisted surgery: a prospective and randomized study. Comput Aided Surg 7:99–106PubMedCrossRefGoogle Scholar
  12. 12.
    Nogler M, Kessler O, Prassl A, Donnelly B, Streicher R, Sledge JB, Krismer M (2004) Reduced variability of acetabular cup positioning with use of an imageless navigation system. Clin Orthop Relat Res 426:159–163PubMedCrossRefGoogle Scholar
  13. 13.
    Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60:217–220PubMedGoogle Scholar
  14. 14.
    McCollum DE, Gray WJ (1990) Dislocation after total hip arthroplasty. Causes and prevention. Clin Orthop Relat Res 261:159–170PubMedGoogle Scholar
  15. 15.
    Ng Fu Yuen, Zhang JT, Chiu KY, Yan CH (2011) A cadaveric study of posterior dislocation after total hip replacement—effects of head diameter and acetabular anteversion. Int Orthop 35(3):325–329PubMedCrossRefGoogle Scholar
  16. 16.
    Paterno SA, Lachiewicz PF, Kelley SS (1997) The influence of patient-related factors and the position of the acetabular component on the rate of dislocation after total hip replacement. J Bone Joint Surg Am 79:1202–1210PubMedGoogle Scholar
  17. 17.
    Kennedy JG, Rogers WB, Soffe KE, Sullivan RJ, Griffen DG, Sheehan LJ (1998) Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration. J Arthroplast 13:530–534CrossRefGoogle Scholar
  18. 18.
    Saxler G, Marx A, Vandevelde D, Langlotz U, Tannast M, Wiese M, Michaelis U, Kemper G, Grutzner PA, Steffen R, von Knoch M, Holland-Letz T, Bernsmann K (2004) The accuracy of free-hand cup positioning—a CT based measurement of cup placement in 105 total hip arthroplasties. Int Orthop 28:198–201PubMedCrossRefGoogle Scholar
  19. 19.
    Moskal JT, Capps SG (2010) Improving the accuracy of acetabular component orientation: avoiding malposition. J Am Acad Orthop Surg 18:286–296PubMedGoogle Scholar
  20. 20.
    Archbold HA, Mockford B, Molloy D, McConway J, Ogonda L, Beverland D (2006) The transverse acetabular ligament: An aid to orientation of the acetabular component during primary total hip replacement. A preliminary study of cases investigating postoperative stability. J Bone Joint Surg Br 88:883–886PubMedCrossRefGoogle Scholar
  21. 21.
    Maruyama M, Feinberg JR, Capello WN, D’Antonio JA (2001) The Frank Stinchfield Award: Morphologic features of the acetabulum and femur. Anteversion angle and implant positioning. Clin Orthop Relat Res 393:52–65PubMedCrossRefGoogle Scholar
  22. 22.
    Dorr LD, Malik A, Wan Z, Long WT, Harris M (2007) Precision and bias of imageless computer navigation and surgeon estimates for acetabular component position. Clin Orthop Relat Res 465:92–99PubMedGoogle Scholar
  23. 23.
    Bosker BH, Verheyen PM, Horstmann WG, Tulp NJA (2007) Poor accuracy of freehand cup positioning during total hip arthroplasty. Arch Orthop Trauma Surg 127:375–379PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • M. Ajith Kumar
    • 1
  • M. Shantharam Shetty
    • 1
  • Kanthi G. Kiran
    • 1
  • Abhishek R. Kini
    • 1
  1. 1.Department of Orthopaedics and TraumatologyTejasvini Hospital and SSIOTMangaloreIndia

Personalised recommendations