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The First SICOT Oral Presentation Award 2011: Imageless computer-assisted femoral component positioning in hip resurfacing: a prospective randomised trial

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Abstract

Purpose

The aim of the study was to evaluate the effects of imageless computer-assisted surgery (CAS) on the accuracy of positioning of the femoral component and on the short-term clinical outcome in hip resurfacing (HR) using a randomised prospective design.

Methods

A total of 75 consecutive patients undergoing HR were randomly allocated to CAS and conventional implantation, respectively. Preoperatively and six months post-operatively standardised pelvic anteroposterior X-ray images, the total Western Ontario and McMaster Universities Osteoarthritis Index, the Harris Hip Score and the EQ-5D utility index were evaluated in a blinded manner. The primary end point of the study was a post-operative femoral component malpositioning in five degrees or more either varus or valgus absolute deviation from the planned stem shaft angle.

Results

Patient demographics and algofunctional scores did not differ between the CAS and conventional implantation samples. Using CAS fewer femoral components were positioned in five or more degrees absolute deviation (4/37 vs 12/38, Fisher’s exact p = 0.047; 95 % confidence interval for the primary end point’s incidence difference: +3 %; +39 %); the respective incidences of five or more degrees of varus deviation were 0/37 vs 5/38. One conversion to a stemmed prosthesis (CAS group) was performed for periprosthetic femoral neck fracture. Radiological signs of superolateral femoral neck/implant impingement were observed in two cases (one CAS-based and one conventional implantation).

Conclusions

The accuracy of femoral HR component positioning was significantly improved using CAS. However, one major complication necessitated early revision in the CAS group at six months of observation. Apart from that adverse event no inter-group differences were observed for the short-term clinical outcome. Future studies need to address the clinical long-term relevance of CAS in HR.

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Acknowledgments

This study was partly supported by Zimmer GmbH, Winterthur, Switzerland; grants were provided for staff resources in data management and statistical evaluation. The authors declare no further conflicts of interest. We are grateful to Stephan Kirschner, M.D. for surgical contribution and critical interpretation of the results and to Heike Voigt and Brit Brethfeld for assistance in data management and in coordination of the study (all of them Department of Orthopaedics, University Hospital Dresden). We furthermore thank Katharina Schaper (Institute of Medical Biometry and Epidemiology, Witten/Herdecke) for assistance in data clearing and statistical analysis implementation.

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Authors and Affiliations

  1. Department of Orthopaedics, University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstr. 74, Building 29, 01307, Dresden, Germany

    Maik Stiehler, Jens Goronzy, Albrecht Hartmann & Klaus-Peter Günther

  2. Institute of Medical Biometry and Epidemiology, Faculty of Health, University of Witten/Herdecke, Witten, Germany

    Frank Krummenauer

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  1. Maik Stiehler
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  2. Jens Goronzy
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  5. Klaus-Peter Günther
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Correspondence to Maik Stiehler.

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Stiehler, M., Goronzy, J., Hartmann, A. et al. The First SICOT Oral Presentation Award 2011: Imageless computer-assisted femoral component positioning in hip resurfacing: a prospective randomised trial. International Orthopaedics (SICOT) 37, 569–581 (2013). https://doi.org/10.1007/s00264-012-1762-8

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