Abstract
Background
The existing studies concerning image-free navigated implantation of hip resurfacing arthroplasty are based on analysis of the accuracy of conventional biplane radiography. Studies have shown that these measurements in biplane radiography are imprecise and that precision is improved by use of three-dimensional (3D) computer tomography (CT) scans. To date, the accuracy of image-free navigation devices for hip resurfacing has not been investigated using CT scans, and anteversion accuracy has not been assessed at all. Furthermore, no study has tested the reliability of the navigation software concerning the automatically calculated implant position. The purpose of our study was to analyze the accuracy of varus-valgus and anteversion using an image-free hip resurfacing navigation device. The reliability of the software-calculated implant position was also determined.
Methods
A total of 32 femoral hip resurfacing components were implanted on embalmed human femors using an image-free navigation device. In all, 16 prostheses were implanted with the proposed position generated by the navigation software; the 16 prostheses were inserted in an optimized valgus position. A 3D CT scan was undertaken before and after operation.
Results
The difference between the measured and planned varus-valgus angle averaged 1° (mean ± SD: group I, 1° ± 2°; group II, 1° ± 1°). The mean ± SD difference between femoral neck anteversion and anteversion of the implant was 4° (group I, 4° ± 4°; group II, 4° ± 3°). The software-calculated implant position differed 7° ± 8° from the measured neck-shaft angle. These measured accuracies did not differ significantly between the two groups.
Conclusions
Our study proved the high accuracy of the navigation device concerning the most important biomechanical factor: the varus-valgus angle. The software calculation of the proposed implant position has been shown to be inaccurate and needs improvement. Hence, manual adjustment of the implant position in the software-planning step is frequently required.
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References
Shimmin A, Beaule PE, Campbell P. Metal-on-metal hip resurfacing arthroplasty. J Bone Joint Surg Am 2008;90:637–654.
Ganapathi M, Vendittoli PA, Lavigne M, Gunther KP. Femoral component positioning in hip resurfacing with and without navigation. Clin Orthop 2009;467:1341–1347.
Beaule PE, Lee JL, Le Duff MJ, Amstutz HC, Ebramzadeh E. Orientation of the femoral component in surface arthroplasty of the hip: a biomechanical and clinical analysis. J Bone Joint Surg Am 2004;86:2015–2021.
Shimmin AJ, Back D. Femoral neck fractures following Birmingham hip resurfacing: a national review of 50 cases. J Bone Joint Surg Br 2005;87:463–464.
Bathis H, Shafizadeh S, Paffrath T, Simanski C, Grifka J, Luring C. [Are computer assisted total knee replacements more accurately placed? A meta-analysis of comparative studies.] Orthopade 2006;35:1056–1065.
Davis ET, Gallie P, Macgroarty K, Waddell JP, Schemitsch E. The accuracy of image-free computer navigation in the placement of the femoral component of the Birmingham hip resurfacing: a cadaver study. J Bone Joint Surg Br 2007;89:557–560.
Hart R, Svab P, Filan P. Intraoperative navigation in hip surface arthroplasty: a radiographic comparative analysis study. Arch Orthop Trauma Surg 2007;128:429–434.
Hodgson AJ, Inkpen KB, Shekhman M, Anglin C, Tonetti J, Masri BA, et al. Computer-assisted femoral head resurfacing. Comput Aided Surg 2005;10:337–343.
Schnurr C, Michael JW, Eysel P, Konig DP. Imageless navigation of hip resurfacing arthroplasty increases the implant accuracy. Int Orthop 2009;33:365–372.
Garry SC, Jhangri GS, Lambert RG. Femoral neck radiography: effect of flexion on visualization. Can Assoc Radiol J 2005;56:155–162.
Herrlin K, Ekelund L. Radiographic measurements of the femoral neck anteversion: comparison of two simplified procedures. Acta Orthop Scand 1983;54:141–147.
Kay RM, Jaki KA, Skaggs DL. The effect of femoral rotation on the projected femoral neck-shaft angle. J Pediatr Orthop 2000;20:736–739.
Kuo TY, Skedros JG, Bloebaum RD. Measurement of femoral anteversion by biplane radiography and computed tomography imaging: comparison with an anatomic reference. Invest Radiol 2003;38:221–229.
Abel MF, Sutherland DH, Wenger DR, Mubarak SJ. Evaluation of CT scans and 3-D reformatted images for quantitative assessment of the hip. J Pediatr Orthop 1994;14:48–53.
Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT. Femoral anteversion. J Bone Joint Surg Am 1987;69:1169–1176.
Beaule PE, Poitras P. Femoral component sizing and positioning in hip resurfacing arthroplasty. Instr Course Lect 2007;56:163–169.
Girard J, Lavigne M, Vendittoli PA, Roy AG. Biomechanical reconstruction of the hip: a randomised study comparing total hip resurfacing and total hip arthroplasty. J Bone Joint Surg Br 2006;88:721–726.
Long JP, Bartel DL. Surgical variables affect the mechanics of a hip resurfacing system. Clin Orthop 2006;453:115–122.
Vail TP, Glisson RR, Dominguez DE, Kitaoka K, Ottaviano D. Position of hip resurfacing component affects strain and resistance to fracture in the femoral neck. J Bone Joint Surg Am 2008;90:1951–1960.
Olsen M, Davis ET, Waddell JP, Schemitsch EH. Imageless computer navigation for placement of the femoral component in resurfacing arthroplasty of the hip. J Bone Joint Surg Br 2009;91:310–315.
Anglin C, Masri BA, Tonetti J, Hodgson AJ, Greidanus NV. Hip resurfacing femoral neck fracture influenced by valgus placement. Clin Orthop 2007;465:71–79.
Cobb JP, Kannan V, Brust K, Thevendran G. Navigation reduces the learning curve in resurfacing total hip arthroplasty. Clin Orthop 2007;463:90–97.
Eastwood HD. Delayed diagnosis of femoral-neck fractures in the elderly. Age Ageing 1987;16:378–382.
Kingsley PC, Olmested KL. A study to determine the angle of anteversion of the neck of the femur. J Bone Joint Surg Am 1948;30:745–751.
Lewis AF. Fracture of neck of the femur: changing incidence. BMJ (Clin Res Ed) 1981;283:1217–1220.
Reikeras O, Hoiseth A, Reigstad A. Evaluation of the Dunlap/Rippstein method for determination of femoral neck angles. Acta Radiol Diagn 1985;26:177–179.
Yoshioka Y, Cooke TD. Femoral anteversion: assessment based on function axes. J Orthop Res 1987;5:86–91.
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Schnurr, C., Nessler, J., Meyer, C. et al. How accurate is image-free computer navigation for hip resurfacing arthroplasty? An anatomical investigation. J Orthop Sci 14, 497–504 (2009). https://doi.org/10.1007/s00776-009-1356-5
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DOI: https://doi.org/10.1007/s00776-009-1356-5