Abstract
Introduction
Navigation of acetabular component orientation is still not commonly performed despite repeated studies that show that more than ½ of acetabular components placed during hip arthroplasty are significantly mal-positioned and that intra-operative radiographic assessment is unreliable. The current study uses postoperative CT to assess the accuracy of a smart mechanical navigation instrument system for cup alignment.
Patients and Methods
Thirty seven hip replacements performed using a smart mechanical navigation device (the HipXpert System) had post-operative CT studies available for analysis. These post-operative CT studies were performed for pre- operative planning of the contralateral side, one to three years following the prior surgery. An application specific software module was developed to measure cup orientation using CT (HipXpert Research Application, Surgical Planning Associates Inc., Boston, Massachusetts). The method involves creation of a 3D surface model from the CT data and then determination of an Anterior Pelvic Plane coordinate system. A multiplaner image viewer module is then used to create an image through the CT dataset that is coincident with the opening plane of the acetabular component. Points in this plane are input and then the orientation of the cup is calculated relative to the AP Plane coordinate space according to Murray's definitions of operative anteversion and operative inclination. The actual cup orientation was then compared to the goal of cup orientation recorded when the surgery was performed using the system for acetabular component alignment.
Results
For the thirty seven hips replacements, mean operative anteversion error was 1.1 degrees (SD 3.6, range −5.5 to 8.2). Mean operative inclination error was − 1.7 degrees (SD 3.0, range −8.0 to 5.6). There were no outliers in either anteversion or inclination.
Conclusion
The current study demonstrates that the mechanical navigation system produces accurate cup alignment results as measured by post-operative CT and confirms the prior accuracy study performed using 2D/3D matching. This improved accuracy compared to robotic systems may be due to the wide-based nature of the docking mechanism and the elimination of the cumulative errors of registration and tracking inherent to more complex systems.
