Computer navigation in total hip arthroplasty: a meta-analysis of randomized controlled trials

Traditional operation frequently depends on experience of doctors and anatomic landmark visual observation, which often leads to deviation in acetabular prosthesis implantation. Computer navigation technique greatly improves accuracy of prosthesis implantation. The present meta-analysis aimed at assessing the accuracy and clinical significance of computer navigation for acetabular implantation.

All studies published through March 2013 were systematically searched from PubMed, EMBnse, Science Direct, Cechrane library and other databases. Relevant journals or conference proceedings were searched manually. Only randomized controlled trials (RCTs) were included. Two independent reviewers identified and assessed the literature. Mean difference (MD) and Odds ratio (OR) of radiologic and clinical outcomes were pooled throughout the study between navigated and conventional THA. The meta-analysis was conducted by RevMan 5.1 software.

Thirteen studies were included in the review, with a total sample size of 1071 hips. Statistically significant differences were observed between navigated and conventional groups in the number of acetabular cups implanted beyond the safe zone [OR = 0.13, 95% confidence interval (CI) (0.08-0.22); P < 0.00001], operative time [MD = 19.87 min, 95% CI (14.04-24.35); P < 0.00001] and leg length discrepancy [MD = -4.16 mm, 95% CI (-7.74 to -1.48); P = 0.004]. No significant differences in cup inclination, anteversion, incidence of postoperative dislocation or deep vein thrombosis were found.

The present meta-analysis indicated that the use of computer navigation in patients undergoing THA improves the precision of acetabular cup placement by decreasing the number of outliers, and decreases leg length discrepancy. More high quality RCTs are required to further confirm our results.