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Can computer-assisted surgery help restore leg length and offset during THA? A continuous series of 321 cases
A Clavé1, V Sauleau2, D Cheval2
1Université de Bretagne Occidentale, Faculté de Médecine, 22, avenue Camille-Desmoulins, 29200 Brest, France; CHRU Brest, Service de Chirurgie Orthopédique et Traumatologique de la Cavale Blanche, boulevard Tanguy-Prigent, 29200 Brest, France; LaTIM, INSERM UMR 1101, 2, avenue Foch, 29609 Brest, France.
Insights
Computer-assisted orthopedic surgery (CAOS) effectively restores leg length in total hip arthroplasty (THA), achieving objectives in over 80% of cases with reliable navigation and radiology correlation. This method demonstrates safety and relevance for preoperative leg length goals.
Area of Science:
- Orthopedic Surgery
- Medical Technology
- Surgical Navigation
Background:
- Total hip arthroplasty (THA) is prone to complications like leg length discrepancies, leading to litigation.
- Computer-assisted orthopedic surgery (CAOS) offers potential solutions, but its efficacy in restoring leg length remains debated.
Purpose of the Study:
- To evaluate the effectiveness of CAOS in achieving leg length and offset goals during THA.
- To assess the reliability of CAOS by correlating radiological and navigation data.
- To determine the safety of CAOS by analyzing navigation-specific and non-specific complications.
Main Methods:
- Retrospective analysis of 321 cementless THA cases using CAOS via a posterolateral approach.
- Minimum 1-year follow-up to assess achievement of leg length and offset goals.
- Evaluation of correlation between navigation and radiological data, and incidence of complications.
Main Results:
- Leg length and offset objectives were met in 83.3% and 88% of cases, respectively.
- Satisfactory correlation observed between navigation and radiology data (Pearson coefficients 0.79 for length, 0.74 for offset).
- Overall complication rate was 14.6%, with 12.1% specific to CAOS.
Conclusions:
- CAOS is relevant for achieving preoperative leg length objectives in THA.
- The study confirms good correlation between navigation and radiological data.
- CAOS was found to be safe, without major complications, in this series.
Introduction:
Total hip arthroplasty (THA) can bring about complications - particularly leg length differences - that are becoming increasingly litigious. Computer-assisted orthopedic surgery (CAOS) can help optimize the procedure, but its ability to effectively restore leg length is controversial. As a consequence, we carried out a study to determine: (1) its contribution to meeting leg length and offset objectives, (2) its reliability, by evaluating the correlation between radiological and navigation data, (3) its safety, by evaluating navigation-specific and non-specific complications.
Hypothesis:
CAOS will help to restore leg length within ± 5 mm in more than 80% of cases.
Material And Methods:
A series of 321 continuous cases of cementless THA implanted through the posterolateral approach using CAOS was analyzed retrospectively. With a minimum 1 year follow-up, we evaluated whether the leg length and offset goals were achieved, how well the navigation and radiology data were correlated and whether navigation-specific and non-specific complications occurred. Based on our hypothesis that 80% of patients would have less than 5 mm leg length difference and the null hypothesis (PA = P0) with an alpha of 0.05, 200 observations were required to achieve a power of 90%.
Results:
The leg length and offset objectives were achieved in 83.3% and 88% of cases, respectively. Twenty-two patients required a heel wedge to compensate for leg length differences. The correlation between the radiology and surgical navigation data was satisfactory - the Pearson coefficient was 0.79 for length and 0.74 for offset. Intraoperative and postoperative complications or adverse events were found in 14.6% of cases; these were specific to CAOS in 12.1% of cases and non-specific in 2.5% of cases.
Conclusion:
This study shows the relevance of CAOS for achieving preoperative leg length objectives, with good correlation between navigation and radiology data, and without major complications.
Level Of Evidence:
IV - retrospective study.
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