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Accuracy of portable navigation during THA in patients with severe developmental dysplasia of hip
Shinya Hayashi1, Yuichi Kuroda2, Naoki Nakano2
1Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. shayashi@med.kobe-u.ac.jp.
Insights
Accurate acetabular cup placement in total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) is challenging. Portable navigation systems show acceptable accuracy for THA in DDH patients, even in severe cases, when considering clinical cost-effectiveness.
Area of Science:
- Orthopedic Surgery
- Medical Imaging
- Biomedical Engineering
Background:
- Acetabular cup placement in total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) presents significant challenges.
- Accurate positioning is crucial for long-term implant survival and patient outcomes.
Purpose of the Study:
- To evaluate the orientation accuracy of acetabular cup insertion during THA using a portable navigation system in DDH patients.
- To compare accuracy between patients with severe DDH and those with non-DDH/mild DDH.
Main Methods:
- Retrospective cohort study of 64 patients undergoing THA with an infrared stereo camera-matching portable navigation system.
- Comparison of intraoperative navigation angles with postoperative CT-measured angles.
- Analysis of differences and predictive factors for outliers in acetabular cup placement.
Main Results:
- Average absolute abduction differences were 3.9° (severe DDH) and 3.3° (non-DDH/mild DDH).
- Average anteversion differences were 4.7° (severe DDH) and 2.3° (non-DDH/mild DDH), with a significant difference between groups.
- Severe DDH and posterior pelvic tilt were associated with larger navigation differences (>5° anteversion).
Conclusions:
- Portable navigation demonstrates acceptable accuracy for THA in DDH patients, even in severe cases.
- Close attention is warranted during navigation-assisted THA for severe DDH.
- The system's accuracy may be clinically acceptable considering its cost-effectiveness.
Introduction:
Correct cup placement in total hip arthroplasty (THA) for patients with developmental dysplasia of the hip (DDH) is considerably difficult. This study aimed to analyze the orientation accuracy of cup insertion during THA using a portable navigation system in patients with DDH.
Materials And Methods:
In this retrospective cohort study, we analyzed data from 64 patients who underwent THA using infrared stereo camera-matching portable navigation. Patients underwent THA via the anterolateral approach in the lateral decubitus position. Navigation records for intraoperative cup angles, postoperative cup angles measured on computed tomography (CT) images, and cup angle measurement differences were measured and compared between patients with non-DDH/mild DDH and severe DDH. Furthermore, the predictive factors for outliers of accurate acetabular cup placement were analyzed.
Results:
The average measurement absolute abduction differences (postoperative CT-navigation record) were 3.9 ± 3.5° (severe DDH) and 3.3 ± 2.6° (non-DDH/ mild DDH), and the anteversion differences were 4.7 ± 3.4° (severe DDH) and 2.3 ± 2.1° (non-DDH/ mild DDH). The anteversion difference was different between the two groups. Multivariate analysis showed that the navigation difference (absolute difference in anteversion between postoperative CT and navigation records of > 5°) was significantly associated with severe DDH (odds ratio [OR]: 3.3; p = 0.049, 95% confidence interval [CI]: 1.0-11.1) and posterior pelvic tilt (OR: 1.1; p = 0.042, 95% CI: 1.0-1.27).
Conclusions:
In patients with severe DDH, it is important to pay close attention during THA using portable navigation. However, the average difference was < 5º even in patients with severe DDH, and the accuracy may be acceptable in a clinical setting when the cost is considered.
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