Effect of digital navigation during anterior-approach total hip arthroplasty on patient outcomes

Fluoroscopic guidance is a well-established technique in anterior-approach total hip arthroplasty (AA-THA) to enhance appropriate implant size and positioning, and to address potential complications, such as leg-length discrepancy (LLD). The primary objective of this study was to assess whether the implementation of a noninvasive fluoroscopy-assisted digital-navigation software improved the accuracy of postoperative leg length in AA-THA.

We conducted a retrospective cohort study involving patients who were identified from the prospectively collected patient-level provincial administrative data repositories. We extracted outcome data and measured leg lengths on postoperative radiographs.

A total of 435 patients were identified. After exclusion, 400 patients were included in the study, with 247 in the navigation-software cohort. There was no significant difference between the groups with respect to demographic data. In the navigation-software cohort, we found no significant difference between the achieved LLD and zero LLD, whereas we found a significant difference in the fluoroscopy-only cohort (p < 0.001). The navigation-software cohort required more fluoroscopy time and significantly reduced case time.

The use of navigation software in AA-THA is safe and effective to achieve more accurate postoperative leg length. Despite the increase in fluoroscopic time, there was a small but statistically significant reduction in operative time. The value of such technology would be expected to substantially increase if used during the learning curve when introducing AA-THA to contemporary practice.