Cup implantation accuracy using the HipCOMPASS mechanical intraoperative support device

BackgroundWhile navigation systems have been developed to increase implantation accuracy in total hip arthroplasty (THA), they are not yet sufficiently versatile or commonly used. Therefore, to elevate the appeal of such systems, we have developed HipCOMPASS, a simple and effective mechanical angle indicator for use in supine THA.Questions/purposesHow accurate is the mean cup orientation [in terms of errors in radiographic anteversion (RA) and inclination (RI)] in cases where HipCOMPASS is used for intraoperative support? Does HipCOMPASS increase this cup orientation accuracy compared to THA cases without it? Does HipCOMPASS increase mean operation time?MethodsWe measured cup orientation in 97 THA cases with HipCOMPASS and in 80 cases without it. Then we compared the angles determined in preoperative planning with the angles revealed by postoperative computed tomography (CT) for both groups. The discrepancy between them was defined as an error. Errors greater than 10° were considered outliers. Additionally, mean operative time with and without the Hip COMPASS were compared.ResultsWith the use of HipCOMPASS, the mean absolute error values in radiographic anteversion and inclination were 2.9° ± 2.3° (range 0°–12.8°) and 2.9° ± 2.1° (0.1°–7.7°), respectively. In contrast, without the use of HipCOMPASS, radiographic anteversion and inclination error values were 8.8° ± 5.8° (0.1°–25.4°) and 6.1° ± 4.5° (0.2°–21.0°), respectively. Outlier occurrence rates were 1.0 % with HipCOMPASS and 48.8 % without it. Mean operative times with and without HipCOMPASS use were 109.2 ± 23.8 min (74–199 min) and 137.6 ± 40.6 min (71–298 min), respectively.ConclusionsThe study has found that HipCOMPASS dramatically increases implantation accuracy and it is also a simple and highly versatile tool that can be implemented quickly. Given its low cost in addition to its favourable accuracy, simple implementation, and short operative time, HipCOMPASS can be regarded as a very useful and effective THA support device.Level of evidenceRetrospective comparative study, Level 3.

[1]  Michael Nogler,et al.  Reduced Variability of Acetabular Cup Positioning with Use of an Imageless Navigation System , 2004, Clinical orthopaedics and related research.

[2]  H. Broers,et al.  How precise is navigation for minimally invasive surgery? , 2007, International Orthopaedics.

[3]  H. Mckellop,et al.  Cup containment and orientation in cemented total hip arthroplasties. , 1990, The Journal of bone and joint surgery. British volume.

[4]  Shantanu Patil,et al.  Polyethylene Wear and Acetabular Component Orientation , 2003, The Journal of bone and joint surgery. American volume.

[5]  B. Jaramaz,et al.  Comparison of fluoroscopic and imageless registration in surgical navigation of the acetabular component , 2007, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[6]  G. Haidukewych,et al.  Hospital cost of dislocation after primary total hip arthroplasty. , 2006, The Journal of bone and joint surgery. American volume.

[7]  Jürgen Götz,et al.  Navigated cup implantation in hip arthroplasty , 2009, Acta orthopaedica.

[8]  B F Morrey,et al.  Dislocations after total hip arthroplasty. , 1982, The Journal of bone and joint surgery. American volume.

[9]  D. Dennis,et al.  The importance of acetabular component position in total hip arthroplasty. , 2012, The Orthopedic clinics of North America.

[10]  J. Jenny,et al.  Navigated non-image-based positioning of the acetabulum during total hip replacement , 2009, International Orthopaedics.

[11]  S. Weinstein,et al.  The natural history and long-term follow-up of Scheuermann kyphosis. , 1993, The Journal of bone and joint surgery. American volume.

[12]  S. Fukunishi,et al.  Assessment of accuracy of acetabular cup orientation in CT-free navigated total hip arthroplasty. , 2011, Orthopedics.

[13]  K. Soffe,et al.  Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration. , 1998, The Journal of arthroplasty.

[14]  Philip Ryan,et al.  Risk factors for revision for early dislocation in total hip arthroplasty. , 2008, The Journal of arthroplasty.

[15]  Brigitte M Jolles,et al.  Computer-assisted Cup Placement Techniques in Total Hip Arthroplasty Improve Accuracy of Placement , 2004, Clinical orthopaedics and related research.

[16]  K. Widmer,et al.  Containment versus impingement: finding a compromise for cup placement in total hip arthroplasty , 2007, International Orthopaedics.

[17]  J. Lewis,et al.  Dislocations after total hip-replacement arthroplasties. , 1978, The Journal of bone and joint surgery. American volume.

[18]  Guoyan Zheng,et al.  PS-GANS: A Patient-Specific, Gravity Assisted Navigation System for Acetabular Cup Placement , 2011, IPCAI.

[19]  B. Zurfluh,et al.  Compliant positioning of total hip components for optimal range of motion , 2004, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[20]  D. McCollum,et al.  Dislocation after total hip arthroplasty. Causes and prevention. , 1990, Clinical orthopaedics and related research.

[21]  Simon D Steppacher,et al.  Improving Cup Positioning Using a Mechanical Navigation Instrument , 2011, Clinical orthopaedics and related research.

[22]  D. Murray.  The definition and measurement of acetabular orientation. , 1993, The Journal of bone and joint surgery. British volume.