Computer navigation in total hip replacement: a meta-analysis

Proponents of navigated hip arthroplasty have suggested that it may increase the precision of acetabular component placement. We conducted a systematic review and meta-analysis to evaluate the validity of this theory. We searched, in duplicate, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials for randomised trials comparing the use of computer navigation with the freehand technique for acetabular cup placement within the desired alignment. We assessed the methodological quality of the studies and abstracted the relevant data. Tests of heterogeneity and publication bias were performed. From the three studies included, there was no evidence of heterogeneity between studies. A total of 250 patients were entered into the analysis. The beneficial odds ratio for the number of outliers was 0.285 (95% confidence interval [CI]: 0.143 to 0.569; p < 0.001). We conclude that navigation in hip arthroplasty improves the precision of acetabular cup placement by decreasing the number of outliers from the desired alignment.RésuméOn peut penser que l’utilisation de la navigation au cours des prothèses de hanche va améliorer la précision du positionnement cotyloïdien. Nous avons conduit une étude systématique et une méta analyse de façon à valider cette théorieMéthode : les recherches ont été réalisé sur MEDLINE, EMBASE et COCHRANE, essais randomisés comparant l’utilisation de la navigation et l’utilisation des techniques classiques à main levée. Différents tests statistiques ont été réalisés.Résultat : à partir de 3 études inclues, il n’y a pas de différence entre ces 3 études. Un total de 250 patients ont été analysés, le ratio des hanches en dehors de la moyenne a été de 0,285 (95% CI: 0,143 et 0,569; p < 0,001). Nous pouvons affirmer que la navigation au cours de la prothèse totale de hanche permet une meilleure précision du positionnement de la cupule et diminue le nombre de cupules en mauvaise position.

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

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

[3]  Branislav Jaramaz,et al.  Mini-incision technique for total hip arthroplasty with navigation. , 2003, The Journal of arthroplasty.

[4]  I. Olkin,et al.  Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement , 1999, The Lancet.

[5]  D. Vandevelde,et al.  Reduction in Variability of Acetabular Cup Abduction Using Computer Assisted Surgery: A Prospective and Randomized Study , 2002, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[6]  S. Kelley,et al.  The Influence of Patient-Related Factors and the Position of the Acetabular Component on the Rate of Dislocation after Total Hip Replacement* , 1997, The Journal of bone and joint surgery. American volume.

[7]  Branislav Jaramaz,et al.  Comparison of a mechanical acetabular alignment guide with computer placement of the socket. , 2002, The Journal of arthroplasty.

[8]  M Tingart,et al.  Imageless navigation for insertion of the acetabular component in total hip arthroplasty: is it as accurate as CT-based navigation? , 2006, The Journal of bone and joint surgery. British volume.

[9]  Richard L Wixson,et al.  Total hip arthroplasty through a minimal posterior approach using imageless computer-assisted hip navigation. , 2005, The Journal of arthroplasty.

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

[11]  B. Morrey,et al.  Effects of acetabular abduction on cup wear rates in total hip arthroplasty. , 1998, The Journal of arthroplasty.

[12]  James B Stiehl,et al.  Comparison of conventional versus computer-navigated acetabular component insertion. , 2007, The Journal of arthroplasty.

[13]  T Nishii,et al.  Mid-term results of cementless total hip replacement using a ceramic-on-ceramic bearing with and without computer navigation. , 2007, The Journal of bone and joint surgery. British volume.

[14]  Moritz Tannast,et al.  THA Performed using Conventional and Navigated Tissue-preserving Techniques , 2006, Clinical orthopaedics and related research.

[15]  J. Argenson,et al.  Validation and usefulness of a computer-assisted cup-positioning system in total hip arthroplasty. A prospective, randomized, controlled study. , 2007, The Journal of bone and joint surgery. American volume.