Femoral Component Positioning in Hip Resurfacing With and Without Navigation

AbstractEarly failures after hip resurfacing often are the result of technical errors in placing the femoral component. We asked whether image-free computer navigation decreased the number of outliers compared with the conventional nonnavigated technique. We retrospectively compared 51 consecutive hip resurfacings performed using image-free computer navigation with 88 consecutive hip resurfacings performed without navigation. Patient demographics were similar. There were no differences in the average native femoral neck-shaft angles, planned stem-shaft angles, or postoperative stem-shaft angles. However, when the postoperative stem-shaft angle was compared with the planned stem-shaft angle, there were 33 patients (38%) in the nonnavigated group with a deviation greater than 5° in contrast to none in the navigated group. Notching was present in four patients in the nonnavigated group and none in the navigated group. The average operative time was 111 minutes for the navigated group and 105 minutes for the nonnavigated group. Image-free navigation decreased the number of patients with potentially undesirable implant placements. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

[1]  M. Guertin,et al.  A multimodal analgesia protocol for total knee arthroplasty. A randomized, controlled study. , 2006, The Journal of bone and joint surgery. American volume.

[2]  M. Bolognesi,et al.  Computer Navigation versus Standard Instrumentation for TKA: A Single-Surgeon Experience , 2005, Clinical orthopaedics and related research.

[3]  B. Hanson,et al.  Navigated total knee replacement. A meta-analysis. , 2007, The Journal of bone and joint surgery. American volume.

[4]  Klaus Radermacher,et al.  Fluoroscopic navigation system for hip surface replacement , 2007, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[5]  K. Bozic,et al.  An overview of economic issues in computer-assisted total joint arthroplasty. , 2007, Clinical orthopaedics and related research.

[6]  J. Cobb,et al.  Navigation Reduces the Learning Curve in Resurfacing Total Hip Arthroplasty , 2007, Clinical orthopaedics and related research.

[7]  T. Seyler,et al.  Resurfacing for Perthes Disease: An Alternative to Standard Hip Arthroplasty , 2007, Clinical orthopaedics and related research.

[8]  P. Beaulé,et al.  Risk factors affecting outcome of metal-on-metal surface arthroplasty of the hip : Section I Symposium , 2004 .

[9]  D. Howie,et al.  Wagner resurfacing hip arthroplasty. The results of one hundred consecutive arthroplasties after eight to ten years. , 1990, The Journal of bone and joint surgery. American volume.

[10]  H. Amstutz,et al.  Fracture of the neck of the femur after surface arthroplasty of the hip. , 2004, The Journal of bone and joint surgery. American volume.

[11]  F. Picard,et al.  Using Navigation Intraoperative Measurements Narrows Range of Outcomes in TKA , 2007, Clinical orthopaedics and related research.

[12]  T. Gampe,et al.  [Intraoperative navigation for hip resurfacing. Methods and first results]. , 2004, Der Orthopade.

[13]  D. Back,et al.  Femoral neck fractures following Birmingham hip resurfacing: a national review of 50 cases. , 2005, The Journal of bone and joint surgery. British volume.

[14]  Pak Lin Chin,et al.  Randomized control trial comparing radiographic total knee arthroplasty implant placement using computer navigation versus conventional technique. , 2005, The Journal of arthroplasty.

[15]  A. Depalma,et al.  CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, No. 44 , 1966 .

[16]  F. Gossé,et al.  Verbesserte Implantationstechnik der Oberflächenendoprothese des Hüftgelenks , 2006, Operative Orthopädie und Traumatologie.

[17]  T. Hess,et al.  Einsatz der Navigation beim Oberflächenersatz des Hüftgelenks , 2004, Der Orthopäde.

[18]  M. Freeman Some anatomical and mechanical considerations relevant to the surface replacement of the femoral head. , 1978, Clinical orthopaedics and related research.

[19]  D. Howie,et al.  Resurfacing hip arthroplasty. Classification of loosening and the role of prosthesis wear particles. , 1990, Clinical orthopaedics and related research.

[20]  M. L. Le Duff,et al.  Cementing the Metaphyseal Stem in Metal-on-Metal Resurfacing: When and Why , 2009, Clinical orthopaedics and related research.

[21]  P. Campbell,et al.  Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study. , 2004, The Journal of bone and joint surgery. American volume.

[22]  H. Amstutz* Conventional versus resurfacing total hip arthroplasty. A long-term prospective study of concomitant bilateral implantation of prostheses. , 1986, The Journal of bone and joint surgery. American volume.

[23]  P. Beaulé,et al.  Risk Factors Affecting Outcome of Metal-on-Metal Surface Arthroplasty of the Hip , 2004, Clinical orthopaedics and related research.

[24]  J Schatzker,et al.  A study of implant failure in the Wagner resurfacing arthroplasty. , 1985, The Journal of bone and joint surgery. American volume.

[25]  P. Zambelli,et al.  Computer-assisted placement technique in hip resurfacing arthroplasty: improvement in accuracy? , 2009, International Orthopaedics.

[26]  A. Hodgson,et al.  Hip Resurfacing Femoral Neck Fracture Influenced by Valgus Placement , 2007, Clinical orthopaedics and related research.

[27]  P Gallie,et al.  The accuracy of image-free computer navigation in the placement of the femoral component of the Birmingham Hip Resurfacing: a cadaver study. , 2007, The Journal of bone and joint surgery. British volume.

[28]  H. Amstutz,et al.  Orientation of the femoral component in surface arthroplasty of the hip. A biomechanical and clinical analysis. , 2004, The Journal of bone and joint surgery. American volume.

[29]  P. Beaulé Removal of acetabular bone in resurfacing arthroplasty of the hip. , 2006, The Journal of bone and joint surgery. British volume.

[30]  Jan Victor,et al.  Image-Based Computer-Assisted Total Knee Arthroplasty Leads to Lower Variability in Coronal Alignment , 2004, Clinical orthopaedics and related research.

[31]  H. Amstutz,et al.  Orientation of the femoral component in surface arthroplasty of the hip. , 2004, The Journal of bone and joint surgery. American volume.

[32]  D. S. Pandher,et al.  Computer-assisted navigation increases precision of component placement in total knee arthroplasty. , 2007, Clinical orthopaedics and related research.

[33]  M. Lavigne,et al.  Resurfacing arthroplasty of the hip in osteopetrosis. , 2006, The Journal of bone and joint surgery. British volume.