A Handheld, Portable Image-Based System May Outperform Computer Navigation or Robotic Platforms in Providing Accurate Acetabular Component Positioning

Abstract

Background

Malposition of the acetabular component during total hip arthroplasty (THA) is a leading cause of complications and need for revision. Robotic-assisted THA purports to improve accuracy of component positioning with many reports demonstrating over 92% of components within 10° of inclination and anteversion compared to intraoperative system output. This study aimed to evaluate the intraoperative accuracy output of acetabular cup position values using a handheld miniaturized portable navigation system (Naviswiss, AG) compared to postoperative computed tomography (CT) scans.

Methods

A total of 108 direct anterior approach THA surgeries using the intraoperative navigation device were performed over a 6-month period. Intraoperative device output for measured acetabular component inclination and anteversion were recorded and compared with values derived from postoperative CT scans.

Results

Postoperative CT analysis of acetabular component positioning demonstrated 97.22% and 94.44% were within 5° of intraoperative inclination and anteversion, respectively, compared to intraoperative values from the navigation unit. No CT demonstrated an absolute inclination or anteversion measurement difference more than 8° from the intraoperative navigation unit value. Overall, 92.59% of components were within 5° and 100% were within 8° for both inclination and anteversion compared to postoperative CT measurements.

Conclusions

This handheld portable navigation system yielded highly accurate intraoperative component positioning values confirmed by postoperative CT scans during direct anterior THA, possibly superior to reported robotic-assisted THA values. These smaller, portable, and more accessible intraoperative units may provide surgeons improved accuracy and availability in a number of surgical settings for use in THA.