No added value for Computer-Assisted surgery to improve femoral component positioning and Patient Reported Outcomes in Hip Resurfacing Arthroplasty; a multi-center randomized controlled trial

M C Koper, M Reijman, E M van Es, J H Waarsing, H W J Koot, S B Keizer, I Jansen, F C van Biezen, J A N Verhaar, P K Bos, M C Koper, M Reijman, E M van Es, J H Waarsing, H W J Koot, S B Keizer, I Jansen, F C van Biezen, J A N Verhaar, P K Bos

Abstract

Background: Computer Assisted Surgery (CAS) has proven to improve the accuracy in several orthopedic procedures. Therefore we used this technique to evaluate femoral component positioning in Hip Resurfacing Arthroplasty (HRA). The aim of this study was to evaluate imageless CAS compared to manually implanted femoral components and subsequently evaluates Patient Related Outcome Measures (PROMs). We hypothesized that the use of CAS optimizes the position of the femoral component and improves PROMs.

Methods: This is a multicenter, single-blinded, randomized, controlled trial of two groups. In the CAS group guiding of the femoral component was done with imageless navigation. In the Conventional (control) group the femoral component was placed manually according to the preplanned position. The primary outcome measure consists of a maximum of 3 degrees difference between the postoperative Stem Shaft Angle (SSA) and preplanned SSA. Secondary outcome measures consist of the Hip disability and Osteoarthritis Outcome Scale (HOOS), the Harris Hip Score (HHS) and Visual Analogue Scale (VAS) pain score.

Results: A total of 122 patients were randomized, 61 in the CAS group and 61 in the conventional group. There was no significant differences in accuracy of femoral implant position. The mean difference between the postoperative- and preplanned SSA was - 2.26 and - 1.75 degrees (more varus) respectively in the CAS and Conventional group. After surgery both groups show significant improvement in all PROMs compared to the baseline measurements, with no significant differences between the groups.

Conclusion: Our cohort indicates no benefit for the use of CAS in accuracy of placement of the femoral component in HRA compared to manual implantation. There are no clinical differences in PROMs after 1 year follow up. This study showed no added value and no justification for the use of CAS in femoral component positioning in HRA.

Trial registration: This trial is registered at ClinicalTrails.gov ( https://ichgcp.net/clinical-trials-registry/NCT00391937" title="See in ClinicalTrials.gov">NCT00391937.

Level of incidence: Level IIb, multicenter randomized controlled trial.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Examples of the use of GeoGebra (International GeoGebra Institute and GeoGebra GmbH, freeware) to calculate the Center-Collum-Diaphysis (a) and the postoperative Stem-Shaft-Angle (b)
Fig. 2
Fig. 2
Study flowchart
Fig. 3
Fig. 3
The 3 year survival Kaplan-Meier curve between the CAS and Conventional group. No significant difference (p = 0.304) in survival was found

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