A new mini-navigation tool allows accurate component placement during anterior total hip arthroplasty

Javad Parvizi, Jessica R Benson, Jeffrey M Muir, Javad Parvizi, Jessica R Benson, Jeffrey M Muir

Abstract

Introduction: Computer-assisted navigation systems have been explored in total hip arthroplasty (THA) to improve component positioning. While these systems traditionally rely on anterior pelvic plane registration, variances in soft tissue thickness overlying anatomical landmarks can lead to registration error, and the supine coronal plane has instead been proposed. The purpose of this study was to evaluate the accuracy of a novel navigation tool, using registration of the anterior pelvic plane or supine coronal plane during simulated anterior THA.

Methods: Measurements regarding the acetabular component position, and changes in leg length and offset were recorded. Benchtop phantoms and target measurement values commonly seen in surgery were used for analysis. Measurements for anteversion and inclination, and changes in leg length and offset were recorded by the navigation tool and compared with the known target value of the simulation. Pearson's r assessed the relationship between the measurements of the device and the known target values.

Results: The device accurately measured cup position and leg length measurements to within 1° and 1 mm of the known target values, respectively. Across all simulations, there was a strong, positive relationship between values obtained by the device and the known target values (r=0.99).

Conclusion: The preliminary findings of this study suggest that the novel navigation tool tested is a potentially viable tool to improve the accuracy of component placement during THA using the anterior approach.

Keywords: accuracy; anterior approach; anterior pelvic plane; computer-assisted navigation; supine coronal plane; total hip arthroplasty.

Conflict of interest statement

Disclosure JP has received consultancy fees from and has equity in Intellijoint Surgical, Inc. JRB and JMM are employees of and hold stock options in Intellijoint Surgical, Inc. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Intraoperative utilization of the Intellijoint HIP® 3D mini-optical navigation tool (Intellijoint Surgical, Inc., Waterloo, ON, Canada). Notes: The camera (A) attaches magnetically to the pelvic platform (B). The platform is secured to the iliac crest of the patient’s pelvis via two pelvic screws (C). The device tracker (D) is magnetically fastened to the impactor. The camera is used intraoperatively to capture the positional changes of the tracker when registering the native orientation or while trialing the implant components. This positional information is then relayed to a workstation (E), located outside of the sterile field, for review by the surgeon.
Figure 2
Figure 2
The anterior benchtop phantom. Notes: The anterior benchtop platform was developed to simulate THA in the anterior approach. 25 mm XYZ translation stages (A; Part No.: PT3/M, Thorlabs Newton, NJ, USA) move the simulated femur and camera in the orthogonal directions of anterior-posterior, medial-lateral, and superior-inferior. The probe and tracker were used to capture leg length and offset measurements relative to a repeatable point (screw head) on the simulated greater trochanter (B). Discrete acetabular angles of inclination were created using a high-precision rotation mount (C; Part No.: PR01/M, Thorlabs). Discrete acetabular angles of anteversion were created using an adjustable angle mounting plate metric (D; Part No.: AP180/M, Thorlabs). Device measurements for anteversion and inclination were recorded by capturing the location of the tracker, attached to the impactor, in a repeatable location provided by the V-clamp (E; Part No.: VC3C/M, Thorlabs). Contralateral and ipsilateral measurements relative to the camera (F) were recorded for acetabular angles and femoral changes in leg length and offset. For simplicity, only ipsilateral acetabular measurements and contralateral femoral measurements are depicted. Abbreviation: THA, total hip arthroplasty.
Figure 3
Figure 3
Anterior benchtop phantom with pelvis and femoral overlay. Notes: The benchtop phantom representation of the pelvis (A), depicting a contralateral femur and ipsilateral acetabulum relative to the camera (B).
Figure 4
Figure 4
Bland–Altman plot for APP anteversion. Notes: Bland–Altman analysis of APP anteversion showed excellent agreement between device measurements and true reference values. A total of 94.4% (68/72) of measurements fell within the statistical limit of agreement (dashed lines). Abbreviation: APP, anterior pelvic plane.
Figure 5
Figure 5
Bland–Altman plot for APP inclination. Notes: Bland–Altman analysis demonstrated a strong agreement between APP inclination measurements. A total of 94.4% (68/72) of inclination measurements fell within the statistical limit of agreement (dashed lines). Abbreviation: APP, anterior pelvic plane.
Figure 6
Figure 6
Bland–Altman plot for APP leg length. Notes: Bland–Altman analysis of leg length demonstrated excellent agreement for measurements. A total of 91.1% (51/56) of measurements were within the statistical limit of agreement (dashed lines). Abbreviation: APP, anterior pelvic plane.
Figure 7
Figure 7
Bland–Altman plot for APP offset. Notes: Bland–Altman analysis of APP offset showed a strong agreement between device and true reference values. A total of 94.6% (53/56) of offset measurements fell within the statistical limit of agreement (dashed lines). Abbreviation: APP, anterior pelvic plane.
Figure 8
Figure 8
Bland–Altman plot for supine coronal anteversion. Notes: Bland–Altman analysis of supine coronal anteversion showed excellent agreement between device measurements and true reference values. A total of 94.4% (68/72) of measurements fell within the statistical limit of agreement (dashed lines).
Figure 9
Figure 9
Bland–Altman plot for supine coronal inclination. Notes: Bland–Altman analysis demonstrated a strong agreement between device measurements and true reference values for supine coronal inclination. A total of 95.8% (69/72) of measurements fell within the statistical limit of agreement (dashed lines).
Figure 10
Figure 10
Bland–Altman plot for supine coronal leg length. Notes: Bland–Altman analysis of supine coronal leg length demonstrated excellent agreement between measurements. A total of 94.6% (53/56) of measurements were within the statistical limit of agreement (dashed lines).
Figure 11
Figure 11
Bland–Altman plot for supine coronal offset. Notes: Bland–Altman analysis of supine coronal offset demonstrated excellent agreement amongst measurements. A total of 92.8% (52/56) of measurements were within the statistical limit of agreement (dashed lines).

References

    1. Chechik O, Khashan M, Lador R, Salai M, Amar E. Surgical approach and prosthesis fixation in hip arthroplasty world wide. Arch Orthop Trauma Surg. 2013;133(11):1595–1600.
    1. Bergin PF, Doppelt JD, Kephart CJ, et al. Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers. J Bone Jt Surg. 2011;93(15):1392–1398.
    1. Bremer AK, Kalberer F, Pfirrmann CW, Dora C. Soft-tissue changes in hip abductor muscles and tendons after total hip replacement. J Bone Jt Surg. 2011;93B(7):886–889.
    1. Yue C, Kang P, Pei F. Comparison of direct anterior and lateral approaches in total hip arthroplasty: a systematic review and meta-analysis (PRISMA) Medicine (Baltimore) 2015;94(50):e2126.
    1. Martin CT, Pugely AJ, Gao Y, Clark CR. A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. J Arthroplasty. 2013;28(5):849–854.
    1. Higgins BT, Barlow DR, Heagerty NE, Lin TJ. Anterior vs. posterior approach for total hip arthroplasty, a systematic review and meta-analysis. J Arthroplasty. 2015;30(3):419–434.
    1. Bender B, Nogler M, Hozack WJ. Direct anterior approach for total hip arthroplasty. Orthop Clin North Am. 2009;40(3):321–328.
    1. Moskal JT, Capps SG, Scanelli JA. Anterior muscle sparing approach for total hip arthroplasty. World J Orthop. 2013;4(1):12–18.
    1. Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty. 2013;28(9):1634–1638.
    1. Elkins JM, Callaghan JJ, Brown TD. The 2014 Frank Stinchfield Award: the “landing zone” for wear and stability in total hip arthroplasty is smaller than we thought: a computational analysis. Clin Orthop Relat Res. 2014;473(2):441–452.
    1. Hart AJ, Allwood SM, Porter M, et al. Which Factors Determine the Wear Rate of Large-Diameter Metal-on-Metal Hip Replacements? J Bone Jt Surg. 2013;95:678–685.
    1. Barrack RL, Krempec JA, Clohisy JC, McDonald DJ RW, Ruh EL NR. Accuracy of acetabular component position in hip arthroplasty. J Bone Jt Surg Am. 2013;95:1760–1768.
    1. Kotwal RS, Ganapathi M, John A, Maheson M, Jones SA. Outcome of treatment for dislocation after primary total hip replacement. J Bone Joint Surg Br. 2009;91(3):321–326.
    1. Matharu GS, Daniel J, Ziaee H, McMinn DJW. Failure of a novel ceramic-on-ceramic hip resurfacing prosthesis. J Arthroplasty. 2015;30(3):416–418.
    1. Ribas M, Cardenas C, Astarita E, Moya E, Bellotti V. Hip resurfacing arthroplasty: mid-term results in 486 cases and current indication in our institution. Hip Int. 2014;24(Suppl 1):S19–S24.
    1. Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Jt Surg. 2009;91(1):128–133.
    1. Masaoka T, Yamamoto K, Shishido T, et al. Study of hip joint dislocation after total hip arthroplasty. Int Orthop. 2006;30(1):26–30.
    1. Nishii T, Sugano N, Miki H, Koyama T, Takao M, Yoshikawa H. Influence of component positions on dislocation: computed tomographic evaluations in a consecutive series of total hip arthroplasty. J Arthroplasty. 2004;19(2):162–166.
    1. Biswas D, Bible JE, Whang PG, Simpson AK, Grauer JN. Sterility of C-arm fluoroscopy during spinal surgery. Spine (Phila Pa 1976) 2008;33(17):1913–1917.
    1. Gershkovich GE, Tiedeken NC, Hampton D, Budacki R, Samuel SP, Saing M. A comparison of three C-arm draping techniques to minimize contamination of the surgical field. J Orthop Trauma. 2016;30(10):e351–e356.
    1. De Geest T, Vansintjan P, De Loore G. Direct anterior total hip arthroplasty: complications and early outcome in a series of 300 cases. Acta Orthop Belg. 2013;79(2):166–173.
    1. Hartford JM, Bellino MJ. The learning curve for the direct anterior approach for total hip arthroplasty: a single surgeon’s first 500 cases. Hip Int. 2017;27(5):483–488.
    1. Masonis J, Thompson C. Safe and accurate: learning the direct anterior total hip arthroplasty. Orthopedics. 2008;31(12 Suppl 2):129–135.
    1. Gross A, Muir JM. Identifying the procedural gap and improved methods for maintaining accuracy during total hip arthroplasty. Med Hypotheses. 2016;94:93–98.
    1. Slover JD, Tosteson AN, Bozic KJ, Rubash HE, Malchau H. Impact of hospital volume on the economic value of computer navigation for total knee replacement. J Bone Joint Surg Am. 2008;90(7):1492–1500.
    1. Brown ML, Reed JD, Drinkwater CJ. Imageless computer-assisted versus conventional total hip arthroplasty: One surgeon’s initial experience. J Arthroplasty. 2014;29(5):1015–1020.
    1. Kalteis T, Handel M, Bäthis H, Perlick L, Tingart M, Grifka J. Imageless navigation for insertion of the acetabular component in total hip arthroplasty: is it as accurate as CT-based navigation? J Bone Jt Surg Br. 2006;88B(2):163–167.
    1. Parratte S, Argenson JA. Validation and usefulness of a computer-assisted cup-positioning system in total hip arthroplasty. A prospective, randomized, controlled study. J Bone Jt Surg. 2007;89(3):494–499.
    1. Ybinger T, Kumpan W, Hoffart HE, Muschalik B, Bullmann W, Zweymüller K. Accuracy of navigation-assisted acetabular component positioning studied by computed tomography measurements: methods and results. J Arthroplasty. 2007;22(6):812–817.
    1. Lee YS, Yoon TR. Error in acetabular socket alignment due to the thick anterior pelvic soft tissues. J Arthroplasty. 2008;23(5):699–706.
    1. Pierrepont J, Walter L, Miles B, et al. ISTA 2015 Vienna. 2015. Pelvic tilt in the standing, supine and seated positions; pp. 1–3.
    1. Wan Z, Malik A, Jaramaz B, Chao L, Dorr LD. Imaging and navigation measurement of acetabular component position in THA. Clin Orthop Relat Res. 2009;467(1):32–42.
    1. Paprosky WG, Muir JM. Intellijoint HIP®: a 3D mini-optical navigation tool for improving intraoperative accuracy during total hip arthroplasty. Med Devices (Auckl) 2016;9:401–408.
    1. Grosso P, Snider M, Muir JM. A smart tool for intraoperative leg length targeting in total hip arthroplasty: a retrospective cohort study. Open Orthop J. 2016;10(1):490–499.
    1. Vigdorchik J, Cross M, Bogner E, Miller T, Muir J, Schwarzkopf R. A cadaver study to evaluate the accuracy of a new 3D mini-optical navigation tool for total hip arthroplasty. Surg Tech Intl. 2017;30:1–8.
    1. Krebs V, Incavo SJ, Shields WH. The anatomy of the acetabulum: What is normal? Clin Orthop Relat Res. 2009;467(4):868–875.
    1. Theivendran K, Hart WJ. Is the tip of the greater trochanter a reliable reference for the rotation centre of the femoral head in total hip arthroplasty? Acta Orthop Belg. 2009;75(4):472–476.
    1. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet (London, England) 1986;1(8476):307–310.
    1. Altman D, Bland J. Measurement in medicine: the analysis of method comparison studies. Statistician. 1983;32:307–317.
    1. Giavarina D. Understanding Bland Altman analysis. Biochem Med. 2015;25(2):141–151.
    1. Plate JF, Brown ML, Wohler AD, Seyler TM, Lang JE. Patient factors and cost associated with 90-Day readmission following total hip arthroplasty. J Arthroplasty. 2016;31(1):49–52.
    1. Rathod PA, Bhalla S, Deshmukh AJ, Rodriguez JA. Does fluoroscopy with anterior hip arthoplasty decrease acetabular cup variability compared with a nonguided posterior approach? Clin Orthop Relat Res. 2014;472(6):1877–1885.
    1. Seng BE, Berend KR, Ajluni AF, Lombardi AV. Anterior-supine minimally invasive total hip arthroplasty: defining the learning curve. Orthop Clin North Am. 2009;40(3):343–350.
    1. Homma Y, Baba T, Kobayashi H, et al. Safety in early experience with a direct anterior approach using fluoroscopic guidance with manual leg control for primary total hip arthroplasty: a consecutive one hundred and twenty case series. Int Orthop. 2016;40(12):2487–2494.
    1. Pomeroy CL, Mason JB, Fehring TK, Masonis JL, Curtin BM. Patient radiation exposure during fluoro-assisted direct anterior approach total hip arthroplasty. J Arthroplasty. 2015;31(6):1218–1221.
    1. Pomeroy CL, Mason JB, Fehring TK, Masonis JL, Curtin BM. Radiation exposure during fluoro-assisted direct anterior total hip arthroplasty. J Arthroplasty. 2015;31(8):1742–1745.
    1. Singer G. Occupational radiation exposure to the surgeon. J Am Acad Orthop Surg. 2005;13(1):69–76.
    1. Rhea EB, Rogers TH, Riehl JT. Radiation safety for anaesthesia providers in the arthopaedic operating room. Anaesthesia. 2016;71:455–461.
    1. Jaramaz B, DiGioia AM, 3rd, Blackwell M, Nikou C. Computer assisted measurement of cup placement in total hip replacement. Clin Orthop Relat Res. 1998;(354):70–81.
    1. DiGioia AM, Jaramaz B, Blackwell M, et al. The Otto Aufranc Award. Image guided navigation system to measure intraoperatively acetabular implant alignment. Clin Orthop Relat Res. 1998;(355):8–22.
    1. Digioia AM, Jaramaz B, Plakseychuk AY, et al. Comparison of a mechanical acetabular alignment guide with computer placement of the socket. J Arthroplasty. 2002;17(3):359–364.
    1. Dorr LD, Hishiki Y, Wan Z, Newton D, Yun A. Development of imageless computer navigation for acetabular component position in total hip replacement. Iowa Orthop J. 2005;25:1–9.
    1. Wolf A, Digioia AM, 3rd, Mor AB, Jaramaz B. Cup alignment error model for total hip arthroplasty. Clin Orthop Relat Res. 2005;(437):132–137.
    1. Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg Br. 1993;75(2):228–232.
    1. Richolt JA, Effenberger H, Rittmeister ME. How does soft tissue distribution affect anteversion accuracy of the palpation procedure in image-free acetabular cup navigation? An ultrasonographic assessment. Comput Aided Surg. 2005;10(2):87–92.
    1. Lembeck B, Mueller O, Reize P, Wuelker N. Pelvic tilt makes acetabular cup navigation inaccurate. Acta Orthop. 2005;76(4):517–523.

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