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Comparison between freehand technique and computed tomography-based navigation in acetabular cup placement through direct anterior approach for total hip arthroplasty

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

In total hip arthroplasty (THA), improper cup orientation can result in dislocation, early excessive polyethylene wear, and pain following THA. The supine position during THA provides a more reproducible functional pelvic position than the lateral decubitus position and may allow freehand cup placement as reliable as that obtained by computer navigation. The purpose of this study was to investigate the accuracy of freehand cup placement through a supine direct anterior approach (DAA) compared with computed tomography (CT)-based navigation.

Materials and methods

The same surgeon performed primary cementless THA through the DAA in 144 supine patients. Seventy-two patients underwent freehand cup placement with standard mechanical guidance-oriented radiographic target cup positioning, and 72 underwent placement with CT-based navigation guidance. Using three-dimensional templating software, the study group calculated cup inclination and anteversion on postoperative CT scans.

Results

The navigation method resulted in a significantly smaller deviation of inclination from the target (p < 0.05); the difference in anteversion was not significant. In addition, the navigation method resulted in significantly fewer cups placed ± 10° outside the target position (0% for inclination, 0% for anteversion) than did the freehand procedure (26% for inclination, 25% for anteversion) (p < 0.0001).

Conclusions

Freehand cup placement is less reliable even in the supine position. Use of a CT-based navigation system can significantly improve cup positioning in THA through the DAA by reducing the incidence of outliers.

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References

  1. Patil S, Bergula A, Chen PC, Colwell CW Jr, D’Lima DD (2003) Polyethylene wear and acetabular component orientation. J Bone Jt Surg Am 85(Suppl 4):56–63

    Article  Google Scholar 

  2. Sadhu A, Nam D, Coobs BR, Barrack TN, Nunley RM, Barrack RL (2017) Acetabular component position and the risk of dislocation following primary and revision total hip arthroplasty: a matched cohort analysis. J Arthroplasty 32(3):987–991

    Article  Google Scholar 

  3. Chalmers BP, Sculco PK, Sierra RJ, Trousdale RT, Berry DJ (2017) Iliopsoas impingement after primary total hip arthroplasty: operative and nonoperative treatment outcomes. J Bone Jt Surg Am 99(7):557–564

    Article  Google Scholar 

  4. Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H (2009) A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty 24(5):698–704

    Article  Google Scholar 

  5. Eilander W, Harris SJ, Henkus HE, Cobb JP, Hogervorst T (2013) Functional acetabular component position with supine total hip replacement. Bone Jt J 95(10):1326–1331

    Article  Google Scholar 

  6. Grammatopoulos G, Gofton W, Cochran M, Dobransky J, Carli A, Abdelbary H, Gill HS, Beaulé PE (2018) Pelvic positioning in the supine position leads to more consistent orientation of the acetabular component after total hip arthroplasty. Bone Jt J 100(10):1280–1288

    Article  Google Scholar 

  7. Matta JM, Shahrdar C, Ferguson T (2005) Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res 441:115–124

    Article  Google Scholar 

  8. Goebel S, Steinert AF, Schillinger J, Eulert J, Broscheit J, Rudert M, Nöth U (2012) Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach. Int Orthop 36(3):491–498

    Article  Google Scholar 

  9. Digioia AM 3rd, Jaramaz B, Plakseychuk AY, Moody JE Jr, Nikou C, Labarca RS et al (2002) Comparison of a mechanical acetabular alignment guide with computer placement of the socket. J Arthroplasty 17(3):359–364

    Article  Google Scholar 

  10. Kalteis T, Handel M, Bäthis H, Perlick L, Tingart M, Grifka J (2006) 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 88(2):163–167

    Article  CAS  Google Scholar 

  11. Parratte S, Argenson JN (2007) Validation and usefulness of a computer-assisted cup-positioning system in total hip arthroplasty. A prospective, randomized, controlled study. J Bone Jt Surg Am 89(3):494–499

    Article  Google Scholar 

  12. Kase M, O’Loughlin PF, Aït-Si-Selmi T, Pagenstert G, Langlois J, Bothorel H, Bonnin MP (2020) Pre-operative templating in THA. Part I: a classification of architectural hip deformities. Arch Orthop Trauma Surg 140:129–137

    Article  Google Scholar 

  13. Tannast M, Langlotz U, Siebenrock KA, Wiese M, Bernsmann K, Langlotz F (2005) Anatomic referencing of cup orientation in total hip arthroplasty. Clin Orthop Relat Res 436(7):144–150

    Article  Google Scholar 

  14. Sugano N, Nishii T, Nakata K, Masuhara K, Takaoka K (1995) Polyethylene sockets and alumina ceramic heads in cemented total hip arthroplasty. A ten-year study. J Bone Jt Surg Br 77(4):548–556

    Article  CAS  Google Scholar 

  15. Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT (1987) Femoral anteversion. J Bone Jt Surg Am 69(8):1169–1176

    Article  CAS  Google Scholar 

  16. Murray DW (1993) The definition and measurement of acetabular orientation. J Bone Jt Surg Br 75(2):228–232

    Article  CAS  Google Scholar 

  17. Widmer KH, Zurfluh B (2004) Compliant positioning of total hip components for optimal range of motion. J Orthop Res 22(4):815–821

    Article  Google Scholar 

  18. Silva GT, Logan BR, Klein JP (2009) Methods for equivalence and non-inferiority testing. Biol Blood Marrow Transplant 15(1 Suppl):120–127

    Article  Google Scholar 

  19. Craiovan B, Renkawitz T, Weber M, Grifka J, Nolte L, Zheng G (2014) Is the acetabular cup orientation after total hip arthroplasty on a two dimension or three dimension model accurate? Int Orthop 38(10):2009–2015

    Article  Google Scholar 

  20. Bayraktar V, Weber M, Kunow FV, Zeman F, Craiovan B, Renkawitz T, Grifka J, Woerner M (2017) Accuracy of measuring acetabular cup position after total hip arthroplasty: comparison between a radiographic planning software and three-dimensional computed tomography. Int Orthop 41(4):731–738

    Article  Google Scholar 

  21. Holzer LA, Scholler G, Wagner S, Friesenbichler J, Maurer-Ertl W, Leithner A (2019) The accuracy of digital templating in uncemented total hip arthroplasty. Arch Orthop Trauma Surg 139:263–268

    Article  Google Scholar 

  22. Savov P, Budde S, Tsamassiotis S, Windhagen H, Klintschar M, Ettinger M (2020) Three-dimensional templating in hip arthroplasty: the basis for template-directed instrumentation? Arch Orthop Trauma Surg 140:827–833

    Article  CAS  Google Scholar 

  23. Higgins BT, Barlow DR, Heagerty NE, Lin TJ (2015) Anterior vs. posterior approach for total hip arthroplasty, a systematic review and meta-analysis. J Arthroplasty 30(3):419–434

    Article  Google Scholar 

  24. Soderquist MC, Scully R, Unger AS (2017) Acetabular placement accuracy with the direct anterior approach freehand technique. J Arthroplasty 32(9):2748–2754

    Article  Google Scholar 

  25. Brun OCL, Sund HN, Nordsletten L, Röhrl SM, Mjaaland KE (2019) Component placement in direct lateral vs minimally invasive anterior approach in total hip arthroplasty: radiographic outcomes from a prospective randomized controlled trial. J Arthroplasty 34(8):1718–1722

    Article  Google Scholar 

  26. Shah SM, Walter WL, Ngo J (2017) Is the pelvis stable during supine total hip arthroplasty? Acta Orthop Belg 83(1):81–86

    CAS  PubMed  Google Scholar 

  27. Maeda Y, Sugano N, Nakamura N, Hamawaki M (2015) The accuracy of a mechanical cup alignment guide in total hip arthroplasty (THA) through direct anterior and posterior approaches measured with CT-based navigation. J Arthroplasty 30(9):1561–1564

    Article  Google Scholar 

  28. Nogler M, Mayr E, Krismer M, Thaler M (2008) Reduced variability in cup positioning: the direct anterior surgical approach using navigation. Acta Orthop 79(6):789–793

    Article  Google Scholar 

  29. Chen AF, Chen CL, Low S, Lin WM, Chinnakkannu K, Orozco FR, Ong AC, Post ZD (2016) Higher acetabular anteversion in direct anterior total hip arthroplasty: a retrospective case-control study. HSS J 12(3):240–244

    Article  CAS  Google Scholar 

  30. Kawarai Y, Iida S, Nakamura J, Shinada Y, Suzuki C, Ohtori S (2017) Does the surgical approach influence the implant alignment in total hip arthroplasty? Comparative study between the direct anterior and the anterolateral approaches in the supine position. Int Orthop 41(12):2487–2493

    Article  Google Scholar 

  31. Esposito CI, Gladnick BP, Lee YY, Lyman S, Wright TM, Mayman DJ, Padgett DE (2015) Cup position alone does not predict risk of dislocation after hip arthroplasty. J Arthroplasty 30(1):109–113

    Article  Google Scholar 

  32. Grammatopoulos G, Thomas GER, Pandit H, Beard DJ, Gill HS, Murray DW (2015) The effect of orientation of the acetabular component on outcome following total hip arthroplasty with small diameter hard-on-soft bearings. Bone Jt J 97(2):164–172

    Article  Google Scholar 

  33. Abdel MP, von Roth P, Jennings MT, Hanssen AD, Pagnano MW (2016) What safe zone? The vast majority of dislocated THAs are within the Lewinnek safe zone for acetabular component position. Clin Orthop Relat Res 474(2):386–391

    Article  Google Scholar 

  34. Biedermann R, Tonin A, Krismer M, Rachbauer F, Eibl G, Stöckl B (2005) Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component. J Bone Jt Surg Br 87(6):762–769

    Article  CAS  Google Scholar 

  35. Garbarino L, Gold P, Sodhi N, Iturriaga C, Mont MA, Boraiah S (2021) Does structured postgraduate training affect the learning curve in direct anterior total hip arthroplasty? A single surgeon’s first 200 cases. Arthroplast Today 12(7):98–104

    Article  Google Scholar 

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Funding

The authors did not receive support from any organisation for the submitted work.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Daini Osaka Police Hospital, 2-6-40 Karasugatsuji, Tennouji-ku, Osaka, 543-8922, Japan

    Shunsaku Nishihara & Kenji Hayashida

Authors
  1. Shunsaku Nishihara
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  2. Kenji Hayashida
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Correspondence to Shunsaku Nishihara.

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The medical ethics committee of our institution approved the study protocol.

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Nishihara, S., Hayashida, K. Comparison between freehand technique and computed tomography-based navigation in acetabular cup placement through direct anterior approach for total hip arthroplasty. Arch Orthop Trauma Surg 142, 323–329 (2022). https://doi.org/10.1007/s00402-021-03920-1

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