Abstract
Imageless navigation is useful in acetabular cup orientation during total hip arthroplasty (THA). There is a limitation of accuracy in the imageless navigation system because of the registration method, that is, to palpate bony landmarks over the skin. To improve this limitation, ultrasound-based navigation was introduced for more precise registration of bony landmarks. We evaluated the accuracy of placement of the implant, which was measured by CT in 66 patients. 22 patients underwent THA with imageless navigation, and 44 patients underwent THA with ultrasound-based navigation. The accuracy was evaluated by comparison of the navigation values obtained during surgery with the CT measured values.
For the 44 patients with ultrasound-based navigation system, the mean CIA was 39.6+4.1 degrees (mean+SD) and the CAA was 18.5+6.1 degrees with CT evaluation. Ultrasound-based navigation showed 39.0+3.2 degrees in CIA and 18.8+5.9 degrees in CAA during surgery. The mean absolute difference in cup inclination angle (CIA) between ultrasound-based navigation and CT was 2.4+2.1 degrees (range 0.1–9.2 degrees). The mean absolute difference in cup anteversion angle (CAA) between navigation and CT was 2.2+2.7 degrees (0.04–12.2 degrees). The rasp ante-torsion angle was 28.6+10.0 degrees in the ultrasound-based navigation system. The mean SAA was 28.8+9.3 degrees in CT. Strong correlation was found between the rasp ante-torsion angle and SAA (r=0.858). The mean absolute difference between the rasp ante-torsion angle and SAA was 4.3+3.6 degrees (0.2-17.2 degrees). For the 22 patients with imageless navigation system, the mean absolute difference between imageless navigation and CT in CIA, CAA, and SAA were 2.5+1.8 degrees (0.1–5.8 degrees), 5.4+3.8 degrees (0.1–17.2 degrees), and 5.2+3.0 degrees (1.1-12 degrees) respectively. The thickness of subcutaneous tissue at the pubic symphysis was correlated to the difference in CAA between the imageless navigation and CT (r=0.456).
Ultrasound-based navigation showed higher accuracy in CAA compare to imageless navigation. Moreover, ultrasound-based navigation showed almost the same accuracy of placement of the implant compare to the reported accuracy with CT-based navigation. Ultrasound-based navigation system improved the limitation of accuracy in the imageless navigation system.
