Abstract
Introduction
CT-based navigation system in total hip arthroplasty (THA) is widely used to achieve accurate implant placement. Now, we developed our own CT-based navigation system originally, and since then we have been conducting various analysis in order to use the system more effectively. We compared the accuracy of registration with this navigation system and land mark matching type navigation system. In this study, we evaluated the influence of the surgical approach to the accuracy of registration.
Methods
Between June 2015 and February 2016, 28 consecutive uncemented THAs were performed in 26 patients. The preoperative diagnosis was osteoarthritis in 20 hips, osteonecrosis of the femoral hips in 5, and rheumatoid arthritis in 3. The newly developed navigation system was a CT based, surface matching type navigation system. We used newly developed navigation system and commercially available land-mark type CT-based navigation system in the setting of acetabular sockets under the same condition. After we fixed the cementless cup, we measured the cup setting angle of inclination and anteversion on each navigation system. Postoperative assessment was performed using CT one week after the operation, and measured the actual angle of the cup. Approach of operations were performed via posterolateral approach in 14 hips, and Hardinge approach in 14 hips. We calculated the absolute value of the cup angle difference between intra-operative value and post-operative value with each navigation system and compared the accuracy between each navigation system and surgical approach.
Results
The mean inclination using the Land-mark type navigation(group L) was 38.3±3.8°, using our navigation system (group S) was 38.7±5.7 °, the mean anteverion on group L was 25.8±5.6°, and group S was 27.3±10.2°. The mean of actual inclination of the implants calculated by postoperative CT was 38.4±7.1°, the mean of actual anteversion was 25.8±8.3°. In comparison with the absolute value of the difference between intra-operative and post-operative date, the mean difference of inclination on group L was 6.5±5.7°, and group L was 3.7±3.1 °, the difference was significant (p<0.05). The mean difference of anteversion of group L was 4.7±4.6 °, group S was 4.0±3.3°. In group L, the mean of absolute value of the difference between intra-operative and post-operative date of inclination via Hardinge approach was 6.0±6.8°, and posterior approach was 7.9±4.5°. In group S, The mean difference of inclination via Hardinge approach was 3.0±1.8°, and posterior approach was 4.5±4.1°. In group L, The mean difference of anteversion of Hardinge approach was 4.2±4.1°, and posterior approach was 5.3±5.3°. In group S, The mean difference of anteversion of Hardinge approach was 3.8±3.5°, and posterior approach was 4.2±3.3°.
Discussion
N-navi was superior on inclination of the acetabular socket setting. Considering surgical approach, the accuracy was not good via posterior approach. We should take surface matching points widely around the acetabulum, however, to take points of anterior the acetabulum via posterior approach was difficult because of the femur. It was the reason of decrease the accuracy via posterior approach. We should choose the area of surface matching points according to surgical approach to make the registration more accurate.
