Obtaining consistently an optimal cup orientation in THA is vital to obtain adequate head coverage and maximum impingement free range of motion and thus reduce the incidence of polyethylene wear, cup loosening, and dislocation rates associated with a limited range of motion. It is clear that THA instability, the most frequent cause of early failure, is a complex problem related to a wide range of causes. However cup orientation is one of the surgeon dependant potentially modifiable variables that continue to have an important influence due to the lack of reliable means of assuring an adequate orientation of the components, particularly the cup anteversion. Standard mechanical guides like Muller’s have been shown to be inaccurate and imprecise. Not surprisingly, dislocation is the most frequent short term complication after a THA. Acetabular cup orientation is a key factor determining joint stability and one of the most important ones under the surgeons’ control. An in vitro study was used to determine the precision, reproducibility and ease of use of a new mechanical guide in comparison to a standard mechanical guide Müllers. The new guide (Gravity Assisted Navigation System) consists of a simple to use navigation tool. It uses the constant direction of the force of gravity identified by two bulls’ eye levels providing real time intraoperative augmented reality thus controlling the orientation of the pelvis. Visualisation of the guide from a single perspective is enough to determine in real time, the orientation of the cup in abduction and anteversion. By using anatomic repairs within the pelvis its flexion/extension is taken into consideration. As part of an invitro study, 310 press-fit acetabular cups were impacted into a plastic model of a pelvis by 5 surgeons (Power 90%, Type I error 5%), The orientation obtained was measured with respect to a fixed reference of 15° of anteversion and 45° of abduction. Results: an average of 10.4° anteversion ,(Range 3°to 21°, Standard of Deviation 5.0°) for Müller s guide and of 0.4° anteversion (Range 1° to 3°, Standard of Deviation 0.7°) for the new guide and an average of −4.7° abduction (Range 7° to −11°, Standard of Deviation 2.3°) for Müllers guide and 0.3° abduction (Range 0° to 3°, Standard of Deviation 0.5°) for the new guide. The average time required for the orientation of the cups was similar with both guides. (6 seconds for Mullers guide and 5 seconds for the new guide) The precision and reproducibility of the cup orientation obtained with the new guide were significantly better than those obtained with Müllers guide (p< 0.00001). The results obtained with with the new mechanical guide are encouraging. The in vitro results are encouraging, the high precision and accuracy are comparable to results obtained by computer assisted navigation systems in similar studies.

Purpose: Dislocation is a short-term complication frequently encountered after implantation of a total hip arthroplasty (THA). Different strategies can be used to limit the influence of technical, particularly surgical, factors. The position of the acetabular element is a key factor, particularly the anteversion angle and the abduction angle. The purpose of this work was to determine the precision, the reproducibility, and the ease of use of a new mechanical guide for insertion of the acetabular cup.

Material and methods: After calculating the sample size necessary to achieve 90% statistical power for a 5% type I error, we had five surgeons who regularly implanted THA implant 310 press-fit hip cups on a plastic anatomic model of the pelvis. A new mechanical guide was developed using the constant direction of gravity as the reference frame. We determined the precision of acetabular cup implantation, its reproducibility, and ease of use compared with that of the Müller mechanical guide during in vitro implantation of 310 cups via a posterolateral approach that allowed the usual vision of the operative field.

Results: The error of cup anteversion relative to the reference set at 15 was 10.4±5.0 (range 3–21) for the Müller guide and 0.4±0.7 (range 1–3) for the new guide. Cup abduction, relative to the reference set at 45, was −4.7±2.3 (range 7–11) for the Müller guide and 0.3±0.5 (range 0–3) for the new guide. Mean time for positioning the cup was comparable with the two guides (mean 6s for the Müller guide and 5s for the new guide).

Discussion: The precision and reproducibility of cup positioning obtained with the new guide are better than those obtained with mechanical guides currently available on the market (p< 0.00001 with the Müller guide). They are more comparable with values found in in vitro studies using computer-assisted surgery techniques. Use of the new guide was also found to be rapid and simple.

Conclusion: The excellent results obtained with this new mechanical guide, as assessed in terms of cup position for THA, should be confirmed with in vivo trials.