OrthoPilot navigation system assisted total hip arthroplasty improves the accuracy and safety of acetabular cup placement

doi:10.12307/2023.648

Abstract

Abstract: BACKGROUND: As a classic surgical method for the treatment of femoral head necrosis and femoral neck fracture, total hip arthroplasty has some problems, such as poor placement of prosthesis, postoperative dislocation and so on. OrthoPilot navigation assisted total hip arthroplasty can theoretically improve the accuracy and safety of prosthesis placement. At present, there are few studies on its application in total hip arthroplasty in China.
OBJECTIVE: To explore the feasibility and short-term clinical effect of OrthoPilot navigation assisted total hip arthroplasty.
METHODS: A retrospective analysis was performed in 23 patients who received OrthoPilot navigation assisted total hip arthroplasty in the Department of Joint surgery of the First Affiliated Hospital of Anhui Medical University from June 2019 to April 2022. A total of 23 patients with freehand total hip arthroplasty were matched at 1:1 according to sex, age, body mass index and preoperative Harris score. The anteversion and inclination angles during and after operation were measured and counted. The operation time, total blood loss, postoperative drainage, average hemoglobin loss and postoperative Harris scores were calculated.
RESULTS AND CONCLUSION: (1) The operation time in the navigation group was (152.4±39.9) minutes and in the non-navigation group was (115.3±35.4) minutes, with statistically significant (P=0.02). (2) In terms of angle measurement, the anteversion angle of acetabular cup was (42.3±3.5)° during operation and (42.6±5.5)° after operation, with no significant difference (P=0.574) in the navigation group. The inclination angle of acetabular cup was (18.5±3.4)° during operation and (19.3±3.9)° after operation, with no significant difference (P=0.567) in the navigation group. (3) According to “Lewinnek safe zone”, 22 hips were in the safety zone and 1 hip outside the safety zone after operation in the navigation group, while 17 hips were in the safety zone and 6 hips outside the safety zone after operation in the non-navigation group, showing a significant difference (χ2=4.212, P=0.04). (4) In terms of surgical treatment, there was no significant difference in total blood loss, postoperative drainage, average hemoglobin loss, Harris score, and the incidence of postoperative lower extremity deep venous thrombosis between the two groups. (5) The average follow-up was 3 months after operation, and there were no patients with early infection or dislocation in the two groups. (6) These results verify that OrthoPilot navigation assisted total hip arthroplasty can improve the accuracy and safety of acetabular cup placement, and its short-term clinical effect is not significantly different from that of freehand total hip arthroplasty.

Key words: OrthoPilot navigation, total hip arthroplasty, inclination angle, anteversion angle, safety zone

CLC Number:

Ren Yi, Lu Ming, Qin Kunpeng, Zhang Hui, Gao Weilu, Li Yetian, Wang Jun, Yin Li, Yin Zongsheng. OrthoPilot navigation system assisted total hip arthroplasty improves the accuracy and safety of acetabular cup placement[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(27): 4318-4323.

Figures/Tables 7

References

[1] LEARMONTH I D, YOUNG C, RORABECK C. The operation of the century: total hip replacement. Lancet. 2007;370(9597):1508-1519.
[2] MONT MA. Hip arthroplasty: edited by Harlan C. Amstutz, MD. Churchill Livingstone, New York, 1991. J Arthroplasty. 1992;7(2):221.
[3] BOZIC KJ, KURTZ SM, LAU E, et al. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91(1): 128-133.
[4] CALLANAN MC, JARRETT B, BRAGDON CR, et al. The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res. 2011;469(2):319-329.
[5] DE PALMA L, PROCACCINI R, SOCCETTI A, et al. Hospital Cost of Treating Early Dislocation following Hip Arthroplasty. HIP International. 2012; 22(1):62-67.
[6] WATERS G, D’ALESSANDRO P, YATES P. Functional navigation in hip resurfacing. ANZ J Surg. 2021;91(1-2):168-173.
[7] MASAOKA T, YAMAMOTO K, SHISHIDO T, et al. Study of hip joint dislocation after total hip arthroplasty. Int Orthop. 2006;30(1):26-30.
[8] MEI XY, ETEMAD-REZAIE A, SAFIR OA, et al. Intraoperative measurement of acetabular component position using imageless navigation during revision total hip arthroplasty. Can J Surg. 2021;64(4):E442-E448.
[9] KALTEIS T, HANDEL M, BäTHIS H, et al. Imageless navigation for insertion of the acetabular component in total hip arthroplasty: is it as accurate as CT-based navigation. J Bone Joint Surg Br. 2006;88(2): 163-167.
[10] NAITO Y, HASEGAWA M, TONE S, et al. The accuracy of acetabular cup placement in primary total hip arthroplasty using an image-free navigation system. BMC Musculoskelet Disord. 2021; 22(1): 1016.
[11] MIGLIORINI F, CUOZZO F, OLIVA F, et al. Imageless navigation for primary total hip arthroplasty: a meta-analysis study. J Orthop Traumatol. 2022;23(1):21.
[12] GROSS JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983;58(3):277-280.
[13] NADLER SB, HIDALGO JH, BLOCH T. Prediction of blood volume in normal human adults. Surgery. 1962;51(2):224-232.
[14] MCLAREN RH. Prosthetic hip angulation. Radiology. 1973;107(3): 705-706.
[15] LEWINNEK GE, LEWIS JL, TARR R, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978;60(2):217-220.
[16] TEZUKA T, HECKMANN ND, BODNER RJ, et al. Functional Safe Zone Is Superior to the Lewinnek Safe Zone for Total Hip Arthroplasty: Why the Lewinnek Safe Zone Is Not Always Predictive of Stability. J Arthroplasty. 2019;34(1):3-8.
[17] 崔瑞开.全髋关节置换术中臼杯外展角的影像学研究[D].长春:吉林大学,2019.
[18] 吕明,吴坚,柳剑,等.全髋置换术后髋臼和股骨假体联合前倾角的CT研究[J].重庆医学,2014,43(24):3127-3129,3132.
[19] KOSIYATRAKUL A, LUENAM S, CHOTANAPHUTI T. Measurement of acetabular cup anteversion with the circle theorem. J Med Assoc Thai. 2009; 92 Suppl 6:S128-S133.
[20] ACKLAND MK, BOURNE WB, UHTHOFF HK. Anteversion of the acetabular cup. Measurement of angle after total hip replacement. J Bone Joint Surg Br. 1986;68(3):409-413.
[21] HASSAN DM, JOHNSTON GH, DUST WN, et al. Radiographic calculation of anteversion in acetabular prostheses. J Arthroplasty. 1995;10(3): 369-372.
[22] WIDMER KH. A simplified method to determine acetabular cup anteversion from plain radiographs. J Arthroplasty. 2004;19(3):387-390.
[23] LIAW CK, HOU SM, YANG RS, et al. A new tool for measuring cup orientation in total hip arthroplasties from plain radiographs. Clin Orthop Relat Res. 2006;451:134-139.
[24] 田润,雷雨田,王坤正,等.机器人辅助人工全髋关节置换术中及术后测量髋臼角度比较研究[J].中国修复重建外科杂志,2021, 35(10):1246-1250.
[25] AGARWAL S, ECKHARD L, WALTER WL, et al. The Use of Computer Navigation in Total Hip Arthroplasty Is Associated with a Reduced Rate of Revision for Dislocation: A Study of 6,912 Navigated THA Procedures from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am. 2021;103(20):1900-1905.
[26] HASEGAWA M, TONE S, NAITO Y, et al. Comparison of the accuracies of computed tomography-based navigation and image-free navigation for acetabular cup insertion in total hip arthroplasty in the lateral decubitus position. Comput Assist Surg (Abingdon). 2021;26(1):69-76.
[27] LASS R, OLISCHAR B, KUBISTA B, et al. Total Hip Arthroplasty Using Imageless Computer-Assisted Navigation-2-Year Follow-Up of a Prospective Randomized Study. J Clin Med. 2020;9(6):1620.
[28] HEPINSTALL M, MOTA F, NAYLOR B, et al. Robotic-Assisted Total Hip Arthroplasty in Patients Who Have Developmental Hip Dysplasia. Surg Technol Int. 2021;39:338-347.