Skip to main content
SpringerLink
Log in

Effect of improved navigation performance on the accuracy of implant placement in total hip arthroplasty with a CT-based navigation system

  • Original Article
  • Artificial Skin, Muscle, Bone / Joint, Neuron
  • Published:
Journal of Artificial Organs Aims and scope Submit manuscript

Abstract

A computed tomography (CT)-based navigation system is one of the support tools to place implant with appropriate alignment and position in total hip arthroplasty (THA). To determine whether the higher performance of the navigation would further improve the accuracy of implant placement in the clinical setting, we retrospectively compared the navigation accuracy of two different versions of a navigation system. The newer version of the navigation system had an upgraded optical sensor with superior positional accuracy. Navigation accuracy, defined as differences between postoperative measurements on CT images and intraoperative records on the navigation system, of 49 THAs performed with the newer version of the navigation system was compared with that of 49 THAs performed with the older version. With the newer version, the mean absolute accuracy (95% limits of agreement) of implant alignment was 1.2° (± 3.3°) for cup inclination, 1.0° (± 2.4°) for cup anteversion, 2.0° (± 4.9°) for stem anteversion, and 1.1° (± 2.4°) for stem valgus angle. The accuracy of the implant position was 1.5 mm (± 3.1 mm), 1.3 mm (± 3.0 mm), and 1.5 mm (± 3.1 mm) for cup x-, y-, and z-axes, respectively, 1.6 mm (± 3.2 mm), 1.4 mm (± 2.9 mm), and 1.5 mm (± 2.7 mm) for stem x-, y-, and z-axes, respectively, and 2.4 mm (± 4.5 mm) for leg length discrepancy. The values for the newer version were significantly more accurate with less variation compared to those of the older version. With upgraded navigation performance, more accurate implant placement was demonstrated in the clinical setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Wan Z, Boutary M, Dorr LD. The influence of acetabular component position on wear in total hip arthroplasty. J Arthroplasty. 2008;23:51–6.

    Article  PubMed  Google Scholar 

  2. Tower SS. Rim cracking of the cross-linked longevity polyethylene acetabular liner after total hip arthroplasty. J Bone Joint Surg. 2007;89:2212–7.

    PubMed  Google Scholar 

  3. Barrack RL. Dislocation after total hip arthroplasty: implant design and orientation. J Am Acad Orthop Surg. 2003;11:89–99.

    Article  PubMed  Google Scholar 

  4. Bader R, Steinhauser E, Zimmermann S, Mittelmeier W, Scholz R, Busch R. Differences between the wear couples metal-on-polyethylene and ceramic-on-ceramic in the stability against dislocation of total hip replacement. J Mater Sci Mater Med. 2004;15:711–8.

    Article  PubMed  CAS  Google Scholar 

  5. Chen PY, Wu CT, Hou CH, Hou SM. Loosening of total hip arthroplasty with a prosthesis employing a skirted femoral head. J Formos Med Assoc. 2005;104:370–3.

    PubMed  Google Scholar 

  6. Shon WY, Baldini T, Peterson MG, Wright TM, Salvati EA. Impingement in total hip arthroplasty. J Arthroplasty. 2005;20:427–35.

    Article  PubMed  Google Scholar 

  7. Parvizi J, Sharkey PF, Bissett GA, Rothman RH, Hozack WJ. Surgical treatment of limb-length discrepancy following total hip arthroplasty. J Bone Joint Surg Am. 2003;85:2310–7.

    Article  PubMed  Google Scholar 

  8. Sugano N, Sasama T, Sato Y, Nakajima Y, Nishii T, Yonenobu K, Tamura S, Ochi T. Accuracy evaluation of surface-based registration methods in a computer navigation system for hip surgery performed through a posterolateral approach. Comput Aided Surg. 2001;6:195–203.

    Article  PubMed  CAS  Google Scholar 

  9. Li Q, Zamorano L, Jiang Z, Gong JX, Pandya A, Perez R, Diaz F. Effect of optical digitizer selection on the application accuracy of a surgical localization system?a quantitative comparison between the OPTOTRAK and flashpoint tracking systems. Comput Aided Surg. 1999;4:314–21.

    PubMed  CAS  Google Scholar 

  10. Schmerber S, Chassat MSF. Accuracy evaluation of a CAS system: laboratory protocol and results with 6D localizers, and clinical experiences in otorhinolaryngology. Comput Aided Surg. 2001;6:1–13.

    Article  PubMed  CAS  Google Scholar 

  11. Sugano N, Tsuda K, Miki H, Takao M, Suzuki N, Nakamura N. Dynamic measurements of hip movement in deep bending activities after total hip arthroplasty using a 4-dimensional motion analysis system. J Arthroplasty. 2012;27:1562–8.

    Article  PubMed  Google Scholar 

  12. Munch B, Ruegsegger P. 3-D repositioning and differential images of volumetric CT measurements. IEEE Trans Med Imaging. 1993;12:509 – 14.

    Article  PubMed  CAS  Google Scholar 

  13. Holden M, Hill DL, Denton ER, Jarosz JM, Cox TC, Rohlfing T, Goodey J, Hawkes DJ. Voxel similarity measures for 3-D serial MR brain image registration. IEEE Trans Med Imaging. 2000;19:94–102.

    Article  PubMed  CAS  Google Scholar 

  14. Watanabe Y, Masumoto J, Sasama T, Sato Y, Sugano N, Nishii T, Miki H, Yoshikawa H, Ochi T, Tamura S. Preprocessing method for rigid registration between pre- and postoperative CT images in total hip replacement. Med Imag Tech. 2003;21:358 – 68.

    Google Scholar 

  15. Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg Br. 1993;75:228 – 32.

    Article  PubMed  CAS  Google Scholar 

  16. Iwana D, Nakamura N, Miki H, Kitada M, Hananouchi T, Sugano N. Accuracy of angle and position of the cup using computed tomography-based navigation systems in total hip arthroplasty. Comput Aided Surg. 2013;18:187–94.

    Article  PubMed  Google Scholar 

  17. Ybinger T, Kumpan W, Hoffart HE, Muschalik B, Bullmann W, Zweymüller K. Accuracy of navigation-assisted acetabular component positioning studied by computed tomography measurements: methods and results. J Arthroplasty. 2007;22:812–7.

    Article  PubMed  Google Scholar 

  18. Parratte S, Argenson JN. Validation and usefulness of a computer-assisted cup-positioning system in total hip arthroplasty. A prospective, randomized, controlled study. J Bone Joint Surg Am. 2007;89:494–9.

    Article  PubMed  Google Scholar 

  19. Ryan JA, Jamali AA, Bargar WL. Accuracy of computer navigation for acetabular component placement in THA. Clin Orthop Relat Res. 2010;468:169 – 77.

    Article  PubMed  Google Scholar 

  20. Jenny JY, Boeri C, Dosch JC, Uscatu M, Ciobanu E. Navigated non-image-based positioning of the acetabulum during total hip replacement. Int Orthop. 2009;33:83 – 7.

    Article  PubMed  Google Scholar 

  21. Fukunishi S, Nishio S, Fujihara Y, Okahisa S, Takeda Y, Fukui T, Yoshiya S. Accuracy of combined anteversion in image-free navigated total hip arthroplasty: stem-first or cup-first technique? Int Orthop. 2016;40:9–13.

    Article  PubMed  Google Scholar 

  22. Takeda Y, Fukunishi S, Nishio S, Fujihara Y, Yoshiya S. Accuracy of component orientation and leg length adjustment in total hip arthroplasty using image-free navigation. Open Orthop J. 2017;11:1432–9.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lin F, Lim D, Wixson RL, Milos S, Hendrix RW, Makhsous M. Limitations of imageless computer-assisted navigation for total hip arthroplasty. J Arthroplasty. 2011;26:596–605.

    Article  PubMed  Google Scholar 

  24. Sendtner E, Schuster T, Wörner M, Kalteis T, Grifka J, Renkawitz T. Accuracy of acetabular cup placement in computer-assisted, minimally-invasive THR in a lateral decubitus position. Int Orthop. 2011;35:809 – 15.

    Article  PubMed  Google Scholar 

  25. Kalteis T, Handel M, Bäthis H, Perlick L, Tingart M, Grifka J. 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;88:163–7.

    Article  PubMed  CAS  Google Scholar 

  26. Hananouchi T, Takao M, Nishii T, Miki H, Iwana D, Yoshikawa H, Sugano N. Comparison of navigation accuracy in THA between the mini-anterior and -posterior approaches. Int J Med Robot. 2009;5:20–5.

    Article  PubMed  Google Scholar 

  27. Hirasawa N, Matsubara M, Ishii K, Hagio S, Okuda N, Sekiya I, Muneta T. Effect of CT slice thickness on accuracy of implant positioning in navigated total hip arthroplasty. Comput Aided Surg. 2010;15:83–9.

    Article  PubMed  CAS  Google Scholar 

  28. Kitada M, Nakamura N, Iwana D, Kakimoto A, Nishii T, Sugano N. Evaluation of the accuracy of computed tomography—based navigation for femoral stem orientation and leg length discrepancy. J Arthroplasty. 2011;26:674–9.

    Article  PubMed  Google Scholar 

  29. Kajino Y, Kabata T, Maeda T, Iwai S, Kuroda K, Tsuchiya H. Does degree of the pelvic deformity affect the accuracy of computed tomography-based hip navigation? J Arthroplasty. 2012;27:1651–7.

    Article  PubMed  Google Scholar 

  30. Kyo T, Nakahara I, Kuroda Y, Miki H. Effects of coordinate-system construction methods on postoperative computed tomography evaluation of implant orientation after total hip arthroplasty. Comput Aided Surg. 2015;20:52–60.

    Article  PubMed  Google Scholar 

  31. Kummer FJ, Shah S, Iyer S, DiCesare PE. The effect of acetabular cup orientations on limiting hip rotation. J Arthroplasty. 1999;14:509–13.

    Article  PubMed  CAS  Google Scholar 

  32. Widmer KH, Zurfluh B. Compliant positioning of total hip components for optimal range of motion. J Orthop Res. 2004;22:815–21.

    Article  PubMed  Google Scholar 

  33. Sugano N, Takao M, Sakai T, Nishii T, Miki H. Does CT-based navigation improve the long-term survival in ceramic-on-ceramic THA? Clin Orthop Relat Res. 2012;470:3054–9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Liu RY, Wang KZ, Wang CS, Dang XQ, Tong ZQ. Evaluation of medial acetabular wall bone stock in patients with developmental dysplasia of the hip using a helical computed tomography multiplanar reconstruction technique. Acta Radiol. 2009;50:791–7.

    Article  PubMed  CAS  Google Scholar 

  35. Austin MS, Hozack WJ, Sharkey PF, Rothman RH. Stability and leg length equality in total hip arthroplasty. J Arthroplasty. 2003;18:88–90.

    Article  PubMed  Google Scholar 

  36. O’Brien S, Kernohan G, Fitzpatrick C, Hill J, Beverland D. Perception of imposed leg length inequality in normal subjects. Hip Int. 2010;20:505–11.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Osaka National Hospital, 2-1-14 oenzaka, Chuo-ku, Osaka, 5400006, Japan

    Ichiro Nakahara, Yasuo Kuroda & Hidenobu Miki

  2. Department of Orthopaedic Surgery, Bellland General Hospital, 500-3 Higashiyama, Naka-ku, Sakai-city, Osaka, Japan

    Takayuki Kyo

Authors
  1. Ichiro Nakahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takayuki Kyo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yasuo Kuroda
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hidenobu Miki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ichiro Nakahara.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nakahara, I., Kyo, T., Kuroda, Y. et al. Effect of improved navigation performance on the accuracy of implant placement in total hip arthroplasty with a CT-based navigation system. J Artif Organs 21, 340–347 (2018). https://doi.org/10.1007/s10047-018-1041-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10047-018-1041-6

Keywords

Search

Navigation