Accuracy of cup placement using computed tomography-based navigation system in total hip arthroplasty through the direct anterior approach

Matsuki, Yuta; Imagama, Takashi; Tokushige, Atsunori; Yamazaki, Kazuhiro; Sakai, Takashi

doi:10.1016/j.jos.2021.10.018

Cited by 7 publications

(10 citation statements)

References 20 publications

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“…This could contribute to the improved accuracy of RA in portable navigation. The accuracy of cup angle using AR is comparable to that previously reported for CT-based navigation 8 , 19 , 20 and portable navigation systems 17 , 23 – 27 . CT-based navigation with AR technologies enables surgeons to recognize not only bone but also soft tissue, whereas portable AR-based navigation is limited to navigating bone only.…”

Section: Discussionsupporting

confidence: 82%

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Comparison between accuracy of augmented reality computed tomography-based and portable augmented reality-based navigation systems for cup insertion in total hip arthroplasty

Hasegawa,

Naito,

Tone

et al. 2024

Sci Rep

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Augmented reality (AR) has been used for navigation during total hip arthroplasty (THA). AR computed tomography (CT)-based navigation systems and AR-based portable navigation systems that use smartphones can also be used. This study compared the accuracy of cup insertion during THA using AR-CT-based and portable AR-based navigation systems. Patients with symptomatic hip disease who underwent primary THA in the supine position using both AR CT-based and portable AR-based navigation systems simultaneously between October 2021 and July 2023 were included. The primary outcome of this study was the absolute difference between cup angles in the intraoperative navigation record and those measured on postoperative CT. The secondary outcome was to determine the factors affecting the absolute value of the navigation error in radiographic inclination (RI) and radiographic anteversion (RA) of the cup, including sex, age, body mass index, left or right side, approach, and preoperative pelvic tilt. This study included 94 consecutive patients. There were 11 men and 83 women, with a mean age of 68 years. The mean absolute errors of RI were 2.7° ± 2.0° in the AR CT-based and 3.3° ± 2.4° in the portable AR-based navigation system. The mean absolute errors of RA were 2.5° ± 2.1° in the AR CT-based navigation system and 2.3° ± 2.2° in the portable AR-based navigation system. No significant differences were observed in RI or RA of the cup between the two navigation systems (RI: p = 0.706; RA: p = 0.329). No significant factors affected the absolute value of the navigation errors in RI and RA. In conclusion, there were no differences in the accuracy of cup insertion between the AR CT-based and portable AR-based navigation systems.

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Section: Discussionsupporting

confidence: 82%

“…Table 1 summarizes the results of previous studies on the accuracy of navigation systems in the supine position. The navigation errors using CT-based navigation were 2.5°–3.0° for RI and 2.5°–3.3° for RA 8 , 19 , 20 . For image-free navigation, accurate registration of the APP is required.…”

Section: Discussionmentioning

confidence: 94%

Comparison between accuracy of augmented reality computed tomography-based and portable augmented reality-based navigation systems for cup insertion in total hip arthroplasty

Hasegawa,

Naito,

Tone

et al. 2024

Sci Rep

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“…To the best of our knowledge, the present study is the first clinical research to investigate the accuracy of cup placement using CT-based navigation with AR technology. In CT-based navigation, absolute navigation errors have been reported to be in the range of 1.2°–4.6° for RI, and 1.0°–4.4° for RA [ 20 , 23 – 27 ]. Clinical use of AR navigation systems is easy, and the accuracy for cup angle is comparable to that previously reported for CT-based navigation [ 20 , 23 – 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…A power analysis was performed using G*Power 3.1.9 (Heinrich Heine Universität Düsseldorf, Germany) [ 19 ]. From a previous navigation study [ 20 ], difference (mean ± standard deviation) in CT-based navigation and conventional groups for cup inclination and anteversion was 1.6° ± 0.7° and 3.0° ± 2.8°, respectively. Based on this finding, a sample size of 14 hips in each group was considered necessary to detect a significant difference between groups ( ɑ = 0.05, power = 0.8).…”

Section: Methodsmentioning

confidence: 99%

Accuracy of augmented reality with computed tomography-based navigation in total hip arthroplasty

Hasegawa,

Naito,

Tone

et al. 2023

J Orthop Surg Res

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Background Augmented reality (AR) provides the surgeon with direct visualization of radiological images by overlaying them on the patient. This study aimed to evaluate the accuracy of cup placement using a computed tomography (CT)-based AR navigation system. Methods Sixty-five prospectively enrolled patients underwent primary cementless total hip arthroplasty (THA) in a supine position using this novel AR navigation system, and changes in pelvic flexion angle (PFA) were evaluated. Absolute navigation errors were defined as the absolute differences between angles in the intraoperative navigation record and those measured on postoperative CT. Factors affecting the absolute navigation error in cup alignment were determined. Results Mean absolute change in PFA between preoperative CT and reduction was 2.1° ± 1.6°. Mean absolute navigation errors were 2.5° ± 1.7° in radiographic inclination (RI) and 2.5° ± 2.2° in radiographic anteversion (RA). While no factors significantly affecting absolute navigation error were found for RI, absolute change in PFA between preoperative CT and reduction correlated significantly with the absolute navigation error for RA. Conclusion This CT-based navigation system with AR enabled surgeons to place the cup more accurately than was possible by freehand placement during THA in a supine position.

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“…Also, significant improvements have been reported based on comparison of CT-based navigation systems with conventional manual positioning, specifically in regard to the direct anterior approach. In particular, a substantial reduction in the mean absolute error of radiographic inclination, nearly two-fold smaller, has been reported (2.8°±2.5° vs. 4.4°±3.2°, P =0.01) 41 ) . Similar findings were reported for the mean absolute error of radiographic anteversion in comparison of the CT-guided approach with a fluoroscopy-guided technique (2.8°±1.9° vs. 4.8°±4.1°, P =0.02).…”

Section: Intraoperative Advantagesmentioning

confidence: 90%

The Value of Computed Tomography Scan in Three-dimensional Planning and Intraoperative Navigation in Primary Total Hip Arthroplasty

Mancino,

Fontalis,

Magan

et al. 2024

Hip & Pelvis

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Total hip arthroplasty (THA) is a frequently performed procedure; the objective is restoration of native hip biomechanics and achieving functional range of motion (ROM) through precise positioning of the prosthetic components. Advanced three-dimensional (3D) imaging and computed tomography (CT)-based navigation are valuable tools in both the preoperative planning and intraoperative execution. The aim of this study is to provide a thorough overview on the applications of CT scans in both the preoperative and intraoperative settings of primary THA. Preoperative planning using CT-based 3D imaging enables greater accuracy in prediction of implant sizes, leading to enhancement of surgical workflow with optimization of implant inventory. Surgeons can perform a more thorough assessment of posterior and anterior acetabular wall coverage, acetabular osteophytes, anatomical landmarks, and thus achieve more functional implant positioning. Intraoperative CT-based navigation can facilitate precise execution of the preoperative plan, to attain optimal positioning of the prosthetic components to avoid impingement. Medial reaming can be minimized preserving native bone stock, which can enable restoration of femoral, acetabular, and combined offsets. In addition, it is associated with greater accuracy in leg length adjustment, a critical factor in patients’ postoperative satisfaction. Despite the higher costs and radiation exposure, which currently limits its widespread adoption, it offers many benefits, and the increasing interest in robotic surgery has facilitated its integration into routine practice. Conducting additional research on ultra-low-dose CT scans and examining the potential for translation of 3D imaging into improved clinical outcomes will be necessary to warrant its expanded application.

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Accuracy of cup placement using computed tomography-based navigation system in total hip arthroplasty through the direct anterior approach

Cited by 7 publications

References 20 publications

Comparison between accuracy of augmented reality computed tomography-based and portable augmented reality-based navigation systems for cup insertion in total hip arthroplasty

Comparison between accuracy of augmented reality computed tomography-based and portable augmented reality-based navigation systems for cup insertion in total hip arthroplasty

Accuracy of augmented reality with computed tomography-based navigation in total hip arthroplasty

The Value of Computed Tomography Scan in Three-dimensional Planning and Intraoperative Navigation in Primary Total Hip Arthroplasty

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