Computer navigation in total hip arthroplasty: A meta-analysis of randomized controlled trials

Xu, Ke; Li, Yaomin; Zhang, Hua-feng; Wang, Chenguang; Xu, Yunqiang; Li, Zhijun

doi:10.1016/j.ijsu.2014.02.014

Cited by 96 publications

(81 citation statements)

References 26 publications

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“…The authors of this article concluded that ''standard cup first'' THA navigation does not improve midterm functional outcome [11]. If most of the studies including the recent meta-analysis comparing CAS THA versus a conventional technique reported improvement in cup positioning, there is still a lack of evidence to link this cup position improvement to substantial clinical improvements at short and midterm followup [23]. Based on our results at long term, and based on the analysis of the work of others as noted, there is no evidence at short or midterm followup showing a potential functional benefit when using CAS for cup positioning.…”

Section: Discussionmentioning

confidence: 99%

“…The method used in our study has, however, been previously validated [7]. Third, the target used in this study was based on the Lewinnek et al [12] study and a recent paper showed that this target may not be appropriate [1], although most of the available systems today still use this target [6,23]. Concerning the surgical technique, the system was strictly a cup positioning software with no integration of the combined cup-stem anteversion.…”

Section: Discussionmentioning

confidence: 99%

“…At last followup, the HOOS was used to evaluate the patient's hip-related quality of life [17] and the SF-12 to evaluate the patient's general health-related quality of life [22]. The HOOS is a self-administrated hip-related quality-of-life questionnaire corresponding to a validated and improved WOMAC [23]. The HOOS includes five dimensions scored separately: pain (nine items); symptoms (seven items); activities of daily life function (17 items); sport and recreation function (five items); and quality of life (four items).…”

Section: Methodsmentioning

confidence: 99%

“…However, to our knowledge, few studies have looked at CAS over the longer term to see whether it confers any advantages in terms of endpoints that a patient might perceive such as differences in validated outcome scores, differences in acetabular wear (which can lead to osteolysis or revision surgery), or differences in the proportion of patients undergoing revision surgery [11,21,23]. Therefore and as a result of the resurgence of interest for computer-assisted cup positioning in THA, as a followup of this prospective case-matching cohort study, we aimed to compare the 10-year results between patients undergoing THA with CAS and those undergoing THA with a conventional technique for component implantation.…”

Section: Introductionmentioning

confidence: 99%

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No Benefit After THA Performed With Computer-assisted Cup Placement: 10-year Results of a Randomized Controlled Study

Parratte

Ollivier

Lunebourg

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Computer-assisted surgery (CAS) for cup placement has been developed to improve the functional results and to reduce the dislocation rate and wear after total hip arthroplasty (THA). Previously published studies demonstrated radiographic benefits of CAS in terms of implant position, but whether these improvements result in clinically important differences that patients might perceive remains largely unknown.Questions/purposes We hypothesized that THA performed with CAS would improve 10-year patient-reported outcomes measured by validated scoring tools, reduce acetabular polyethylene wear as measured using a validated radiological method, and increase survivorship. Methods Sixty patients operated on for a THA between April 2004 and April 2005 were randomized into two groups using either the CAS technique or a conventional technique for cup placement. All patient candidates for a THA with the diagnosis of primary arthritis or avascular necrosis were eligible for the CAS procedure and randomly assigned to the CAS group by the Hospital Informatics Department with use of a systematic sampling method. The patients assigned to the freehand cup placement group were matched for sex, age within 5 years, pathological condition, operatively treated side, and body mass index within 3 points. All patients were operated on through an anterolateral approach (patient in the supine position) using cementless implants. In the CAS group, a specific surgical procedure using an imageless cup positioning computerbased navigation system was performed. There were 16 men and 14 women in each group; mean age was 62 years (range, 24-80 years), and mean body mass index was 25 ± 3 kg/m 2 . No patient was lost to followup at 10 years, but five patients have died (two in the CAS group and three in the control group). At the 10-year followup, an independent observer blinded to the type of technique performed patients' evaluation. Cup positioning was evaluated postoperatively using a CT scan in the two groups with results previously published. At 10 years, we assessed subjective functional outcome and quality of life using validated questionnaires (SF-12, Harris hip score [HHS], Hip injury and Osteoarthritis Outcome Score). Wear rate was then evaluated on standardized radiographs using a previously validated semiautomated computer analogic measurement Each author certifies that he, or a member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any dr...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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No Benefit After THA Performed With Computer-assisted Cup Placement: 10-year Results of a Randomized Controlled Study

Parratte

Ollivier

Lunebourg

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Originally pioneered to assist with neurosurgery, these systems require substantial alteration of the surgical space to accommodate their components and are associated with disruption of surgical workflow and prolonged surgical time 25. Currently used in only 1%–3% of procedures, these systems provide important information but do so in a manner that is neither cost-effective nor minimally intrusive 26,27…”

Section: Introductionmentioning

confidence: 99%

Intellijoint HIP<sup>®</sup>: a 3D mini-optical navigation tool for improving intraoperative accuracy during total hip arthroplasty

Paprosky¹,

Muir²

2016

MDER

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Total hip arthroplasty is an increasingly common procedure used to address degenerative changes in the hip joint due to osteoarthritis. Although generally associated with good results, among the challenges associated with hip arthroplasty are accurate measurement of biomechanical parameters such as leg length, offset, and cup position, discrepancies of which can lead to significant long-term consequences such as pain, instability, neurological deficits, dislocation, and revision surgery, as well as patient dissatisfaction and, increasingly, litigation. Current methods of managing these parameters are limited, with manual methods such as outriggers or calipers being used to monitor leg length; however, these are susceptible to small intraoperative changes in patient position and are therefore inaccurate. Computer-assisted navigation, while offering improved accuracy, is expensive and cumbersome, in addition to adding significantly to procedural time. To address the technological gap in hip arthroplasty, a new intraoperative navigation tool (Intellijoint HIP®) has been developed. This innovative, 3D mini-optical navigation tool provides real-time, intraoperative data on leg length, offset, and cup position and allows for improved accuracy and precision in component selection and alignment. Benchtop and simulated clinical use testing have demonstrated excellent accuracy, with the navigation tool able to measure leg length and offset to within <1 mm and cup position to within <1° in both anteversion and inclination. This study describes the indications, procedural technique, and early accuracy results of the Intellijoint HIP surgical tool, which offers an accurate and easy-to-use option for hip surgeons to manage leg length, offset, and cup position intraoperatively.

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