Direct Anterior Approach Using Navigation Improves Accuracy of Cup Position Compared to Conventional Posterior Approach

Abstract

The accuracy of cup position in total hip arthroplasty is essential for a satisfactory result as malpositioning increases the risk of complications including dislocation, high wear rate, loosening, squeaking, edge loading, impingement and ultimately failure.We studied 166 patients in a single-surgeon-series of matched cohorts of patients who underwent total hip arthroplasties. Four separate groups were identified comprising of the posterior approach +/- navigation and the direct anterior approach +/- navigation.We found a significant difference between the direct anterior navigated group and the posterior non-navigated group for both anteversions (P < 0.05, confidence interval (CI) -3.86 to -1.73) and inclination (P < 0.05, CI -3.08 to -1.08). Almost, 72% of anterior navigated patients fell within 5o of the navigation software set target cup position of 45o inclination and 20o anteversion and 100% were within 10o. Only 30% of posterior non-navigated were within 5o of both anteversion and inclination and 73% were within 10o.There was also a significant difference between the direct anterior navigated and non-navigated group with respect to anteversion only (p < 0.05, CI 1.50 to 1.30). There were no other significant differences between approaches +/- navigation.The direct anterior approach allows ease of access to both anterior-superior iliac spines for navigation and a supine patient allows anteversion and inclination to be measured in the frontal plane. We conclude that the direct anterior approach with navigation improves the accuracy of cup position compared to the conventional posterior approach without navigation.

The Impingement-free, Prosthesis-specific, and Anatomy-adjusted Combined Target Zone for Component Positioning in THA Depends on Design and Implantation Parameters of both Components

“…The analysis provided recommendations on how to reach the largest ROM for a prosthesis with design parameters familiar to many surgeons (straight stem, hemispherical shell). Transformation of these results into precise component implantation during surgery may benefit from additional tools like navigation and/or robotics [ 14 , 17 , 29 , 43 , 44 , 49 , 59 , 80 , 81 , 82 ]; however, this is speculative and as of now, unproven. Future clinical studies might show if such prosthesis- and patient-adjusted component orientations will help to enhance THA stability in our patients.…”

Descripción anatómica del abordaje anterior de cadera: seguridad y efecto para artroplastía total

“…12,13,14,15 En cuanto al tiempo de hospitalización, éste se reduce en 1.19 días en comparación con los pacientes operados mediante abordaje anterolateral y posterior, produciendo menor costo operativo; sin embargo, el índice de transfusiones fue similar entre los tres grupos así como los análisis radiográficos en cuanto a inclinación y anteversión del componente femoral. 13,15,16 En cuanto a la curva de aprendizaje, investigadores de la Universidad de Melbourne determinaron que un cirujano debe realizar al menos 50 procedimientos para que el rango de cirugías de revisión no sea diferente al del cirujano que ha realizado 100 o más procedimientos, es así que el rango de cirugías de revisión por diversos motivos en cirujanos noveles (principiantes, de poca experiencia) de 6% y el ci-rujano experimentado con más de 100 procedimientos es de 3%. 17,18 Una de las complicaciones más frecuentes es la lesión del nervio femorocutáneo lateral (de 0.3 a 2.6%), este riesgo se puede disminuir significativamente centrando la incisión sobre el vientre del músculo tensor de la fascia lata.…”