Evaluation of a new fluoroscopy-based navigation system in the placement of the femoral component in hip resurfacing

Abstract

Prosthesis-specific mechanical alignment instruments for the precise and reproducible positioning of the femoral component constitute one of the major improvements in modern hip resurfacing prostheses. However, mechanical failure of the femoral component is mostly attributable to the surgical technique, and in particular to notching of the femoral neck. In order to evaluate a novel computer-assisted fluoroscopy-based planning and navigation system, six DUROM hip resurfacing prostheses were implanted into artificial femurs by means of computer-assisted fluoroscopy-based navigation and prosthesis-specific mechanical alignment instruments. Subsequently, the planning and navigation system was tested within the scope of a cadaver study on three fixed whole-body preparations (six femurs). The average difference between planned and actual angle of the prosthesis was 0 +/- 0.7 degrees for fluoroscopy-based navigation versus 6.5 +/- 7.8 degrees for the in-vitro use of the prosthesis-specific mechanical alignment instruments, and 1 +/- 1.4 degrees for fluoroscopic navigation in the cadaver study. The average discrepancy between planned and actual anterior offset was -1.2 +/- 1.2 mm versus 0.8 +/- 4 mm, and 0.3 +/- 2.2 mm in the cadaver study, and the time required for the total of five planning and navigation steps was 17.2 +/- 1.5 min versus 14 +/- 0.8 min and 20.2 +/- 2.5 min respectively. No notching of the femoral neck occurred under fluoroscopy nor under conventional treatment. During in-vitro studies, use of the computer-assisted fluoroscopy-based planning and navigation system resulted in enhanced accuracy compared with conventional prosthesis-specific mechanical alignment instruments. The system has yielded initial promising results within the scope of the cadaver study.

Evaluation of a fluoroscopy-based navigation system enabling a virtual radiation-free preview of X-ray images for placement of cannulated hip screws. A cadaver study

“…Thus, the acquisition of useless or sub-optimal image projections can be avoided [14]. During in vitro and cadaver evaluations in previous studies, use of this novel computer-assisted fluoroscopybased planning and navigation system has resulted in enhanced accuracy in positioning the guide wire and subsequently the DUROM TM hip resurfacing prosthesis (Zimmer GmbH Germany, Freiburg, Germany) [15,16]. Our intention was to evaluate the newly developed system in a trauma application.…”

Thermal Imaging as a Noninvasive Diagnostic Tool for Anterior Knee Pain Following Implantation of Artificial Knee Joints

“…An incidence of 10% of anterior knee pain following implantation of an artificial knee joint has been published (Muoneke et al, 2003). Recently, much attention has been directed to femoral component overhang and also femoral component malrotation in artificial knee joints (Berend et al, 2010;Classen et al, 2010;Ghosh et al, 2010;Gravius et al, 2010;Mahoney et al, 2010;Moon et al, 2010;Popovic and Lemaire, 2003;Verlinden et al, 2010). The variety of radiographic tools used to help diagnose pain localised close to metal implants is still limited.…”

Fluoroscopy-based computer-assisted navigation for implant placement and hip resurfacing arthroplasty in the proximal femur: the zero-dose C-arm navigation approach

“…This approach enables a virtual radiation-free preview of X-ray images of the bone [3,15] . Figures 1 -5 exemplarily illustrate the operative procedure, whereas the technique itself is explained in detail in the literature [8,21,42] . During in vitro and cadaver studies, the use of the novel computer-assisted fl uoroscopy-based planning and navigation system was tested in insertion of cannulated hip screws (6.5 mm; DePuy, Kirkel-Limbach, Germany) and the DHS (Synthes, Bochum, Germany) in the femoral neck, and in HR using the DUROM prosthesis (Zimmer GmbH, Freiburg, Germany) [8, 19 -21, 42 -44] .…”