Femoral Component Positioning in Hip Resurfacing With and Without Navigation

Ganapathi, M.; Vendittoli, Pascal‐André; Lavigne, Martin; Günther, Klaus‐Peter

doi:10.1007/s11999-008-0299-z

Cited by 49 publications

(42 citation statements)

References 29 publications

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“…In a previous series retrospectively comparing 51 vs 88 consecutive HRs performed with and without navigation, respectively, using the same surgical approach, type of prosthesis and CAS system as used in this study, Ganapathi et al did not observe any inter-group differences in the mean native CCD angles, planned or post-operative SSAs. However, in accordance with the findings of our study, deviations between planned and post-operative SSAs of greater than five degrees were found in 33 patients (38 %) in the conventional group in contrast to none in the CAS group [17]. Taking this body of evidence from the current literature together with the results of our prospectively randomised study, we conclude that the use of CAS can prevent nonoptimal femoral component placement in HR.…”

Section: Systematic Review Resultssupporting

confidence: 91%

“…According to the literature an incidence of this end point of less than ten percent was assumed for the CAS implantation and of less than 40 % for the conventional method, respectively [17]. To detect the resulting clinically relevant incidence difference of 30 % in the primary end point by means of a two-sided Fisher's exact test at the five percent significance under minimum power of 80 %, the evaluation of 2×38 patients was found necessary.…”

Section: Study Design and Sample Size Justificationmentioning

confidence: 99%

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The First SICOT Oral Presentation Award 2011: Imageless computer-assisted femoral component positioning in hip resurfacing: a prospective randomised trial

Stiehler

Goronzy

Hartmann

et al. 2013

International Orthopaedics (SICOT)

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Purpose The aim of the study was to evaluate the effects of imageless computer-assisted surgery (CAS) on the accuracy of positioning of the femoral component and on the shortterm clinical outcome in hip resurfacing (HR) using a randomised prospective design. Methods A total of 75 consecutive patients undergoing HR were randomly allocated to CAS and conventional implantation, respectively. Preoperatively and six months postoperatively standardised pelvic anteroposterior X-ray images, the total Western Ontario and McMaster Universities Osteoarthritis Index, the Harris Hip Score and the EQ-5D utility index were evaluated in a blinded manner. The primary end point of the study was a post-operative femoral component malpositioning in five degrees or more either varus or valgus absolute deviation from the planned stem shaft angle. Results Patient demographics and algofunctional scores did not differ between the CAS and conventional implantation samples. Using CAS fewer femoral components were positioned in five or more degrees absolute deviation (4/37 vs 12/38, Fisher's exact p=0.047; 95 % confidence interval for the primary end point's incidence difference: +3 %; +39 %); the respective incidences of five or more degrees of varus deviation were 0/37 vs 5/38. One conversion to a stemmed prosthesis (CAS group) was performed for periprosthetic femoral neck fracture. Radiological signs of superolateral femoral neck/implant impingement were observed in two cases (one CAS-based and one conventional implantation). Conclusions The accuracy of femoral HR component positioning was significantly improved using CAS. However, one major complication necessitated early revision in the CAS group at six months of observation. Apart from that adverse event no inter-group differences were observed for the short-term clinical outcome. Future studies need to address the clinical long-term relevance of CAS in HR.

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Section: Systematic Review Resultssupporting

confidence: 91%

Section: Study Design and Sample Size Justificationmentioning

confidence: 99%

The First SICOT Oral Presentation Award 2011: Imageless computer-assisted femoral component positioning in hip resurfacing: a prospective randomised trial

Stiehler

Goronzy

Hartmann

et al. 2013

International Orthopaedics (SICOT)

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“…However, other investigators have found no improvement in positioning [25,26]. It has also been shown that measurements provided by the navigation system are consistent with those obtained from postoperative radiographs [19,20,25] or CT images [27,28]. Our study did not show a significant difference in femoral component positioning between conventional and navigated implantation.…”

Section: Discussionsupporting

confidence: 73%

“…Some studies have reported more accurate placement of the femoral component, mainly with respect to varus/valgus alignment, by using navigation in sawbones [18], cadavers [13][14][15][16]19] or patients [20][21][22][23][24]. However, other investigators have found no improvement in positioning [25,26].…”

Section: Discussionmentioning

confidence: 99%

Accuracy of navigation in hip resurfacing with different surgeons and varying anatomy

Schleicher

Haselbacher

Mayr

et al. 2012

Computer Aided Surgery

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The accuracy of a commercial imageless navigation system for hip resurfacing and its reproducibility among different surgeons and for varying femoral anatomy was tested by comparing conventional and navigated implantation of the femoral component on different sawbones in a hip simulator. The position of the component was measured on postoperative radiographs. Variance for varus/valgus alignment and anteversion was higher for conventional implantation. Among the three surgeons, operation time, chosen implant size and anteversion were significantly different for conventional implantation but not for the navigated method. Using navigation, no difference was found for normal and abnormal anatomy. Values obtained with the navigation system were consistent with those measured on radiographs. Navigation appeared to be accurate and helped to reduce outliers. This was true for the three different surgeons and in varying anatomical situations.

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“…Seyler, in a study comparing the accuracy of implantation of femoral components based on the experience of the surgeon, found an average accuracy compared to the planned angle SSA of 0.9-1.5°(p <0.17) [21]. Ganapathi et al found a difference of position with navigation less than 1°compared to planning in a retrospective study comparing 51 hips operated with navigation and 88 by the conventional technique [22]. These results are comparable to those of our technique and in some cases even better.…”

Section: Discussionmentioning

confidence: 99%

Radiological validation of a fluoroscopic guided technique for femoral implant positioning during hip resurfacing

Chiron

Pailhé

Reina

et al. 2013

International Orthopaedics (SICOT)

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Purpose The positioning of the femoral cup in hip resurfacing is essential for the survival of the implant. We described a technique in 2005 to position the femoral cup guided by fluoroscopy independent of the approach performed. The main objectives were to study the positioning of the femoral components of the implant and the accuracy of the technique. Methods Between 2003 and 2011 we conducted a prospective study of 160 consecutive hip resurfacings all operated with this fluoroscopic-guided technique. Three independent observers performed a radiographic analysis at the pre-operative planning stage and on postoperative radiographs using OsiriX software. The statistical analysis was based on comparison of two groups by Student's t test. Results The entire implant was positioned in valgus, with an average of 7.816°valgus (p <0.001). All implants were positioned in neutral or anteverted with a mean of 1.98°( p <0.001). The risk of malpositioning on the antero-posterior plane was less than 1.41°with p <0.019. The risk of profile positioning error was lower than 0.80°with p <0.047. ConclusionThis study validates a technique of femoral implant positioning for resurfacing. It is simple, precise and independent of the approach performed.

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Femoral Component Positioning in Hip Resurfacing With and Without Navigation

Abstract: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Cited by 49 publications

References 29 publications

The First SICOT Oral Presentation Award 2011: Imageless computer-assisted femoral component positioning in hip resurfacing: a prospective randomised trial

The First SICOT Oral Presentation Award 2011: Imageless computer-assisted femoral component positioning in hip resurfacing: a prospective randomised trial

Accuracy of navigation in hip resurfacing with different surgeons and varying anatomy

Radiological validation of a fluoroscopic guided technique for femoral implant positioning during hip resurfacing

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