Imageless navigation for primary total hip arthroplasty: a meta-analysis study

Abstract

Background There has been a growing interest in imageless navigation for primary total hip arthroplasty (THA). Its superiority over standard THA is debated. This meta-analysis compared surgical duration, implant positioning, Harris Hip Score and rate of dislocation of imageless navigation versus conventional THA. Methods The present study was conducted according to the PRISMA 2020 guidelines. All the clinical trials comparing imageless navigation versus conventional for primary THA were accessed. In January 2022, the following databases were accessed: PubMed, Web of Science, Google Scholar and Embase. No time constraints were used for the search. The outcomes of interest were to compare cup inclination and anteversion, leg length discrepancy, surgical duration, Harris Hip Score and rate of dislocation of imageless navigation versus conventional THA. Results Twenty-one studies (2706 procedures) were retrieved. Fifty-two percent of patients were women. There was between-group comparability at baseline in terms of age, body mass index (BMI), visual analogue scale, Harris Hip Score and leg length discrepancy (P > 0.1). Compared with conventional THA, the navigated group demonstrated slightly lower leg length discrepancy (P = 0.02) but longer duration of the surgical procedure (P < 0.0001). Cup anteversion (P = 0.6) and inclination (P = 0.5), Harris Hip Score (P = 0.1) and rate of dislocation (P = 0.98) were similar between the two interventions. Conclusion Imageless navigation may represent a viable option for THA.

Achieving Precise Cup Positioning in Direct Anterior Total Hip Arthroplasty: A Narrative Review

“…Including this mean deviation, the values were still within the safe zones [ 90 ]. Another meta-analysis published by Migliorini et al in 2022 found slightly lower leg length discrepancies for navigated THA, but similar results for cup positioning and dislocation rates when comparing conventional and navigated THA [ 85 ].…”

“…Furthermore, increased spinopelvic mobility has been found to be a risk factor for errors in cup positioning, yet this has only been reported when operating the patient in lateral decubitus position [ 84 ]. Imageless navigation is associated with longer operation time compared to conventional THA [ 85 ]. Brown et al reported additional time demand especially during the pre-operative phases, specifically to re-drape and re-position the patient after the placement of the initial tracker and to register the landmarks [ 86 ].…”

The learning curve for a novel, fluoroscopy‐based robotic‐assisted total hip arthroplasty system

“…In addition to RA-THA platforms, imageless computer-navigation THA systems have also been developed in recent years to improve the accuracy of component placement. 27,28 These technologies are layered onto DAA THA to aid with acetabular cup positioning, and, similar to surgical robots, have been studied for learning curve during adoption. Valsamis et al found the learning curve of an imageless computer-navigated THA system was 15 cases, 29 while Thorey et al…”

The Top Three Burning Questions in Total Hip Arthroplasty

“…An imageless navigation systems is a computer-assisted procedure, where the surgeon uses three-dimensional sensors to detect anatomical features. An important meta-analysis published later in 2022 included all the clinical trials comparing imageless navigation versus conventional primary THA [31]. The analysis consisted of 21 studies (2706 procedures) aiming to compare cup inclination and anteversion, leg length discrepancy, surgical duration, Harris Hip Score, and rate of dislocation between the two THA approaches.…”