Department of Orthopaedic and Trauma Surgery, Lukas-Hospital Bünde, Germany.
Center for Musculoskeletal Surgery, Orthopaedic Department, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Technol Health Care. 2020;28(3):315-323. doi: 10.3233/THC-191888.
Incorrect cup positioning in primary total hip arthroplasty is known as a risk factor for early implant failure. The use of navigation systems leads to more accurate cup positioning.
The aim of this study was to compare the registration accuracy of the anterior pelvic plane and the measurement accuracy of the definite cup position for a pointer computer-assisted orthopaedic navigation system (P-CAOS) and an ultrasound-based navigation tool (US-CAOS) in an intra-individual study design.
Anterior pelvic plane registration was performed in 44 patients receiving a primary total hip arthroplasty with P-CAOS and US-CAOS. The cup implantation was performed using US-CAOS. Intraoperatively, the cup position was assessed using P-CAOS and US-CAOS. The postoperative cup position was determined via CT scan. Inclination and anteversion errors were calculated using intraoperative values and CT data. All operations were performed by a single, high-volume surgeon using a minimally invasive anterolateral approach.
The mean inclination error was 0.9∘ in the US-CAOS group and -1.1∘ in the P-CAOS group. This was not statistically significant. The mean anteversion error was significantly reduced (p< 0.001) in the US-CAOS group (1.4∘) compared to the P-CAOS group (-8.0∘). Significantly more cups (23 of 44; 52%) in the P-CAOS group were outliers regarding to the defined anteversion error range of 15∘± 10∘. Outliers in the US-CAOS group amounted to two (of 44; 5%) (p< 0.001). The number of outliers regarding the inclination error range of 40∘± 10∘, did not differ significantly between the P-CAOS (2; 5%) and US-CAOS (1; 2%) group.
We were able to show a systematic anterior pelvic plane registration error in this intraindividual study design. US-CAOS based APP landmark registration showed to be significantly more precise compared to P-CAOS registration. The anteversion error of the cup using US-CAOS showed to be significantly reduced compared to the P-CAOS method.
初次全髋关节置换术中杯位不正确被认为是早期植入物失败的一个风险因素。导航系统的使用可以使杯位定位更准确。
本研究旨在比较基于前骨盆平面的计算机辅助骨科导航系统（P-CAOS）和基于超声的导航工具（US-CAOS）的注册精度和确定杯位置的测量精度，这是一项个体内研究设计。
对 44 例接受 P-CAOS 和 US-CAOS 初次全髋关节置换术的患者进行前骨盆平面注册。使用 US-CAOS 进行杯植入。术中使用 P-CAOS 和 US-CAOS 评估杯位。术后通过 CT 扫描确定杯位。使用术中值和 CT 数据计算倾斜和前倾角误差。所有手术均由一名高容量的单名外科医生使用微创前外侧入路进行。
US-CAOS 组的平均倾斜误差为 0.9°，P-CAOS 组为-1.1°。这没有统计学意义。US-CAOS 组的平均前倾角误差显著降低（p<0.001）（1.4°），而 P-CAOS 组为-8.0°。在 P-CAOS 组中，有 23 个（52%）杯明显超出了定义的前倾角误差范围（15°±10°）。在 US-CAOS 组中，有两个（5%）（p<0.001）。在 P-CAOS（2；5%）和 US-CAOS（1；2%）组中，杯倾斜误差范围（40°±10°）的异常值数量没有显著差异。
在这项个体内研究设计中，我们能够显示出一种系统性的前骨盆平面注册误差。基于 US-CAOS 的 APP 标志点注册明显比 P-CAOS 注册更精确。与 P-CAOS 方法相比，使用 US-CAOS 的杯的前倾角误差明显降低。
