Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA.
Department of Orthopaedic Surgery, Geisinger Health, Scranton, PA, USA.
Eur J Orthop Surg Traumatol. 2023 Jul;33(5):1989-1995. doi: 10.1007/s00590-022-03383-z. Epub 2022 Sep 8.
Despite the excellent outcomes associated with primary total hip arthroplasty (THA), implant failure and revision continue to burden the healthcare system. The use of computer-assisted navigation (CAN) offers the potential for more accurate placement of hip components during surgery. While intraoperative CAN systems have been shown to improve outcomes in primary THA, their use in the context of revision total hip arthroplasty (rTHA) has not been elucidated. We sought to investigate the validity of using CAN during rTHA.
A retrospective analysis was performed at an academic medical institution identifying all patients who underwent rTHA using CAN from 2016-2019. Patients were 1:1 matched with patients undergoing rTHA without CAN (control) based on demographic data. Cup anteversion, inclination, change in leg length discrepancy (ΔLLD) and change in femoral offset between pre- and post-operative plain weight-bearing radiographic images were measured and compared between both groups. A safety target zone of 15-25° for anteversion and 30-50° for inclination was used as a reference for precision analysis of cup position.
Eighty-four patients were included: 42 CAN cases and 42 control cases. CAN cases displayed a lower ΔLLD (5.74 ± 7.0 mm vs 9.13 ± 7.9 mm, p = 0.04) and greater anteversion (23.4 ± 8.53° vs 19.76 ± 8.36°, p = 0.0468). There was no statistical difference between the proportion of CAN or control cases that fell within the target safe zone (40% vs 20.9%, p = 0.06). Femoral offset was similar in CAN and control cases (7.63 ± 5.84 mm vs 7.14 ± 4.8 mm, p = 0.68).
Our findings suggest that the use of CAN may improve accuracy in cup placement compared to conventional methodology, but our numbers are underpowered to show a statistical difference. However, with a ΔLLD of ~ 3.4 mm, CAN may be useful in facilitating the successful restoration of pre-operative leg length following rTHA. Therefore, CAN may be a helpful tool for orthopedic surgeons to assist in cup placement and LLD during complex revision cases.
尽管初次全髋关节置换术（THA）的效果非常出色，但植入物失败和翻修仍然给医疗保健系统带来了负担。计算机辅助导航（CAN）的使用为手术中髋关节组件的更精确放置提供了潜力。虽然术中 CAN 系统已被证明可改善初次 THA 的效果，但它们在翻修全髋关节置换术（rTHA）中的应用尚未阐明。我们试图研究在 rTHA 中使用 CAN 的有效性。
在一家学术医疗机构中进行了回顾性分析，确定了 2016 年至 2019 年期间使用 CAN 进行 rTHA 的所有患者。根据人口统计学数据，将患者与接受 rTHA 但未使用 CAN（对照）的患者进行 1：1 匹配。在术前和术后负重线片上测量并比较了两组的杯倾斜角、倾斜角、下肢长度差异（ΔLLD）变化和股骨偏移变化。使用 15-25°的安全目标区作为杯位置精度分析的参考，用于前倾角，30-50°用于倾斜角。
共纳入 84 例患者：42 例 CAN 病例和 42 例对照病例。CAN 病例的 ΔLLD 较低（5.74±7.0mm 比 9.13±7.9mm，p=0.04），前倾角较大（23.4±8.53°比 19.76±8.36°，p=0.0468）。在落入安全目标区的 CAN 或对照病例比例方面，无统计学差异（40%比 20.9%，p=0.06）。CAN 和对照病例的股骨偏移相似（7.63±5.84mm 比 7.14±4.8mm，p=0.68）。
我们的研究结果表明，与传统方法相比，CAN 的使用可能会提高杯放置的准确性，但我们的数量不足以显示统计学差异。然而，CAN 的 ΔLLD 约为 3.4mm，在 rTHA 后成功恢复术前下肢长度方面可能很有用。因此，CAN 可能是骨科医生在复杂翻修病例中辅助杯放置和 LLD 的有用工具。
