Handheld Navigation Improves Accuracy in Direct Anterior Total Hip Replacement

N L Kolodychuk et al conducted a study to determine the accuracy in placing the acetabular component, estimation of leg length, offset, radiation time and dose, and operative time using a handheld navigation device compared to conventional anterior total hip arthroplasty (THA). It also examined the learning curve of the handheld navigation device.

The study has been published in ‘Arthroplasty today’.

Data were prospectively collected for a consecutive series of 159 THAs; 99 THAs with handheld navigation and 60 conventional THAs. Thresholds of <50, >= 50 to <100, and >=100 for acetabular inclination and version and thresholds of <5mm, >=5mm to <10mm, and >=10mm for leg-length and combined offset discrepancy were used to assess accuracy. Fluoroscopy time and exposure, operative time, and complications were compared. Learning curve was determined using operative time. Statistical analysis was performed for the different accuracy thresholds with P values set a <0.05 for significance.

Key findings of the study were:

• The handheld navigation device demonstrated a mean accuracy of 3.20 and 1.80 for version and inclination, respectively.

• The handheld navigation group had significantly fewer outliers in version (P<.001), inclination (P<.001), and offset discrepancy (P<.001).

• Fluoroscopic dose and time (P < .001) were lower in the handheld navigation cohort.

• The learning curve for handheld navigation was 31-35 cases• The mean operative time after the learning curve was similar to that in the conventional fluoroscopy group (P = .113).

The authors concluded that – “this study established that the handheld navigation system provides accurate intraoperative information during DAA THA regarding LLD, combined offset, and acetabular cup position. The use of the handheld navigation system was more accurate and resulted in fewer outliers in LLD, combined offset, and acetabular cup position than conventional fluoroscopy-aided DAA THA, while mitigating radiation time and dose. The learning curve for this handheld navigation system was 31-35 cases. After completion of the learning curve, the use of the handheld navigation system offered extremely accurate cup placement and recreation of leg length and offset, decreased operative time, and significantly fewer outliers in implant position.”

Further reading:

Handheld Navigation Improves Accuracy in Direct Anterior Total Hip Replacement

Nicholas L. Kolodychuk, Jesse A. Raszewski et al

Arthroplasty Today 17 (2022) 58-65

https://doi.org/10.1016/j.artd.2022.06.016