Mixed-reality navigation tool may yield accurate acetabular component placement in THA
Key takeaways:
- Mixed-reality navigation tool may aid acetabular component placement in patients undergoing THA.
- The system was accurate for operative inclination and anteversion relative to preoperatively planned targets.
According to published results, a CT-based, mixed-reality navigation system yielded accurate and precise acetabular component placement in patients undergoing total hip arthroplasty.
Results showed the mixed-reality navigation system was accurate for operative inclination and tilt-adjusted operative anteversion relative to preoperatively planned targets and had no outliers.
“HipInsight (Surgical Planning Associates) allows for a fast, easy and accurate way to follow a patient-specific preoperative plan, including for complex revisions. The upfront costs and OR footprint are minimal compared with existing robotic systems, and it can be installed on and used from any computer,” Samuel S. Wellman, MD, professor of orthopedic surgery in the department of orthopedic surgery at Duke University, told Healio. “It allows detailed planning for both sides of the joint and can be used to validate leg lengths and offset intraoperatively, and it works with any surgical approach. Compared to existing enabling technology for hip replacement, it represents a generational leap forward.”
Wellman and colleagues performed a retrospective review of data from 39 patients who underwent posterior THA with a single surgeon between February and October 2023. In all operations, HipInsight, a CT-based mixed-reality navigation system, was used to preoperatively plan and execute personalized acetabular component position.
At 6-week follow-up, Wellman and colleagues used 3D imaging to assess acetabular component positioning with operative inclination and tilt-adjusted operative anteversion. The also calculated absolute error and outliers for cup positioning. Outliers were defined as cup position outside a range of 10° from the preoperatively planned target.
Mean preoperatively planned operative inclination was 40.8° (range, 39°-42°), and mean postoperatively measured operative inclination was 40.4° (range, 37°-46°). Wellman and colleagues found the mean absolute error for operative inclination was 1.8° (range, 0°-5°).
Mean preoperatively planned operative anteversion was 30.2° (range, 26°-35°), and mean postoperatively measured operative anteversion was 31.1° (range, 27°-42°). Wellman and colleagues found the mean absolute error for operative anteversion was 2° (range, 0°-6°).
Wellman and colleagues found no outliers outside of 10° for either operative inclination or operative anteversion.
Perspective
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According to the 2024 American Joint Replacement Registry Annual Report, the use of technology for primary total hip arthroplasty is around 10% in the United States and increasing each year. In total knee replacement, this rate is closer to 20% in the United States, with some countries, including Australia, surpassing 30%. Technology has been proven to decrease outliers in component position and has greatly affected complication rates after surgery.
A study by Ilya Bendich, MD, MBA, and colleagues showed a lower risk of revision for dislocations with technology when compared with manual techniques, highlighting the importance of a well-thought-out surgical plan and a technically well-executed surgery. Samuel S. Wellman, MD, and colleagues also demonstrate that there are many technologies available to help surgeons create a preoperative plan and allow for precise execution during surgery. Using a novel CT-based mixed-reality navigation system, they showed that they have zero outliers beyond 10° of their surgical plan, with inclination 100% of the time within 5° and anteversion 94.9% of the time within 5°. The future is bright for technology-assisted surgical planning and surgery, and we must continue to perform research that evaluates the economics and outcomes to prove the value in technology.
References:
Bendich I, et al. J Arthroplasty. 2022;doi:10.1016/j.arth.2022.01.085.
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