Hip Pelvis.  2017 Mar;29(1):1-14. 10.5371/hp.2017.29.1.1.

The Evolution of Computer-Assisted Total Hip Arthroplasty and Relevant Applications

• Chang JD
• Kim IS
• Bhardwaj A
• Badami RN

• KMID: 2371762
• DOI: http://doi.org/10.5371/hp.2017.29.1.1

Abstract

In total hip arthroplasty (THA), the accurate positioning of implants is the key to achieve a good clinical outcome. Computer-assisted orthopaedic surgery (CAOS) has been developed for more accurate positioning of implants during the THA. There are passive, semi-active, and active systems in CAOS for THA. Navigation is a passive system that only provides information and guidance to the surgeon. There are 3 types of navigation: imageless navigation, computed tomography (CT)-based navigation, and fluoroscopy-based navigation. In imageless navigation system, a new method of registration without the need to register the anterior pelvic plane was introduced. CT-based navigation can be efficiently used for pelvic plane reference, the functional pelvic plane in supine which adjusts anterior pelvic plane sagittal tilt for targeting the cup orientation. Robot-assisted system can be either active or semi-active. The active robotic system performs the preparation for implant positioning as programmed preoperatively. It has been used for only femoral implant cavity preparation. Recently, program for cup positioning was additionally developed. Alternatively, for ease of surgeon acceptance, semi-active robot systems are developed. It was initially applied only for cup positioning. However, with the development of enhanced femoral workflows, this system can now be used to position both cup and stem. Though there have been substantial advancements in computer-assisted THA, its use can still be controversial at present due to the steep learning curve, intraoperative technical issues, high cost and etc. However, in the future, CAOS will certainly enable the surgeon to operate more accurately and lead to improved outcomes in THA as the technology continues to evolve rapidly.

Keyword

Hip; Arthroplasty; Computer-assisted orthopaedic surgery; Navigation; Robot

MeSH Terms

Arthroplasty
Arthroplasty, Replacement, Hip*
Hip
Learning Curve
Methods

Figure

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  Fig. 1 The femoral anteversion of each side in same patient is different.

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  Fig. 2 Outliers of safe zone non-navigated total hip arthroplasty (THA) group and imageless navigation THA group. (A) Ten outliers in non-navigated THA group. (B) No outliers in imageless navigation THA group.

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  Fig. 3 (A) and (B) Right-sided aseptic implant loosening in a 62-year-old male patient. The preoperative CT shows cup anteversion of 25.1°, stem anteversion of −28.2° (retroversion), and combined anteversion of 5.36°. (C) and (D) The postoperative X-ray and CT show the cup inclination and anteversion, stem anteversion and combined anteversion to be 46.1° and 30.1°, 8.9° and 36.3° respectively.

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  Fig. 4 Outliers of safe zone post revision total hip arthroplasty (THA) using imageless navigation with the concept of combined anteversion. It shows no outliers after revision THA.

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  Fig. 5 (A, B) Degenerative osteoarthritis of right hip joint in 26-year-old female with osteopetrosis was treated by total hip arthroplasty using imageless navigation. (C) The postoperative computed tomography shows the cup anteversion, stem anteversion and combined anteversion to be 28.0° and 10.0° and 35.0°, respectively.

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  Fig. 6 A new method of registration in navigated hip arthroplasty without the need to register the anterior pelvic plane. (A) Landmarks used for lateral positon, (B) landmarks used for supine positon. * Reused from the article of Davis ET, et al. (J Arthroplasty. 2015;30:55-60)

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  Fig. 7 Preoperative check of impingement, leg length, and offset after cup and stem planning in computed tomography-based navigation.

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  Fig. 8 Robot-assisted total hip arthroplasty for the cup positioning using TSolution One® system. TCAT ™ is positioned according to the pre-operatively planned orientation of the cup. (A) Schematic drawing and (B) photograph from operation field.

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  Fig. 9 Enhanced femoral workflow in MAKOplasty® System. (A) Femoral array screw placement and checkpoint, (B) femoral array placement, (C) femur registration & verification, (D) guided femoral neck resection, (E) stem version check, and (F) combined anteversion check.

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  Fig. 10 Computer-assisted mechanical navigation system (HipSextant™). (A) Schematic drawing and (B) photograph from operation field.

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