Application of surgical navigation to total hip arthroplasty

Abstract

Instability, impingement, and leg-length discrepancy are among the most common early problems following total hip arthroplasty (THA). Component positioning is the primary factor affecting all three of these issues and, therefore, all three can be potentially addressed using surgical navigation. While the advent of less invasive surgical techniques performed through smaller incisions has been shown to accelerate recovery, these techniques have also been associated with a further increase in the incidence of these three problems. Acetabular component malpositioning has been a particular problem with less invasive surgical techniques. Nonetheless, it is clear that maximal preservation of the soft tissues around the hip joint may accelerate recovery following surgery and confer greater hip joint stability. Accomplishing these goals without compromising component positioning is the single greatest potential advantage to the application of surgical navigation to THA. The present paper describes the general principles of surgical navigation in THA with respect to methods of tracking, methods of registration, the role of image-free and image-based navigation, and methods of measuring leg-length change during surgery. Further, a description is given of the clinical effect of combining surgical navigation with use of the superior capsulotomy technique of performing THA, which aims maximally to preserve the soft tissues surrounding the hip joint, allowing unrestricted progression of motion and weight-bearing following surgery. These methods have led to statistically significant acceleration of recovery, improvement in acetabular component positioning, and reductions in peri-operative surgical complications.