Guides, Jigs, and Navigation-Assisted Birmingham Hip Resurfacing

Abstract

Total hip replacement has been successfully performed since 1960. It could be argued that as surgeons have managed to perform successful total hip replacements all these years without the aid of navigation, navigation is not required now. However, surgeons who assess their results accurately understand that the problem is not the average; it is the outliers. If one considers the issue of acetabular cup inclination angle, then there is good evidence that high inclination angles are associated with edge loading of the implant and excess wear, which can lead to premature failure. This has been seen with the Birmingham Hip Resurfacing (BHR) and other hip resurfacing devices. (See Chapter 6 to observe the effects of edge loading on the wear of these metal on metal devices.) No doubt, with experience, surgeons improve their implantation technique. There is also the problem of realizing that acetabular inclination angle is important. I know that I was tricked into thinking that because we had virtually no instances of dislocation of these large-headed metal on metal articulations in the early years, our inclination angles must have been perfectly satisfactory.