Joint replacement—total hip replacement with CT-based navigation

Abstract

Correct orientation of the cup optimizes the range of motion of total hip arthroplasty (THA) and reduces the risk of dislocation, wear, impingement,and pelvic osteolysis. Therefore, CT-based navigation is used to position the acetabular cup precisely in a planned orientation relative to predefined bony landmarks in order to increase the function and longevity of THA. Fourteen patients were operated on using CT-based navigation for acetabular cup positioning. After scanning the patient's pelvis in a preoperative CT, a3-D plan was developed before surgery. Intraoperatively, the CT/3-D model is registered to coincide with the actual position of the patient on the operating table. Mean time for surgery increased by an average of 46 minutes and mean blood loss increased by 140 ml. Positioning of the cup was optimized, ie, it was close to the predefined target. There were no complications related to the use of CT-based navigation. Due to some technical failures at the beginning, two operations were completed manually. CT-based navigation greatly enhanced the precision of cup positioning,thus eliminating malpositioning. Although CT-based navigation does support the surgeon in controlling cup orientation, it increases time for surgery, blood loss, radiation of the patient, and total costs of the whole procedure. Furthermore,navigation of the acetabular cup alone is not sufficient for optimizing the range of motion in THA.