Accelerometer-based Portable Navigation Research Articles

Comparison of Implant Placement Accuracy Between Manual, Robot-Assisted, Computer-Navigated, Augmented Reality Navigated, Patient-Specific Instrumentation, and Accelerometer Navigated Total Hip Arthroplasty: A Systematic Review and Network Meta-Analysis.

Malpositioning of the acetabular cup during total hip arthroplasty (THA) can lead to complications. Robotic surgery and navigation techniques aim to address this issue, but there is limited evidence regarding which method can achieve better clinical outcomes. Therefore, this network meta-analysis (NMA) aimed to compare the efficacy of various navigation methods. This NMA of prospective randomized controlled trials compared robot-assisted systems (RAS), computer-assisted navigation systems (CAS), augmented reality-based portable navigation (AR), patient-specific instrumentation (PSI), portable accelerometer-based navigation (PN), and conventional methods (C) for THA procedures. We searched MEDLINE, EMBASE, Cochrane, Central Register of Controlled Trials, International Clinical Trials Platform Search Portal, and ClinicalTrials.gov. databases. The primary outcomes included revision surgery and postoperative clinical scores, and the secondary outcomes encompassed cup placement accuracy, acetabular cup placement outliers from the Lewinnek safe zone, surgical time, and complications. We used a Bayesian random-effects NMA, and confidence of evidence was assessed using confidence in NMA. We identified 45 studies including 2,122 patients. We did not find large differences in revision surgery, clinical outcome scores, cup inclination, or anteversion angle accuracy among the modalities. AR, CAS, and PSI exhibited a lower risk of outliers from safe zones than C. In addition, RAS and CAS had a longer surgical time than C. Robotic and navigation tools did not reduce the revision risk or enhance clinical outcomes. AR, CAS, PSI, and PN may decrease the risk of cup placement outliers in safe zones. However, the cup placement accuracy was equivalent, and the surgical time may be longer in RAS and CAS than in C. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Accelerometer-based portable navigation system shows no superior accuracy over pelvic alignment guide for acetabular cup placement in total hip arthroplasty in lateral decubitus position.

Total hip arthroplasty (THA) using a portable navigation system (PNS) incurs costs per procedure. However, it does not require a large console. This study aimed to compare the accuracy of acetabular cup placement using a pelvic alignment guide (PAG) attached to the pelvis and an accelerometer-based PNS in THA performed in the lateral decubitus position. We retrospectively analyzed 100 hips that underwent primary THA in the lateral decubitus position between July 2018 and January 2021. The PAG was used in 50 hips, whereas the PNS was used in the other 50. Cup placement accuracy was measured using postoperative computed tomography scans, comparing errors in inclination and anteversion angles. The surgical time, blood loss, and complications were recorded. The follow-up period was at least 2 years in all cases. The mean absolute error of the inclination angle was similar between the groups (the PAG group: 3.7° ± 2.3° [range, 0.0-9.0]; the PNS group: 3.7° ± 2.3° [range, 0.2-10.5], p = 0.705). The mean absolute error of the anteversion angle was significantly smaller in the PAG group than in the PNS group (3.0° ± 2.4° [range, 0.0-9.7] vs. 6.5° ± 4.8° [range, 0.3-17.3], p < 0.001). The PAG group had a higher proportion of hips within 5° and 10° of the target angle (64 vs. 42%, P = 0.028, and 100 vs. 74%, p < 0.001, respectively). The PNS group had six hips with anteversion errors of 15° or more. Surgical time and blood loss were lower in the PAG group. The PNS group had one dislocation, whereas the PAG group did not. The accelerometer-based PNS did not demonstrate superior cup alignment accuracy compared to the PAG in THA performed in the lateral decubitus position. This finding informs surgeons that computer-assisted surgery is not necessarily superior to conventional THA using a PAG.

A novel imageless accelerometer-based navigation system improves acetabular cup placement accuracy during total hip arthroplasty in the lateral decubitus position.

The accuracy of acetabular cup placement using conventional portable imageless navigation systems in total hip arthroplasty (THA) in the lateral decubitus position remains challenging. Several novel portable imageless navigation systems have been developed recently to improve cup placement accuracy in THA. This study compared the accuracy of acetabular cup placement using a conventional accelerometer-based portable navigation (c-APN) system and a novel accelerometer-based portable navigation (n-APN) system during THA in the lateral decubitus position. This retrospective cohort study compared 45 THAs using the c-APN and 45 THAs using the n-APN system. The primary outcomes were the absolute errors between the intraoperative and postoperative values of acetabular cup radiographic inclination and anteversion angles and the percentage of cases with absolute errors within 5°. Intraoperative values were shown on navigation systems, and postoperative measurements were conducted using computed tomography images. The median absolute errors of the cup inclination angles were significantly smaller in the n-APN group than in the c-APN group (3.9° [interquartile range 2.2°-6.0°] versus 2.2° [interquartile range 1.0°-3.3°]; P = 0.002). Additionally, the median absolute errors of the cup anteversion angles were significantly smaller in the n-APN group than in the c-APN group (4.4° [interquartile range 2.4°-6.5°] versus 1.9° [interquartile range 0.8°-2.7°]; P < 0.001). Significant differences were observed in the percentage of cases with absolute errors within 5° of inclination (c-APN group 67% versus n-APN group 84%; P = 0.049) and anteversion angles (c-APN group 62% versus n-APN group 91%; P = 0.001). The n-APN system improved the accuracy of the cup placement compared to the c-APN system for THA in the lateral decubitus position.

Two- and three-dimensional measurements of leg length change using an accelerometer-based portable navigation system in total hip arthroplasty

BackgroundThe aim of this study was examining the accuracy of accelerometer-based portable navigation systems (HipAlign) when measuring leg length changes using two-dimensional (2D) and three-dimensional (3D) methods.MethodsInclusion criteria were patients ≥ 20 years old with symptomatic hip disease who underwent primary total hip arthroplasty (THA) in the supine position using HipAlign between June 2019 and April 2020. The exclusion criteria were patients who underwent THA via a posterior approach. We examined correlations between the leg length change measurement with HipAlign and either 2D or 3D measurement. We performed a multivariate analysis to determine which factors may have influenced the absolute error results.ResultsThis study included 34 patients. The absolute error in leg length change between the HipAlign and 3D measurement (4.0 mm) was greater than the HipAlign and 2D measurement (1.7 mm). There were positive correlations between leg length change with HipAlign and 2D and 3D measurements. Male patients had larger errors with 2D measurement. No significant factors were identified for 3D measurement.ConclusionHipAlign provided acceptable measurement accuracy for leg length changes.

An updated meta-analysis comparing complications, functional, clinically relevant and radiological outcomes of accelerometer based portable navigation and conventional technique of total knee arthroplasty

IntroductionSince previous studies, including small-scale meta-analyses comparing accelerometer-based portable navigation (APN-TKA) and conventional techniqueof total knee arthroplasty (CONV-TKA), have reported divergent results, there is a need for an updated meta-analysis to compare complications, functional outcomes, clinically relevant outcomes and radiographic alignment of components. MethodsThis meta-analysis was conducted as per PRISMA guidelines. Randomised controlled trials, and non-randomised comparative cohort studies in English language on primary TKA were included. The complications compared were Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), infection, manipulation under anaesthesia (MUA) for postoperative knee stiffness, re-operation and mortality. The functional outcomes compared were the Knee Society Knee Score, Knee Society Score function, Oxford Knee Score, Knee Injury and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Arthritis Index. The evaluated clinically relevant outcomes were surgical time, blood loss, drop in haematocrit, tourniquet time, postoperative knee flexion and complications). The number of radiological outliers; as well as the absolute values of the alignment of the overall prosthesis, femoral and tibial components in both coronal and sagittal planes, was assessed. ResultsTwenty-five studies were included. Both the groups were comparable in terms of preoperative demographic features. There was no difference in complications and functional outcomes. Operation time was longer in APN-TKA (p < 0.00001) but there was no difference in rest of the clinically relevant outcomes. Restoration of the lower limb mechanical axis (p = 0.003) and coronal femoral alignment angle (p = 0.0002) was better with APN. APN also significantly reduced the risk of the odds of outliers of lower limb mechanical axis (p < 0.0001), coronal femoral alignment (p = 0.03), coronal tibial alignment (p < 0.0001) and sagittal tibial alignment (p = 0.0001). ConclusionThe improvement in the accuracy of implantation by the use of APN-TKA, as determined by the overall alignments of prosthesis, or femoral and tibial components, does not necessarily translate into lesser complications and better functional and clinical outcomes. Level of evidenceTherapeutic study, Level II.

The accuracy of an accelerometer-based portable navigation system for total hip arthroplasty using 3D CT measurement in the supine position: a prospective multicenter study

PurposeThis multicenter prospective study aimed to evaluate the accuracy of the cup alignment of an accelerometer-based portable navigation system (AP navigation) for a total hip arthroplasty (THA) in spine position. MethodsThis study prospectively enrolled 324 THAs using supine position in 9 hospitals. An AP navigation was used for cup fixation and the intraoperative navigation data (cup alignment, pelvic tilt, and pelvic rotation) were recorded. Computed tomography (CT) of the pelvis was performed 2 weeks post-operatively and cup alignment was measured on 3D-CT images. ResultThe accuracy (absolute difference in cup alignment between the intraoperative navigation record and postoperative 3D-CT measurements) was 3 ​± ​3° (mean ​± ​standard deviation) for cup inclination and 3 ​± ​3° for cup anteversion. The pelvis tilted anteriorly in 148 hips (46%) and posteriorly in 162 hips (50%), and did not tilt in 14 hips (4%). The pelvis rotated toward the operating side in 179 hips (55%), toward the contralateral side in 112 hips (35%), and did not rotate in 33 hips (10%). Multiple regression analysis showed that the patients’ characteristics (sex, body mass index, diagnosis, Crowe classification, laterality, intraoperative pelvic tilt, intraoperative pelvic rotation, and cup size) and the surgical factors (approach, preparation time, number of screws, and institution) did not affect the accuracy of the navigation system. ConclusionsThis is the first prospective multicenter study of this navigation system. The accuracy was not affected by patient characteristics, surgical factors, or substantial pelvic movement during cup fixation.

The Accuracy of a Portable Accelerometer-Based Navigation System for Tibial Alignment Can be Reliable during Total Knee Arthroplasty for Obese Patients.

A portable accelerometer-based navigation system can be useful for achieving the target alignment. Tibial registration is based on the medial and lateral malleoli; however, the identification of landmarks may be difficult in obese (body mass index [BMI] >30 kg/m2) patients whose bones are not easily palpable from the body surface. This study compared tibial component alignment achieved using a portable accelerometer-based navigation system (Knee Align 2 [KA2]) in obese and control groups and aimed to validate the accuracy of bone cutting in obese patients. A total of 210 knees that underwent primary total knee arthroplasty using the KA2 system were included. After 1:3 propensity score matching, there were 32 and 96 knees in the BMI >30 group (group O) and BMI ≤30 group (group C), respectively. The absolute deviations of the tibial implant from the intended alignment were evaluated in the coronal plane (hip-knee-ankle [HKA] angle and medial proximal tibial angle) and sagittal plane (posterior tibial slope [PTS]). The inlier rate of each cohort, which was defined as tibial component alignment within 2 degrees of the intended alignment, was investigated. In the coronal plane, the absolute deviations of the HKA and MPTA from the intended alignment were 2.2 ± 1.8 degrees and 1.8 ± 1.5 degrees in group C and 1.7 ± 1.5 degrees and 1.7 ± 1.0 degrees in group O (p = 1.26, and p = 0.532). In the sagittal plane, the absolute deviations of the tibial implant were 1.6 ± 1.2 degrees in group C and 1.5 ± 1.1 degrees in group O (p = 0.570). The inlier rate was not significantly different between group C and group O (HKA: 64.6 vs. 71.9%, p = 0.521; MPTA: 67.7 vs. 78.1%, p = 0.372; PTS: 82.2 vs. 77.8%, p = 0.667). The accuracy of tibial bone cutting for the obese group was comparable to that of the control group. An accelerometer-based portable navigation system can be useful when attempting to achieve the target tibial alignment in obese patients. LEVEL OF EVIDENCE: Level IV.

Does Augmented Reality-based Portable Navigation Improve the Accuracy of Cup Placement in THA Compared With Accelerometer-based Portable Navigation? A Randomized Controlled Trial.

Previous studies reported good outcomes of acetabular cup placement using portable navigation systems during THA. However, we are aware of no prospective studies comparing inexpensive portable navigation systems using augmented reality (AR) technology with accelerometer-based portable navigation systems in THA. (1) Is the placement accuracy of the acetabular cup using the AR-based portable navigation system superior to that of an accelerometer-based portable navigation system? (2) Do the frequencies of surgical complications differ between the two groups? We conducted a prospective, two-arm, parallel-group, randomized controlled trial involving patients scheduled for unilateral THA. Between August and December 2021, we treated 148 patients who had a diagnosis of osteoarthritis, idiopathic osteonecrosis, rheumatoid arthritis, or femoral neck fracture and were scheduled to undergo unilateral primary THA. Of these patients, 100% (148) were eligible, 90% (133) were approached for inclusion in the study, and 85% (126) were finally randomized into either the AR group (62 patients) or the accelerometer group (64 patients). An intention-to-treat analysis was performed, and there was no crossover between groups and no dropouts; all patients in both groups were included in the analysis. There were no differences in any key covariates, including age, sex, and BMI, between the two groups. All THAs were performed via the modified Watson-Jones approach with the patient in the lateral decubitus position. The primary outcome was the absolute difference between the cup placement angle displayed on the screen of the navigation system and that measured on postoperative radiographs. The secondary outcome was intraoperative or postoperative complications recorded during the study period for the two portable navigation systems. There were no differences between the AR and accelerometer groups in terms of the mean absolute difference in radiographic inclination angle (3° ± 2° versus 3° ± 2° [95% CI -1.2° to 0.3°]; p = 0.22). The mean absolute difference in radiographic anteversion angle displayed on the navigation screen during surgery compared with that measured on postoperative radiographs was smaller in the AR group than that in the accelerometer group (2° ± 2° versus 5° ± 4° [95% CI -4.2° to -2.0°]; p < 0.001). There were few complications in either group. In the AR group, there was one patient each with a surgical site infection, intraoperative fracture, distal deep vein thrombosis, and intraoperative pin loosening; in the accelerometer group, there was one patient each with an intraoperative fracture and intraoperative loosening of pins. Although the AR-based portable navigation system demonstrated slight improvements in radiographic anteversion of cup placement compared with the accelerometer-based portable navigation system in THA, whether those small differences will prove clinically important is unknown. Until or unless future studies demonstrate clinical advantages that patients can perceive that are associated with such small radiographic differences, because of the costs and the unquantified risks associated with novel devices, we recommend against the widespread use of these systems in clinical practice. Level I, therapeutic study.

A new accelerometer-based portable navigation system provides high accuracy of acetabular cup placement in total hip arthroplasty in both the lateral decubitus and supine positions.

No studies have compared the accuracy of acetabular cup placement in total hip arthroplasty (THA) in the supine and lateral decubitus positions using the same portable navigation system. Thus, this study aimed to compare the accuracy of acetabular cup placement using a new accelerometer-based portable navigation system combined with an infrared stereo camera and inertial measurement unit between the supine and lateral decubitus positions. This retrospective study compared 45 THAs performed in the supine position (supine group) and 44 THAs performed in the lateral decubitus position (lateral group) using the same portable navigation system. The primary outcome was the absolute errors of cup placement angles, defined as the absolute values of the differences between cup radiographic inclination and anteversion angles displayed on the navigation system and those measured on postoperative computed tomography images. No significant difference in the median absolute error of the cup inclination angle (supine group 1.7° [interquartile range 0.8°-3.1°] vs. lateral group 2.1° [interquartile range 1.0°-3.7°]; p = 0.07) was found between the two groups. Similarly, no significant difference in the median absolute error of the anteversion angle (supine group 1.9° [interquartile range 0.8°-3.4°] vs. lateral group 2.1° [interquartile range 0.9°-3.1°]; p = 0.42) was found. This new accelerometer-based portable navigation system may provide high accuracy of the cup placement in THA in the lateral decubitus and supine positions.

Comparing the accuracy of three-dimensional mini-optical portable navigation and accelerometer-based portable navigation system for acetabular cup placement during total hip arthroplasty.

This study compared the accuracy of three dimensional (3D) mini-optical navigation and accelerometer-based portable navigation systems for cup positioning during a total hip arthroplasty (THA) in the supine position. This retrospective cohort study assessed data for 77 hips using 3D mini-optical navigation (n = 37) and accelerometer-based portable navigation (n = 40). The patients underwent THA through the mini-anterolateral approach in the supine position using a portable navigation system. We assessed the preoperative target angles, recorded intraoperative cup angles, postoperative CT imaging angles, cup angle measurement errors, and other clinical parameters. The mean absolute differences in radiographic inclination were similar between 3D mini-optical navigation and accelerometer-based portable navigation systems during THA in the supine position (2.8° ± 1.7° vs 2.8° ± 1.9°, p = 0.637). The mean absolute differences in radiographic anteversion were also similar (2.6° ± 2.3° vs 2.5° ± 1.9°, p = 0.737). Cup malalignment (absolute difference of inclination or anteversion between postoperative CT and preoperative target angle of > 5°) was significantly associated with body mass index (BMI) in accelerometer-based portable navigation but not in 3D mini-optical navigation. This is the first study to compare the accuracy of cup positioning between 3D mini-optical and accelerometer-based navigations in THA in the supine position. Both portable navigation systems accurately identified the orientation of cup placement. The accuracy of 3D mini-optical navigation is not affected by high BMI and may be preferred over other options in such patients.

Does accelerometer-based portable navigation provide more accurate and precise cup orientation without prosthetic impingement than conventional total hip arthroplasty? A randomized controlled study

This prospective randomized controlled study examined whether accelerometer-based navigation resulted in more accurate or precise cup orientation than a conventional mechanical guide. We used a simulation to evaluate how cup orientation affected potential hip range of motion (RoM) and freedom from prosthetic impingement. Sixty hips were randomly allocated 1:1 to accelerometer-based portable navigation or conventional guidance. Procedures were performed through a standard posterolateral approach and combined anteversion technique. Cup inclination, cup anteversion, and stem anteversion were measured using computed tomography (CT). Using CT-based simulation, we evaluated impingement-free potential RoM and the proportion of hips with potential RoM required for daily activities. Absolute cup inclination and anteversion error averaged 4.3° ± 3.2° and 4.4° ± 2.9° for the navigation cohort and 5.6° ± 3.7° and 5.7° ± 4.2° for the conventional cohort, with no significant differences. Navigation resulted in significantly less variation in anteversion error than the conventional guide (p = .0049). Flexion, internal rotation (IR) at 90° of flexion, extension, and external rotation (ER) averaged 123° ± 12°, 46° ± 13°, 50° ± 10°, and 73° ± 23°, respectively, in the navigation cohort and 127° ± 10°, 52° ± 14°, 45° ± 10°, and 63° ± 12°, respectively, in the conventional cohort (p = .15, .15, .03, and .03, respectively). Flexion > 110°, IR > 30° at 90° of flexion, extension > 30°, and ER > 30° were achieved by 93%, 90%, 100%, and 100% of hips, respectively, in the navigation cohort and 97%, 93%, 97%, and 100% of hips, respectively, in the conventional cohort, with no significant differences. Cup anteversion with the navigation system was more precise, but not more accurate, than with the conventional guide. The navigation cohort exhibited greater potential extension and ER than the conventional cohort, but no significant difference in impingement within the potential RoM required for daily activities. 29036. Date of registration: November 14, 2017.

Augmented Reality- vs Accelerometer-Based Portable Navigation System to Improve the Accuracy of Acetabular Cup Placement During Total Hip Arthroplasty in the Lateral Decubitus Position.

There have been no studies regarding the effectiveness of augmented reality (AR)-based portable navigation systems compared with accelerometer-based portable navigation systems in total hip arthroplasty (THA). We retrospectively compared THAs performed using an AR-based portable navigation system (n= 45) and those performed using an accelerometer-based portable navigation system (n= 42). All THAs were performed with the patient in the lateral decubitus position. The primary outcome was the absolute difference between cup placement angles displayed on the navigation screen and those measured on postoperative X-ray. The mean absolute differences were significantly smaller in the AR-based portable navigation system group than the accelerometer-based portable navigation system group in radiographic inclination (2.5° ± 1.7° vs 4.6° ± 3.1°; 95% confidence interval 1.1°-3.2°, P < .0001). Similarly, the mean absolute differences were significantly better in the AR-based portable navigation system group in radiographic anteversion (2.1° ± 1.8° vs 6.4° ± 4.2°; 95% confidence interval 3.0°-5.7°, P < .0001). Neither hip dislocation, surgical site infection, nor other complications associated with use of the navigation system occurred in either group. The AR-based portable navigation system may provide more precise acetabular cup placement compared with the accelerometer-based portable navigation system in THA.

Comparison of alignment and position of prosthesis between portable accelerometer-based navigation device and conventional instrumentation in total knee arthroplasty with valgus deformity

Objective: To explore the differences of alignment and position of prosthesis between portable accelerometer-based navigation device (PAD) and conventional instrumentation (CI) in total knee arthroplasty (TKA) with valgus deformity. Methods: Patients with knee osteoarthritis and valgus deformity who underwent primary TKA in Peking University Third Hospital from January 2017 to December 2020 were enrolled in this retrospective study and were divided into PAD group and CI group according to the surgical instruments. Five male patients and 44 female patients were included with a mean age of (67.2±7.0) years. The differences in preoperative general data, preoperative and postoperative alignment between the two groups were studied. Results: A total of 49 patients (25 patients in the PAD group and 24 in the CI group) were enrolled in this study. There were no statistically significant differences in gender, age, height, weight, body mass index, surgical side, preoperative hip-knee-ankle (HKA) angle, preoperative HKA angle deviation, Keblish classification and Ranawat classification between the two groups (all P>0.05). There was no significant difference in the accuracy of postoperative HKA angle (2.0°±1.4° vs 3.0°±2.2°, P=0.082), coronal femoral component angle (CFCA) (1.5°±1.2° vs 2.1°±1.6°, P=0.144) and coronal tibial component angle (CTCA) (1.2°±0.8° vs 1.3°±1.0°, P=0.695) between the two groups; but the standard deviation of the above-mentioned three indices in PAD group were all smaller than those in CI group. The rate of outliers of postoperative HKA angle of the PAD group was smaller than that in the CI group (P<0.05), but there was no significant difference in the rate of outliers of CFCA and CTCA between the two groups (both P>0.05). Conclusion: TKA assisted by PAD can provide good alignment and prosthesis position in patients with valgus deformity, and it is superior to TKA with CI in terms of precision and rate of outliers of postoperative overall alignment of lower extremity.

No difference in clinical outcomes between portable navigation and conventional instrumentation in total knee arthroplasty: A randomised trial.

Portable accelerometer-based navigation devices (PAD) in total knee arthroplasty (TKA) have been proposed to combine the alignment precision of computer navigation with the efficiency of conventional instrumentation (CON). The aim of this study was to determine if PAD was more effective than CON in TKA in improving clinical outcomes at medium term follow-up. Participants undergoing primary TKA were randomly assigned to either PAD or CON. The primary outcome was the mean between-group difference in the four subscales of the Knee injury and Osteoarthritis Outcome Score (∆KOOS4 ) between preoperative status and latest follow-up. Secondary outcomes included analysis of between-group differences in all KOOS subscales, Western Ontario and McMaster Universities Osteoarthritis Index (∆WOMAC) scores, complications and reoperation rates. Of the 178 participants allocated to a treatment arm, 159 (89.3%) completed follow-up at a mean of 4.3 years (range 3.2-5.8 years). There was no statistically significant or clinically meaningful difference in ∆KOOS4 between preoperative status and latest follow-up (PAD=41, CON=43; p=0.5). There was no difference in mean ∆WOMAC scores (PAD=39, CON=41; p=0.9) or ∆KOOS subscales between groups. In addition, there were no differences in complications or reoperations between groups. PAD was not superior to CON in improving patient-reported outcomes or reducing complications and reoperation rates at medium term follow-up. The use of PAD in TKA to improve clinical outcomes alone cannot be justified based on the results of this study.

Accuracy of a portable accelerometer-based navigation system for cup placement and intraoperative leg length measurement in total hip arthroplasty: a cross-sectional study

BackgroundComplications after total hip arthroplasty (THA) are frequently the consequence of malpositioned components or leg length discrepancy after surgery. Recently, a new version of a portable, accelerometer-based hip navigation system (New HipAlign) was made available with a change in the method of measuring cup abduction and the addition of a leg length measurement function. The purposes of this study were to investigate cup positioning and to examine the accuracy of leg length measurement with New HipAlign.MethodsCups were implanted and intraoperative leg length change was measured using New HipAlign in 60 THAs through a posterior approach in the lateral decubitus position. The cup position and radiographic leg length change were determined postoperatively on pelvic radiograph and computed tomography scans. We previously compared cup positioning with a previous version of a portable, accelerometer-based hip navigation system (Previous HipAlign) and conventional surgical techniques. Cup positioning in this study was compared with the results of out previous study using Previous HipAlign.ResultsThe mean cup abduction of 40.3° ± 4.9° (range, 26° to 53°) and the mean cup anteversion of 15.8° ± 5.6° (range, 6.7° to 29.5°) were found. The deviation of the postoperative measured angles from the target cup position was 3.7° ± 3.3° for cup abduction and 5.9° ± 3.6° for cup anteversion. 56/60 of the cups were inside the Lewinnek safe zone. Compared with our previous study using Previous HipAlign, there were no significant differences with regard to cup abduction, cup anteversion, the deviation from the target cup position for cup abduction, the value of deviation for cup anteversion, and the number of cups inside the Lewinnek safe zone (P = 0.218, 0.334, 0.651, 0.797, 0.592). The mean difference between the intraoperative and radiographic leg length changes was + 0.8 ± 3.4 mm. There was significant correlation between the intraoperative and radiographic leg length changes (r = 0.804, P = 0.000).ConclusionsUse of New HipAlign allowed for accurate cup placement and reliable leg length measurement during THA.Trial registrationClinical trial is defined as ‘any research study that prospectively assigns human participants or groups of humans to one or more health-related interventions to evaluate the effects on health outcome’ by the World Health Organization (WHO). Because this study is not a clinical trial, trial registration is not needed.

Effectiveness of an accelerometer-based portable navigation for intraoperative adjustment of leg length discrepancy in total hip arthroplasty in the supine position

BackgroundThis study aimed to examine the accuracy of the HipAlign® accelerometer-based portable navigation system by measuring the intraoperative leg length change of patients who underwent total hip arthroplasty (THA) and comparing the measured leg length discrepancy (LLD) determined by the navigation system and a freehand technique. MethodsA total of 61 patients who underwent THA using the anterolateral approach in the supine position were included in this study and divided into two groups: those who underwent THA with navigation (Group N; N = 31) and with the freehand technique (Group F; N = 30). Statistical analyses were performed to compare the intraoperative leg length change, pre- and post-LLD, absolute values of post-LLD, and the number of patients with the postoperative LLD within 10 mm and 5 mm between the two groups. Additionally, we examined the correlation between the leg length change obtained through intraoperative navigation and measured from the radiographs. Moreover, to evaluate the navigation accuracy, we examined the correlation between the absolute error of leg length change and cup orientation. ResultsThe postoperative LLD was significantly lower and the number of patients with the postoperative LLD within 5 mm was significantly higher in Group N, compared with Group F. Additionally, the amount of leg length change measured intraoperatively by the navigation system was strongly correlated with the values obtained by the postoperative radiographic measurement with a small absolute error and minimal wasted time. Moreover, a significant positive correlation was found between the absolute error of the leg length change and that of the cup inclination. ConclusionsOur study demonstrates that the accelerometer-based portable navigation system is useful for the intraoperative adjustment of leg length discrepancy during THA for patients in the supine position, as it provides good accuracy and minimizes required time for use.

Usefulness of an Accelerometer-Based Portable Navigation System for Total Knee Arthroplasty: A Multicenter Prospective Randomized Controlled Trial.

An accelerometer-based portable navigation system was recently introduced to improve prosthetic alignment during total knee arthroplasty (TKA). The purpose of this multicenter prospective randomized controlled trial (RCT) was to evaluate the effects of this accelerometer-based portable navigation system for achieving more accurate alignment during TKA in the clinical setting. One hundred patients with primary varus osteoarthritis of the knee were enrolled in this prospective RCT conducted in 5 hospitals. A navigation system was utilized in 50 patients (navigation group), and a conventional intramedullary femoral guide and an extramedullary tibial guide were utilized in 50 patients (conventional group). At 6 months postoperatively, weight-bearing radiographs were obtained of the whole operative leg. An experienced surgeon who was blinded to the treatment assignments then measured the alignment to 1 decimal place with use of computer software. Power analysis showed that 41 knees were required in each group. There were no complications as a result of the use of the accelerometer-based portable navigation system. Postoperative radiographs were obtained in 45 patients from each group. There were no significant differences in sex, age, height, body weight, body mass index, preoperative femorotibial angle, and operative time between groups. The absolute differences of the femoral prosthesis (p = 0.01), tibial prosthesis (p < 0.01), and hip-knee-ankle angle (p < 0.01) from a neutral mechanical axis were less in the navigation group compared with those in the conventional group. Alignment outliers (>2° away from the neutral mechanical axis) of the tibial prosthesis and hip-knee-ankle angle were less in the navigation group (9% and 27%, respectively) compared with those in the conventional group (31% and 49%; p = 0.01 and p = 0.04, respectively). To our knowledge, this is the first multicenter prospective RCT to evaluate an accelerometer-based portable navigation system. An accelerometer-based portable navigation system provides more accurate prosthetic and limb alignment in the coronal plane than conventional techniques, without extended operative time or an increased rate of complications. The results of this study may help orthopaedic surgeons decide whether or not to use an accelerometer-based portable navigation system. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Accuracy of acetabular cup insertion in an anterolateral supine approach using an accelerometer-based portable navigation system.

The purpose of this study was to determine the accuracy of acetabular cup insertion during total hip arthroplasty (THA) in a supine position using an accelerometer-based portable navigation system. A single-surgeon study was conducted in which 62 prospective patients with navigation and 42 retrospective patients without navigation as historical controls were compared. The patients underwent THA via an anterolateral supine approach. The absolute values of errors of radiographic inclination and anteversion were calculated. The navigation error was also calculated. The factors that affected the absolute values of errors of cup alignment were determined. The mean absolute error of the postoperative CT measurement from the target angle for radiographic inclination was 3.8° in the navigation group and 6.6° in the control group (P < 0.001). The mean absolute error for anteversion was 3.3° in the navigation group and 5.9° in the control group (P < 0.001). The mean absolute values of navigation error were 3.7° ± 2.8° in inclination and 3.0° ± 2.6° in anteversion. Changes in the pelvic tilt angle among preoperative, intraoperative, and postoperative were the significant risk factors for the absolute values of navigation error of anteversion relative to the anterior pelvic plane. Other factors affecting the absolute values of errors in the navigation group were not found for radiographic inclination and anteversion. The portable navigation system significantly improved the accuracy of cup inclination and anteversion. Changes in the pelvic tilt were the risk factors for the error of anteversion relative to the anterior pelvic plane.

Systematic Review of Accelerometer Based Navigation in Total Knee Arthroplasty: Improved Alignment, Clinical Results, and Patient Reported Outcomes Compared to Conventional Guides?

Background: There have been significant advancements to restore knee alignment postoperatively in the TKA population. This includes the use of accelerometer-based portable navigation (ABN). ABN can lead to a more precise restoration of the neutral mechanical axis, improve efficiency and potentially decrease early- and long-term complications. The degree with which ABN can achieve this remains unclear. We performed a systematic review to answer this question. Methods: We performed a systematic review in accordance with Cochrane guidelines of controlled studies (prospective and retrospective) in MEDLINE with an emphasis on studies comparing postoperative outcomes such as mechanical axis alignment, operative time, blood loss, complications and clinical outcome scores in total knee arthroplasty patients using ABN versus conventional intramedullary guides. Results: ABN was associated with significantly fewer outliers in hip-knee-ankle alignment (p = 0.0006), femoral component alignment (p &lt; 0.0001). ABN was associated with significantly less estimated blood loss (p = 0.05) and no difference in operative times (p = 0.21). Finally, there was no difference regarding functional outcomes or DVT. Conclusion: ABN more accurately achieves neutral mechanical alignment with a smaller incidence of outliers. There was not an increase in operative time with using ABN and there were reductions in blood loss as well. We conclude that ABN offers the benefit of improved mechanical alignment.

Comparison of accuracy of cup position using portable navigation versus alignment guide in total hip arthroplasty in supine position.

Accelerometer-based portable navigation systems in supine total hip arthroplasty (THA) have been developed, but there are no reports on the accuracy of cup placement. We aimed to investigate and compare the accuracy of the accelerometer-based portable navigation system versus the acetabular alignment guide placed on the pelvis in THA using the direct anterior approach (DAA). Both devices tracked changes in the pelvic position. In this single-centre, retrospective study, we reviewed 115 hips in 113 patients who underwent primary THA via the DAA using an accelerometer-based portable navigation system in the supine position (portable navigation group) and 106 hips in 101 patients who underwent THA using an acetabular alignment guide (alignment guide group) as controls. Hips were evaluated postoperatively using computed tomography to measure cup orientation. The accuracy of cup orientation was compared between the 2 groups. Absolute values of inclination error were 3.1° ± 2.2° and 2.9° ± 2.3° (p = 0.708) in the portable navigation and alignment guide groups and those of anteversion error were 2.8° ± 2.3° and 3.7° ± 2.7°, respectively (p = 0.005). The number of cups placed within 10° of error was 98.3% and 96.2% in the portable navigation and alignment guide groups, respectively (p = 0.304). The portable navigation group had significantly more hips (72.2%) placed within a 5° margin of error than did the alignment guide group (56.6%) (p = 0.016). High accuracy in cup placement was achieved using accelerometer-based portable navigation in supine THA. Using a navigation system may contribute to improved long-term outcomes.