Computer-assisted positioning of the acetabular cup for total hip arthroplasty based on joint kinematics without prior imaging: preliminary results with computed tomographic assessment

Purpose of the study Most navigation systems for computer-assisted total hip arthroplasty (THA) require prior computed tomography (CT) or acquisition of multiple bone landmarks on the pelvis. In order to avoid these problems, we developed a computer-assisted navigation system without CT based on a kinematic approach to the hip joint. The principle is to orient the cup in relation to the cone describing the hip joint range of motion. The purpose of this work was to analyze preliminary results. Material and methods Eighteen primary THA were implanted with the system (16 women, two men, mean age 68 +/- 7.8 years, age range 54-83 years, 18 degenerative hip disease). Two optoelectronic captors were fixed percutaneously on the pelvis and the distal femur. The acetabulum was prepared first followed by the femur using reamers and broaches of increasing size. The last broach placed in the femur was equipped with a large head adapted to the newly prepared acetabulum. The range of hip motion was recorded to determine the maximal range of motion cone. The acetabular cup was thus positioned in order the prosthesis range of motion included entirely the maximal range of motion of the hip joint. Results One patient fell three weeks after implantation causing posterior dislocation; there was no recurrence. The Postel-Merle-d'Aubligne score improved from 8 +/- 2.9 (range 3-12) preoperatively to 17 +/- 0.8 (range 16-18) at last follow-up. None of the patients complained about the captor insertion and there were no cases of hematoma or fracture. Operative time was 35-40 minutes longer for the first four cases and was progressively reduced 15-20 minutes for the last four cases. Mean leg length discrepancy was 5.6 +/- 7.5 mm (range 0-25) before implantation and 0.6 +/- 3 mm (range -5 to 10 mm) at last follow-up. CT-scan measurements revealed a mean anteversion of the femoral implant of 18.2 +/- 8.5 degrees (range 0-31). Anatomic anteversion of the cup (measured from the pelvis landmark and thus independently of the position of the pelvis) was 24.7 +/- 8.8 degrees (range 12-40). The sum of the femoral and anatomic acetabular anteversions was 43 +/- 13.1 degrees (range 22-71). Anteversions were 16 degrees for the cup and 160 for the stem for the one case of dislocation. Conclusion This method can be used in routine without lengthening operative time significantly. It safely controls leg length and helps position the cup. This study demonstrated that there is no ideal position for the cup which can be used for all patients. Because of the wide range of inclination and anteversion figures, half of the cases were outside the safety zone recommended by Lewinnek.