Image-based navigation improves the positioning of the humeral component in total elbow arthroplasty

Hypothesis: Implant alignment in total elbow arthroplasty (TEA) is a challenging and error-prone process using conventional techniques. Identification of the flexion-extension (FE) axis is further complicated for situations of bone loss. This study evaluated the accuracy of humeral component alignment in TEA. We hypothesized that an image-based navigation system would improve humeral component positioning, with navigational errors less than or approaching 2.0 mm and 2.0 degrees. Materials and methods: Implantation of a modified commercial TEA humeral component was performed with and without navigation on 11 cadaveric distal humeri. Navigated alignment was based on positioning the humeral component with the aid of a computed tomography (CT)-based preoperative plan registered to landmarks on the distal humerus. Alignment was performed under 2 scenarios of bone quality: (1) an intact distal humerus, and (2) a distal humerus without articular landmarks. Results: Navigation significantly improved implant alignment accuracy (P<.001). Navigated implant alignment was 1.2 +/- 0.3 mm in translation and 1.3 degrees +/- 0.3 degrees in rotation for the intact scenario. For the bone loss scenario, navigated alignment error was 1.1 +/- 0.5 mm and 2.0 degrees +/- 1.3 degrees. Non-navigated alignment was 3.1 +/- 1.3 mm and 5.0 degrees +/- 3.8 degrees for the intact scenario and 3.0 +/- 1.6 mm and 12.2 degrees +/- 3.3 degrees for the bone loss scenario. Discussion: Image-based navigation improves the accuracy and reproducibility of humeral component placement in TEA. Implant alignment errors for the navigated alignments were below the target of 2.0 degrees and 2 mm that is considered standard for most navigation systems. Non-navigated implant alignment error was significantly greater for the bone loss scenario compared with the intact scenario. Conclusions: Implant malalignment may increase the likelihood of early implant wear, instability, and loosening. Improved implant positioning will likely lead to fewer complications and greater prosthesis longevity.