"Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has."

Margaret Mead
Original article
peer-reviewed

Direct Anterior Approach Using Navigation Improves Accuracy of Cup Position Compared to Conventional Posterior Approach



Abstract

The accuracy of cup position in total hip arthroplasty is essential for a satisfactory result as malpositioning increases the risk of complications including dislocation, high wear rate, loosening, squeaking, edge loading, impingement and ultimately failure.

We studied 166 patients in a single-surgeon-series of matched cohorts of patients who underwent total hip arthroplasties. Four separate groups were identified comprising of the posterior approach +/- navigation and the direct anterior approach +/- navigation.

We found a significant difference between the direct anterior navigated group and the posterior non-navigated group for both anteversions (P < 0.05, confidence interval (CI) -3.86 to -1.73) and inclination (P < 0.05, CI -3.08 to -1.08). Almost, 72% of anterior navigated patients fell within 5o of the navigation software set target cup position of 45o inclination and 20o anteversion and 100% were within 10o. Only 30% of posterior non-navigated were within 5o of both anteversion and inclination and 73% were within 10o.

There was also a significant difference between the direct anterior navigated and non-navigated group with respect to anteversion only (p < 0.05, CI 1.50 to 1.30). There were no other significant differences between approaches +/- navigation.

The direct anterior approach allows ease of access to both anterior-superior iliac spines for navigation and a supine patient allows anteversion and inclination to be measured in the frontal plane. We conclude that the direct anterior approach with navigation improves the accuracy of cup position compared to the conventional posterior approach without navigation.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.



Original article
peer-reviewed

Direct Anterior Approach Using Navigation Improves Accuracy of Cup Position Compared to Conventional Posterior Approach


Author Information

Jason Chow

Orthopaedics, Nepean hospital

Simon Pearce

Orthopaedics, Nepean hospital

Kuk-ki Cho Corresponding Author

Orthopaedics, Royal North Shore Hospital

William Walter

Orthopaedics, Mater Hospital


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

Acknowledgements

The findings of this research have been summarized as an abstract in the Orthopaedic Proceedings Abstract Catalog printed on the 31st of December 2013 as a part of the collective submission following its presentation at the International Society for Technology in Arthroplasty Congress of that same year. No formal journal publications have been published using this data prior to this submission. The abstract is of the same title and can be accessed via http://www.bjjprocs.boneandjoint.org.uk/content/95-B/SUPP_34/195.


Original article
peer-reviewed

Direct Anterior Approach Using Navigation Improves Accuracy of Cup Position Compared to Conventional Posterior Approach


Figures etc.

Share
Original article
peer-reviewed

Direct Anterior Approach Using Navigation Improves Accuracy of Cup Position Compared to Conventional Posterior Approach

  • Author Information
    Jason Chow

    Orthopaedics, Nepean hospital

    Simon Pearce

    Orthopaedics, Nepean hospital

    Kuk-ki Cho Corresponding Author

    Orthopaedics, Royal North Shore Hospital

    William Walter

    Orthopaedics, Mater Hospital


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements

    The findings of this research have been summarized as an abstract in the Orthopaedic Proceedings Abstract Catalog printed on the 31st of December 2013 as a part of the collective submission following its presentation at the International Society for Technology in Arthroplasty Congress of that same year. No formal journal publications have been published using this data prior to this submission. The abstract is of the same title and can be accessed via http://www.bjjprocs.boneandjoint.org.uk/content/95-B/SUPP_34/195.


    Article Information

    Published: July 17, 2017

    DOI

    10.7759/cureus.1482

    Cite this article as:

    Chow J, Pearce S, Cho K, et al. (July 17, 2017) Direct Anterior Approach Using Navigation Improves Accuracy of Cup Position Compared to Conventional Posterior Approach. Cureus 9(7): e1482. doi:10.7759/cureus.1482

    Publication history

    Received by Cureus: April 06, 2017
    Peer review began: July 06, 2017
    Peer review concluded: July 09, 2017
    Published: July 17, 2017

    Copyright

    © Copyright 2017
    Chow et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

The accuracy of cup position in total hip arthroplasty is essential for a satisfactory result as malpositioning increases the risk of complications including dislocation, high wear rate, loosening, squeaking, edge loading, impingement and ultimately failure.

We studied 166 patients in a single-surgeon-series of matched cohorts of patients who underwent total hip arthroplasties. Four separate groups were identified comprising of the posterior approach +/- navigation and the direct anterior approach +/- navigation.

We found a significant difference between the direct anterior navigated group and the posterior non-navigated group for both anteversions (P < 0.05, confidence interval (CI) -3.86 to -1.73) and inclination (P < 0.05, CI -3.08 to -1.08). Almost, 72% of anterior navigated patients fell within 5o of the navigation software set target cup position of 45o inclination and 20o anteversion and 100% were within 10o. Only 30% of posterior non-navigated were within 5o of both anteversion and inclination and 73% were within 10o.

There was also a significant difference between the direct anterior navigated and non-navigated group with respect to anteversion only (p < 0.05, CI 1.50 to 1.30). There were no other significant differences between approaches +/- navigation.

The direct anterior approach allows ease of access to both anterior-superior iliac spines for navigation and a supine patient allows anteversion and inclination to be measured in the frontal plane. We conclude that the direct anterior approach with navigation improves the accuracy of cup position compared to the conventional posterior approach without navigation.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.



Jason Chow, M.D., M.P.H., M.Sc., Orthopaedic Registrar

Orthopaedics, Nepean hospital

Simon Pearce

Orthopaedics, Nepean hospital

Kuk-ki Cho

Orthopaedics, Royal North Shore Hospital

For correspondence:
jkkcho@gmail.com

William Walter

Orthopaedics, Mater Hospital

Jason Chow, M.D., M.P.H., M.Sc., Orthopaedic Registrar

Orthopaedics, Nepean hospital

Simon Pearce

Orthopaedics, Nepean hospital

Kuk-ki Cho

Orthopaedics, Royal North Shore Hospital

For correspondence:
jkkcho@gmail.com

William Walter

Orthopaedics, Mater Hospital