Obesity does not influence acetabular component accuracy when using a 3D optical computer navigation system

Abstract

Introduction

Improper cup positioning and leg length discrepancy (LLD) are two of the most common errors following total hip arthroplasty (THA) and are associated with potentially significant consequences. Obesity is associated with increased risk of mechanical complications, including dislocations, which may be secondary to cup malposition and failure to restore leg length and offset. 3D Optical Camera computer assisted navigation (CAN) system may reduce the risk of component malposition and LLD with real time intraoperative feedback. The aim of this study was to investigate whether the use of CAN influences acetabular component placement (CP) accuracy and leg length restoration in obese (body mass index(BMI)≥35kg/m 2 ) patients undergoing primary THA.

Methods

A multi-center retrospective review was conducted identifying consecutive THA cases with BMI > 35kg/m 2 using CAN (Intellijoint Hip, Waterloo, CA) from 2015-2019. These patients were then matched with patients undergoing conventional THA (control) at a 1:1 ratio according to BMI, American Society of Anesthesiologists score, and gender. TraumaCad™ software (Brainlab, Chicago, IL) was used to measure cup anteversion, inclination, and change (Δ) in LLD between pre- and postoperative radiographic images. The safety target zones used as reference for precision analysis of CP were 15°-30° for anteversion and 30°-50° for inclination.

Results

176 patients were included: 88 CAN and 88 control cases. CAN cases were found to have a lower ΔLLD than controls (3.53±2.12mm vs. 5.00±4.05mm; p=0.003). Additionally, more CAN cases fell within the target safe zone than controls (83% vs.60%, p=0.00083).

Conclusion

Our findings suggest that the use of a CAN system may be more precise in component placement, and useful in facilitating the successful restoration of preoperative leg length following THA than conventional methodology.

Journal of Clinical Orthopaedics and Trauma

Available online 3 October 2020

Mohamad Sharan^a, Alex Tang^a, Lauren Schoof^a, Alexander Gaukhman^a, Morteza Meftah^a, Peter Sculco^b, Ran Schwarzkopf^a

Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA^bDepartment of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA

Received 30 June 2020, Revised 14 September 2020, Accepted 22 September 2020, Available online 3 October 2020.