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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2010 August;61(4):285-92
Computer-assisted surgery in total hip arthroplasty. A review of the literature and current concepts
Beckmann J., Springorum H. R., Lechler P., Lüring C., Tingart M., Grifka J.
Department of Orthopaedic Surgery, University of Regensburg, Germany
The correct implantation and orientation in THA is crucial for its clinical outcome with ROM, functionality and longevity. Regarding cup navigation in THA, navigation is a reliable evidence-proven tool to optimize cup placement, significantly reducing the incidence of outliers. Femoral navigation proved as precise tool with reliable orientation, too. More emphasis has to be given to the individuality of pelvic tilt and range of motion. Therefore, new and very promising developments code the next generation of navigation-based implantation, regarding a more functional orientation by the “combined anteversion” method. The surgeon’s intraoperative task is to weigh stable and possible cup and stem containment and orientation against optimal postoperative ROM. Uncertainty is remaining regarding the correct intraoperative as well as the postoperative assessment due to the pelvic tilt and rotation with inexact incorporation of the pelvis. True anatomic conditions can just be approximated. Although influenced by the tilt and rotation as well, the APP seems to be the most reliable reference frame so far. For the intraoperative assessment of the APP, the meticulous determination of the bony landmarks including the pushing aside of fat is mandatory. For the standard plain radiography, the standardized positioning of the patient and approximation of pelvic tilt by a strict lateral view is mandatory. An additional CT must be carried out for certain indications and if the strict x-ray requirements cannot be attained. For the intraoperative assessment of the APP, it is mandatory to further minimize bias by meticulous determination of the bony landmarks including the pushing aside of fat.