Research Article
Volume 12 Issue 4 - 2021
Implant Positioning in Total Hip Arthroplasty within a Target Zone: A Comparison between Conventional vs Computer Assisted Navigated Surgery
Bradley S Lambert*, Richard Okafor, Kwan J Park, Michael A Trakhtenbroit, David R Lionberger and Terry A Clyburn
Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
*Corresponding Author: Bradley S Lambert, Director of Human Subjects Research, Orthopedic Biomechanics Research Laboratory, Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA.
Received: February 24, 2021; Published: March 31, 2021


Background: Computer-assisted-navigated-surgery (CANS) has recently been utilized to improve implant positioning. The purpose of this study was to compare acetabular cup positioning between conventional (CON) surgery and CANS in primary total-hip arthroplasty (THA).

Methods: A review of 176 (86 CANS/90 CON) primary THA cases was performed. Acetabular component inclination (target range: 30° - 50°) and anteversion (target range: 15° - 35°) were measured. Limb length discrepancy (LLD) was measured on post-operative radiographs. Ninety-day complications and assessments of hip strength, gait, and range of motion (ROM) were recorded. Chi-square was used to compare %outside the target ranges between groups and complication frequencies. A t-test was used to compare distance from the center of the target range and operative time. A generalized linear model was used to compare post-operative assessments. Type-I error, α = 0.05.

Results: More cups were observed to be out of range for inclination in the CON group (35.2%) compared to CANS (18.6%) (p = 0.013) with the CON group measuring farther from the center range of 40° (CON: 8.2° ± 0.62; CANS: 6.3° ± 0.47; p = 0.015). No differences were observed between groups for anteversion or LLD. Operative time was longer for the CANS group (92.1 min ± 4.6 vs 81.4 min ± 4.1) (p < 0.001). Although not statistically significant (p = 0.019), CANS trended towards reduced 90-day dislocation frequency (CANS = 1; CON = 4). Post-operative follow-up measures were higher in the CANS group for flexion (p < 0.01), adduction (p = 0.014), and abduction (p = 0.004) strength (~+5%) and internal rotation ROM (+3.6°, p = 0.019).

Conclusion: CANS can improve some aspects of cup placement. Future studies are necessary to explore the potential long-term benefits in clinical outcomes with regards to clinical significance and should be weighed against the cost of its use.

Level of Evidence: Level III, Retrospective.


Keywords: Total Hip Arthroplasty; Total Joint Replacement; Computer Assisted Navigated Surgery


  1. Learmonth ID., et al. “The operation of the century: total hip replacement". The Lancet 9597 (2007): 1508-1519.
  2. Ninomiya JT., et al. “What’s New in Hip Replacement”. Journal of Bone and Joint Surgery 18 (2017): 1591-1596.
  3. Callanan MC., et al. “The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital". Clinical Orthopaedics and Related Research® 2 (2011): 319-329.
  4. Biedermann R., et al. “Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component". The Journal of Bone and Joint Surgery. British volume 6 (2005): 762-769.
  5. Abdel MP., et al. “What safe zone? The vast majority of dislocated THAs are within the Lewinnek safe zone for acetabular component position". Clinical Orthopaedics and Related Research® 2 (2016): 386-391.
  6. Esposito CI., et al. “Cup position alone does not predict risk of dislocation after hip arthroplasty". The Journal of arthroplasty1 (2015): 109-113.
  7. Tezuka T., et al. “Functional safe zone is superior to the Lewinnek safe zone for total hip arthroplasty: why the Lewinnek safe zone is not always predictive of stability". The Journal of Arthroplasty1 (2019): 3-8.
  8. D'lima DD., et al. “The effect of the orientation of the acetabular and femoral components on the range of motion of the hip at different head-neck ratios". Journal of Bone and Joint Surgery 3 (2000): 315-321.
  9. Jolles B., et al. "Factors predisposing to dislocation after primary total hip arthroplasty: a multivariate analysis". The Journal of Arthroplasty3 (2002): 282-288.
  10. Kennedy J., et al. “Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration". The Journal of Arthroplasty5 (1998): 530-534.
  11. Penenberg BL., et al. “Digital radiography in total hip arthroplasty: technique and radiographic results". Journal of Bone and Joint Surgery 3 (2018): 226-235.
  12. Snijders TE., et al. “Lack of consensus on optimal acetabular cup orientation because of variation in assessment methods in total hip arthroplasty: a systematic review". HIP International1 (2019): 41-50.
  13. Xu K., et al. “Computer navigation in total hip arthroplasty: a meta-analysis of randomized controlled trials". International Journal of Surgery5 (2014): 528-533.
  14. Paprosky WG., et al. “Intellijoint HIP®: a 3D mini-optical navigation tool for improving intraoperative accuracy during total hip arthroplasty". Medical Devices 9 (2016): 401.
  15. Schwarzkopf R., et al. “Quantifying pelvic motion during total hip arthroplasty using a new surgical navigation device". The Journal of Arthroplasty10 (2017): 3056-3060.
  16. Westacott DJ., et al. “Assessment of cup orientation in hip resurfacing: a comparison of TraumaCad and computed tomography". Journal of Orthopaedic Surgery and Research1 (2013): 8.
  17. Widmer K-H. "A simplified method to determine acetabular cup anteversion from plain radiographs". The Journal of Arthroplasty3 (2004): 387-390.
  18. Koo TK., et al. “A guideline of selecting and reporting intraclass correlation coefficients for reliability research". Journal of Chiropractic Medicine2 (2016): 155-163.
  19. Auerbach N., et al. "Antalgic Gait in Adults". In. StatPearls: StatPearls Publishing (2020).
  20. Naqvi U. "Muscle strength grading". In. Statpearls: StatPearls Publishing (2019).
  21. Confalonieri N., et al. “Is computer-assisted total knee replacement for beginners or experts? Prospective study among three groups of patients treated by surgeons with different levels of experience". Journal of Orthopaedics and Traumatology4 (2012): 203-210.
  22. Wang AW., et al. “Computer navigation of the glenoid component in reverse total shoulder arthroplasty: a clinical trial to evaluate the learning curve". Journal of Shoulder and Elbow Surgery3 (2020): 617-623.
  23. Sawilowsky SS. "New effect size rules of thumb". Journal of Modern Applied Statistical Methods2 (2009): 26.
  24. Beckmann J., et al. “Navigated cup implantation in hip arthroplasty: a meta-analysis". Acta Orthopaedica5 (2009): 538-544.
  25. Li Y-L., et al. “Evidence-based computer-navigated total hip arthroplasty: an updated analysis of randomized controlled trials". European Journal of Orthopaedic Surgery and Traumatology4 (2014): 531-538.
  26. Liu Z., et al. “Imageless navigation versus traditional method in total hip arthroplasty: A meta-analysis". International Journal of Surgery 21(2015): 122-127.
  27. Snijders T., et al. “Precision and accuracy of imageless navigation versus freehand implantation of total hip arthroplasty: A systematic review and meta‐analysis". The International Journal of Medical Robotics and Computer Assisted Surgery4 (2017): e1843.
  28. Moskal JT., et al. “Acetabular component positioning in total hip arthroplasty: an evidence-based analysis”. The Journal of Arthroplasty8 (2011): 1432-1437.
  29. Murphy WS., et al. “The safe zone range for cup anteversion is narrower than for inclination in THA". Clinical Orthopaedics and Related Research2 (2018): 325.
  30. Danoff JR., et al. “Redefining the acetabular component safe zone for posterior approach total hip arthroplasty". The Journal of Arthroplasty2 (2016): 506-511.
  31. Reina N., et al. “Can a target zone safer than Lewinnek's safe zone be defined to prevent instability of total hip arthroplasties? Case-control study of 56 dislocated THA and 93 matched controls". Orthopaedics and Traumatology: Surgery and Research5 (2017): 657-661.
  32. Aoude AA., et al. “Thirty-day complications of conventional and computer-assisted total knee and total hip arthroplasty: analysis of 103,855 patients in the American College of Surgeons National Surgical Quality Improvement Program database". The Journal of Arthroplasty8 (2016): 1674-1679.
  33. Shah SM., et al. “Computer navigation helps reduce the incidence of noise after ceramic-on-ceramic total hip arthroplasty". The Journal of Arthroplasty 9 (2017): 2783-2787.
  34. Upadhyay A., et al. “Medical malpractice in hip and knee arthroplasty". The Journal of Arthroplasty 6 (2007): 2-7.
  35. Keshmiri A., et al. “No difference in clinical outcome, bone density and polyethylene wear 5–7 years after standard navigated vs. conventional cementfree total hip arthroplasty". Archives of Orthopaedic and Trauma Surgery 5 (2015): 723-730.
  36. Parratte S., et al. “No benefit after THA performed with computer-assisted cup placement: 10-year results of a randomized controlled study”. Clinical Orthopaedics and Related Research®10 (2016): 2085-2093.
  37. Azodi OS., et al. “High body mass index is associated with increased risk of implant dislocation following primary total hip replacement: 2,106 patients followed for up to 8 years". Acta Orthopaedica 1 (2008): 141-147.
  38. Dorr LD. "Letter to the Editor: Editor’s Spotlight/Take 5: No Benefit after THA Performed with Computer-assisted Cup Placement: 10-year Results of a Randomized Controlled Study". Clinical Orthopaedics and Related Research® 2 (2017): 565-566.
  39. Vigdorchik JM., et al. “Evaluating surgeon estimation of cup position in total hip arthroplasty: a cadaver study". The Journal of Hip Surgery 2 (2017): 105-111.
  40. Park KJ., et al. “The Usefulness of Meta-Analyses to Hip and Knee Surgeons". Journal of Bone and Joint Surgery 23 (2019): 2082-2090.
Citation: Bradley S Lambert., et al. “Implant Positioning in Total Hip Arthroplasty within a Target Zone: A Comparison between Conventional vs Computer Assisted Navigated Surgery”. EC Orthopaedics 12.4 (2021): 87-98.

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