What you see is what you get: High degree of alignment accuracy with hand-held computer-aided technology when comparing intraoperative alignment to postoperative radiographs in direct anterior total hip arthroplasty.

Abstract

IntroductionTotal Hip Arthroplasty (THA) is a widely performed orthopaedic surgery, essential for treating severe pain and mobility issues arising from various conditions. The anticipated rise in Total Hip Arthroplasty (THA) procedures underscores the critical importance of their success, which is heavily dependent on the accurate positioning of prosthetic components. Various approaches like the Direct Anterior Approach with Fluoroscopy (DAA-F THA) and Robotic-assisted THA (RA THA) have their limitations. Computer-Navigated THA (CN THA) has emerged as a promising alternative, offering real-time feedback and potentially enhanced accuracy in component placement. This study evaluates the precision of CN THA in correcting leg length discrepancies and accurately positioning the acetabular component.MethodsThe study involved 122 consecutive patients undergoing direct anterior CN THA by the senior author. Exclusions were based on different surgical approaches, need for revision surgery, and infections. The study focused on the precise placement of acetabular components and leg length restoration. CN THA was used for intra-operative measurements, while post-operative radiographs were analyzed with TraumaCad® for comparison. Statistical analyses included Pearson correlation coefficients and descriptive analyses.ResultsCN THA showed high accuracy in leg length restoration with 85.25% of cases showing less than 5 mm discrepancy. Similarly, acetabular component positioning was precise, with 90.98% of inclination and 74.59% of anteversion measurements within acceptable ranges. The correlation between intra-operative and post-operative measurements was strong, indicating the reliability of CN THA measurements.ConclusionCN THA was shown to be highly accurate in correcting leg length discrepancies and achieving proper acetabular component positioning. The strong correlation between intra- and post-operative measurements underscores the reliability of CN THA. The study, however, is limited by its single-surgeon, single-approach design, and lack of a control group. Despite these limitations, CN THA shows considerable potential in improving THA precision, enhancing surgical outcomes, and customizing patient care.