28 янв. 2012 г.

Although computer navigation can increase accuracy in total hip arthroplasty (THA), surgeons using conventional instruments can achieve proper component positioning without additional costs and time, according to a presentation at Orthopedics Today Hawaii 2012.

“Ideal component position can be achieved with conventional instruments and a consistent surgical technique, so I see no reason to use computer navigation, at least on a regular basis,” Michael D. Ries, MD, said during his presentation.

Templating and positioning

Proper component positioning, Ries said, starts with patient positioning. He noted that the most important thing is to have the pelvis in a secure position.

“There is going to be some variability in the positioning of the pelvis regardless of how much effort you put into making it secure, and putting it into a little more abduction is going to be helpful,” Ries said.

Templating is also important to properly place components.

“It is helpful in order to get in your mind, not only the size and orientation of the components figured out, but also just to think about the case and what you are going to be looking at, such as identifying landmarks radiographically,” he said. “Those are what you are going to be looking for intraoperatively.”

Computer-assisted vs. conventional

Ries cited numerous comparisons between the use of computer navigation and conventional instruments, noting that one meta-analysis of nine studies indicated no difference in median cup position.

“Studies that report other variables demonstrate increased accuracy, as well as increased cost, time and hassle,” Ries said. “That has been my personal experience as well.”

Ultimately, Ries said, it comes down to a matter of whether or not the component is placed properly — and if your results are fine, the addition of computer navigation is largely unnecessary and could result in additional time and cost.

“Conventional instruments, when used correctly, work well,” he concluded. “The benefit of navigation is increased accuracy, but right now it still adds time, cost and hassle. I do think ultimately we need better methods of acetabular component fixation, but without the hassle involved with computer navigation.”


Ries MD. Component position and standard instruments. Presented at Orthopedics Today Hawaii 2012. Jan. 15-18. Wailea, Hawaii.
Disclosure: Ries is a consultant for Stryker and Smith & Nephew.

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