Skip to main content
SpringerLink
Log in

Does accelerometer-based portable navigation provide more accurate and precise cup orientation without prosthetic impingement than conventional total hip arthroplasty? A randomized controlled study

  • Original Article
  • Published:
International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

This prospective randomized controlled study examined whether accelerometer-based navigation resulted in more accurate or precise cup orientation than a conventional mechanical guide. We used a simulation to evaluate how cup orientation affected potential hip range of motion (RoM) and freedom from prosthetic impingement.

Methods

Sixty hips were randomly allocated 1:1 to accelerometer-based portable navigation or conventional guidance. Procedures were performed through a standard posterolateral approach and combined anteversion technique. Cup inclination, cup anteversion, and stem anteversion were measured using computed tomography (CT). Using CT-based simulation, we evaluated impingement-free potential RoM and the proportion of hips with potential RoM required for daily activities.

Results

Absolute cup inclination and anteversion error averaged 4.3° ± 3.2° and 4.4° ± 2.9° for the navigation cohort and 5.6° ± 3.7° and 5.7° ± 4.2° for the conventional cohort, with no significant differences. Navigation resulted in significantly less variation in anteversion error than the conventional guide (p = .0049). Flexion, internal rotation (IR) at 90° of flexion, extension, and external rotation (ER) averaged 123° ± 12°, 46° ± 13°, 50° ± 10°, and 73° ± 23°, respectively, in the navigation cohort and 127° ± 10°, 52° ± 14°, 45° ± 10°, and 63° ± 12°, respectively, in the conventional cohort (p = .15, .15, .03, and .03, respectively). Flexion > 110°, IR > 30° at 90° of flexion, extension > 30°, and ER > 30° were achieved by 93%, 90%, 100%, and 100% of hips, respectively, in the navigation cohort and 97%, 93%, 97%, and 100% of hips, respectively, in the conventional cohort, with no significant differences.

Conclusions

Cup anteversion with the navigation system was more precise, but not more accurate, than with the conventional guide. The navigation cohort exhibited greater potential extension and ER than the conventional cohort, but no significant difference in impingement within the potential RoM required for daily activities.

Trial registration number: 29036. Date of registration: November 14, 2017.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Availability of data and materials

The datasets supporting the conclusions of the present study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

References

  1. Ritter MA, Keating EM, Sueyoshi T, Davis KE, Barrington JW, Emerson RH (2016) Twenty-five-years and greater, results after nonmodular cemented total knee arthroplasty. J Arthroplasty 31(10):2199–2202. https://doi.org/10.1016/j.arth.2016.01.043

    Article  PubMed  Google Scholar 

  2. Shiomoto K, Hamai S, Motomura G, Ikemura S, Fujii M, Nakashima Y (2020) Influencing factors for joint perception after total hip arthroplasty: Asian cohort study. J Arthroplasty 35(5):1307–1314. https://doi.org/10.1016/j.arth.2019.12.039

    Article  PubMed  Google Scholar 

  3. Kennedy JG (1998) Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration. J Arthroplasty 13(5):530–534. https://doi.org/10.1016/s0883-5403(98)90052-3

    Article  CAS  PubMed  Google Scholar 

  4. Teeter MG, Goyal P, Yuan X, Howard JL, Lanting BA (2018) Change in acetabular cup orientation from supine to standing position and its effect on wear of highly crosslinked polyethylene. J Arthroplasty 33(1):263–267. https://doi.org/10.1016/j.arth.2017.08.016

    Article  PubMed  Google Scholar 

  5. D’Lima DD, Urquhart AG, Buehler KO, Walker RH, Colwell CW Jr (2000) The effect of the orientation of the acetabular and femoral components on the range of motion of the hip at different head-neck ratios. J Bone Joint Surg Am 82(3):315–321. https://doi.org/10.2106/00004623-200003000-00003

    Article  CAS  PubMed  Google Scholar 

  6. Kiyohara M, Hamai S, Hara D, Fujiyoshi D, Harada S, Kawaguchi K, Nakashima Y (2019) Do component position and muscle strength affect the cup-head translation during gait after total hip arthroplasty? Eur J Orthop Surg Traumatol 29(6):1263–1269. https://doi.org/10.1007/s00590-019-02443-1

    Article  PubMed  Google Scholar 

  7. Shon WY, Park BY, Rajsankar RN, Park PS, Im JT, Yun HH (2019) Total hip arthroplasty: past, present, and future. What has been achieved? Hip Pelvis 31(4):179–189. https://doi.org/10.5371/hp.2019.31.4.179

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hassan DM, Johnston GH, Dust WN, Watson G, Dolovich AT (1998) Accuracy of intraoperative assessment of acetabular prosthesis placement. J Arthroplasty 13(1):80–84. https://doi.org/10.1016/s0883-5403(98)90079-1

    Article  CAS  PubMed  Google Scholar 

  9. Digioia AM 3rd, Jaramaz B, Plakseychuk AY, Moody JE Jr, Nikou C, Labarca RS, Levison TJ, Picard F (2002) Comparison of a mechanical acetabular alignment guide with computer placement of the socket. J Arthroplasty 17(3):359–364. https://doi.org/10.1054/arth.2002.30411

    Article  PubMed  Google Scholar 

  10. Leenders T, Vandevelde D, Mahieu G, Nuyts R (2002) Reduction in variability of acetabular cup abduction using computer assisted surgery: a prospective and randomized study. Comput Aided Surg 7(2):99–106. https://doi.org/10.1002/igs.10033

    Article  CAS  PubMed  Google Scholar 

  11. Sugano N, Takao M, Sakai T, Nishii T, Miki H (2012) Does CT-based navigation improve the long-term survival in ceramic-on-ceramic THA? Clin Orthop Relat Res 470(11):3054–3059. https://doi.org/10.1007/s11999-012-2378-4

    Article  PubMed  PubMed Central  Google Scholar 

  12. Inaba Y, Kobayashi N, Ike H, Kubota S, Saito T (2016) The current status and future prospects of computer-assisted hip surgery. J Orthop Sci 21(2):107–115. https://doi.org/10.1016/j.jos.2015.10.023

    Article  PubMed  Google Scholar 

  13. Kalteis T, Handel M, Bathis H, Perlick L, Tingart M, Grifka J (2006) Imageless navigation for insertion of the acetabular component in total hip arthroplasty: is it as accurate as CT-based navigation? J Bone Joint Surg Br 88(2):163–167. https://doi.org/10.1302/0301-620X.88B2.17163

    Article  CAS  PubMed  Google Scholar 

  14. Parratte S, Argenson JN (2007) Validation and usefulness of a computer-assisted cup-positioning system in total hip arthroplasty. A prospective, randomized, controlled study. J Bone Joint Surg Am 89(3):494–499. https://doi.org/10.2106/JBJS.F.00529

    Article  PubMed  Google Scholar 

  15. Najarian BC, Kilgore JE, Markel DC (2009) Evaluation of component positioning in primary total hip arthroplasty using an imageless navigation device compared with traditional methods. J Arthroplasty 24(1):15–21. https://doi.org/10.1016/j.arth.2008.01.004

    Article  PubMed  Google Scholar 

  16. Lass R, Kubista B, Olischar B, Frantal S, Windhager R, Giurea A (2014) Total hip arthroplasty using imageless computer-assisted hip navigation: a prospective randomized study. J Arthroplasty 29(4):786–791. https://doi.org/10.1016/j.arth.2013.08.020

    Article  PubMed  Google Scholar 

  17. Bohl DD, Nolte MT, Ong K, Lau E, Calkins TE, Della Valle CJ (2019) Computer-assisted navigation is associated with reductions in the rates of dislocation and acetabular component revision following primary total hip arthroplasty. J Bone Joint Surg Am 101(3):250–256. https://doi.org/10.2106/JBJS.18.00108

    Article  PubMed  Google Scholar 

  18. Kamenaga T, Hayashi S, Hashimoto S, Matsumoto T, Takayama K, Fujishiro T, Hiranaka T, Niikura T, Kuroda R (2019) Accuracy of cup orientation and learning curve of the accelerometer-based portable navigation system for total hip arthroplasty in the supine position. J Orthop Surg (Hong Kong) 27(2):2309499019848871. https://doi.org/10.1177/2309499019848871

    Article  Google Scholar 

  19. Tanino H, Nishida Y, Mitsutake R, Ito H (2020) Portable Accelerometer-based navigation system for cup placement of total hip arthroplasty: a prospective, randomized. Controlled Study J Arthroplasty 35(1):172–177. https://doi.org/10.1016/j.arth.2019.08.044

    Article  PubMed  Google Scholar 

  20. Renkawitz T, Weber M, Springorum HR, Sendtner E, Woerner M, Ulm K, Weber T, Grifka J (2015) Impingement-free range of movement, acetabular component cover and early clinical results comparing “femur-first” navigation and “conventional” minimally invasive total hip arthroplasty: a randomised controlled trial. Bone Joint J 97-B(7):890–898. https://doi.org/10.1302/0301-620X.97B7.34729

    Article  CAS  PubMed  Google Scholar 

  21. Woerner M, Weber M, Sendtner E, Springorum R, Worlicek M, Craiovan B, Grifka J, Renkawitz T (2017) Soft tissue restricts impingement-free mobility in total hip arthroplasty. Int Orthop 41(2):277–282. https://doi.org/10.1007/s00264-016-3216-1

    Article  PubMed  Google Scholar 

  22. Nadzadi ME, Pedersen DR, Yack HJ, Callaghan JJ, Brown TD (2003) Kinematics, kinetics, and finite element analysis of commonplace maneuvers at risk for total hip dislocation. J Biomech 36(4):577–591. https://doi.org/10.1016/s0021-9290(02)00232-4

    Article  PubMed  Google Scholar 

  23. Hemmerich A, Brown H, Smith S, Marthandam SS, Wyss UP (2006) Hip, knee, and ankle kinematics of high range of motion activities of daily living. J Orthop Res 24(4):770–781. https://doi.org/10.1002/jor.20114

    Article  CAS  PubMed  Google Scholar 

  24. Sugano N, Tsuda K, Miki H, Takao M, Suzuki N, Nakamura N (2012) Dynamic measurements of hip movement in deep bending activities after total hip arthroplasty using a 4-dimensional motion analysis system. J Arthroplasty 27(8):1562–1568. https://doi.org/10.1016/j.arth.2012.01.029

    Article  PubMed  Google Scholar 

  25. Hirata M, Nakashima Y, Ohishi M, Hamai S, Hara D, Iwamoto Y (2013) Surgeon error in performing intraoperative estimation of stem anteversion in cementless total hip arthroplasty. J Arthroplasty 28(9):1648–1653. https://doi.org/10.1016/j.arth.2013.03.006

    Article  PubMed  Google Scholar 

  26. Nakashima Y, Hirata M, Akiyama M, Itokawa T, Yamamoto T, Motomura G, Ohishi M, Hamai S, Iwamoto Y (2014) Combined anteversion technique reduced the dislocation in cementless total hip arthroplasty. Int Orthop 38(1):27–32. https://doi.org/10.1007/s00264-013-2091-2

    Article  PubMed  Google Scholar 

  27. Kanazawa M, Nakashima Y, Ohishi M, Hamai S, Motomura G, Yamamoto T, Fukushi J, Ushijima T, Hara D, Iwamoto Y (2016) Pelvic tilt and movement during total hip arthroplasty in the lateral decubitus position. Mod Rheumatol 26(3):435–440. https://doi.org/10.3109/14397595.2015.1092914

    Article  PubMed  Google Scholar 

  28. Murray DW (1993) The definition and measurement of acetabular orientation. J Bone Joint Surg Br 75(2):228–232. https://doi.org/10.1302/0301-620X.75B2.8444942

    Article  CAS  PubMed  Google Scholar 

  29. Zhu J, Wan Z, Dorr LD (2010) Quantification of pelvic tilt in total hip arthroplasty. Clin Orthop Relat Res 468(2):571–575. https://doi.org/10.1007/s11999-009-1064-7

    Article  PubMed  Google Scholar 

  30. Komiyama K, Nakashima Y, Hirata M, Hara D, Kohno Y, Iwamoto Y (2016) Does high hip center decrease range of motion in total hip arthroplasty? A Computer Simulation Study. J Arthroplasty 31(10):2342–2347. https://doi.org/10.1016/j.arth.2016.03.014

    Article  PubMed  Google Scholar 

  31. D’Aubigne RM (1954) Function al results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg (Am) 36(3):451–475

    Article  Google Scholar 

  32. Tetsunaga T, Yamada K, Tetsunaga T, Sanki T, Kawamura Y, Ozaki T (2020) An accelerometer-based navigation system provides acetabular cup orientation accuracy comparable to that of computed tomography-based navigation during total hip arthroplasty in the supine position. J Orthop Surg Res 15(1):147. https://doi.org/10.1186/s13018-020-01673-y

    Article  PubMed  PubMed Central  Google Scholar 

  33. Jolles BM, Genoud P, Hoffmeyer P (2004) Computer-assisted cup placement techniques in total hip arthroplasty improve accuracy of placement. Clin Orthop Relat Res 426:174–179. https://doi.org/10.1097/01.blo.0000141903.08075.83

    Article  Google Scholar 

  34. Iwana D, Nakamura N, Miki H, Kitada M, Hananouchi T, Sugano N (2013) Accuracy of angle and position of the cup using computed tomography-based navigation systems in total hip arthroplasty. Comput Aided Surg 18(5–6):187–194. https://doi.org/10.3109/10929088.2013.818713

    Article  PubMed  Google Scholar 

  35. Otero JE, Fehring KA, Martin JR, Odum SM, Fehring TK (2018) Variability of pelvic orientation in the lateral decubitus position: are external alignment guides trustworthy? J Arthroplasty 33(11):3496–3501. https://doi.org/10.1016/j.arth.2018.07.021

    Article  PubMed  Google Scholar 

  36. Tetsunaga T, Yamada K, Tetsunaga T, Furumatsu T, Sanki T, Kawamura Y, Ozaki T (2020) Comparison of the accuracy of CT- and accelerometer-based navigation systems for cup orientation in total hip arthroplasty. Hip Int:1120700020904940. doi:https://doi.org/10.1177/1120700020904940

  37. Tsukamoto M, Kawasaki M, Suzuki H, Fujitani T, Sakai A (2021) Proposal of accurate cup placement procedure during total hip arthroplasty based on pelvic tilt discrepancies in the lateral position. Sci Rep 11(1):13870. https://doi.org/10.1038/s41598-021-93418-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Geier A, Kluess D, Grawe R, Herrmann S, D’Lima D, Woernle C, Bader R (2017) Dynamical analysis of dislocation-associated factors in total hip replacements by hardware-in-the-loop simulation. J Orthop Res 35(11):2557–2566. https://doi.org/10.1002/jor.23549

    Article  CAS  PubMed  Google Scholar 

  39. Komiyama K, Hamai S, Ikebe S, Yoshimoto K, Higaki H, Shiomoto K, Gondo H, Hara D, Wang Y, Nakashima Y (2019) In vivo kinematic analysis of replaced hip during stationary cycling and computer simulation of optimal cup positioning against prosthetic impingement. Clin Biomech (Bristol, Avon) 68:175–181. https://doi.org/10.1016/j.clinbiomech.2019.05.035

    Article  Google Scholar 

  40. Sendtner E, Tibor S, Winkler R, Worner M, Grifka J, Renkawitz T (2010) Stem torsion in total hip replacement. Acta Orthop 81(5):579–582. https://doi.org/10.3109/17453674.2010.524596

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Motoji Yamamoto, Yoshihiko Furuta, and Koki Honda from the Department of Medical-Engineering Collaboration for Healthy Longevity, Kyushu University for providing helpful advice during this study. This work was performed in the Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Masato Kiyohara, Satoshi Hamai, Kyohei Shiomoto, Satoru Harada, Tetsunari Harada, Goro Motomura, Satoshi Ikemura, Masanori Fujii, Shinya Kawahara & Yasuharu Nakashima

  2. Department of Medical-Engineering Collaboration for Healthy Longevity, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Satoshi Hamai

Authors
  1. Masato Kiyohara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Satoshi Hamai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kyohei Shiomoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Satoru Harada
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tetsunari Harada
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Goro Motomura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Satoshi Ikemura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masanori Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shinya Kawahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yasuharu Nakashima
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MK and SH designed the study and drafted the manuscript. MK, SH, KS, SH, TH, GM, SI, MF, SK and YN collected the data. All authors contributed to data analysis, revised the manuscript for important intellectual content, and approved the final submitted manuscript.

Corresponding author

Correspondence to Satoshi Hamai.

Ethics declarations

Competing interests

Each author certifies that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Not applicable.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of our institution and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kiyohara, M., Hamai, S., Shiomoto, K. et al. Does accelerometer-based portable navigation provide more accurate and precise cup orientation without prosthetic impingement than conventional total hip arthroplasty? A randomized controlled study. Int J CARS 17, 1007–1015 (2022). https://doi.org/10.1007/s11548-022-02592-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11548-022-02592-5

Keywords

Search

Navigation