When it comes to acetabular cup positioning during total hip arthroplasty (THA), precision really matters. Malpositioned cups increase the risk of dislocation, early wear, and loosening, among other unwanted outcomes.
In the January 20, 2016 issue of The Journal of Bone & Joint Surgery, Sariali et al. report on results of a randomized trial that compared cup positioning guided by three-dimensional (3-D) visualization tools used intraoperatively (28 patients) with freehand cup placement (28 patients). Cup anteversion was more accurate in the 3-D planning group, and the percentage of anteversion outliers according to the Lewinnek safe zone was lower in the 3-D planning group. Although cup abduction was restored with greater accuracy in the 3-D planning group, the percentage of abduction outliers was comparable between groups.
Interestingly, operative times did not differ between the two groups. The authors note that CT-based navigation, a more expensive technology used to improve acetabular-cup positioning, does increase operative times, although its reported accuracy is higher than that of the 3-D planning technique used in this trial. That apparent tradeoff leads the authors to conclude that “3-D planning may be a good compromise between accuracy on the one hand and extra cost and duration of surgery on the other hand.”
It should also be noted that Sariali et al. did not measure clinical outcomes in this study, so there’s no evidence here that the accuracy enhancements arising from 3-D planning translate into meaningful clinical improvements.