How Accurate Is Acetabular Cup Placement Using Imageless Navigation? A Validation Study

Purpose: Correct placement of the acetabular cup is a crucial step in hip replacement to achieve a satisfactory result and remains a challenge with free hand techniques. Imageless navigation may provide a viable alternative to freehand technique and improve placement significantly. The purpose of this project was to assess and validate intra-operative placement values as displayed by an imageless navigation system to postoperative measurement of cup position using high resolution CT scans. Methods: Thirty-two subjects who underwent primary hip joint arthroplasty using imageless navigation were included. The average age was 66.5 years (range 32–87). 23 non-cemented and 9 cemented acetabular cups were implanted. The desired position for the cup was 45 degrees of inversion and 15 degrees of anteversion. A pelvic CT scan using a multi-slice CT was used to assess the position of the cup radiographically. Results: Two subjects were excluded because of dislodgement of the tracking pin. Pearson correlation revealed a strong and significant correlation (r=0.68; p Conclusion: These findings can be explained with the possible introduction of systematic error. Even though the acquisition of anatomic landmarks is simple, they must be acquired with great precision. An error of 1 cm can result in a mean anteversion error of 6 degrees and inclination error of 2.5 degrees. Whilst computer assisted surgery results in highly accurate cup placements for inclination, anteversion of the cup cannot be