Computer navigation in total hip replacement: a meta-analysis

Proponents of navigated hip arthroplasty have suggested that it may increase the precision of acetabular component placement. We conducted a systematic review and meta-analysis to evaluate the validity of this theory. We searched, in duplicate, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials for randomised trials comparing the use of computer navigation with the freehand technique for acetabular cup placement within the desired alignment. We assessed the methodological quality of the studies and abstracted the relevant data. Tests of heterogeneity and publication bias were performed. From the three studies included, there was no evidence of heterogeneity between studies. A total of 250 patients were entered into the analysis. The beneficial odds ratio for the number of outliers was 0.285 (95% confidence interval [CI]: 0.143 to 0.569; p < 0.001). We conclude that navigation in hip arthroplasty improves the precision of acetabular cup placement by decreasing the number of outliers from the desired alignment

Enhanced acetabular component positioning through computer-assisted navigation

Optimal positioning of the acetabular component improves the long-term success of total hip arthroplasty by reducing the rate of adverse outcomes, such as component wear and dislocation. Mechanical guides designed to facilitate proper component orientation are inadequate, as they do not account for variations in patient position and pelvic motion during surgery. Pioneering image-guided surgical navigation systems were developed to provide surgeons with improved methods for intraoperatively measuring orientation and alignment. Although enhanced orientation has been reported with such systems, they require preoperative CT scans and are therefore limited by the need for preplanning, the necessitiy of matching CT data with the actual patient position, and the additional costs associated with CT. The recent development of CT-free navigational tools addresses these disadvantages and offers real-time surgical feedback regarding the actual position of the acetabular component and instruments relative to the pelvis. Proper training and enhanced identification of bony landmarks will improve upon the success of these systems

Reducing incision length or intensifying rehabilitation: what makes the difference to length of stay in total hip replacement in a UK setting?

Minimal-incision surgery for hip arthroplasty and intensive post-op physiotherapy have both been shown to allow early mobilisation and to reduce hospital stay. Forty-five patients undergoing primary total hip arthroplasty using a standard posterior approach were compared with 51 patients using a minimal incision. In both groups, physiotherapy involved either a routine or intensive regime. Patients were matched in age, sex and body mass index. There was no significant difference in blood loss, post-operative stay and change in Oxford hip scores at one year between the mini- and standard-incision groups. There was a significant difference (P=0.003) in length of stay between routine- and intensive-physiotherapy groups (11.4 vs. 7.9 days). The dislocation rate was higher in the mini-incision group. This study suggests that in a standard UK setting, intensive physiotherapy can significantly decrease in-patient stay, but reducing the incision length does not