Introduction
Methods
Search strategy
Eligibility criteria
Study selection
Risk of bias in individual studies
Outcome measures
Study characteristics
Study (year) | Study design | Data source | Sample size | Sex (%M) | Age | BMI (kg/m2) | Follow- up | Surgical approach | Acetabular implant | Platform | MINORS |
---|---|---|---|---|---|---|---|---|---|---|---|
Christ et al. (2018) [24] | Prospective cohort | Single | 57 | N/R | N/R | N/R | N/R | Posterior | N/R | Intellijoint HIP | 20 |
Gofton et al. (2007) [22] | Prospective cohort | Multi | 45a | 62 | N/R | N/R | 4–6 weeks | N/R | N/R | Vector vision | 24 |
Inori et al. (2012) [21] | Retrospective cohort | Single | 80 | 16 | 60 | 24 | N/R | Anterior lateral | Plasmacup | Ortho pilot | 21 |
Kamenaga et al. (2019) [27] | Prospective cohort | Single | 75 | 15 | 70 | 24 | N/R | Anterior | G7 | Hipalign | 22 |
Kolodychuk et al. (2022) [23] | Prospective cohort | Single | 159 | 49 | 64 | 27 | N/R | Anterior | N/R | Hipalign | 21 |
Najarian et al. (2009) [29] | Retrospective cohort | Single | 149 | N/R | 65 | 28 | N/R | Posterior | N/R | Stryker image guided navigation | 20 |
Suhardi et al. (2021) [30] | Retrospective cohort | Single | 90 | 46 | N/R | 29 | N/R | Posterior | N/R | Intellijoint HIP | 20 |
Thorey et al. (2009) [25] | Prospective cohort | Single | 60 | 42 | N/R | 29 | N/R | Lateral | Threaded SC cup | Ortho pilot | 21 |
Wixson et al. (2005) [28] | Retrospective cohort | Single | 132 | 48 | 63 | 29 | 1 month | Posterior | Varied | Sigma scan pro | 21 |
Results
Temporal assessment of the CN-THA learning curve
Study (year) | LC analysis | Key findings |
---|---|---|
Inori et al. (2012) [21] | Initial 40 cases compared: A. Cases 1–20 B. Cases 21–40 | After 20 cases, cup medialization showed marked improvement with a decreased mean discrepancy from 3.1° to 1.6 mm. No difference in deviation from planned cup height, anteversion, inclination, or LLD |
Kamenaga et al. (2019) [27] | Initial 75 cases compared: A. Cases 1–25 B. Cases 26–50 C. Cases 51–75 | Operative time and navigation time showed a marked decrease after 5 cases and then remained stable for the remaining 70 cases. No difference in deviation from planned cup inclination or anteversion between groups |
Najarian et al. (2009) [29] | Initial 96 cases compared: A. Cases 1–49 B. Cases 50–96 | Deviation from planned anteversion decreased after 49 cases (1.04° vs 0.85°). Deviation from planned inclination also decreased from 0.88° to 0.69°. Mean blood loss decreased from 520 to 356 mL No difference in operative time |
Thorey et al. (2009) [25] | Initial 60 cases compared: A. Cases 1–30 B. Cases 31–60 | Navigation time was significantly lessened in the latter 30 cases (13 vs 5 min). The first 30 cases showed a significant difference between intraoperatively planned and postoperative radiographic inclination (43.7° vs 47.3°) and anteversion (15.2° vs 20.9°). However, in the latter 30 cases, there was no difference in intraoperative and postoperatively measured inclination or anteversion, demonstrating improved placement accuracy after 30 cases |
Wixson et al. (2005) [28] | Initial 82 cases compared: A. Cases 1–20 B. Cases 21–82 | After 20 cases, cup anteversion and inclination accuracy showed marked improvement with experience, as 44% of cups were placed in the combined target zone in the first 20 cases, compared to 87% in the remaining cases |
Kolodychuk et al. (2022) [23] | Learning curve was considered completed when the 5-case mean operative time was maintained within the 95% confidence interval of the mean operative time for conventional direct anterior THA | There was a learning curve of 31–35 cases based on operative time |
Comparative assessment of the CN-THA learning curve
Study (year) | Comparison | Key findings |
---|---|---|
Christ et al. (2018) [24] | Single surgeon: initial CN-THA (n = 26) vs M-THA (n = 31) | The set-up and hands-on utilization of a novel surgical navigation tool required an additional 2.9 min per case (SD: 1.6) compared to M-THA |
Wixson et al. (2005) [28] | Single surgeon: initial CN-THA (n = 82) vs M-THA (n = 50) | Cup inclination of 40° to 45° was achieved in more navigated cases (55 vs 32%). Cup anteversion of 17 to 23° was also achieved in more navigated cases (54 vs 34%). More navigated cases fell into both of these ranges combined (30 vs 6%) |
Najarian et al. (2009) [29] | Single surgeon: A. M-THA (n = 53) B. initial CN-THA (n = 49; cases 1–49) C. later CN-THA (n = 47; cases 50–96) | Comparing groups A to B: Navigation had fewer ≥ 10° outliers in anteversion (14 vs 21%) and inclination (4 vs 13%). Operative time was higher in the navigation cohort (128 vs 105 min). No difference in deviation from planned anteversion or estimated blood loss Comparing groups A to C: Navigation had fewer ≥ 10° outliers in anteversion (9 vs 21%) and inclination (4° vs 13%). Operative time was higher in the navigation cohort (124 vs 105 min), although estimated blood loss was lower (356 vs 428 mL) |
Kolodychuk et al. (2022) [23] | Single surgeon: initial CN-THA (n = 99) vs fluoroscopy-assisted (n = 60) | In the learning phase (n = 30): Handheld navigation demonstrated lower deviation from planned inclination (2.9° vs 3.4°) and a longer operative time (92 vs 72 min). No difference in deviation from planned anteversion, anteversion outliers, LLD, or radiation time and dose In the proficiency phase (n = 64): Handheld navigation demonstrated lower deviation from planned anteversion (2.0° vs 5.8°) and inclination (1.3° vs 5.4°), as well as a lower LLD (1.0 vs 3.4 mm) and offset (1.4 vs 6.1 mm). There were also fewer ≥ 10° outliers for version (0 vs 20%) and inclination (0 vs 15%). Radiation time and dose were lower in the handheld navigation group (dose: 0.6 vs 2.1 mGy; time: 5.3 vs 19.1 s). No difference in operative time |
Suhardi et al. (2021) [30] | CN-THA cup placement performed by: A. trials by residents (n = NR) B. trials by fellows (n = NR) C. Final placement by attending (n = 2) | Resident Trials vs Attending: Residents demonstrated greater deviation from planned inclination (5.5° vs 1.3°) and placed more cups outside of the inclination safe zone (23.3 vs 0%). Residents also had greater deviation from planned anteversion (9.6° vs 1.4°). There was no difference in safe zone outliers for version Fellow Trials vs Attending: Fellows demonstrated greater deviation from planned inclination (4.3° vs 1.0°) and anteversion (6.7° vs 1.0°). No difference in proportion of outliers for inclination or version Resident Trials vs Fellow Trials: Fellows achieved fewer outliers from the inclination safe zone (3.3 vs 23%). Residents displayed greater deviation from planned version (9.6° vs 6.7°). There was no difference in outliers from the anteversion safe zone |
Gofton et al. (2007) [22] | Medical students and non-orthopedic surgical residents performed simulation-based training in three ways: A. M-THA training (n = 15) B. CN-THA training (n = 15) C. knowledge-of-results training (n = 15) | All groups displayed enhanced accuracy and precision for cup placement inclination and version (p < 0.001). The group using computer navigation exhibited superior accuracy and precision in the initial stages of training (p < 0.05), maintaining better precision throughout the training process (p < 0.05). There was no noteworthy decline in performance when comparing immediate and delayed testing for any of the groups |