Minimally invasive computer-assisted total hip arthroplasty

摘要

Objectives/Background: Minimally invasive surgical techniques have been shown to decrease morbidity and facilitate recovery following total hip arthroplasty. However, component position with less exposure can be challenging and require heavy reliance on intraoperative fluoroscopy. Surgical navigation of acetabular component insertion has been shown to increase both the accuracy and position of acetabular components. Combining minimally invasive and computer-assisted techniques offers the advantage of facilitating patient recovery while maintaining the accuracy of component insertion without acquiring intraoperative images throughout the procedure. The current abstract reviews our experience combining these techniques. Design/Methods: 12 primary total hip arthroplasties were performed using a combination of minimally invasive exposure and surgical navigation. Patients were placed in the lateral position. All muscle origins and insertions were preserved. The femoral component was inserted through a superior capsulotomy between the minimus (retracted anteriorly) and the piriformis (retracted posteriorly). The acetabular component was inserted anterior to the femoral shaft and inferior to the gluteus minimus and medius, deep to the rectus femoris. The femur was prepared with the femoral head in situ, placing the reamers and broaches through the top of the femoral head and neck. Following insertion of the broach, a pelvic reference frame was affixed. Three virtual fluoroscopic images were acquired, one of each acetabulum, and one of the affected femur with the broach in place. The horizontal position of the pelvis was determined by creating a virtual line connecting the two teardrops (FluoroNav Software, ION hardware, Medtronic Surgical Navigation Technology). The acetabular component was then inserted with a goal of 41 degrees of abduction relative to the inter-teardrop line. The actual abduction angle was then measured post-operatively on an AP pelvis radiograph. Post-operatively, patients were mobilized without restriction of weight-bearing or motion.