Computer-assisted navigation systems for hip resurfacing arthroplasty are designed to minimize the chance of implant malposition. However, there is little evidence computer navigation is useful in the presence of anatomical deformity. We therefore determined the accuracy of an image-free resurfacing hip arthroplasty navigation system in the presence of a pistol grip deformity of the head and femoral neck junction and of a slipped upper femoral epiphysis deformity. We constructed an artificial phantom leg from machined aluminum with a simulated hip and knee. The frontal and lateral plane implant-shaft angles for the guide wire of the femoral component reamer were calculated with the computer navigation system and with an electronic caliper combined with micro-CT. There was a consistent disagreement between the navigation system and our measurement system in both the frontal plane and lateral plane with the pistol grip deformity. We found close agreement only for the frontal plane angle calculation in the presence of the slipped upper femoral epiphysis deformity, but calculation of femoral head size was inaccurate. The use of image-free navigation for the positioning of the femoral component appears questionable in these settings.
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