Vpliv modifikacije navigacijskega sistema na natančnost postavitve acetabularnih komponent pri totalni artroplastiki kolčnih sklepov

Mihalič, René (author), Trebše, Rihard (mentor)

Uvod Vstavitev totalne endoproteze v kolčni sklep (totalna kolčna arthroplastika, TKA) velja za enega najuspešnejših kirurških posegov. Zlati standard pri izvedbi posega je še zmeraj prostoročna kirurška tehnika, ki je močno odvisna od izkušenosti kirurga, položaja bolnika na operacijski mizi in od orientacijskih anatomskih struktur, ki pomagajo pri določanju položaja komponent. Za izboljšanje položaja komponent so bili razviti številni pripomočki in naprave, med njimi tudi navigacijski sistemi, ki pa imajo tudi svoje pomanjkljivosti. Natančnost običajnih navigacijskih sistemov je namreč močno odvisna od natančne registracije kostnih orientacijskih točk, ki definirajo sprednjo medenično ravnino (SMR), ki predstavlja orientir za navigacijo postavitve komponent totalne kolčne endoproteze (TKE). Registracija SMR je s trenutnimi metodami in pripomočki precej zamudna in predvsem pri debelih bolnikih tudi nenatančna. Namen dela je zato bil ugotoviti klinično uporabo elektromagnetnega navigacijskega (EMN) sistema, pri katerem smo razvili unikatno orodje Navi-frame, ki omogoča natančno in ponovljivo določanje SMR. Bolniki in metode Bolnike, pri katerih je bila načrtovana vstavitev TKE, smo naključno razdelili v dve skupini, v vsako po 42 bolnikov. V testni skupini (EHIP) smo acetabularne komponente vstavili s pomočjo EMN sistema. Kota, ki jih je določil EMN sistem, sta predstavljala referenčna kota za kasnejši izračun točnosti in natančnosti EMN sistema. V kontrolni skupini (PR) smo acetabularne komponente vstavili prostoročno s ciljem približati se vnaprej določenima tarčnima kotoma (inklinacijski kot: 42,5°; anteverzni kot: 15°), ki sta obenem predstavljala referenčna kota za izračun točnosti in natančnosti prostoročne tehnike. Resničen položaj acetabularnih komponent smo po operaciji določili s pomočjo računalniške tomografije medenice. Med obema metodama smo nato primerjali točnost (koren povprečne kvadratne napake, RMSE), pristranskost (srednja napaka pristranskosti, ME), natančnost in čas trajanja operacije. Rezultati V EHIP skupini je bila anteverzija acetabularne komponente natančnejša in bolj točna kot v kontrolni skupini. V EHIP skupini smo izračunali ME -1,7° (95% CI -2,4-1,1), v PR skupini pa -4,5 ° (CI -6,5-2,5). V EHIP skupini smo izračunali RMSE 2,8° (CI 2,3-3,2), v PR skupini pa 8,0° (CI 6,3-9,5). Tudi inklinacija je bila bolj točna v EHIP skupini z RMSE 4,6° (CI 3,4-5,9) v primerjavi z 6,5° (CI 5,4-7,5) v PR skupini. Natančnost inklinacije je bila tudi višja v EHIP skupini, vendar ni bila statistično značilna. V EHIP skupini smo izračunali ME 1,7° (95% CI 0,4-3,0), v PR skupini pa 1,9° (95% CI 0,0-3,8). V času trajanja operacij med obema skupinama ni bilo statistično značilne razlike (P = 0,78). Zaključek Postavitev acetabularne komponente s pomočjo EMN sistema je bolj točna in natančnejša v primerjavi s prostoročno tehniko in ne vpliva na čas trajanja operacije.

• Language: Slovenian
• Keywords: navigacija, čas operacije, kolk, artroza, endoproteza, artroplastika
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2021
• PID: 20.500.12556/RUL-127842
• COBISS.SI-ID: 67002883
• Publication date in RUL: 25.06.2021

Secondary language

• Language: English
• Title: Impact of the modification of the navigation system on the accuracy of the acetabular component placement in total hip arthroplasty

Abstract

Introduction Total hip arthroplasty is one of the most successful surgical procedures ever performed. The gold standard in performing the procedure is still the freehand surgical technique which strongly depends on the surgeon's experience, the patient's position on the surgical table, and the landmarks that help determine the components' position. Several devices have been developed to overcome the described problems, including navigation systems which also have drawbacks. The accuracy of the conventional navigation systems depends largely on the accurate registration of the boney landmarks that define the anterior pelvic plane (APP) representing a guide for the navigated placement of the total hip endoprosthesis components. With current methods and devices, APP registration is rather time-consuming and inaccurate, especially in obese patients. The purpose of this work was to determine the clinical use of the electromagnetic navigation (EMN) system with the specially developed and unique tool (Navi-frame) for accurate and reproducible determination of APP. Patients and methods We randomly allocated patients scheduled for total hip arthroplasty into 2 groups of 42 patients each. In the study group, acetabular components were placed with the support of the EMN system. The angles determined by the EMN system were the reference angles for the subsequent calculation of the accuracy and precision of the EMN system. In the control group, cups were placed freehand, aiming to achieve the predefined target angles (inclination:42.5°; anteversion:15°). Postoperatively, the true position of the acetabular component was determined using the computed tomography scan of the pelvis. Precision (root mean squared error, RMSE) bias (mean bias error, ME), accuracy, and surgery duration were compared between both methods. Results Acetabular component anteversion was more accurate and precise in the navigated group. The ME in the navigated and freehand group was -1.7° (95% CI -2.4–-1.1) and -4.5° (CI -6.5–-2.5), respectively. The RMSE in the navigated and freehand group was 2.8° (CI 2.3-3.2) and 8.0° (CI 6.3-9.5), respectively. The inclination was also more precise in the navigated group, with the RMSE in the navigated and freehand group at 4.6° (CI 3.4-5.9) and 6.5° (CI 5.4-7.5), respectively. The accuracy of the inclination was also higher in the EHIP group, but not statistically significant. The ME in the EHIP and PR group was 1,7° (95% CI 0.4-3.0) and 1,9° (95% CI 0.0-3.8), respectively. The duration of surgeries was similar between both groups (P = 0.78). Conclusions Acetabular component placement with the help of EMN is more accurate and precise than the freehand technique, and it does not affect the duration of surgery.

• Keywords: navigation, surgical time, hip, arthritis, prosthesis, arthroplasty