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Does Computer-Assisted Surgery Improve Accuracy and Decrease the Learning Curve in Hip Resurfacing? A Radiographic Analysis
Thorsten M. Seyler, MD1; Lawrence P. Lai, MD, MS1; Denise I. Sprinkle, BSRT, CT1; William G. Ward, MD1; Riyaz H. Jinnah, MD1
1 Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1070
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Smith and Nephew and Wright Medical). Also, a commercial entity (Wright Medical) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical 4practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Aug 01;90(Supplement 3):71-80. doi: 10.2106/JBJS.H.00697
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Background: Hip resurfacing is a technically demanding procedure in which accurate positioning of the femoral component is critical to the avoidance of early implant failures. The purpose of this study was to assess the accuracy of computer-assisted placement of the femoral component and to evaluate the impact of computer-assisted surgery on the learning curve associated with this procedure.

Methods: The accuracy of positioning the femoral component was analyzed radiographically in hips undergoing resurfacing procedures performed by surgeons assigned to four different study groups: Group 1, in which the operations were performed with use of computer-assisted surgery by a fellowship-trained surgeon who was experienced in performing resurfacing arthroplasty (surgical experience, more than 250 hip resurfacings); Group 2, in which the operations were performed with use of computer-assisted surgery by senior residents who were inexperienced in performing resurfacing arthroplasty and who were closely supervised by faculty; Group 3, in which the operations were performed with use of conventional instruments by fellowship-trained faculty members; and Group 4, in which the operations were performed with use of computer-assisted surgery by a lesser experienced fellowship-trained faculty member (surgical experience, more than forty but less than seventy-five hip resurfacings) from Group 3.

Results: The range of error in varus or valgus angulation that was observed for navigated procedures was 6° in Group 1, 7° in Group 2, and 5° in Group 4. Compared with the preoperative neck-shaft angle value, the mean postoperative stem-shaft angle value increased by a mean of 4.7° in Group 1, 7.2° in Group 2, 6.5° in Group 3, and 11.6° in Group 4. When compared with the use of standard instrumentation, the use of computer-assisted surgery reduced the number of outliers and facilitated valgus insertion.

Conclusions: In the present study, computer-assisted surgery resulted in improved accuracy and precision in positioning the femoral component. In addition, computer-assisted surgery led to a reduction in the length of the learning curve for beginners in hip resurfacing and improved the surgeon's ability to perform this procedure safely.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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