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Scientific Articles   |    
A Comparison of Conventional Guidewire Alignment Jigs with Imageless Computer Navigation in Hip Resurfacing Arthroplasty
Michael Olsen, PhD1; Mark Chiu, MD, FRCS(C)2; Patrick Gamble, MD, FRCS(C)2; Richard A. Boyle, MD, FRACS2; Nezar Tumia, MD, FRCSEd(Tr&Orth)2; Emil H. Schemitsch, MD, FRCS(C)3
1 Martin Orthopaedic Biomechanics Laboratory, Institute of Biomaterials and Biomedical Engineering, St. Michael's Hospital, University of Toronto, 5-066 Shuter Wing, 30 Bond Street, Toronto, ON M5B 1W8, Canada. E-mail address: olsenmi@smh.toronto.on.ca
2 Division of Orthopaedic Surgery, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
3 Division of Orthopaedic Surgery, Department of Surgery, St. Michael's Hospital, Suite 800, 55 Queen Street East, Toronto, ON M5C 1R6, Canada
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Smith and Nephew. In addition, 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).

Investigation performed at St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Aug 04;92(9):1834-1841. doi: 10.2106/JBJS.I.00648
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Abstract

Background: 

Correct positioning of the initial femoral guidewire is vital in order to prepare the femoral head properly for hip resurfacing. The purpose of the present investigation was to determine the accuracy and precision of the placement of the initial femoral guidewire with use of conventional alignment jigs and to compare the results with those of imageless computer navigation.

Methods: 

Five commercially available jigs (two lateral pin jigs, two neck centering jigs, and one head planing jig) were obtained. Four surgeons used each jig and navigation three times to insert a guidewire in 10° of relative valgus and neutral version into individual synthetic femora. A single surgeon then used each jig three times to align the initial guidewire in 10° of relative valgus and neutral version in each of ten human cadaver femora. Radiographs of the synthetic and human femora were made to assess and compare guidewire inclination and version between conventional instrumentation and navigation.

Results: 

Navigation provided ranges of error in the coronal guidewire alignment of up to eight times less than the conventional jigs, but both methods provided similar ranges of error for version. In both arms of the study, there were significant differences in coronal alignment accuracy between the two neck centering jigs. Next to navigation, one lateral pin jig provided the most accurate coronal placement of the initial guidewire whereas one neck centering jig provided the most precise coronal placement of the guidewire. Navigation was similar to conventional jigs in terms of the accuracy and precision of guidewire version.

Conclusions: 

In hip resurfacing arthroplasty, the choice of a femoral alignment device may influence the accuracy and precision of guidewire insertion, ultimately impacting femoral component placement. Imageless computer navigation can facilitate accurate and precise coronal alignment of the initial femoral guidewire, superior to that of conventional instrumentation.

Clinical Relevance: 

The results of this study may aid surgeons in the selection of alignment instruments for placement of the initial femoral guidewire during hip resurfacing.

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    Accreditation Statement
    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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