Image-based navigation improves the positioning of the humeral component in total elbow arthroplasty

McDonald, Colin P.; Johnson, James A.; Peters, Terry M.; King, Graham J.W.

doi:10.1016/j.jse.2009.10.010

« Previous Next »Journal of Shoulder and Elbow Surgery
Volume 19, Issue 4 , Pages 533-543, June 2010

Image-based navigation improves the positioning of the humeral component in total elbow arthroplasty

Colin P. McDonald, PhD
- Bioengineering Research Laboratory, The Hand and Upper Limb Centre, St. Joseph's Health Care London, London, Ontario, Canada
- Department of Biomedical Engineering, The University of Western Ontario, London, Ontario, Canada
- Imaging Research Labs, Robarts Research Institute, London, Ontario, Canada
- Reprint requests: Colin P McDonald, PhD, Bioengineering Research Laboratory, The Hand and Upper Limb Centre, St. Joseph's Health Care London, 268 Grosvenor St, London, ON N6A 4V2, Canada.
James A. Johnson, PhD
- Bioengineering Research Laboratory, The Hand and Upper Limb Centre, St. Joseph's Health Care London, London, Ontario, Canada
- Department of Biomedical Engineering, The University of Western Ontario, London, Ontario, Canada
- Department of Surgery, The University of Western Ontario, London, Ontario, Canada
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada
Terry M. Peters, PhD
- Department of Biomedical Engineering, The University of Western Ontario, London, Ontario, Canada
- Imaging Research Labs, Robarts Research Institute, London, Ontario, Canada
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada
Graham J.W. King, MD
- Bioengineering Research Laboratory, The Hand and Upper Limb Centre, St. Joseph's Health Care London, London, Ontario, Canada
- Department of Surgery, The University of Western Ontario, London, Ontario, Canada
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada

published online 05 February 2010.

Hypothesis

Implant alignment in total elbow arthroplasty (TEA) is a challenging and error-prone process using conventional techniques. Identification of the flexion-extension (FE) axis is further complicated for situations of bone loss. This study evaluated the accuracy of humeral component alignment in TEA. We hypothesized that an image-based navigation system would improve humeral component positioning, with navigational errors less than or approaching 2.0 mm and 2.0°.

Materials and methods

Implantation of a modified commercial TEA humeral component was performed with and without navigation on 11 cadaveric distal humeri. Navigated alignment was based on positioning the humeral component with the aid of a computed tomography (CT)-based preoperative plan registered to landmarks on the distal humerus. Alignment was performed under 2 scenarios of bone quality: (1) an intact distal humerus, and (2) a distal humerus without articular landmarks.

Results

Navigation significantly improved implant alignment accuracy (P < .001). Navigated implant alignment was 1.2 ± 0.3 mm in translation and 1.3° ± 0.3° in rotation for the intact scenario. For the bone loss scenario, navigated alignment error was 1.1 ± 0.5 mm and 2.0° ± 1.3°. Non-navigated alignment was 3.1 ± 1.3 mm and 5.0° ± 3.8° for the intact scenario and 3.0 ± 1.6 mm and 12.2° ± 3.3° for the bone loss scenario.

Discussion

Image-based navigation improves the accuracy and reproducibility of humeral component placement in TEA. Implant alignment errors for the navigated alignments were below the target of 2.0 degrees and 2 mm that is considered standard for most navigation systems. Non-navigated implant alignment error was significantly greater for the bone loss scenario compared with the intact scenario.

Conclusions

Implant malalignment may increase the likelihood of early implant wear, instability, and loosening. Improved implant positioning will likely lead to fewer complications and greater prosthesis longevity.

Level of evidence: Basic Science Study

Keywords: Computer-assisted orthopedic surgery, navigation, registration, total elbow arthroplasty, computed tomography, preoperative planning