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Meta-Analysis
. 2009 Oct;80(5):538-44.
doi: 10.3109/17453670903350073.

Navigated cup implantation in hip arthroplasty

Johannes Beckmann  1 , Dirk Stengel, Markus Tingart, Jürgen Götz, Joachim Grifka, Christian Lüring
Affiliations
Meta-Analysis

Navigated cup implantation in hip arthroplasty

Johannes Beckmann et al. Acta Orthop. 2009 Oct.

Abstract

Background and purpose: Many studies have suggested that navigation-based implantation can improve cup positioning in total hip arthroplasty (THA). We conducted a systematic review and meta-analysis to compile the best available evidence, and to overcome potential shortcomings because of small sample sizes in individual studies.

Methods: The search strategy covered the major medical databases from January 1976 through August 2007, as well as various publishers' databases. The internal validity of individual studies was evaluated independently by 3 reviewers. We used random-effects modeling to obtain mean differences in cup angulation and relative risk (RR) of cup positioning outside Lewinnek's safe zone.

Results: Of 363 citations originally identified, 5 trials of moderate methodology enrolling a total of 400 patients were included in the analysis. Mean cup inclination and anteversion were not statistically significantly different between the conventional groups and the navigated groups. Navigation reduced the variability in cup positioning and the risk of placing the acetabular component beyond the safe zone (RR = 0.21, CI: 0.13-0.32).

Interpretation: Based on the current literature, navigation is a reliable tool to optimize cup placement, and to minimize outliers. However, long-term outcomes and cost utility analyses are needed before conclusive statements can be drawn about the value of routine navigation in THA.

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Figures

Figure 1.
Figure 1.
Study selection process according to QUOROM (Quality of Reporting of Meta-Analyses) standards.
Figure 2.
Figure 2.
Forest plot showing that there was no statistically significant difference in mean inclination of cups placed with and without navigational support. Mean effect sizes of individual studies are expressed as squares, with larger squares denoting larger sample sizes, higher precision, and higher relative weight within the meta-analysis. Values lower than zero favor navigation and values higher than zero favor conventional cup positioning. The diamond shows the pooled overall effect size with the 95% confidence interval. When the 95% confidence interval includes the zero, it can be assumed that there is no statistical significance at the two-tailed p < 0.05 level.
Figure 3.
Figure 3.
Forest plot showing that there was no statistically significant difference in mean anteversion of cups placed with and without navigational support. No information on anteversion was available in the trial by Leenders et al. (Leenders et al. 2002).
Figure 4.
Figure 4.
Forest plot showing the statistically significantly reduced relative risk of cup positioning outside the safe zone with navigation.
See this image and copyright information in PMC

References

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