Acetabular component navigation in lateral decubitus based on EOS imaging: A preliminary study of 13 cases

IntroductionAcetabular component navigation classically requires palpation of the bone landmarks defining the anterior pelvic plane (APP) (anterior superior iliac spine [ASIS] and pubis), the recording of which is not very reliable when performed in lateral decubitus. The objectives of the current experimental study were: (1) to assess the clinical feasibility of NAVEOS navigation (based on EOS imaging) in lateral decubitus; and (2) to compare precision versus classical APP-based navigation (NAVAPP).HypothesisIliac plane navigation using EOS is as reliable as APP navigation.Patients and methodsA continuous prospective series of 13 total hip replacements were implanted in lateral decubitus under APP-guided navigation (NAVAPP). Planning used preoperative EOS measurement. The ASIS, pubis and ipsilateral posterior superior iliac spine (PSIS) were located and exported to the navigator. Intra-operatively, NAVEOS landmarks (acetabular center, ASIS and PSIS on the operated side) were palpated. Postoperatively, cup inclination and anteversion with respect to the APP were measured on EOS imaging (SterEOS3D software). The SterEOS3D measurements were compared to those of the performed NAVAPP and simulated NAVEOS navigations.ResultsThree patients were excluded for technical reasons. In the remaining 10, inclination on NAVAPP and SterEOS3D differed by a median 4° (range, 0–12°), and on NAVEOS versus SteEOS3D by 5° (range, 2–10°); anteversion on NAVAPP and SterEOS3D differed by a median 4.5° (range, 0–12°), and on NAVEOS versus SteEOS3D by 4° (range, 0–14°).ConclusionPrecision was comparable between NAVEOS and classical navigation. NAVEOS simplifies cup navigation in lateral decubitus on initial acquisition. These results require validation on a larger sample.Level 4 studyProspective case series.