Gravity-Assisted Navigation System for Total Hip Arthroplasty

  • Guoyan ZhengEmail author
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1093)


In this chapter we propose a new system that allows reliable acetabular cup placement in total hip arthroplasty (THA) when the surgery is operated in lateral approach. Conceptually it combines the accuracy of computer-generated patient-specific morphology information with an easy-to-use mechanical guide, which effectively uses natural gravity as the angular reference. The former is achieved by using a statistical shape model-based 2D-3D reconstruction technique that can generate a scaled, patient-specific 3D shape model of the pelvis from a single conventional anteroposterior (AP) pelvic X-ray radiograph. The reconstructed 3D shape model facilitates a reliable and accurate co-registration of the mechanical guide with the patient’s anatomy in the operating theater. We validated the accuracy of our system by conducting experiments on placing seven cups to four pelvises with different morphologies. Taking the measurements from an image-free navigation system as the ground truth, our system showed an average accuracy of 2. 1 ± 0. 7 for inclination and an average accuracy of 1. 2 ± 1. 4 for anteversion.


Total hip arthroplasty (THA) Gravity-assisted navigation system (GANS) Statistical shape model 2D-3D reconstruction Smart instrumentation Mechanical guide 



This chapter was modified from the paper published by our group in the 2011 International Conference on Information Processing in Computer Assisted Interventions (IPCAI 2011) (Zheng et al., IPCAI 2011:101–112). The related contents were reused with the permission.


  1. 1.
    Ali Kahn AMA, Brakenbury PH, Reynolds IS (1981) Dislocation following total hip replacement. J Bone Joint Surg 63B:214–218CrossRefGoogle Scholar
  2. 2.
    McCollum DE, Gray WJG (1990) Dislocation after total hip arthroplasty. Causes and Prevention. Clin Orthop 261:159–170Google Scholar
  3. 3.
    Sarmiento A, Ebramzadeh E, Gogan WJ, McKellop HA (1990) Cup containment and orientation in cemented total hip arthroplasties. J Bone Joint Surg 72B:996–960CrossRefGoogle Scholar
  4. 4.
    Bader RJ, Steinhauser E, Willmann G, Gradinger R (2001) The effects of implant position, design and wear on the range of motion after total hip arthroplasty. Hip Int 11:80–90CrossRefGoogle Scholar
  5. 5.
    Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocation after total hip-replacement arthroplasties. J Bone Joing Surg 60A:217–220CrossRefGoogle Scholar
  6. 6.
    Kotwal RS, Ganapathi M, John A, Maheson M, Jones SA (2009) Outcome of treatment for dislocation after primary total hip replacement. J Bone Joint Surg 91B:321–326CrossRefGoogle Scholar
  7. 7.
    Digioia AM III, Jaramaz B, Plakseychuk AY, Moody JE Jr, Nikou C, Labarca RS, Levison TJ, Picard F (2002) Comparison of a mechanical acetabular alignment guide with computer placement of the socket. J Arthroplasty 17:359–364CrossRefPubMedCentralGoogle Scholar
  8. 8.
    DiGioia AM III, Jaramaz B, Blackwell M, Simon DA, Morgan F, Moody JE, Nikou C, Colgan BD, Aston CA, Labarca RS, Kischell E, Kanade T (1998) The Otto Aufranc award: image-guided navigation system to measure intraoperatively acetabular implant alignment. Clin Orthop 355:8–22CrossRefGoogle Scholar
  9. 9.
    Bargar WL, Bauer A, Börner M (1998) Primary and revision total hip replacement using the Robodoc systems. Clin Orthop 354:82–91CrossRefGoogle Scholar
  10. 10.
    Jaramaz B, DiGioia AM 3rd, Blackwell M, Nikou C (1998) Computer assisted measurement of cup placement in total hip replacement. Clin Orthop 354:70–81CrossRefGoogle Scholar
  11. 11.
    Taylor RH, Joskowicz L, Williamson B, Guéziec A, Kalvin A, Kazanzides P, Van Vorhis R, Yao J, Kumar R, Bzostek A, Sahay A, Börner M, Lahmer A (1999) Computer-integrated revision total hip replacement surgery: concept and preliminary results. Med Image Anal 3:301–319CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Zheng G, Marx A, Langlotz U, Widmer KH, Buttaro M, Nolte LP (2002) A hybrid CT-free navigation system for total hip arthroplasty. Comput Aided Surg 7:129–145CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Dorr LD, Hishiki Y, Wan Z, Newton D, Yun A (2005) Development of imageless computer navigation for acetabular component position in total hip replacement. Iowa Orthop J 25:1–9PubMedPubMedCentralGoogle Scholar
  14. 14.
    Spencer JM, Day RE, Sloan KE, Beaver RJ (2006) Computer navigation of the acetabular component: a cadaver reliability study. J Bone Joint Surg 88B: 972–975CrossRefGoogle Scholar
  15. 15.
    Asayama I, Akiyoshi Y, Naito M, Ezoe M (2004) Intraoperative pelvic motion in total hip Arthroplasty. J Arthroplasty 19:992–997CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Ezoe M, Naito M, Asayama I, Ishiko T, Fujisawa M (2005) Pelvic motion during total hip Arthroplasty with translateral and posterolateral approaches. J Orthop Sci 10:167–172CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Echeverri S, Leyvraz PF, Zambelli PY, Jolles BM (2006) Reliable acetabular cup orientation with a new gravity-assisted guidance system. J Arthroplasty 21:413–419CrossRefPubMedCentralGoogle Scholar
  18. 18.
    Dong X, Nolte LP, Zheng G (2008) Acetabular cup orientation using a statistical data based calibration table. In: Proceedings of CAOS 2008, Hongkong, 4–7 June 2008, pp 262–265Google Scholar
  19. 19.
    Murray DW (1993) The definition and measurement of acetabular orientation. J Bone Joint Surg 75: 228–232CrossRefGoogle Scholar
  20. 20.
    Zheng G (2010) Statistically deformable 2D/3D registration for estimating post-operative cup orientation from a single standard X-ray radiograph. Ann Biomed Eng 38:2910–2927CrossRefPubMedCentralGoogle Scholar
  21. 21.
    Arai N, Nakamura S, Matsushita T, Suzuki S (2010) Minimal radiation dose computed tomography for measurement of cup orientation in total hip arthroplasty. J Arthroplasty 25:263–267CrossRefPubMedCentralGoogle Scholar
  22. 22.
    Beckmann J, Lüring C, Tingart M, Anders S, Grifka J, Köck FX (2009) Cup positioning in THA: current status and pitfalls. A systematic evaluation of the literature. Arch Orthop Trauma Surg 129: 863–872CrossRefPubMedCentralGoogle Scholar
  23. 23.
    Kalteis T, Handel M, Herold T, Perlick L, Paetzel C, Grifka J (2006) Position of the acetabular cup – accuracy of radiographic calculation compared to CT-based measurement. Eur J Radiol 58:294–300CrossRefPubMedCentralGoogle Scholar
  24. 24.
    Lin F, Lim D, Wixson RL, Milos S, Hendrix RW, Makhsous M (2008) Validation of a computer navigation system and a CT method for determination of the orientation of implanted acetabular cup in total hip arthroplasty: a cadaver study. Clin Biomech 23:1004–1011CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Institute for Surgical Technology and BiomechanicsUniversity of BernBernSwitzerland

Personalised recommendations