Use of augmented reality surgical navigation reduces intraoperative fluoroscopic imaging in anterior total hip arthroplasty with equivalent accuracy for component positioning.

Background: Computer-assisted surgical navigation was designed to reduce the rates of acetabular component malpositioning, a common cause for revision following primary total hip arthroplasty (THA). We compared intraoperative measures such as radiation exposure, radiographic acetabular cup placement, and outcomes of patients who underwent a THA using computer-assisted surgical navigation with augmented reality (AR) compared to those who underwent traditional manual THA with fluoroscopic assistance (FA).

Methods: We retrospectively reviewed 115 hips who underwent primary direct anterior THAs using the intraoperative AR surgical navigation system between 3/30/2021 and 12/30/2022. These were compared to a matched cohort of 115 primary THAs performed with FA through a direct anterior approach during the same time period. Patients were matched based on age, gender, American Society of Anesthesiologists score (ASA), and BMI. Goal inclination and anteversion were set to 42° (°) and 22°, respectively.

Results: THA with AR patients had decreased intraoperative radiation exposure (mean 2.0 versus 3.2 mGy, p < 0.001) and radiation time (mean 0.2 versus 0.4 min, p < 0.001). Deviation from the preoperative plan was similar between AR and FA for both radiographic inclination and anteversion. There was no difference in the operative time, estimated blood loss, or reoperations, all of which were for infection (1.7 versus 0.0 %, p = 0.5).

Conclusion: AR surgical navigation in primary THA has similar radiographic, operative and clinical results as THA with intraoperative FA. However, AR surgical navigation is associated with decreased intraoperative fluoroscopic radiation and time. Further research is needed to evaluate accuracy of acetabular component positioning and complications.