The Accuracy of Cup Placement in Total Hip Arthroplasty (THA) Using an Augmented Reality-Based Navigation System

Background AR HIP Navigation System (R) (AR-navi; Zimmer-Biomet, Warsaw, IN) is a portable navigation system employing augmented reality via a smartphone app, which was developed in Japan. We retrospectively analyzed the accuracy of cup placement in total hip arthroplasty (THA) using AR-navi, to investigate whether obesity is associated with an absolute value error in cup placement angle. Methods We retrospectively analyzed 45 hips in 43 patients who underwent THA using AR-navi (AR-navi group) and compared them with 45 hips in 45 patients who underwent THA using alignment rods (conventional group). Results The mean absolute error of cup placement (AR-navi group vs. conventional group) was found to be 2.60 degrees (+/- 2.11) in radiographic inclination (RI) for the AR-navi group and 4.61 degrees (+/- 3.28) for the conventional group, which indicates significant difference in the AR-navi group compared to that in the conventional group (p = 0.0036). The mean absolute error of radiographic anteversion (RA) was 3.57 degrees (+/- 3.36) for the AR-navi group and 3.87 degrees (+/- 2.97) for the conventional group (p = 0.4732). The mean absolute error of RI was 2.36 degrees (+/- 2.24) in the obese group and 3.16 degrees (+/- 2.03) in the nonobese group, and the mean absolute error of RA was 4.08 degrees (+/- 4.51) and 3.16 degrees (+/- 2.05) in the obese and nonobese groups, respectively. Conclusions Cup placement accuracy for THA using AR-navi was 2.60 +/- 2.11 degrees for RI and 3.87 +/- 2.97 degrees for RA. Compared to THA using the conventional method, the RI installation error was significantly improved with AR Navi. There was no significant difference in the mean absolute error of RI and RA among the obese and nonobese groups.