Total knee and total hip arthroplasty are two of the most common procedures performed in orthopaedic surgery. Proper implant alignment is an important variable to surgical success and patient satisfaction.The exposure and positioning in total hip arthroplasty can be especially challenging given the deeper position within the body and limited viewing space. A recent study has shown that an orthopedic app could help with that.
A recent study, published in the journal Orthopedics, tested a unique use of mobile technology in the operating room that is designed to facilitate the positioning of hip acetabular implants to obtain the surgeon’s ideal component position. A team of researchers from Hyogo College of Medicine, Hyogo, Japan performed a cadaveric study measuring inclination of the acetabular cup with an iPhone application for angle measurement (Angle Sumude Apps) and an iPad protractor application (Camera Protractor Lite YJ Soft) for anteversion. They compared the surgical positioning results between these two measurements between resident surgeons-in-training and experienced arthroplasty surgeons. The results were assessed using the OrthoPilot image-free navigation system (Aesculap Implant Systems, Center Valley, Pennsylvania).
The article had several surprising findings. The surgical residents and experienced surgeons all placed the acetabular cups within the “safe zone” or acceptable range for inclination and anteversion set by the study. Anteversion was less reliable but acceptable within the system. The use of the mobile devices to place the implants did not add excessive amounts of time to the case, but this was not properly measured in the study. The study was also limited by its sample size using only five cadavers, and reusing the specimens for various measurements. The applications could not be combined between the iPad and iPhone which also added to the surgical time and required additional equipment. Similarly, the two measurements, inclination and anteversion, could not be measured simultaneously with one mobile application. Finally, they were not able to compare to a control group without the mobile applications or place the specimens under CT analysis, which would have been ideal to measure final implant position.
This study has important implications for mobile technology use in the operating room. The accuracy and reliability of these mobile applications has set the field for further research and application development. Given the widespread use of mobile devices by surgical teams, the availability and familiarity with the technology could be adapted and developed for more surgical applications.
