Image-based navigation improves the positioning of the humeral component in total elbow arthroplasty.
OBJECTIVE
Implant alignment in total elbow arthroplasty (TEA) is a challenging and error-prone process using conventional techniques. Identification of the flexion-extension (FE) axis is further complicated for situations of bone loss. This study evaluated the accuracy of humeral component alignment in TEA. We hypothesized that an image-based navigation system would improve humeral component positioning, with navigational errors less than or approaching 2.0 mm and 2.0 degrees .


METHODS
Implantation of a modified commercial TEA humeral component was performed with and without navigation on 11 cadaveric distal humeri. Navigated alignment was based on positioning the humeral component with the aid of a computed tomography (CT)-based preoperative plan registered to landmarks on the distal humerus. Alignment was performed under 2 scenarios of bone quality: (1) an intact distal humerus, and (2) a distal humerus without articular landmarks.


RESULTS
Navigation significantly improved implant alignment accuracy (P < .001). Navigated implant alignment was 1.2 +/- 0.3 mm in translation and 1.3 degrees +/- 0.3 degrees in rotation for the intact scenario. For the bone loss scenario, navigated alignment error was 1.1 +/- 0.5 mm and 2.0 degrees +/- 1.3 degrees . Non-navigated alignment was 3.1 +/- 1.3 mm and 5.0 degrees +/- 3.8 degrees for the intact scenario and 3.0 +/- 1.6 mm and 12.2 degrees +/- 3.3 degrees for the bone loss scenario.


CONCLUSIONS
Image-based navigation improves the accuracy and reproducibility of humeral component placement in TEA. Implant alignment errors for the navigated alignments were below the target of 2.0 degrees and 2 mm that is considered standard for most navigation systems. Non-navigated implant alignment error was significantly greater for the bone loss scenario compared with the intact scenario.


CONCLUSIONS
Implant malalignment may increase the likelihood of early implant wear, instability, and loosening. Improved implant positioning will likely lead to fewer complications and greater prosthesis longevity.
Bioengineering Research Laboratory, The Hand and Upper Limb Centre, St. Joseph's Health Care London, London, Ontario, Canada. colin.p.mcdonald@gmail.com
Colin P
CP
McDonald
James A
JA
Johnson
Terry M
TM
Peters
Graham J W
GJ
King
D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000379:methods*; D002102:Cadaver; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome