Computer simulation: how can it help the surgeon optimize implant position?

Component placement critically affects the performance and longevity of total hip replacements (THRs). Because of limitations of observation and anatomic orientation imposed by the operative site, selection of the correct size, and position of the acetabular and femoral components is best done through preoperative planning. Currently, this is done by comparing two-dimensional templates of prosthetic components with clinical radiographs; however, this method has the inherent limitation that AP and lateral radiographs each provide one projection of the pelvis and the femur. Computer technology makes it possible to observe implantation of the femoral and acetabular components in three dimensions. This approach allows surgeons to template with superior accuracy, while providing an intimate view of the fit of the components in the implantation site. Additionally, computer routines can predict the functional outcome of a preoperative plan before its implementation. Restoration of leg length, center of rotation, ROM of the joint during various activities, and points of bony and prosthetic impingement can be analyzed preoperatively by the surgeon. This is a valuable tool for surgical navigation and surgeon training. With emerging technologic advances in surgical technique, computer-based preoperative planning tools should prove all the more essential to reliable component placement.