Validation of the femoral anteversion measurement method used in imageless navigation

Total hip arthroplasty restores lost mobility to patients suffering from osteoarthritis and acute trauma. In recent years, navigated surgery has been used to control prosthetic component placement. Furthermore, there has been increasing research on what constitutes correct placement. This has resulted in the definition of a safe-zone for acetabular cup orientation. However, there is less definition with regard to femoral anteversion and how it should be measured. This study assesses the validity of the femoral anteversion measurement method used in imageless navigation, with particular attention to how the neutral rotation of the femur is defined. CT and gait analysis methodologies are used to validate the reference which defines this neutral rotation, i.e., the ankle epicondyle piriformis (AEP) plane. The findings of this study indicate that the posterior condylar axis is a reliable reference for defining the neutral rotation of the femur. In imageless navigation, when these landmarks are not accessible, the AEP plane provides a useful surrogate to the condylar axis, providing a reliable baseline for femoral anteversion measurement.