Precision, standarized Iso-C-arm based navigated boring on the proximal femur

C-arm navigation is a new tool in computer assisted surgery. The aim of this study is to evaluate the accuracy of Iso-C-arm based drill holes in the proximal femur. In nine artificial proximal femura, two holes with an angle of 135degrees and 100degrees in relation to the shaft axis were drilled in the direction of the femoral head. The defined target of the 3.2 mm drillings was a 4 mm steel ball, which had previously been placed and fixed at the cranial center of the femoral head. All the drillings were standardized with a navigated drilling machine fixed to a frame which only allowed movement of the system in the direction of the drill. During navigation the positions of the drill before commencement and at the deepest point of the canal were recorded. After drilling all specimens were evaluated by CT, and the coordinates of the center of the start and the end of the drilled hole and the center of the ball were determined, Using vector calculation,the smallest distance between the straight line, defined by the center of the starting point and the end point of the drill hole,and the center of the ball was calculated. Additionally, the coordinates of the intersection between the perpendicular to the center of the ball and the straight line were determined (x,, y(y)z(y)),to evaluate the direction of misplacement of the drilled canal in relation to the target. For the 135degrees drill holes, a median of 2.5 mm for the smallest distance between the straight line,given by the center of the start and the end of the hole, and the center of the ball was investigated (range 1.6-3.7 mm). For the 100degrees holes the median was 3.1 mm (range 1.8-4.2 mm). The main plane of deviation in all of the 135degrees holes was posteriorly, whereas in the 100degrees holes posterior deviation occurred in four cases, cranial in three cases, and in one case each caudal and anterior deviation occurred. In our opinion, the accuracy of fluoroscopy based navigation applied in the region of the proximal femur is sufficient and reproducible. This technique can be used for implant placement at the proximal femur in the future.