Minimum 10-year outcomes of cementless total hip arthroplasty using a 32-mm femoral head with CT-based navigation: a comparative study with manual technique

Computed tomography (CT)-based navigation improves the accuracy of component placement in total hip arthroplasty (THA). To date, evidence of its long-term clinical impact is limited. This study aimed to compare minimum 10-year outcomes of cementless THA performed using CT-based navigation and a manual technique with a 32-mm femoral head. This study included a minimum follow-up of 10 years. The CT-based group included 58 hips and the manual group included 53 hips. Postoperative cup orientation was assessed using CT. Clinical outcomes were evaluated using the Merle d’Aubigné and Postel score, Harris Hip Score (HHS), and Forgotten Joint Score-12 (FJS-12). Kaplan–Meier analysis was used to estimate the 10-year implant survival with revision for any reason as the endpoint. The CT-based group achieved a significantly higher cup placement accuracy (100% within Lewinnek’s safe zone versus 49% in the manual group, p < 0.001). At the final follow-up, the CT-based group showed higher Merle d’Aubigné and Postel total score (16.8 vs. 16.1, p = 0.035) and HHS (90.3 vs. 85.0, p = 0.015), although the difference in HHS did not exceed the minimal clinically important difference. The FJS-12 scores did not differ significantly (71.1 vs. 62.2, p = 0.051). Ten-year survival rates were 98.2% in the CT-based group and 100% in the manual group (n.s.). CT-based navigation improved cup placement accuracy and produced modest improvements in some clinical scores; however, long-term implant survival and clinically meaningful benefits were not superior to those of manual THA.