Image-based navigation improves the positioning of the humeral component in total elbow arthroplasty

Hypothesis t 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°. als and methods tation 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. s tion significantly improved implant alignment accuracy (P < .001). Navigated implant alignment was 1.2 ± 0.3 mm in translation and 1.3° ± 0.3° in rotation for the intact scenario. For the bone loss scenario, navigated alignment error was 1.1 ± 0.5 mm and 2.0° ± 1.3°. Non-navigated alignment was 3.1 ± 1.3 mm and 5.0° ± 3.8° for the intact scenario and 3.0 ± 1.6 mm and 12.2° ± 3.3° for the bone loss scenario. sion 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. sions t 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.