Introduction: Femoral component alignment has been identified as one of the major contributors to weakening and ultimately failure of the proximal femur following hip resurfacing arthroplasty [1-5]. While a valgus component alignment is generally recommended, some believe a relative valgus orientation with respect to native neck-shaft angle is favourable [1,2], whereas others recommend an absolute component orientation of 140 degrees to achieve optimal clinical outcome [3-5]. Computer assisted surgery is fast becoming the superior method of clinical preparation in arthroplasty and, in particular, hip resurfacing. Imageless intraoperative navigation in hip resurfacing provides the surgeon increased precision in achieving accurate component stem-shaft alignment over previous mechanical methods. Not only is computer navigation critical for achieving improved clinical accuracy it is also important to mirror clinical methods in the laboratory setting. The purpose of our study was to investigate the effect of relative varus and valgus alignment of the femoral hip resurfacing component in both synthetic and cadaveric femurs prepared with imageless computer navigation to determine the optimal implant orientation in hip resurfacing arthroplasty.
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