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Terhune EB, Serino J, Hall DJ, Nam D, Della Valle CJ, Jacobs JJ, Pourzal R. Fretting and Tribocorrosion of Modular Dual Mobility Liners: Role of Design, Microstructure, and Malseating. J Arthroplasty 2024:S0883-5403(24)00368-1. [PMID: 38640966 DOI: 10.1016/j.arth.2024.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Modular dual mobility (DM) bearings have a junction between a cobalt chrome alloy (CoCrMo) liner and titanium shell, and the risk of tribocorrosion at this interface remains a concern. The purpose of this study was to determine whether liner malseating and liner designs are associated with taper tribocorrosion. METHODS We evaluated 28 retrieved modular DM implants with a mean in situ duration of 14.6 months (range, 1 to 83). There were two manufacturers included (12 and 16 liners, respectively). Liners were considered malseated if a distinct divergence between the liner and shell was present on postoperative radiographs. Tribocorrosion was analyzed qualitatively with the modified Goldberg Score (mGS) and quantitatively with an optical coordinate-measuring machine. An acetabular shell per manufacturer was sectioned for metallographic analysis. RESULTS There were six implants (22%) that had severe grade 4 corrosion, six (22%) had moderate grade 3, 11 (41%) had mild grade 2, and five (18.5%) had grade 1 or no visible corrosion. The average volumetric material loss at the taper was 0.086 ± 0.19 mm3. There were seven liners (25%) that had radiographic evidence of malseating, and all were of a single design (P = 0.01). The two liner designs were fundamentally different from one another with respect to the CoCrMo alloy type, taper surface finish, and shape deviations. Malseating was an independent risk factor for increased volumetric material loss (P = 0.017). CONCLUSION Dual mobility tribocorrosion with quantifiable material loss occurred more commonly in malseated liners. Specific design characteristics may make liners more prone to malseating, and the interplay between seating mechanics, liner characteristics, and patient factors likely contributes to the shell/liner tribocorrosion environment.
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Affiliation(s)
- E Bailey Terhune
- Department of Orthopedic Surgery, Rush University Medical Center; Chicago, IL.
| | - Joseph Serino
- Department of Orthopedic Surgery, Rush University Medical Center; Chicago, IL
| | - Deborah J Hall
- Department of Orthopedic Surgery, Rush University Medical Center; Chicago, IL
| | - Denis Nam
- Department of Orthopedic Surgery, Rush University Medical Center; Chicago, IL
| | - Craig J Della Valle
- Department of Orthopedic Surgery, Rush University Medical Center; Chicago, IL
| | - Joshua J Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center; Chicago, IL
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center; Chicago, IL
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Sarpong NO, Rodriguez S, Kuyl EV, Lyman S, Della Valle AG, Vigdorchik JM, Rodriguez JA. Dislocation Following Anterior and Posterior Total Hip Arthroplasty in the Setting of Spinal Deformity and Stiffness: Evolving Trends Using a High-Risk Protocol at a Single Tertiary Center. J Arthroplasty 2024; 39:1019-1024.e1. [PMID: 37918487 DOI: 10.1016/j.arth.2023.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/16/2023] [Accepted: 10/21/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Patients who have spinal stiffness and deformity are at the highest risk for dislocation after total hip arthroplasty (THA). Previous reports of this cohort are limited to antero-lateral and postero-lateral (PL) approaches. We investigated the dislocation rate after direct anterior (DA) and PL approach THA with a contemporary high-risk protocol to optimize stability. METHODS We investigated patients undergoing THA who had preoperative biplanar imaging from January-December 2019. Patients were identified using radiographic criteria of spinal-stiffness (<10-degree change in sacral slope from standing to seated) and deformity (flatback deformity with >10-degree difference in pelvic incidence and lumbar lordosis). There were 367 patients identified (181 DA, 186 PL). The primary outcome was dislocation rate at 2-years postoperatively. Risk-factors for dislocation were evaluated using logistic regressions (significance level of 0.05). RESULTS There were 6 (1.6%) dislocations in the entire cohort, with low dislocation rates for both DA (0.6%) and PL-THA (2.7%). We observed increased utilization of dual mobility with larger outer head bearings (>38 mm) with PL-THA (34.4 versus 5.0%, P < .01) and conversely increased utilization of 32-mm femoral-heads with DA-THA (39.4 versus 7.0%, P < .001). Surgical approach (PL) was not a significant risk-factor for dislocation (odds ratio: 5.03, P = .15). Patients who had a history of lumbar-fusion had 8-times higher odds for dislocation (OR: 8.20, P = .020). CONCLUSIONS To the best of our knowledge, this is the largest series to date evaluating DA and PL-THA in the hip-spine 2B-group. Our results demonstrate lower dislocation rate than expected with either surgical approach using a high-risk protocol.
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Affiliation(s)
- Nana O Sarpong
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Samuel Rodriguez
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Emile-Victor Kuyl
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Stephen Lyman
- Department of Biostatistics, Hospital for Special Surgery, New York, New York
| | | | | | - Jose A Rodriguez
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
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Chen G, Wang CY, Ma Z, Yi HL, Bi NM, Zhu WJ, Han J, Lu SL, Zhang SS, Shen H, Zhang WH, Zhang P, Si Y. A prospective and consecutive study assessing short-term clinical and radiographic outcomes of Chinese domestically manufactured 3D printing trabecular titanium acetabular cup for primary total hip arthroplasty: evaluation of 236 cases. Front Surg 2024; 11:1279194. [PMID: 38601877 PMCID: PMC11004300 DOI: 10.3389/fsurg.2024.1279194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Purpose We prospectively evaluate the short-term clinical and radiographic outcomes of the only Chinese domestically produced trabecular titanium acetabular cup(3D ACT™ cup) in primary total hip arthroplasty (THA), aiming to provide evidence-based support for its clinical application. Methods A total of 236 patients, who underwent primary THA using 3D ACT™ cup in the Department of Joint Surgery at our hospital between January 2017 and June 2019, were included in this study. General patient data, imaging information, functional scores, and complications were collected to evaluate the early clinical efficacy. Results All patients were followed up for 33-52 months, with an average of (42.2 ± 9.2) months. At the last follow-up, the preoperative HHS score increased significantly from 43.7 ± 6.8 to 85.6 ± 9.3 points (P < 0.01). Similarly, the preoperative WOMAC scores showed significant improvement from 59.2 ± 5.8 to 13.1 ± 3.5 points (P < 0.01). 92.3% of the patients expressed satisfaction or high satisfaction with the clinical outcome. Furthermore, 87.7% of the acetabular cups were positioned within the Lewinnek safe zone, achieving successful reconstruction of the acetabular rotation center. The cup survival rate at the last follow-up was 100%. Conclusions The utilization of the only Chinese domestically manufactured 3D printing trabecular titanium acetabular cup in primary THA demonstrated favorable short-term clinical and radiographic outcomes. The acetabular cup exhibits excellent initial stability, high survival rate, and favorable osseointegration, leading to a significant enhancement in pain relief and functional improvement. In the future, larger sample sizes and multicenter prospective randomized controlled trials will be required to validate the long-term safety and effectiveness of this 3D ACT™ cup.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Yan Si
- Department of Geriatric Orthopedics, Sichuan Provincial Orthopedic Hospital, Chengdu, Sichuan, China
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Wang J, Zhao Z, Liang H, Niu J, Liu X, Wang H, Yang Y, Yan T, Guo W, Tang X. Clinical outcomes in patients with neurological disorders following periacetabular tumor removal and endoprosthetic reconstruction of the hemipelvis. Front Surg 2024; 11:1279179. [PMID: 38505408 PMCID: PMC10948498 DOI: 10.3389/fsurg.2024.1279179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/19/2024] [Indexed: 03/21/2024] Open
Abstract
Background Surgical treatment of musculoskeletal tumors in the periacetabular region present extremely difficult due to the complex anatomy and need for reconstruction. Orthopedic surgeons face more difficulties in patients with neurological conditions, which can cause increased muscle tone, an elevated risk of fractures, and compromised bone quality. There is limited evidence regarding endoprosthetic reconstruction for periacetabular tumors in individuals with neurological disorders. Methods We conducted a single-center retrospective study to examine the outcomes of patients with preexisting neurological conditions who underwent surgery to remove periacetabular tumors and who underwent endoprosthesis reconstruction. Clinical presentation, detailed neurological conditions, complications, and functional outcomes were studied. Results Sixteen out of the 838 patients were identified (1.91%), with a mean follow-up time of 33 months. The primary neurological conditions encompassed Parkinson's disease, Alzheimer's disease, dementia, and cerebral ischemic stroke. Every patient was diagnosed with periacetabular lesions that were either primary or oligometastatic. They underwent tumor resection and subsequently received endoprosthetic reconstruction of the hemipelvis. Three patients developed metastasis lesions later, and two patients experienced tumor recurrence. Five cases experienced hip dislocation-one with periprosthetic fracture and one with surgical site infection. The position of the prosthetic rotating center was not correlated with dislocation. The reoperation rate was 31.25%. The cohort of patients all presented with more extended hospital stays and rehabilitation. In 3 patients, the general functional score was good, while in 6 patients, it was fair; in 7 patients, it was regarded as poor. The average MSTS93 score was 49.71%. Conclusion Endoprosthetic reconstruction after periacetabular tumor resection is an effective way to eliminate tumors and salvage limbs. However, this group of patients has an increased likelihood of secondary surgery, complications, extended hospital stay, and no significant improvement in functional outcomes. Despite the diverse nature of the cohort, it is recommended to consider enhanced soft tissue reconstruction, supervised functional recovery and rehabilitation training.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Xiaodong Tang
- The Musculoskeletal Tumor Center, Peking University People’s Hospital, Xicheng District, Beijing, China
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Hubert J, Ritter J, Krüger L, Simon A, Beil FT, Jandl NM, Rolvien T. Are Synovial Inflammatory Markers Increased in Patients Who Have Aseptic Total Hip Arthroplasty Dislocation Indicated for Revision? J Arthroplasty 2024; 39:787-794.e1. [PMID: 37611677 DOI: 10.1016/j.arth.2023.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Previous studies have speculated on elevated synovial inflammatory markers in patients undergoing surgical revision for total hip arthroplasty (THA) dislocation. However, this assumption is based on small patient series and a full investigation according to International Consensus Meeting (ICM) criteria has not yet been performed. METHODS Patients who had aseptic THA dislocation indicated for revision surgery were identified retrospectively. Only patients who had available diagnostic workup according to ICM 2018 criteria, including preoperative and intraoperative parameters, were included. For comparison, we analyzed a matched cohort of patients indicated for aseptic THA revision for other conditions. The 2 cohorts each consisted of 55 patients and were not different regarding age, sex, BMI, or implant fixation. RESULTS There was no difference in synovial white blood cell count (2,238 ± 2,544 versus 2,533 ± 3,448 c/μL; P = .601), alpha-defensin quotient (0.14 ± 0.11 versus 0.19 ± 0.28; P = .207), or polymorphonuclear neutrophil percentage (% PMN) (36.7 ± 22.6 versus 31.3 ± 24.5%; P = .312) between the groups. In the dislocation cohort, 20% of patients had a synovial white blood cell count of 3,000 c/μL or higher, compared with 18% in the control cohort. However, all patients in the dislocation cohort were below the cutoff for alpha-defensin or % PMN. CONCLUSION In patients who have aseptic THA dislocation, synovial inflammatory markers are not elevated compared with patients undergoing aseptic revision for other complications. A detailed preoperative analysis of synovial inflammatory markers using ICM criteria appears critical in patients who have a THA dislocation to exclude periprosthetic joint infection. LEVEL OF EVIDENCE Level III, retrospective, comparative study.
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Affiliation(s)
- Jan Hubert
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jacob Ritter
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lara Krüger
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Simon
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Timo Beil
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nico Maximilian Jandl
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Rolvien
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Palit A, Williams MA, Kiraci E, Seemala V, Gupta V, Pierrepont J, Plaskos C, King R. Evaluating computed bony range of motion (BROM) by registering in-vitro cadaver-based functional range of motion (FROM) to a hip motion simulation. Comput Biol Med 2024; 169:107799. [PMID: 38104517 DOI: 10.1016/j.compbiomed.2023.107799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/09/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND While modern hip replacement planning relies on hip motion simulation (HMS), it lacks the capability to include soft-tissues and ligaments restraints on computed bony range of motion (BROM), often leading to an overestimation of the in-vivo functional range of motion (FROM). Furthermore, there is a lack of literature on BROM assessment in relation to FROM. Therefore, the study aimed to assess computed BROM using in-vitro cadaver-derived FROM measurements, registered to a CT-based in-house HMS, and to further investigate the effect of functional and anatomical hip joint centres (FHJC and AHJC) on BROM. METHOD Seven limiting and three non-limiting circumducted passive FROM of four cadaver hips were measured using optical coordinate measuring machine with reference spheres (RSs) affixed to the pelvis and the femur, following CT-scan of the specimen. The RSs' centres were used to register the measured FROM in HMS, enabling its virtual recreation to compute corresponding BROM by detecting nearest bony impingement. FHJC, estimated from non-limiting FROM, was compared with AHJC to examine their positional differences and effect on BROM. RESULTS Differences in BROM and FROM were minimal in deep flexion (3.0° ± 4.1°) and maximum internal rotation (IR) at deep flexion (3.0° ± 2.9°), but substantially greater in extension (53.2° ± 9.5°). Bony impingement was observed during flexion, and IR at deep flexion for two hips. The average positional difference between FHJC and AHJC was 3.1 ± 1.2 mm, resulting in BROM differences of 1°-13° across four motions. CONCLUSIONS The study provided greater insight into the applicability and reliability of computed BROM in pre-surgical planning.
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Affiliation(s)
- Arnab Palit
- WMG, The University of Warwick, Coventry, UK.
| | | | | | | | - Vatsal Gupta
- Department of Trauma & Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jim Pierrepont
- Corin Ltd, Corinium Centre, Cirencester, Gloucestershire, GL7 1YJ, UK
| | | | - Richard King
- Department of Trauma & Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Kahn TL, Rainey JP, Frandsen JJ, Blackburn BE, Anderson LA, Gililland JM, Pelt CE. The Empty Ischial Fossa Sign: A Visual Representation of Relative Inadequate Anteversion in the Posteriorly Tilted Pelvis. Arthroplast Today 2024; 25:101309. [PMID: 38235398 PMCID: PMC10792180 DOI: 10.1016/j.artd.2023.101309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/27/2023] [Accepted: 11/26/2023] [Indexed: 01/19/2024] Open
Abstract
Background Instability is a known complication following total hip arthroplasty (THA) and is influenced by spinopelvic alignment. Radiographic markers have been investigated to optimize the acetabular cup position. This study evaluated if the empty ischial fossa (EIF) sign and the position of the trans-teardrop line were predictive of postoperative instability. Methods All patients who underwent THA from 2011 to 2018 at a single institution were retrospectively reviewed. Pelvic tilt was measured using a trans-teardrop line compared to the superior aspect of the pubic symphysis on standing anteroposterior pelvis radiographs. Postoperative dislocations were identified through chart review and radiographic review. The EIF sign was determined by the presence of uncovered bone below the posterior inferior edge of the acetabular component at the level of the native ischium and posterior wall on standing postoperative anteroposterior radiographs. Results One thousand seven hundred fifty patients (952 anterior approach and 798 posterior approach) were included. The EIF sign was present in 458 patients (26.2%) and associated with an increased dislocation rate (3.9% vs 0.9%, P < .0001). Patients with spondylosis/instrumented fusion, and positive EIF sign had a dislocation risk of 5.1% vs 1.3% (P = .001). A postoperative outlet pelvis was not significant for increased dislocation risk (odds ratio 2.16, P = .058). Patients with combined spondylosis/fusion, posterior approach, outlet pelvis, and EIF sign had a dislocation rate of 14.5%. Conclusions The EIF sign was an independent risk factor for postoperative instability and may represent failure to account for pelvic tilt. Avoidance of the EIF sign during cup positioning may help reduce dislocations following THA.
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Affiliation(s)
| | - Joshua P. Rainey
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | | | | | - Lucas A. Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
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Yao Y, Chai S, Qiao L, Jiang Q, Xu R. An analysis of the prevalence and risk factors of deep vein thrombosis in non-fracture patients awaiting total hip arthroplasty: a retrospective study of 1244 cases. J Orthop Surg Res 2024; 19:84. [PMID: 38254120 PMCID: PMC10801973 DOI: 10.1186/s13018-023-04488-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/17/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Deep vein thrombosis (DVT) has been one of the most dangerous complications in total hip arthroplasty (THA). If a patient's pre-surgical DVT is overlooked, it can easily be mistaken for a post-operative thrombus and lead to an increased risk of DVT during and after surgery. This retrospective study was to explore the incidence and associated risk factors of deep vein thrombosis (DVT) in non-fracture patients before total hip arthroplasty (THA). METHODS From September 2015 to September 2020, 1242 patients admitted for THA were enrolled with 1120 patients (90.2%) for primary THA and 122 patients (9.8%) for revision THA. An experienced sonographer performed a bedside ultrasound to detect DVT in bilateral lower limbs preoperatively. Univariate and logistic regression analysis was performed to identify the independent risk factors. RESULTS 38 patients (3.1%) were detected with preoperative DVT. Univariate analysis showed that age (P < 0.001), D-dimer level (P = 0.002), female patients (P = 0.016), revision THA (P < 0.001), Barthel Index score (P = 0.010) were significantly associated with preoperative DVT. In subgroup comparison, the incidence of DVT increased with age significantly (P < 0.001) and D-dimer level (P < 0.001). In logistic regression analysis, age ≥ 75 years old (odds ratio [OR] 3.678, 95% CI [2.197-18.721], P < 0.001), gender (OR 2.709, 95% CI [1.244-5.896], P = 0.012), higher D-dimer ≥ 0.5 mg/l (OR 6.841, 95% CI [2.197-18.721], P < 0.001) and revision THA (OR 2.240, 95% CI [1.143-5.372], P = 0.05) were confirmed as the independent risk factors. CONCLUSIONS The incidence of preoperative DVT in non-fracture patients was 3.1%, with 2.4% in primary THA and 9.0% in revision THA. Age ≥ 75 years old, female, D-dimer ≥ 0.5 mg/l, and revision THA were independent risk factors. When evaluating the risk factors associated with thrombus formation preoperatively, it is important to take these into account before surgery.
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Affiliation(s)
- Yao Yao
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, People's Republic of China
| | - Senlin Chai
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, People's Republic of China
| | - Liang Qiao
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, People's Republic of China
- Department of Orthopedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, Jiangsu, People's Republic of China
| | - Qing Jiang
- State Key Laboratory of Pharmaceutical Biotechnology, Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.
- Branch of National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Nanjing, People's Republic of China.
| | - Rong Xu
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, People's Republic of China.
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Lu X, Zhang Z, Xu H, Wang W, Zhang H. A new designed full process coverage robot-assisted total hip arthroplasty: a multicenter randomized clinical trial. Int J Surg 2024; 110:01279778-990000000-01000. [PMID: 38241325 PMCID: PMC11020098 DOI: 10.1097/js9.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVE To compare the effect of a new complete robot-assisted total hip arthroplasty (RA-THA) with that of the manual total hip arthroplasty (MTHA) and to verify the accuracy and safety of the former. METHODS Overall, 148 patients were enrolled from March 3, 2021 to December 28, 2021 in this study and classified into RA-THA (n=74 patients) and MTHA (n=74 patients) groups. The sex, age, operative side, body mass index (BMI), diagnosis, other basic information, operative time, acetabular prosthesis anteversion and inclination, femoral prosthesis anteversion and angulation, femoral prosthesis filling rate, leg length discrepancy (LLD), Harris hip score, and visual analog scale (VAS) score of the two groups were compared. RESULTS No significant differences were observed in the two groups regarding sex, age, operative side, BMI, diagnosis, Harris hip score, VAS score, acetabular inclination, acetabular prosthesis anteversion, femoral prosthesis anteversion, combined anteversion, and femoral prosthesis filling rate (P>0.05). The operative time was significantly longer in the RA-THA group than in the MTHA group (106.71±25.22 min vs. 79.42±16.16 min; t=7.30, P<0.05). The femoral angulation (1.78°±0.64°) and LLD (2.87±1.55 mm) in the RA-THA group were significantly lesser than those in the MTHA group (2.22°±1.11° and 5.81±6.27 mm, respectively; t=-2.95 and t=-3.88, P<0.05). CONCLUSION The complete RA-THA has some advantages over the traditional procedure in restoring the lower limb length and controlling the femoral prosthesis angulation. Thus, this study verifies the accuracy and safety of the robot-assisted system.
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Affiliation(s)
| | | | | | | | - Haining Zhang
- Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Krygowski J, Reicherzer L, Marcin T. Clinical reasoning for the continuation or discontinuation of hip precautions after total hip arthroplasty in Switzerland: a qualitative study. Swiss Med Wkly 2024; 154:3536. [PMID: 38579291 DOI: 10.57187/s.3536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Growing evidence raises doubts about the need for routine hip precautions after primary total hip replacements to reduce the risk of postoperative dislocation. However, hip precautions are still routinely and widely prescribed in postoperative care in Switzerland. We aimed to investigate experts' clinical reasoning for hip precaution recommendations after total hip arthroplasty. METHODS Using a convenience sampling strategy, 14 semi-structured expert interviews were conducted with surgeons, physiotherapists, and occupational therapists in the vicinity of an inpatient rehabilitation clinic in Switzerland. Data analysis followed Mayring's principle of inductive and deductive structuring content analysis. RESULTS Expert statements from the interviews were summarised into four main categories and 10 subcategories. Categories included statements on the incidences of dislocation and underlying risk factors; current preferences and use of hip precautions; their effect on physical function, anxiety, or costs; and patient's adherence to the movement restrictions. Hip surgeons routinely prescribed hip precautions, although in different variations. Fear of dislocation and caution are barriers to changing current practice. Some surgeons are considering individualised prescribing based on patients' risk of dislocation, which therapists would welcome. CONCLUSION A lack of clear instructions from the surgeon leads to ambiguity among therapists outside the acute hospital. A shared understanding of the need for and nature of hip precautions, guidelines from societies, or at least specific instructions from surgeons to therapists are warranted.
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Affiliation(s)
- Jaroslaw Krygowski
- Berner Reha Zentrum, Rehabilitation and Sports Medicine, Insel Group, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Physiotherapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Leah Reicherzer
- Institute of Physiotherapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Thimo Marcin
- Berner Reha Zentrum, Rehabilitation and Sports Medicine, Insel Group, Bern University Hospital, University of Bern, Bern, Switzerland
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Ben Salah S, Ben Abdellah A, Lachkar A, Yacoubi H, Abdeljaouad N. Bilateral Total Hip Prosthesis in Coxarthritis of Inflammatory Origin: Technical Features and Intraoperative Complications Encountered in Five Cases. Cureus 2024; 16:e52242. [PMID: 38352088 PMCID: PMC10862528 DOI: 10.7759/cureus.52242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
Total hip arthroplasty remains the treatment of last resort in inflammatory coxarthritis, where joint destruction is bilateral as well as the treatment which must be bilateral. We present in this work the experience of our orthopaedic department with a series of five cases (10 hips) operated for total hip arthroplasty. the first particularity observed in this series is the abnormal bone fragility present in 55% of the cases. For this reason, we had two other intraoperative complications that are related to this bone fragility, during the preparation of the acetabulum, we had a destruction of the medial wall by the burr that went unnoticed intraoperatively and was discovered during the patient's recovery from acute ischemia secondary to the burr, which led to an extensive rupture of the common femoral vein and partial sectioning of the common femoral artery. We also had an exceptional incident in a case with two ankylosed hips; in fact, when the approach was performed, the sciatic nerve was found pressed against the posterior surface of the greater trochanter, which was unusual but was explained by the retraction of the structures of the gluteal region secondary to prolonged immobilization. Thus, there was one case of cement shock manifested by hypotension occurring immediately after cement placement. In front of this inflammatory disease and ankylosis terrain, the surgeon must always be prepared for any complication and must keep in mind that he is operating on a hip that is anatomically not normal due to ankylosis and retraction of the vascular, nerve, and muscle structures.
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Affiliation(s)
- Samir Ben Salah
- Orthopedic Trauma Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohamed I University, Oujda, MAR
| | - Ayman Ben Abdellah
- Orthopedic Trauma Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohamed I University, Oujda, MAR
| | - Adnane Lachkar
- Orthopedic Trauma Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohamed I University, Oujda, MAR
| | - Hicham Yacoubi
- Orthopedic Trauma Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohamed I University, Oujda, MAR
| | - Najib Abdeljaouad
- Orthopedic Trauma Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohamed I University, Oujda, MAR
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Higa M, Tanino H, Ito H, Banks SA. Soft-tissue tension during total hip arthroplasty measured in four patients and predicted using a musculoskeletal model. J Exp Orthop 2023; 10:130. [PMID: 38051361 PMCID: PMC10697917 DOI: 10.1186/s40634-023-00689-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/29/2023] [Indexed: 12/07/2023] Open
Abstract
PURPOSE Soft-tissue tension around the hip joint is related to the incidence of dislocation after total hip arthroplasty (THA), but it remains difficult to quantify the soft-tissue tension during surgery. In this study, a three-dimensional force sensor-instrumented modular femoral head was developed and used to quantify soft-tissue tension during THA. The forces at the hip joint were also calculated using a three-dimensional musculoskeletal computer model to validate the measured forces. METHODS Soft-tissue tension was investigated by measuring the hip joint forces and directions during intraoperative trialing in four patients through passive range of motion (ROM) from 0° extension to 90° flexion. A musculoskeletal model with THA, which was scaled to one of four patients, was developed. The hip joint forces were calculated under the same motion. RESULTS Through the passive ROM, the magnitude of soft-tissue tension was greatest when the hip was extended, decreased with flexion to 34°, and progressively increased to flexion at 90°. The mediolateral force component was relatively constant, but the supero-inferior and anterior-posterior force components changed significantly. Within-individual variations were small during three repeated cycles of measurement, but magnitudes varied significantly among patients. Similar force patterns and magnitudes were calculated by the musculoskeletal model. CONCLUSIONS This study demonstrates that it is possible to quantify soft-tissue tension and direction during THA with an instrumented head. There was general agreement between the calculated and measured forces in both pattern and magnitude. Including additional subject-specific details would further enhance agreement between the model and measured hip forces.
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Affiliation(s)
- Masaru Higa
- Department of Mechanical Engineering, University of Hyogo, Shosha2167, HimejiHyogo, 671-2280, Japan.
| | - Hiromasa Tanino
- Department of Orthopaedic Surgery and Arthroplasty, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiroshi Ito
- Department of Orthopaedic Surgery and Arthroplasty, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Scott A Banks
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, FL, USA
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Aubert T, Galanzino G, Gerard P, Le Strat V, Rigoulot G, Lhotellier L. Accuracy of Preoperative 3D vs 2D Digital Templating for Cementless Total Hip Arthroplasty Using a Direct Anterior Approach. Arthroplast Today 2023; 24:101260. [PMID: 38023640 PMCID: PMC10652126 DOI: 10.1016/j.artd.2023.101260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/26/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background An important aspect of preoperative planning for total hip arthroplasty is templating. Although two-dimensional (2D) templating remains the gold standard, computerized tomography (CT)-based three-dimensional (3D) templating is a novel preoperative planning technique. This study aims to compare the accuracy of a 2D and 3D plan using an anterior approach for the placement of the same uncemented prosthesis. Methods Two consecutive cohorts of 100 patients each were retrospectively analyzed. We analyzed the accuracy of the size of the implant (stem, cup, head), the length of head, and offset. As a secondary criterion, we analyzed the rates of stems with more than 3° of varus, fracture, and/or subsidence at 3 months postoperatively. Results Within the exact size, the accuracy of the stem and cup size with the 2D plan was 69% and 56%, respectively. With the 3D plan accuracy being 88% (P = .0046) and 96% (P < .0001), respectively. Regarding size and length of the implant head, accuracy was 86% and 82% with the 2D plan and 100% (P < .0001) and 94% (P = .016), respectively, with the 3D plan. The offset of the implants increased beyond 3 mm in 23% of patients in the 2D group and in 5% of patients in the 3D group (P = .0003). The rate of varus stems was 10% in the 2D group and 2% in the 3D group (P = .03). Two fractures and one case of subsidence occurred in the 2D group. None were identified in the 3D cohort. Conclusions A CT-based 3D plan is more accurate for implant size selection, allows better prosthetic offset, and reduces the rate of varus stems.
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Affiliation(s)
- Thomas Aubert
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Giacomo Galanzino
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Philippe Gerard
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Vincent Le Strat
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Guillaume Rigoulot
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Luc Lhotellier
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
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Lu X, Zhang Z, Wang W, Xu H, Zhang H. Accuracy and safety of a new robotic arm for both femoral and acetabular side in total hip arthroplasty: a cadaveric study. J Orthop Surg Res 2023; 18:830. [PMID: 37924147 PMCID: PMC10625291 DOI: 10.1186/s13018-023-04263-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/04/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND To investigate the accuracy and safety of a newly constructed robotic arm which can cover the whole process of THA, we performed a series of robot-assisted total hip replacement on the cadaver. METHODS Fifteen frozen cadaveric specimens (30 hips) were used for this study. In this investigation, united hip system and Longwell robotic-assisted system were used. The entire lower limb was CT scanned prior to surgery. The 3D model was produced based on CT data; the site of the prosthesis, including acetabular anteversion, inclination angle, and the position of femoral prosthesis, was planned. With the assistance of a robotic arm, the surgeon changed the parameters based on the preoperative plan and the actual condition during surgery, and completed the whole procedure. Following surgery, we measured the acetabular anteversion angle, acetabular inclination angle, femur anteversion angle, combined anteversion angle, stem angulation, and canal fill ratio. RESULTS The parameters proved that the acetabular anteversion angle was 16.85 ± 3.00°, the acetabular inclination angle was 40.38 ± 5.37°, femur anteversion angle was 15.90 ± 9.01°, combined anteversion angle was 32.75 ± 9.03°, stem angulation was 1.84 ± 0.99°, and leg length discrepancy was 2.47 ± 1.43 mm. The canal fill ratio (CFR) of femoral prosthesis of osteotomy line in sagittal section is 99.72 ± 1.54% and in coronal section is 62.94 ± 8.91%; below osteotomy line 2.5 cm in sagittal section is 100.00% and in coronal section is 81.48 ± 12.94%; below osteotomy line 7.5 cm in sagittal section is 59.51 ± 12.94% and in coronal section is 89.79 ± 11.13%; femoral shaft isthmus in sagittal section is 56.41 ± 13.80% and in coronal section is 84.95 ± 15.17%. CONCLUSION The accuracy and safety of this novel robotic arm are suitable for preparing both the acetabular and femoral sides, providing evidence for clinical trial.
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Affiliation(s)
- Xinzhe Lu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266100, Shandong, China
| | - Zian Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266100, Shandong, China
| | - Wenzhe Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266100, Shandong, China
| | - Hao Xu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266100, Shandong, China
| | - Haining Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266100, Shandong, China.
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Feng T, Tang H, Zhang X, Zhang Y, Zhou Y, Jin Z. A novel algorithm to efficiently calculate the impingement-free range of motion of irregularly-shaped total hip arthroplasty components. J Orthop Res 2023; 41:2516-2529. [PMID: 37132499 DOI: 10.1002/jor.25585] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 04/18/2023] [Accepted: 05/01/2023] [Indexed: 05/04/2023]
Abstract
There is great difficulty in quickly calculating the impingement-free range of motion (IFROM) of hip components with complex shapes after total hip arthroplasty. We have established a new algorithm to investigate the effect of different shapes of hip components on the IFROM and impingement-free safe zone (IFSZ). Then find the best combination of hip prosthesis and the optimal mounting position of the elevated-rim liner under different radiographic anteversion (RA) and radiographic inclination (RI) of the cup. We found the larger the opening angle of the beveled-rim liner and the smaller the cross-sectional area of the stem neck with an inverted teardrop cross-sectional shape, the greater the IFROM of the hip component. The beveled-rim liner in combination with the stem neck with an inverted teardrop-shaped cross-section could provide the greatest IFSZ (excluding the flat-rim liner). The optimal orientation of the elevated-rim liner was the posterior-inferior side (RI ≤ 37°), posterior-superior side (RI ≥ 45°), and posterior side (37° ≤ RI ≤ 45°). Our novel algorithm provides a solution to analyze the IFROM of any hip prosthesis with any complex shape. The shape and size of the cross-section of the stem neck, the orientation of the elevated rim, and the shape and opening angle of the liner are all critical factors for the quantitative calculation of the IFROM and mounting safe zone of the prosthesis. Stem necks with inverted teardrop cross-section and beveled-rim liner improved the IFSZ. The optimal direction of the elevated rim is not constant but varies with RI and RA.
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Affiliation(s)
- Tao Feng
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Hao Tang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Xiaogang Zhang
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Yali Zhang
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Zhongmin Jin
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
- School of Mechanical Engineering, University of Leeds, Leeds, UK
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16
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Luu K, Nishioka ST, Lawton DRY, Unebasami E, Andrews SN, Nakasone CK. Influence of obesity and intra-operative imaging guidance technology on acetabular cup positioning in total hip arthroplasty. Arch Orthop Trauma Surg 2023; 143:6857-6863. [PMID: 37270739 DOI: 10.1007/s00402-023-04922-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Accuracy of acetabular cup positioning during total hip arthroplasty (THA) can be improved with intra-operative imaging but may be influenced by body mass index (BMI). This study assessed the influence of BMI (kg/m2) on cup accuracy when using intra-operative fluoroscopy (IF) alone or supplemented with a commercial product. METHODS This retrospective review included four consecutive cohorts of patients having undergone anterior approach THA with IF alone (2011-2015), IF and Overlay (2015-2016) (Radlink Inc., Los Angeles, CA), IF and Grid (2017-2018) (HipGrid Drone™, OrthoGrid Systems Inc., Salt Lake City, UT) and IF and Digital (2018-2020) (OrthoGrid Phantom®, OrthoGrid Systems, Inc., Salt Lake City, UT). Component placement accuracy was measured on 6-week post-operative weight bearing radiographs and compared between four BMI patient groups (BMI ≤ 25, 25 < BMI ≤ 30, 30 < BMI ≤ 35, and 35 < BMI). Total fluoroscopy times were also recorded directly from the fluoroscopy unit. RESULTS Abduction angle significantly increased as BMI increased (p = 0.003) with IF alone but no difference was present in groups with guidance technology. Anteversion was significantly different between BMI groups for IF alone (p = 0.028) and Grid (p = 0.027) but was not different in Overlay (p = 0.107) or Digital (p = 0.210). Fluoroscopy time was significantly different between BMI categories for IF alone (p = 0.005) and Grid (p = 0.018) but was not different in Overlay (p = 0.444) or Digital (p = 0.170). CONCLUSION Morbid obesity (BMI > 35) increases risk for malpositioning of acetabular cups and increases surgical time with IF alone or the Grid. Additional IF guidance technology (Overlay or Digital) increased cup positioning accuracy without decreasing surgical efficiency.
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Affiliation(s)
- Kayti Luu
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Scott T Nishioka
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Dylan R Y Lawton
- John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Emily Unebasami
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96818, USA
| | - Samantha N Andrews
- Department of Surgery, University of Hawai'I, John A Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96818, USA
| | - Cass K Nakasone
- Department of Surgery, University of Hawai'I, John A Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA.
- Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96818, USA.
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Lee TS, Kwon HM, Park JY, Kim DK, Kang KT, Park KK. Could We Expect Postoperative Cup Anteversion after Total Hip Arthroplasty Using Postoperative Plain Anteroposterior and Lateral Radiograph? A Three-Dimensional Experimental Operation Study. J Clin Med 2023; 12:6664. [PMID: 37892802 PMCID: PMC10607240 DOI: 10.3390/jcm12206664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 09/29/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND A postoperative radiograph in total hip arthroplasty (THA) is usually obtained to evaluate the inclination and anteversion of the acetabular components. However, there is no gold-standard method for calculating the exact inclination and anteversion of the acetabular components on post-THA radiographs. We aimed to measure the actual anteversion of the acetabular component on postoperative radiographs by obtaining correlation data between the virtual and actual acetabular component positioning using virtual three-dimensional (3D) surgery. METHODS A total of 64 hip scans of 32 patients who underwent lower-extremity computed tomography (CT) were retrospectively reviewed. We reconstructed 3D models of the 64 hips using customized computer software (Mimics). Furthermore, to identify the safe zone of acetabular component position in THA, we performed virtual 3D surgery simulations for five anteversion (-10°, 0°, 10°, 20°, and 30°) and five inclination (20°, 30°, 40°, 50°, and 60°) types. We analyzed the acetabular anatomy using 3D models to measure the radiographic, anatomical, and operative anteversion (RA, AA, OA) and inclination (RI, AI, OI) angles. Additionally, we used the Woo-Morrey (WM) method to calculate the anteversion angle in the reconstructed cross-table lateral (CL) radiographs and determined the correlation between these measurements. RESULTS The safe zone of the acetabular component was visualized on post-THA CL radiographs using the WM method of anteversion measurement based on the different anteversions and inclinations of the acetabular component. The AA, RA, OA, OI, and WM differed significantly between males and females (p value < 0.05). As the anatomical inclination or anteversion increased, the WM anteversion measurements also increased. The radiographic anteversion measurement best matched the WM method of measurement, followed by anatomical and operative methods. CONCLUSIONS The actual anteversion of the acetabular component after THA can be measured on CL radiographs with the WM method using a 3D virtual program, with good reproducibility.
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Affiliation(s)
- Tae Sung Lee
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (T.S.L.); (H.M.K.); (J.Y.P.); (D.K.K.)
| | - Hyuck Min Kwon
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (T.S.L.); (H.M.K.); (J.Y.P.); (D.K.K.)
| | - Jun Young Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (T.S.L.); (H.M.K.); (J.Y.P.); (D.K.K.)
| | - Dong Ki Kim
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (T.S.L.); (H.M.K.); (J.Y.P.); (D.K.K.)
| | - Kyoung Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul 03722, Republic of Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (T.S.L.); (H.M.K.); (J.Y.P.); (D.K.K.)
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18
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Huang Z, Dong H, Ye C, Zou Z, Wan W. Clinical utilization of methylprednisolone in conjunction with tranexamic acid for accelerated rehabilitation in total hip arthroplasty. J Orthop Surg Res 2023; 18:747. [PMID: 37789429 PMCID: PMC10548678 DOI: 10.1186/s13018-023-04249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 09/28/2023] [Indexed: 10/05/2023] Open
Abstract
PURPOSE This study aimed to evaluate the efficacy and safety of combined methylprednisolone (MP) and tranexamic acid (TXA) in promoting accelerated rehabilitation following total hip arthroplasty (THA). We further investigated effective strategies for rapid rehabilitation post-THA. METHODS Conducted as a randomized controlled trial involving 80 patients, the study allocated subjects into two groups. The control group received saline and TXA, whereas the experimental group was administered with an additional dose of MP. Several clinical parameters, including markers of inflammation, pain, nausea, and coagulation factors, were meticulously assessed in both groups. RESULTS It was observed that the group receiving the MP + TXA treatment showcased significant reductions in postoperative levels of CRP and IL-6, as well as an alleviation in pain scores. Furthermore, this group demonstrated lower incidences of postoperative nausea and fatigue, facilitating enhanced hip joint mobility. Interestingly, this group did exhibit blood glucose fluctuations within the first 24 h postoperatively. However, there was no notable difference between the groups concerning transfusion rate, postoperative hospital stay duration, and coagulation profile, and no severe complications were reported. CONCLUSION The findings suggest that the combined administration of MP and TXA can appreciably enhance postoperative recovery, by reducing inflammatory markers, alleviating pain, reducing nausea and fatigue, and improving hip mobility, without leading to an increased risk of severe perioperative complications. This highlights the potential role of this combined therapy in facilitating improved postoperative patient experiences.
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Affiliation(s)
- Zuqi Huang
- Department of Traumatology and Orthopaedics, Hezhou People's Hospital, Guangxi Zhuang Autonomous Region, Hezhou, China
| | - Huazhang Dong
- Department of Traumatology and Orthopaedics, Hezhou People's Hospital, Guangxi Zhuang Autonomous Region, Hezhou, China
| | - Changping Ye
- Department of Traumatology and Orthopaedics, Hezhou People's Hospital, Guangxi Zhuang Autonomous Region, Hezhou, China
| | - Zhuan Zou
- Department of Traumatology and Orthopaedics, Hezhou People's Hospital, Guangxi Zhuang Autonomous Region, Hezhou, China
| | - Weiliang Wan
- Department of Traumatology and Orthopaedics, Hezhou People's Hospital, Guangxi Zhuang Autonomous Region, Hezhou, China.
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Pangaud C, Pioger C, Pauly V, Orleans V, Boyer L, Argenson JN, Ollivier M. Response to letter from Sheng Zhao, Yuanmin Zhang, Caining Wen. Orthop Traumatol Surg Res 2023; 109:103667. [PMID: 37506836 DOI: 10.1016/j.otsr.2023.103667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Corentin Pangaud
- Institute of Movement and Locomotion UMR 7287, Aix-Marseille université et CNRS, 270, boulevard Saint-Marguerite, 13009 Marseille, France; Public Hospital of Marseille, 80, rue Brochier, 13005 Marseille, France.
| | - Charles Pioger
- Public Hospital of Paris, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulles, 92100 Boulogne-Billancourt, France
| | - Vanessa Pauly
- Public Health Department, Public Hospital of Marseille, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France
| | - Veronica Orleans
- Public Health Department, Public Hospital of Marseille, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France
| | - Laurent Boyer
- Public Health Department, Public Hospital of Marseille, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France
| | - Jean-Noël Argenson
- Institute of Movement and Locomotion UMR 7287, Aix-Marseille université et CNRS, 270, boulevard Saint-Marguerite, 13009 Marseille, France; Public Hospital of Marseille, 80, rue Brochier, 13005 Marseille, France
| | - Matthieu Ollivier
- Institute of Movement and Locomotion UMR 7287, Aix-Marseille université et CNRS, 270, boulevard Saint-Marguerite, 13009 Marseille, France; Public Hospital of Marseille, 80, rue Brochier, 13005 Marseille, France
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20
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Rizk PA, Silverberg A, Deen J, Pulido L, Horodyski M, Gray C. Radiographic parameters of pelvic and proximal femoral morphology do not predict outcomes for direct anterior total hip arthroplasty. Injury 2023; 54:110968. [PMID: 37679210 DOI: 10.1016/j.injury.2023.110968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/24/2023] [Accepted: 07/30/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Radiographic predictors of outcomes associated with direct anterior approach (DAA) total hip arthroplasty (THA) are largely unknown. Anecdotally, some surgeons limit surgery to patients with low body mass index (BMI) or "favorable" bony morphology. Objective data on the impact of these factors is limited. We sought to determine radiographic and demographic predictors of outcomes after DAA arthroplasty. METHODS A consecutive series of patients undergoing unilateral, elective DAA THA, who had linked pre- and post-operative patient reported outcome scores, from January 1, 2017 to March 30, 2019 were included. Radiographic measurements, including proxies for pelvic overhang, femoral canal access, acetabular morphologic changes, and markers of disease severity, were performed on calibrated radiographs. Intra-observer consistency was also evaluated. Outcome measures included disease specific and general health patient-reported outcomes scores, while surgical difficulty was approximated by estimated blood loss and surgical time. Multivariate analyses were performed to determine statistically significant correlations. RESULTS 168 patients were included. Overall, patients experienced significant improvement in outcome scores (mean ∆ HOOS-JR 39.4, PROMIS-physical 12.3). There were two reoperations (1.2%), for recurrent dislocation. Female sex (p = 0.015) and increasing age (p == 0.019) were associated with shorter surgical times. No statistically significant correlations were found between the radiographic parameters and outcome measures. Intraclass correlation coefficients of the radiographic measurements were overall strong (0.73-1.0). CONCLUSION We demonstrated consistent results in this series of patients despite variation in bony morphology. Our findings suggest that DAA THA can be safely performed on a broader patient population.
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Affiliation(s)
- Paul A Rizk
- Department of Orthopaedics, University of Florida College of Medicine, 3450 Hull Road, PO Box 112727, Gainesville, FL 32611, United States.
| | - Arnold Silverberg
- Haywood Regional Medical Center, 262 Leroy George Drive, Clyde, NC 28721, United States
| | - Justin Deen
- Department of Orthopaedics, University of Florida College of Medicine, 3450 Hull Road, PO Box 112727, Gainesville, FL 32611, United States
| | - Luis Pulido
- Department of Orthopaedics, University of Florida College of Medicine, 3450 Hull Road, PO Box 112727, Gainesville, FL 32611, United States
| | - Marybeth Horodyski
- Department of Orthopaedics, University of Florida College of Medicine, 3450 Hull Road, PO Box 112727, Gainesville, FL 32611, United States
| | - Chancellor Gray
- Department of Orthopaedics, University of Florida College of Medicine, 3450 Hull Road, PO Box 112727, Gainesville, FL 32611, United States
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21
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Kim MJ, Moon SG, Kang JH, Lee DW. Usefulness of 3-Dimensional Computed Tomography Assessment of Femoral Tunnel after Anterior Cruciate Ligament Reconstruction. Medicina (Kaunas) 2023; 59:1716. [PMID: 37893436 PMCID: PMC10608529 DOI: 10.3390/medicina59101716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
Positioning of the femoral tunnel during anterior cruciate ligament (ACL) reconstruction is the most crucial factor for successful procedure. Owing to the inter-individual variability in the intra-articular anatomy, it can be challenging to obtain precise tunnel placement and ensure consistent results. Currently, the three-dimensional (3D) reconstruction of computed tomography (CT) scans is considered the best method for determining whether femoral tunnels are positioned correctly. Postoperative 3D-CT feedback can improve the accuracy of femoral tunnel placement. Precise tunnel formation obtained through feedback has a positive effect on graft maturation, graft failure, and clinical outcomes after surgery. However, even if femoral tunnel placement on 3D CT is appropriate, we should recognize that acute graft bending negatively affects surgical results. This review aimed to discuss the implementation of 3D-CT evaluation for predicting postoperative outcomes following ACL re-construction. Reviewing research that has performed 3D CT evaluations after ACL reconstruction can provide clinically significant evidence of the formation of ideal tunnels following anatomic ACL reconstruction.
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Affiliation(s)
- Min-Jeong Kim
- Department of Radiology, Incheon Sarang Hospital, Incheon 22135, Republic of Korea;
| | - Sung-Gyu Moon
- Department of Radiology, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea; (S.-G.M.); (J.-H.K.)
| | - Ji-Hee Kang
- Department of Radiology, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea; (S.-G.M.); (J.-H.K.)
| | - Dhong-Won Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
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22
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McMellen CJ, Sinkler MA, Calcei JG, Hobson TE, Karns MR, Voos JE. Management of Bone Loss and Tunnel Widening in Revision ACL Reconstruction. J Bone Joint Surg Am 2023; 105:1458-1471. [PMID: 37506198 DOI: 10.2106/jbjs.22.01321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
➤ Both mechanical and biological factors can contribute to bone loss and tunnel widening following primary anterior cruciate ligament (ACL) reconstruction.➤ Revision ACL surgery success is dependent on graft position, fixation, and biological incorporation.➤ Both 1-stage and 2-stage revision ACL reconstructions can be successful in correctly indicated patients.➤ Potential future solutions may involve the incorporation of biological agents to enhance revision ACL surgery, including the use of bone marrow aspirate concentrate, platelet-rich plasma, and bone morphogenetic protein-2.
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Affiliation(s)
- Christopher J McMellen
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Margaret A Sinkler
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jacob G Calcei
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- University Hospitals Drusinsky Sports Medicine Institute, Cleveland, Ohio
| | - Taylor E Hobson
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- University Hospitals Drusinsky Sports Medicine Institute, Cleveland, Ohio
| | - Michael R Karns
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- University Hospitals Drusinsky Sports Medicine Institute, Cleveland, Ohio
| | - James E Voos
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- University Hospitals Drusinsky Sports Medicine Institute, Cleveland, Ohio
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23
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Kakoulidis P, Panagiotidou S, Profitiliotis G, Papavasiliou K, Tsiridis E, Topalis C. Medial pivot design does not yield superior results compared to posterior-stabilised total knee arthroplasty: a systematic review and meta-analysis of randomised control trials. Knee Surg Sports Traumatol Arthrosc 2023; 31:3684-3700. [PMID: 36522493 DOI: 10.1007/s00167-022-07238-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/10/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The aim of this meta-analysis was a comparison between medial pivot (MP) and posterior-stabilised (PS) knee designs regarding functional and radiological outcomes as well as gait parameters. METHODS A systematic literature search was conducted in PubMed, Cochrane Library, Science Direct and Clinical Trials.gov from conception up to April 2022, to identify eligible randomised control trials (RCTs). The extracted data were analysed according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement. RESULTS Fifteen studies met inclusion criteria, enrolling 1101 patients who underwent 1242 total knee arthroplasties (TKAs). A total of 1158 TKAs (581 MP/577 PS) were included in the quantitative analysis. Mean follow-up ranged from 6 months up to 6.6 years. MP knees showed comparable range of motion (ROM) with PS design 1, 2 and 4 years postoperatively (p = 0.2, p = 0.25, p = 0.34, respectively). No statistical difference was found in patient-related outcome measures (PROMs) (p > 0.05). Mean walking speed (MWS), length of stay (LOS), radiographic alignment and complications rates were also similar between the two groups (p > 0.05). DISCUSSION The present meta-analysis demonstrated that the theoretical biomechanical advantage of MP implants does not have a better impact on patient satisfaction compared to the traditional PS knees. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Panagiotis Kakoulidis
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece.
| | - Sousana Panagiotidou
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece
| | | | - Kyriakos Papavasiliou
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.)-Center of Interdisciplinary Research and Innovation (C.I.R.I.)-Aristotle University Thessaloniki, Balkan Center, Buildings A and B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Christos Topalis
- School of Medicine, Aristotle University of Thessaloniki, Academic Orthopaedic Unit, Papageorgiou General Hospital, Thessaloniki Ring Road West, Nea Efkarpia, 56403, Thessaloniki, Greece
- Center of Orthopaedics and Regenerative Medicine (C.O.RE.)-Center of Interdisciplinary Research and Innovation (C.I.R.I.)-Aristotle University Thessaloniki, Balkan Center, Buildings A and B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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24
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Saunders P, Shaw D, Sidharthan S, Young SK, Board T. Hip offset and leg-length restoration in revision hip arthroplasty with a monoblock, hydroxyapatite-coated stem. Hip Int 2023; 33:880-888. [PMID: 35993222 DOI: 10.1177/11207000221117782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIMS Restoration of normal hip biomechanics in arthroplasty surgery is important in order to achieve good muscle function and joint stability. METHODS In this retrospective cohort study, we examined the postoperative radiographs of 131 femoral revision arthroplasty procedures using a monoblock, fully hydroxyapatite (HA)-coated titanium stem. Femoral offset, modified-global offset and leg length were measured of the operated and contralateral hips. RESULTS Femoral offset was restored to ±10 mm in 108 cases (82%), modified-global offset was restored ±10 mm in 93 cases (71%) and leg length was restored to ±10 mm in 102 cases (81%). There were 4 dislocations with a mean follow-up period of 38 months. CONCLUSIONS Restoration of hip biomechanics is achievable with a monoblock stem and thus is a viable option in revision hip arthroplasty.
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Affiliation(s)
- Paul Saunders
- Department of Orthopaedics, Warwick Hospital, Warwick, UK
| | - Debbie Shaw
- Wrightington Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
| | - Sijin Sidharthan
- Wrightington Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
| | | | - Tim Board
- Wrightington Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
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25
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van Erp JHJ, Hüsken MFT, Filipe MD, Snijders TE, Kruyt MC, de Gast A, Schlösser TPC. Did the dislocation risk after primary total hip arthroplasty decrease over time? A meta-analysis across six decades. Arch Orthop Trauma Surg 2023; 143:4491-4500. [PMID: 36357707 PMCID: PMC10293125 DOI: 10.1007/s00402-022-04678-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/26/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND While continuous optimization is attempted to decrease the incidence of dislocation after total hip arthroplasty (THA), dislocation remains a major complication. This meta-analysis aims to analyze the evolution of the dislocation risk after primary THA over the decades and to evaluate its potential publication bias. PATIENTS AND METHODS A systematic search was performed according to the PRISMA guidelines for this meta-analysis in the literature published between 1962 and 2020. MEDLINE, Cochrane and Embase databases were searched for studies reporting the dislocation risk and length of follow-up. Studies that reported on revision rates only and did not mention separate dislocations were excluded. All study designs were eligible. Study quality was assessed by existing quality assessment tools adjusted for arthroplasty research. Overall risk and yearly dislocation rates were calculated and related to historical time frame, study design, sample size and length of follow-up. RESULTS In total, 174 studies were included with an overall moderate quality. In total there were 85.209 dislocations reported in 5.030.293 THAs, showing an overall dislocation risk of 1.7%, with a median follow-up of 24 months. The overall dislocation risk classified per decade decreased from 3.7% in 1960-1970 to 0.7% in 2010-2020. The yearly dislocation rate decreased from 1.8 to 0.7% within these same decades. There was no significant correlation between the reported dislocation risk and the duration of follow-up (p = 0.903) or sample size (p = 0.755). The reported dislocation risk was higher in articles with registry data compared to other study designs (p = 0.021). CONCLUSION The dislocation risk in THA has been decreasing over the past decades to 0.7%. Non-selective registry studies reported a higher dislocation risk compared to studies with selective cohorts and RCTs. This indicates that the actual dislocation risk is higher than often reported and 'real-world data' are reflected better in large-scale cohorts and registries.
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Affiliation(s)
- J H J van Erp
- Clinical Orthopedic Research Center-mN, Diakonessenhuis, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
- Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, The Netherlands.
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - M F T Hüsken
- Clinical Orthopedic Research Center-mN, Diakonessenhuis, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
- Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - M D Filipe
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T E Snijders
- Clinical Orthopedic Research Center-mN, Diakonessenhuis, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
- Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - M C Kruyt
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Developmental Bioengineering, Twente University, Enschede, The Netherlands
| | - A de Gast
- Clinical Orthopedic Research Center-mN, Diakonessenhuis, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
| | - T P C Schlösser
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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26
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Wang Z, Zhang J, Wang R, Chen Q, Tong P, Zhan H, Lv S. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review. Open Med (Wars) 2023; 18:20230731. [PMID: 37305521 PMCID: PMC10251161 DOI: 10.1515/med-2023-0731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/07/2023] [Accepted: 05/14/2023] [Indexed: 06/13/2023] Open
Abstract
Neuropathy in surgical-related locations has received concerns after total hip arthroplasty (THA), while the contralateral intercostal nerve (ICN) injury has not been reported. A 25-year-old female patient with a body mass index (BMI) of 17.9 kg/m2 visited the orthopedic outpatient clinic with complaints of progressive left hip pain for 20 days. She was diagnosed with left end-stage hip osteoarthritis and developmental dysplasia of the bilateral hips after radiographs and a detailed history-taking. After painstaking consideration, a cementless THA with the standard posterolateral approach was performed under general anesthesia. The procedure was difficult but successful. Unexpectedly, the numbness and slight tingling in the skin of the right breast, lateral chest wall, and axilla cropped up on the first postoperative day. Following the clinical features and the conclusion of the multidisciplinary discussion, we assume that ICN neuropathy is the diagnosis in this case due to compression of the lateral decubitus position during the operation. Her symptoms completely disappeared after using mecobalamin injection (0.5 mg, intramuscular injection, every other day) for 11 days. The Harris left hip score improved from 39 to 94, and the visual analogue scale from 7 was reduced to 2 on the day of discharge. There were no other complications within the first year after the operation. For THA, we should pay attention to some unexpected complications by virtue of the special position, especially in thin and low-BMI people, which suggested that further comprehensive perioperative nursing measures and the beneficial surgical position and anesthesia type were called for.
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Affiliation(s)
- Zhengming Wang
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, 310006, China
| | - Jingjing Zhang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, 310006, China
| | - Rui Wang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, 310006, China
| | - Quanquan Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, 310006, China
| | - Peijian Tong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Zhejiang, 310006, China
| | - Hongsheng Zhan
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuaijie Lv
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Hangzhou, Zhejiang, 310006, China
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27
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Lu H, Zhu N, Ling T, Cao J, Xu H, Zhou K, Zhao E, Zhou Z. Total hip arthroplasty for failed internal fixation of femoral neck fracture: a retrospective study with 2-14 years' follow-up of 345 patients. J Orthop Surg Res 2023; 18:341. [PMID: 37161494 PMCID: PMC10169472 DOI: 10.1186/s13018-023-03827-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/04/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVES The purpose of this study was to analyze mid- to long-term outcomes of total hip arthroplasty (THA) following failed internal fixation of femoral neck fracture. METHODS This study retrospectively analyzed 345 patients with femoral neck fracture who underwent THA after failure of internal fixation at our hospital between January, 2003 and December, 2019. Patients older than 55 years (n = 175) and patients no older than 55 years (n = 170) were compared in terms of complications and survival rates during follow-up, which lasted a mean of 6 years. RESULTS The two age groups showed similarly low incidence of complications and similarly long periods of survival without revision surgery. Only three younger patients and two older patients underwent revision surgery during follow-up. The two groups showed similarly high survival rates at the end of follow-up (> 93%). Younger patients showed significantly bettter Harris hip score at last follow-up (90.2 vs. 88.1 points, p < 0.001) without clinically significant difference, but they required THA significantly earlier after internal fixation (4.4 vs. 6.8 years, p < 0.001). CONCLUSIONS THA after failed internal fixation of femoral neck fracture is a well tolerated and effective procedure in older and younger patients.
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Affiliation(s)
- Hanpeng Lu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Niu Zhu
- Precision Medicine Center, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Tingxian Ling
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jian Cao
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Xu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Kai Zhou
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Enze Zhao
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zongke Zhou
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China.
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28
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Sirignano M, Nessler JM, Rhea EB, Ong KL, Watson H, Yakkanti MR, Malkani AL. "Incidence of Instability Following Primary Total Hip Arthroplasty Continues to Decline in the Medicare Population". J Arthroplasty 2023:S0883-5403(23)00391-1. [PMID: 37088227 DOI: 10.1016/j.arth.2023.04.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Instability has been the primary cause of failure following primary total hip arthroplasty (THA) leading to revision hip surgery. The purpose of this study was to determine if instability rates have further declined following advances in primary THA including dual mobility articulations, direct anterior approaches, advanced technologies, and improved knowledge of the hip-spine relationships. METHODS Using the 5% Medicare Part B claims data from 1999 to 2019, we identified 81,573 patients who underwent primary THA for osteoarthritis. Patients who experienced instability at 3 months, 6 months, 1 year, and 2 years were identified. Multivariate cox regression analyses evaluated the effect of patient and procedure characteristics on the risk for instability. RESULTS Instability at 1 year following primary THA declined from approximately 4% in 2000 to 2.3% in 2010 and 1.6% in 2018. The leading cause of revision surgery was infection (18.6%), followed by peri-prosthetic fracture (14%), mechanical loosening (11.5%), and instability (9.4%). High risk groups for instability continue to include increased age, higher Charlson index, obesity, lumbar spine pathology, and neurocognitive disorders. CONCLUSION Instability is no longer the leading etiology of failure following primary THA with a decline of approximately 40% over the past decade. Infection, periprosthetic fracture, mechanical loosening, and then instability are now the leading causes of failure. Multiple factors may play a role in the decline of instability including increased use of dual mobility articulations, direct anterior approaches, improved knowledge of the hip-spine relationships, and use of advanced technologies.
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Affiliation(s)
- Michael Sirignano
- University of Louisville, Dept. of Orthopaedic Surgery, 550 South Jackson Street, Louisville, KY 40202, USA
| | - Joseph M Nessler
- University of Louisville, Dept. of Orthopaedic Surgery, 550 South Jackson Street, Louisville, KY 40202, USA
| | - Evan B Rhea
- University of Louisville, Dept. of Orthopaedic Surgery, 550 South Jackson Street, Louisville, KY 40202, USA
| | - Kevin L Ong
- Exponent Inc., 3440 Market Street, Suite 600, Philadelphia, PA 19104, USA
| | - Heather Watson
- Exponent Inc., 15375 SE 30th Place, Suite 250, Bellevue, WA 98007, USA
| | | | - Arthur L Malkani
- University of Louisville, Dept. of Orthopedic Surgery, Adult Reconstruction Program, 550 South Jackson Street, Louisville, KY 40202, USA.
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29
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Maniar A, Kazarian GS, Torres-Ramirez RJ, Ranawat A. Short term outcomes (average follow up of 2.4 years) of a constrained acetabular liner in primary and revision total hip arthroplasty. J Arthroplasty 2023:S0883-5403(23)00342-X. [PMID: 37028773 DOI: 10.1016/j.arth.2023.03.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND As instability continues to be a burden post total hip arthroplasty (THA), there has been a controversial discussion on the ideal implant choice. We report here the outcomes of a modern constrained acetabular liner (CAL) system in primary and revision THA at an average follow up of 2.4 years. METHODS We performed a retrospective study of all patients undergoing primary and revision hip arthroplasty and being implanted with the modern CAL system from 2013 to 2021. We identified 31 hips, of which 13 underwent primary THA and the remaining 18 underwent revision THA for instability. RESULTS Of those implanted with CAL primarily, 3 had concomitant abductor tear repair and gluteus maximus transfer, 5 had Parkinson's disease, 2 had inclusion body myositis, 1 had amyotrophic lateral sclerosis, and the remaining 2 were above 94 years of age. All patients implanted with the CAL were as a result of active instability post-primary THA and underwent only liner and head exchange without revision of the acetabular or femoral components. At an average follow up of 2.4 years (range, 9 months to 5 years and 4 months), we had 1 case (3.2 %) of dislocation post-CAL implantation. None of the patients undergoing surgery with CAL for active instability had a re-dislocation. CONCLUSION In conclusion, a constrained acetabular liner provides excellent stability in both primary THA in high risk individuals and revision THA in cases of active instability. There were no dislocations when using a constrained acetabular liner to treat active instability post THA.
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Affiliation(s)
- Adit Maniar
- Fellow in Adult Reconstruction and Total Joint Replacement, Ranawat Orthopaedic Research Foundation, 535 E 70th St, New York, NY 10021, USA.
| | - Gregory S Kazarian
- Resident (PGY-3), Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Ricardo J Torres-Ramirez
- Research Coordinator for Adult Reconstruction and Joint replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Amar Ranawat
- Professor of Clinical Orthopaedic Surgery, Weill Cornell Medical College, Attending Surgeon, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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30
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Risitano S, Cacciola G, Capella M, Bosco F, Giustra F, Fusini F, Indelli PF, Massé A, Sabatini L. Comparison between gaits after a medial pivot and posterior stabilized primary total knee arthroplasty: a systematic review of the literature. Arthroplasty 2023; 5:15. [PMID: 36927464 PMCID: PMC10022170 DOI: 10.1186/s42836-023-00165-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/16/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is one of the most performed orthopedic procedures worldwide. While excellent efficacy has been reported, about 20% of patients are not satisfied with the result. A potential cause is the problematic reproduction of knee kinematics. This systematic review examines gait analysis studies in primary medial pivot (MP) and posterior stabilized (PS) TKAs to investigate the differences between the two prosthesis designs. METHODS A systematic review was conducted by following PRISMA guidelines. Five databases (PubMed, Medline, Embase, Scopus and the Cochrane Database of Systematic Reviews) were analyzed, and eligible articles were evaluated in terms of the levels of evidence. The methodological quality of the articles was assessed by using the MINORS scoring. This review was registered in PROSPERO. RESULTS Nine studies were included. Gait analysis was performed in 197 MP TKA and 192 PS TKA patients. PS TKA cases showed (P < 0.05) a significantly higher peak of knee flexion angle during the swing phase, greater knee flexion angle at toe-off, an increased knee adduction angle, higher knee flexion and extension moment, increased anterior femoral roll during knee flexion and anterior translation on medial and lateral condyle during knee flexion compared to MP TKA. MP TKA showed statistically significant (P < 0.05) higher knee rotational moment and greater tibiofemoral external rotation motion during knee flexion than PS TKA. No statistically significant difference (P > 0.05) was reported regarding gait spatial-temporal parameters. The Forgotten Joint Score (FJS) and Western Ontario and McMaster Universities Comparison in terms of Arthritis Index (WOMAC) score (mean stiffness) showed that MP TKA yielded significantly better results than PS TKA. CONCLUSIONS This systematic review revealed significant kinematic and kinetic differences between MP and PS TKA at all gait analysis phases. Furthermore, the considerable difference between TKA design and the kinematics of healthy knee were highlighted in this study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Salvatore Risitano
- Department of Orthopaedic Surgery and Traumatology, University of Turin, 10126, Turin, Italy. .,Department of Orthopaedic Surgery and Traumatology, CTO Hospital of Turin, Città Della Salute E Della Scienza, 10126, Turin, Italy.
| | - Giorgio Cacciola
- Department of Orthopaedic Surgery and Traumatology, University of Turin, 10126, Turin, Italy
| | - Marcello Capella
- Department of Orthopaedic Surgery and Traumatology, University of Turin, 10126, Turin, Italy.,Department of Orthopaedic Surgery and Traumatology, CTO Hospital of Turin, Città Della Salute E Della Scienza, 10126, Turin, Italy
| | - Francesco Bosco
- Department of Orthopaedic Surgery and Traumatology, University of Turin, 10126, Turin, Italy.,Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco-ASL Città di Torino, Piazza del Donatore Di Sangue, 3, 10154, Turin, Italy
| | - Fortunato Giustra
- Department of Orthopaedic Surgery and Traumatology, University of Turin, 10126, Turin, Italy.,Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco-ASL Città di Torino, Piazza del Donatore Di Sangue, 3, 10154, Turin, Italy
| | - Federico Fusini
- Department of Orthopaedic Surgery, Regina Montis Regalis Hospital, 12084, MondovìCuneo, Italy
| | - Pier Francesco Indelli
- Department of Orthopaedic Surgery and Bioengineering, Stanford University School of Medicine, Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, CA, 94304, USA
| | - Alessandro Massé
- Department of Orthopaedic Surgery and Traumatology, University of Turin, 10126, Turin, Italy.,Department of Orthopaedic Surgery and Traumatology, CTO Hospital of Turin, Città Della Salute E Della Scienza, 10126, Turin, Italy
| | - Luigi Sabatini
- Department of Orthopaedic Surgery and Traumatology, University of Turin, 10126, Turin, Italy.,Department of Orthopaedic Surgery and Traumatology, CTO Hospital of Turin, Città Della Salute E Della Scienza, 10126, Turin, Italy
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Funahashi H, Osawa Y, Seki T, Takegami Y, Nishida K, Imagama S. Pelvic morphologies of developmental dysplasia and primary osteoarthritis on range of motion after total hip arthroplasty. J Orthop Res 2023. [PMID: 36866827 DOI: 10.1002/jor.25544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/29/2023] [Accepted: 03/01/2023] [Indexed: 03/04/2023]
Abstract
Bony impingement, especially in the anterior inferior iliac spine (AIIS) after total hip arthroplasty (THA), may cause dislocation. However, the influence of AIIS characteristics on bony impingement after THA is not fully understood. Thus, we aimed to determine the morphological characteristics of AIIS with developmental dysplasia of the hip (DDH) and primary osteoarthritis (pOA) and to evaluate its effect on range of motion (ROM) after THA. Hips from 130 patients who underwent THA, including pOA were analyzed. In total, we had 27 male and 27 female participants with pOA, and 38 male and 38 female participants with DDH. The horizontal distances of AIIS from teardrop (TD) were compared. In the computed tomography simulation, flexion ROM was measured, and its relationship to the distance between TD and AIIS was investigated. DDH had a more medial (male: DDH, 36.9 ± 5.8; pOA, 45.5 ± 6.1; p < 0.001) (female: DDH, 31.5 ± 10.0; pOA, 36.2 ± 4.7; p < 0.001) position of AIIS than pOA. In the male with pOA group, flexion ROM was significantly smaller than that in the other groups, and there was a correlation between flexion ROM and horizontal distances (r = -0.543; 95% confidence interval = -0.765 to -0.206; p = 0.003). AIIS position is a factor that limits ROM during flexion after THA, particularly in males. Further studies are required to develop surgical strategies for cases of impingement at the AIIS site after THA. Level of evidence: Ш, retrospective comparative study.
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Affiliation(s)
- Hiroto Funahashi
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kazuki Nishida
- Department of Biostatistics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Staunton DM, Mohan R, Carter JR, Highcock AJ. Total knee replacement survivorship by Design Philosophy: are we ignoring medial pivot design? Analysis based on the UK National Joint Registry. Acta Orthop Belg 2023; 89:37-43. [PMID: 37294983 DOI: 10.52628/89.1.9913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The UK National Joint Registry(NJR) has not reported total knee replacement (TKR) survivorship based on design phi- losophy alone, unlike its international counterparts. We report outcomes of implant survivorship based on design phi- losophy using data from NJR's 2020 annual report. All TKR implants with an identifiable design philosophy from NJR data were included. Cumulative revision data for cruciate-retaining(CR), posterior stabilised(PS), mobile-bearing(MB) design philosophies was derived from merged NJR data. Cumulative revision data for individual brands of implants with the medial pivot (MP) philosophy were used to calculate overall survivorship for this design philosophy. The all-cause revision was used as the endpoint and calculated to 15 years follow-up with Kaplan-Meier curves. 1,144,384 TKRs were included. CR is the most popular design philosophy (67.4%), followed by PS(23.1%), MB (6.9%) and least commonly MP (2.6%). MP and CR implants showed the best survivorship (95.7% and 95.6% respectively) at 15 years which is statistically significant at, and beyond, 10 years. Observed survivorship was lower at all time points with the PS and MB implants (94.5% for both designs at 15 years). While all design philosophies considered in this study survive well, CR and MP designs offer statistically superior survivorship at and beyond 10 years. MP design performs better than CR beyond 13 years yet, remain the least popular design philosophy used. Publishing data based on knee arthroplasty design phi- losophy would help surgeons when making decisions on implant choice.
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Matsuki Y, Imagama T, Tokushige A, Yamazaki K, Sakai T. Accuracy of cup placement using computed tomography-based navigation system in total hip arthroplasty through the direct anterior approach. J Orthop Sci 2023; 28:370-375. [PMID: 34823976 DOI: 10.1016/j.jos.2021.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/23/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to elucidate the accuracy of cup placement with the computed tomography (CT)-based navigation system (CTN) in the direct anterior approach (DAA)-total hip arthroplasty (THA) in the supine position compared with the mechanical cup alignment guide (MG) or the fluoroscopy (FS). METHODS A total of 171 hips of 156 patients undergone primary THA were classified into the following three groups (the MG group: 63 hips, the FS group: 58 hips, the CTN group: 50 hips). Comparing the preoperative planning with postoperative CT measurement by three-dimensional templating software, the accuracy of cup placement was investigated in the three groups. RESULTS There were significant differences in the mean absolute error of radiographic inclination (RI) between the MG group (4.4° ± 3.2°) and the CTN group (2.8° ± 2.5°) (p = 0.01). The mean absolute error of radiographic anteversion (RA) also showed significant differences between the CTN group (2.8° ± 1.9°) and the MG group (5.8° ± 4.7°) (p = 0.0001) or the FS group (4.8° ± 4.1°) (p = 0.02). Regarding the cup center position, the mean absolute error of vertical position from preoperative planning was the smallest in the CTN group (1.8 ± 1.4 mm) compared with those in other groups (MG: 3.3 ± 3.2 mm, p = 0.007, FS: 3.2 ± 3.0 mm, p = 0.017). CONCLUSION The CTN guarantees accurate cup placement in the DAA-THA in the supine position compared with the MG and FS groups.
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Affiliation(s)
- Yuta Matsuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Takashi Imagama
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Atsunori Tokushige
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, 862-3 Ogori Shimogo, Yamaguchi City, Yamaguchi, 754-0002, Japan
| | - Kazuhiro Yamazaki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
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Lin L, Wang HJ, Wang YJ, Wang J, Chen YR, Yu JK. Comparison of the Clinical Outcomes of Revision and Primary ACL Reconstruction: A Matched-Pair Analysis With 3-5 Years of Follow-up. Am J Sports Med 2023; 51:634-641. [PMID: 36734479 DOI: 10.1177/03635465221148746] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There are limited studies designed by matching related factors to compare clinical outcomes and return to sport (RTS) between patients undergoing revision anterior cruciate ligament reconstruction (R-ACLR) and primary ACLR (P-ACLR). PURPOSE (1) To compare the outcomes between R-ACLR and P-ACLR in a matched-pair analysis with 3- to 5-year follow-up and (2) to evaluate patient-reported factors for not returning to preinjury-level sport. STUDY DESIGN Cohort study; Level of evidence, 4. METHODS Patients who underwent R-ACLR between September 2016 and November 2018 were propensity matched by age, sex, body mass index, passive anterior tibial subluxation, and generalized hypermobility in a 1:1 ratio to patients who underwent P-ACLR during the same period. By combining in person follow-up at 2 years postoperatively and telemedicine interview at the final follow-up (January 2022), knee stability and clinical scores were compared, including International Knee Documentation Committee (IKDC), Lysholm, and Tegner. Status of RTS was requested, specifically whether the patient returned to preinjury level of sport. Patient-reported reasons for not returning were analyzed. RESULTS There were 63 matched pairs in the present study. Knee stability was similar in terms of KT-2000 arthrometer, Lachman test, and pivot-shift test results between the groups at 2 years of follow-up. At the final follow-up, no significant difference was found between groups for postoperative clinical scores (IKDC, Tegner, and Lysholm) (P > .05). There was a significant difference in total RTS: 53 (84.1%) in the P-ACLR cohort and 41 (65.1%) in the R-ACLR cohort (P = .014). No significant difference was shown in terms of RTS at the same level: 35 (55.6%) in P-ACLR and 31 (49.2%) in R-ACLR (P = .476). Significantly more patients showed fear of reinjury: 26 of 32 (81.3%) in the R-ACLR group as compared with 15 of 28 (53.5%) in the P-ACLR group (P < .021). CONCLUSION R-ACLR resulted in similar clinical scores (IKDC, Tegner, and Lysholm) but significantly lower RTS versus P-ACLR at 3 to 5 years of follow-up. Fear of reinjury was the most common factor that caused sport changes in patients with R-ACLR.
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Affiliation(s)
- Lin Lin
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
| | - Hai-Jun Wang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
| | - Yong-Jian Wang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
| | - Jian Wang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
| | - You-Rong Chen
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
| | - Jia-Kuo Yu
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine of Peking University, Beijing, China
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Abstract
Bone tunnel-related complications are frequently encountered during revision anterior cruciate ligament reconstruction (ACLR). Issues with tunnel positioning, enlargement, containment, and hardware interference may complicate surgery and compromise outcomes. As a result, several strategies have emerged to address these issues and optimize results. However, a systematic, unified approach to tunnel pathology in revision ACLR is lacking. The purpose of this review is to highlight the current state of the literature on bone tunnel complications and, although extensive literature on the subject is lacking, present an updated approach to the evaluation and management of tunnel-related issues in revision ACLR.
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Affiliation(s)
| | | | - Brett D Owens
- Brown University Alpert Medical School, East Providence, Rhode Island, USA
| | - Brian R Waterman
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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de Cano JJM, Trias E. THE CEMENTED DOUBLE MOBILITY CUP IN HIP REVISION: DIFFERENT POSSIBILITIES OF USE. Acta Ortop Bras 2023; 31:e256913. [PMID: 37082167 PMCID: PMC10112351 DOI: 10.1590/1413-785220233101e256913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 02/10/2022] [Indexed: 04/22/2023]
Abstract
Introduction The aim of our work is to review those patients who underwent prosthetic hip revision surgery in our hospital considered to be patients at high risk of dislocation or recurrent dislocation, and who underwent a double mobility cemented cup (CMD). Analyzing the different ways to place these cups and the clinical results and reluxations. Material and methods The 69 cases comprised 34 men and 35 women with a mean age of 77,39 years. The mean follow-up was 4.7536 years. The type of intervention performed varied according to the cause of the intervention, the acetabular bone stock and the state of the primary cup. In the cases in which there was a good fixation of the primary metalback, we opted to carry out a cementation of the cemented DMC into the existing well-fixed metal acetabular shell, this occurred in 23 cases. In the cases where there was loosening of the primary cup but there was a good bone stock, a CMD was cemented into the bone (21 cases). In the cases where there was a Paprosky type III we cemented a DMC to a Bursch-Schneider reinforcement ring together with the placement of a cancellous bone graft (25 cases). Results The clinical evaluation at the end of the follow-up, according to the MD Scale, showed the mean value was 16.454 (SD 0.79472), with a survival at the end of the follow-up of 100% of the placed DMC. Conclusion The use of cemented DMC is a good solution in the replacement of THA, especially in cases of reluxation or risk of dislocation due to personal or technical predisposing factors. The use of these DMC cemented can be directly to the bone, into the existing well-fixed metal Shell, or cemented to a reinforcing ring, depending on the acetabular defect. Evidence Level III; Comparative Case Series .
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Yong M, Xu M, Lou Y, Lin G. Risk factors for postoperative avascular necrosis of the femoral head in children with developmental dysplasia of the hip. Front Pediatr 2023; 11:1089341. [PMID: 36950177 PMCID: PMC10025389 DOI: 10.3389/fped.2023.1089341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/30/2023] [Indexed: 03/24/2023] Open
Abstract
Aim To investigate factors associated with postoperative avascular necrosis of the femoral head (ANFH) in developmental dysplasia of the hip (DDH) patients, and if or how the associations varied among different subpopulations of age, sex and surgical method. Methods Patients with DDH were enrolled between October 31, 2016 and July 15, 2020 in this retrospective cohort study. The average follow-up time was 21.42 ± 10.02 months. The outcome was postoperative ANFH. The main study variables were the DDH classification, Tonnis grade, International Hip Dysplasia Institute (IHDI) classification, and preoperative traction. Multivariate logistic regression was employed to assess the associations between main study variables and postoperative ANFH. Subgroup analysis was carried out based on age at reduction, sex and surgical method. Odds ratio (ORs) and 95% confidence intervals (CIs) were calculated. Results A total of 427 children with DDH were included, with 92 (21.55%) in the ANFH group, and 335 (78.45%) in the non-ANFH group. DDH classification was positively correlated with the risk of postoperative ANFH (OR = 4.14, 95% CI, 1.08-15.77, P = 0.038). Children with preoperative traction had a significantly decreased risk of postoperative ANFH in contrast to those without preoperative traction (OR = 0.37, 95% CI, 0.22-0.61, P < 0.001). Children aged 1-3 years who received preoperative traction has a significantly reduced risk of postoperative ANFH than those who did not receive preoperative traction (OR = 0.28, 95% CI, 0.15-0.51, P < 0.001). For children aged >3 years, positive association was found between DDH classification and the risk of postoperative ANFH (OR = 3.75, 95% CI, 1.51-9.31, P = 0.004). Girls with a more severe DDH type had a significantly higher risk of postoperative ANFH (OR = 3.80, 95% CI, 1.80-8.02, P < 0.001). Receiving preoperative traction was associated with a significantly decreased risk of postoperative ANFH in girls (OR = 0.37, 95% CI, 0.22-0.61, P < 0.001). For children undergoing open reduction, DDH classification was positively associated with the risk of postoperative ANFH (OR = 3.01, 95% CI, 1.65-5.50, P < 0.001), and those with preoperative traction had a lower risk of postoperative ANFH compared with those without preoperative traction (OR = 0.35, 95% CI, 0.20-0.61, P < 0.001). Conclusion DDH classification and preoperative traction were associated with the risk of postoperative ANFH, and these associations varied across DDH patients with different ages, sexes and surgical methods.
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Chen M, Kaneuji A, Takahashi E, Fukui M, Ichiseki T, Kawahara N. Angular changes in pelvic tilt and cup orientation at a minimum of eighteen years after primary total hip arthroplasty with an uncemented cup. Int Orthop 2023; 47:75-81. [PMID: 36323872 DOI: 10.1007/s00264-022-05610-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/07/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Changes in pelvic tilt angle (PTA) and cup orientation have been reported in patients after total hip arthroplasty, but the current literature generally has a brief follow-up period. This study will be the first to report PTA and cup orientation changes in the supine position for a minimum 18 years after total hip arthroplasty (THA) and investigate the factors associated with pelvic tilt and cup orientation changes. METHODS In this study, 101 patients (120 hips) who underwent THA were retrospectively analyzed. The aims of our study were to evaluate the PTA and cup orientation change over 18 years after THA to assess differential PTA, cup inclination, and anteversion. We also investigated whether factors such as gender, body mass index, and age have any influence on PTA and cup orientation after THA. RESULTS Patients showed a significant incremental change in PTA pre-operatively, immediately post-operatively, and at final follow-up. Cup orientation increased significantly at the final follow-up compared to the immediate post-operative period. Gender subgroup analysis showed that PTA was significantly greater in females than in males at the final follow-up (p = 0.025). Age subgroup analysis showed that PTA was significantly greater in the over 60 years group than in the other groups. CONCLUSION Our patients showed significant changes in PTA and cup orientation at a minimum 18 years after surgery, especially in females over 60 years. Female patients over 60 are a risk factor after THA.
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Affiliation(s)
- Mingliang Chen
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Ayumi Kaneuji
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, 920-0293, Japan.
| | - Eiji Takahashi
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Makoto Fukui
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Toru Ichiseki
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Norio Kawahara
- Department of Orthopaedic Surgery, Kanazawa Medical University, Kahoku-gun, Ishikawa, 920-0293, Japan
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Kato M, Warashina H, Mitamura S, Kataoka A. Medial pivot-based total knee arthroplasty achieves better clinical outcomes than posterior-stabilised total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:998-1010. [PMID: 36089624 PMCID: PMC9464619 DOI: 10.1007/s00167-022-07149-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 08/30/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Stability in the sagittal plane, particularly regarding anterior cruciate ligament compensation, and postoperative functionality and satisfaction remain issues in total knee arthroplasty. Therefore, this prospective study compared the clinical outcomes between medial-pivot-based and posterior-stabilised total knee arthroplasty based on anterior translation and clinical scores. METHODS To assess outcomes of total knee arthroplasty for varus osteoarthritis, the anterior translation distance of the tibia relative to the femur was measured at 30 and 60° of flexion using a KS measure Arthrometer at 6 months postoperatively. The 2011 Knee Society Score, Forgotten Joint Score, visual analogue scale for pain, and range of motion were assessed at 6 months and 1 year postoperatively. The correlations among each score, anterior translation distance, range of motion, and visual analogue scale score for pain were investigated. RESULTS The medial-pivot and posterior-stabilised groups comprised 70 and 51 patients, respectively. The medial-pivot group exhibited a significantly shorter anterior translation distance at 60° flexion than the posterior-stabilised group. Furthermore, the medial-pivot group achieved significantly better outcomes regarding the visual analogue scale for pain, 2011 Knee Society Score, and Forgotten Joint Score than the posterior-stabilised group. A significant negative correlation was observed between the anterior translation distance and the function score of the 2011 Knee Society Score, whereas a significant positive correlation was found between the anterior translation distance and flexion angle, and between the extension angle and score of the Forgotten Joint Score or 2011 Knee Society Score. Significant negative correlations were also found between the pain visual analogue scale and both the 2011 Knee Society Score and Forgotten Joint Score. CONCLUSION In total knee arthroplasty for osteoarthritis, the medial-pivot group displayed a shorter anterior translation distance than the posterior-stabilised group at 6 months postoperatively. The visual analogue scale score for pain was also significantly lower in the medial-pivot group than that in the posterior-stabilised group at both 6 months and 1 year postoperatively. Because a correlation was observed between the anterior translation distance and the function score, medial-pivot-based total knee arthroplasty was considered to significantly improve postoperative function compared to posterior-stabilised total knee arthroplasty.
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Affiliation(s)
- Michitaka Kato
- Nagoya Joint Replacement Orthopaedic Clinic, 7 Iponbashi, Takadaji, Kita-Nagoya, Aichi, 481-0011, Japan.
| | - Hideki Warashina
- Nagoya Joint Replacement Orthopaedic Clinic, 7 Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
| | - Shingo Mitamura
- Nagoya Joint Replacement Orthopaedic Clinic, 7 Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
| | - Akito Kataoka
- Nagoya Joint Replacement Orthopaedic Clinic, 7 Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
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O’Driscoll CS, Hughes AJ, Davey MS, Queally JM, O’Daly BJ. Total Hip Arthroplasty in Patients With Neurological Conditions: A Systematic Review. Arthroplast Today 2022; 19:101068. [PMID: 36568851 PMCID: PMC9768244 DOI: 10.1016/j.artd.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 10/20/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022] Open
Abstract
Background As operative techniques and implant design have evolved over time, total hip arthroplasty (THA) is increasingly being carried out for patients with neurological impairment. This patient group places unique surgical challenges to the arthroplasty surgeon, which may include contractures, instability, and altered muscular tone. The purpose of this systematic review is to report the patient outcomes, complications, and implant survival following THA for patients with neurological conditions affecting the hip. Thus, we aim to support orthopaedic surgeon decision-making when considering and planning THA for these patients. Methods A systematic review was performed as per Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using the PubMed/Medline OVID, Cochrane, and Embase databases. All studies reporting the outcomes of THA in the neurological population which met defined inclusion criteria were included. Results From an initial screen of 1820 studies, 45 studies with a total of 36,251 THAs were included in the final selection. All 45 studies reported complication rates, with controls included in 16 for comparison. High complication rates were observed following THA in the neurologically impaired population, most notably dislocation with observed rates up to 10.6%. An improvement was noted in all 36 studies (1811 THAs) which reported upon patient-reported outcomes. Conclusions THA may be beneficial in the selected patients with neurological conditions, to reduce pain and improve function. There is an increased risk of complications which require careful consideration when planning the operation and open discussion with prospective patients and caregivers before proceeding with surgery.
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Affiliation(s)
- Conor S. O’Driscoll
- Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin, Ireland,Department of Trauma & Orthopaedics, Galway University Hospital, Galway, Ireland,Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland,Corresponding author. Tallaght University Hospital, Dublin, Ireland. Tel.: +353857884714.
| | - Andrew J. Hughes
- Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin, Ireland,Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland,Rothman Orthopedic Institute, Thomas Jefferson University Hospital, PA, USA
| | - Martin S. Davey
- Department of Trauma & Orthopaedics, Galway University Hospital, Galway, Ireland,Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Joseph M. Queally
- Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin, Ireland,Department of Trauma & Orthopaedics, St James Hospital, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland
| | - Brendan J. O’Daly
- Department of Trauma & Orthopaedics, Tallaght University Hospital, Dublin, Ireland,Department of Trauma & Orthopaedics, Royal College of Surgeons Ireland, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland
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Peng L, Zeng Y, Wu Y, Si H, Pei F, Shen B. Radiologic restoration inaccuracy increases postoperative dislocation in primary total hip arthroplasty: a retrospective study with propensity score matching. Arch Orthop Trauma Surg 2022; 142:3995-4005. [PMID: 34821944 DOI: 10.1007/s00402-021-04263-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/12/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Dislocation is a complicated process and associated with multivariate etiology and risk factors. The purpose of this study was to verify if radiologic restoration inaccuracy increases postoperative dislocation in primary total hip arthroplasty (THA) individually or synergistically. METHODS From 2017 to 2020, we identified 76 (1.9%) patients who suffered postoperative dislocations from 3926 THAs in our institution. After excluded patients with previously proven patient-related and implant-related risk factors, the remaining patients were used to match a 1:1 control patients who were without dislocation. The cup position (inclination and anteversion angles), hip offset (HO), leg length discrepancy (LLD), and abductor lever arm (ALA) were analyzed by univariate analyses and multivariate logistic regressions. RESULTS Measurements on radiographs showed excellent interobserver agreement (intraclass correlation coefficient (ICC) 0.922-0.952) and intraobserver agreements (ICC 0.933-0.967). HO restoration inaccuracy (without ± 5 mm) was associated with higher dislocation risk (OR 4.241 95% CI 1.440-12.492, P = 0.009). The restoration inaccuracy of the cup position, LLD, or ALA could not increase the dislocation risk individually. When combining the radiologic restoration inaccuracy factors, the HO + LLD restoration inaccuracy and HO + ALA restoration inaccuracy increased the odds of postoperative dislocation (OR 12.056, 95% CI 1.409-103.127, P = 0.023; OR 4.770, 95% CI 1.336-17.028, P = 0.016, respectively). Combining the four risk factors of cup safe zone, HO, LLD, and ALA, patients with 3 or 4 radiologic restoration inaccuracy factors showed a higher risk of dislocation (OR 13.500, 95% CI 1.340-135.983, P = 0.027). CONCLUSION Hip offset (HO) restoration inaccuracy increased the risk of dislocation following primary THA. Multivariate radiologic restoration accuracy is critical for the prevention of dislocation and needs to be valued by surgeons.
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Affiliation(s)
- Linbo Peng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yi Zeng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yuangang Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Haibo Si
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Fuxing Pei
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Bin Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China.
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Hoskins W, Smith G, Spelman T, Vince KG. Medial Pivot Designs Versus Conventional Bearing Types in Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Am Acad Orthop Surg Glob Res Rev 2022; 6. [PMID: 36732308 DOI: 10.5435/JAAOSGlobal-D-22-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/09/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Medial pivot (MP) designs are growing in popularity. They provide increased sagittal plane stability and theoretically replicate some aspects of native joint kinematics, which may improve total knee arthroplasty outcomes. METHODS A systematic review was performed of randomized controlled trials (RCTs) that compared MP designs with cruciate-retaining, posterior-stabilized (PS), ultracongruent, or mobile-bearings in primary total knee arthroplasty, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome measures were all clinical function scores, patient-reported outcome measures, and range of motion. The secondary outcome was complications. Two authors independently selected studies, performed data extraction, and risk-of-bias assessment. Studies at high risk of bias were excluded from meta-analysis. Treatment effects were assessed using random-effects meta-analysis and quantified using pooled mean differences or incidence rate differences as appropriate. RESULTS Eight RCTs met inclusion criteria. Five compared MP with PS, two with ultracongruent, and one with cruciate-retaining and mobile-bearing. In total, 350 knees were randomized to MP and 375 to conventional bearings. One RCT was excluded from meta-analysis because of high risk of bias. Meta-analysis comparing MP with PS only was possible and found no differences at any time points for any outcome measure, including 2-year follow-up for Oxford Knee Score (MD = 0.35 favoring PS; 95% CI -0.49 to 1.20) and range of motion (MD = 1.58 favoring MP; 95% CI -0.76 to 11.92, P = 0.30) and 12 months for Western Ontario Arthritis Index (MD = 4.42 favoring MP; 95% CI -12.04 to 3.20, P = 0.09). CONCLUSIONS There is no difference in clinical outcomes, with contemporary measurement tools, at any time points, between MP and PS. There are insufficient RCTs comparing MP with other bearings.
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Ogilvie A, Kim WJ, Asirvatham RD, Fontalis A, Putzeys P, Haddad FS. Robotic-Arm-Assisted Total Hip Arthroplasty: A Review of the Workflow, Outcomes and Its Role in Addressing the Challenge of Spinopelvic Imbalance. Medicina (B Aires) 2022; 58:1616. [DOI: 10.3390/medicina58111616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/27/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022] Open
Abstract
Robotic-arm-assisted total hip arthroplasty (RoTHA) offers the opportunity to improve the implant positioning and restoration of native hip mechanics. The concept of individualised, functional implant positioning and how it relates to spinopelvic imbalance is an important yet rather novel consideration in THA. There is mounting evidence that a significant percentage of dislocations occur within the perceived “safe zones”; hence, in the challenging subset of patients with a stiff spinopelvic construct, it is imperative to employ individualised component positioning based on the patients’ phenotype. Restoring the native centre of rotation, preserving offset, achieving the desired combined anteversion and avoiding leg length inequality are all very important surgeon-controlled variables that have been shown to be associated with postoperative outcomes. The latest version of the software has a feature of virtual range of motion (VROM), which preoperatively identifies potential dynamic causes of impingement that can cause instability. This review presents the workflow of RoTHA, especially focusing on pragmatic solutions to tackle the challenge of spinopelvic imbalance. Furthermore, it presents an overview of the existing evidence concerning RoTHA and touches upon future direction.
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Khosravi B, Rouzrokh P, Maradit Kremers H, Larson DR, Johnson QJ, Faghani S, Kremers WK, Erickson BJ, Sierra RJ, Taunton MJ, Wyles CC. Patient-specific Hip Arthroplasty Dislocation Risk Calculator: An Explainable Multimodal Machine Learning-based Approach. Radiol Artif Intell 2022; 4:e220067. [PMID: 36523643 PMCID: PMC9745445 DOI: 10.1148/ryai.220067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/30/2022] [Accepted: 09/12/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE To develop a multimodal machine learning-based pipeline to predict patient-specific risk of dislocation following primary total hip arthroplasty (THA). MATERIALS AND METHODS This study retrospectively evaluated 17 073 patients who underwent primary THA between 1998 and 2018. A test set of 1718 patients was held out. A hybrid network of EfficientNet-B4 and Swin-B transformer was developed to classify patients according to 5-year dislocation outcomes from preoperative anteroposterior pelvic radiographs and clinical characteristics (demographics, comorbidities, and surgical characteristics). The most informative imaging features, extracted by the mentioned model, were selected and concatenated with clinical features. A collection of these features was then used to train a multimodal survival XGBoost model to predict the individualized hazard of dislocation within 5 years. C index was used to evaluate the multimodal survival model on the test set and compare it with another clinical-only model trained only on clinical data. Shapley additive explanation values were used for model explanation. RESULTS The study sample had a median age of 65 years (IQR: 18 years; 52.1% [8889] women) with a 5-year dislocation incidence of 2%. On the holdout test set, the clinical-only model achieved a C index of 0.64 (95% CI: 0.60, 0.68). The addition of imaging features boosted multimodal model performance to a C index of 0.74 (95% CI: 0.69, 0.78; P = .02). CONCLUSION Due to its discrimination ability and explainability, this risk calculator can be a potential powerful dislocation risk stratification and THA planning tool.Keywords: Conventional Radiography, Surgery, Skeletal-Appendicular, Hip, Outcomes Analysis, Supervised Learning, Convolutional Neural Network (CNN), Gradient Boosting Machines (GBM) Supplemental material is available for this article. © RSNA, 2022.
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Barimani B, Alraiyes T, Epure LM, Zukor DJ, Huk OL, Antoniou J, Bergeron SG. Long-Term Survivorship of Cemented and Uncemented Polyethylene Liner Exchange. J Arthroplasty 2022; 37:2247-2250. [PMID: 35598761 DOI: 10.1016/j.arth.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Revision surgery is usually required for complications associated with total hip arthroplasty (THA). Significant morbidity can be associated with revision THA and thus some may only revise the liner of the original metal back component if it is found to be well fixed. We compare the long-term survivorship of cemented and uncemented head-liner THA exchange surgeries and possible causes. METHODS Between 2000 and 2018, we reviewed cases from our arthroplasty database who underwent THA revision for head-liner exchange. We stratified our cohort into 2 groups: cemented and uncemented liners. Patients were followed clinically and radiographically to determine survivorship of the exchanges for both cemented and uncemented liners. Implant survivorship was measured using a competing risk analysis considering death and patients lost to follow-up as competing risks. RESULTS A total of 84 patients (85 hips) underwent head-liner exchange surgery during the study period (21 cemented and 64 uncemented liners). The mean follow-up time was 6.9 years, with 75.3% and 24.7% of patients having been revised due to non-dislocation and dislocation causes, respectively. Two cemented liners (9.5%) and 11 uncemented liners (17.2%) required revision. The survival analysis of all head-liner revision was 86.4% at 18 years. Survival estimates liner exchanges due to dislocation versus non-dislocation groups were 57.3% versus 82.7% respectively (P = .034). CONCLUSION The present study shows improved survivorship of head-liner exchanges performed due to non-dislocation etiology compared to dislocation etiology, but no difference in survivorship between cemented and uncemented head-liner exchange. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Bardia Barimani
- Department of Orthopaedic, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Thamer Alraiyes
- Department of Orthopaedic, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Laura M Epure
- Department of Orthopaedic, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - David J Zukor
- Department of Orthopaedic, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Olga L Huk
- Department of Orthopaedic, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - John Antoniou
- Department of Orthopaedic, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Stephane G Bergeron
- Department of Orthopaedic, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Li F, Huang X, Liu W, Huang W, Wang C, Yin D. Application of dexamethasone combined with tranexamic acid in perioperative period of total hip arthroplasty. Medicine (Baltimore) 2022; 101:e31223. [PMID: 36281151 PMCID: PMC9592332 DOI: 10.1097/md.0000000000031223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of dexamethasone (DEXA) combined with tranexamic acid (TXA) in the perioperative period of total hip arthroplasty. MATERIALS AND METHODS A total of 100 cases were randomly divided into 2 groups (50 cases per group). All patients were given 15 mg/kg TXA before skin incision and 3 hours later. Patients in the intervention group (TXA + DEXA group) were given 20 mg dexamethasone intravenously after the onset of anesthesia, and the same dose of DEXA was administered again 24 hours later. Patients in the placebo group (TXA group) were only given the same dose of normal saline. Postoperative c-reactive protein and interleukin-6, postoperative nausea and vomiting, fatigue visual analogue scale score, postoperative length of stay, range of motion, and consumption of analgesic and antiemetics were statistically analyzed in the 2 groups. RESULTS The levels of c-reactive protein and interleukin-6 in the TXA + DEXA group were lower than those in the TXA group at 24, 48, 72 hours post-operatively (P < .001). Walking pain scores in the TXA + DEXA group were also significantly lower than those in the TXA group at 24 and 48 hours (P < .001); rest pain scores were lower at 24 hours (P < .001). Compared with the TXA group, the incidence of nausea VAS, postoperative nausea and vomiting, fatigue, analgesia and antiemetics consumption, postoperative length of stay, and range of motion were lower in the TXA + DEXA group (all P < .05), while there were no significant differences in postoperative hematocrit, total blood loss, and complications (P > .05). CONCLUSION The combination of TXA (15 mg/kg; before skin incision and 3 hours later) and DEX (20 mg dexamethasone intravenously after the onset of anesthesia, and again 24 hours later) is an effective and safe strategy for patients undergoing total hip arthroplasty.
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Affiliation(s)
- Fulin Li
- Department of Joint Surgery and Sports Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xiao Huang
- Department of Joint Surgery and Sports Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Wenhui Liu
- Department of Joint Surgery and Sports Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Wenwen Huang
- Department of Joint Surgery and Sports Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Chaoqun Wang
- Department of Joint Surgery and Sports Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Dong Yin
- Department of Joint Surgery and Sports Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
- * Correspondence: Dong Yin, Department of Joint Surgery and Sports Medicine, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China (e-mail: )
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Kanayama A, Minami M, Yamamoto S, Ohmine T, Fujiwara M, Murakami T, Okuno S, Ueba R, Iwata A. Examination of the Impact of Strength and Velocity of the Knee and Ankle on Gait Speed in Community-Dwelling Older Adults. Healthcare (Basel) 2022; 10:2093. [PMID: 36292540 PMCID: PMC9602105 DOI: 10.3390/healthcare10102093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/25/2022] [Accepted: 10/18/2022] [Indexed: 11/22/2022] Open
Abstract
The muscle strength of the knee extension and plantarflexion plays a crucial role in determining gait speed. Recent studies have shown that no-load angular velocity of the lower limb joints is essential for determining gait speed. However, no reports have compared the extent to which lower limb functions, such as knee extension strength, knee extension velocity, plantarflexion strength, and plantarflexion velocity, impact gait speed in a single study. Therefore, this study aimed to examine the relative importance of maximum strength and no-load angular velocity on gait speed. Overall, 164 community-dwelling older adults (72.9 ± 5.0 years) participated in this study. We measured the gait speed and lower limb function (the strength and velocity of knee extension and plantarflexion). Strength was measured with a hand-held dynamometer, and velocity with a gyroscope. A multiple regression analysis was performed with gait speed as the dependent variable and age, sex, and lower-limb function as independent variables. Plantarflexion velocity (β = 0.25) and plantarflexion strength (β = 0.21) were noted to be significant predictors of gait speed. These findings indicate that no-load plantarflexion velocity is more important than the strength of plantarflexion and knee extensions as a determinant of gait speed, suggesting that improvement in plantarflexion velocity may increase gait speed.
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Zhou Z, Li Y, Peng Y, Jiang J, Zuo J. Clinical efficacy of direct anterior approach vs. other surgical approaches for total hip arthroplasty: A systematic review and meta-analysis based on RCTs. Front Surg 2022; 9:1022937. [PMID: 36263087 PMCID: PMC9574056 DOI: 10.3389/fsurg.2022.1022937] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/16/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Direct anterior approach (DAA) is an accurate technique for total hip arthroplasty (THA) through the muscle gap. Physicians who apply DAA believe that it accelerates patient recovery and results in lower rates of postoperative dislocation. However, the traditional surgical approach adherents believe that it is shorter and has fewer complications than DAA. METHODS We use the method of META analysis to organize and analyze the data of the randomized controlled studies (RCT) obtained after our screening. To compare the clinical efficacy of DAA approach and other surgical approaches for THA. RESULTS After rigorous screening, 15 RCT studies were included in our study, and data were extracted. The study included 1,450 patients from 15 RCTs, with a mean age of 63 years and a distribution of 52-67 years. Six weeks after the operation, the Harris hip score of the DAA approach improved by an average of 4.06 points (95% confidence interval (CI) 2.54 -5.59, P < 0.01, I 2 = 45%, which can significantly improve the clinical efficacy of patients. However, the 0.61 points [95% confidence interval (CI) -1.13 -2.34, P > 0.01, I 2 = 0%] at 3 months and 1.49 points [95% confidence interval (CI) -1.65 -2.25, P > 0.01, I 2 = 0%] at 12 months postoperatively. In terms of dislocation rate, results show that the use of DAAs does not reduce Dislocation Rate with significant statistical heterogeneity among study groups (95% CI 0.18-2.94 P > 0.001, I 2 = 0%). CONCLUSION The hip function of DAA was superior to posterolateral approach (PLA) and latera approach (LA) in the early days after hip replacement, especially within six weeks. However, at six months or more after surgery, the difference was not significant. The DAA did not show a lower rate of dislocation than other surgical approaches. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/PROSPERO.
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Affiliation(s)
- Zhongsheng Zhou
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China,Scientific Research Center, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yang Li
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yachen Peng
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jinlan Jiang
- Scientific Research Center, China-Japan Union Hospital of Jilin University, Changchun, China,Correspondence: Jinlan Jiang, Jianlin Zuo
| | - Jianlin Zuo
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China,Correspondence: Jinlan Jiang, Jianlin Zuo
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Qu H, Mou H, Wang K, Tao H, Huang X, Yan X, Lin N, Ye Z. Risk factor investigation for hip dislocation after periacetabular tumour resection and endoprosthetic reconstruction via thin-slice CT-based 3D model. Bone Joint J 2022; 104-B:1180-1188. [PMID: 36177644 DOI: 10.1302/0301-620x.104b10.bjj-2022-0265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Dislocation of the hip remains a major complication after periacetabular tumour resection and endoprosthetic reconstruction. The position of the acetabular component is an important modifiable factor for surgeons in determining the risk of postoperative dislocation. We investigated the significance of horizontal, vertical, and sagittal displacement of the hip centre of rotation (COR) on postoperative dislocation using a CT-based 3D model, as well as other potential risk factors for dislocation. METHODS A total of 122 patients who underwent reconstruction following resection of periacetabular tumour between January 2011 and January 2020 were studied. The risk factors for dislocation were investigated with univariate and multivariate logistic regression analysis on patient-specific, resection-specific, and reconstruction-specific variables. RESULTS The dislocation rate was 13.9% (n = 17). The hip COR was found to be significantly shifted anteriorly and inferiorly in most patients in the dislocation group compared with the non-dislocation group. Three independent risk factors were found to be related to dislocation: resection of gluteus medius (odds ratio (OR) 3.68 (95% confidence interval (CI) 1.24 to 19.70); p = 0.039), vertical shift of COR > 18 mm (OR 24.8 (95% CI 6.23 to 128.00); p = 0.001), and sagittal shift of COR > 20 mm (OR 6.22 (95% CI 1.33 to 32.2); p = 0.026). CONCLUSION Among the 17 patients who dislocated, 70.3% (n = 12) were anterior dislocations. Three independent risk factors were identified, suggesting the importance of proper restoration of the COR and the role of the gluteus medius in maintaining hip joint stability.Cite this article: Bone Joint J 2022;104-B(10):1180-1188.
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Affiliation(s)
- Hao Qu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Diagnosis and Treatment Center of Bone Metastasis, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haochen Mou
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Diagnosis and Treatment Center of Bone Metastasis, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Keyi Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Diagnosis and Treatment Center of Bone Metastasis, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huimin Tao
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Diagnosis and Treatment Center of Bone Metastasis, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xin Huang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Diagnosis and Treatment Center of Bone Metastasis, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaobo Yan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Diagnosis and Treatment Center of Bone Metastasis, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Nong Lin
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Diagnosis and Treatment Center of Bone Metastasis, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhaoming Ye
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopaedics Research Institute, Zhejiang University, Hangzhou, China.,Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou, China.,Diagnosis and Treatment Center of Bone Metastasis, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Welder E, Magnussen RA, Fitzpatrick S, Duerr RA, Kaeding CC, Flanigan DC. Arthroscopic Bone Graft Technique for Two-Stage Revision Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2022; 11:e1667-e1674. [PMID: 36311315 PMCID: PMC9596458 DOI: 10.1016/j.eats.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/24/2022] [Indexed: 02/03/2023] Open
Abstract
Revision anterior cruciate ligament reconstruction is an increasingly common procedure, with 2-stage surgery often required to address large bone defects and malpositioned tunnels. The arthroscopic bone grafting technique described herein uses morselized allograft bone to provide reproducible fill of asymmetrical bone defects without autograft harvest or additional loss of native bone. The second stage of the anterior cruciate ligament reconstruction can typically proceed 6 months following bone grafting.
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Affiliation(s)
- Eric Welder
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A
| | - Robert A. Magnussen
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A.,OSU Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, U.S.A
| | - Sean Fitzpatrick
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A.,OSU Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, U.S.A
| | - Robert A. Duerr
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A.,OSU Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, U.S.A
| | - Christopher C. Kaeding
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A.,OSU Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, U.S.A
| | - David C. Flanigan
- Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A.,OSU Sports Medicine Research Institute, The Ohio State University, Columbus, Ohio, U.S.A.,Address correspondence to David C. Flanigan, M.D., Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Dr., Columbus, OH 43202.
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