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Inoue D, Kabata T, Kimura H, Tsuchiya H. A prospective clinical trial to assess the accuracy of an MRI-based patient-specific acetabular instrument guide in total hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:65-71. [DOI: 10.1007/s00590-018-2279-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/23/2018] [Indexed: 12/16/2022]
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Abstract
Surgeons and engineers constantly search for methods to improve the surgical positioning of implants used for joint arthroplasty. Rapid prototyping is being used to develop patient-specific instrumentation (PSI) and has already been successfully translated into large-scale clinical use for knee arthroplasty. PSI has been used in shoulder arthroplasty; however, it is not yet known whether PSI provides improved accuracy and outcomes compared with conventional methods in either shoulder arthroplasty or knee arthroplasty. In the hip, PSI has been limited to the positioning of custom-manufactured implants and a small number of surgeons testing the emerging solutions from different manufacturers. Early results indicate consistent accurate positioning of implants with the use of PSI in hip arthroplasty but with added costs and uncertain effect on clinical outcomes.
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Darrith B, Bell JA, Culvern C, Della Valle CJ. Can the use of an inclinometer improve the positioning of the acetabular component in total hip arthroplasty? Bone Joint J 2018; 100-B:862-866. [PMID: 29954211 DOI: 10.1302/0301-620x.100b7.bjj-2017-1607.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Accurate placement of the acetabular component is essential in total hip arthroplasty (THA). The purpose of this study was to determine if the ability to achieve inclination of the acetabular component within the 'safe-zone' of 30° to 50° could be improved with the use of an inclinometer. Patients and Methods We reviewed 167 primary THAs performed by a single surgeon over a period of 14 months. Procedures were performed at two institutions: an inpatient hospital, where an inclinometer was used (inclinometer group); and an ambulatory centre, where an inclinometer was not used as it could not be adequately sterilized (control group). We excluded 47 patients with a body mass index (BMI) of > 40 kg/m2, age of > 68 years, or a surgical indication other than osteoarthritis whose treatment could not be undertaken in the ambulatory centre. There were thus 120 patients in the study, 68 in the inclinometer group and 52 in the control group. The inclination angles of the acetabular component were measured from de-identified plain radiographs by two blinded investigators who were not involved in the surgery. The effect of the use of the inclinometer on the inclination angle was determined using multivariate regression analysis. Results The mean inclination angle for the THAs in the inclinometer group was 42.9° (95% confidence interval (CI) 41.7° to 44.0°; range 29.0° to 63.8°) and 46.5° (95% CI 45.2° to 47.7°; range 32.8° to 63.2°) in the control group (p < 0.001). Regression analysis identified a 9.1% difference in inclination due to the use of an inclinometer (p < 0.001), and THAs performed without the inclinometer were three times more likely to result in inclination angles of > 50° (odds ratio (OR) 2.8, p = 0.036). The correlation coefficient for the interobserver reliability of the measurement of the two investigators was 0.95 (95% CI 0.93 to 0.97). Conclusion The use of a simple inclinometer resulted in a significant reduction in the number of outliers compared with a freehand technique. Cite this article: Bone Joint J 2018;100-B:862-6.
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Affiliation(s)
- B Darrith
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - J A Bell
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - C Culvern
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Ililnois, USA
| | - C J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Affiliation(s)
- F S Haddad
- NIHR University College London Hospitals Biomedical Research Centre, UK
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Lee YK, Kim JW, Kim TY, Ha YC, Koo KH. Validity of the intra-operative measurement of stem anteversion and factors for the erroneous estimation in cementless total hip arthroplasty using postero-lateral approach. Orthop Traumatol Surg Res 2018; 104:341-346. [PMID: 29458202 DOI: 10.1016/j.otsr.2017.11.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/07/2017] [Accepted: 11/23/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Intra-operative estimation of stem anteversion in total hip arthroplasty (THA) using postero-lateral approach is made by the surgeon's visual assessment, using the tibia as a guide, with the assumption that tibial axis is vertical to the trans-epicondylar axis. However, the accuracy of the intra-operative estimation has rarely been verified with postoperative CT-scans, with controversies regarding these measurements particularly in case of knee osteoarthritis. Therefore we performed a prospective study to: (1) determine the accuracy of the intra-operative measurement and (2) investigate factors affecting the discrepancy between the surgeon's estimation and the real stem anteversion. HYPOTHESIS Intra-operative estimation of stem anteversion correlated with the real stem anteversion on CT-scan. PATIENTS AND METHODS Sixty-seven THAs using cementless straight stems (65 patients) without ipsilateral total knee arthroplasty were prospectively evaluated to compare the intra-operative measurement of stem anteversion with the real stem anteversion on computed tomography (CT) scans. There were 33 men and 34 women with a mean age of 59.7years (range, 27-84years) at the time of surgery. Age, tibia plateau angle, native femoral anteversion, femoro-tibial angle, body mass index, operative site, gender, coronal and sagittal tilt of the stem, stem type, ipsilateral knee osteoarthritis, and preoperative diagnosis were analyzed to evaluate the factors affecting the discrepancy between the intra-operative and CT measurements. RESULTS The intra-operative estimation (mean, 21.5°±8.5°; range, 5.0°-39.0°) was greater than the CT measurement (mean, 19.5°±8.7°; range, 4.5°-38.5°) by 2.0°. The mean absolute value of discrepancy was 4.5°. The correlation coefficient between intra-operative and CT measurements was 0.837. The femoro-tibial angle was associated with the discrepancy between the two measurements. In the presence of genu varum deformity, the intra-operative measurement underestimated the stem anteversion. DISCUSSION Although intra-operative estimation of stem anteversion was slightly greater than the real stem anteversion, there was an excellent correlation between the two. The femoro-tibial angle should be considered to optimize the stem anteversion during cementless THA using postero-lateral approach. LEVEL OF EVIDENCE Level III, prospective case control study.
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Affiliation(s)
- Y K Lee
- Seoul National University Bundang Hospital, Department of Orthopaedic Surgery, 166 Gumi-ro, Bundang-gu, Seongnam 463-707 South Korea
| | - J W Kim
- Seoul National University Bundang Hospital, Department of Orthopaedic Surgery, 166 Gumi-ro, Bundang-gu, Seongnam 463-707 South Korea
| | - T Y Kim
- Hallym University Sacred Heart Hospital, Department of Orthopaedic Surgery, 896 Pyeongchon-dong, Dongan-gu, Anyang 431-070, South Korea; Konkuk University Medical Center, Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul 05030, South Korea.
| | - Y C Ha
- Chung-Ang University, College of Medicine, Department of Orthopaedic Surgery, 224-1 Heukseok-dong, Dongjak-gu, Seoul 156-755, South Korea
| | - K H Koo
- Seoul National University Bundang Hospital, Department of Orthopaedic Surgery, 166 Gumi-ro, Bundang-gu, Seongnam 463-707 South Korea
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An VVG, Phan K, Sivakumar BS, Mobbs RJ, Bruce WJ. Prior Lumbar Spinal Fusion is Associated With an Increased Risk of Dislocation and Revision in Total Hip Arthroplasty: A Meta-Analysis. J Arthroplasty 2018; 33:297-300. [PMID: 28974376 DOI: 10.1016/j.arth.2017.08.040] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The biomechanical relationship between the lumbar spine and the hip is well-documented. It follows that fusing the lumbar spine would have implications on the outcomes of total hip arthroplasty (THA). This study aimed to determine the effect of preexisting lumbar spinal fusion surgery on the outcomes of THA by synthesizing the available evidence via systematic review and meta-analysis. METHODS A systematic review with meta-analysis was performed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic searches were performed in 6 different databases for studies comparing outcomes in patients after THA with or without a history of lumbar fusion. Studies were required to report at least one outcome out of dislocation, revision due to hip instability or patient-reported outcomes. RESULTS Patients with a history of lumbar spinal fusion are at a significantly increased risk of dislocation (relative risk 2.03, P < .00001) and revision (relative risk 3.36, P = .006) after THA. Patient-reported outcomes were also poorer in patients with prior lumbar fusion compared with those without, although meta-analysis could not be performed due to heterogeneity in the outcome measure used between studies. CONCLUSION Previous lumbar spinal fusion increases risk of dislocation and revision, and may negatively impacts patient-reported outcomes after THA. Orthopaedic surgeons should pay particular attention to these patients and could use patient-specific planning, instrumentation, and targeted counselling to optimize clinical and subjective outcomes. Future studies could clarify the impact of prior fusion on patient-reported outcomes after THA.
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Affiliation(s)
- Vincent V G An
- Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - Ralph J Mobbs
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia; Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Warwick J Bruce
- Faculty of Medicine, University of Sydney, Sydney, Australia; Sydney Olympic Park Hip and Knee Clinic, Sydney, Australia
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Pierrepont J, Hawdon G, Miles BP, Connor BO, Baré J, Walter LR, Marel E, Solomon M, McMahon S, Shimmin AJ. Variation in functional pelvic tilt in patients undergoing total hip arthroplasty. Bone Joint J 2017; 99-B:184-191. [DOI: 10.1302/0301-620x.99b2.bjj-2016-0098.r1] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 10/25/2016] [Indexed: 11/05/2022]
Abstract
Aims The pelvis rotates in the sagittal plane during daily activities. These rotations have a direct effect on the functional orientation of the acetabulum. The aim of this study was to quantify changes in pelvic tilt between different functional positions. Patients and Methods Pre-operatively, pelvic tilt was measured in 1517 patients undergoing total hip arthroplasty (THA) in three functional positions – supine, standing and flexed seated (the moment when patients initiate rising from a seated position). Supine pelvic tilt was measured from CT scans, standing and flexed seated pelvic tilts were measured from standardised lateral radiographs. Anterior pelvic tilt was assigned a positive value. Results The mean pelvic tilt was 4.2° (-20.5° to 24.5°), -1.3° (-30.2° to 27.9°) and 0.6° (-42.0° to 41.3°) in the three positions, respectively. The mean sagittal pelvic rotation from supine to standing was -5.5° (-21.8° to 8.4°), from supine to flexed seated was -3.7° (-48.3° to 38.6°) and from standing to flexed seated was 1.8° (-51.8° to 39.5°). In 259 patients (17%), the extent of sagittal pelvic rotation could lead to functional malorientation of the acetabular component. Factoring in an intra-operative delivery error of ± 5° extends this risk to 51% of patients. Conclusion Planning and measurement of the intended position of the acetabular component in the supine position may fail to predict clinically significant changes in its orientation during functional activities, as a consequence of individual pelvic kinematics. Optimal orientation is patient-specific and requires an evaluation of functional pelvic tilt pre-operatively. Cite this article: Bone Joint J 2017;99-B:184–91.
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Affiliation(s)
- J. Pierrepont
- The University of Sydney, School of Aerospace,
Mechanical and Mechatronic Engineering, Building J07, Sydney NSW
2006, Australia and Optimized Ortho, 17 Bridge
Street, Pymble NSW 2073, Australia
| | - G. Hawdon
- Malabar Orthopaedic Clinic, 43
The Avenue, Windsor, VIC
3181, Australia
| | - B. P. Miles
- Optimized Ortho, 17
Bridge Street, Pymble NSW 2073, Australia
| | - B. O’ Connor
- Optimized Ortho, 17
Bridge Street, Pymble NSW 2073, Australia
| | - J. Baré
- Melbourne Orthopaedic Group, 33
The Avenue, Windsor, VIC
3191, Australia
| | - L. R. Walter
- Peninsula Orthopaedics, 812
Pittwater Rd, Dee Why, NSW
2099, Australia
| | - E. Marel
- Peninsula Orthopaedics, 812
Pittwater Rd, Dee Why, NSW
2099, Australia
| | - M. Solomon
- Sydney Orthopaedic Specialists, Suite
29, Prince of Wales Private Hospital, Randwick
NSW 2031, Australia
| | - S. McMahon
- Monash University, 43
The Avenue, Windsor VIC 3181, Australia
| | - A. J. Shimmin
- Monash
University, 43 The Avenue, Windsor VIC 3181, Australia and Melbourne
Orthopaedic Group, 33 The Avenue, Windsor, VIC
3191, Australia
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An VVG, Sivakumar BS, Levy YD, Pierrepont J, Bruce WJ. Practical implications of the lumbar spine and its function on total hip arthroplasty. JOURNAL OF SPINE SURGERY 2017; 2:334-337. [PMID: 28097253 DOI: 10.21037/jss.2016.11.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Correct component placement is of significant importance to ensure optimal outcomes in total hip arthroplasty (THA). Traditionally, the Lewinnek plane has been referenced as an adequate "safe zone", formed between the anterior superior iliac spines and public tubercles to optimize acetabular orientation. However, recent evidence shows that the positioning of this plane may vary due to the biomechanical relationship between the lumbar spine and hip. Therefore, the plane acquired intraoperatively may not accurately recreate the actual functional plane and acetabular orientation encountered outside of the intraoperative environment. This review summarizes the hip-spine relationship and its implications on THA.
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Affiliation(s)
- Vincent Vinh Gia An
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | | | - Yadin David Levy
- Department of Orthopaedic Surgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Jim Pierrepont
- University of Sydney, Camperdown, New South Wales, Australia;; Optimized Ortho, Sydney, Australia
| | - Warwick James Bruce
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia;; Department of Orthopaedic Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Napier RJ, Shimmin AJ. Ceramic-on-ceramic bearings in total hip arthroplasty: “The future is now”. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.sart.2017.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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