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Shoji T, Ota Y, Saka H, Murakami H, Takahashi W, Yamasaki T, Yasunaga Y, Iwamori H, Adachi N. Factors affecting impingement and dislocation after total hip arthroplasty - Computer simulation analysis. Clin Biomech (Bristol, Avon) 2020; 80:105151. [PMID: 32836081 DOI: 10.1016/j.clinbiomech.2020.105151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/06/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Studies on the causes and factors affecting dislocation after total hip arthroplasty have revealed conflicting results. The purpose of this study was to evaluate the factors affecting impingement and dislocation after total hip arthroplasty, using a 3-dimensional dynamic motion analysis. METHODS The CT data of 53 patients (53 hips: anterior dislocation; 11 cases, and posterior dislocation; 42 cases) who experienced hip dislocation after total hip arthroplasty with posterior approach, and 120 control patients (120 hips) without dislocation were analyzed. Parameters related to implant alignment, offset and leg length were evaluated. The impingement type was also analyzed using a software. FINDINGS Considering implant settings affecting dislocation, patients at risk for posterior dislocation had decreased stem anteversion, combined anteversion, femoral offset, and leg length. Nevertheless, patients at risk for anterior dislocation had only lower leg length, and these patients may also be at risk for a higher incidence of recurrent dislocation. Bony impingement occurred in almost half of the cases with posterior dislocation, while implant impingement was associated with anterior dislocation. Importantly, anterior dislocation was not as common as posterior dislocation even in cases with occurrence of posterior impingement. INTERPRETATION Bony impingement substantially affects dislocation even in the situation where the implant position and alignment are determined by the so-called "safe zone", especially on the anterior side, while implant impingement affects anterior dislocation. The restoration of anterior offset (i.e., prescribed by the stem anteversion and femoral offset) and combined anteversion is critical for avoidance of posterior dislocation after total hip arthroplasty.
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Affiliation(s)
- Takeshi Shoji
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Yuki Ota
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hideki Saka
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hiroaki Murakami
- Department of Orthopaedic Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-ku, Hiroshima 730-8562, Japan
| | - Wakan Takahashi
- Department of Orthopaedic Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-ku, Hiroshima 730-8562, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama town, Kure city, Hiroshima 737-0023, Japan
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-town, Higashi-hiroshima 739-0036, Japan
| | - Hiroshi Iwamori
- Department of Orthopaedic Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-ku, Hiroshima 730-8562, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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152
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Kouyoumdjian P, Mansour J, Assi C, Caton J, Lustig S, Coulomb R. Current concepts in robotic total hip arthroplasty. SICOT J 2020; 6:45. [PMID: 33258445 PMCID: PMC7705325 DOI: 10.1051/sicotj/2020041] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/16/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Total hip replacement provides mostly fair functional and clinical results. Many factors play an essential role in hip stability and long-term outcomes. Surgical positioning remains fundamental for obtaining accurate implant fit and prevent hip dislocation or impingement. Different categories of robotic assistance have been established throughout the previous years and all of the technologies target accuracy and reliability to reduce complications, and enhance clinical outcomes. MATERIALS AND METHODS An overview is proposed over the principles of robotic assistance in hip arthroplasty surgery. Accuracy, reliability, management of the bone stock, clinical outcomes, constraints and limits of this technology are reported, based on recent literature. RESULTS Potential advantages regarding pre-operative planning accuracy, cup positioning, maintenance of the center of rotation, preservation of an adequate bone stock nay clinical short- and mid-term outcomes are balanced with some reported disadvantages and limits like hip anatomical specificity, cost-effectiveness, engineering dependence. DISCUSSION The use of robotic-assisted THA presents clear and evident benefits related to accurate implant positioning and maintenance of a minimal bone while allowing. For some authors, an early improvement in functional results and patient's recovery. This technology demonstrated a shorter surgical time and a short learning curve required to optimize its use and this technology presents promising outcomes and results and potential use in routine clinical application but its limitation of use is still present especially the cost of the robot, the need for the presence of an engineer during the surgery, its availability of use in all hospitals as well as the difficulty presented in dysplastic or dysmorphic hip joints.
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Affiliation(s)
- Pascal Kouyoumdjian
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Centre Hospitalo-universitaire de Nîmes Rue du Pr. Robert Debré 30029 Nîmes France
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Université Montpellier 1 2 Rue de l’École de Médecine 34090 Montpellier France
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Laboratoire de Mécanique et Génie Civile (LMGC), CNRS-UM1 860 Rue de St-Priest 34090 Montpellier France
| | - Jad Mansour
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Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital Beirut Lebanon
| | - Chahine Assi
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Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital Beirut Lebanon
| | | | - Sebastien Lustig
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Centre Albert-Trillat, CHU Lyon Croix-Rousse, Hospices Civils de Lyon 69004 Lyon France
| | - Remy Coulomb
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Centre Hospitalo-universitaire de Nîmes Rue du Pr. Robert Debré 30029 Nîmes France
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Université Montpellier 1 2 Rue de l’École de Médecine 34090 Montpellier France
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153
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Inagaki K, Iida S, Miyamoto S, Suzuki C, Nakatani T, Shinada Y, Kawarai Y, Hagiwara S, Nakamura J, Orita S, Ohtori S. Natural history of noise and squeaking in cementless ceramic-on-ceramic total hip arthroplasty. J Orthop 2020; 21:544-549. [PMID: 33029042 DOI: 10.1016/j.jor.2020.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/13/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Ceramic-on-ceramic (COC) total hip arthroplasty (THA) was developed to reduce wear debris, and consequently the occurrence of osteolysis and aseptic loosening. The purpose of the present study was to determine the incidence and natural history of noise including squeaking after COC THA, and to clarify whether clinical outcomes and any demographic and implant-related factors are associated with noise from these ceramic bearings. Methods This was a retrospective observational study of 137 primary COC THAs between 2004 and 2009 at our institute. The Mean follow-up was for 10.5 years. All patients were followed up with an office visit to obtain information regarding noise, pain, and function. The correlations between the noise, and patient demographic, radiographic, and implant-related factors were evaluated. Results Noise developed in 30 hips (21.9%), specifically squeaking in 2 (1.5%) of the 137 hips during the follow-up period. Noise including squeaking was not associated with pain or functional outcomes. There was significant correlation between noise and cup anteversion, in that cup anteversion of patients with noise was smaller than that in those without noise. No significant correlation was found between noise and any other patient demographic including age, sex, height, body weight, or body mass index. Kaplan-Meier survivorship analysis with revision for any reason and an aseptic loosening of either component as the end point, revealed a cumulative survival rate at 10 years of 98.4% and 99.1% respectively. Conclusion The long-term clinical and radiographic outcome of cementless COC THA is excellent, but we should be vigilant for noise from COC bearings.
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Affiliation(s)
- Kenta Inagaki
- Department of Orthopaedic Surgery, Matsudo City General Hospital. 993-1 Sendabori, Matsudo City, Chiba, 270-2296, Japan
| | - Satoshi Iida
- Department of Orthopaedic Surgery, Matsudo City General Hospital. 993-1 Sendabori, Matsudo City, Chiba, 270-2296, Japan
| | - Shuichi Miyamoto
- Department of Orthopaedic Surgery, Matsudo City General Hospital. 993-1 Sendabori, Matsudo City, Chiba, 270-2296, Japan
| | - Chiho Suzuki
- Department of Orthopaedic Surgery, Matsudo City General Hospital. 993-1 Sendabori, Matsudo City, Chiba, 270-2296, Japan
| | - Takushi Nakatani
- Department of Orthopaedic Surgery, Matsudo City General Hospital. 993-1 Sendabori, Matsudo City, Chiba, 270-2296, Japan
| | - Yoshiyuki Shinada
- Department of Orthopaedic Surgery, Matsudo City General Hospital. 993-1 Sendabori, Matsudo City, Chiba, 270-2296, Japan
| | - Yuya Kawarai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University. 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Shigeo Hagiwara
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University. 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Junichi Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University. 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Sumihisa Orita
- Chiba University Center for Frontier Medical Engineering, Department of Orthopaedic Surgery, Chiba University Division of Spine Surgery, Chiba University 1-8-1 Inohana Chuo-ku, Chiba, 260-8670, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University. 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
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154
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Yeh KL, Wu TY, Ma HH, Hou SM, Liaw CK. Ellipse method for measuring Liaw's anteversion of the acetabular component after total hip arthroplasty. BMC Musculoskelet Disord 2020; 21:667. [PMID: 33032565 PMCID: PMC7545546 DOI: 10.1186/s12891-020-03669-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several cup anteversion measurements for post-operative total hip arthroplasty (THA) surgery have been described. We developed the standardized Liaw's trigonometric method to eliminate the influence of patient position, which is the most accurate method for cup anteversion measurement. We then developed an ellipse method using the Elliversion software and reported an interobserver error reduction in 2013. In this study, we attempted to apply this ellipse method in the clinic and compared its accuracy with the standard trigonometric version. METHODS In the present study, we attempted to incorporate the ellipse method with Liaw's standardized anteversion in the simulated cup position. We measured standardized Liaw's anteversion for 434 radiographs in the clinic using the ellipse method. Repeated standard deviation (RSD) was calculated for accuracy evaluation. Furthermore, paired t-test was used for comparison with the interobserver and intraobserver errors. RESULTS We found that the standardized Liaw's anteversion measured using the ellipse method showed lower RSD than the radiographic version. RSD was 0.795 in the standardized Liaw's anteversion with ellipse method group. The p-values of the paired t-test were all higher than 0.05 when measuring the interobserver and intraobserver errors. It indicated that the ellipse method was a precise and simple tool for cup anteversion measurement. CONCLUSION We believe that this ellipse measurement can assist surgeons while placing the acetabulum cup into the precise position and enable early diagnosis of acetabulum loosening.
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Affiliation(s)
- Kuei-Lin Yeh
- Department of Orthopedics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, 11101, Taiwan
| | - Tai-Yin Wu
- Department of Family Medicine, Zhongxing Branch, Taipei City Hospital, Taipei City, 10341, Taiwan.,Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei City, 10055, Taiwan.,National Taipei University of Nursing and Health Science, Taipei City, 11219, Taiwan
| | - Hsuan-Hsiao Ma
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, 11217, Taiwan.,Department of Orthopedics, School of Medicine, National Yang-Ming University, Taipei, 11221, Taiwan
| | - Sheng-Mou Hou
- Department of Orthopedics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, 11101, Taiwan
| | - Chen-Kun Liaw
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, 11031, Taiwan. .,Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe Dist, New Taipei City, 23561, Taiwan. .,Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering; Research Center of Biomedical Device, Taipei Medical University, Taipei City, 11301, Taiwan.
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155
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Taniguchi N, Jinno T, Endo H, Wako M, Tatsuno R, Ochiai S, Haro H. Improvement of locomotive syndrome after total hip arthroplasty: A two-year longitudinal cohort study. Mod Rheumatol 2020; 31:1050-1058. [PMID: 32924686 DOI: 10.1080/14397595.2020.1823552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Patients requiring total hip arthroplasty (THA) may possibly have locomotive syndrome (LS). Therefore, we investigated changes of LS in patients undergoing THA and clarified key factors that affected LS stage. METHODS A prospective cohort study was conducted with 88 patients undergoing THA (74 females, 14 males, mean age: 67.6 years). Data collected using LS stage, stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale results were evaluated before THA, and 6 months, 1 year, and 2 years after THA. Key factors were determined using multivariate analysis and receiver operating characteristic (ROC) curve analysis. RESULTS Before THA, all patients had fallen LS (stage1: 3.4% and stage2: 96.6%). Overall, 56.8% patients improved their LS stage, and 17.0% of patients overcame LS at 2 years after THA. The key factors that affected LS stage were preoperative two-step test and age. ROC analyses showed a preoperative two-step test score of 0.988 and an age of 67.5 years as a cut-off value for the change of LS stage. CONCLUSIONS Patients experiencing LS due to hip disorders have the potential to recover after THA. Additional postoperative training may be beneficial for patients with low preoperative two-step test scores to improve their LS stage.
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Affiliation(s)
- Naofumi Taniguchi
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan.,Department of Rehabilitation Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tetsuya Jinno
- Second Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Hiroshi Endo
- Department of Rehabilitation Medicine, University of Yamanashi, Yamanashi, Japan
| | - Masanori Wako
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan
| | - Rikito Tatsuno
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan
| | - Satoshi Ochiai
- Department of Orthopaedic Surgery, Kofu National Hospital, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, University of Yamanashi, Yamanashi, Japan
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156
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Kim JT, Kim HS, Lee YK, Ha YC, Koo KH. Total Hip Arthroplasty With Trochanteric Ostectomy for Patients With Angular Deformity of the Proximal Femur. J Arthroplasty 2020; 35:2911-2918. [PMID: 32473769 DOI: 10.1016/j.arth.2020.04.099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) of patients with a proximal femoral deformity is technically demanding. This deformity poses the risk of femoral fracture or perforation; stem malposition; and failed stem fixation. To insert a femoral stem in neutral position with a good fit, we removed the greater trochanter in case of a varus deformity, and the lesser trochanter in case of valgus deformity, while performing THA. We aimed to evaluate stem position, implant stability, clinical results, and radiological changes after THAs using this technique. METHODS Fifteen patients (17 hips; 11 varus hips and 6 valgus hips) underwent cementless THA using the trochanteric osteotomy technique in one institution. We evaluated procedure-specific complications: intraoperative femoral fracture, stem malposition, weakness of the abductor power and limp. Modified Harris Hip Score, radiological changes, and the stability of stems were assessed at a mean of 7.1 years of follow-up (range 2.0-15.5). RESULTS Femoral fracture occurred during the insertion of the stem in 4 hips. All stems were aligned in neutral position. At the latest follow-up, the mean power of the abductor was 4.3 (range 3-5). Eleven patients had slight limp and 4 patients had moderate limp. All stems had bone-ingrown stability and no stem was revised. The mean modified Harris Hip Score improved from 50 points at the preoperative evaluation to 81 points at the final follow-up. CONCLUSION The trochanteric excision enabled neutral insertion of cementless stem in patients with varus/valgus deformity of the proximal femur, and THA using this technique rendered favorable results.
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Affiliation(s)
- Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Hong Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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157
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Fischer MCM, Tokunaga K, Okamoto M, Habor J, Radermacher K. Preoperative factors improving the prediction of the postoperative sagittal orientation of the pelvis in standing position after total hip arthroplasty. Sci Rep 2020; 10:15944. [PMID: 32994419 PMCID: PMC7524714 DOI: 10.1038/s41598-020-72782-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/02/2020] [Indexed: 11/09/2022] Open
Abstract
The aims of this study were to investigate if the sagittal orientation of the pelvis (SOP) in the standing position changes after total hip arthroplasty (THA) and evaluate what preoperative factors may improve the prediction of the postoperative standing SOP in the context of a patient-specific functional cup orientation. 196 primary THA patients from Japan were retrospectively selected for this study. Computed tomography imaging of the pelvis, EOS imaging of the lower body and lateral radiographs of the lumbar spine in the standing position were taken preoperatively. Common biometrics and preoperative Harris Hip Score were recorded. The EOS imaging in the standing position was repeated three months following THA. A 3D/2.5D registration process was used to determine the standing SOP. Thirty-three preoperative biometric, morphological and functional parameters were measured. Important preoperative parameters were identified that significantly improve the prediction of the postoperative standing SOP by using multiple linear LASSO regression. On average, the SOP changed significantly (p < 0.001) between the preoperative and postoperative standing position three months after THA by 3° ± 4° in the posterior direction. The age, standing lumbar lordosis angle (LLA) and preoperative supine and standing SOP significantly (p < 0.001) improve the prediction of the postoperative standing SOP. The linear regression model for the prediction of the postoperative standing SOP is significantly (p < 0.001) improved by adding the parameters preoperative standing SOP and LLA, in addition to the preoperative supine SOP, reducing the root mean square error derived from a leave-one-out cross-validation by more than 1°. The mean standing SOP in Japanese patients changes already three months after THA in comparison to the preoperative value. The preoperative factors age, LLA, supine and standing SOP can significantly improve the prediction of the postoperative standing SOP and should be considered within the preoperative planning process of a patient-specific functional cup orientation.
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Affiliation(s)
- Maximilian C M Fischer
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany.
| | - Kunihiko Tokunaga
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City, Japan
| | - Masashi Okamoto
- Department of Radiology, Kameda Daiichi Hospital, Niigata City, Japan
| | - Juliana Habor
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Klaus Radermacher
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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158
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Impact of spinal alignment and stiffness on impingement after total hip arthroplasty: a radiographic study of pre- and post-operative spinopelvic alignment. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:2443-2449. [PMID: 32918604 DOI: 10.1007/s00586-020-06589-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/11/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Recent studies have revealed the impact of spinopelvic factors on the risk of dislocation after total hip arthroplasty (THA). This study examined the risk factors of impingement that can lead to dislocation using pre- and postoperative spinopelvic radiographs. METHODS We studied 143 consecutive patients with end-stage hip osteoarthritis who were eligible for THA at our institute. Pre-operative pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), sagittal vertical axis (SVA) in the standing and sitting position, and centre-edge angle (CE) were measured. The post-operative SS, LL, SVA, femoral shaft angle, and radiographic alignment of the acetabular component were also measured. We performed a multiple linear regression analysis to determine the risk factors for anterior and posterior impingement using pre-operative demographic and radiographic parameters. The clearance of anterior and posterior implant impingement was used for the surrogate-dependent variable for dislocation. RESULTS A total of 95 patients were included in the analysis. There were significant differences in SS, LL, and SVA between the standing and sitting positions (P < 0.001). A multiple linear regression analysis showed that the PI-LL, LL changes, and CE were associated with the posterior impingement (β = - 0.21, 0.24, and -0.27, respectively). Moreover, PI-LL was also associated with the anterior impingement in the sitting position (β = - 0.27). CONCLUSION Our results suggest that a flatback with a rigid spine leads to posterior impingement, and a well-balanced spine leads to anterior impingement, which can be a potential risk factor for dislocation.
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159
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[Intraoperative assessment of pelvic tilt and cup position in total hip arthroplasty: the relevance of navigation and robotics]. DER ORTHOPADE 2020; 49:893-898. [PMID: 32909050 DOI: 10.1007/s00132-020-03978-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The optimal 3D positioning of the prosthesis components is of great importance for the stability and function of a total hip endoprosthesis. Pelvic tilt has a particular influence on the position of the implant. In order to use intraoperatively the knowledge on pelvic kinematics gained through preoperative imaging procedures and movement analyses, "image-based" and "image-free" robotic and navigation procedures are available. With the "image-based" procedures, a 3D CT scan serves as the surgeon's basis for operative planning. The "image-free" procedures are based on the principles of stereotaxy. In the future, information about static and dynamic pelvic tilt will be conntected with navigation and robotic systems for total hip arthroplasty. Along with intraoperative data a patientindividual optimized implant position can be achieved.
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160
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Jackson JB, Martin JR, Christal A, Masonis JL, Springer BD, Mason JB. The Direct Anterior Approach Total Hip Arthroplasty Reliably Achieves "Safe Zones" for Combined Anteversion. Arthroplast Today 2020; 6:651-654. [PMID: 32875014 PMCID: PMC7451890 DOI: 10.1016/j.artd.2020.07.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/19/2020] [Accepted: 07/11/2020] [Indexed: 11/26/2022] Open
Abstract
Background In total hip arthroplasty (THA), component position is critical to avoid instability and improve longevity. Appropriate combined femoral and acetabular component anteversion is important for improved THA stability and increased impingement-free range of motion. In direct anterior THA (DA-THA), concern has been expressed regarding the accuracy of femoral component positioning. This study seeks to quantify acetabular, femoral, and combined component orientation relative to the accepted “safe zones” in patients who have undergone DA-THA. Methods Twenty-nine patients who had THA performed via direct anterior approach had postoperative computerized tomography scans done to assess femoral anteversion. Stem rotational alignment was measured relative to the transepicondylar axis (TEA) and the posterior condylar axis (PCA) of the femur at the knee. Acetabular abduction and version were recorded on anteroposterior pelvis radiographs. Results The mean stem anteversion was 17.5° (standard deviation = 10.8°) from the TEA and 21.7° (standard deviation = 11.3°) from the PCA. Ten of 30 cups were appropriately anteverted; however, all the cups had appropriate abduction. Combined version when using the TEA resulted in 79% (23/29) of patients within the “safe zone” of 25°-50°. Pearson correlation coefficients were high for both stem anteversion from the TEA (R = 0.96) and PCA (R = 0.98); however, interobserver reliability for combined component anteversion was greater for the TEA (kappa, 0.83 vs 0.65). Conclusions Combined anteversion within the “safe zone” was achieved 79% of the time with DA-THA. Interestingly, most of the “excessive” combined anteversion appears to be related to increased anteversion of the acetabular component with only 10 patients within the acetabular cup “safe zone” of 5°-25°.
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161
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Inaccurate offset restoration in total hip arthroplasty results in reduced range of motion. Sci Rep 2020; 10:13208. [PMID: 32764592 PMCID: PMC7413373 DOI: 10.1038/s41598-020-70059-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 07/14/2020] [Indexed: 02/08/2023] Open
Abstract
Offset restoration in total hip arthroplasty (THA) is associated with postoperative range of motion (ROM) and gait kinematics. We aimed to research into the impact of high offset (HO) and standard stems on postoperative ROM. 121 patients received cementless THA through a minimally-invasive anterolateral approach. A 360° hip ROM analysis software calculated impingement-free hip movement based on postoperative 3D-CTs compared to ROM values necessary for activities of daily living (ADL). The same model was then run a second time after changing the stem geometry between standard and HO configuration with the implants in the same position. HO stems showed higher ROM for all directions between 4.6 and 8.9° (p < 0.001) compared with standard stems but with high interindividual variability. In the subgroup with HO stems for intraoperative offset restoration, the increase in ROM was even higher for all ROM directions with values between 6.1 and 14.4° (p < 0.001) compared to offset underrestoration with standard stems. Avoiding offset underrestoration resulted in a higher amount of patients of over 20% for each ROM direction that fulfilled the criteria for ADL (p < 0.001). In contrast, in patients with standard stems for offset restoration ROM did increase but not clinically relevant by offset overcorrection for all directions between 3.1 and 6.1° (p < 0.001). Offset overcorrection by replacing standard with HO stems improved ROM for ADL in a low number of patients below 10% (p > 0.03). Patient-individual restoration of offset is crucial for free ROM in THA. Both over and underrestoration of offset should be avoided.
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Kobayashi D, Choe H, Kobayashi N, Tezuka T, Ike H, Inaba Y. Association of Femoral Rotation With Whole-Body Alignment in Patients Who Underwent Total Hip Arthroplasty. Arthroplast Today 2020; 6:532-537. [PMID: 32743036 PMCID: PMC7387674 DOI: 10.1016/j.artd.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/06/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022] Open
Abstract
Background Although rotational changes in lower limb alignment after total hip arthroplasty (THA) affect functional stem anteversion, less is known about the effects of femoral rotational alignment in the standing position. This study investigated postoperative changes in femoral rotation and evaluated the association with whole-body alignment in patients who underwent THA. Methods Sixty-five patients with unilateral hip osteoarthritis who underwent THA were enrolled. Preoperative and postoperative femoral rotation in the standing and supine positions were measured using EOS 2D/3D X-ray imaging system and computed tomography. Negative and positive changes in femoral rotation angle were indicative of internal and external rotation, respectively. The associations between femoral rotation and preoperative clinical and radiological factors were investigated. Results Femoral rotation showed significant internal changes in both the standing (-4.7° ± 11.0°) and supine (-3.5°± 10.9°) positions after THA. The preoperative femoral rotation angle, knee flexion angle, sagittal vertical axis (SVA), lumbar lordosis, body mass index, age, and internal and external rotation angles of the hip range of motion on the contralateral side were significantly correlated with femoral rotation in the standing position after THA. Multiple regression analysis showed that preoperative femoral rotation (β = 0.416, P < .001) and SVA (β = 0.216, P = .040) were significant predictors of postoperative femoral rotation in the standing position. Conclusions Femoral rotation had significant association with the patient-inherent posture represented by the SVA in the standing position. Because extensive external change of femoral rotation may increase the risk of hip impingement and dislocation, careful attention is required in patients with external femoral rotation and forward bent posture in the preoperative standing position.
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Affiliation(s)
- Daigo Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Hyonmin Choe
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Naomi Kobayashi
- Department of Orthopedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Taro Tezuka
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
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Widmer KH. The Impingement-free, Prosthesis-specific, and Anatomy-adjusted Combined Target Zone for Component Positioning in THA Depends on Design and Implantation Parameters of both Components. Clin Orthop Relat Res 2020; 478:1904-1918. [PMID: 32732575 PMCID: PMC7371099 DOI: 10.1097/corr.0000000000001233] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/04/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lewinnek's recommendation for orienting the cup in THA is criticized because it involves a static assessment of the safe zone and because it does not consider stem geometry. A revised concept of the safe zone should consider those factors, but to our knowledge, this has not been assessed. QUESTIONS/PURPOSES (1) To determine the shape, size, and location of target zones for combined cup and stem orientation for a straight stem/hemispheric cup THA to maximize the impingement-free ROM and (2) To determine whether and how these implant positions change as stem anteversion, neck-shaft angle, prosthetic head size and target range of movements are varied. METHODS A three-dimensional computer-assisted design model, in which design geometry was expressed in terms of parameters, of a straight stem/hemispheric cup hip prosthesis was designed, its design parameters modified systematically, and each prosthesis model was implanted virtually at predefined component orientations. Functional component orientation referencing to body planes was used: cups were abducted from 20° to 70°, and anteverted from -10° to 40°. Stems were rotated from -10° to 40° anteversion, neck-shaft angles varied from 115° to 143°, and head sizes varied from 28 to 40 mm. Hip movements up to the point of prosthetic impingement were tested, including simple flexion/extension, internal/external rotation, ab/adduction, combinations of these, and activities of daily living that were known to trigger dislocation. For each combination of parameters, the impingement-free combined target zone was determined. Maximizing the size of the combined target zone was the optimization criterion. RESULTS The combined target zones for impingement-free cup orientation had polygonal boundaries. Their size and position in the diagram changed with stem anteversion, neck-shaft angle, head size, and target ROM. The largest target zones were at neck-shaft angles from 125° to 127°, at stem anteversions from 10° to 20°, and at radiographic cup anteversions between 17° and 25°. Cup anteversion and stem anteversion were inverse-linearly correlated supporting the combined-anteversion concept. The range of impingement-free cup inclinations depended on head size, stem anteversion, and neck-shaft angle. For a 127°-neck-shaft angle, the lowest cup inclinations that fell within the target zone were 42° for the 28-mm and 35° for the 40-mm head. Cup anteversion and combined version depended on neck-shaft angle. For head size 32-mm cup, anteversion was 6° for a 115° neck-shaft angle and 25° for a 135°-neck-shaft angle, and combined version was 15° and 34° respectively. CONCLUSIONS The shape, size, and location of the combined target zones were dependent on design and implantation parameters of both components. Changing the prosthesis design or changing implantation parameters also changed the combined target zone. A maximized combined target zone was found. It is mandatory to consider both components to determine the accurate impingement-free prosthetic ROM in THA. CLINICAL RELEVANCE This study accurately defines the hypothetical impingement-free, design-specific component orientation in THA. Transforming it into clinical precision may be the case for navigation and/or robotics, but this is speculative, and as of now, unproven.
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Affiliation(s)
- Karl-Heinz Widmer
- K.-H. Widmer, Medical Faculty University of Basel, Basel, Switzerland
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164
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Nakahara I, Kyo T, Kuroda Y, Miki H. Does difference in stem design affect accuracy of stem alignment in total hip arthroplasty with a CT-based navigation system? J Artif Organs 2020; 24:74-81. [PMID: 32710390 DOI: 10.1007/s10047-020-01196-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
The efficacy of a computed tomography (CT)-based navigation system to accurately position the stem for intended alignment is unclear. In addition, the influence of stem design on the accuracy of insertion is unknown. We therefore retrospectively compared the accuracy and precision for the intended alignment of two different designs of femoral stem which were implanted with or without the navigation system. Forty-nine total hip arthroplasties (THAs) using a tapered wedge stem and 91 THAs using an anatomic stem were evaluated for the navigation group. Thirty-three THAs using the tapered wedge stem and 15 THAs using the anatomic stem were controls for the non-navigation group. Differences between postoperative measurement and preoperative planning were compared among the groups. In the navigation groups, accuracy (mean absolute difference) and precision (95% limits of agreement) of stem anteversion were 4.3° and ± 10.1° in the tapered wedge stem and 3.1° and ± 6.9° in the anatomic stem. In the non-navigation groups, these were 6.0° and ± 15.2° and 4.8° and ± 12.4°, respectively. The accuracy and precision in the navigation groups were significantly superior to those in the non-navigation group, and those in the anatomic stem group were significantly superior to those in the tapered wedge group. Using the CT-based navigation system, the accuracy and precision for intended stem anteversion were improved. When compared under guidance of navigation system, the accuracy and precision for intended stem anteversion in the anatomic stem were superior to those in the tapered wedge stem.
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Affiliation(s)
- Ichiro Nakahara
- Department of Orthopaedic Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 5400006, Japan.
| | - Takayuki Kyo
- Department of Orthopaedic Surgery, Bellland General Hospital, 500-3 Higashiyama, Naka-ku, Sakai-city, Osaka, 5998247, Japan
| | - Yasuo Kuroda
- Department of Orthopaedic Surgery, Suita Municipal Hospital, 5-7 Kishibeshinmachi, Suita-city, Osaka, 5648567, Japan
| | - Hidenobu Miki
- Department of Orthopaedic Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 5400006, Japan
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165
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Achievement of optimal implant alignment using taper wedge stems with cup-first THA through the MIS antero-lateral approach. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1505-1514. [PMID: 32638123 DOI: 10.1007/s00590-020-02696-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/06/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE Combined anteversion (CA) technique (stem-first procedure) has become generally accepted as an ideal means to achieve optimal CA value in THA. However, we hypothesized that CA technique for patients with various native femoral anteversions could pose a risk of anterior or posterior cup protrusion. In the present study, we examined whether it is possible to use the taper wedge stem to change the stem version to achieve optimal CA while avoiding cup protrusions with the cup-first procedure through minimally invasive (MIS) antero-lateral approach. METHODS Eighty-one patients underwent cup-first THA with a taper wedge stem. The acetabular cup was placed following the preoperative planning of the cup alignment to avoid anterior cup protrusions using CT-based navigation. Following the CA theory, anteversion of the taper wedge stem was changed to the target anteversion from the patient's native femoral anteversion. The native femoral anteversion, the change in version angle of the stem, postoperative CA and the length of anterior cup protrusions were evaluated in postoperative CT measurements. RESULTS The native femoral anteversion averaged 25.7° ± 8.9° (range 8°-45°). Cases with increased and decreased stem anteversion were observed in 42 hips (51.8%) and 33 hips (40.7%), respectively. The amount of increased and decreased version angles averaged 7.7° ± 4.8° (range 2°-21°) and 7.8° ± 5.1° (range 2°-20°), respectively. Postoperative CA values averaged 36.7° ± 3.4° (range 29.4°-44.2°) and anterior cup protrusion length averaged 2.0 mm ± 2.6 mm (0 ~ 8.8 mm) in axial view and 0.4 mm ± 1.0 mm (0 ~ 3.6 mm) in sagittal view. Anterior cup protrusion of more than 10 mm was not observed in any hips. CONCLUSION This procedure can be considered as an option to achieve optimal CA anteversion while avoiding anterior cup protrusion in THA.
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166
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Hayashi S, Hashimoto S, Takayama K, Matsumoto T, Kamenaga T, Fujishiro T, Hiranaka T, Niikura T, Kuroda R. Evaluation of the accuracy of acetabular cup orientation using the accelerometer-based portable navigation system. J Orthop Sci 2020; 25:612-617. [PMID: 31619323 DOI: 10.1016/j.jos.2019.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/14/2019] [Accepted: 09/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Accurate orientation of acetabular and femoral components is important during total hip arthroplasty (THA). In recent years, several navigation systems have been developed. However, these navigation systems for THA are unpopular worldwide because of their high cost. We assessed the orientation accuracy of cups inserted using a disposable accelerometer-based portable navigation system for THAs. METHODS This was a prospective cohort study. We analyzed 63 hips with navigation prospectively and 30 hips without navigation retrospectively as historical control. The patients underwent THA via the mini anterolateral approach in the supine position using an accelerometer-based portable navigation system. We compared the preoperative target angles, intraoperative cup angles using navigation records, postoperative angles using postoperative CT data, measurement errors of cup angles, and clinical parameters such as sex, treated side, age at surgery, and body mass index (BMI). RESULTS The average absolute error (postoperative CT-navigation record) was 2.7 ± 2.1° (inclination) and 2.7 ± 1.8° (anteversion), and the absolute error (postoperative CT-preoperative target angle) was 2.6 ± 1.9° (inclination) and 2.7 ± 2.2° (anteversion). The absolute error between postoperative CT and target angle with navigation was significantly lower than the error without navigation (inclination; p = 0.025, anteversion; p = 0.005). Cup malalignment (absolute difference of inclination or anteversion between postoperative CT and preoperative target angle of over 5°) was significantly associated with BMI value (OR: 1.3, 95% CI: 1.1-1.7). The absolute measurement error of cup inclination and anteversion was significantly correlated with patients' BMI (inclination error: correlation coefficient = 0.53, p < 0.001, anteversion error: correlation coefficient = 0.58, p < 0.001). CONCLUSIONS The clinical accuracy of accelerometer-based portable navigation is precise for the orientation of cup placement, although accurate cup placement was affected by high BMI. This is the first study to report the accuracy of accelerometer-based portable navigation for THA in the supine position.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe Univ. Graduate School of Med., Kobe, Japan.
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe Univ. Graduate School of Med., Kobe, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe Univ. Graduate School of Med., Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe Univ. Graduate School of Med., Kobe, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe Univ. Graduate School of Med., Kobe, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery, Takatsuki General Hospital, Osaka, Japan
| | - Takafumi Hiranaka
- Department of Orthopaedic Surgery, Takatsuki General Hospital, Osaka, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe Univ. Graduate School of Med., Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe Univ. Graduate School of Med., Kobe, Japan
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167
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Belzunce MA, Henckel J, Di Laura A, Hart A. Uncemented femoral stem orientation and position in total hip arthroplasty: A CT study. J Orthop Res 2020; 38:1486-1496. [PMID: 32056292 DOI: 10.1002/jor.24627] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/09/2020] [Accepted: 02/11/2020] [Indexed: 02/04/2023]
Abstract
In total hip arthroplasty (THA), accurate positioning of components is important for the functionality and long life of the implant. Femoral component version has been underinvestigated when compared with the acetabular cup. Accurate prediction of the femoral version on the preoperative plan is particularly important because a well-fitting uncemented stem will, by definition, press-fit into a version that is dictated by the anatomy of the proximal femur. A better understanding of this has recently become an unmet need because of the increased use of uncemented stems and of preoperative image-based planning. We present the first, three-dimensional (3D) comparison between the planned and achieved orientation and position of the femoral components in THA. We propose a comparison method that uses the 3D models of a, computed tomography-generated (CT-generated), preoperative plan and a postoperative CT to obtain the discrepancy in the six possible degrees of freedom. We ran a prospective study (level 2 evidence) of 30 patients undergoing uncemented THA to quantify the discrepancy between planned and achieved femoral stem orientation and position. The discrepancy was low for femoral stem vertical position and leg length, and varus-valgus and anterior-posterior orientation. The discrepancy was higher for femoral version with a mean (±SD) of -1.5 ± 7.8 deg. Surgeons should be aware of the variability of the eventual position of uncemented stems in THA and acknowledge the risk of achieving a less-than-optimal femoral version, different from the preoperative 3D CT plan.
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Affiliation(s)
- Martin A Belzunce
- Institute of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Johann Henckel
- Institute of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Anna Di Laura
- Institute of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Alister Hart
- Institute of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK.,Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, UK
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168
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Ike H, Bodner RJ, Lundergan W, Saigusa Y, Dorr LD. The Effects of Pelvic Incidence in the Functional Anatomy of the Hip Joint. J Bone Joint Surg Am 2020; 102:991-999. [PMID: 32496744 DOI: 10.2106/jbjs.19.00300] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The spine-pelvis-hip interaction during postural change should be considered in the functional anatomy of the hip. The component parts of this anatomy and how they influence hip function are important to know. Pelvic incidence (PI) is one of these components. We studied if PI was preoperatively predictive of impingement risk and if it postoperatively influences hip position, which could cause outliers from the functional safe zone of hip replacement. METHODS This was a prospective radiographic study of 187 consecutive patients (200 hips) who had lateral spinopelvis-hip radiographs before and after primary total hip arthroplasty with measurements of the component factors that influence mobility and position of the functional anatomy. The predictive value of PI for risk of impingement of the hip and its postoperative relationship to functional safe-zone outliers were assessed. Forty-one dislocations from our clinical practice were also reviewed. RESULTS Of 200 hips, the PI was normal in 145 hips (73%), low in 18 hips (9%), and high in 37 hips (19%). Eighty-two hips had spinopelvic imbalance: 12 (67%) of the 18 hips with low PI, 56 (39%) of the 145 hips with normal PI, and 14 (38%) of the 37 hips with high PI. Low-PI hips was the most predictive of the risk of impingement and postoperatively these hips had the most outliers from the functional safe zone. CONCLUSIONS PI is an anatomical component that is predictive of both impingement risk and functional safe-zone outliers. Preoperative risk, based on factors such as the Lewinnek zones and combined anteversion, is an established guide in determining cup position in hip replacement. Low-PI hips that have the "terrible triad" of a posteriorly tilted pelvis, stiff pelvic mobility, and increased femoral flexion therefore have no functional safe zone. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hiroyuki Ike
- Departments of Orthopaedic Surgery (H.I.) and Biostatistics (Y.S.), Yokohama City University School of Medicine, Yokohama, Japan
| | | | | | - Yusuke Saigusa
- Departments of Orthopaedic Surgery (H.I.) and Biostatistics (Y.S.), Yokohama City University School of Medicine, Yokohama, Japan
| | - Lawrence D Dorr
- Dorr Institute for Arthritis Research and Education, Pasadena, California
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Perazzini P, Trevisan M, Sembenini P, Alberton F, Laterza M, Marangon A, Magnan B. The Mako ™ robotic arm-assisted total hip arthroplasty using direct anterior approach: surgical technique, skills and pitfals. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:21-30. [PMID: 32555073 PMCID: PMC7944824 DOI: 10.23750/abm.v91i4-s.9659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 12/13/2022]
Abstract
In the last decades many innovations have improved the hip replacement and the hip reconstruction surgery such as the introduction of the robotic-arm assisted surgery associated with the direct anterior approach (DAA). This surgical approach for total hip arthroplasty (THA) is growing in popularity and its effectiveness has been demonstrated to improve patients’ outcomes, especially regarding more accurate implant placement, less post operative pain, faster recovery and lower of prosthesis dislocation risk. The robotic-arm assisted surgery is another really great innovation for the orthopedic surgeons. It allows to create a patient-specific THA pre-operative planning and to perform a much more accurate surgical procedure. This article outlines authors’ surgical technique of performing accurate pre-operative planning and robotic-assisted THA using direct anterior approach based on the experience of 534 patients and to discuss details of this technique. (www.actabiomedica.it)
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Affiliation(s)
| | | | | | | | | | | | - Bruno Magnan
- Department of Orthopedics and Trauma surgery, University of Verona (Italy).
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170
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Watanabe S, Choe H, Kobayashi N, Ike H, Kobayashi D, Higashihira S, Inaba Y. Utility of CT-based navigation in revision total hip arthroplasty for a patient with severe posterior pelvic tilt-case report. BMC Musculoskelet Disord 2020; 21:249. [PMID: 32299412 PMCID: PMC7164195 DOI: 10.1186/s12891-020-03263-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 04/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background Hip dislocation after total hip arthroplasty (THA) or hemi-arthroplasty is a rare but serious complication. Dislocation may be prevented by appropriate positioning of the cup angle of inclination and anteversion. Case presentation This report describes a 66-year-old woman who underwent revision THA using a computer tomography (CT)-based navigation system to treat an anterior dislocation after hemi-arthroplasty due to a severe posterior pelvic tilt. At initial presentation, her sagittal pelvic tilt angle, measured as anterior pelvic plane (APP) in the supine position, was 38 degrees posterior to the coronal plane. Owing to the posterior pelvic tilt, revision THA was performed using CT-based navigation, while dual mobility was utilized to reduce the risk of re-dislocation. Postoperatively, her sagittal pelvic tilt angle showed further progression over time, with an APP of 66 degrees posterior to the coronal plane in the standing position 3 years after revision THA. Simulation with the Zed Hip system showed that the risk of implant-to-implant impingement was much higher posteriorly than anteriorly. Gait analysis demonstrated hyperextension of the hip joint while walking, although hip joint function required for daily activity was maintained. Conclusions Preoperative planning of implant orientation, based on posterior progression of pelvic tilt and accurate placement of components, is important to prevent dislocation in patients with severe posterior pelvic tilt. A dual mobility cup may also improve hip function in these patients.
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Affiliation(s)
- Shintaro Watanabe
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama City, Kanagawa, Japan
| | - Hyonmin Choe
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama City, Kanagawa, Japan.
| | - Naomi Kobayashi
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama City, Kanagawa, Japan
| | - Hiroyuki Ike
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama City, Kanagawa, Japan
| | - Daigo Kobayashi
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama City, Kanagawa, Japan
| | - Syota Higashihira
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama City, Kanagawa, Japan
| | - Yutaka Inaba
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama City, Kanagawa, Japan
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171
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Sahin A, Simsek ME, Gursoy S, Akkaya M, Isik C, Bozkurt M. Three-dimensional analysis of acetabular cup orientation and an evaluation of the relationship with pelvic sagittal parameters. J Orthop Surg (Hong Kong) 2020; 27:2309499019861225. [PMID: 31284813 DOI: 10.1177/2309499019861225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the effect of total hip arthroplasty (THA) on sagittal pelvic parameters and to evaluate the effect of sagittal pelvic parameters on acetabular cup orientation. METHODS The study included 86 patients who underwent THA for a diagnosis of unilateral coxarthrosis between 2011 and 2015. Measurements were taken of the preoperative and postoperative acetabular cup inclination (ACI), anteversion, and sagittal pelvic parameters. The effect of THA on sagittal pelvic parameters and the effects of the sagittal pelvic parameters on acetabular cup orientation were investigated. RESULTS The sagittal pelvic tilt values calculated were mean 9.7° ± 6.3° (2°; 23°) preoperatively and 11.0° ± 6.1° (2°; 25°) postoperatively. The increase in postoperative pelvic incidence (PI) values was determined to be statistically significant (p < 0.05). The preoperative PI values had no significant effect on ACI, but in cases with high preoperative PI values, a tendency to high anteversion values was determined. The mean inclination values were found to be 40.2° ± 11.0° in the low PI group, 41.7° ± 7.4° in the normal PI group, and 44.1° ± 8.3° in the high PI group. As no increase in inclination values was observed with an increase in PI values, no statistical correlation was determined (p = 0.343). Average of anteversion values in the low PI group was 9.2° ± 13.7°, in the normal PI group 19.3° ± 10.5°, and in the high PI group 21.1° ± 12.5°. The difference between the groups was statistically significant (p = 0.001). CONCLUSION Evaluating the results of this study, it can be concluded that varying PI values do affect the acetabular cup anterversion in THA. So, preoperative assessment of PI values is important in preventing postoperative acetabular cup malposition.
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Affiliation(s)
- Ali Sahin
- 1 Department of Orthopedics and Traumatology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Mehmet Emin Simsek
- 2 Department of Orthopedics and Traumatology, Yenimahalle Training and Research Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Safa Gursoy
- 2 Department of Orthopedics and Traumatology, Yenimahalle Training and Research Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Mustafa Akkaya
- 2 Department of Orthopedics and Traumatology, Yenimahalle Training and Research Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Cetin Isik
- 3 Department of Orthopedics and Traumatology, Ataturk Training and Research Hospital, Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Murat Bozkurt
- 4 Department of Orthopedics and Traumatology, Ankara Yildirim Beyazit University, Ankara, Turkey
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172
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Watanabe K, Mitsui K, Usuda Y, Nemoto K. An increase in the risk of excessive femoral anteversion for relatively younger age and types of femoral morphology in total hip arthroplasty with direct anterior approach. J Orthop Surg (Hong Kong) 2020; 27:2309499019836816. [PMID: 30913961 DOI: 10.1177/2309499019836816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Direct anterior approach (DAA) is known to diminish a dislocation risk and widely used for total hip arthroplasty (THA). On the other hand, anterior dislocation due to increasing stem anteversion and cup anteversion is an important complication. METHODS A retrospective analysis of 140 (male/female: 10/130) consecutive patients with 149 hips who had undergone primary THA in the period between 2011 and 2015 was conducted. Factors including age, gender, body mass index (BMI), and primary diagnosis were examined. Radiographic parameters including the Dorr proximal femoral types, cortical thickness index (CTI), canal flare index (CFI), and canal to calcar index were measured. To investigate relationships of combined anteversion (CA) with other factors, a stepwise regression analysis was performed. RESULTS The mean age, BMI, and the follow-up period were 69.5 ± 10.3 years old, 23.4 ± 3.4 kg/m2, and 48.2 ± 13.6 months, respectively. The proximal femurs of the 149 hips were categorized as Dorr type A ( n = 33), type B ( n = 110), and type C ( n = 6). The mean CTI, CFI, and canal to calcar index were 0.56 ± 0.08, 4.15 ± 0.83, and 0.46 ± 0.09, respectively. The mean stem varus angle, radiographic inclination, and radiographic anteversion of the cup were 0.19 ± 1.63, 40.9 ± 6.0°, and 12.7 ± 3.5°, respectively. Stem anteversion measured by computed tomography (CT) axial image was 17.7 ± 12.0°. The mean radiographic inclination, radiographic anteversion (CTRA), and anatomical anteversion analyzed by Kyocera 3-D template were 40.8 ± 7.2°, 19.8 ± 6.6°, and 28.8 ± 10.0°, respectively. Mean CA defined as the sum of stem anteversion and CTRA was 37.5 ± 14.5°. To investigate relationships of CA with other factors, a stepwise regression analysis was performed and resulted in a model with age ( p < 0.001). In the same way, stem anteversion and CTRA were analyzed; only for the stem anteversion, the stepwise selection process resulted in a model with age ( p < 0.001) and the Dorr types ( p = 0.047). CONCLUSION The risk of excessive femoral anteversion increases for relatively younger age and for types of femoral morphology according to the Dorr classification, moreover with an increase of CA in DAA-THA with cementless tapered-wedge stem.
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Affiliation(s)
- Kenya Watanabe
- Department of Orthopedic Surgery, Nagano Prefectural Shinshu Medical Center, Nagano, Japan
| | - Katsuhiro Mitsui
- Department of Orthopedic Surgery, Nagano Prefectural Shinshu Medical Center, Nagano, Japan
| | - Yu Usuda
- Department of Orthopedic Surgery, Nagano Prefectural Shinshu Medical Center, Nagano, Japan
| | - Kazuaki Nemoto
- Department of Orthopedic Surgery, Nagano Prefectural Shinshu Medical Center, Nagano, Japan
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Hsieh CM, Howell SM, Hull ML. Errors in femoral anteversion, femoral offset, and vertical offset following robot-assisted total hip arthroplasty. Int J Med Robot 2020; 16:e2104. [PMID: 32163669 DOI: 10.1002/rcs.2104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 03/03/2020] [Accepted: 03/10/2020] [Indexed: 11/12/2022]
Abstract
The objectives were to determine errors in femoral anteversion (FA), femoral offset (FO), and vertical offset (VO) with robot-assisted total hip arthroplasty (THA) and how consistently these errors are within clinically desirable limits of ±5° and ±5 mm. After preoperative planning, robot-assisted THAs were performed on twelve cadaveric specimens. The error between achieved and planned component placements was used to determine bias (mean error) and precision (SD of error). The percent of the population within clinically desirable limits was determined. Bias of 1.5° and 2.7 mm occurred for FA and VO, respectively. Precision was 1.2° for FA and better than 1.5 mm for FO and VO. The percent of population within clinically desirable limits was at least 95% for FA and at least 99% for FO. With limits of ±7 mm, at least 95% of the population was within these limits for VO. Robot-assisted THA may improve clinical outcomes.
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Affiliation(s)
- Chih-Ming Hsieh
- Department of Biomedical Engineering, University of California, Davis, Sacramento, California, USA
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California, Davis, Sacramento, California, USA
| | - Maury L Hull
- Department of Biomedical Engineering, University of California, Davis, Sacramento, California, USA.,Department of Mechanical Engineering, University of California, Davis, Sacramento, California, USA.,Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
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174
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Nakahara E, Uemura K, Ando W, Hamada H, Takao M, Sugano N. Effect of a modular neck hip prosthesis on anteversion and hip rotation in total hip arthroplasty for developmental dysplasia of the hip. J Artif Organs 2020; 23:255-261. [DOI: 10.1007/s10047-020-01162-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 02/12/2020] [Indexed: 01/25/2023]
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175
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Tagomori H, Kaku N, Tabata T, Kubota Y, Tsumura H. Comparison of cementless and cemented cups in revision total hip arthroplasty using a computed tomography-based navigation system. J Clin Orthop Trauma 2020; 11:S206-S210. [PMID: 32189941 PMCID: PMC7067992 DOI: 10.1016/j.jcot.2019.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 05/10/2019] [Accepted: 05/27/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies comparing cementless and cemented cups are lacking, especially for revision total hip arthroplasty (THA). The aim of this study was to investigate and compare the differences in implant accuracy between two fixation methods in revision THA. METHODS We conducted a retrospective study of 85 hips in 70 patients who underwent revision THA using a computed tomography (CT)-based navigation system. Among these, 53 hips underwent cementless THA and 32 hips underwent cemented THA. We measured cup inclination and anteversion using the Kyocera two-dimensional-template with X-ray (Japan-Kyocera, Shiga, Japan) and stem anteversion with CT. We calculated the combined anteversion [cup anteversion+0.7×stem anteversion]. RESULTS There were no significant differences between the two groups with respect to definitive cup inclination and anteversion. The mean deviations in the inclination and anteversion angle were 40.3 ± 4.3 and 19.6 ± 6.2° in the cementless group and 40.5 ± 3.3 and 17.1 ± 5.1° in the cemented group. There were 11 outliers with respect to the Lewinnek safe zone in the cementless group and two in the cemented group (P = 0.072). Although there was no statistically significant difference, the number of safe zone outliers in the cemented group was less than that in the cementless group. CONCLUSION We conclude that when using a navigation system for revision THA, high precision can be obtained for the cup placement angle with or without cement. However, it seems that a major error in the installation angle of the cup is less likely to occur when using a cemented cup than when using a cementless cup in revision THA with a navigation system.
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Affiliation(s)
| | - Nobuhiro Kaku
- Corresponding author. Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi Yufu city, Oita, 879-5593, Japan.
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176
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Midterm Outcomes and Frequency of Osteolysis of Total Hip Arthroplasty Using Cementless Modular Stem for Asian Patients. J Arthroplasty 2020; 35:811-817. [PMID: 31685396 DOI: 10.1016/j.arth.2019.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/06/2019] [Accepted: 10/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Modular stems are useful for total hip arthroplasty (THA) in anatomically difficult dysplasia. Here, we present mean 6.8-year outcomes of cementless primary THA using S-ROM-A (modified modular stem for Asian patients) femoral prosthesis in anatomically difficult cases. METHODS Charts of 373 patients (461 hips) undergoing THA (mean age, 58 years) were reviewed for clinical evaluation of modified Merle d'Aubigné-Postel score and Kaplan-Meier survivorship with revision for any reason as the end point. For radiographic analysis, 331 patients (412 hips) followed up for ≥5 years were included. Bearing couples were metal-on-metal (n = 145), metal-on-polyethylene (n = 120), and ceramic-on-polyethylene (n = 147). Radiography and multiplanar computed tomography were performed. RESULTS No postoperative dislocation or deep infection occurred. Mean modified Merle d'Aubigné-Postel score improved significantly (10.9 points preoperatively, 16.7 points at last follow-up; P < .001). Cumulative 5- and 10-year stem survival rates were 100% and 84%, respectively (95% confidence interval, 75%-93%). All stems were classified as bone ingrown fixation. Osteolysis occurred in metal-on-metal (42.8%) and metal-on-polyethylene (15.8%) groups. Mean time to osteolysis was ~3 years, with no significant difference between 3 groups (P = .264). In logistic regression, lower cup inclination angle was significantly associated with osteolysis (odds ratio, 0.914; 95% confidence interval, 0.84-0.99; P = .029). CONCLUSION S-ROM-A femoral prosthesis achieved excellent midterm fixation, and the modular system was useful in primary THA with severe deformity. Bearing couples are potentially associated with adverse reactions to metal debris. S-ROM-A with ceramic-on-polyethylene bearing couples may be an option for anatomically difficult THA.
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177
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Mitsutake R, Tanino H, Nishida Y, Higa M, Ito H. A simple angle-measuring instrument for measuring cemented stem anteversion during total hip arthroplasty. BMC Musculoskelet Disord 2020; 21:113. [PMID: 32075628 PMCID: PMC7031998 DOI: 10.1186/s12891-020-3142-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/17/2020] [Indexed: 11/30/2022] Open
Abstract
Background During total hip arthroplasty (THA), the accurate placement of the femoral components is an important determinant of the success of the procedure. This study assessed the accuracy of cemented stem placement using a new angle-measuring instrument. The primary objective was to investigate the accuracy of the intraoperative measurements of cemented stem anteversion obtained using the angle-measuring instrument. Our secondary objective was to evaluate the accuracy of stem positioning performed using the angle-measuring instrument. Methods We compared the intraoperative stem anteversion measurements obtained using the angle-measuring instrument with postoperative stem anteversion measurements obtained using computed tomography in 149 hips (measurement accuracy). We also compared the target angle and postoperative stem anteversion in 105 hips (implantation accuracy). Results The mean amount of intraoperative stem anteversion was 37.9° ± 10.1°, and the mean amount of postoperative stem anteversion was 37.0° ± 10.4°. The mean measurement accuracy was 0.9° ± 6.1°, and the absolute measurement accuracy was 4.9° ± 3.7°. The correlation coefficient for the relationship between the intraoperative and postoperative stem anteversion measurements was 0.824 (p = 0.000). The mean amount of target angle was 37.4° ± 7.6°, and the mean amount of postoperative stem anteversion was 35.9° ± 9.1°. The mean implantation accuracy was 1.4° ± 5.6°, and the mean absolute implantation accuracy was 4.3° ± 3.6°. The correlation coefficient for the relationship between the target angle and postoperative stem anteversion was 0.795 (p = 0.000). Conclusions The angle-measuring instrument measured intraoperative stem anteversion accurately, and cemented stem was implanted accurately during THA with the angle-measuring instrument.
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Affiliation(s)
- Ryo Mitsutake
- Department of Orthopaedic Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510, Japan.
| | - Hiromasa Tanino
- Department of Orthopaedic Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Yasuhiro Nishida
- Department of Orthopaedic Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Masaru Higa
- Department of Mechanical Engineering, University of Hyogo, 2167 Shosha, Himeji, 671-2280, Japan
| | - Hiroshi Ito
- Department of Orthopaedic Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
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178
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Esposito CI, Miller TT, Lipman JD, Carroll KM, Padgett DE, Mayman DJ, Jerabek SA. Biplanar Low-Dose Radiography Is Accurate for Measuring Combined Anteversion After Total Hip Arthroplasty. HSS J 2020; 16:23-29. [PMID: 32015737 PMCID: PMC6974156 DOI: 10.1007/s11420-018-09659-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acetabular component position alone has not been predictive of stability after total hip arthroplasty (THA). Combined anteversion of the acetabulum and femur has the potential of being more predictive of stability. Unfortunately, femoral component position is difficult to measure on plain radiographs. Computed tomography (CT) is the gold standard for measuring implant position post-operatively, but CT exposes patients to a substantial amount of radiation. QUESTIONS/PURPOSES We sought to determine whether biplanar low-dose radiography can be used to accurately measure both acetabular and femoral implant position after THA. METHODS Twenty patients underwent standing low-dose biplanar spine-to-ankle radiographs and supine CT scans 6 weeks after THA. Measurements of acetabular inclination, acetabular anteversion, and femoral anteversion were performed by two blinded observers and compared. RESULTS The average absolute differences between biplanar radiographs and CT scans were 2° ± 2° for acetabular inclination, 3° ± 2° for acetabular anteversion, and 4° ± 4° for femoral anteversion between EOS measurements and CT measurements. Interobserver agreement was good for acetabular inclination, acetabular anteversion, and femoral anteversion (Cronbach's α = 0.90) using biplanar low-dose imaging. CONCLUSION Biplanar radiography is a reliable low-radiation alternative for measuring acetabular inclination, acetabular anteversion, femoral version, and thus combined anteversion compared to CT. Femoral anteversion had the most variability but is still clinically relevant.
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Affiliation(s)
| | - Theodore T. Miller
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Joseph D. Lipman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Kaitlin M. Carroll
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Douglas E. Padgett
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - David J. Mayman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Seth A. Jerabek
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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179
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Palit A, King R, Hart Z, Gu Y, Pierrepont J, Elliott MT, Williams MA. Bone-to-Bone and Implant-to-Bone Impingement: A Novel Graphical Representation for Hip Replacement Planning. Ann Biomed Eng 2020; 48:1354-1367. [PMID: 31970546 PMCID: PMC7089906 DOI: 10.1007/s10439-020-02451-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/06/2020] [Indexed: 01/19/2023]
Abstract
Bone-to-bone impingement (BTBI) and implant-to-bone impingement (ITBI) risk assessment is generally performed intra-operatively by surgeons, which is entirely subjective and qualitative, and therefore, lead to sub-optimal results and recurrent dislocation in some cases. Therefore, a method was developed for identifying subject-specific BTBI and ITBI, and subsequently, visualising the impingement area on native bone anatomy to highlight where prominent bone should be resected. Activity definitions and subject-specific bone geometries, with planned implants were used as inputs for the method. The ITBI and BTBI boundary and area were automatically identified using ray intersection and region growing algorithm respectively to retain the same ‘conical clearance angle’ obtained to avoid prosthetic impingement (PI). The ITBI and BTBI area was then presented with different colours to highlight the risk of impingement, and importance of resection. A clinical study with five patients after 2 years of THA was performed to validate the method. The results supported the study hypothesis, in that the predicted highest risk area (red coloured zone) was completely/majorly resected during the surgery. Therefore, this method could potentially be used to examine the effect of different pre-operative plans and hip motions on BTBI, ITBI, and PI, and to guide bony resection during THA surgery.
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Affiliation(s)
- Arnab Palit
- WMG, The University of Warwick, Coventry, CV4 7AL, UK.
| | - Richard King
- Department of Trauma & Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Zoe Hart
- Optimized Ortho, 17 Bridge Street, Pymble, NSW, 2073, Australia
- Corin Ltd, Corinium Centre, Cirencester, Gloucestershire, GL7 1YJ, UK
| | - Yolanda Gu
- Optimized Ortho, 17 Bridge Street, Pymble, NSW, 2073, Australia
- Corin Ltd, Corinium Centre, Cirencester, Gloucestershire, GL7 1YJ, UK
| | - James Pierrepont
- Optimized Ortho, 17 Bridge Street, Pymble, NSW, 2073, Australia
- Corin Ltd, Corinium Centre, Cirencester, Gloucestershire, GL7 1YJ, UK
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180
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Gu J, Feng H, Feng X, Zhou Y. Degeneration of three or more lumbar discs significantly decreases lumbar spine/hip ROM ratio during position change from standing to sitting in AVN patients before THA. BMC Musculoskelet Disord 2020; 21:39. [PMID: 31954404 PMCID: PMC6969977 DOI: 10.1186/s12891-020-3043-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background Limitations in the lumbar spine movement reduce lumbar vertebral motion and affect spinopelvic kinematics. We studied the influence of lumbar intervertebral disc degeneration on spinofemoral movement, from standing to sitting, in patients undergoing total hip arthroplasty (THA). Methods Of 138 consecutive patients scheduled for THA due to unilateral avascular necrosis (AVN) of the femoral head, those with ≥3 discs with University of California at Los Angeles (UCLA) disc degeneration score > 1 were defined as the lumbar degenerative disc disease (LDD) group, and the remaining patients constituted d the control group. Full body anteroposterior and lateral EOS images in the standing and sitting positions were obtained. Pelvic incidence (PI), L1 slope (L1 s), lumbar lordosis angle (LL), pelvic tilt (PT), sacral slope (SS), femoral slope (Fs), sagittal vertical axis (SVA), hip flexion, lumbar spine flexion, and total spinofemoral flexion were measured on the images and compared between groups. Results No significant between-group differences were observed in the height, weight, body mass index, AVN staging, or PI, SS, and Fs on standing. The LDD group included more females and older patients, had 5° lesser LL, 5° greater PT, and larger SVA. From standing to sitting, the PI remained constant in both groups. Total spinofemoral flexion was 7° less, lumbar spine flexion 16° less, L1 slope change 6° less, and SS change 8° less, and hip flexion was 7° more in the LDD than in the control group. The spine/hip flexion ratio was significantly lower in the LDD group (0.3 versus 0.7; p < 0.001). On regression analysis, the LDD group (p < 0.001) and older age (p = 0.048) but not sex, weight, or height were significant univariate predictors of decreased spine/hip ratio. Conclusions Patients with LDD leant more forward and had a larger pelvis posterior tilt angle on standing and a decreased lumbar spine/hip flexion ratio, with more hip joint flexion, on sitting, to compensate for reduced lumbar spine flexion. Surgeons should be aware that elderly patients with multiple LDD have significantly different spinofemoral movements and increased risk of posterior dislocation post-THA. Preoperative patient identification, intraoperative surgical technique modification, and individualized rehabilitation protocols are necessary.
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181
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Takada R, Jinno T, Miyatake K, Hirao M, Yoshii T, Okawa A. Portable imageless navigation system and surgeon's estimate for accurate evaluation of acetabular cup orientation during total hip arthroplasty in supine position. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:707-712. [PMID: 31925538 DOI: 10.1007/s00590-020-02625-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/08/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND This prospective study aimed to clarify whether this novel device can evaluate the cup orientation during total hip arthroplasty (THA) more closely to that measured in postoperative computed tomography (CT) compared to the surgeon's estimate using a manual goniometer. METHODS We prospectively performed 30 cementless THAs via the anterolateral approach in supine position between October 2018 and July 2019, wherein cup orientation was evaluated by both a portable imageless navigation system (HipAlign) and a manual goniometer during surgeries. Primary outcome was the absolute estimate error [the absolute value of the difference between cup angles measured by postoperative CT and those measured by HipAlign (group H) or surgeon's estimate using the manual goniometer (group S) during surgery]. The number of outliers of the absolute estimate error (> 10°) in each group was also estimated. RESULTS The absolute estimate error of cup inclination in groups H and S was 3.3° ± 2.7° and 3.0° ± 2.5°, respectively (p = 0.51), whereas that of cup anteversion was 3.8° ± 3.4° and 6.0° ± 3.7°, respectively (p = 0.0008). The number of outliers of the estimate error in groups H and S was one case (3.3%) and six cases (20.0%), respectively (p = 0.04). In all six outlier cases, surgeons underestimated cup anteversion during surgeries. CONCLUSIONS This portable imageless navigation system was a useful method, especially for avoiding incorrect cup anteversion. Underestimation of cup anteversion during THA in the supine position with the conventional alignment assisting device should be given attention.
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Affiliation(s)
- Ryohei Takada
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kazumasa Miyatake
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Masanobu Hirao
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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182
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Yun HH, Murphy WS, Ward DM, Zheng G, Hayden B, Murphy SB. Effect of pelvic tilt and rotation on cup orientation in standing anteroposterior radiographs. Hip Int 2020; 30:48-55. [PMID: 30834795 DOI: 10.1177/1120700019831665] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Individual pelvic tilt and rotation have wide variability that can affect the measurement of cup orientation in anteroposterior (AP) radiographs. The purpose of this study was to analyse the effect of pelvic tilt and rotation on radiographic measurements of cup orientation. METHODS A total of 53 patients (63 hips) were included in this study. The patients underwent a computed tomography study with standing AP pelvis radiographs taken both preoperatively and approximately 3 months postoperatively. We used 2-dimensional/3-dimensional matching to measure the pelvic tilt and rotation, and the non-standardised and standardised cup orientation. RESULTS There was no difference in the pelvic tilt and rotation between the preoperative and postoperative radiographs. The distribution of the differences between the non-standardised and standardised cup anteversion exhibited a change within 5° in only 34/63 (54%) hips. The pelvic tilt correlated with the difference between the non-standardised and standardised cup anteversion, but the pelvic rotation did not. When all 63 hips were separated into the right and left sides, the pelvic rotation inversely correlated with the pelvic tilt-adjusted difference between the non-standardised and standardised cup anteversion of the right side but directly correlated with that of the left side. CONCLUSIONS The current study demonstrated that the measurement of cup anteversion in standing AP radiographs is significantly affected by both the pelvic tilt and pelvic rotation. An improved understanding of the pelvic orientation may eventually allow for desired cup positioning on a patient-specific basis to potentially reduce complications associated with the malposition of the cup.
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Affiliation(s)
- Ho Hyun Yun
- Department of Orthopaedic Surgery, Seoul Veterans Hospital, Seoul, Republic of Korea
| | - William S Murphy
- Center for Computer Assisted and Reconstructive Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, USA
| | - Daniel M Ward
- Center for Computer Assisted and Reconstructive Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, USA
| | - Guoyan Zheng
- ARTORG Center for Biomedical Engineering Research, ISTB-Institute for Surgical Technology and Biomechanics, University of Bern, Switzerland
| | - Brett Hayden
- Center for Computer Assisted and Reconstructive Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, USA
| | - Stephen B Murphy
- Center for Computer Assisted and Reconstructive Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, USA
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Masumoto Y, Fukunishi S, Fukui T, Yoshiya S, Nishio S, Fujihara Y, Okahisa S, Okada T, Kanto M, Goshi A, Morio F, Takeda Y. New combined anteversion technique in hybrid THA: cup-first procedure with CT-based navigation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:465-472. [PMID: 31705402 DOI: 10.1007/s00590-019-02589-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 11/02/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE Combined anteversion (CA) technique (stem-first procedure) is generally accepted as the optimal technique to attain an appropriate CA value in total hip arthroplasty (THA). However, cup anteversion is strongly influenced by the native femoral anteversion. Accordingly, anterior protrusion of the cup in the acetabulum might occur. The purpose of the present study is to investigate the achievement of the optimal CA while avoiding anterior cup protrusion and examine the significance of our new CA technique with cup-first procedure in hybrid THA. METHODS Seventy-nine hybrid THAs with the cup-first procedure used a CT-based navigation system for cup positioning. In the preoperative planning, cup anteversion was aimed at approximately 20°. However, in actuality, sufficient cup coverage in the original acetabulum based on individual anatomy is given priority over cup placement based on CT-based planning to ensure adequate cup coverage. The target stem anteversion was determined following Widmer's mathematical formula (37.3 = femoral stem anteversion × 0.7 + cup anteversion). Cemented stem was inserted according to the target stem anteversion angle. RESULTS Regarding the assessment of overall alignment, the calculated Widmer's CA values during surgery and postoperative CT evaluation were 34.1° ± 6.0° (range 20.7°-51.2°) and 35.1° ± 6.7° (range 21.6°-50.7°). There were 72 hips (91.1%) within 25°-50° of CA. Cup protrusion length averaged 2.0 mm ± 2.6 mm (0-8.8 mm) in the axial view and 0.4 mm ± 1.0 mm (0-3.6 mm) in the sagittal view. Cup protrusion length of more than 5 mm was indicated in 10 hips, and no hips observed more than 10 mm. CONCLUSION Our new CA technique (cup-first procedure) with hybrid THA was able to achieve optimal CA value while avoiding anterior cup protrusion.
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Affiliation(s)
- Yoshinobu Masumoto
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | | | | | | | - Shoji Nishio
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yuki Fujihara
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Shohei Okahisa
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Taishi Okada
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Makoto Kanto
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Ariha Goshi
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Futoshi Morio
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yu Takeda
- Department of Orthopedic Surgery, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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Taniguchi N, Jinno T, Koga D, Ochiai S, Okawa A, Haro H. Comparative study of stem anteversion using a cementless tapered wedge stem in dysplastic hips between the posterolateral and anterolateral approaches. Orthop Traumatol Surg Res 2019; 105:1271-1276. [PMID: 31615749 DOI: 10.1016/j.otsr.2019.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 06/02/2019] [Accepted: 08/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND In total hip arthroplasty (THA), the concept of combined anteversion is accepted as one of best indicators of prosthetic joint stability. Technical parameters may influence the stem and cup anteversion. We therefore investigated if stem anteversion could be influenced by surgical approaches in cementless THA using a tapered wedge stem with stem-first technique. HYPOTHESIS We postulated that the type of approach, posterolateral (PLA) or anterolateral approach (ALA), would influence stem anteversion in dysplastic hip patients. We asked (1) whether stem anteversion was higher in the PLA group and (2) how postoperative stem anteversion was correlated to preoperative femoral anteversion in each group. PATIENTS AND METHODS We retrospectively compared two groups of hips that underwent THA using a tapered wedge stem with the posterolateral (PLA group; 154 hips) or anterolateral (ALA group; 81 hips) approaches. Computed tomography was utilized to measure femoral neck and stem anteversion. To investigate related factors that affect stem anteversion, a stepwise regression analysis was performed. RESULTS The stem anteversion in the PLA and ALA groups was 43.7°±9.8° and 34.0°±12.3°, respectively (p<0.01). The stepwise selection process resulted in a model involving femoral neck anteversion and surgical approach (p<0.01). The stem anteversion of the ALA group (r=0.75, p<0.01) was better correlated to femoral neck anteversion than that of the PLA group (r=0.52, p<0.01). DISCUSSION The stem implantation through the ALA is thought to be more restricted than that through the PLA due to the difference of difficulty in femoral exposure. Tapered wedge stems, which are relatively thin and flat, have a high degree of freedom in the femoral canal. Consequently, in cementless THA using a tapered wedge stem, the surgical approaches affected stem anteversion differently. Stem anteversion was more anatomically restored to femoral neck anteversion through the ALA than through the PLA. LEVEL OF EVIDENCE III, retrospective case-control study.
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Affiliation(s)
- Naofumi Taniguchi
- Department of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo-shi, 409-3898 Yamanashi, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan; Second Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya-shi, 343-8555 Saitama, Japan.
| | - Daisuke Koga
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan
| | - Satoshi Ochiai
- Department of Orthopaedic Surgery, Kofu National Hospital, 11-35 Tenjin-cho, Kofu-shi, 409-8533 Yamanashi, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo-shi, 409-3898 Yamanashi, Japan
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185
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Ueoka K, Kabata T, Kajino Y, Yoshitani J, Ueno T, Tsuchiya H. The Accuracy of the Computed Tomography-Based Navigation System in Total Hip Arthroplasty Is Comparable With Crowe Type IV and Crowe Type I Dysplasia: A Case-Control Study. J Arthroplasty 2019; 34:2686-2691. [PMID: 31256919 DOI: 10.1016/j.arth.2019.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/27/2019] [Accepted: 06/03/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Clinical outcomes of total hip arthroplasty (THA) for Crowe type IV are poorer than for Crowe type I, because it is more difficult to accurately position the acetabular components. This study aimed to examine the accuracy of the computed tomography (CT)-based navigation system for acetabular component positioning in primary THA for Crowe type IV. METHODS From 2006 to 2018, 29 patients who underwent 34 primary THAs for Crowe type IV were enrolled in the "Type IV" group and 32 patients who underwent 34 THAs for Crowe type I were enrolled in the "Type I" group, formed by matching patients in the Type IV group on age, gender, body mass index, and surgical approach. We investigated (1) the accuracy of the cup size between that at preoperative planning and that actually implanted and (2) the mean deviation of the cup angle and 3-dimensional position of acetabular components between preoperative plan and postoperative records. RESULTS The accuracy of the cup size was 79.4% and 94.1% in the Type IV and Type I groups, respectively, without a statistically significant change detected (P = .075). The mean deviations of the cup angle and 3-dimensional position were comparable in both groups. CONCLUSION Using the CT-based navigation system, it was possible to accurately implant the acetabular component for Crowe type IV, and the accuracy was comparable to that for Crowe type I. The CT-based navigation system is a useful intraoperative tool to accurately implant the acetabular component, especially with severe pelvic deformities such as Crowe type IV.
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Affiliation(s)
- Ken Ueoka
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Tamon Kabata
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Yoshitomo Kajino
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Junya Yoshitani
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Takuro Ueno
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan
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186
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Kubota Y, Kaku N, Tagomori H, Kataoka M, Tsumura H. Isolated acetabular revision with femoral stem retention using computed tomography-based navigation. Orthop Traumatol Surg Res 2019; 105:1311-1317. [PMID: 31522901 DOI: 10.1016/j.otsr.2019.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/27/2019] [Accepted: 08/21/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND In isolated acetabular revision surgery, surgeons must place the cup at an appropriate angle with various retained stem anteversion angles to prevent postoperative dislocation. For accurate acetabular cup position, various navigation systems have been used. Nevertheless, no publications have reported combined cup and stem anteversion and dislocation rates after isolated acetabular revision, especially comparing the use of navigation with manual implantation. Therefore we performed a retrospective comparative study to answer the following questions: (1) What is the combined anteversion after isolated acetabular revision with computed tomography-based navigation? (2) Does navigation improve the accuracy of cup angle and combined anteversion, (3) reduce dislocation rate, and (4) reduce operative time? HYPOTHESIS A navigation system makes combined anteversion near the target angle in isolated acetabular revision. PATIENTS AND METHODS We conducted a retrospective study of 32 hips in 24 patients who underwent isolated acetabular revision total hip arthroplasty using computed tomography-based navigation system. The control group comprised 8 hips in 8 patients who underwent the same procedure without navigation. RESULTS In the navigation group, average Widmer's combined anteversion was 39.0°±8.7° (range, 25.3°-56.6°). Cup positions were 40.3°±2.9° (range, 29.0°-49.0°) for radiographic abduction angle, 24.3°±8.0° (range, 4.6°-42.6°) for radiographic anteversion. In the control group, Widmer's combined anteversion was 47.2°±15.1° (range, 27.0°-74.3°, p=0.048). The average cup positions for radiographic abduction angle and anteversion were 36.7°±8.9° (range, 24.5°-54.9°) and 29.1°±7.3° (range, 17.2°-38.8°), respectively (p>0.05). Widmer's combined anteversion deviated from the target angle by a smaller amount in the navigation group than in the control group: errors in measurement of Widmer's combined anteversion were 7.2°±5.1° (range, 0.74°-19.6°) in the navigation group and 13.9°±11.1° (range, 3.6°-37.3°) in the control group (p=0.135). Postoperative dislocation occurred in none of the 32 hips (0%) in the navigation group and in one of the 8 hips (12.5%) in the control group (p=0.2). DISCUSSION Using the navigation system, combined anteversion is made near the target angle in isolated acetabular revision surgery and more accurately than manual implantation. These results should be considered as preliminary since this is a limited cohort, but it brings new knowledge in navigation considering the very limited number of series using of navigation in isolated cup revision of total hip arthroplasty. In addition this is the first study to investigate combined cup and stem anteversion in isolated acetabular revision. The use of CT-scan is helpful to diagnose error in stem anteversion and to adapt the orientation of the new cup. LEVEL OF EVIDENCE III, Retrospective case control study.
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Affiliation(s)
- Yuta Kubota
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi Yufu City, Oita, 879-5593, Japan
| | - Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi Yufu City, Oita, 879-5593, Japan.
| | - Hiroaki Tagomori
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi Yufu City, Oita, 879-5593, Japan
| | - Masashi Kataoka
- Physical Therapy Course of Study, Faculty of Welfare and Health Sciences, Oita University, 700 Dannoharu, Oita City, 870-1192, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi Yufu City, Oita, 879-5593, Japan
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187
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Yoshitani J, Nakamura T, Maruhashi Y, Hashimoto N, Sasagawa T, Ueshima K, Funaki K. Is the alignment guide technique in total hip arthroplasty sufficient for accurate cup positioning with a modified Watson Jones approach? J Orthop Surg (Hong Kong) 2019; 26:2309499018806645. [PMID: 30352543 DOI: 10.1177/2309499018806645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE: Cup setting with only an alignment guide has been reported to be inaccurate in the lateral decubitus position in total hip arthroplasty (THA). We assessed the accuracy of cup positioning using only the alignment guide technique via a modified Watson Jones approach in the lateral decubitus position. METHODS: Two hundred hips of 189 patients underwent THA from October 2014 to September 2016 via a modified Watson Jones approach. In the final sample, 181 hips of 171 patients (35 males, 136 females) were included in this investigation. The alignment of the cup was evaluated by an anteroposterior radiograph of the pelvis 1 week after surgery. Measurements were divided into safe zone determined by Callanan and Lewinnek. RESULTS: There were 168 (92.8%) acetabular cups that were placed within the safe zone for both inclination and anteversion based on the safe zones defined by Lewinnek, and 134 (74%) acetabular cups that were placed within the safe zone defined by Callanan. Multiple logistic analysis showed that the laterality and the addition of the confirmation method were indicators for malpositioning of combined inclination and anteversion. CONCLUSION: Our data suggested that even if special tools were not used in the lateral decubitus position, using only the alignment guide enabled cup positioning to be achieved with 92.8% accuracy in the Lewinnek safe zone and 74% accuracy in the Callanan safe zone. Multiple logistic analysis showed that the laterality and the addition of a confirmation alignment guide influenced the accuracy of cup positioning.
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Affiliation(s)
- Junya Yoshitani
- 1 Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Takuya Nakamura
- 2 Department of Orthopaedic Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Yoshinobu Maruhashi
- 2 Department of Orthopaedic Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Noriyuki Hashimoto
- 2 Department of Orthopaedic Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Takeshi Sasagawa
- 2 Department of Orthopaedic Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Kenichi Ueshima
- 2 Department of Orthopaedic Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Kiyonobu Funaki
- 2 Department of Orthopaedic Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
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Tetsunaga T, Fujiwara K, Endo H, Tetsunaga T, Miyake T, Yamada K, Sanki T, Ozaki T. Changes in acetabular component alignment due to screw fixation in patients with hip dysplasia. Hip Int 2019; 29:535-542. [PMID: 30724114 DOI: 10.1177/1120700019828708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Adequate initial stability of the acetabular cup is essential for total hip arthroplasty (THA). However, changes in the alignment of the acetabular component caused by screw fixation are concerning in patients with inadequate bone stock. This study aimed to investigate the effects of screw fixation on the alignment of the acetabular component in THA patients with hip dysplasia. METHODS We retrospectively examined 256 hips (range 28-87 years) that underwent THA using a navigation system. Patients were divided into 2 groups based on the presence or absence of changes in the alignment of the intraoperative acetabular cup, and univariate and multivariate analyses were performed to identify factors that were predictive of changes in acetabular component alignment after screw fixation in 2 dimensions: inclination and anteversion. RESULTS Screw fixation led to a mean change in inclination of 1.6° (range 0-10°) and a mean change in anteversion of 1.4° (range 0-14°). The Crowe classification, the presence of bone cysts, and the use of an inferior quadrant screw were identified as factors that correlated with acetabular cup alignment changes in inclination (odds ratios, 6.01, 5.94 and 0.03, respectively). Only the Crowe classification was identified as a factor that correlated with intraoperative alignment changes in anteversion (odds ratio, 2.08). CONCLUSIONS Screw fixation altered the acetabular cup alignment. The inclination changes were related to the extent of the dysplasia, and the risk was reduced when the inferior quadrant screw was used. Surgeons should use caution during screw fixation in THAs performed on severely dysplastic hips.
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Affiliation(s)
| | - Kazuo Fujiwara
- 2 Department of Intelligent Orthopaedic System Development, Okayama University, Japan
| | - Hirosuke Endo
- 1 Department of Orthopaedics, Okayama University, Japan
| | | | | | - Kazuki Yamada
- 1 Department of Orthopaedics, Okayama University, Japan
| | - Tomoaki Sanki
- 1 Department of Orthopaedics, Okayama University, Japan
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189
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Supine versus lateral position for accurate positioning of acetabular cup in total hip arthroplasty using the modified Watson-Jones approach: A randomized single-blind controlled trial. Orthop Traumatol Surg Res 2019; 105:915-922. [PMID: 31204181 DOI: 10.1016/j.otsr.2019.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The orientation of the acetabular cup is a critical factor for prevention of various postoperative complications in total hip arthroplasty (THA). Although most patients are treated in either supine or lateral position during surgery, it is still unclear which position is superior to achieve more accurate cup positioning. Our study was conducted in order to answer the following questions: (1) does the supine position provide a higher accuracy of cup positioning than the lateral position in THA using modified Watson-Jones approach? (2) is there any difference in the distribution of cup position between the two positions? Hypothesis Our hypothesis was that the supine position would provide a higher accuracy of cup positioning than the lateral position in THA using modified Watson-Jones approach. PATIENTS AND METHODS A single-center prospective randomized study (registration number: UMIN000021627) was conducted between May 2016 and December 2017. We recruited a total of 60 participants undergoing unilateral primary cementless THA using modified Watson-Jones anterolateral approach based on the result of the sample size calculation. They were randomly assigned to either supine position (n=29) or lateral position (n=31). The cup alignment was targeted using a goniometer during surgery. The radiographic cup inclination was targeted to 40° and the radiographic cup anteversion was targeted considering the femoral stem anteversion during surgery. Postoperative cup alignment was measured by plain radiography and computed tomography. We defined the difference between postoperative and target cup angle as target error and our primary outcome was the absolute value of the target angle. As secondary outcome, the distribution of the target error was evaluated. The target errors of each inclination and anteversion were divided into 3 groups; neutral (-3°≤the target error≤3°), positive error (3°<the target error), and negative error (the target error<-3°). RESULTS The assessment of primary outcome for all recruited patients showed that supine group was significantly more accurate than lateral group in terms of radiographic inclination (2.4° vs. 4.5°, respectively, mean difference 2.1°; 95% confidence interval, 0.7 to 3.5; p<0.01). There was no significant difference in terms of radiographic cup anteversion (5.6° vs. 5.2°, mean difference 0.4°; 95% confidence interval, -1.8 to 2.6; p=0.69). The rate of positive error of anteversion in supine and lateral group was larger than that of negative value of anteversion (51.7% vs. 10.3% and 48.4% vs. 12.9%, respectively). Any acute complication (dislocation, fracture, and infection) was not found in both groups during postoperative 3 months. DISCUSSION In this randomized-controlled trial, higher accuracy of acetabular cup inclination was provided by supine position than by lateral position in THA. On the other hand, there was no significant difference between both groups in terms of cup anteversion. In both groups, most cups were placed with larger anteversion than we targeted. Modified Watson-Jones approach in both positions should be performed considering these results. STUDY REGISTRATION NUMBER UMIN000021627. Level of evidence II, randomised controlled study (population-limited).
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190
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Yoshitani J, Kabata T, Kajino Y, Ueno T, Ueoka K, Yamamuro Y, Tsuchiya H. Anatomic stem inserted according to native anteversion could reproduce the native anterior distance of the femoral head and decrease bony impingement in total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2019; 44:245-251. [PMID: 31456058 DOI: 10.1007/s00264-019-04394-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/14/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate whether anatomic and straight stems could reproduce the anteroposterior distance (AD) of the native femoral head and evaluate the effect of AD of the femoral head on range of motion (ROM) and bony impingement. METHODS This retrospective simulation study included 64 patients who had undergone primary total hip arthroplasty between 2012 and 2014. Using computed tomography (CT)-based templating software, anatomic and straight stems were inserted with same alignment. AD of the head centre was compared between the two stems and native anatomy. Furthermore, post-operative ROM was calculated, and correlation between AD and ROM was assessed. RESULTS There was a strong positive correlation between native anteversion (mean 21.9°) and anatomic stem anteversion (mean 22.5°) (R = 0.975, P < 0.001). There was no significant difference in AD between the native and anatomic stems (mean 37.7 and 38.8 mm, respectively), but AD of the straight stem was significantly lower than that of the native and anatomic stems. The straight stem showed a significantly lower ROM in flexion and internal rotation angles with 90° flexion (IR) than the anatomic stem (P < 0.05 and P < 0.001, respectively). AD showed a stronger correlation with ROM of IR than with stem anteversion. CONCLUSIONS The anatomic stem could reproduce AD of the native femoral head centre, but the head centre of the straight stem in the same anteversion with anatomic stem translated significantly posterior, significantly decreasing the ROM of flexion and IR and increasing bony impingement of IR. To avoid bony impingement and acquire sufficient ROM, reproducing AD was important.
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Affiliation(s)
- Junya Yoshitani
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tamon Kabata
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Yoshitomo Kajino
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takuro Ueno
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Ken Ueoka
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yuki Yamamuro
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
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191
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Komiyama K, Hamai S, Ikebe S, Yoshimoto K, Higaki H, Shiomoto K, Gondo H, Hara D, Wang Y, Nakashima Y. In vivo kinematic analysis of replaced hip during stationary cycling and computer simulation of optimal cup positioning against prosthetic impingement. Clin Biomech (Bristol, Avon) 2019; 68:175-181. [PMID: 31229697 DOI: 10.1016/j.clinbiomech.2019.05.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/21/2019] [Accepted: 05/30/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dynamic hip kinematics during stationary cycling after total hip arthroplasty (THA) have been unclear. Furthermore, no computer simulation of optimal cup position based on in vivo kinematics has yet been assessed. METHODS This study consisted of 7 patients who underwent unilateral primary THA for symptomatic osteoarthritis. Using a flat-panel X-ray detector, continuous radiographs were obtained during stationary cycling. We analyzed the three-dimensional replaced hip kinematics from the top to the bottom position of the crank using image-matching techniques and quantified minimum liner-to-stem neck distance. Simulation analyses with in vivo kinematics were performed to examine patient-specific optimal cup placement against prosthetic impingement. FINDINGS During stationary cycling, pelvis showed 27.1° of posterior tilt on average without significant change. Hip flexed by 59.4° and 19.3° on average at the top and bottom positions, respectively. Minimum liner-to-neck distance was 8.8 mm on average at the bottom position. Liner-to-neck, bone-to-bone, or bone-to-component impingement was not observed at any positions in any hips. Simulation analysis of cup placement showed that larger cup anteversion, inclination, and use of elevated liner significantly decreased the minimum distance between posterior liner and stem neck. Cup anteversion of more than 30° with elevated liner could cause posterior liner-to-neck impingement at bottom position. INTERPRETATION Stationary cycling after THA provides no excessive hip range of motion or liner-to-neck contact. Cup placement and use of elevated liner significantly influence the minimum liner-to-neck distance, in some cases simulating posterior prosthetic impingement.
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Affiliation(s)
- Keisuke Komiyama
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Satoru Ikebe
- Department of Creative Engineering, National Institute of Technology, Kitakyushu College, 5-20-1 Shii, Kokuraminami-ku, Kitakyushu, Fukuoka 802-0985, Japan
| | - Kensei Yoshimoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hidehiko Higaki
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-0004, Japan
| | - Kyohei Shiomoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hirotaka Gondo
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-0004, Japan
| | - Daisuke Hara
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yifeng Wang
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-0004, Japan
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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192
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A Preoperative Analytical Model for Patient-Specific Impingement Analysis in Total Hip Arthroplasty. Adv Orthop 2019; 2019:6293916. [PMID: 31355005 PMCID: PMC6634079 DOI: 10.1155/2019/6293916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/16/2019] [Indexed: 11/17/2022] Open
Abstract
Prosthetic impingement is important to consider during total hip arthroplasty planning to minimise the risk of joint instability. Modelling impingement preoperatively can assist in defining the required component alignment for each individual. We developed an analytical impingement model utilising a combination of mathematical calculations and an automated computational simulation to determine the risk of prosthetic impingement. The model assesses cup inclination and anteversion angles that are associated with prosthetic impingement using patient-specific inputs, such as stem anteversion, planned implant types, and target Range of Motion (ROM). The analysed results are presented as a range of cup inclination and anteversion angles over which a colour map indicates an impingement-free safe zone in green and impingement risk zones in red. A validation of the model demonstrates accuracy within +/- 1.4° of cup inclination and anteversion. The study further investigated the impact of changes in stem anteversion, femoral head size, and head offset on prosthetic impingement, as an example of the application of the model.
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193
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Castagnini F, Valente G, Crimi G, Taddei F, Bordini B, Stea S, Toni A. Component positioning and ceramic damage in cementless ceramic-on-ceramic total hip arthroplasty. J Orthop Sci 2019; 24:643-651. [PMID: 30612885 DOI: 10.1016/j.jos.2018.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/21/2018] [Accepted: 12/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND In ceramic-on-ceramic (CoC) total hip arthroplasty (THA), component positioning demonstrated to influence the bearing damage: however the connection between angles and clinical outcomes at long-term follow-ups is currently lacking. Aims of this study were: the computer tomography (CT) assessment of component positioning in CoC THAs; the correlation analysis between positioning and ceramic damage; the identification of safe zones. METHODS 91 consecutive post-operative CT scans including two types of CoC implants, with a mean follow-up of 12 ± 4.4 years, were evaluated. III generation (74.2%) and IV generation (25.8%) CoC surfaces were included. The angle measurements (cup abduction, anteversion, cup tilt, stem antetorsion, sacral slope) were automated using a CT-based software. The combined anteversion was assessed as well as the cup-neck position at -15°, 0°, 45° and 90° of flexion. Ceramic damage was diagnosed using synovial fluid analyses and radiological criteria. RESULTS 63.7% of THAs was inside the cup abduction target 30°-45° and 68.1% was inside the cup anteversion target 5°-25°. 19 patients (20.9%) showed signs of ceramic damage. High cup abduction and high cup-neck 45° minimum angle (which stood for high abduction and extreme combined version) significantly correlated with ceramic damage. No demographical features apart III generation ceramic bearings influenced the results. No safe zones could be detected. CONCLUSIONS In CoC THA, no safe zones can be described. However it is important to avoid cup inclination over 45° and a combination of steep cup and extreme combined version.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy.
| | - Giordano Valente
- Laboratorio di Bio Ingegneria Computazionale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Gianluigi Crimi
- Laboratorio di Bio Ingegneria Computazionale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Fulvia Taddei
- Laboratorio di Bio Ingegneria Computazionale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Susanna Stea
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, 40136, Italy
| | - Aldo Toni
- Ortopedia-Traumatologia e Chirurgia Protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, 40136, Italy
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Kanto M, Maruo K, Tachibana T, Fukunishi S, Nishio S, Takeda Y, Arizumi F, Kusuyama K, Kishima K, Yoshiya S. Influence of Spinopelvic Alignment on Pelvic Tilt after Total Hip Arthroplasty. Orthop Surg 2019; 11:438-442. [PMID: 31148364 PMCID: PMC6595105 DOI: 10.1111/os.12469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/14/2018] [Accepted: 05/07/2018] [Indexed: 11/29/2022] Open
Abstract
Objective To evaluate the impact of spinopelvic parameters and hip contracture on change in the pelvic tilt (PT) after Total hip arthroplasty (THA). Methods One hundred patients (15 male and 85 female) who underwent THA were included in this prospective study. Radiographic data were obtained preoperatively and 1 year after THA. Radiographic parameters included sagittal anterior pelvic plane (APP), sagittal vertical axis (SVA), sacral slope (SS), pelvic inclination (PI), and lumbar lordosis angle (LL). The APP was defined as the angle between the anterior pelvic plane and the vertical plane. A positive value indicates pelvic retroversion. Postoperative changes in PT were divided into three groups: the PA group (pelvic anteversion, ΔAPP < −5°), the PR group (pelvic retroversion, ΔAPP > 5°), and the PT group (minimal change, ΔAPP ≤ ± 5°). The Kruskal–Wallis test and the Steel–Dwass test were used to compare the preoperative and postoperative spinopelvic parameters among the three groups. The Spearman's rank correlation coefficient was used to evaluate the correlation between ΔAPP and spinopelvic parameters. Results Minimal change in pelvic tilt was observed in 59% of patients, while pelvic anteversion was observed in 16% of patients and pelvic retroversion was observed in 25% of patients. There were no significant changes in the spinopelvic parameters, including TK, LL, SVA, LL, SS, and APP after THA. The Femoral angle (FA) was significantly decreased after THA (P < 0.001). Preoperative APP was significantly more retroverted in the PA group than the PR group, and the PT group (6.8 ± 12.2, 0.2 ± 9.9, −8.3 ± 8.3, P < 0.001). Preoperative SS, PI‐LL, and PI were significantly smaller in the PA group than the PT group and the PR group. A significant negative correlation was identified between preoperative APP and ΔAPP (r = −0.418, P < 0.001). Conclusion Approximately 60% of the patients did not have any marked change in PT after THA. Preoperative APP was the only predictive factor associated with marked anterior or posterior change in PT.
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Affiliation(s)
- Makoto Kanto
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Keishi Maruo
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shigeo Fukunishi
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shoji Nishio
- Department of Orthopaedic Surgery, Takarazuka City Hospital, Japan
| | - Yu Takeda
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Fumihiro Arizumi
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuki Kusuyama
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuya Kishima
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shinichi Yoshiya
- Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Japan
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Tabori-Jensen S, Hansen TB, Stilling M. Low dislocation rate of Saturne ®/Avantage ® dual-mobility THA after displaced femoral neck fracture: a cohort study of 966 hips with a minimum 1.6-year follow-up. Arch Orthop Trauma Surg 2019; 139:605-612. [PMID: 30547264 DOI: 10.1007/s00402-018-3093-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Dislocation is a serious and common complication and a great concern with the use of total hip arthroplasty (THA) when treating displaced femoral neck fracture (FNF). Dual-mobility (DM) THA might reduce the dislocation risk. We aim to report the dislocation and revision rate of primary DM THA in patients with displaced FNF. MATERIALS AND METHODS Between 2005 and 2015, 966 consecutive patients (676 women) at mean age 80.5 years (range 42-104) with displaced FNF were operated with DM articulation THA by posterolateral approach (PLA). Patient files and radiographs were evaluated for dislocations, revisions, and other complications until death of the patient or August 1st, 2017. Data were crosschecked with the National Patient Registry. Patient's mental state was tested upon admissions. Surgeon's educational level was noted and post-operative cup position was measured. RESULTS At minimum 1.6-year follow-up, there were 45 (4.7%) dislocations and eight (0.8%) cup revisions. The 30-day mortality was 9.2% and 533 patients (55.2%) were dead at the time of last follow-up. We observed eight intraprosthetic dislocations (IPD); six occurred in relation to closed reduction. Cementless stem fixation was associated with higher dislocation risk (p = 0.04) and higher rate of stem complications (p = 0.002). There was no significant association between cognitive impairment and dislocation (OR 2.0, 95% CI 0.96-4.34, p = 0.06). CONCLUSION Overall, DM THA inserted via PLA results in an acceptable dislocation risk and low revision rate in fragile, old patients with acute FNF fracture, regardless of mental status. A unique complication in DM THA is IPD, which requires an immediate open reduction surgery.
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Affiliation(s)
- Steffan Tabori-Jensen
- University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Building 8, Entrance N, 1st floor, Laegaardvej 12, 7500, Holstebro, Denmark. .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Torben B Hansen
- University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Building 8, Entrance N, 1st floor, Laegaardvej 12, 7500, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Maiken Stilling
- University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Building 8, Entrance N, 1st floor, Laegaardvej 12, 7500, Holstebro, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Imai N, Takubo R, Suzuki H, Shimada H, Miyasaka D, Tsuchiya K, Endo N. Accuracy of acetabular cup placement using CT-based navigation in total hip arthroplasty: Comparison between obese and non-obese patients. J Orthop Sci 2019; 24:482-487. [PMID: 30522927 DOI: 10.1016/j.jos.2018.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/31/2018] [Accepted: 11/11/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND In obese patients, malpositioning of the acetabular cup increases the risk of dislocation in total hip arthroplasty (THA). The aim of this study was to determine whether obesity affects the accuracy of acetabular cup positioning using a computed tomography (CT)-based navigation system. METHODS We retrospectively evaluated 226 consecutive patients who underwent cementless primary THAs assisted by the CT-based hip navigation system. We divided the patients into three groups according to body mass index (BMI) and examined the difference between preoperative planning and postoperative implantation angles from CT data. RESULTS There was no significant correlation between BMI and both inclination and anteversion differences (R = 0.028 and R = 0.045, respectively). There were no significant differences among the BMI < 25, 25 ≦ BMI < 30, and BMI ≧ 30 groups (p value: 0.725, 0.934, respectively); between the BMI < 25 and BMI ≧ 25 groups (p value: 0.542, 0.697, respectively); and between the BMI < 30 and BMI ≧ 30 groups with regard to inclination and anteversion (p value: 0.859, 0.456, respectively). Moreover, similar findings were observed with regard to the distance between the preoperative planning and postoperative cup positioning for the transverse, anteroposterior, and craniocaudal axes of the pelvis. CONCLUSION We found that the accuracy of acetabular cup placement using CT based-navigation in THA was not affected in obese patients. Therefore, THAs with a CT-based navigation system are considered useful in obese patients.
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Affiliation(s)
- Norio Imai
- Division of Comprehensive Geriatrics in Community, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 9518520, Japan.
| | - Ryota Takubo
- Department of Orthopedic Surgery, Tachikawa General Hospital, Nagaoka, 9408621, Japan
| | - Hayato Suzuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 9518520, Japan
| | - Hayato Shimada
- Department of Orthopedic Surgery, Tachikawa General Hospital, Nagaoka, 9408621, Japan
| | - Dai Miyasaka
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 9518520, Japan
| | - Kazuki Tsuchiya
- Division of Advanced Materials Science and Technology, Niigata University Graduate School of Science and Technology, Niigata, 9502181, Japan
| | - Naoto Endo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, 9518520, Japan
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Ohmori T, Kabata T, Kajino Y, Inoue D, Taga T, Yamamoto T, Takagi T, Yoshitani J, Ueno T, Ueoka K, Tsuchiya H. The optimal combined anteversion pattern to achieve a favorable impingement-free angle in total hip arthroplasty. J Orthop Sci 2019; 24:474-481. [PMID: 30554937 DOI: 10.1016/j.jos.2018.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/06/2018] [Accepted: 11/08/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND There have been no studies on the differences in impingement-free angle that result from different combined anteversion (CA) patterns. The aim of this study was to find the optimal CA pattern for achieving a favorable impingement-free angle, including bony and prosthetic impingement, in total hip arthroplasty. METHODS We evaluated 100 patients with no hip arthritis. We investigated the impingement-free angle (flexion, internal rotation with 90° flexion, extension, and external rotation) after changing the stem and cup anteversions to satisfy several CA patterns [cup anteversion + stem anteversion = 30°, 40°, 50°, and 60°; cup anteversion + 0.7 × stem anteversion = 37.3° (:Widmer's theory); and cup anteversion + 0.77 × stem anteversion = 43.3° (:Yoshimine's theory)] using 3-dimensional templating software. RESULTS The impingement-free angle changed dramatically among the various CA patterns. The optimal CA was changed by various stem anteversion. Only CA: Widmer with stem anteversion of 20° satisfied daily-life range of motion (ROM) requirements (flexion ≥130°, internal rotation with 90° flexion ≥ 45°, extension ≥ 40°, external rotation ≥ 40°). CONCLUSION Good impingement-free angle cannot be obtained with single fixed CA. Different CA patterns should be used, depending on the differences in the stem anteversion. A CA of 30° with 0° ≤ stem anteversion ≤10°; a CA:Widmer with 20° of stem anteversion; a CA of 40° or Widmer with 30° of stem anteversion. When stem anteversion is ≥40°, CA should be decided by each patient's state. Among them, a stem anteversion of 20° with cup anteversion of 23.3° was found to be the best CA pattern.
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Affiliation(s)
- Takaaki Ohmori
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tamon Kabata
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Yoshitomo Kajino
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Daisuke Inoue
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tadashi Taga
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takashi Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tomoharu Takagi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Junya Yoshitani
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takuro Ueno
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Ken Ueoka
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
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Palit A, King R, Gu Y, Pierrepont J, Simpson D, Williams MA. Subject-Specific Surgical Planning for Hip Replacement: A Novel 2D Graphical Representation of 3D Hip Motion and Prosthetic Impingement Information. Ann Biomed Eng 2019; 47:1642-1656. [PMID: 30972601 PMCID: PMC6542782 DOI: 10.1007/s10439-019-02260-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 03/29/2019] [Indexed: 11/29/2022]
Abstract
Prosthetic impingement (PI) following total hip arthroplasty (THA), which arises due to the undesirable relative motion of the implants, results in adverse outcomes. Predicting PI through 3D graphical representation is difficult to comprehend when all activities are combined for different implant positions. Therefore, the aim of the paper was to translate this 3D information into a 2D graphical representation for improved understanding of the patient’s hip motion. The method used planned implanted geometry, positioned onto native bone anatomy, and activity definitions as inputs to construct the 2D polar plot from 3D hip motion in four steps. Three case studies were performed to highlight its potential use in (a) combining different activities in a single plot, (b) visualising the effect of different cup positions and (c) pelvic tilt on PI. A clinical study with 20 ‘Non-Dislocators’ and 20 ‘Dislocators’ patients after 2 years of THA was performed to validate the method. The results supported the study hypothesis, in that the incidence of PI was always higher in the ‘Dislocators’ compared to the ‘Non-Dislocators’ group. The proposed 2D graphical representation could assist in subject-specific THA planning by visualising the effect of different activities, implant positions, pelvic tilt and related aspects on PI.
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Affiliation(s)
- Arnab Palit
- WMG, University of Warwick, Coventry, CV4 7AL, UK.
| | - Richard King
- Department of Trauma & Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Yolanda Gu
- Optimized Ortho, 17 Bridge Street, Pymble, NSW, 2073, Australia
- Corin Ltd, Corinium Centre, Cirencester, Gloucestershire, GL7 1YJ, UK
| | - James Pierrepont
- Optimized Ortho, 17 Bridge Street, Pymble, NSW, 2073, Australia
- Corin Ltd, Corinium Centre, Cirencester, Gloucestershire, GL7 1YJ, UK
| | - David Simpson
- Corin Ltd, Corinium Centre, Cirencester, Gloucestershire, GL7 1YJ, UK
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Fujihara Y, Fukunishi S, Fukui T, Nishio S, Takeda Y, Okahisa S, Yoshiya S. Comparison of G-guide and Image-free Navigation System in Accuracy of Stem Anteversion Assessment During Total Hip Arthroplasty. Open Orthop J 2019. [DOI: 10.2174/1874325001913010109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Introduction:
We have developed and utilized the Gravity-guide (G-guide) as a simple manual instrument for intraoperative assessment and adjustment of stem anteversion (AV). Since 2013, we simultaneously measured stem AV using the G-guide and image-free navigation during THA procedure. The purpose of this study was to compare the measurement accuracy of the G-guide and navigation system using the postoperative CT results as a reference.
Methods:
In total, 59 hips in 56 patients who underwent primary THA using both the G-guide and image-free navigation system were included in the study. All patients underwent postoperative CT examination, and the femoral stem AV was assessed using a 3D image analysis system (Zed hip, LEXI, Japan). The AV angle derived from the postoperative CT image analysis was used as the reference value to assess the accuracy of the two intraoperative measurement systems.
Results:
The discrepancy between the G-guide and the postoperative CT-measured values averaged 5.0° ± 3.9°, while the corresponding value for the navigation system was 5.2° ± 4.1°. Acceptable accuracy with a measurement error of less than 10° was achieved in 86% and 90% of the cases for the G-guide and navigation measurements respectively.
Conclusion:
Consequently, it was shown that both navigation and G-guide measurements can achieve comparative accuracy and are clinically useful.
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Messer-Hannemann P, Bätz J, Lampe F, Klein A, Püschel K, Campbell GM, Morlock M. The influence of cavity preparation and press-fit cup implantation on restoring the hip rotation center. Clin Biomech (Bristol, Avon) 2019; 63:185-192. [PMID: 30913461 DOI: 10.1016/j.clinbiomech.2019.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Reaming of the acetabular cavity and cup implantation directly influence the hip rotation center and contact area between implant and bone. Previous studies have reported on an altered rotation center after total hip arthroplasty, but have not studied the influence of reaming and cup implantation separately. Aim of this study was therefore to analyze the individual influence of acetabular reaming and subsequent cup implantation on the rotation center and how this influences the contact conditions at the bone-implant interface. METHODS Acetabular press-fit cups were implanted into the left and right hips of three full cadavers (n = 6). CT scans were performed to calculate the change in hip rotation center after reaming and prior to liner insertion. 3D models of the cups were used to determine the polar gap, the contact conditions and the effective press-fit. FINDINGS Reaming the acetabular cavity shifted the rotation center medially (median 5.8 mm, range 4.8-9.1), superiorly (5.3 mm, 3.0-7.0) and posteriorly (2.9 mm, 1.0-5.3). With cup implantation, the rotation center shifted back towards the native position, but no full restoration was observed. The degree of shift increased with the size of polar gap (rs = 0.829, P = .042), which inversely reduced the contact area (rs = 0.886, P = .019). INTERPRETATION This study reveals that the dominant factor in hip rotation center restoration is the reaming process, while the cup implantation for a given nominal press-fit has only a small influence. Increasing the press-fit would improve the restoration but bares the danger of insufficient bone coverage and periprosthetic fractures due to the high forces needed.
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Affiliation(s)
- Philipp Messer-Hannemann
- TUHH, Hamburg University of Technology, Institute of Biomechanics, Denickestrasse 15, 21073 Hamburg, Germany.
| | - Johanna Bätz
- TUHH, Hamburg University of Technology, Institute of Biomechanics, Denickestrasse 15, 21073 Hamburg, Germany
| | - Frank Lampe
- Hamburg University of Applied Sciences, Department of Life Sciences, Ulmenliet 20, 21033 Hamburg, Germany
| | - Anke Klein
- University Medical Center Hamburg-Eppendorf, Department of Legal Medicine, Butenfeld 34, 22529 Hamburg, Germany
| | - Klaus Püschel
- University Medical Center Hamburg-Eppendorf, Department of Legal Medicine, Butenfeld 34, 22529 Hamburg, Germany
| | - Graeme M Campbell
- TUHH, Hamburg University of Technology, Institute of Biomechanics, Denickestrasse 15, 21073 Hamburg, Germany
| | - Michael Morlock
- TUHH, Hamburg University of Technology, Institute of Biomechanics, Denickestrasse 15, 21073 Hamburg, Germany
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