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Kumaran Y, Mumtaz M, Quatman C, Balch-Samora J, Soehnlen S, Hoffman B, Tripathi S, Nishida N, Goel VK. Does spinopelvic alignment affect femoral head cartilage and the proximal femoral physis in slipped capital femoral epiphysis? A finite element analysis. Clin Biomech (Bristol, Avon) 2024; 116:106269. [PMID: 38861874 DOI: 10.1016/j.clinbiomech.2024.106269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/10/2024] [Accepted: 05/17/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Slipped capital femoral epiphysis is a prevalent pediatric hip disorder. Recent studies suggest the spine's sagittal profile may influence the proximal femoral growth plate's slippage, an aspect not extensively explored. This study utilizes finite element analysis to investigate how various spinopelvic alignments affect shear stress and growth plate slip. METHODS A finite element model was developed from CT scans of a healthy adult male lumbar spine, pelvis, and femurs. The model was subjected to various sagittal alignments through reorientation. Simulations of two-leg stance, one-leg stance, walking heel strike, ascending stairs heel strike, and descending stairs heel strike were conducted. Parameters measured included hip joint contact area, stress, and maximum growth plate Tresca (shear) stress. FINDINGS Posterior pelvic tilt cases indicated larger shear stresses compared to the anterior pelvic tilt variants except in two leg stance. Two leg stance resulted in decreases in the posterior tilted pelvi variants hip contact and growth plate Tresca stress compared to anterior tilted pelvi, however a combination of posterior pelvic tilt and high pelvic incidence indicated larger shear stresses on the growth plate. One leg stance and heal strike resulted in higher shear stress on the growth plate in posterior pelvic tilt variants compared to anterior pelvic tilt, with a combination of posterior pelvic tilt and high pelvic incidence resulting in the largest shear. INTERPRETATION Our findings suggest that posterior pelvic tilt and high pelvic incidence may lead to increased shear stress at the growth plate. Activities performed in patients with these alignments may predispose to biomechanical loading that shears the growth plate, potentially leading to slip.
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Affiliation(s)
- Yogesh Kumaran
- Engineering Center for Orthopaedic Research (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, United States; Ohio State University Wexner Medical Center, Department and Orthopaedics, Columbus, OH, United States
| | - Muzammil Mumtaz
- Engineering Center for Orthopaedic Research (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, United States
| | - Carmen Quatman
- Ohio State University Wexner Medical Center, Department and Orthopaedics, Columbus, OH, United States
| | - Julie Balch-Samora
- Nationwide Children's Hospital, Department of Orthopedics, Columbus, OH, United States
| | - Sophia Soehnlen
- Engineering Center for Orthopaedic Research (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, United States; Ohio State University Wexner Medical Center, Department and Orthopaedics, Columbus, OH, United States
| | - Brett Hoffman
- Engineering Center for Orthopaedic Research (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, United States
| | - Sudharshan Tripathi
- Engineering Center for Orthopaedic Research (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, United States
| | - Norihiro Nishida
- Yamaguchi University Hospital, Department of Orthopaedic Surgery, Ube, Yamaguchi, Japan
| | - Vijay K Goel
- Engineering Center for Orthopaedic Research (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, United States.
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Li Z, Yang Y, Guo S, Liu J, Zhou X, Ji H. Insufficient stem antetorsion and lower cup abduction is a combined risk factor for posterior hip dislocation in patients undergoing THA for femoral neck fractures: a retrospective analysis. BMC Musculoskelet Disord 2024; 25:103. [PMID: 38291445 PMCID: PMC10826068 DOI: 10.1186/s12891-024-07199-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/12/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND The role of acetabular and femoral component positions with respect to the risk of post-operative instability and dislocation remains debated. In this study, we aimed to identify potential risk factors for early dislocation following primary total hip arthroplasty (THA) for displaced intracapsular femoral neck fractures (FNF) using radiological measurements. METHODS We retrospectively analyzed data for patients who underwent cementless primary THA for FNF using a posterolateral approach between January 2018 and December 2021. Follow-up duration, age, sex, affected side, and mean time from THA to dislocation were recorded. Leg-length inequality, abductor lever arm, vertical and horizontal femoral offsets, vertical and horizontal hip centers of rotation, abduction, anteversion of the acetabulum and femoral prosthesis, and combined anteversion were measured. RESULTS The study sample included 17 men and 34 women, with 21 and 30 patients undergoing left- and right-hip operations, respectively. The mean patient age was 70.18 ± 7.64 years, and the mean follow-up duration was 27.73 ± 13.52 months. The mean time between THA and dislocation was 1.58 ± 0.79 months. Seven patients (13.73%) sustained posterior dislocation of the hip. The abduction angle (36.05 ± 6.82° vs. 45.68 ± 8.78°) (p = 0.008) and anteversion of the femoral prosthesis (8.26 ± 4.47° vs. 19.47 ± 9.01°) (p = 0.002) were significantly lower in the dislocation group than in the control group. There were no significant differences in other parameters. CONCLUSIONS Insufficient stem antetorsion combined with lower abduction angle of the acetabular component were associated with a high risk of dislocation, especially in patients with deep flexion or internal rotation of the flexed hip joint and knees, or in patients with a stiff spine or anterior pelvic tilt, impingement may then occur in the neck of the prosthesis and cup component, ultimately resulting in posterior dislocation. These findings could remind surgeons to avoid simultaneous occurrence of both in THA surgery. These results provide new insight into risk factors for hip dislocation in patients undergoing primary THA for FNF and may aid in reducing the risk of instability and dislocation. LEVEL OF EVIDENCE Prospective comparative study Level II.
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Affiliation(s)
- Zhuokai Li
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yang Yang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical College, Zhejiang, China
| | - Shengyang Guo
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Ju Liu
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Xiaoxiao Zhou
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
| | - Houlin Ji
- Jinji Lake Community Health Service Center of Suzhou Industrial Park, Suzhou, China.
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Avram GM, Prill R, Gurau CD, Georgeanu V, Deleanu B, Russu O, Becker R, Predescu V. Acetabular cup placement and offset control in robotic total hip arthroplasty performed through the modified anterolateral approach. INTERNATIONAL ORTHOPAEDICS 2023; 47:2265-2273. [PMID: 37160646 DOI: 10.1007/s00264-023-05835-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE The modified anterolateral approach (Röttinger) for total hip arthroplasty (THA) offers great advantages over conventional approaches, especially concerning early postoperative symptoms, which are mild and well tolerated by patients. Robotic-assisted implantation might facilitate rapid adoption of the modified anterolateral approach without exposing surgeons to risks encountered during the learning curve. This study posits that the use of robotic assistance in conjunction with the modified anterolateral approach for total hip arthroplasty (THA) can provide a substantial enhancement in the accuracy of cup placement in comparison to manual surgery. METHODS Thirty-two robotic-assisted THAs met the inclusion criteria and were matched to 32 conventional cases. Acetabular cup inclination, anteversion, limb-length discrepancy, and acetabular offset were assessed using certified planning software by two independent observers using pre- and postoperative anterior-posterior radiographs. Data was analyzed for normal distribution. Chi2 test was used to determine whether implanted acetabular cups that were within Lewinnek's safe zones were influenced by type of implantation. Effect size estimates and statistical power analysis were also performed to appreciate the appropriateness of the chosen sample size. RESULTS Robotic-assisted implantation was found to significantly improve acetabular cup placement in terms of inclination (p < 0.001) but not anteversion (p = 0.783). Although mean postoperative limb-length discrepancy and mean acetabular offset did not differ between groups, a significantly smaller variance was found in the robotic-assisted group (p < 0.001) and (p = 0.04), respectively. There were no significant differences between the two groups in terms of consistently implanting the acetabular cup within the Lewinnek safe zones p = 0.641 for anteversion and p = 0.230 for inclination, respectively. CONCLUSIONS Our results show that although robotic-assisted acetabular cup implantation performed through the modified anterolateral approach did not significantly differ from conventional implantation, it did offer increased accuracy in cup positioning, acetabular bone preservation, and limb-length restoration.
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Affiliation(s)
- George Mihai Avram
- Orthopaedics and Traumatology Department, Ponderas Academic Hospital, 014142, Bucharest, Romania.
| | - Robert Prill
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg/Havel, 14770, Brandenburg a.d.H, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg a.d.H, Germany
| | - Cristian Dorin Gurau
- Orthopaedics and Traumatology Department, Ponderas Academic Hospital, 014142, Bucharest, Romania
| | - Vlad Georgeanu
- Orthopaedics and Traumatology Department, Clinical Emergency Hospital St. Pantelimon, Bucharest, Romania
| | - Bogdan Deleanu
- Orthopaedics and Traumatology Department, University of Medicine and Pharmacy Victor Babes, Timisoara, Romania
| | - Octav Russu
- Orthopaedic and Traumatology Department, Pharmacy, Sciences and Technology George Emil Palade, University of Medicine, 540139, Targu Mures, Romania
| | - Roland Becker
- Center of Orthopaedics and Traumatology, Brandenburg Medical School Theodor Fontane, University Hospital Brandenburg/Havel, 14770, Brandenburg a.d.H, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 14770, Brandenburg a.d.H, Germany
| | - Vlad Predescu
- Orthopaedics and Traumatology Department, Ponderas Academic Hospital, 014142, Bucharest, Romania
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Xie R, Huang J, Wu Q, Qian Y, Jiang D, Li L, Huang L. A Comparison of Radiographic Outcomes after Total Hip Arthroplasty between the Direct Lateral Approach and Posterior Lateral Approach with EOS 2D/3D X-Ray Imaging System. Orthop Surg 2023; 15:1312-1324. [PMID: 37076774 PMCID: PMC10157717 DOI: 10.1111/os.13726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE The classical approaches for total hip arthroplasty (THA) are the direct lateral approach (DLA) and posterior lateral approach (PLA). There are few studies comparing implant orientation with these two approaches, and the impact of surgical approaches on implant orientation remains controversial. With the rise of the EOS imaging system, we aimed to use it to identify the differences between and factors associated with implant orientation after THA using DLA and PLA. METHODS In our department from January 2019 to December 2021, 321 primary unilateral THAs that used PLA and DLA were enrolled. A total of 201 patients who received PLA and 120 patients who received DLA were included in this study. Two blinded observers measured each case using EOS imaging data. Postoperative imaging metrics and other relevant influencing factors of the two surgical approaches were compared. Postoperative imaging metrics, including the anteversion and inclination of the cup, anteversion of the stem, and combined anteversion were measured based on EOS. Other relevant influencing factors included age, approach, gender, laterality, BMI, anterior pelvic plane inclination, femoral head diameter, femoral offset, lateral pelvic tilt, pelvic incidence, pelvis axial rotation, sacral slope, sagittal pelvic tilt, and surgery time. Multiple linear regression analyses were performed to identify the predictors of acceptability for each imaging data point. RESULTS No dislocation was found in the 321 patients who underwent primary THA during this period. The mean anteversion and combined anteversion of the cups using the DLA were 21.33° ± 17.31° (-51.7°-60.8°) and 33.71° ± 20.85° (-38.8°-77.6°) and PLA were 25.34° ± 12.76° (-5.5°-57.0°) and 42.37° ± 18.85° (-8.7°-84.7°), respectively. The DLA group had smaller anteversion (p = 0.038) and combined anteversion (p < 0.001). We found that surgical approach (p < 0.05), anterior pelvic plane inclination (p < 0.001), gender (p < 0.001), and femoral head diameter (p < 0.001) were important factors affecting acetabular cup anteversion (R2 = 0.375) and combined anteversion (R2 = 0.525). CONCLUSIONS In total hip arthroplasty, different prosthesis installation directions should be made according to different surgical approaches. Compared with the direct lateral approach, the acetabular anteversion can be intentionally enlarged when using the posterolateral approach. Surgical approach, anterior pelvic plane inclination (APPI), gender, and femoral head diameter were significant predictors of prosthesis orientation. The anterior pelvic plane inclination may be a useful standard for assessing the position of the prosthesis using EOS.
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Affiliation(s)
- Rui Xie
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Jun Huang
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Qian Wu
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Yu‐fan Qian
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Dinghua Jiang
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Lisong Li
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Lixin Huang
- Department of Orthopaedic SurgeryThe First Affiliated Hospital of Soochow UniversitySuzhouChina
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Jiang X, Zhang H, Hu X, Xie K, Kan T, Li B, Zhang C, Ai S, Gao L, Yan M, Wang L. [Semi-automated measurement and analysis of three-dimensional acetabular orientation in asymptomatic population and patients of developmental dysplasia of the hip]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1555-1562. [PMID: 34913312 DOI: 10.7507/1002-1892.202107112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the three-dimensional acetabular orientation in asymptomatic population and patients of developmental dysplasia of the hip (DDH) using a semi-automated measurement software, which provides data for the differential diagnosis, surgical planning, surgical instrument design, and postoperative evaluation of hip related diseases. Methods Eighty-four cases of CT data in asymptomatic population (asymptomatic group) and 47 cases of CT data in DDH patients (DDH group) were collected. There was no significant difference in gender and age (including age of male and female subgroups) between the two groups ( P<0.05). MaxTHA, a semi-automatic measurement software, was used to measure acetabular inclination and anteversion, including operative inclination (OI), radiographic inclination (RI), anatomic inclination (AI), operative anteversion (OA), radiographic anteversion (RA), and anatomic anteversion (AA). Comparisons were made between the two populations, between different Crowe classification subgroups, between different gender subgroups, and between left and right sides of acetabula. Results The comparison between asymptomatic group, healthy side of DDH group, and affected side of DDH group showed that there was no significant difference in acetabular orientation between asymptomatic group and healthy side of DDH group ( P>0.05). The OI, RI, and AI of affected side of DDH group were significantly higher than those in healthy side of DDH group and asymptomatic group, and AA was significantly lower than that in healthy side of DDH group and asymptomatic group ( P<0.05). The comparison between the normal acetabula and DDH acetabula with different Crowe classifications showed that there was no significant difference in the acetabulum orientation between Crowe Ⅰ group and the normal group ( P>0.05). The OI, RI, and AI of Crowe Ⅱ, Ⅲ, and Ⅳ groups were significantly higher than those of normal group ( P<0.05), the OI of Crowe Ⅲ group, RI and AI of Crowe Ⅳ group were significantly higher than those of Crowe Ⅰ group ( P<0.05), the AI of Crowe Ⅳ group was significantly higher than that of Crowe Ⅱ group ( P<0.05), and the OA, RA, and AA of Crowe Ⅲ group were significantly lower than other subgroups ( P<0.05) except Crowe Ⅰ group. The OA, RA, and AA in asymptomatic female group, and the OA and AI in DDH female group were significantly higher than those in all male groups ( P<0.05). The OI, RI, AI, and OA of the right acetabula in asymptomatic male group, and the RI and AI of the right acetabula in asymptomatic female group were significantly higher than those on the left side ( P<0.05). Conclusion There were significant differences in acetabular orientation between asymptomatic and DDH populations, inter-group differences among Crowe classification subgroups, inter-gender differences among subgroups, and bilateral differences among asymptomatic individuals.
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Affiliation(s)
- Xu Jiang
- Department of Orthopedics, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, P.R.China.,Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou Guangdong, 510120, P.R.China
| | - Henghui Zhang
- Department of Orthopedics, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, P.R.China
| | - Xumin Hu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou Guangdong, 510120, P.R.China
| | - Kai Xie
- Department of Orthopedics, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, P.R.China
| | - Tianyou Kan
- Department of Orthopedics, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, P.R.China
| | - Bo Li
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou Guangdong, 510120, P.R.China
| | - Chi Zhang
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou Guangdong, 510120, P.R.China
| | - Songtao Ai
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, P.R.China
| | - Liangbin Gao
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou Guangdong, 510120, P.R.China
| | - Mengning Yan
- Department of Orthopedics, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, P.R.China
| | - Liao Wang
- Department of Orthopedics, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, P.R.China
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