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Samarita CMC, Coruña JAD, Coruña JMR. Shifting to an app-based method of preoperative templating in orthopaedic surgery. OTA Int 2024; 7:e336. [PMID: 38912200 PMCID: PMC11191017 DOI: 10.1097/oi9.0000000000000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/03/2024] [Accepted: 05/08/2024] [Indexed: 06/25/2024]
Abstract
Background Preoperative templating plays an important part in attaining successful surgical outcomes after fracture fixation. Traditionally, surgeons have performed this task with printed radiographs, tracing paper, and colored markers. Now that digital radiography is ubiquitous, and digital templating platforms are needed but are expensive and may not be available to all surgeons, especially those in low-income and middle-income countries. In this study, we evaluate an innovative and user-friendly method using a mobile app that may facilitate the use of digital templating for all surgeons worldwide. Methods A study involving 2 groups of residents (N = 12) was conducted. Group A (n = 6) was assigned to do conventional templating; Group B (n = 6) was assigned to perform digital templating. Each group then switched to the other templating method and the process was repeated. Conventional templates were evaluated using the Arbeitsgemeinschaft für Osteosynthesefragen-Association for the Study of Internal Fixation (AO-ASIF) guidelines of template completeness. Digital templates were assessed using Image-Based Surgery Planning. Each subject in both groups completed templates for 3 injury patterns: AO 2R2A3/2U2C2, 32B2, and 43C2. Wilcoxon signed-rank and binomial tests (5% level of significance) were used for statistical analysis. Results Template processing, fracture classification, and plan elaboration were comparable between the traditional and digital template groups, with good interobserver and intraobserver reproducibility using the Wilcoxon signed-ranks test (all |z values| below 1.96, all P-values > 0.05). There was no significant difference in the evaluation scores for either exercise, whether doing a traditional standard template or the digital template (P value > 0.05). Conclusions This study shows that digital templating can achieve the same goals as conventional preoperative templating for fracture fixation. With the ubiquity of digital radiography, digital templating provides an opportunity to visualize fracture configurations and create an optimum preoperative plan for fracture reconstruction using an innovative and user-friendly platform.
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Affiliation(s)
- Chloe Marie C. Samarita
- Corazon Locsin Montelibano Memorial Regional Hospital, Bacolod City, Negros Occidental, Philippines
| | - Juan Agustin D. Coruña
- Corazon Locsin Montelibano Memorial Regional Hospital, Bacolod City, Negros Occidental, Philippines
| | - Jose Maria R. Coruña
- Corazon Locsin Montelibano Memorial Regional Hospital, Bacolod City, Negros Occidental, Philippines
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Cypel S, Bouche PA, Heliere G, David G, Rony L. Junior surgeon learning curve for performing digital planning of a first-line uncemented total hip prothesis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2709-2715. [PMID: 38758389 DOI: 10.1007/s00590-024-03986-8] [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: 03/04/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE Preoperative digital planning of total hip arthroplasty (THA) anticipates difficulties while increasing implant survival. The objective was to establish the learning curve to produce a reliable and reproducible preoperative planning for THA. We hypothesize that a learning curve exists for planning, and we want to determine the number of procedures required to accomplish it. METHODS This prospective study included patients for THA from 02/11/2019 to 01/11/2022. Ten junior (Juniors) and senior surgeons (Seniors) had received dedicated training in the use of the software. Modeling was done blindly by Juniors and Senior before surgery on a standardized front pelvis X-ray (mediCAD 2D Classic Hospital software). Statistical analyses to establish the learning curve were done to compare the Juniors and Seniors. RESULTS 60% of the Juniors achieved competence after 31.5 ± 12.9 [14-54] planning sessions for the acetabular implant, and 80% after 30.3 ± 8.3 [17-40] planning sessions for the femoral implant. Femoral neck size was achieved by all ten Juniors after 23.1 ± 6.8 [17-38] planning. The offset was correctly restored on the plan by 30% of the Juniors after 33.5 ± 11.6 [18-46] planning. CONCLUSION There is a learning curve for 2D planning of uncemented THA. The different planning items seem to have different learning curves. Compared to Seniors, the completion of 75 planning sessions is not sufficient in totality. The competence of the Juniors for the acetabular implant, the length of the neck and the size of the femoral stem are mostly acquired before 75 sessions. LEVEL OF EVIDENCE Prospective study-Level II.
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Affiliation(s)
- S Cypel
- Département de Chirurgie Osseuse, CHU-Angers, 4, rue Larrey, 49933, Angers Cedex 9, France
| | - P-A Bouche
- Service d'orthopédie, Hopital Lariboisière, 2 rue Ambroise Paré, 75015, Paris, France
| | - G Heliere
- Département de Chirurgie Osseuse, CHU-Angers, 4, rue Larrey, 49933, Angers Cedex 9, France
| | - G David
- Département de Chirurgie Osseuse, CHU-Angers, 4, rue Larrey, 49933, Angers Cedex 9, France
| | - L Rony
- Département de Chirurgie Osseuse, CHU-Angers, 4, rue Larrey, 49933, Angers Cedex 9, France.
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Surroca M, Miguela S, Bartra-Ylla A, Nuñez JH, Angles-Crespo F. Surgeon's Experience and Accuracy of Preoperative Digital Templating in Primary Total Hip Arthroplasty. Hip Pelvis 2024; 36:129-134. [PMID: 38825822 PMCID: PMC11162868 DOI: 10.5371/hp.2024.36.2.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 06/04/2024] Open
Abstract
Purpose Preoperative planning has become essential in performance of total hip arthroplasty (THA). However, data regarding the effect of the planner's experience on the accuracy of digital preoperative planning is limited. The objective of this study was to assess the accuracy of digital templating in THA based on the surgeon's experience. Materials and Methods A retrospective study was conducted. An analysis of 98 anteroposterior pelvic radiographs, which were individually templated by four surgeons (two hip surgeons and two orthopaedic residents) using TraumaCad® digital planning, was performed. A comparison of preoperatively planned sizes with implanted sizes was performed to evaluate the accuracy of predicting component size. The results of preoperative planning performed by hip surgeons and orthopaedic residents were compared for testing of the planner's experience. Results Femoral stem was precisely predicted in 32.4% of cases, acetabular component in 40.3%, and femoral offset in 76.7%. Prediction of cup size showed greater accuracy than femoral size among all observers. No differences in any variable were observed among the four groups (acetabular cup P=0.07, femoral stem P=0.82, femoral offset P=0.06). All measurements showed good reliability (intraclass correlation coefficient [ICC] acetabular cup: 0.76, ICC femoral stem: 0.79). Conclusion The results of this study might suggest that even though a surgeon's experience supports improved precision during the planning stage, it should not be restricted only to surgeons with a high level of experience. We consider preoperative planning an essential part of the surgery, which should be included in training for orthopaedics residents.
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Affiliation(s)
- Maria Surroca
- Hip Unit, Department of Orthopedic Surgery, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
- Department of Surgery, Universitat de Barcelona, Barcelona, Spain
| | - Silvia Miguela
- Hip Unit, Department of Orthopedic Surgery, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
- Department of Surgery, Universitat de Barcelona, Barcelona, Spain
| | - Agustí Bartra-Ylla
- Hip Unit, Department of Orthopedic Surgery, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
- Department of Surgery, Universitat de Barcelona, Barcelona, Spain
| | - Jorge H. Nuñez
- Hip Unit, Department of Orthopedic Surgery, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
- Department of Surgery, Universitat de Barcelona, Barcelona, Spain
| | - Francesc Angles-Crespo
- Hip Unit, Department of Orthopedic Surgery, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
- Department of Surgery, Universitat de Barcelona, Barcelona, Spain
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Pongkunakorn A, Udomluck P, Aksornthung C, Wangjiraphan N. Digital Templating of THA Using PACS and an iPhone or iPad is as Accurate as Commercial Digital Templating Software. Clin Orthop Relat Res 2023; 481:1104-1113. [PMID: 36730564 PMCID: PMC10194723 DOI: 10.1097/corr.0000000000002474] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/07/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Digital templating is a standard preoperative planning method in THA. Unfortunately, many hospitals cannot afford the software or have accessibility barriers owing to a limited number of installed computer workstations. We created a templating method using a picture archiving and communication system and the Keynote program on a mobile phone. The method's accuracy and reliability have not been compared with those of commercial digital templating software. QUESTIONS/PURPOSES (1) How accurate is this novel method on iPhone and iPad mobile devices compared with a commercially available digital templating software program? (2) Is the method reproducible among users with different levels of experience? (3) Are the results similar for different types of femoral prostheses? METHODS Between January 2017 and May 2020, we treated 209 patients for hip disease or trauma with primary cementless THA. We considered patients with a normal contralateral hip as potentially eligible for this retrospective study. Thus, 91% (191 of 209 hips) were eligible; a further 13% (27 hips) were excluded because of postoperative leg length discrepancy > 5 mm, femoral offset discrepancy > 5 mm (9% [18 hips]), intraoperative periprosthetic fracture (4% [eight hips]), and proximal femoral deformity (0.5% [one hip]), leaving 78% (164 hips) for analysis here. Their preoperative radiographs were evaluated by three independent assessors, including one senior orthopaedic surgeon, one senior resident, and one junior resident, using three methods. The first was digital templating using OrthoView software, which is a commercially available digital templating software program used worldwide and known to possess high accuracy. The other two methods were technically similar to one another, with the only difference being the interface: iPhone versus iPad. In both of those approaches, using the picture archiving and communication system measurement tool, we drew a circle on an acetabular radiograph to depict the cup. We took a photograph of the computer display and imported the photograph into slides of the Keynote program, a presentation software application for Mac computers, on both devices. It was then underlaid on transparent digital templates of the femoral stem, which were scanned from plastic templates and positioned at the center of each slide. We scaled the image to the template by adjusting the image size until a 15-cm straight line on the hip photograph was equal to the 15-cm scale markers of the template. All templating results were compared with the actual implanted cementless THA components to assess accuracy. All assessors were blinded to the information about the actual implants, and they were not involved in performing the surgical procedures. The intrarater and interrater reliabilities were analyzed using intraclass correlation coefficients and kappa values. The accuracy for predicting stem size for each type of the four stem designs was compared among the three methods. RESULTS We were able to predict the acetabular cup size within one size in 92% of hips (151 of 164) using OrthoView and in 92% (150 of 164) using the novel method (p > 0.99). The accuracies of the three methods were comparable for predicting a femoral stem size within one size (OrthoView: 90% [148 hips], iPhone: 93% [152 hips], and iPad: 91% [149 hips]; p = 0.78), and neck length (OrthoView: 96% [157 hips], iPhone: 96% [158 hips], and iPad: 97% [159 hips]; p = 0.95). Using OrthoView, the neck offset was correctly predicted in 80% (132 hips), compared to 85% (139 hips) when using the iPhone and 82% (134 hips) when using the iPad (p = 0.57). All methods showed substantial or excellent agreement regarding intrarater and interrater reliability. There was no difference in accuracy regarding any of the four femoral stem designs we evaluated (Avenir, Excia, ML taper, and Metha). CONCLUSION The digital templating technique for THA using an iPhone or iPad combined with a picture archiving and communication system demonstrated high accuracy, comparable to that of commercial digital templating software. This technique is reliable and reproducible for predicting a cementless prosthesis size, neck length, and offset in different types of femoral stems. It may be useful as an alternative in resource-constrained centers where commercial software programs are too expensive to be used in practice. LEVEL OF EVIDENCE Level IV, diagnostic study.
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Affiliation(s)
- Anuwat Pongkunakorn
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | - Phatcharapon Udomluck
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | - Chayanut Aksornthung
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | - Noppadol Wangjiraphan
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
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Al-Ashqar M, Aslam N, Azhar MS, Grayston J, Hahnel J. KingMark's dual-marker versus a conventional single-marker templating system: is there a difference in accuracy of predicting final implant sizes and leg lengths? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:167-175. [PMID: 34842990 DOI: 10.1007/s00590-021-03174-y] [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: 07/22/2021] [Accepted: 11/19/2021] [Indexed: 01/07/2023]
Abstract
AIMS Pre-operative templating for total hip replacement (THR) surgery leads to more accurate implant sizing and positioning. This study aimed to compare the KingMark™ dual-marker system for magnification calibration to the current gold standard single-marker system in accuracy of predicting implant size and restoration of leg length post-operatively. METHODS This is a retrospective analysis of patients who had primary THR surgery from 2013 to 2019 by a single surgeon. Patients were in two cohorts whose operations were completed at separate healthcare facilities. Patients in the first cohort had pre-operative templating using the KingMark system; patients in the second cohort had templating using a single-marker. For all patients, pre-operative radiographs were reviewed; predicted implants noted; and leg length discrepancies calculated. These were compared to post-operative data. We then tested the null hypothesis that there was no difference between the templating methods for prediction accuracy of implant size and achieving restoration of leg length. RESULTS A total of 121 patients were included in the KingMark cohort, and 104 were included in the single-marker cohort. In the KingMark cohort, 83.5% of patients had implantation of a cup within one size of that predicted, compared to 71.2% of the single-marker cohort. This superiority was statistically significant. There was a greater proportion of exact cup size predictions in the KingMark cohort, but this was not statistically significant. We did not find any significant difference between the cohorts for stem size, or stem placement, or reduction of leg length discrepancy. CONCLUSION We have demonstrated statistically significant superiority of the KingMark over a single-marker templating system for predicting cup size in primary THR surgery. For post-operative restoration of leg length, our study did not show any advantage of KingMark templating compared to single-marker templating.
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Affiliation(s)
- Mohammad Al-Ashqar
- Bradford Royal Infirmary, Bradford, UK.
- Leeds Teaching Hospitals, Leeds, UK.
| | - Nayef Aslam
- Bradford Royal Infirmary, Bradford, UK
- Leeds Teaching Hospitals, Leeds, UK
| | | | - James Grayston
- Bradford Royal Infirmary, Bradford, UK
- Leeds Teaching Hospitals, Leeds, UK
| | - James Hahnel
- Bradford Royal Infirmary, Bradford, UK
- Leeds Teaching Hospitals, Leeds, UK
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de Waard S, Verboom T, Bech NH, Sierevelt IN, Kerkhoffs GM, Haverkamp D. Femoroacetabular offset restoration in total hip arthroplasty; Digital templating a short stem vs a conventional stem. World J Orthop 2022; 13:139-149. [PMID: 35317405 PMCID: PMC8891660 DOI: 10.5312/wjo.v13.i2.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/02/2021] [Accepted: 01/08/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Failure in restoring individual anatomy could be a reason for persistent functional limitations post total hip arthroplasty. Femoroacetabular offset (FAO) plays an important role in anatomic restoration, as loss of offset ≥ 5 mm is associated with altered gait and decreased functional outcome. Preoperative assessment by use of digital templating has shown to be a reliable method for sizing the components in total hip arthroplasty, and can show if anatomic restoration is achieved. In recent years, short stems are growing in popularity as it could allow better restoration due to more variety in placement.
AIM To assess whether restoration of the FAO differs between a short or a conventional stem by use of digital templating. Additionally, association of the preoperative offset and caput-colllum-diaphyseal angle (CCD-angle) within restoration of both stems was investigated, and the reliability of measurements was assessed.
METHODS A total of 100 standardized hip radiographs were used for digital templating. Restoration of FAO was classified into “restored” or “not restored”, when a < 5 mm or ≥ 5 mm difference from baseline value presented, respectively. Differences between the two stems concerning proportions of correct restoration of the FAO were analyzed by use of McNemar tests. To assess association between CCD-angle and preoperative FAO with absolute FAO restoration, multi-level analysis was performed by use of a linear mixed model to account for paired measurements. Through determination of the optimal point under the curve in operating curve-analysis, bootstrapping of thousand sets was performed to determine the optimal cutoff point of the preoperative FAO for restoration within the limits of 5 mm. Three observers participated for inter-observer reliability, with two observers measuring the radiographs twice for intra-observer reliability.
RESULTS The mean preoperative FAO was 79.7 mm (range 62.5-113 mm), with a mean CCD-angle of 128.6° (range 114.5°-145°). The conventional stem could only restore the FAO in 72 of the cases, whereas the short stem restored the FAO in all cases. CCD-angle was not a predictor, but the preoperative FAO was. A cut-off point of 81.25 mm (95% confidence interval of 80.75-84.75 mm) in preoperative FAO was found where the conventional stem was unable to restore the FAO. Reliability of measurements was excellent, with an intra-observer reliability of 0.99 and inter-observer reliability in baseline measurements higher than 0.9 between the three observers.
CONCLUSION In preoperative planning of FAO restoration in total hip arthroplasty, digital templating shows that short stems with a curve following the medial calcar are potentially better at restoring the FAO compared to conventional stems if the preoperative offset is ≥ 80.0 mm.
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Affiliation(s)
- Sheryl de Waard
- Orthopedic Surgery, Xpert Orthopedie Amsterdam, Amsterdam 1101 EA, Netherlands
| | - Tom Verboom
- Orthopedic Surgery, Xpert Orthopedie Amsterdam, Amsterdam 1101 EA, Netherlands
| | - Niels Hendrik Bech
- Orthopedic Surgery, Xpert Orthopedie Amsterdam, Amsterdam 1101 EA, Netherlands
| | - Inger N Sierevelt
- Orthopedic Surgery, Xpert Orthopedie Amsterdam, Amsterdam 1101 EA, Netherlands
| | - Gino M Kerkhoffs
- Orthopaedic Surgery, Academic Medical Centre, Amsterdam 1105 AZ, Netherlands
| | - Daniël Haverkamp
- Orthopedic Surgery, Xpert Orthopedie Amsterdam, Amsterdam 1101 EA, Netherlands
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Smith JBV, Bishi H, Wang C, Asopa V, Field RE, Sochart DH. The accuracy and reliability of preoperative digital 2D templating in prosthesis size prediction in uncemented versus cemented total hip arthroplasty: a systematic review and meta-analysis. EFORT Open Rev 2021; 6:1020-1039. [PMID: 34909222 PMCID: PMC8631246 DOI: 10.1302/2058-5241.6.210048] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The purpose of this study was to compare the accuracy and the inter- and intra-observer reliability of preoperative digital 2D templating in prosthesis size prediction for the planning of cemented or uncemented THA. This study was registered in the NIHR PROSPERO database (ID: CRD42020216649) and conducted according to the PRISMA guidelines. A search of electronic databases in March 2021 found 29 papers overall. The quality of evidence was assessed using the IHE Quality Appraisal of Case Series Studies Checklist and the CASP Randomised Controlled Trials Checklist. A meta-analysis was conducted, and the accuracy was presented as proportions and the inter- and intra-observer reliability were measured using intraclass correlation coefficients (ICC). Accuracy within one prosthesis size (±1) for cemented stems was 0.89 (95% confidence interval (CI) 0.83–0.95), cemented cups 0.78 (95% CI 0.67–0.89), uncemented stems 0.74 (95% CI 0.66–0.82) and uncemented cups 0.73 (95% CI 0.67–0.79) (test of group differences: p = 0.010). Inter-observer reliability (ICC) for uncemented cups was 0.88 (95% CI 0.85–0.91), uncemented stems 0.86 (95% CI 0.81–0.91), cemented stems 0.69 (95% CI 0.54–0.84) and cemented cups 0.68 (95% CI 0.55–0.81) (test of group differences: p = 0.004). Due to lack of data, intra-observer reliability (ICC) could only be calculated for uncemented prostheses, which for the stems was 0.90 (95% CI 0.88–0.92) and for the cups was 0.87 (95% CI 0.83–0.90) (test of group differences: p = 0.124). The accuracy of preoperative digital templating is greater for cemented prostheses, but the inter-observer reliability is greater for uncemented prostheses. The intra-observer reliability showed a high level of agreement for uncemented prostheses.
Cite this article: EFORT Open Rev 2021;6:1020-1039. DOI: 10.1302/2058-5241.6.210048
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Affiliation(s)
- Joshua B V Smith
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
| | - Habeeb Bishi
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
| | - Chao Wang
- Kingston University and St George's University of London, Tooting, London, UK
| | - Vipin Asopa
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
| | - Richard E Field
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
| | - David H Sochart
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
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Kristoffersson E, Otten V, Crnalic S. The accuracy of digital templating in cementless total hip arthroplasty in dysplastic hips. BMC Musculoskelet Disord 2021; 22:942. [PMID: 34758811 PMCID: PMC8582185 DOI: 10.1186/s12891-021-04793-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) is a complex procedure due to associated anatomical abnormalities. We studied the extent to which preoperative digital templating is reliable when performing cementless THA in patients with DDH. Methods We templated and compared the pre- and postoperative sizes of the acetabular and femoral components and the center of rotation (COR), and analysed the postoperative cup coverage, leg length discrepancy (LLD), and stem alignment in 50 patients (56 hips) with DDH treated with THA. Results The implant size exactly matched the template size in 42.9% of cases for the acetabular component and in 38.2% of cases for the femoral component, whereas the templated ±1 size was used in 80.4 and 81.8% of cases for the acetabular and femoral components, respectively. There were no statistically significant differences between templated and used component sizes among different DDH severity levels (acetabular cup: p = 0.30 under the Crowe classification and p = 0.94 under the Hartofilakidis classification; femoral stem: p = 0.98 and p = 0.74, respectively). There were no statistically significant differences between the planned and postoperative COR (p = 0.14 horizontally and p = 0.52 vertically). The median postoperative LLD was 7 (range 0–37) mm. Conclusion Digital preoperative templating is reliable in the planning of cementless THA in patients with DDH.
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Affiliation(s)
- Emelie Kristoffersson
- Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, 90185, Umeå, Sweden
| | - Volker Otten
- Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, 90185, Umeå, Sweden
| | - Sead Crnalic
- Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, 90185, Umeå, Sweden.
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Dutka J, Kiepura S, Bukowczan M. Is analog preoperative planning still applicable?-comparison of accuracy of analog and computer preoperative planning methods in total hip arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:749. [PMID: 34268362 PMCID: PMC8246200 DOI: 10.21037/atm-20-7489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/28/2021] [Indexed: 01/01/2023]
Abstract
Background Preoperative planning is an integral part of total hip arthroplasty and has a significant impact on surgical technique and clinical outcome. The variety of types and sizes of endoprosthesis components makes the procedure more demanding and generates a need for accurate preoperative planning. The objective of this study was to analyze an analog method of preoperative planning of primary total hip arthroplasty based on templates overlaying on preoperative radiograms and compare its accuracy for predicting the size, both the stem and cup, with computer planning methods. Methods A retrospective cohort study based on 360 X-ray images of hip joints in 348 patients qualified for total hip arthroplasty between 2018 and 2019. The study group consisted of 136 men and 212 women, with an average age of 65 years (56 to 85 years). Material included both cementless and cemented endoprostheses. Results In the analyzed material, the accuracy of cup planning using the analog method was 85% (P<0.001) and 77% (P<0.001) in the planning of stem size. However, using the computer method, planning accuracy was 82% (P<0.001) for the cup and 72% (P<0.001) for the stem. Conclusions Both methods of preoperative planning remain effective. The analog method of preoperative planning is simple, precise, and repeatable in choosing the type and size of endoprosthesis components with an accuracy of 85% and 77% for the cup and stem respectively. The accuracy of planning depends on the type of endoprosthesis and in the case of the cemented endoprosthesis, it is lower than in cementless.
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Affiliation(s)
- Julian Dutka
- Department of Orthopedic and Trauma Surgery in Zeromski's Memorial Specialistic Hospital, Krakow, Poland
| | - Slawomir Kiepura
- Department of Orthopedic and Trauma Surgery in Zeromski's Memorial Specialistic Hospital, Krakow, Poland
| | - Mateusz Bukowczan
- Department of Orthopedic and Trauma Surgery in Zeromski's Memorial Specialistic Hospital, Krakow, Poland
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10
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Peng HM, Feng B, Chen X, Wang YO, Bian YY, Wang W, Weng XS, Qian WW. Usefulness of a Simple Preoperative Planning Technique using Plain X-rays for Direct Anterior Approach for Total Hip Arthroplasty. Orthop Surg 2020; 13:145-152. [PMID: 33305484 PMCID: PMC7862183 DOI: 10.1111/os.12854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/20/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022] Open
Abstract
Objective To examine the accuracy, reliability, and reproducibility of a simple preoperative planning technique using plain X‐rays. Methods A retrospective analysis of 96 consecutive cases of primary direct anterior approach (DAA)‐total hip arthroplasty (THA) from July 2015 to December 2018 was performed. The 96 patients included 24 males and 72 females, with an average age of 70 years. The standard AP pelvis radiographs with the patients' hips extended and internally rotated were obtained pre‐ and postoperatively. The preoperative planning was also completed on the standardized AP pelvic radiographs. The prearranged cup positioning was radiologically measured intraoperatively using fluoroscopy. The correct leg length was assessed intraoperatively, which was compared with the preoperative planning. The component positioning was measured by three independent researchers. Two of the researchers completed the measurements three times, and intra‐observer and inter‐observer reliability were calculated. All patients received at least 6 months follow‐up (6 months–4 years). Results In all cases, the median leg length discrepancy (LLD) was 4.4 mm (range 1.6–15.9 mm), and 84 patients had an LLD smaller than 10 mm, of which 58 patients had an LLD of less than 5 mm. None of the patients had a critical LLD of 2 cm or larger. The multivariable logistic regression for LLD (safe range: yes/no) with the co‐variables including gender, ASA classification, type of cup, the surgeon's experience level, and the presence of a total hip arthroplasty (THA) on the contralateral side did not present statistical significance. The median angle of the inclination of the acetabular component (IA) was 42.3° (range: 28.7°–52.2°). Ninety‐one patients were within the defined safe range. The hit ratio for the cup to be within the safe zone was significantly higher for the Pinnacle cups than that for the Continuum cups (P < 0.05). However, there was no significant difference in gender, ASA classification, the surgeon's experience level, and the presence of a total hip arthroplasty (THA) on the contralateral side. The median of its anteversion (AA) was 20.6° (range: 10.6°–40.1°). Only 41 patients were within the defined safe range. None of the co‐variables presented a statistical significance affecting the AA of the cup positioning. Meanwhile, the average fluoroscopy time for the cup positioning (n = 86, missing data in 10 cases) was 4 seconds (range: 1–74), with most of the patients (97.9%) having a fluoroscopy time of fewer than 20 seconds. Conclusions The combination of correct preoperative planning and standardized intraoperative measurements can reestablish right leg length and assure the correct cup positioning.
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Affiliation(s)
- Hui-Ming Peng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(CAMS), Beijing, China
| | - Bin Feng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(CAMS), Beijing, China
| | - Xi Chen
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(CAMS), Beijing, China
| | - Yi-Ou Wang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(CAMS), Beijing, China
| | - Yan-Yan Bian
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(CAMS), Beijing, China
| | - Wei Wang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(CAMS), Beijing, China
| | - Xi-Sheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(CAMS), Beijing, China
| | - Wen-Wei Qian
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(CAMS), Beijing, China
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Goyal T, Sethy SS, Ansari S, Das L, Paul S. Use of Acetate Templates Over Digital Radiographs for Templating in Total Hip Arthroplasty: Technique and Its Validation. Indian J Orthop 2020; 55:81-87. [PMID: 34122759 PMCID: PMC8149513 DOI: 10.1007/s43465-020-00300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Acetate templates were commonly used for templating for total hip arthroplasty. With digital radiographs having replaced conventional analogue radiographs, newer techniques are required. We describe a method for templating images of digital radiographs using conventional acetate templates, which is independent of a magnification marker or PACS system. METHODS Fifty-one patients (64 hips) who were treated with primary THA were prospectively evaluated. Templating was done by keeping the acetate template directly over the digital image of the radiograph on a liquid crystal display (LCD) monitor, after calibrating the linear scale generated by the digital radiography machine. The size of prosthesis predicted on this templating technique was compared with the actual sizes used during the surgery. Inter-observer and intra-observer reliabilities were assessed. Our calibration method was further validated by comparing the size of the cup calculated on postoperative radiograph using digital templating software (mediCAD Hectec GmbH) and the actual size used during surgery. RESULTS Accurate size was predicted for 36.7% of the acetabular cup and 35.9% of femoral stems. The accuracy within ± one size was 89.9% for acetabular cups and 91.4% for femoral stems. Excellent inter-observer and intra-observer reliability were seen for both femoral and acetabular components. CONCLUSION The method described provides an accurate, reproducible, convenient and low-cost technique of preoperative templating. It combines the ease of using acetate templates with the convenience of being able to use digital images, without the need for expensive software.
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Affiliation(s)
- Tarun Goyal
- grid.413618.90000 0004 1767 6103Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab 151001 India
| | - Siddharth S. Sethy
- grid.413618.90000 0004 1767 6103Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Sajid Ansari
- grid.413618.90000 0004 1767 6103Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Lakshmana Das
- grid.413618.90000 0004 1767 6103Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Souvik Paul
- grid.413618.90000 0004 1767 6103Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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Montiel V, Troncoso S, Valentí-Azcárate A, Valentí-Nin JR, Lamo-Espinosa JM. Total Hip Arthroplasty Digital Templating: Size Predicting Ability and Interobserver Variability. Indian J Orthop 2020; 54:840-847. [PMID: 33133407 PMCID: PMC7572938 DOI: 10.1007/s43465-020-00217-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/23/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND During the last century, total hip arthroplasties have become more popular. They have had a huge impact on the quality of life, pain, range of motion, social interaction, and psychological well-being. A number of studies have emphasized the importance of using templates to choose the appropriate implant size when planning the surgery. Our aim is to use MediCad® software to analyze the ability of the digital template system MediCad® to predict the size of the implant needed in total hip arthroplasties. MATERIALS AND METHODS An arthroplasty preoperative plan was created according to the MediCad® software guidelines, on anteroposterior hip X-ray by one junior resident, one senior resident, and three experienced hip surgeons. RESULTS The median size accuracy was 0.7 (range: 0.27-0.87) for the cup, 0.73 (range: 0.36-0.83) for the stem, and 0.28 (range: -0.14-0.69) for the neck. Interobserver reliability was good (kappa > 0.4) and stronger when measuring the stem than when doing so with the cup. Conclusion: Digital preoperative total hip arthroplasty planning is a good method for predicting component size, restoring hip anatomy (vertical offset and horizontal offset), with good interobserver reliability.
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Affiliation(s)
- Veronica Montiel
- grid.411730.00000 0001 2191 685XDepartment of Orthopedic Surgery and Traumatology, Clínica Universidad de Navarra, Av. Pio XII, 36, 31008 Pamplona, Navarra Spain
| | - Santiago Troncoso
- grid.411730.00000 0001 2191 685XDepartment of Orthopedic Surgery and Traumatology, Clínica Universidad de Navarra, Av. Pio XII, 36, 31008 Pamplona, Navarra Spain
| | - Andrés Valentí-Azcárate
- grid.411730.00000 0001 2191 685XDepartment of Orthopedic Surgery and Traumatology, Clínica Universidad de Navarra, Av. Pio XII, 36, 31008 Pamplona, Navarra Spain
| | - Juan Ramón Valentí-Nin
- grid.411730.00000 0001 2191 685XDepartment of Orthopedic Surgery and Traumatology, Clínica Universidad de Navarra, Av. Pio XII, 36, 31008 Pamplona, Navarra Spain
| | - Jose María Lamo-Espinosa
- grid.411730.00000 0001 2191 685XDepartment of Orthopedic Surgery and Traumatology, Clínica Universidad de Navarra, Av. Pio XII, 36, 31008 Pamplona, Navarra Spain
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13
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Kobayashi H, Cech A, Kase M, Pagenstart G, Carrillon Y, O'Loughlin PF, Bothorel H, Aït-Si-Selmi T, Bonnin MP. Pre-operative templating in THA. Part II: a CT-based strategy to correct architectural hip deformities. Arch Orthop Trauma Surg 2020; 140:551-562. [PMID: 31974697 DOI: 10.1007/s00402-020-03341-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Pre-operative templating for total hip arthroplasty (THA) remains inaccurate due to improper magnification and alignment. We aimed to describe an improved templating strategy using computed tomography (CT) to predict component sizes and offsets with greater accuracy. MATERIALS AND METHODS We analysed 184 CT images acquired for pre-operative templating of primary THA. We aimed to restore native (pre-arthritic) femoral offset and limb length, by raising the head center to the level of the templated cup center cranio-caudally, but maintaining the pathologic (pre-operative) head center medio-laterally (except in medialized hips). Acetabular offset (AO) and femoral offset (FO) were measured on pre-operative CT scans, during acetate templating, and on post-operative true antero-posterior radiographs. RESULTS The post-operative offsets were within ± 5 mm from templated estimates in 174 hips (91%) for AO, in 116 hips (61%) for FO, in 111 hips (58%) for GO, and in 134 hips (70%) for neck cut level. The post-operative hip architecture reproduced the templated hip architecture within ±5 mm in 77 hips (40%). The agreement between planned and post-operative parameters was moderate for stem size (0.57), cup size (0.62), AO (0.50), but fair for FO (0.45). The AO decreased in most arthritic types, notably in lateralized hips (6.6 mm), but remained unchanged in medialized hips. The FO increased in most arthritic types (1.8-3.1 mm) but remained unchanged in medialized and lateralized hips. CONCLUSIONS We described a strategy for pre-operative templating in THA. Despite the accuracy of CT, the authors found significant variations between planned and post-operative reconstructions, which suggest that pre-operative templating should only be used as an approximate guide.
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Affiliation(s)
- Hideo Kobayashi
- Department of Orthopaedic Surgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Alexandre Cech
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Masanori Kase
- Department of Orthopaedic Surgery, Nissan Tamagawa Hospital, Setagayaku, Tokyo, Japan
| | - Geert Pagenstart
- Department of Clinical Research, University of Basel, Basel, Switzerland.,Clarahof Clinic of Orthopaedic Surgery, Merian-Iselin-Hospital Swiss Olympic Medical Center, Basel, Switzerland.,Knee Institute Basel, Basel, Switzerland
| | - Yannick Carrillon
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Padhraig F O'Loughlin
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.,Cork University Hospital, South Infirmary, Victoria University Hospital, Mater Private Cork, Cork, Ireland
| | - Hugo Bothorel
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Tarik Aït-Si-Selmi
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.,Artro Institute, Lyon, France
| | - Michel P Bonnin
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.,Artro Institute, Lyon, France
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Pre-operative planning in THA. Part III: do implant size prediction and offset restoration influence functional outcomes after THA? Arch Orthop Trauma Surg 2020; 140:563-573. [PMID: 31974695 DOI: 10.1007/s00402-020-03342-5] [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: 05/14/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Few studies evaluated clinical benefits of pre-operative templating in total hip arthroplasty (THA). We investigated whether mismatch between planned and real implant sizes and medio-lateral offsets compromises THA outcomes. MATERIALS AND METHODS We reviewed records of 184 primary THAs with pre-operative CT scans used for templating. Acetabular offset (AO), femoral offset (FO) and global offset (GO) were measured on pre-operative CT scans, during acetate templating, and post-operative antero-posterior radiographs. Multivariable analyses were performed to determine if Forgotten Joint Score (FJS) and Oxford Hip Score (OHS) at > 2 years were associated with differences between post-operative and planned parameters. RESULTS The FJS and OHS were not influenced by mismatch of component sizes nor of FO and GO. The FJS was better when the post-operative AO was greater than planned (p = 0.050). The FJS differed among arthritic types (p = 0.015). Multivariable analyses confirmed that older patients had better OHS (beta - 0.16; p = 0.033) and FJS (beta 0.74; p = 0.002), medialized hips had worse FJS (beta - 20.1; p = 0.041) and hips with greater AO than planned had better FJS (beta 1.71; p = 0.024) CONCLUSIONS: Implanting a component of different size than planned did not compromise THA outcomes, but medialized hips had worse scores, and conservative acetabular reaming improved scores.
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Schiffner E, Latz D, Jungbluth P, Grassmann JP, Tanner S, Karbowski A, Windolf J, Schneppendahl J. Is computerised 3D templating more accurate than 2D templating to predict size of components in primary total hip arthroplasty? Hip Int 2019; 29:270-275. [PMID: 29781288 DOI: 10.1177/1120700018776311] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The aim of this study was to compare the accuracy of preoperative templating in total hip arthroplasty (THA) using conventional 2-dimensional (2D) and computed tomography (CT)-based 3-dimensional (3D) measures. METHODS One hundred and sixteen consecutive primary THAs were analysed. The preoperative diagnosis was primary osteoarthritis in all cases. The 2D templating and the 3D templating were performed by two different residents. All templating results were available for the orthopaedic surgeon performing the procedure. Accuracies with regard to the predicted and actual implant sizes were determined for each procedure. Implantation of the size as planned was defined as "exact", whereas the use of components within one size larger or smaller (±1) as planned were defined as "accurate." RESULTS The 3D templating was significantly more accurate in predicting implant sizing compared to 2D templating for primary total hip arthroplasty (THA). The difference was statistically significant for the cup templating (''exact'' p = 0.02; ''accurate'' p = 0.01) and for the stem templating (''exact'' p = 0.04; ''accurate'' p = 0.01). CONCLUSION Our results support the superiority of 3D templating over 2D templating in predicting implant size.
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Affiliation(s)
- Erik Schiffner
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
| | - David Latz
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
| | - Pascal Jungbluth
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
| | - Jan P Grassmann
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
| | - Stephan Tanner
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
| | - Alfred Karbowski
- 2 Department of Orthopaedic Surgery, Hospital of the Augustinians, Cologne, Germany
| | - Joachim Windolf
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
| | - Johannes Schneppendahl
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
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Alnahhal A, Aslam-Pervez N, Sheikh HQ. Templating Hip Arthroplasty. Open Access Maced J Med Sci 2019; 7:672-685. [PMID: 30894933 PMCID: PMC6420946 DOI: 10.3889/oamjms.2019.088] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND: Different methods have been developed and employed with variable degrees of success in pre-operative templating for total hip arthroplasty. Preoperative templating, especially digital templating, has been claimed to have increased the effectiveness of total hip arthroplasty by improving the precision of prediction of prosthetic implant size. AIMS: The overall aim of this systematic review is to identify whether the use of pre-operative templating in total hip arthroplasty procedures has resulted in increased accuracy, reliability and precision of the procedure. Various methods of templating, like traditional acetate overlay and digital method of templating that includes a single radiographic marker and double radiographic marker methods, have been compared to establish the most reliable method of templating. METHODS: We searched the PubMed, Google Scholar Cochrane Central Register of Controlled Trials (CENTRAL), and MEDLINE (1966 to present), EMBASE (1980 to present), CINAHL (1982 to present), Psych INFO (1967 to present) and Clinical Trials Gov. CONCLUSION: The results of this systemic review suggest that preoperative templating is resulting in an enormous increase in the accuracy of total hip arthroplasty and among various methods, King Mark is the most reliable method.
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Affiliation(s)
- Amro Alnahhal
- Barnsley District General Hospital NHS Trust, Gawber Road Barnsley S75 2EP, Great Britain
| | - Nayef Aslam-Pervez
- Calderdale and Huddersfield NHS trust, Acre St, Huddersfield HD3 3EA, Great Britain
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Holzer LA, Scholler G, Wagner S, Friesenbichler J, Maurer-Ertl W, Leithner A. The accuracy of digital templating in uncemented total hip arthroplasty. Arch Orthop Trauma Surg 2019; 139:263-268. [PMID: 30523444 PMCID: PMC6373540 DOI: 10.1007/s00402-018-3080-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Preoperative planning is an essential part of total hip arthroplasty (THA). It facilitates the surgical procedure, helps to provide the correct implant size and aims at restoring biomechanical conditions. In recent times, surgeons rely more and more on digital templating techniques. Although the conversion to picture archiving and communication system had many positive effects, there are still problems that have to be taken into consideration. OBJECTIVES The core objective was to evaluate the impact of the planners' experience on the accuracy of predicting component size in digital preoperative templating of THA. In addition, the influence of overweight and obesity (according to WHO-criteria), patient's sex and component design on the accuracy of preoperative planning have been analysed. MATERIALS AND METHODS The retrospective study included 632 consecutive patients who had primary uncemented THA. Digital templating was done using "syngo-EndoMap" software by Siemens Medical Solutions AG. Mann-Whitney U test and Kruskal-Wallis test have been used for statistical analysis. The accuracy of predicting component size has been evaluated by comparing preoperative planned sizes with implanted sizes as documented by the surgeons. The planner's experience was tested by comparing the reliability of preoperative planning done by senior surgeons or residents. The influence of BMI on predicting component size has been tested by comparing the accuracy of digital templating between different groups of BMI according to WHO-criteria. The same procedure has been done for evaluating the impact of patient´s sex and component design. RESULTS The implant size was predicted exactly in 42% for the femoral and in 37% for the acetabular component. 87% of the femoral components and 78% of the acetabular cups were accurate within one size. Digital templating of femoral implant size was significantly more reliable when done by a senior surgeon. No difference was found for the acetabular component sizes. The BMI also had an impact on estimating the correct femoral implant size. In overweight patients, planning was significantly more inaccurate than normal weight people. Differences were seen in obese patients. However, these were not significant. Accuracy of acetabular components was not affected. The design of the prostheses and the patient's sex had no influence on predicting component size. CONCLUSIONS Inexperience and overweight are factors that correlate with inaccuracy of preoperative digital templating in femoral components, whereas acetabular components seem to be independent of these factors.
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Affiliation(s)
- Lukas A. Holzer
- 0000 0000 8988 2476grid.11598.34Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria ,AUVA Trauma Center Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Georg Scholler
- 0000 0000 8988 2476grid.11598.34Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria ,grid.459693.4Department of Traumatology, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Stefan Wagner
- 0000 0001 1941 5140grid.9970.7Department of Sociology, Johannes Keppler University Linz, Linz, Austria
| | - Jörg Friesenbichler
- 0000 0000 8988 2476grid.11598.34Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Werner Maurer-Ertl
- 0000 0000 8988 2476grid.11598.34Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Andreas Leithner
- 0000 0000 8988 2476grid.11598.34Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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Al-Amiry B, Mahmood S, Krupic F, Sayed-Noor A. Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem - stem or cup positioning? Acta Radiol 2017; 58:1125-1131. [PMID: 28068823 DOI: 10.1177/0284185116684676] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background Restoration of femoral offset (FO) and leg length is an important goal in total hip arthroplasty (THA) as it improves functional outcome. Purpose To analyze whether the problem of postoperative leg lengthening and FO reduction is related to the femoral stem or acetabular cup positioning or both. Material and Methods Between September 2010 and April 2013, 172 patients with unilateral primary osteoarthritis treated with THA were included. Postoperative leg-length discrepancy (LLD) and global FO (summation of cup and FO) were measured by two observers using a standardized protocol for evaluation of antero-posterior plain hip radiographs. Patients with postoperative leg lengthening ≥10 mm (n = 41) or with reduced global FO >5 mm (n = 58) were further studied by comparing the stem and cup length of the operated side with the contralateral side in the lengthening group, and by comparing the stem and cup offset of the operated side with the contralateral side in the FO reduction group. We evaluated also the inter-observer and intra-observer reliability of the radiological measurements. Results Both observers found that leg lengthening was related to the stem positioning while FO reduction was related to the positioning of both the femoral stem and acetabular cup. Both inter-observer reliability and intra-observer reproducibility were moderate to excellent (intra-class correlation co-efficient, ICC ≥0.69). Conclusion Post THA leg lengthening was mainly caused by improper femoral stem positioning while global FO reduction resulted from improper positioning of both the femoral stem and the acetabular cup.
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Affiliation(s)
- Bariq Al-Amiry
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Sarwar Mahmood
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Ferid Krupic
- Department of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Arkan Sayed-Noor
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
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Abstract
BACKGROUND When performing total hip arthroplasty (THA) on a dysplastic hip, proper positioning of the acetabular component may not allow for more than 70% coverage. Structural support in the form of an autograft or a high porosity metal augment may be necessary. The purpose of the study was to investigate the value of preoperative templating and deformity classification in predicting cup coverage and the need for structural support. METHODS 65 cases of THA for DDH were retrospectively analysed. 2 observers independently classified each dysplastic hip according to Hartofilakidis and determined the extent of cup coverage via templating software on preoperative digital AP pelvic radiographs. RESULTS Weighted kappa interobserver agreement was 0.68 for cup coverage and 0.76 for Hartofilakidis type. Structural support was necessary in 10 hips. No structural support was necessary in Hartofilakidis type 1, dysplasia cases. However, 27-30% of cases with type 2 or type 3 dysplasia required structural support. All cases with templated cup coverage of 65% or less required structural support. Templated coverage within 65-75% and over 75% resulted in 20% and 10% of patients receiving structural augmentation, respectively. CONCLUSIONS Preoperative planning for THA in the setting of hip dysplasia is crucial and can provide valuable insight to the need for column augmentation. However, the 3-D severity of the deformity may be underestimated in the 2-D radiographs.
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Stigler SK, Müller FJ, Pfaud S, Zellner M, Füchtmeier B. Digital templating in total hip arthroplasty: Additional anteroposterior hip view increases the accuracy. World J Orthop 2017; 8:30-35. [PMID: 28144576 PMCID: PMC5241542 DOI: 10.5312/wjo.v8.i1.30] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 09/21/2016] [Accepted: 12/02/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To analyze planning total hip arthroplasty (THA) with an additional anteroposterior hip view may increases the accuracy of preoperative planning in THA.
METHODS We conducted prospective digital planning in 100 consecutive patients: 50 of these procedures were planned using pelvic overview only (first group), and the other 50 procedures were planned using pelvic overview plus antero-posterior (a.p.) hip view (second group). The planning and the procedure of each patient were performed exclusively by the senior surgeon. Fifty procedures with retrospective analogues planning were used as the control group (group zero). After the procedure, the planning was compared with the eventually implanted components (cup and stem). For statistic analysis the χ2 test was used for nominal variables and the t test was used for a comparison of continuous variables.
RESULTS Preoperative planning with an additional a.p. hip view (second group) significantly increased the exact component correlation when compared to pelvic overview only (first group) for both the acetabular cup and the femoral stem (76% cup and 66% stem vs 54% cup and 32% stem). When considering planning ± 1 size, the accuracy in the second group was 96% (48 of 50 patients) for the cup and 94% for the stem (47 of 50 patients). In the analogue control group (group zero), an exact correlation was observed in only 1/3 of the cases.
CONCLUSION Digital THA planning performed by the operating surgeon and based on additional a.p. hip view significantly increases the correlation between preoperative planning and eventual implant sizes.
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Shin JK, Son SM, Kim TW, Shin WC, Lee JS, Suh KT. Accuracy and Reliability of Preoperative On-screen Templating Using Digital Radiographs for Total Hip Arthroplasty. Hip Pelvis 2016; 28:201-207. [PMID: 28097109 PMCID: PMC5240321 DOI: 10.5371/hp.2016.28.4.201] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/26/2016] [Accepted: 11/26/2016] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Preoperative on-screen templating is a method of using acetate templates on digital images. The aim of the present study was to evaluate the accuracy, intra- and interobserver reliabilities of preoperative on-screen templating using digital radiographs for total hip arthroplasty (THA). MATERIALS AND METHODS Two hundred patients with hip disease who were treated with primary cementless THA were retrospectively evaluated. The accuracy of on-screen templating was assessed by comparing the predicted prosthesis sizes with the actual sizes used operatively. The inter- and intraobserver reliabilities of the templating results were also evaluated. RESULTS The prosthesis prediction accuracy within ±one size was 96.6% for the cup size and 97.8% for the stem size. The inter- and intraobserver reliabilities for the implant size were substantial (kappa>0.70). The intra- and interobserver reliabilities for the leg length discrepancy and femoral offset difference using the intraclass correlation coefficient ranged from 0.89 to 0.97. CONCLUSION Preoperative on-screen templating using digital radiographs showed substantial accuracy and reliability for implant prediction. It is an effective method for predicting the size of implant, correcting the leg length discrepancy and restoring the femoral offset.
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Affiliation(s)
- Jong Ki Shin
- Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Korea
| | - Seung Min Son
- Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Korea
| | - Tae Woo Kim
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Won Chul Shin
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jung Sub Lee
- Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Korea
| | - Kuen Tak Suh
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
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Lakstein D, Bachar I, Debi R, Lubovsky O, Cohen O, Tan Z, Atoun E. Radiographic templating of total hip arthroplasty for femoral neck fractures. INTERNATIONAL ORTHOPAEDICS 2016; 41:831-836. [PMID: 27271723 DOI: 10.1007/s00264-016-3235-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/25/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the use of pre-operative digital templating to minimize complications including limb length discrepancy (LLD), intraoperative fractures and early dislocations in patients with intracapsular femoral neck fractures. METHODS We retrospectively compared 23 patients undergoing total hip arthroplasty (THA) for intracapsular femoral fractures with pre-operative digital templating and 48 patients without templating. RESULTS The mean post-operative LLD was significantly lower in patients who had pre-operative templating than in the control group (6.7 vs. 11.5 mm, p = 0.023). Only three patients (13 %) with templating had LLD greater than 1.5 cm, compared to the 15 patients (31 %) without templating (p = 0.17). In eight cases the final femoral stem size matched the templated size, while 19 patients were within two size increments. Complications included one dislocation and one intra-operative fracture in the control group. CONCLUSION The present study demonstrated that careful pre-operative planning may reduce LLD in patients undergoing THA due to intracapsular hip fractures.
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Affiliation(s)
- Dror Lakstein
- Faculty of Medicine, Tel Aviv University, Wolfson Medical Centre, Holon, Israel
| | - Ira Bachar
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Ronen Debi
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Omri Lubovsky
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Ornit Cohen
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Zachary Tan
- Faculty of Medicine, Tel Aviv University, Wolfson Medical Centre, Holon, Israel
| | - Ehud Atoun
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel.
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Acetate templating on digital images is more accurate than computer-based templating for total hip arthroplasty. Clin Orthop Relat Res 2015; 473:3752-9. [PMID: 25910779 PMCID: PMC4626475 DOI: 10.1007/s11999-015-4321-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Templating is an important aspect of preoperative planning for total hip arthroplasty and can help determine the size and positioning of the prosthesis. Historically, templating has been performed using acetate templates over printed radiographs. As a result of the increasing use of digital imaging, surgeons now either obtain additional printed radiographs solely for templating purposes or use specialized digital templating software, both of which carry additional cost. QUESTIONS/PURPOSES The purposes of this study was to compare acetate templating of digitally calibrated images on an LCD monitor to digital templating in terms of (1) accuracy; (2) reproducibility; and (3) time efficiency. METHODS Acetate onlay templating was performed directly over digital radiographs on an LCD monitor and was compared with digital templating. Five separate observers participated in this study templating on 52 total hip arthroplasties. For the acetate templating, the digital images were magnified to the scaled reference on the templates provided by the manufacturer (ratio 1.2:1) before templating using a 25-mm marker as a reference. Both the acetate and digital templating results were then compared with the actual implanted components to determine accuracy. Interobserver and intraobserver variability was determined by an intraclass correlation coefficient. Observers recorded time to complete templating from the time of complete upload of patients' imaging onto the system to completion of templating. RESULTS Both acetate and digital templates demonstrated moderate accuracy in predicting within one size of the eventual implanted acetabular cup (77% [199 of 260]; 70% [181 of 260], respectively; p = 0.050; 95% confidence interval [CI], 0.058-0.32), whereas acetate templating was better at predicting the femoral stem compared to digital templating (75% [195 of 260]; 60% [155 of 260], respectively; p < 0.001; 95% CI, 0.084-0.32). Acetate templating showed moderate to substantial interobserver agreement (cup intraclass correlation coefficient [ICC] = 0.55; 95% CI, 0.14-0.86; femoral ICC = 0.75; 95% CI, 0.39-0.95) and both methods showed almost perfect intraobserver agreement in reproducibility (acetate cup ICC = 0.82; 95% CI, 0.66-0.97; acetate femoral ICC = 0.86; 95% CI, 0.74-0.97; digital cup ICC = 0.82; 95% CI, 0.68-0.97; digital femoral ICC = 0.88; 95% CI, 0.77-1.0). Acetate templating could be performed more quickly (acetate mean 119 seconds; range, 37-220 seconds versus 154 seconds; range, 73-343 seconds; p < 0.001). CONCLUSIONS Acetate onlay templating on digitally calibrated images can be a reliable substitute for digital templating using specialized software. It is quicker to perform and much less expensive. Hospitals and practices need not purchase expensive software, particularly at lower volume centers. LEVEL OF EVIDENCE Level III, diagnostic study.
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Huppertz A, Radmer S, Wagner M, Roessler T, Hamm B, Sparmann M. Computed tomography for preoperative planning in total hip arthroplasty: what radiologists need to know. Skeletal Radiol 2014; 43:1041-51. [PMID: 24622927 DOI: 10.1007/s00256-014-1853-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 02/06/2014] [Accepted: 02/17/2014] [Indexed: 02/02/2023]
Abstract
The number of total hip arthroplasties is continuously rising. Although less invasive surgical techniques, sophisticated component design, and intraoperative navigation techniques have been introduced, the rate of peri- and postoperative complications, including dislocations, fractures, nerve palsies, and infections, is still a major clinical problem. Better patient outcome, faster recovery and rehabilitation, and shorter operation times therefore remain to be accomplished. A promising strategy is to use minimally invasive techniques in conjunction with modular implants, aimed at independently reconstructing femoral offset and leg length on the basis of highly accurate preoperative planning. Plain radiographs have clear limitations for the correct estimation of hip joint geometry and bone quality. Three-dimensional assessment based on computed tomography (CT) allows optimizing the choice and positions of implants and anticipating difficulties to be encountered during surgery. Postoperative CT is used to monitor operative translation and plays a role in arthroplastic quality management. Radiologists should be familiar with the needs of orthopedic surgeons in terms of CT acquisition, post-processing, and data transfer. The CT protocol should be optimized to enhance image quality and reduce radiation exposure. When dedicated orthopedic CT protocols and state-of-the-art scanner hardware are used, radiation exposure can be decreased to a level just marginally higher than that of conventional preoperative radiography. Surgeons and radiologists should use similar terminology to avoid misunderstanding and inaccuracies in the transfer of preoperative planning.
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Affiliation(s)
- Alexander Huppertz
- Department of Radiology, Charité-University Hospitals Berlin, Charitéplatz 1, 10117, Berlin, Germany,
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Issa K, Pivec R, Boyd B, Harwin SF, Wuestemann T, Nevelos J, Mont MA. Comparing the accuracy of radiographic preoperative digital templating for a second- versus a first-generation THA stem. Orthopedics 2012; 35:1028-34. [PMID: 23218615 DOI: 10.3928/01477447-20121120-03] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study assessed the accuracy of preoperative digital templating for a second-generation cementless stem compared with its first-generation design. A prospective cohort of 100 consecutive patients who had undergone a primary total hip arthroplasty using a new second-generation cementless stem was compared with the prior 100 hips that had received the first-generation stem. The authors believe that the second-generation stem may allow equal or more accurate digital templating compared with its predicate design.
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Affiliation(s)
- Kimona Issa
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, USA
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