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Kitziger RL, Dugan AL, Waddell BS, Kitziger KJ, Peters PC, Gladnick BP. Fluoroscopy-Assisted Computer Navigation Accurately Determines Cup Position and Leg Length for Anterior Hip Arthroplasty. Orthopedics 2024; 47:e174-e180. [PMID: 38567996 DOI: 10.3928/01477447-20240325-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
BACKGROUND Recently, fluoroscopy-assisted computer navigation has been developed to assess intraoperative cup inclination/anteversion and leg-length discrepancy (LLD) in the operating room. However, there is a relative dearth of studies investigating the accuracy of this software compared with postoperative radiographs. MATERIALS AND METHODS We prospectively enrolled 211 navigated anterior total hip arthroplasties using fluoroscopy-assisted computer navigation software. Intraoperative navigated measurements were compared with postoperative anteroposterior radiographs to assess accuracy of cup inclination/anteversion and LLD. Continuous variables were analyzed using the Student's t test, and categorical variables were analyzed using Fisher's exact test. RESULTS On postoperative radiographs, 94.3% of cups (199 of 211) were positioned within the Lewinnek "safe zone," compared with 99.1% navigated intraoperatively (P=.01). Eighty-two percent of hips (174 of 211) were navigated intraoperatively to LLDs within ±2 mm; on postoperative radiographs, 65% of hips (138 of 211) had LLDs within ±2 mm (P=.0001). Intraoperatively, 100% of hips (211 of 211) were navigated to LLDs within ±5 mm; similarly, on postoperative radiographs, 98% of hips (207 of 211) had LLDs within ±5 mm (P=.12). CONCLUSION A novel fluoroscopy-assisted computer navigation platform accurately assessed intraoperative cup position and LLD during anterior total hip arthroplasty. Careful attention to fluoroscopic technique, positioning of radiographic landmarks, and knowledge of the limitations of fluoroscopy, including parallax effect, are important concepts that surgeons should incorporate into their decision algorithm. [Orthopedics. 2024;47(4):e174-e180.].
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Chung C, Bin Hazzaa I, Hakim R, Zywiel MG. Techniques and Technologies for the Intraoperative Assessment of Component Positioning, Leg Lengths, and Offset in Total Hip Arthroplasty: A Systematic Review. Arthroplast Today 2024; 27:101361. [PMID: 39071838 PMCID: PMC11282408 DOI: 10.1016/j.artd.2024.101361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/15/2024] [Accepted: 02/26/2024] [Indexed: 07/30/2024] Open
Abstract
Background Many techniques and technologies exist for the intraoperative assessment of component positioning, leg lengths, and offset in total hip arthroplasty, but with limited comparative data. We conducted a systematic review of the available literature to evaluate the range of techniques and technologies for the intraoperative assessment of component position as well as leg lengths and offset in terms of accuracy, precision, surgical time, cost, and relationship to clinical outcomes. Methods A comprehensive search of the Embase and Medline databases from 1974 to 2023 was performed. We included controlled or comparative prospective clinical studies. Cochrane's risk-of-bias tool for randomized trials and Risk of Bias in Non-Randomized Studies - of Interventions tools were used by 2 independent reviewers to evaluate each study for risk of bias. We conducted both qualitative and quantitative analyses of the studies included. However, a meta-analysis was deemed not to be feasible due to heterogeneity. Results Our review included 25 studies with 52 intraoperative techniques and technologies. Mechanical guides and computerized navigation were most frequently evaluated in the included studies. Computerized navigation systems consistently showed the greatest accuracy and precision across all measures, at the cost of longer mean operative time. In contrast, freehand techniques demonstrated the poorest accuracy and precision. Insufficient data were found to reach any meaningful conclusions in terms of differences in overall surgical cost or clinical outcomes. Conclusions Evidence shows that computerized navigation systems are most accurate and precise in positioning components during total hip arthroplasty. Further research is needed to determine their health and economic impact and whether the accuracy and precision of navigated techniques are justified in terms of clinical outcomes.
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Affiliation(s)
- Cedric Chung
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, University of Toronto, Toronto, Ontario Canada
| | - Ibrahim Bin Hazzaa
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, University of Toronto, Toronto, Ontario Canada
| | - Raja Hakim
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, University of Toronto, Toronto, Ontario Canada
| | - Michael G. Zywiel
- Division of Orthopaedic Surgery, Schroeder Arthritis Institute, University Health Network, University of Toronto, Toronto, Ontario Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
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Ong CB, Chiu YF, Premkumar A, Gonzalez Della Valle A. Use of a novel imageless navigation system reduced fluoroscopy exposure and improved acetabular positioning in anterior approach total hip arthroplasty: a case-control study. Arch Orthop Trauma Surg 2023; 143:2739-2745. [PMID: 35776176 DOI: 10.1007/s00402-022-04520-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/12/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Direct anterior approach (DAA) for total hip arthroplasty (THA) frequently utilizes fluoroscopy. The purpose of this study is to assess the impact of using a novel, imageless THA navigation system on radiation exposure and acetabular cup placement consistency. MATERIALS AND METHODS This was a retrospective, single-surgeon cohort study of a consecutive group of patients who underwent DAA THA for osteoarthritis. An optic-based imageless navigation system was used to determine intraoperative acetabular inclination and anteversion angles referenced off of a generic coronal and sagittal plane in 71 cases (study group). These were compared with 71 manual cases (control group) for fluoroscopy exposure, operative duration, and acetabular placement variation. Cohorts were similar in their distributions of sex, race, ethnicity, and body mass index. Comparisons between groups were made using independent samples t tests. Alpha error was 0.05. RESULTS Study patients experienced significantly less fluoroscopy exposure time {3.59 [Standard Deviation (SD) 1.95] vs. 9.15 (SD 5.98) seconds; p < 0.001} and dosage (0.30 [SD 0.23] vs. 0.78 [SD 0.63] mGy; p < 0.001). Study and control patients had similar operative times [82.69 (SD 11.70) vs. 89.54 (SD 14.60) minutes; p = 0.09]. The study group had a significantly lower radiographic variation for inclination and anteversion, based on mean proximity to the centroid of each cohort [3.55 (SD 1.88) vs. 5.39 (SD 3.51); p < 0.001] and also a greater proportion of cases that fell within 1 SD of the mean cohort inclination and anteversion (40.8% vs. 21.1%; p = 0.009). CONCLUSIONS Use of a novel imageless navigation system for DAA THA significantly reduced fluoroscopic radiation exposure and improved consistency in acetabular cup placement.
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Affiliation(s)
- Christian B Ong
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - Yu-Fen Chiu
- Department of Biostatistics, Hospital for Special Surgery, New York, NY, USA
| | - Ajay Premkumar
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
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Li H, Wang D, Zhang W, Xu G, Xu C, Zhang H, Zhang L, Li J, Tang P. Does computer-assisted orthopaedics system (ADAPT system) improve outcomes of intertrochanteric hip fractures? Injury 2023; 54:1047-1054. [PMID: 36759309 DOI: 10.1016/j.injury.2023.02.011] [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: 07/03/2022] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Intramedullary nailing (IMN) is a general treatment for intertrochanteric hip fractures. The computer-assisted orthopaedics system (CAOS), ADAPT system (Stryker, NJ), has been developed to facilitate lag screw insertion. When compared to the conventional freehand method, the efficacy of CAOS has not been clearly clarified. Therefore, we conducted this systematic review and meta-analysis to answer: does the CAOS performed better than freehand method in IMN. MATERIALS AND METHODS Studies published up to January 2023 were searched in the PubMed, Embase, Web of Science and Cochrane Library databases with predetermined key words. Comparative clinical studies between CAOS (ADAPT system) and freehand method were included. The primary outcomes of interest were the tip-apex-distance (TAD) and positions of lag screw. Fluoroscopy use, operation duration and intraoperative/postoperative complications were also extracted. A meta-analysis was performed for pooled analysis. RESULTS There were seven studies with 326 fractures in CAOS group and 325 fractures in Freehand group. All studies included presented high qualities. The CAOS group showed a statistically smaller TAD than Freehand group (weighted mean difference = -3.24 mm; 95% confidence interval [CI] -5.10 to -1.37 mm; p = 0.0007) and a better lag screw position (83/92 [90.2%] VS 64/92 [69.6%]; RR = 1.3; 95% CI 1.12 to 1.51; p = 0.0007). The operative time and radiation use revealed no difference between two groups. CONCLUSIONS The current evidence indicated that ADAPT system could help to perform a more accurate lag screw than freehand manipulation while the operative time and radiation time was not reduced as expectations on such new technique. Long-term follow-up studies are appealed.
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Affiliation(s)
- Hua Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Daofeng Wang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Wupeng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China; School of Medicine, Nankai University, No.94 Weijin Road, Tianjin, 300071, China
| | - Gaoxiang Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Cheng Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Hao Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Licheng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
| | - Jiantao Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
| | - Peifu Tang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
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Guezou-Philippe A, Dardenne G, Letissier H, Yvinou A, Burdin V, Stindel E, Lefèvre C. Anterior pelvic plane estimation for total hip arthroplasty using a joint ultrasound and statistical shape model based approach. Med Biol Eng Comput 2023; 61:195-204. [PMID: 36342596 DOI: 10.1007/s11517-022-02681-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/21/2022] [Indexed: 11/09/2022]
Abstract
Orienting properly the prosthetic cup in total hip arthroplasty is key to ensure the postoperative stability. Several navigation solutions have been developed to assist surgeons in orienting the cup regarding the anterior pelvic plane (APP), defined by both anterior superior iliac spines (ASIS) and the pubic symphysis. However acquiring the APP when the patient is ready for surgery, i.e., mainly in lateral decubitus, is difficult due to the contralateral ASIS being against the operating table. We propose a method to determine the APP from both (1) alternative anatomical landmarks which are easy to acquire with a navigated ultrasound probe and (2) a Statistical Shape Model (SSM) of the pelvis. After creating a pelvic SSM from 40 data, a SSM-based morphometric analysis has been carried out to identify the best anatomical landmarks allowing the easy determination of the APP. The proposed method has then been assessed with both in silico and in vivo experiments on respectively forty synthetic data, and five healthy volunteers. The in silico experiment shows the feasibility to determine the APP with an average error of 4.7∘ by only acquiring the iliac crest, the anterior superior iliac spine, the anterior inferior iliac spine, and the pubic symphysis. The average in vivo error using the ultrasound modality was 7.3∘ with an estimated impact on both the cup anteversion and inclination of 4.0∘ and 1.7∘ respectively. The proposed method shows promising results that could allow the determination of the APP in lateral decubitus with a clinically acceptable impact on the computation of the cup orientation.
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Affiliation(s)
- Aziliz Guezou-Philippe
- Latim INSERM UMR 1101, Brest, France. .,CHU, Brest, France. .,University of Western Brittany, Brest, France.
| | | | - Hoel Letissier
- Latim INSERM UMR 1101, Brest, France.,CHU, Brest, France.,University of Western Brittany, Brest, France
| | - Agathe Yvinou
- Latim INSERM UMR 1101, Brest, France.,CHU, Brest, France.,University of Western Brittany, Brest, France
| | - Valérie Burdin
- Latim INSERM UMR 1101, Brest, France.,IMT Atlantique, Brest, France
| | - Eric Stindel
- Latim INSERM UMR 1101, Brest, France.,CHU, Brest, France.,University of Western Brittany, Brest, France
| | - Christian Lefèvre
- Latim INSERM UMR 1101, Brest, France.,CHU, Brest, France.,University of Western Brittany, Brest, France
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Tang A, Singh V, Sharan M, Roof MA, Mercuri JJ, Meftah M, Schwarzkopf R. The accuracy of component positioning during revision total hip arthroplasty using 3D optical computer-assisted navigation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03383-z. [PMID: 36074304 DOI: 10.1007/s00590-022-03383-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Despite the excellent outcomes associated with primary total hip arthroplasty (THA), implant failure and revision continue to burden the healthcare system. The use of computer-assisted navigation (CAN) offers the potential for more accurate placement of hip components during surgery. While intraoperative CAN systems have been shown to improve outcomes in primary THA, their use in the context of revision total hip arthroplasty (rTHA) has not been elucidated. We sought to investigate the validity of using CAN during rTHA. METHODS A retrospective analysis was performed at an academic medical institution identifying all patients who underwent rTHA using CAN from 2016-2019. Patients were 1:1 matched with patients undergoing rTHA without CAN (control) based on demographic data. Cup anteversion, inclination, change in leg length discrepancy (ΔLLD) and change in femoral offset between pre- and post-operative plain weight-bearing radiographic images were measured and compared between both groups. A safety target zone of 15-25° for anteversion and 30-50° for inclination was used as a reference for precision analysis of cup position. RESULTS Eighty-four patients were included: 42 CAN cases and 42 control cases. CAN cases displayed a lower ΔLLD (5.74 ± 7.0 mm vs 9.13 ± 7.9 mm, p = 0.04) and greater anteversion (23.4 ± 8.53° vs 19.76 ± 8.36°, p = 0.0468). There was no statistical difference between the proportion of CAN or control cases that fell within the target safe zone (40% vs 20.9%, p = 0.06). Femoral offset was similar in CAN and control cases (7.63 ± 5.84 mm vs 7.14 ± 4.8 mm, p = 0.68). CONCLUSION Our findings suggest that the use of CAN may improve accuracy in cup placement compared to conventional methodology, but our numbers are underpowered to show a statistical difference. However, with a ΔLLD of ~ 3.4 mm, CAN may be useful in facilitating the successful restoration of pre-operative leg length following rTHA. Therefore, CAN may be a helpful tool for orthopedic surgeons to assist in cup placement and LLD during complex revision cases.
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Affiliation(s)
- Alex Tang
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
- Department of Orthopaedic Surgery, Geisinger Health, Scranton, PA, USA
| | - Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Mohamad Sharan
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Mackenzie A Roof
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
| | - John J Mercuri
- Department of Orthopaedic Surgery, Geisinger Health, Scranton, PA, USA
| | - Morteza Meftah
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA.
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Sicat CS, Buchalter DB, Luthringer TA, Schwarzkopf R, Vigdorchik JM. Intraoperative Technology Use Improves Accuracy of Functional Safe Zone Targeting in Total Hip Arthroplasty. J Arthroplasty 2022; 37:S540-S545. [PMID: 35428540 DOI: 10.1016/j.arth.2022.02.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Targets of acetabular inclination and anteversion have been suggested based on a patient's spinopelvic mobility. Current methods in total hip arthroplasty (THA) include manual instrumentation, computer-assisted navigation, and robotic-assisted surgery. This study aims to compare the accuracy of these 3 methods in targeting the functional safe zone. METHODS This is a prospective multicenter study including a series of 251 consecutive primary posterior THA patients from April 2019 to January 2021. Preoperative lateral standing and sitting spinopelvic radiographs were obtained. Each patient was classified using the Hip-Spine Classification. A functional safe zone plan was determined. Surgeons used their preferred method (manual instrumentation, computer-assisted, or robotic-assisted). Postoperative anteversion and inclination was measured and compared to the preoperative plan. Mean differences between preoperative and postoperative values were calculated. Welch's t-test was used to assess significant between-group differences with P < .05 considered significant. RESULTS Of the 249 patients, there were 63 manual instrumentation, 68 computer-assisted navigation, and 118 robotic-assisted surgery. Robotic-assisted surgery (rTHA) was significantly more accurate in targeting anteversion (1 ± 2) compared to manual instrumentation (mTHA; 7 ± 6, P < .001) and computer-assisted navigation (cTHA; 6 ± 6, P < .001). rTHA was also significantly more accurate in targeting inclination (1 ± 1) compared to mTHA (8 ± 7, P < .001) and cTHA (6 ± 7, P < .001). Although cTHA had greater accuracy in targeting both inclination and anteversion compared to mTHA, these differences were not statistically significant. CONCLUSION Robotic-assisted surgery was more accurate than both computer-assisted navigation and manual instrumentation in targeting the functional safe zone in primary THA. Further research is needed to evaluate the effect of improved accuracy on dislocation rates.
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Affiliation(s)
- Chelsea S Sicat
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | | | | | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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Jang SJ, Vigdorchik JM, Windsor EW, Schwarzkopf R, Mayman DJ, Sculco PK. Abnormal spinopelvic mobility as a risk factor for acetabular placement error in total hip arthroplasty using optical computer-assisted surgical navigation system. Bone Jt Open 2022; 3:475-484. [PMID: 35694779 PMCID: PMC9233429 DOI: 10.1302/2633-1462.36.bjo-2022-0055] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims Navigation devices are designed to improve a surgeon’s accuracy in positioning the acetabular and femoral components in total hip arthroplasty (THA). The purpose of this study was to both evaluate the accuracy of an optical computer-assisted surgery (CAS) navigation system and determine whether preoperative spinopelvic mobility (categorized as hypermobile, normal, or stiff) increased the risk of acetabular component placement error. Methods A total of 356 patients undergoing primary THA were prospectively enrolled from November 2016 to March 2018. Clinically relevant error using the CAS system was defined as a difference of > 5° between CAS and 3D radiological reconstruction measurements for acetabular component inclination and anteversion. Univariate and multiple logistic regression analyses were conducted to determine whether hypermobile ([Formula: see text]sacral slope(SS)stand-sit > 30°), or stiff ([Formula: see text]SSstand-sit < 10°) spinopelvic mobility contributed to increased error rates. Results The paired absolute difference between CAS and postoperative imaging measurements was 2.3° (standard deviation (SD) 2.6°) for inclination and 3.1° (SD 4.2°) for anteversion. Using a target zone of 40° (± 10°) (inclination) and 20° (± 10°) (anteversion), postoperative standing radiographs measured 96% of acetabular components within the target zone for both inclination and anteversion. Multiple logistic regression analysis controlling for BMI and sex revealed that hypermobile spinopelvic mobility significantly increased error rates for anteversion (odds ratio (OR) 2.48, p = 0.009) and inclination (OR 2.44, p = 0.016), whereas stiff spinopelvic mobility increased error rates for anteversion (OR 1.97, p = 0.028). There were no dislocations at a minimum three-year follow-up. Conclusion Despite high reliability in acetabular positioning for inclination in a large patient cohort using an optical CAS system, hypermobile and stiff spinopelvic mobility significantly increased the risk of clinically relevant errors. In patients with abnormal spinopelvic mobility, CAS systems should be adjusted for use to avoid acetabular component misalignment and subsequent risk for long-term dislocation. Cite this article: Bone Jt Open 2022;3(6):475–484.
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Affiliation(s)
- Seong J. Jang
- Weill Cornell Medical College, New York, New York, USA
- Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Jonathan M. Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Eric W. Windsor
- Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | | | - David J. Mayman
- Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Peter K. Sculco
- Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Migliorini F, Cuozzo F, Oliva F, Eschweiler J, Hildebrand F, Maffulli N. Imageless navigation for primary total hip arthroplasty: a meta-analysis study. J Orthop Traumatol 2022; 23:21. [PMID: 35426527 PMCID: PMC9012775 DOI: 10.1186/s10195-022-00636-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been a growing interest in imageless navigation for primary total hip arthroplasty (THA). Its superiority over standard THA is debated. This meta-analysis compared surgical duration, implant positioning, Harris Hip Score and rate of dislocation of imageless navigation versus conventional THA. METHODS The present study was conducted according to the PRISMA 2020 guidelines. All the clinical trials comparing imageless navigation versus conventional for primary THA were accessed. In January 2022, the following databases were accessed: PubMed, Web of Science, Google Scholar and Embase. No time constraints were used for the search. The outcomes of interest were to compare cup inclination and anteversion, leg length discrepancy, surgical duration, Harris Hip Score and rate of dislocation of imageless navigation versus conventional THA. RESULTS Twenty-one studies (2706 procedures) were retrieved. Fifty-two percent of patients were women. There was between-group comparability at baseline in terms of age, body mass index (BMI), visual analogue scale, Harris Hip Score and leg length discrepancy (P > 0.1). Compared with conventional THA, the navigated group demonstrated slightly lower leg length discrepancy (P = 0.02) but longer duration of the surgical procedure (P < 0.0001). Cup anteversion (P = 0.6) and inclination (P = 0.5), Harris Hip Score (P = 0.1) and rate of dislocation (P = 0.98) were similar between the two interventions. CONCLUSION Imageless navigation may represent a viable option for THA.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany.
| | - Francesco Cuozzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
| | - Joerg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, ST4 7QB, UK.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, E1 4DG, UK
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10
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Anatomic Navigation Using the Transverse Acetabular Ligament for Acetabular Component Positioning in Total Hip Arthroplasty Through the Direct Anterior Approach. J Am Acad Orthop Surg 2022; 30:100-103. [PMID: 35772088 DOI: 10.5435/jaaos-d-20-00839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 03/04/2021] [Indexed: 02/01/2023] Open
Abstract
The transverse acetabular ligament (TAL) is a reliable native anatomic landmark that can be used to guide accurate acetabular implant positioning during total hip arthroplasty through the direct anterior approach. The accurate acetabular implant position is defined by the preoperative plan, which corresponds to the Lewinnek safe zone. This article describes the anatomy of the TAL , exposure of the TAL, and pearls and pitfalls for exposure of the acetabulum during total hip arthroplasty through the direct anterior approach. This article discusses how the TAL is used to guide acetabular implant positioning and describes pilot data from our single surgeon case series (n = 31).
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Hepinstall M, Zucker H, Matzko C, Meftah M, Mont MA. Adoption of Robotic Arm-Assisted Total Hip Arthroplasty Results in Reliable Clinical and Radiographic Outcomes at Minimum Two-Year Follow Up. Surg Technol Int 2021; 38:440-445. [PMID: 34000754 DOI: 10.52198/21.sti.38.os1420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Longevity and success of total hip arthroplasty (THA) is largely dependent on component positioning. While use of robotic platforms can improve this positioning, published evidence on its clinical benefits is limited. Therefore, the aim of this study was to assess the clinical outcomes of THA with robotic surgical assistance. MATERIALS AND METHODS We conducted an analysis of robotic arm-assisted primary THAs performed by a single surgeon utilizing a posterior approach. A total of 99 patients (107 cases) who had a minimum two-year follow up were identified. Their mean age was 61 years (range, 33 to 84 years), and their mean body mass index was 30.5 kg/m2 (range, 18.5 to 49.1 kg/m2). There were 56% female patients and primary osteoarthritis was the principal hip diagnosis in 88.8%. Operative times, lengths of hospital stay, and discharge dispositions were recorded, along with any complications. Modified Harris Hip Scores (HHS) were calculated to quantify clinical outcomes. RESULTS Mean postoperative increases in HHS at 2- to 5.7-year follow up was 33 points (range, 6 to 77 points). There were no complications attributable to the use of robotic assistance. Surgical-site complications were rare; one case underwent a revision for prosthetic joint infection (0.93%) but there were no dislocations, periprosthetic fractures, or cases of mechanical implant loosening. There was no evidence of progressive radiolucencies or radiographic failure. DISCUSSION Robotic arm-assisted THA resulted in low complication rates at minimum two-year follow up, with clinical outcomes comparable to those reported with manual surgery.1-4 The haptically-guided acetabular bone preparation enabled reliable cementless acetabular fixation and there were no adverse events related to the use of the robot. Dislocations were avoided in this case series. Randomized controlled clinical trials are needed to compare manual to robotic surgery and to investigate whether the precision found with this functional planning will reliably reduce the incidence of dislocations.
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Affiliation(s)
| | - Harrison Zucker
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | | | - Morteza Meftah
- Clinical Associate Director, NYU Langone Orthopedic Center, New York, New York
| | - Michael A Mont
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
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Okanoue Y, Aso K, Dan J, Takaya S, Izumi M, Kawakami T, Ikeuchi M. Accuracy of acetabular cup placement using an angle-adjusting alignment guide with laser pointer in total hip arthroplasty. J Orthop Surg (Hong Kong) 2021; 28:2309499020962860. [PMID: 33078676 DOI: 10.1177/2309499020962860] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate cup-positioning accuracy in total hip arthroplasty (THA) using a novel angle-adjusting alignment guide with laser pointer and determine whether level of surgical experience affects accuracy of cup placement or not. METHODS We included 117 hips in 104 patients who underwent THA using the novel guide. We retrospectively reviewed 44 hips in 40 patients who underwent THA before the novel guide was introduced. We compared differences in cup angles between the novel guide group and the conventional guide group as well as the discrepancies in targeted angles between the experienced surgeon group and the inexperienced surgeon group. RESULTS There were 114/117 hips (97.4%) within the Lewinnek safe zone in the novel guide group and 32/44 hips (72.7%) within the safe zone in the conventional guide group. There were significantly fewer outliers in the novel guide group (p < 0.001). In the experienced surgeon group, the mean absolute errors in inclination and anteversion were 2.0 ± 1.7° and 2.1 ± 2.3°, respectively; which were not significantly different from those in the inexperienced surgeon group (2.3 ± 2.1° and 2.8 ± 2.3°, respectively). CONCLUSION The novel angle-adjusting alignment guide with laser pointer is a simple tool that provides better accuracy of cup position than that obtained using conventional guides. Accurate cup placement is possible using the novel guide, regardless of surgeons' experience.
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Affiliation(s)
- Yusuke Okanoue
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Koji Aso
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Junpei Dan
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Shogo Takaya
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Masashi Izumi
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Teruhiko Kawakami
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Masahiko Ikeuchi
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
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Kaku N, Tagomori H, Tsumura H. Comparison of Cup Setting Angle Accuracy between Computed Tomography-Based and Computed Tomography-Free Navigation in the Same Patients with Crowe's Classification I or II Hip Dysplasia. Clin Orthop Surg 2021; 13:144-151. [PMID: 34094004 PMCID: PMC8173244 DOI: 10.4055/cios20145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/28/2020] [Accepted: 11/25/2020] [Indexed: 12/21/2022] Open
Abstract
Backgroud In total hip arthroplasty, the cup setting angle may affect the postoperative results. In recent years, both computed tomography-based navigation and computed tomography-free (imageless) navigation have been reported to produce high accuracy in cup installation; however, no direct comparison between these two methods has been performed. The present study aimed to directly compare the cup installation angle accuracy between computed tomography-based navigation and computed tomography-free navigation in patients with Crowe's classification stage I or II dysplastic osteoarthritis and to examine the factors affecting the cup installation accuracy. Methods Using both navigation systems for the same technique, primary total hip arthroplasty was performed by the same surgeon in 36 patients. A cup was installed using computed tomography-based navigation, and the installed cup was measured again using computed tomography-free navigation. We compared the error between the target angle and the intraoperative installation angle for each navigation method by performing statistical analyses. Results For computed tomography-based navigation, errors in the inclination and the anteversion angles compared to the target angle were 3.14° ± 1.55° and 1.47° ± 0.99°, respectively. For computed tomography-free navigation, the inclination and anteversion angle errors were significantly larger, i.e., 6.84° ± 4.78° and 5.43° ± 5.22°, respectively (p < 0.01). The inclination and anteversion angles of computed tomography-free navigation were correlated, and there were no significant factors influencing the error. Conclusions Computed tomography-based navigation is more accurate for cup installation than computed tomography-free navigation. When using computed tomography-free navigation, it is necessary to add technical schemes before and during surgery to improve the cup installation accuracy.
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Affiliation(s)
- Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroaki Tagomori
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
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Hayashi S, Hashimoto S, Kuroda Y, Nakano N, Matsumoto T, Ishida K, Shibanuma N, Kamenaga T, Kuroda R. Accuracy of cup position following robot-assisted total hip arthroplasty may be associated with surgical approach and pelvic tilt. Sci Rep 2021; 11:7578. [PMID: 33828113 PMCID: PMC8027591 DOI: 10.1038/s41598-021-86849-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/22/2021] [Indexed: 12/16/2022] Open
Abstract
This study aimed to investigate the accuracy of cup placement and determine the predictive risk factors for inaccurate cup positioning in robot-assisted total hip arthroplasty (THA). We retrospectively analyzed 115 patients who underwent robot-assisted THA between August 2018 and November 2019. Acetabular cup alignment and three-dimensional (3D) position were measured using pre- or postoperative computed tomography (CT) data. Absolute differences in cup inclination, anteversion, and 3D position were assessed, and their relation to preoperative factors was evaluated. The average measurement of the absolute differences was 1.8° ± 2.0° (inclination) and 1.9° ± 2.3° (anteversion). The average absolute difference in the 3D cup position was 1.1 ± 1.2 mm (coronal plane) and 0.9 ± 1.0 mm (axial plane). Multivariate analysis revealed that a posterior pelvic tilt [odds ratio (OR, 1.1; 95% confidence interval (CI), 1.00–1.23] and anterior surgical approach (OR, 5.1; 95% CI, 1.69–15.38) were predictive factors for inaccurate cup positioning with robot-assisted THA. This is the first study to demonstrate the predictive risk factors (posterior pelvic tilt and anterior surgical approach) for inaccurate cup position in robot-assisted THA.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Nao Shibanuma
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Accuracy of imageless navigation for functional cup positioning and restoration of leg length in total hip arthroplasty: a matched comparative analysis. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000000952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Kievit AJ, Dobbe JGG, Mallee WH, Blankevoort L, Streekstra GJ, Schafroth MU. Accuracy of cup placement in total hip arthroplasty by means of a mechanical positioning device: a comprehensive cadaveric 3d analysis of 16 specimens. Hip Int 2021; 31:58-65. [PMID: 31506002 PMCID: PMC7797610 DOI: 10.1177/1120700019874822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION We tested whether a mechanical device (such as Hipsecure) to pinpoint the anterior pelvic plane (APP) as a guide can improve acetabular cup placement. To assess accuracy we asked: (1) is the APP an effective guide to position acetabular cup placement within acceptable ° of divergence from the optimal 40° inclination and 15° anteversion; (2) could a mechanical device increase the number of acetabular cup placements within Lewinnek's safe zone (i.e. inclination 30° to 50°; anteversion 5° to 25°)? METHODS 16 cadaveric specimens were used to assess the 3D surgical success of using a mechanical device APP to guide acetabular cup placement along the APP. We used the Hipsecure mechanical device to implant acetabular cups at 40° inclination and 15° anteversion. Subequently, all cadaveric specimens with implants were scanned with a CT and 3D models were created of the pelvis and acetabular cups to assess the outcome in terms of Lewinnek's safe zones. RESULTS The mean inclination of the 16 implants was 40.6° (95% CI, 37.7-43.4) and the mean anteversion angle was 13.4° (95% CI, 10.7-16.1). All 16 cup placements were within Lewinnek's safe zone for inclination (between 30° and 50°) and all but 2 were within Lewinnek's safe zone for anteversion (between 5° and 25°). CONCLUSION In cadaveric specimens, the use of a mechanical device and the APP as a guide for acetabular cup placement resulted in good positioning with respect to both of Lewinnek's safe zones.
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Affiliation(s)
- Arthur J Kievit
- Orthopaedic Research Centre Amsterdam, Department of Orthopaedics of the Amsterdam University Medical Centre, University of Amsterdam, The Netherlands,Arthur J Kievit, Orthopaedic Research Centre Amsterdam, Department of Orthopaedics of the Amsterdam University Medical Centre, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands.
| | - Johannes G G Dobbe
- Department of Biomedical Engineering and Physics of the Amsterdam University Medical Centre, University of Amsterdam, The Netherlands
| | - Wouter H Mallee
- Orthopaedic Research Centre Amsterdam, Department of Orthopaedics of the Amsterdam University Medical Centre, University of Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Orthopaedic Research Centre Amsterdam, Department of Orthopaedics of the Amsterdam University Medical Centre, University of Amsterdam, The Netherlands
| | - Geert J Streekstra
- Department of Biomedical Engineering and Physics of the Amsterdam University Medical Centre, University of Amsterdam, The Netherlands
| | - Matthias U Schafroth
- Orthopaedic Research Centre Amsterdam, Department of Orthopaedics of the Amsterdam University Medical Centre, University of Amsterdam, The Netherlands
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Burapachaisri A, Elbuluk A, Abotsi E, Pierrepont J, Jerabek SA, Buckland AJ, Vigdorchik JM. Lewinnek Safe Zone References are Frequently Misquoted. Arthroplast Today 2020; 6:945-953. [PMID: 33299915 PMCID: PMC7701843 DOI: 10.1016/j.artd.2020.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/13/2020] [Accepted: 09/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Optimal acetabular component orientation in total hip arthroplasty (THA) is a necessity in achieving a stable implant. Although there has been considerable debate in the literature concerning the safe zone, to date, there has not been any review to determine if these references are consistent with the definition applied by Lewinnek et al. in 1978. Therefore, this article aims to examine the available literature in the PubMed database to determine how often a correct reference to the safe zone as defined by Lewinnek was applied to discussions regarding THA. METHODS A search for literature in the PubMed database was performed for articles from 1978 to 2019. Search criteria included terms 'Lewinnek,' 'safe zone,' and 'total hip arthroplasty.' Exclusions included abstract-only articles, non-English articles, articles unrelated to THA, and those lacking full content. RESULTS A review of literature yielded 147 articles for inclusion. Overall, only 11% (17) cited the Lewinnek article correctly. Forty-five percent (66) of articles referenced measurements in the supine position, 18% (26) referenced other positions, and 37% (55) did not specify. Nineteen percent (28) reported measurements of the acetabular cup orthogonal to the anterior pelvic plane, while 73% (108) did not, and 7% (11) did not specify. Twenty-three percent (34) measured from computed tomography scans instead of other methods. CONCLUSIONS In the discussion of the safe zone regarding THA, only 11% of articles listed are consistent with the definition established by Lewinnek. This warrants further investigation into a consistent application of the term and its implications for THA implant stability and dislocation rates.
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Affiliation(s)
- Aonnicha Burapachaisri
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Ameer Elbuluk
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Edem Abotsi
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Jim Pierrepont
- Chief Innovation Officer, Corin Group, New South Wales, Australia
| | - Seth A. Jerabek
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Aaron J. Buckland
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Jonathan M. Vigdorchik
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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Gao YY, Zhang R, Che XD, Wang CF, Shi DP, Liang B, Li PH, Liang SF, Li PC. WITHDRAWN: Comparison of the accuracy between imageless navigation and manual freehand approaches for total hip arthroplasty: a systematic review and meta-analysis. Chin J Traumatol 2020:S1008-1275(20)30180-2. [PMID: 33008740 DOI: 10.1016/j.cjtee.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/07/2020] [Accepted: 06/06/2020] [Indexed: 02/04/2023] Open
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Yang-Yang Gao
- Department of Orthopaedic Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Rong Zhang
- Department of Oncology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, 046000, Shanxi, China
| | - Xian-Da Che
- Department of Orthopaedic Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Chun-Fang Wang
- Department of Experimental Animal Center, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Dong-Ping Shi
- Department of Nephrology, Fenyang Hospital of Shanxi Province, Fenyang, 032200, Shanxi, China
| | - Bin Liang
- Department of Orthopaedic Surgery, Fenyang Hospital of Shanxi Province, Fenyang, 032200, Shanxi, China
| | - Peng-Hua Li
- Department of Laboratory, Fenyang Hospital of Shanxi Province, Fenyang, 032200, Shanxi, China
| | - Shu-Fen Liang
- Department of Laboratory, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Peng-Cui Li
- Department of Orthopaedic Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
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Kamenaga T, Hayashi S, Hashimoto S, Matsumoto T, Takayama K, Fujishiro T, Hiranaka T, Niikura T, Kuroda R. Accuracy of cup orientation and learning curve of the accelerometer-based portable navigation system for total hip arthroplasty in the supine position. J Orthop Surg (Hong Kong) 2020; 27:2309499019848871. [PMID: 31104563 DOI: 10.1177/2309499019848871] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess the accuracy of cup orientation and learning curve of the disposable accelerometer-based portable navigation system for total hip arthroplasty (THA) in the supine position. METHODS A total of 75 patients who underwent THA through the anterolateral supine approach (ALS) with an accelerometer-based portable navigation system for the supine position (HipAlign®) between July 2017 and October 2018 were analyzed in this study. We compared the intraoperative cup angles using navigation records with the postoperative angles using postoperative computed tomography (CT) data. All patients were categorized into the following groups according to the course of three discrete, sequential operative time periods: 1-25 (initial group), 26-50 (intermediate group), and 51-75 (recent group). We compared the accuracy of cup inclination and anteversion among the three groups. The time required for navigation and the operative time of all patients were measured. RESULTS The average absolute error in measurement (postoperative CT-navigation record) was 2.6° ± 2.7° (inclination) and 2.8° ± 2.7° (anteversion). There were no significant differences among the three groups. The average time required for navigation and the operative time were 365.1 ± 90.3 s and 76.1 ± 1.6 min, respectively. The required time for HipAlign® navigation and operative time were constant in most patients, except for those of the initial five cases. CONCLUSION The accelerometer-based portable navigation system provides good accuracy of cup orientation, has a short learning curve, and requires a minimal surgical time for THA in supine position.
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Affiliation(s)
- Tomoyuki Kamenaga
- 1 Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Shinya Hayashi
- 1 Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Shingo Hashimoto
- 1 Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Tomoyuki Matsumoto
- 1 Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Koji Takayama
- 1 Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takaaki Fujishiro
- 2 Department of Orthopaedic Surgery, Takatsuki General Hospital, Osaka, Japan
| | - Takafumi Hiranaka
- 2 Department of Orthopaedic Surgery, Takatsuki General Hospital, Osaka, Japan
| | - Takahiro Niikura
- 1 Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Ryosuke Kuroda
- 1 Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
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Hsiue PP, Chen CJ, Villalpando C, Ponzio D, Khoshbin A, Stavrakis AI. Trends and patient factors associated with technology-assisted total hip arthroplasty in the United States from 2005 to 2014. Arthroplast Today 2020; 6:112-117.e1. [PMID: 32211486 PMCID: PMC7083725 DOI: 10.1016/j.artd.2019.12.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/07/2019] [Accepted: 12/27/2019] [Indexed: 01/14/2023] Open
Abstract
Background Technology-assisted total hip arthroplasty (TA-THA) using either computer-assisted navigation or robotic assistance has become increasingly more popular. The purpose of this study was to examine the trends and patient factors associated with TA-THA. Methods This is a retrospective review utilizing the National Inpatient Sample, a large national database incorporating inpatient hospitalization information. International Classification of Diseases, 9th Revision codes were used to identify patients with hip osteoarthritis who underwent primary total hip arthroplasty (THA). Patients were then separated into those who underwent TA-THA or conventional THA. Outcomes of interest included annual TA-THA utilization; patient and hospital characteristics associated with TA-THA; and trends for length of stay (LOS), cost, and discharge to home. Results From 2005 to 2014, a total of 2,588,304 patients with hip osteoarthritis who underwent THA were identified in the National Inpatient Sample database. Of those, 39,700 (1.5%) underwent TA-THA. The number of TA-THA procedures increased from 178 (0.1% of all THA) in 2005 to 10,045 (3.0% of all THA) in 2014, which represented a 30-fold increase in incidence (P-trend <.0001). TA-THA was associated with Hispanic race, higher patient income, and the Western region of the United States. During the study period, there was a trend toward decreased LOS and increased discharge to home for both TA-THA and conventional THA. TA-THA was associated with higher inpatient cost. Conclusion TA-THA is being increasingly used in the United States and is associated with specific patient factors. However, the value of TA-THA compared to conventional THA remains unclear and should be assessed with future research. Level of Evidence III (retrospective cohort study).
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Affiliation(s)
- Peter P. Hsiue
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
- Corresponding author. Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, 10833 Le Conte Avenue, 76-143 CHS, Los Angeles, CA 90095, USA. Tel.: +310-825-6557.
| | - Clark J. Chen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Cristina Villalpando
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Danielle Ponzio
- Rothman Institute at Thomas Jefferson University, Egg Harbor Township, NJ, USA
| | - Amir Khoshbin
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Alexandra I. Stavrakis
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
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Tanino H, Nishida Y, Mitsutake R, Ito H. Portable Accelerometer-Based Navigation System for Cup Placement of Total Hip Arthroplasty: A Prospective, Randomized, Controlled Study. J Arthroplasty 2020; 35:172-177. [PMID: 31563396 DOI: 10.1016/j.arth.2019.08.044] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/12/2019] [Accepted: 08/20/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Malposition of the acetabular component during total hip arthroplasty (THA) is associated with increased risk of dislocation, reduced range of motion, and accelerated wear. The purpose of this study is to compare cup positioning with a portable, accelerometer-based hip navigation system and conventional surgical technique. METHODS In a prospective, randomized, clinical study, cups were implanted with a portable, accelerometer-based hip navigation system (navigation group; n = 55) or conventional technique (conventional group; n = 55). THA was conducted in the lateral position and through posterior approach. The cup position was determined postoperatively on pelvic radiograph and computed tomography scans. RESULTS An average cup abduction of 39.2° ± 4.6° (range, 27° to 50°) and an average cup anteversion of 14.6° ± 6.1° (range, 1° to 27.5°) were found in the navigation group, and an average cup abduction of 42.9° ± 8.0° (range, 23° to 73°) and an average cup anteversion of 11.6° ± 7.7° (range, -12.1° to 25°) in the conventional group. A smaller variation in the navigation group was indicated for cup abduction (P = .001). The deviations from the target cup position were significantly lower in the navigation group (P = .001, .016). While only 37 of 55 cups in the conventional group were inside the Lewinnek safe zone, 51 of 55 cups in the navigation group were placed inside this safe zone (P = .006). The navigation procedure took a mean of 10 minutes longer than the conventional technique. CONCLUSION Use of the portable, accelerometer-based hip navigation system can improve cup positioning in THA.
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Affiliation(s)
- Hiromasa Tanino
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Yasuhiro Nishida
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Ryo Mitsutake
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroshi Ito
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan
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Periprosthetic Fracture of Greater Trochanter in Total Hip Replacement Stemming from Pin Site Placement in Navigation-Assisted Surgery. Case Rep Orthop 2019; 2019:1945895. [PMID: 31093397 PMCID: PMC6476136 DOI: 10.1155/2019/1945895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/24/2019] [Indexed: 01/16/2023] Open
Abstract
Surgeons are looking to use computer computer-assisted surgery (CAS) in total hip arthroplasty (THA) in order to quantify leg length measurement, angular cup placement, and enhance stability to provide enhanced accuracy in implant placement. As a result, CAS in THA is gaining popularity. This technology employs the use of pins and provides the surgeon with real-time feedback on positioning intraoperatively. Previous total knee arthroplasty (TKA) literature has reported pin-associated complications such as infections, neuropraxia, and suture abscess. To our knowledge, there have been reports of tibial stress fracture after CAS TKA, but this is the first report of a pin causing fracture of the greater trochanter leading to dislocation in THA. Further studies may be warranted to optimize pin placement for trackers to prevent fractures of the greater trochanter.
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Bohl DD, Nolte MT, Ong K, Lau E, Calkins TE, Della Valle CJ. Computer-Assisted Navigation Is Associated with Reductions in the Rates of Dislocation and Acetabular Component Revision Following Primary Total Hip Arthroplasty. J Bone Joint Surg Am 2019; 101:250-256. [PMID: 30730484 DOI: 10.2106/jbjs.18.00108] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Prior work suggests that computer-assisted navigation improves acetabular component position during primary total hip arthroplasty (THA). However, it is not known whether this translates to improvements in clinical outcomes. The purpose of this study was to test for associations between navigation use and the risk of dislocation, aseptic revision of the acetabular component, aseptic revision of the femoral component, aseptic revision of either component, and acute periprosthetic joint infection (PJI). METHODS This was a retrospective cohort study, conducted using the 100% Medicare Part A claims data set. Inclusion criteria were an age of ≥65 years and primary THA for osteoarthritis. First, the association between navigation use and patient and hospital characteristics was assessed. Second, while controlling for these characteristics, multivariate regression was used to test for the association of navigation use and the outcomes listed above. RESULTS A total of 803,732 primary THA procedures were identified; 14,540 (1.81%) involved the use of navigation. Navigation use was associated with younger age, other/unknown race, the Western census region, higher socioeconomic status, lower Charlson Comorbidity Index, shorter length of stay, private hospitals, teaching hospitals, and larger hospitals (p < 0.05 for each). Navigation use was associated with a lower rate of dislocation (1.00% versus 1.70% for no navigation; adjusted hazard ratio [HR] = 0.69; 95% confidence interval [CI] = 0.58 to 0.82; p < 0.001) and aseptic revision of the acetabular component (1.03% versus 1.55%; adjusted HR = 0.75; 95% CI = 0.64 to 0.88; p < 0.001). Navigation was not associated with aseptic revision of the femoral component (1.54% versus 1.87%; p = 0.064), aseptic revision of either component (1.91% versus 2.31%; p = 0.077), acute PJI at 6 weeks (0.34% versus 0.45%; p = 0.121), or acute PJI at 90 days (0.50% versus 0.66%; p = 0.458). CONCLUSIONS The findings of this study suggest that navigation is associated with reductions in the rates of dislocation and aseptic acetabular revision following primary THA. However, these results should be interpreted carefully in the setting of potential confounding by unmeasured variables, such as surgeon volume, family support, and patient compliance. Causality cannot be inferred until further prospective trials can vet this technology. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Michael T Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Kevin Ong
- Exponent, Inc., Philadelphia, Pennsylvania
| | | | - Tyler E Calkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Christ A, Ponzio D, Pitta M, Carroll K, Muir JM, Sculco PK. Minimal Increase in Total Hip Arthroplasty Surgical Procedural Time with the Use of a Novel Surgical Navigation Tool. Open Orthop J 2018; 12:389-395. [PMID: 30416609 PMCID: PMC6187742 DOI: 10.2174/1874325001812010389] [Citation(s) in RCA: 14] [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] [Received: 05/15/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 02/03/2023] Open
Abstract
Background Computer-assisted navigation has proven effective at improving the accuracy of component placement during Total Hip Arthroplasty (THA); however, the material costs, line-of-site issues and potential for significant time increases have limited their widespread use. Objective The purpose of this study was to investigate the impact of an imageless navigation device on surgical time, when compared with standard mechanical guides. Methods We retrospectively reviewed prospectively collected data from 61 consecutive primary unilateral THA cases (posterior approach) performed by a single surgeon. Procedural time (incision to closure) for THA performed with (intervention) or without (control) a computer-assisted navigation system was compared. In the intervention group, the additional time associated with the use of the device was recorded. Mean times were compared using independent samples t-tests with statistical significance set a priori at p<0.05. Results There was no statistically significant difference between procedural time in the intervention and control groups (102.3±28.3 mins vs. 99.1±14.7 mins, p=0.60). The installation and use of the navigation device accounted for an average of 2.9 mins (SD: 1.6) per procedure, of which device-related setup performed prior to skin incision accounted for 1.1 mins (SD: 1.1) and intra-operative tasks accounted for 1.6 mins (SD: 1.2). Conclusion In this series of 61 consecutive THAs performed by a single surgeon, the set-up and hands-on utilization of a novel surgical navigation tool required an additional 2.9 minutes per case. We suggest that the intraoperative benefits of this novel computer-assisted navigation platform outweigh the minimal operative time spent using this technology.
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Affiliation(s)
- Alexander Christ
- Division of Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Danielle Ponzio
- Division of Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Michael Pitta
- Division of Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Kaitlin Carroll
- Division of Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jeffrey M Muir
- Intellijoint Surgical, 60 Bathurst St., Suite 6, Waterloo, ON, N2V 2A9, Canada
| | - Peter K Sculco
- Division of Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Valsamis EM, Ricketts D, Hussain A, Jenabzadeh AR. Imageless navigation total hip arthroplasty - an evaluation of operative time. SICOT J 2018; 4:18. [PMID: 29792786 PMCID: PMC5967858 DOI: 10.1051/sicotj/2018016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 04/15/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction: Imageless navigation has been successfully integrated in knee arthroplasty but its effectiveness in total hip arthroplasty (THA) has been debated. It has consistently been shown that navigation adds significant time and cost to the operation. Further, the relative success of traditional hip replacements has impeded the adoption of new techniques. Methods: We compared the operative time between fifty total hip replacements with and without the use of imageless navigation by a single senior surgeon in a retrospective study. We employed standard statistical tools to compare the two methods. A correlation-based analysis was used to delimit the “learned” phase of imageless navigation to make comparisons meaningful. Results: Contrary to what has previously been reported, there was no significant difference between operative time in navigated, when compared to traditional operations (p = 0.498). Only fourteen operations were required to delimit the learning phase of this operation. Discussion: This is the first study that demonstrates no added operative time when using imageless navigation in THA, achieved with an improved workflow. The results also demonstrate a very reasonable learning curve.
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Affiliation(s)
| | - David Ricketts
- Brighton and Sussex University Hospitals, Brighton BN2 5BE, UK
| | - Adnan Hussain
- Hinchingbrooke Hospital NHS Trust, Huntingdon PE29 6NT, UK
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Effect of Pelvic Tilt and Rotation on Cup Orientation in Both Supine and Standing Positions. J Arthroplasty 2018; 33:1442-1448. [PMID: 29276116 DOI: 10.1016/j.arth.2017.11.069] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/15/2017] [Accepted: 11/30/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to analyze the effect of pelvic tilt and rotation on radiographic measurement of cup orientation. METHODS A total of 68 patients (79 hips) were included in this study. The patients had a computed tomography study and approximately 3 months of postoperative standing anteroposterior pelvic radiographs in both supine and standing positions. We used 2-dimensional (2D)/3-dimensional (3D) matching to measure pelvic tilt and rotation, and cup orientation. RESULTS There was a wide range of pelvic tilt between individuals in both supine and standing positions. Supine pelvic tilt was different from standing pelvic tilt (P < .05). There were differences in cup anteversion before and after 2D/3D matching in both supine and standing positions (P < .05). Supine and standing pelvic tilt correlated with differences in cup anteversion before and after 2D/3D matching. When all 79 hips were separated into right and left side, pelvic rotation inversely correlated with the pelvic tilt-adjusted difference in anteversion before and after 2D/3D matching of the right side but directly correlated with that of the left side in both supine and standing positions. CONCLUSION This study demonstrated that the measurement of cup anteversion on anteroposterior radiographs is significantly affected by both pelvic tilt and pelvic rotation (depending on the side). Improved understanding of pelvic orientation and improved ability to measure pelvic orientation may eventually allow for desired cup positioning to potentially protect against complications associated with malposition of the cup.
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Krämer M, Kahrs LA, Friese KI, von Falck C, Hurschler C. Inter- and intra-operator reliability in patient-specific template positioning for total hip arthroplasty. A cadaver study. Int J Med Robot 2018; 14. [PMID: 29336121 DOI: 10.1002/rcs.1887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 10/05/2017] [Accepted: 11/19/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND The implantation of the acetabular cup essentially determines the clinical outcome of total hip arthroplasty. To address this issue, the aim of this study was to build patient-specific instruments (PSIs) with various reference surfaces, followed by in vitro investigations to examine the inter- and intra-operator reliability as well as the overall precision of these patient-specific templates. METHODS Seven human hemi-pelvis specimens were used for this study. After a CT scan, PSIs with different imprint heights were created. The overall precision of the templates and the inter- and intra-operator reliabilities were calculated. RESULTS Strong differences in precision between the PSI designs could be observed. The desired orientation of the acetabular cup could be adjusted with a precision of up to 1.55°. CONCLUSION Based on our results, we believe that the application of the PSI-based acetabular cup positioning in total hip arthroplasty procedures can potentially increase the precision of cup placement.
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Affiliation(s)
- Manuel Krämer
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
| | - Lüder A Kahrs
- Institute of Mechatronic Systems, Leibniz Universität Hannover, Hannover, Germany
| | | | - Christian von Falck
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Christof Hurschler
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
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Yamada K, Endo H, Tetsunaga T, Miyake T, Sanki T, Ozaki T. Accuracy of Cup Positioning With the Computed Tomography-Based Two-dimensional to Three-Dimensional Matched Navigation System: A Prospective, Randomized Controlled Study. J Arthroplasty 2018; 33:136-143. [PMID: 28870743 DOI: 10.1016/j.arth.2017.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The accuracy of various navigation systems used for total hip arthroplasty has been described, but no publications reported the accuracy of cup orientation in computed tomography (CT)-based 2D-3D (two-dimensional to three-dimensional) matched navigation. METHODS In a prospective, randomized controlled study, 80 hips including 44 with developmental dysplasia of the hips were divided into a CT-based 2D-3D matched navigation group (2D-3D group) and a paired-point matched navigation group (PPM group). The accuracy of cup orientation (absolute difference between the intraoperative record and the postoperative measurement) was compared between groups. Additionally, multiple logistic regression analysis was performed to evaluate patient factors affecting the accuracy of cup orientation in each navigation. RESULTS The accuracy of cup inclination was 2.5° ± 2.2° in the 2D-3D group and 4.6° ± 3.3° in the PPM group (P = .0016). The accuracy of cup anteversion was 2.3° ± 1.7° in the 2D-3D group and 4.4° ± 3.3° in the PPM group (P = .0009). In the PPM group, the presence of roof osteophytes decreased the accuracy of cup inclination (odds ratio 8.27, P = .0140) and the absolute value of pelvic tilt had a negative influence on the accuracy of cup anteversion (odds ratio 1.27, P = .0222). In the 2D-3D group, patient factors had no effect on the accuracy of cup orientation. CONCLUSION The accuracy of cup positioning in CT-based 2D-3D matched navigation was better than in paired-point matched navigation, and was not affected by patient factors. It is a useful system for even severely deformed pelvises such as developmental dysplasia of the hips.
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Affiliation(s)
- Kazuki Yamada
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Hirosuke Endo
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Tomonori Tetsunaga
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Takamasa Miyake
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Tomoaki Sanki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Okayama, Japan
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Redmond JM, Gupta A, Hammarstedt JE, Petrakos A, Stake CE, Domb BG. Accuracy of Component Placement in Robotic-Assisted Total Hip Arthroplasty. Orthopedics 2016; 39:193-9. [PMID: 27064781 DOI: 10.3928/01477447-20160404-06] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 10/13/2015] [Indexed: 02/03/2023]
Abstract
Robotic-assisted total hip arthroplasty (THA) is a recent platform introduced to decrease the risk of malpositioned components. The goals of this study were to determine whether intraoperative data on robotic-assisted THA acetabular component position accurately predict postoperative radiographic acetabular component position and to determine whether intraoperative data on robotic-assisted THA leg length and offset accurately predict postoperative radiographic leg length and offset data. In 146 patients, pre- and postoperative radiographs and intraoperative component measurements were reported for acetabular inclination, anteversion, leg length change, and offset change. Component position obtained by the robotic system and radiographic data were compared with subgroup analysis for the posterior and direct anterior approaches. The average difference between groups was 3.3°±3.1° for inclination, 2.9°±2.3° for anteversion, 3.0±2.3 mm for leg length change, and 4.0±3.1 mm for change in global offset. Correlation between the robotic system and postoperative radiographs was within 10° for 95.9% of cases for inclination and 99.3% for anteversion. Posterior approach correlation was within 10° for 97.1% of cases for inclination and 100% for anteversion. Anterior approach correlation was within 10° for 92.7% of cases for inclination and 97.6% for anteversion. Intraoperative data on component position obtained from the robotic system compared well with radiographic data on component position. Surgeons must remain vigilant to ensure outliers related to robotic system malfunction do not occur. [Orthopedics. 2016; 39(3):193-199.].
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Sculco PK, McLawhorn AS, Carroll KM, McArthur BA, Mayman DJ. Anteroposterior Radiographs Are More Accurate than Cross-Table Lateral Radiographs for Acetabular Anteversion Assessment: a Retrospective Cohort Study. HSS J 2016; 12:32-8. [PMID: 26855625 PMCID: PMC4733699 DOI: 10.1007/s11420-015-9472-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 09/14/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Measuring acetabular anteversion is relevant to routine follow-up of total hip arthroplasties (THAs) and for malfunctioning THAs. Imageless navigation facilitates acetabular component orientation relative to the anterior pelvic plane (APP) or to the APP adjusted for sagittal pelvic tilt (PT). The optimal plain radiographic method for the postoperative assessment of anteversion is not agreed upon. QUESTIONS/PURPOSES (1) Do anteversion measurements on plain radiographs correlate more with APP anteversion or PT-adjusted anteversion? (2) Do measurements of anteversion performed on supine anteroposterior (AP) radiographs more accurately reflect intraoperative anteversion values for navigated THA compared to anteversion measured on cross-table lateral (CL) radiographs? METHODS Seventy patients receiving primary navigated THA were included. APP and PT-adjusted anteversion were recorded; the latter defined the intraoperative target for anteversion. Postoperative anteversion was measured on supine AP pelvis radiographs with computer software and CL radiographs with conventional methods. Intraoperative measurements were used as the reference standards for comparisons. RESULTS Mean intraoperative APP anteversion was 20.6° ± 5.6°. Mean intraoperative PT-adjusted anteversion was 22.9° ± 4.5°. Mean anteversion was 22.7° ± 4.7° on AP radiographs and 27.2° ± 4.2° on CL radiographs (p < 0.001). Only correlations between PT-adjusted anteversion and radiographic assessments of anteversion were significant. The mean difference between PT-adjusted anteversion and anteversion on AP radiographs was -0.2° ± 4.3°, while the mean difference between the PT-adjusted anteversion and anteversion measured on CL radiographs was 4.3 ± 5.1° (p < 0.001). CONCLUSION Plain film assessment of anteversion was more accurate on supine AP radiographs than on CL radiographs, which overestimated acetabular anteversion.
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Affiliation(s)
- Peter K. Sculco
- />Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Alexander S. McLawhorn
- />Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Kaitlin M. Carroll
- />Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Benjamin A. McArthur
- />Washington Orthopedics and Sports Medicine, 5215 Loughboro Road NW, Suite 200, Washington, DC 20016 USA
| | - David J. Mayman
- />Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Xu J, Li D, Ma RF, Barden B, Ding Y. Application of Rapid Prototyping Pelvic Model for Patients with DDH to Facilitate Arthroplasty Planning: A Pilot Study. J Arthroplasty 2015; 30:1963-70. [PMID: 26129852 DOI: 10.1016/j.arth.2015.05.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/13/2015] [Accepted: 05/15/2015] [Indexed: 02/01/2023] Open
Abstract
Total hip arthroplasty (THA) is challenging in cases of osteoarthritis secondary to developmental dysplasia of the hip (DDH). Acetabular deficiency makes the positioning of the acetabular component difficult. Computer tomography based, patient-individual three dimensional (3-D) rapid prototype technology (RPT)-models were used to plan the placement of acetabular cup so that a surgeon was able to identify pelvic structures, assess the ideal extent of reaming and determine the size of cup after a reconstructive procedure. Intraclass correlation coefficients (ICCs) were used to analyze the agreement between the sizes of chosen components on the basis of preoperative planning and the actual sizes used in the operation. The use of the 3-D RPT-model facilitates the surgical procedures due to better planning and improved orientation.
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Affiliation(s)
- Jie Xu
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Deng Li
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruo-fan Ma
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bertram Barden
- Department of Orthopaedic Surgery, Düren Hospital, Academic Hospital of University of RWTH Aachen, Düren, Germany
| | - Yue Ding
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Tischler EH, Orozco F, Aggarwal VK, Pacheco H, Post Z, Ong A. Does intraoperative fluoroscopy improve component positioning in total hip arthroplasty? Orthopedics 2015; 38:e1-6. [PMID: 25611413 DOI: 10.3928/01477447-20150105-52] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 03/25/2014] [Indexed: 02/03/2023]
Abstract
Accurate placement of components is imperative for successful outcomes after total hip arthroplasty (THA). Although technology-assisted techniques offer the potential for greater accuracy in prosthesis positioning, the need for additional resources prevents their widespread use. The goal of this study was to compare primary THA procedures performed with and without intraoperative fluoroscopic guidance with regard to accuracy of prosthesis placement, operative time, and postoperative complications. The authors reviewed 341 consecutive cases (330 patients) undergoing primary THA at the authors' institution from September 2007 to January 2010. Postoperative anteroposterior radiographs were used to measure acetabular inclination angle, leg length discrepancy, and femoral offset discrepancy. Operative time and postoperative complications related to implant positioning were recorded. Mean acetabular inclination angle, leg length discrepancy, and offset discrepancy for control vs study groups were 43.0° (range, 32.2°-61.4°) vs 43.8° (range, 29.0°-55.1°), 4.75 mm (range, 0-25) vs 4.24 mm (range, 0-27), and 8.47 mm (range, 0-9.7) vs 7.70 mm (range, 0-31), respectively. Complication rates were not significantly different between the control (8.1%) and study (5.3%) groups. Mean operative time was significantly higher in the study group compared with the control group (59.8 vs 52.8 minutes) (P<.0001). The findings showed that intraoperative fluoroscopy may not improve prosthesis accuracy or decrease postoperative complication rates compared with a freehand technique. Because of significantly increased operative time and cost associated with fluoroscopic guidance, the authors discourage the use of this technique in uncomplicated primary THA performed at high-volume arthroplasty institutions.
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Xie W, Franke J, Chen C, Grützner PA, Schumann S, Nolte LP, Zheng G. A complete-pelvis segmentation framework for image-free total hip arthroplasty (THA): methodology and clinical study. Int J Med Robot 2014; 11:166-80. [PMID: 25258044 DOI: 10.1002/rcs.1619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 08/25/2014] [Accepted: 08/27/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Complete-pelvis segmentation in antero-posterior pelvic radiographs is required to create a patient-specific three-dimensional pelvis model for surgical planning and postoperative assessment in image-free navigation of total hip arthroplasty. METHODS A fast and robust framework for accurately segmenting the complete pelvis is presented, consisting of two consecutive modules. In the first module, a three-stage method was developed to delineate the left hemi-pelvis based on statistical appearance and shape models. To handle complex pelvic structures, anatomy-specific information processing techniques were employed. As the input to the second module, the delineated left hemi-pelvis was then reflected about an estimated symmetry line of the radiograph to initialize the right hemi-pelvis segmentation. The right hemi-pelvis was segmented by the same three-stage method, RESULTS Two experiments conducted on respectively 143 and 40 AP radiographs demonstrated a mean segmentation accuracy of 1.61±0.68 mm. A clinical study to investigate the postoperative assessment of acetabular cup orientations based on the proposed framework revealed an average accuracy of 1.2°±0.9° and 1.6°±1.4° for anteversion and inclination, respectively. Delineation of each radiograph costs less than one minute. CONCLUSIONS Despite further validation needed, the preliminary results implied the underlying clinical applicability of the proposed framework for image-free THA.
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Affiliation(s)
- Weiguo Xie
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Switzerland.,BG Trauma Centre Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Jochen Franke
- BG Trauma Centre Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Cheng Chen
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland
| | - Paul A Grützner
- BG Trauma Centre Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Steffen Schumann
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland
| | - Lutz-P Nolte
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland
| | - Guoyan Zheng
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland
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Xu K, Li YM, Zhang HF, Wang CG, Xu YQ, Li ZJ. Computer navigation in total hip arthroplasty: A meta-analysis of randomized controlled trials. Int J Surg 2014; 12:528-33. [DOI: 10.1016/j.ijsu.2014.02.014] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 01/03/2014] [Accepted: 02/25/2014] [Indexed: 11/29/2022]
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Ulivi M, Orlandini L, Pascale W, Consonni O, Sansone V. Intraoperative validation of navigated limb measurements in THA using a pinless femoral array. J Arthroplasty 2014; 29:1026-9. [PMID: 24210668 DOI: 10.1016/j.arth.2013.09.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 07/26/2013] [Accepted: 09/23/2013] [Indexed: 02/01/2023] Open
Abstract
Appropriate limb length (LL) and femoral offset (OS) after total hip arthroplasty (THA) are crucial for a successful and lasting outcome. However, intraoperative assessment is difficult. Computed navigation is effective but the use of radiation and of invasive bone references is cause of concern. Imageless, pinless navigation systems have been shown to be accurate in experimental studies. However, almost no clinical validation has been performed. We used a minimally-invasive computer-navigated system (MICNS) in conjunction with an imageless measurement technique for implanting 60 consecutive THAs. Head/neck trial components of different size were applied, and the differences in LL and femoral OS measurements were recorded and compared to the implant manufacturer's specifications, corrected for the anatomical variations of each patient. The imageless MICNS revealed a valid and accurate intra-operative tool for measuring LL and femoral OS in vivo.
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Affiliation(s)
- Michele Ulivi
- Clinica Ortopedica dell' Università degli Studi di Milano, Istituto Ortopedico Galeazzi IRCCS
| | - Luca Orlandini
- Clinica Ortopedica dell' Università degli Studi di Milano, Istituto Ortopedico Galeazzi IRCCS
| | - Walter Pascale
- Clinica Ortopedica dell' Università degli Studi di Milano, Istituto Ortopedico Galeazzi IRCCS
| | - Olmo Consonni
- Clinica Ortopedica dell' Università degli Studi di Milano, Istituto Ortopedico Galeazzi IRCCS
| | - Valerio Sansone
- Clinica Ortopedica dell' Università degli Studi di Milano, Istituto Ortopedico Galeazzi IRCCS.
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Gurgel HMC, Croci AT, Cabrita HABA, Vicente JRN, Leonhardt MC, Rodrigues JC. Acetabular component positioning in total hip arthroplasty with and without a computer-assisted system: a prospective, randomized and controlled study. J Arthroplasty 2014; 29:167-71. [PMID: 23711798 DOI: 10.1016/j.arth.2013.04.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 02/20/2013] [Accepted: 04/12/2013] [Indexed: 02/01/2023] Open
Abstract
In a study of the acetabular component in total hip arthroplasty, 20 hips were operated on using imageless navigation and 20 hips were operated on using the conventional method. The correct position of the acetabular component was evaluated with computed tomography, measuring the operative anteversion and the operative inclination and determining the cases inside Lewinnek's safe zone. The results were similar in all the analyses: a mean anteversion of 17.4° in the navigated group and 14.5° in the control group (P=.215); a mean inclination of 41.7° and 42.2° (P=.633); a mean deviation from the desired anteversion (15°) of 5.5° and 6.6° (P=.429); a mean deviation from the desired inclination of 3° and 3.2° (P=.783); and location inside the safe zone of 90% and 80% (P=.661). The acetabular component position's tomography analyses were similar whether using the imageless navigation or performing it conventionally.
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Affiliation(s)
- Henrique M C Gurgel
- Department of Orthopedics and Traumatology, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil
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Domb BG, El Bitar YF, Sadik AY, Stake CE, Botser IB. Comparison of robotic-assisted and conventional acetabular cup placement in THA: a matched-pair controlled study. Clin Orthop Relat Res 2014; 472:329-36. [PMID: 23990446 PMCID: PMC3889439 DOI: 10.1007/s11999-013-3253-7] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/15/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Improper acetabular component orientation in THA has been associated with increased dislocation rates, component impingement, bearing surface wear, and a greater likelihood of revision. Therefore, any reasonable steps to improve acetabular component orientation should be considered and explored. QUESTIONS/PURPOSES We therefore sought to compare THA with a robotic-assisted posterior approach with manual alignment techniques through a posterior approach, using a matched-pair controlled study design, to assess whether the use of the robot made it more likely for the acetabular cup to be positioned in the safe zones described by Lewinnek et al. and Callanan et al. METHODS Between September 2008 and September 2012, 160 THAs were performed by the senior surgeon. Sixty-two patients (38.8%) underwent THA using a conventional posterior approach, 69 (43.1%) underwent robotic-assisted THA using the posterior approach, and 29 (18.1%) underwent radiographic-guided anterior-approach THAs. From September 2008 to June 2011, all patients were offered anterior or posterior approaches regardless of BMI and anatomy. Since introduction of the robot in June 2011, all THAs were performed using the robotic technique through the posterior approach, unless a patient specifically requested otherwise. The radiographic cup positioning of the robotic-assisted THAs was compared with a matched-pair control group of conventional THAs performed by the same surgeon through the same posterior approach. The safe zone (inclination, 30°-50°; anteversion, 5°-25°) described by Lewinnek et al. and the modified safe zone (inclination, 30°-45°; anteversion, 5°-25°) of Callanan et al. were used for cup placement assessment. Matching criteria were gender, age ± 5 years, and (BMI) ± 7 units. After exclusions, a total of 50 THAs were included in each group. Strong interobserver and intraobserver correlations were found for all radiographic measurements (r > 0.82; p < 0.001). RESULTS One hundred percent (50/50) of the robotic-assisted THAs were within the safe zone described by Lewinnek et al. compared with 80% (40/50) of the conventional THAs (p = 0.001). Ninety-two percent (46/50) of robotic-assisted THAs were within the modified safe zone described by Callanan et al. compared with 62% (31/50) of conventional THAs p (p = 0.001). The odds ratios for an implanted cup out of the safe zones of Lewinnek et al. and Callanan et al. were zero and 0.142, respectively (95% CI, 0.044, 0.457). CONCLUSIONS Use of the robot allowed for improvement in placement of the cup in both safe zones, an important parameter that plays a significant role in long-term success of THA. However, whether the radiographic improvements we observed will translate into clinical benefits for patients-such as reductions in component impingement, acetabular wear, and prosthetic dislocations, or in terms of improved longevity-remains unproven.
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Affiliation(s)
- Benjamin G. Domb
- American Hip Institute, Chicago, IL USA ,Hinsdale Orthopaedics, Hinsdale, IL USA ,Loyola University Stritch School of Medicine, Chicago, IL USA ,American Hip Institute in Chicago, Hinsdale Orthopedics, 1010 Executive Court, Suite 250, Westmont, IL 60559 USA
| | | | | | - Christine E. Stake
- American Hip Institute, Chicago, IL USA ,Hinsdale Orthopaedics, Hinsdale, IL USA
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Liu F, Gross TP. A safe zone for acetabular component position in metal-on-metal hip resurfacing arthroplasty: winner of the 2012 HAP PAUL award. J Arthroplasty 2013; 28:1224-30. [PMID: 23540536 DOI: 10.1016/j.arth.2013.02.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 02/12/2013] [Accepted: 02/21/2013] [Indexed: 02/01/2023] Open
Abstract
A safe zone for acetabular component positioning in hip resurfacing (RAIL: Relative Acetabular Inclination Limit) was calculated based on implant size and acetabular inclination angle (AIA). For AIA below the RAIL, there were no adverse wear failures or dislocations, and only 1% of cases with ion levels above 10 μg/L. Other than high inclination angle and small bearing size, female gender was the only other factor that correlated with high ion levels in the multivariate analysis. Seven hundred sixty-one hip resurfacing cases are included in this study. The UCLA activity score, femoral shaft angle, body mass index, weight, American Society of Anesthesiologists score, combined range of motion, diagnosis, age, gender, implant brand, AIA, bearing size, and duration of implantation were analyzed to determine the potential risk factors for elevated metal ion levels. These findings apply to sub hemispheric metal-on-metal bearings with similar coverage arcs as the Biomet and Corin hip resurfacing brands. Additional problems may occur when these bearings are connected with trunions on stems for total hip arthroplasty.
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Affiliation(s)
- Fei Liu
- Midlands Orthopaedics, P.A. Columbia, SC 29201, USA
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Li YL, Jia J, Wu Q, Ning GZ, Wu QL, Feng SQ. Evidence-based computer-navigated total hip arthroplasty: an updated analysis of randomized controlled trials. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:531-8. [DOI: 10.1007/s00590-013-1222-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/07/2013] [Indexed: 11/28/2022]
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Kajino Y, Kabata T, Maeda T, Iwai S, Kuroda K, Tsuchiya H. Does degree of the pelvic deformity affect the accuracy of computed tomography-based hip navigation? J Arthroplasty 2012; 27:1651-7. [PMID: 22552221 DOI: 10.1016/j.arth.2012.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 03/08/2012] [Indexed: 02/01/2023] Open
Abstract
Although some navigation systems have been used for improvement of component positioning, there have been few reports regarding cases of severe pelvic deformity. We performed a retrospective review of 25 cases of total hip arthroplasty with a computed tomography-based navigation system in patients with severe pelvic deformities and estimated acetabular component position and angle between severe deformity group and mild dysplastic group as a control. There were no significant differences in accuracy of navigation system between 2 groups in terms of 3-dimensional component position or angle. Accuracy of computed tomography-based hip navigation does not depend on the degree of pelvic deformity, and this system is also useful to identify acetabular orientation and for precise component implantation in cases of pelvic deformity.
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Affiliation(s)
- Yoshitomo Kajino
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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Inori F, Ohashi H, Yo H, Okajima Y, Matsui Y, Shintani K. Accuracy of cup height and medialization in THA for dysplastic hip osteoarthritis using an imageless navigation system. Orthopedics 2012; 35:7-12. [PMID: 23026245 DOI: 10.3928/01477447-20120919-50] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In total hip arthroplasty (THA) for dysplastic hip osteoarthritis, bony deformity makes it difficult to identify the correct cup height and medialization. The authors developed a new technique for registration and navigation of cup position for dysplastic hips using an imageless navigation system. Eighty dysplastic hips (Crowe type I, n=58; type II, n=18; type III, n=4) underwent THA. Thirty-four hips were operated on while in the supine position and 46 hips were operated on while in the lateral position. Before capsulectomy, the anterior pelvic plane and the position of the femur were registered. After exposure of the acetabulum, the teardrop, posterior rim, and medial wall of the acetabulum were registered. Then the cup height, cup medialization, cup inclination, anteversion, and leg lengthening were navigated. The difference between the navigated and radiographic cup heights was 4.5 ± 4.0 mm, the difference in cup medialization was 3.0 ± 2.5 mm, the difference in cup inclination was 4.3° ± 3.1°, the difference in cup anteversion was 5.5° ± 3.8°, and the difference in leg lengthening was 3.7 ± 3.0 mm. Comparison of the first 20 cases with the last 20 cases showed that the accuracy of cup medialization was significantly improved. These differences were not affected by Crowe type or surgical position. Because the correct cup height and medialization are key issues in THA for dysplastic hip osteoarthritis, the accuracy of cup height and medialization in this imageless navigation system were acceptable for clinical application.
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Affiliation(s)
- Fumiaki Inori
- Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
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Kim TH, Lee SH, Yang JH, Oh KJ. Computed tomography assessment of image-free navigation-assisted cup placement in THA in an Asian population. Orthopedics 2012; 35:13-7. [PMID: 23026246 DOI: 10.3928/01477447-20120919-52] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The authors hypothesized that an image-free navigation system would be more accurate than postoperative 3-dimensional (3-D) reconstructed computed tomography (CT) for acetabular cup inclination and anteversion during total hip arthroplasty (THA) in an Asian population. Eighty-one THAs were performed in 72 patients using the OrthoPilot image-free navigation system (B. Braun Aesculap, Tuttlingen, Germany). Cup placement position was measured by postoperative 3-D CT and compared with intraoperative navigation data. The discrepancies between the navigation data and the 3-D CT data were analyzed, as well as the correlation factors that affected the discrepancies. The discrepancies between the navigation data and the 3-D CT data were -1.5° ± 7.1° (P=.04) for anteversion and -1.1° ± 7.6° (P=.02) for inclination. The accuracy and precision of the anteversion discrepancies were 5.6° ± 4.4° and 3.2°, respectively. The accuracy and precision of the inclination discrepancies were 4.5° ± 4.4° and 2.8°, respectively. Five (6%) outliers existed in terms of the safe zones of anteversion and inclination. The main correlated factor among the pelvic geometry was tilt rather than rotation and obliquity of the bony anterior pelvic plane.In an Asian population, the calculated accuracy and precision of acetabular cup inclination and anteversion during THA were more reliable and the outliers were reduced using the OrthoPilot navigation system. However, discrepancies existed between intraoperative navigation data and postoperative 3-D CT data. The pelvic geometry of biometrical factors influenced the discrepancies in the navigation data.
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Affiliation(s)
- Tae-Hoon Kim
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Gwangjin-gu, Seoul, Korea
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Hausselle J, Moreau PE, Wessely L, de Thomasson E, Assi A, Parratte S, Essig J, Skalli W. Intra- and extra-articular planes of reference for use in total hip arthroplasty: a preliminary study. INTERNATIONAL ORTHOPAEDICS 2012; 36:1567-73. [PMID: 22434132 PMCID: PMC3535022 DOI: 10.1007/s00264-012-1516-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 02/13/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Acetabular component malalignment in total hip arthroplasty can lead to potential complications such as dislocation, component impingement and excessive wear. Computer-assisted orthopaedic surgery systems generally use the anterior pelvic plane (APP). Our aim was to investigate the reliability of anatomical landmarks accessible during surgery and to define new potential planes of reference. METHODS Three types of palpations were performed: virtual, on dry bones and on two cadaveric specimens. Four landmarks were selected, the reproducibility of their positioning ranging from 0.9 to 2.3 mm. We then defined five planes and tested them during palpations on two cadaveric specimens. RESULTS Two planes produced a mean orientation error of 5.0° [standard deviation (SD 3.3°)] and 5.6° (SD 2.7°). CONCLUSIONS Even if further studies are needed to test the reliability of such planes on a larger scale in vivo during surgery, these results demonstrated the feasibility of defining a new plane of reference as an alternative to the APP.
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Affiliation(s)
- Jerome Hausselle
- />LBM, Arts et Metiers ParisTech, 151 bd de l’Hôpital, 75013 Paris, France
| | - Pierre Etienne Moreau
- />Polyclinique Saint Roch, 43 rue du Faubourg Saint Jaumes, 34000 Montpellier, France
| | - Loic Wessely
- />Polyclinique Keraudren, rue Ernestine de Tremaudan, 29200 Brest, France
| | | | - Ayman Assi
- />LBM, Arts et Metiers ParisTech, 151 bd de l’Hôpital, 75013 Paris, France
| | - Sebastien Parratte
- />Institut du Mouvement et de l’Appareil Locomoteur, 270 bd Sainte marguerite, 13009 Marseille, France
| | - Jerome Essig
- />Clinique Médipôle Garonne, 45 rue de Gironis, 31100 Toulouse, France
| | - Wafa Skalli
- />LBM, Arts et Metiers ParisTech, 151 bd de l’Hôpital, 75013 Paris, France
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Hohmann E, Bryant A, Tetsworth K. Anterior pelvic soft tissue thickness influences acetabular cup positioning with imageless navigation. J Arthroplasty 2012; 27:945-52. [PMID: 22036932 DOI: 10.1016/j.arth.2011.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 09/16/2011] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to investigate acetabular component position after total hip arthroplasty correlating both version and inclination to anterior pelvic soft tissue thickness. Thirty patients with a mean age of 66.5 ± 14 (28-87) years and an average body mass index of 30.04 ± 4.6 were included. The same surgeon operated on all 30 patients, using an anterolateral approach in a supine position and an imageless navigation system. Postoperative assessment of cup inclination, cup anteversion, and soft tissue thickness was measured by an independent research associate using computed tomographic scans. Pearson's moment correlations did not reveal any significant relationships between body mass index, soft tissue thickness, final intraoperative, or postoperative cup position. Anterior soft tissue thickness had no significant effect on the accuracy of acetabular cup positioning.
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Affiliation(s)
- Erik Hohmann
- Musculoskeletal Research Unit, CQ University, Rockhampton QLD 4700, Australia
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Clarke SG, Phillips ATM, Bull AMJ, Cobb JP. A hierarchy of computationally derived surgical and patient influences on metal on metal press-fit acetabular cup failure. J Biomech 2012; 45:1698-704. [PMID: 22513086 DOI: 10.1016/j.jbiomech.2012.03.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 02/20/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
The impact of anatomical variation and surgical error on excessive wear and loosening of the acetabular component of large diameter metal-on-metal hip arthroplasties was measured using a multi-factorial analysis through 112 different simulations. Each surgical scenario was subject to eight different daily loading activities using finite element analysis. Excessive wear appears to be predominantly dependent on cup orientation, with inclination error having a higher influence than version error, according to the study findings. Acetabular cup loosening, as inferred from initial implant stability, appears to depend predominantly on factors concerning the area of cup-bone contact, specifically the level of cup seating achieved and the individual patient's anatomy. The extent of press fit obtained at time of surgery did not appear to influence either mechanism of failure in this study.
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Affiliation(s)
- S G Clarke
- Structural Biomechanics, Department of Civil and Environmental Engineering, Imperial College London, Skempton Building, South Kensington Campus, London SW7 2AZ, UK.
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Hohmann E, Bryant A, Tetsworth K. Accuracy of acetabular cup positioning using imageless navigation. J Orthop Surg Res 2011; 6:40. [PMID: 21831275 PMCID: PMC3162566 DOI: 10.1186/1749-799x-6-40] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Accepted: 08/10/2011] [Indexed: 11/25/2022] Open
Abstract
Background Correct placement of the acetabular cup is a crucial step in total hip replacement to achieve a satisfactory result and remains a challenge with free-hand techniques. Imageless navigation may provide a viable alternative to free-hand technique and improve placement significantly. The purpose of this project was to assess and validate intra-operative placement values for both inclination and anteversion as displayed by an imageless navigation system to post-operative measurement of cup position using high resolution CT scans. Methods Thirty-two subjects who underwent primary hip joint arthroplasty using imageless navigation were included. The average age was 66.5 years (range 32-87). 23 non-cemented and 9 cemented acetabular cups were implanted. The desired position for the cup was 45 degrees of inversion and 15 degrees of anteversion. A pelvic CT scan using a multi-slice CT was used to assess the position of the cup radiographically. Results Two subjects were excluded because of dislodgement of the tracking pin. Pearson correlation revealed a strong and significant correlation (r = 0.68; p < 0.006) for cup inclination and a moderate non-significant correlation (r = 0.53; p = 0.45) between intra-operative readings and cup placement for anteversion. Conclusions These findings can be explained with the possible introduction of systematic error. Even though the acquisition of anatomic landmarks is simple, they must be acquired with great precision. An error of 1 cm can result in a mean anteversion error of 6 degrees and inclination error of 2.5 degrees. Whilst computer assisted surgery results in highly accurate cup placements for inclination, anteversion of the cup cannot be determined accurately.
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Affiliation(s)
- Erik Hohmann
- Musculoskeletal Research Unit, CQ University, Yaamba Road, Rockhampton 4700, Australia.
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Abstract
BACKGROUND Various clinical and biomechanical studies suggest certain acetabular positions may be associated with higher wear and failure rates in modern metal-on-metal hip resurfacing arthroplasties. However, there are no widely available, reliable, and cost-effective surgical techniques that ensure surgeons are able to place an acetabular component within the safe range of inclination angles after hip resurfacing surgeries. QUESTIONS/PURPOSES We investigated the accuracy of intraoperative radiographs to determine the acetabular inclination angle in resurfacing arthroplasty procedures. PATIENTS AND METHODS The study group included the first 100 resurfacing arthroplasties performed after we started routinely checking the intraoperative acetabular inclination angles. The acetabular component was repositioned if the intraoperative acetabular inclination angle was out of the target range of 30° to 50°. The control group included the previous 100 resurfacing arthroplasties performed without the benefit of intraoperative radiographs. A posterior minimally invasive surgical approach was used in both groups. Demographics and diagnoses were similar in both groups. RESULTS The average (± SD) difference between the intraoperative and 6-week radiographs was 2.7° ± 2.5°. The acetabular inclination angles at 6-week followup were within the targeted range more frequently in the study group than in the control group (outliers: 4% versus 29%). CONCLUSIONS These data suggest a single intraoperative radiograph is a quick, reliable, and cost-effective method for ensuring the acetabular inclination angle is within the targeted range.
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Kumar MA, Shetty MS, Kiran KG, Kini AR. Validation of navigation assisted cup placement in total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2011; 36:17-22. [PMID: 21537975 DOI: 10.1007/s00264-011-1268-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 04/10/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE Computer navigation has the potential to provide precise intraoperative knowledge to the surgeon. Previous studies with navigation have confirmed its function for improved component position but few studies have reported the accuracy and precision of navigation system in clinical use. With this study we propose to evaluate the efficacy of navigation in guiding cup placement. METHODS Fifty-six patients undergoing primary total hip arthroplasty were prospectively included in this study. Stryker imageless navigation system which is accurate to 0.5° was used in all cases. Intraoperative data was collected for the acetabular component position using navigation for the freehand cup placement and the final cup placement done using navigation. Postoperative evaluation of component position was done with computed tomography (CT) and the deviation from intraoperative freehand and navigation values were calculated. RESULTS The mean inclination of the freehand reading was 39.5° (range, 20°-58°), mean version of freehand reading was 10.7° (-6°- 27°), and the mean navigation reading was 43.2° (37°-49°) for inclination and 13.0° (-8° - 24°) for version. On postoperative CT scan analysis the mean inclination was 45.3° (34°-56°) and mean version was 15.1° (4°-25°). The deviation of the freehand inclination from the post operative CT scan reading was 11.4° (1°-30°) and the version deviated by a mean of 10.8° (2°-26°). The deviation of the navigation reading from the CT scan reading had a mean of 5.3° (1°-13°) for inclination and 5.6° (1°-17°) for version. CONCLUSION The accuracy of the navigation system over conventional freehand cup placement is validated by this study.
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Affiliation(s)
- M Ajith Kumar
- Department of Orthopaedics and Traumatology, Tejasvini Hospital and SSIOT, Kadri, Mangalore 575 002, India
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Fukui T, Fukunishi S, Nishio S, Shibanuma N, Yoshiya S. Use of image-free navigation in determination of acetabular cup orientation: analysis of factors affecting precision. Orthopedics 2010; 33:38-42. [PMID: 20954628 DOI: 10.3928/01477447-20100510-61] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We have been using an image-free total hip arthroplasty (THA) navigation system (OrthoPilot; Aesculap, Tuttlingen, Germany) to ensure accurate and reproducible acetabular cup orientation. In this study, the accuracy of this system in the assessment of acetabular cup orientation was evaluated by comparing the intraoperative inclination and anteversion angles presented by the navigation system and the corresponding postoperative values obtained by computed tomography measurement. In the intraoperative accuracy analysis, we additionally examined the influence of factors such as body mass index and soft tissue thickness on assessment error. Intraoperative and postoperative results obtained from 115 consecutive navigated THAs were compared and analyzed. In both inclination and anteversion angles, good agreement was observed; a discrepancy of more than 5° was observed in 1 and 3 cases, respectively. In the analysis of factors potentially affecting the accuracy of the intraoperative assessment, no correlation between each parameter and the intraoperative and postoperative discrepancy was demonstrated.
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Affiliation(s)
- Tomokazu Fukui
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho Nishinomiya, Hyogo 663-8501, Japan
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