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Ho L, Ford B, Gaston P, Clement ND. Total hip arthroplasty for fractured neck of femur does not restore preoperative hip-specific function, health-related quality of life, or level of fitness. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04034-1. [PMID: 38926209 DOI: 10.1007/s00590-024-04034-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE The primary aim was to assess whether a total hip arthroplasty (THA) was able to restore health-related quality of life (HRQoL) following an intracapsular hip fracture. The secondary aims were to assess changes in hip-specific function, fitness/frailty, mortality risk, complications and revision risk, and factors independently associated with these. METHODS This retrospective cohort study included all patients aged ≥ 50 years admitted with a hip fracture from the emergency department at a single centre during a 42-month period. Patient demographics, perioperative variables, complications, revision, and mortality were collected. Patient-reported outcome measures (PROMs) were assessed at final follow-up. RESULTS Among 250 identified patients, 189 (75.6%) were women with a mean age of 70.3 (range 50-94 years). Mean follow-up was 2.3 (SD 1.1) years. The implant and patient survival rates at 2 years were both 95.5% (95% confidence intervals (CI) +/- 2.7). Older age (hazard ratio [HR] 1.22, 95% CI 1.12-1.33, p < 0.001) and male sex (HR 3.33, 95% CI 1.15-10.0, p = 0.026) were independently associated with mortality. There were 19 (7.6%) postoperative complications that included 6 (2.4%) periprosthetic fractures, 5 (2.0%) deep infections, and 8 (3.2%) dislocations, of which 13 underwent revision. Increasing time to theatre (HR 1.02, 95% CI 1.01-1.03, p = 0.017) was independently associated with a postoperative complication. Postoperative PROMs were available for 166 (66.4%) patients. There were significant (p < 0.001) deteriorations in EuroQol-5D (Mean difference [MD] 0.192, 95% CI 0.133-0.252), Oxford hip score (MD 2.5, 95% CI 1.5-3.6), and fitness (Rockwood score MD 0.7, 95% CI 0.5-0.8) relative to preoperative levels of function. CONCLUSION THA may be the treatment of choice in a physically active patient with the aim of restoring their HRQoL, hip function, and fitness, but this was not observed. Furthermore, there was a high complication rate which was associated with increasing time to theatre. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Lucas Ho
- Edinburgh Medical School, University of Edinburgh, Chancellor's Building, Little France, Edinburgh, EH16 4SB, UK.
| | - Benjamin Ford
- Edinburgh Medical School, University of Edinburgh, Chancellor's Building, Little France, Edinburgh, EH16 4SB, UK
| | - Paul Gaston
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Little France, Edinburgh, UK
- Department of Orthopaedics and Usher Institute, University of Edinburgh, Little France, Edinburgh, UK
| | - Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Little France, Edinburgh, UK
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朱 家, 孙 家, 刘 金, 马 博, 张 驰, 张 超, 夏 天, 沈 计. [Effectiveness analysis of revision surgery after total hip arthroplasty assisted by artificial intelligence preoperative planning system]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:455-460. [PMID: 38632066 PMCID: PMC11024537 DOI: 10.7507/1002-1892.202312099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/25/2024] [Indexed: 04/19/2024]
Abstract
Objective To explore the short-term effectiveness of hip revision surgery guided by artificial intelligence preoperative planning (AIHIP) system. Methods The clinical data of 22 patients (23 hips) who were admitted between June 2019 and March 2023 and met the selection criteria were retrospectively analyzed. There were 12 males and 10 females with an average age of 69.7 years (range, 44-90 years). There were 19 hips in the first revision, 3 hips in the second revision, and 1 hip in the third revision. The causes of revision included 12 hips with prosthesis loosening, 4 hips with acetabular cup loosening, 3 hips with osteolysis, 2 hips with acetabular dislocation, 1 hip with postoperative infection, and 1 hip with prosthesis wear. There were 6 hips in stage ⅡA, 9 hips in stage ⅡB, 4 hips in stage ⅡC, 3 hips in stage ⅢA, and 1 hip in stage ⅢB according to Paprosky staging of acetabular bone defect. The replacement of prosthesis type, operation time, hospitalization stay, ground active condition, and postoperative infection, fracture, prosthesis loosening, and other adverse events were recorded. The function of the affected limb was evaluated by Harris score before operation, at 1 week and 6 months after operation, and the range of motion of the hip joint was compared before operation and at 6 months after operation. Results The operation time was 85-510 minutes, with an average of 241.8 minutes; the hospitalization stay was 7-35 days, with an average of 15.2 days; the time of disassociation from the walker was 2-108 days, with an average of 42.2 days. All the 22 patients were followed up 8-53 months (mean, 21.7 months). No adverse events such as prosthesis loosening or infection occurred in the rest of the patients, except for postoperative hematoma of the thigh in 1 patient and dislocation of the hip in 1 hip. The matching degree of acetabular cup was completely matched in 22 hips and mismatched in 1 hip (+2), the matching rate was 95.65%. The matching degree of femoral stem was completely matched in 22 hips and generally matched in 1 hip (-1), and the matching rate was 100%. The Harris scores were 55.3±9.8 and 89.6±7.2 at 1 week and 6 months after operation, respectively, which significantly improved when compared with before operation (33.0±8.6, P<0.05), and further improved at 6 months after operation than at 1 week after operation ( P<0.05). The function of hip joint was evaluated by Harris score at 6 months after operation, and 21 hips were good and 2 hips were moderate, which could meet the needs of daily life. The range of motion of hip joint was (111.09±10.11)° at 6 months after operation, which was significantly different from (79.13±18.50)° before operation ( t=-7.269, P<0.001). Conclusion AIHIP system can improve the accuracy of revision surgery, reduce the difficulty of surgery, and achieve good postoperative recovery and satisfactory short-term effectiveness.
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Affiliation(s)
- 家庆 朱
- 南京中医药大学附属医院骨伤科(南京 210029)Department of Orthopaedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China
| | - 家豪 孙
- 南京中医药大学附属医院骨伤科(南京 210029)Department of Orthopaedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China
| | - 金柱 刘
- 南京中医药大学附属医院骨伤科(南京 210029)Department of Orthopaedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China
| | - 博闻 马
- 南京中医药大学附属医院骨伤科(南京 210029)Department of Orthopaedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China
| | - 驰宇 张
- 南京中医药大学附属医院骨伤科(南京 210029)Department of Orthopaedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China
| | - 超 张
- 南京中医药大学附属医院骨伤科(南京 210029)Department of Orthopaedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China
| | - 天卫 夏
- 南京中医药大学附属医院骨伤科(南京 210029)Department of Orthopaedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China
| | - 计荣 沈
- 南京中医药大学附属医院骨伤科(南京 210029)Department of Orthopaedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P. R. China
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Li ZL, Li YW, Qi YM, Zhang YQ. How much of the superolateral femoral neck should be removed in intramedullary nail fixation for intertrochanteric fracture? J Orthop Res 2024; 42:661-670. [PMID: 37804208 DOI: 10.1002/jor.25712] [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: 04/26/2023] [Revised: 09/21/2023] [Accepted: 10/05/2023] [Indexed: 10/09/2023]
Abstract
The objective of this study was to measure how much of the superolateral femoral neck should be removed to reduce the incidence of wedge effect. Simulating surgery: Computed Tomography images of 131 intertrochanteric fracture patients were included, three-dimensionally reconstructed, virtually reduced and implanted with Proximal Femoral Nail Antirotation blade-Ⅱ(PFNA-Ⅱ) nail. The antero-posterior length and media-lateral width of the intersection between superolateral femoral neck and PFNA-Ⅱ nail were measured. Retrospective study: The pre- and postoperative CT of 30 patients were collected. The average varus angle of the neck-shaft angle and the correlation between the angles and the difference in the actual and estimated width of the fragments removed were measured. Models of 108 patient were selected for analysis. The average antero-posterior length and media-lateral width were 14.46 mm (14.00-14.93 mm) and 9.33 mm (8.79-9.87 mm), respectively. The AO/OTA classification was not significantly associated with the outcome, but the gender was. In the retrospective study, the mean value of the varus angles was -4.58° (SE = 6.85°), and the difference of width was strongly positively correlated with the varus angle with a correlation coefficient of 0.698. Results obtained in this study can improve the understanding of this region and help surgeons to make appropriate preoperative planning to reduce the incidence of wedge effect. Retrospective study provided effective proof of the reliability of this study.
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Affiliation(s)
- Zong-Long Li
- Department of Orthopaedics Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yi-Wei Li
- Department of Orthopaedics Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yi-Ming Qi
- Department of Orthopaedic Surgery, School of Medicine, Yangpu Hospital, Tongji University, Shanghai, China
| | - Ying-Qi Zhang
- Department of Orthopaedics Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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Lu H, Xiao Q, Xu H, Yan T, Zhou Z. Robotic arm-assisted total hip arthroplasty for preoperative planning and intraoperative decision-making. J Orthop Surg Res 2023; 18:608. [PMID: 37605281 PMCID: PMC10440908 DOI: 10.1186/s13018-023-04095-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023] Open
Abstract
AIMS This article aimed to explore the efficacy of robotic arm-assisted total hip arthroplasty (THA) in improving preoperative planning and intraoperative decision-making. METHODS In this single-center, prospective, randomized clinical controlled trial, 60 patients were randomly divided into two groups: conventional THA (cTHA) and robotic arm-assisted THA (rTHA). The rTHA underwent procedures using a robot-assisted surgical system, which generated three-dimensional models to determine the most appropriate prosthesis size and position. The standard process of replacement was executed in cTHA planned preoperatively via X-ray by experienced surgeons. Differences between predicted and actual prosthetic size, prosthetic position, and leg length were evaluated. RESULTS Sixty patients were included in the study, but one patient was not allocated due to anemia. No significant preoperative baseline data difference was found between the two groups. The actual versus predicted implantation size of both groups revealed that 27/30 (90.0%) in the rTHA group and 25/29 (86.2%) in the cTHA group experienced complete coincidence. The coincidence rate for the femoral stem was higher in the rTHA group (83.3%) than that in the cTHA group (62.7%). Between the actual and predicted rTHA, the difference in anteversion/inclination degree (< 6°) was largely dispersed, while cTHA was more evenly distributed in degree (< 9°). The differences in leg length between the surgical side and contralateral side showed a significant deviation when comparing the two groups (P = 0.003), with 0.281 (- 4.17 to 3.32) mm in rTHA and 3.79 (1.45-6.42) mm in cTHA. CONCLUSION Robotic arm-assisted total hip arthroplasty can be valuable for preoperative planning and intraoperative decision-making.
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Affiliation(s)
- Hanpeng Lu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041, Si Chuan, People's Republic of China
| | - Qiang Xiao
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041, Si Chuan, People's Republic of China
| | - Hong Xu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041, Si Chuan, People's Republic of China
| | - Tingfang Yan
- Yuanhua Intelligent Technology Co., Ltd, Shenzhen, People's Republic of China
| | - Zongke Zhou
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Road, Wuhou District, Chengdu, 610041, Si Chuan, People's Republic of China.
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Accuracy of a Three-Dimensional (3D)-Printed Patient-Specific (PS) Femoral Osteotomy Guide: A Computed Tomography (CT) Study. Bioengineering (Basel) 2022; 9:bioengineering9110667. [PMID: 36354578 PMCID: PMC9687720 DOI: 10.3390/bioengineering9110667] [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: 09/21/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
Femoral neck osteotomy creates a critical anatomical landmark for surgeons performing primary Total Hip Arthroplasty (THA); it affects the final height and position of the femoral component. Patient Specific Instrumentation (PSI) has been developed to guide the osteotomy. We aimed to assess the accuracy of a patient-specific (PS) femoral osteotomy guide in primary THA using three-dimensional (3D) computed tomography (CT) analysis. We included pre- and post-operative CT data of 103 THAs. All patients underwent 3D planning to define the optimal femoral neck osteotomy level. Our primary objective was to quantify the discrepancy between the achieved and planned osteotomy level; our secondary objective was to evaluate the clinical outcome. The median (Interquartile Range—IQR) discrepancy between the achieved and planned osteotomy level was 0.3 mm (−1 mm to 2 mm). We found a strong positive correlation between the planned and achieved osteotomy level (R2 = 0.9, p < 0.001). A satisfactory clinical outcome was recorded. Our findings suggest that surgeons can use 3D-printed PS guides to achieve a femoral neck osteotomy with a high level of accuracy to the plan.
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Zhang JS, Zheng YQ, Liu XF, Xu YQ, Fang YZ, Lin ZY, Lin L, Xu YJ. A novel method of manual positioning based on anatomical mark (shoulder-to-shoulder) to prevent postoperative leg-length discrepancy for femoral neck fractures in hip arthroplasty. Front Surg 2022; 9:1030657. [PMID: 36386505 PMCID: PMC9663648 DOI: 10.3389/fsurg.2022.1030657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/10/2022] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To determine whether the two lower extremities are of equal length after hip arthroplasty for femoral neck fractures, we developed a novel method of manual positioning based on anatomical mark (shoulder-to-shoulder) in hip arthroplasty. METHODS Patients with femoral neck fractures requiring hip arthroplasty from July 2020 to March 2022 in the orthopedic department of Jinjiang Municipal Hospital, Fujian Province, China were recruited. Hip arthroplasty was performed using the proposed "shoulder-to-shoulder" method of manual positioning based on anatomical mark in 52 patients with femoral neck fractures who met the inclusion criteria. "Shoulder-to-shoulder" was achieved by alignment of the marked femoral "shoulder" and the "shoulder" of prosthesis stem. There were 16 male and 36 female patients, with 27 undergoing total hip arthroplasty (THA) and 25 undergoing hip hemiarthroplasty (HA). The fractures were categorized according to the Garden classification: type II, type III, and type IV in 5, 11, and 36 patients, respectively. The vertical distance from the apex of the medial margin of the femoral trochanter to the tear drop line on both sides which was regarded as the length of both limbs were compared via postoperative imaging, and the apex-shoulder distance on the ipsilateral side measured via postoperative imaging was compared with those measured intraoperatively. RESULTS All patients completed the surgery successfully. The measurement results for the lower extremities after THA were as follows: contralateral group, 43.87 ± 5.59 mm; ipsilateral group, 44.64 ± 5.43 mm. The measurement results for the lower extremities after HA were as follows: contralateral group, 45.18 ± 7.82 mm; ipsilateral group, 45.16 ± 6.43 mm. The measurement results for the lower extremities after all arthroplasties were as follows: contralateral group, 44.50 ± 6.72 mm; ipsilateral group, 44.89 ± 5.90 mm. The results for the apex-shoulder distance were as follows: postoperative imaging, 19.44 ± 3.54 mm; intraoperative apex-shoulder distance, 27.28 ± 2.84 mm. Statistical analysis results indicated no statistically significant difference in the postoperative bilateral lower extremity length after hip arthroplasty (P = 0.75), while a statistically significant difference was found between the intraoperative and postoperative imaging measurements of the apex-shoulder distance (P < 0.01). CONCLUSION The novel method of manual positioning based on anatomical mark (shoulder-to-shoulder) for femoral neck fractures in hip arthroplasty is simple and accurate, making it effective for preventing postoperative bilateral leg length discrepancy.
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Affiliation(s)
- Jin-shan Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Jiangsu, China,Department of Orthopedics, Jinjiang Municipal Hospital, Fujian, China
| | - Yong-qiang Zheng
- Department of Orthopedics, Jinjiang Municipal Hospital, Fujian, China
| | - Xiao-feng Liu
- Department of Orthopedics, Jinjiang Municipal Hospital, Fujian, China
| | - Yong-quan Xu
- Department of Orthopedics, Jinjiang Municipal Hospital, Fujian, China
| | - Yang-zhen Fang
- Department of Orthopedics, Jinjiang Municipal Hospital, Fujian, China
| | - Zhen-yu Lin
- Department of Orthopedics, Jinjiang Municipal Hospital, Fujian, China
| | - Liang Lin
- Department of Orthopedics, Jinjiang Municipal Hospital, Fujian, China
| | - You-jia Xu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Jiangsu, China,Correspondence: You-jia Xu
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Diamond OJ, Hill JC, McCann AJ, McGrath C, Napier RJ, Beverland DE. Using a ring to locate femoral head centre in total hip arthroplasty. Hip Int 2022; 32:627-633. [PMID: 33829898 DOI: 10.1177/11207000211005442] [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: 02/04/2023]
Abstract
AIMS Traditional methods of determining femoral head centre (FHC) during total hip arthroplasty (THA) rely on measuring the distance from a fixed point on the femur or using a calliper. The aim of this experiment was to investigate how accurately a simple circular ring could locate FHC. METHODS 144 consecutively available femoral heads (FHs) were collected from patients undergoing THA. Each FH was orientated and mounted on a Sawbone, to create a model of its position on a proximal femur. The ring was applied to the posterior aspect of the FH and a head-centre pin (HCP) was then drilled into the FH and the ring removed, leaving the HCP in place.Each FH was then photographed normal to the axis of the HCP. A MATLAB analysis program then assessed the accuracy of the ring in locating FHC. RESULTS Mean location accuracy for FHC was 1.77 (range 0.07-5.83) mm with 97.2% within 4 mm and all but 1 within 5 mm. CONCLUSIONS This ring device located FHC to within 4 mm in 97% of a series of osteoarthritic FHs. This indicates that the posterior aspect of the FH maintains its sphericity late into the osteoarthritic process. Having a simple FHC location device during THA would be of value to control leg length and offset when using the posterior approach.
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Affiliation(s)
- Owen J Diamond
- Primary Joint Unit, Musgrave Park Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Janet C Hill
- Primary Joint Unit, Musgrave Park Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Aaron J McCann
- Regional Medical Physics Service, Belfast Health and Social Care Trust, Belfast, UK
| | - Cormac McGrath
- Regional Medical Physics Service, Belfast Health and Social Care Trust, Belfast, UK
| | - Richard J Napier
- Primary Joint Unit, Musgrave Park Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - David E Beverland
- Primary Joint Unit, Musgrave Park Hospital, Belfast Health and Social Care Trust, Belfast, UK
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Jiang Z, Cheng R, Kernkamp WA, Xia C, Liang J, Wang L, Tsai TY. The midcortical-line is more reliable than the T-line in predicting stem anteversion in patients with developmental hip dysplasia after total hip arthroplasty. Front Surg 2022; 9:966617. [PMID: 36117825 PMCID: PMC9474688 DOI: 10.3389/fsurg.2022.966617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background Precise preoperative planning improves postoperative outcomes in total hip arthroplasty (THA), especially in developmental dysplasia of the hip (DDH) cases. Previous studies used the T-line and midcortical-line as preoperative landmarks to predict postoperative stem anteversion (PSA). However, the most reliable landmark in predicting PSA in DDH patients remains unclear. To find the most reliable measurement to predict the PSA in DDH patients, this study compared the midcortical-line and T-line at different femoral neck levels. Methods Pre- and postoperative Computed Tomography (CT) scans of 28 hips in 21 DDH patients who received THA were obtained for three-dimensional femoral models. The preoperative CT scan was used to measure the anteversion of the midcortical-line on the axial cross-sectional plane images (AM-CT), the anteversion of the midcortical-line from 3D models (AM-3D), and the T-line from 3D models (AT-3D) at simulated osteotomy planes at 5 and 10 mm heights proximal to the base of the lesser trochanter. The correlation between the preoperative femoral anteversion (AM-CT, AM-3D, AT-3D) and the PSA was assessed to evaluate the prediction accuracy. Results The correlations between the AM-CT and the PSA were 0.86 (mean difference (MD) = 1.9°) and 0.92 (MD = −3.0°) at 5 and 10 mm heights, respectively. The correlation between the AM-3D and the PSA were 0.71 (MD = −11.6°) and 0.61 (MD = −12.9°) at 5 and 10 mm heights. The AT-3D was significantly greater (MD = 15.4°) than the PSA (p-value <0.01) at 5 mm cutting height, and the correlation between the AT-3D and the PSA was 0.57 (MD = 7.8°) at 10 mm cutting height. Conclusions The AM-CT at the 10 mm height had the strongest correlation with the PSA and was more reliable in predicting the PSA when compared with the AM-3D and the AT-3D in DDH patients.
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Affiliation(s)
- Ziang Jiang
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Jiao Tong University School of Medicine, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
| | - Rongshan Cheng
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Jiao Tong University School of Medicine, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
| | | | - Chunjie Xia
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Junjie Liang
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Guangxi Clinical Research Center for Digital Medicine and 3D Printing, Guigang City People's Hospital, Guigang, China
| | - Liao Wang
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Jiao Tong University School of Medicine, Shanghai, China
- Correspondence: Liao Wang Tsung-Yuan Tsai
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Jiao Tong University School of Medicine, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Correspondence: Liao Wang Tsung-Yuan Tsai
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Klemt C, Drago J, Oganesyan R, Smith EJ, Yeo I, Kwon YM. Gait and Knee Flexion In Vivo Kinematics of Asymmetric Tibial Polyethylene Geometry Cruciate Retaining Total Knee Arthroplasty. J Knee Surg 2022; 35:828-837. [PMID: 33111271 DOI: 10.1055/s-0040-1718681] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The preservation of the posterior cruciate ligament in cruciate retaining (CR) total knee arthroplasty (TKA) designs has the potential to restore healthy knee biomechanics; however, concerns related to kinematic asymmetries during functional activities still exist in unilateral TKA patients. As there is a limited data available regarding the ability of the contemporary CR TKA design with concave medial and convex lateral tibial polyethylene bearing components to restore healthy knee biomechanics, this study aimed to investigate in vivo three-dimensional knee kinematics in CR TKA patients during strenuous knee flexion activities and gait. Using a combined computer tomography and dual fluoroscopic imaging system approach, in vivo kinematics of 15 unilateral CR TKA patients (comparison of replaced and contralateral nonreplaced knee) were evaluated during sit-to-stand, step-ups, single-leg deep lunge, and level walking. The patient cohort was followed-up at an average of 24.5 months ( ± 12.6, range 13-42) from surgical procedure. Significantly smaller internal knee rotation angles were observed for the contemporary CR TKA design during step-ups (2.6 ± 5.8 vs. 6.3 ± 6.6 degrees, p < 0.05) and gait (0.6 ± 4.6 vs. 6.3 ± 6.8 degrees, p < 0.05). Significantly larger proximal and anterior femoral translations were measured during sit-to-stand (34.7 ± 4.5 vs. 29.9 ± 3.1 mm, p < 0.05; -2.5 ± 2.9 vs. -8.1 ± 4.4 mm, p < 0.05) and step-ups (34.1 ± 4.5 vs. 30.8 ± 2.9 mm, p < 0.05; 2.2 ± 3.2 vs. -3.5 ± 4.5 mm, p < 0.05). Significantly smaller ranges of varus/valgus and internal/external rotation range of motion were observed for CR TKA, when compared with the nonoperated nee, during strenuous activities and gait. The preservation of the posterior cruciate ligament in the contemporary asymmetric bearing geometry CR TKA design with concave medial and convex lateral tibial polyethylene bearing components has the potential to restore healthy knee biomechanics; however, the study findings demonstrate that native knee kinematics were not fully restored in patients with unilateral asymmetric tibial polyethylene bearing geometry CR TKA during functional activities.
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Affiliation(s)
- Christian Klemt
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John Drago
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruben Oganesyan
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Evan J Smith
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ingwon Yeo
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Murai A, Kurosawa A, Tada K, Tachiya H, Tamai A, Akahane M, Matsuta M, Nakamura Y, Kawashima H, Tsuchiya H. Optimal Center of Rotation for Ball-And-Socket Thumb Carpometacarpal Arthroplasty Identified Using Three-Dimensional Kinematic Analysis: A Pilot Study. Front Bioeng Biotechnol 2022; 10:868150. [PMID: 35721848 PMCID: PMC9200493 DOI: 10.3389/fbioe.2022.868150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/13/2022] [Indexed: 11/18/2022] Open
Abstract
Total joint arthroplasty is one of the surgical option for thumb carpometacarpal (CMC) joint arthritis, however the optimal position the center of rotation (COR) has not been quantified. The purpose of this study is to identify ideal ball-and-socket thumb carpometacarpal joint implants and the optimal position of the COR. We obtained eight right thumb computed tomography images each from ten healthy men, comprising four images each of thumbs at various angles of flexion-extension and abduction-adduction. We reconstructed 3D bone models on 3D CAD, created virtual ball-and-socket implants with three variables (neck offset, implant height, neck rotation), and found the optimal COR where the position change in the COR was smallest across various thumb positions. When the offset was 4.5 mm, neck rotation angle was 130.6° from the radial side to the palmar side of the first metacarpal, and implant height from the distal end of the metacarpal was 43.6 mm, we could restore almost normal kinematics. This study could serve as a reference for implant development and surgical technique guidelines.
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Affiliation(s)
- Atsuro Murai
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Akihiro Kurosawa
- Institute of Science and Engineering, Faculty of Mechanical Engineering, Kanazawa University, Kanazawa, Japan
| | - Kaoru Tada
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
- *Correspondence: Kaoru Tada,
| | - Hiroshi Tachiya
- Institute of Science and Engineering, Faculty of Mechanical Engineering, Kanazawa University, Kanazawa, Japan
| | - Atsuya Tamai
- Institute of Science and Engineering, Faculty of Mechanical Engineering, Kanazawa University, Kanazawa, Japan
| | - Mika Akahane
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Masashi Matsuta
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Yuta Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Hiroki Kawashima
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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11
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Veldman HD, Boymans TAEJ, van Steenbergen LN, Heyligers IC. Age-Associated Changes in Proximal Femur Morphology Affect Femoral Component Sizing in Cementless Hip Arthroplasty. Geriatr Orthop Surg Rehabil 2022; 13:21514593221144615. [DOI: 10.1177/21514593221144615] [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: 07/13/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Background In cementless hip arthroplasty, the femoral component should obtain firm fixation within the endosteal bone and achieve adequate reconstruction of hip joint biomechanics simultaneously. Previous anatomical studies described age-related changes of the proximal femoral canal, such as canal widening, which theoretically necessitates the use of larger stem sizes in elderly patients. This study examines a potential association between patients’ age at surgery and the implant size of a cementless femoral component. Material and methods A total of 13,423 primary hip arthroplasties with a single cementless stem registered in the Dutch Arthroplasty Register (LROI) were included. Patient characteristics (ie patients’ age, sex, height and weight at time of surgery) and femoral component size were derived. A one-way ANCOVA was used to compare the mean stem size between age groups, and multivariable linear regression analysis was used in order to investigate to which extent ageing impacted stem size. Results Each subsequent age- group (ten-year intervals) had a significantly larger mean stem size than the prior age- group. Multivariable linear regression analysis revealed that age is positively correlated with stem size and that this correlation is more prominent in females than in males (beta = .046, P < .001 and beta = .028, P < .001 respectively). Interpretation Implant size is positively correlated with age, in particular in females and independently from investigated anthropometric characteristics. The present study endorses that the femoral canal morphology is related to patients’ characteristics such as age and sex. The morphology will subsequently influence implant sizing and therefore may have biomechanical and clinical implications.
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Affiliation(s)
- Hidde D. Veldman
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center Heerlen, Netherlands
| | | | | | - Ide C. Heyligers
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center Heerlen, Netherlands
- School of Health Professions Education, Maastricht University, Netherlands
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Xia T, Liu X, Liu J, Zhang C, Zhang Z, Fan Y, Zhang C, Zhang Y, Shen J. [Artificial intelligence assisted total hip arthroplasty for patients with Crowe type Ⅳ developmental dysplasia of the hip]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1265-1272. [PMID: 34651479 DOI: 10.7507/1002-1892.202106103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the early effectiveness of artificial intelligence (AI) assisted total hip arthroplasty (THA) system (AIHIP) in the treatment of patients with Crowe type Ⅳ developmental dysplasia of the hip (DDH). Methods The clinical data of 23 patients with Crowe type Ⅳ DDH who met the selection criteria between May 2019 and December 2020 were retrospectively analyzed. There were 3 males and 20 females, the age ranged from 44 to 74 years, with an average of 52.65 years. The absolute value of the lower limbs discrepancy before operation was (15.17±22.17) mm. The preoperative Harris score was 62.4±7.2. The AIHIP system was used for preoperative planning, and the operations were all performed via conventional posterolateral approach. Thirteen patients with difficulty in reduction during operation underwent subtrochanteric shortening osteotomy (SSOT). The operation time, hospital stay, and adverse events were recorded; Harris score was used to evaluate the function of the affected limb at 1 day before operation and 1 week and 6 months after operation; pelvic anteroposterior X-ray film was taken at 1 day after operation to evaluate the position of the prosthesis. The matching degree of prosthesis was evaluated according to the consistency of intraoperative prosthesis model and preoperative planning. Results The matching degree of acetabular cup model after operation was 16 cases of perfect matching, 4 cases of general matching (1 case of +1, 3 cases of -1), and 3 cases of mismatch (all of them were +2), the coincidence rate was 86.96%. The matching degree of femoral stem model was perfect matching in 22 cases and general matching in 1 case of -1, and the coincidence rate was 100%. One patient had a periprosthesis fracture during operation, and was fixed with a wire cable during operation, and walked with the assistance of walking aid at 6 weeks after operation; the rest of the patients walked with the assistance of walking aid at 1 day after operation. The operation time was 185-315 minutes, with an average of 239.43 minutes; the hospital stay was 8-20 days, with an average of 9.96 days; and the time of disengagement from the walking aid was 2-56 days, with an average of 5.09 days. All patients were followed up 6 months. All incisions healed by first intension, and there was no complication such as infection, dislocation, refracture, and lower extremity deep venous thrombosis; X-ray films at 1 day and 6 months after operation showed that the acetabular and femoral prostheses were firmly fixed and within the safe zone; the absolute value of lower limbs discrepancy at 1 day after operation was (11.96±13.48) mm, which was not significantly decreased compared with that before operation ( t=0.582, P=0.564). All osteotomies healed at 6 months after operation. The Harris scores at 1 week and 6 months after operation were 69.5±4.9 and 79.2±5.7 respectively, showing significant differences between pre- and post-operation ( P<0.05). At 6 months after operation, the hip function was evaluated according to Harris score, and 13 cases were good, 9 cases were fair, and 1 case was poor. Conclusion AIHIP system-assisted THA (difficult to reposition patients combined with SSOT) for adult Crowe type Ⅳ DDH has high preoperative planning accuracy, easy intraoperative reduction, early postoperative landing, and satisfactory short-term effectiveness.
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Affiliation(s)
- Tianwei Xia
- Department of Traumatology & Orthopedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P.R.China
| | - Xingyu Liu
- School of Life Sciences, Tsinghua University, Beijing, 100089, P.R.China
| | - Jinzhu Liu
- Department of Traumatology & Orthopedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P.R.China
| | - Changhao Zhang
- Department of Traumatology & Orthopedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P.R.China
| | - Zhiguang Zhang
- Department of Traumatology & Orthopedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P.R.China
| | - Yanxing Fan
- Department of Traumatology & Orthopedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P.R.China
| | - Chao Zhang
- Department of Traumatology & Orthopedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P.R.China
| | - Yiling Zhang
- Longwood Valley Medical Technology Co. Ltd., Beijing, 100176, P.R.China
| | - Jirong Shen
- Department of Traumatology & Orthopedics, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu, 210029, P.R.China
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Tan J, Zou D, Zhang X, Zheng N, Pan Y, Ling Z, Tsai TY, Chen Y. Loss of Knee Flexion and Femoral Rollback of the Medial-Pivot and Posterior-Stabilized Total Knee Arthroplasty During Early-Stance of Walking in Chinese Patients. Front Bioeng Biotechnol 2021; 9:675093. [PMID: 34249882 PMCID: PMC8264512 DOI: 10.3389/fbioe.2021.675093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background The medial-pivot (MP) prosthesis was developed to produce more physiological postoperative knee kinematics and better patient satisfaction than traditional prostheses, but outcomes are inconsistent in different studies of Caucasian patients. This study aimed to investigate the postoperative patient satisfaction and in vivo knee kinematics of the MP and posterior-stabilized (PS) prosthesis during gait activity in Chinese patients. Methods A retrospective analysis of 12 patients was received for this study in each MP group and PS group. Patient-reported satisfaction level and Forgotten Joint Score (FJS) were evaluated with questionnaires. A dual fluoroscopic imaging system was used to investigate in vivo knee kinematics of MP and PS total knee arthroplasty (TKA) during treadmill walking at a speed of 0.4 m/s. Results Comparable promising patient satisfaction and overall FJS (MP 60.7 ± 15.35 vs. PS 51.3 ± 17.62, p = 0.174) were found between the MP and PS groups. Peak flexion appeared at around 70% of gait cycle with values of 52.4 ± 7.4° for MP and 50.1 ± 3.6° for PS groups (no difference). Both groups maintained a stable position at the stance phase and began to translated anteriorly at toe-off with an amount of 4.5 ± 2.3 mm in the MP and 6.6 ± 2.7 mm in the PS (p = 0.08) group until late swing. The range of this external rotation motion was 5.9 ± 4.8 and 6.2 ± 4.1° (p = 0.79) for the MP and PS, respectively. Conclusion A similar knee kinematics pattern characterized by a loss of early-stance knee flexion and femoral rollback during walking was observed in the MP and PS TKAs. Our study confirmed similar effectiveness of MP TKA compared to PS TKA in Chinese patients, while the change of knee kinematics of both implants during slow walking should be noted.
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Affiliation(s)
- Jiaqi Tan
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Diyang Zou
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xianlong Zhang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Nan Zheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuqi Pan
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi Ling
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunsu Chen
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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14
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Zheng N, Hu X, Dimitriou D, Dai K, Guo T, Tsai TY. Well-Placed Acetabular Component Oriented Outside the Safe Zone During Weight-Bearing Daily Activities. Front Bioeng Biotechnol 2021; 9:664907. [PMID: 34178961 PMCID: PMC8222599 DOI: 10.3389/fbioe.2021.664907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: A comprehensive and thorough understanding of functional acetabular component orientation is essential for optimizing the clinical outcome after total hip arthroplasty (THA). This study aimed to quantify the functional acetabular anteversion and inclination of unilateral THA patients during walking and static standing and to determine whether the functional acetabular orientation falls within the Lewinnek safe zone. Methods: Seventeen patients with unilateral THA received a CT scan and dual fluoroscopic imaging during level walking and static standing to evaluate in vivo hip kinematics. The pelvic functional coordinate system of the 3D CT-based computer model was defined by the line of gravity and anterior pelvic plane (APP) to measure functional acetabular anteversion and inclination in different postures. The Lewinnek safe zone was used to determine the acetabular malposition during functional activities. Results: The THA side demonstrated an average of 10.1° (± 9.6°, range -7.5° to 29.9°) larger functional anteversion and 16.0° (± 9.2°, range -7.2° to 29.9°) smaller inclination than native hips during level walking. Functional acetabular anteversion in the THA side during level walking and static standing was significantly larger than anatomical measurements (p < 0.05). Acetabular orientation of most well-placed THA components anatomically in the Lewinnek safe zone fell outside the safe zone during more than half of the gait cycle and static standing. Conclusion: The current study revealed that an anatomically well-placed acetabular cup does not guarantee a well-functional orientation during daily activities. The in vivo mechanical performance and loading conditions of the THA component during other weight-bearing activities should be investigated in further studies.
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Affiliation(s)
- Nan Zheng
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangjun Hu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dimitris Dimitriou
- Department of Orthopaedics Bürgerspital Solothurn, Solothurn, Switzerland
| | - Kerong Dai
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Guo
- Department of Orthopaedics, Guizhou Provincial People's Hospital, Guiyang, China
| | - Tsung-Yuan Tsai
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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15
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Faraj A, Andrews M, Li W. Inter and intra-observer errors for postoperative total hip radiographic assessment using computer aided design. Acta Orthop Belg 2021. [DOI: 10.52628/87.1.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Plain radiographic assessment of primary total hip arthroplasty following surgery remains to be the commonest radiological assessment. The current paper, studies the accuracy and concordance between observers reviewing these radiographs.
A prospective radiographic and medical note review of ten patients who underwent total hip replacement for primary osteoarthritis, with a mean age of 69 years. Early and 6 weeks postoperative x-rays were assessed for hip profile and version profile using computer aided design (CAD) by two observers on two different occasions. The observers were Orthopaedic surgeons who perform arthroplasty of the hip. The results were analyzed statistically.
Dimensions, including Femoral offset, medial offset and ilioischial offset showed a high degree of inter- film and intra-film correlation, with inter-class correlation (ICC) over 0.8. Except of the intra-film correlation of ilioischial offset measured on the post- operative films (p=0.067) by the first rater, all the intra and inter film correlation were significantly over the benchmark of 0.6. In terms of stem alignment, cup inclination and cup version, the intra-film correlation by rater n°2 ranges from 0.574 to 0.975 and were significantly over the benchmark of 0.6, except in the case of cup inclination measured on the 6 th? week follow-up ; meanwhile the intra-film correlation by rater n°1 ranges from 0.581 to 0.819 and none were significantly over the benchmark of 0.6.
The inter-rater reliability and inter-film correlation showed a dichotomy of results among different dimensions of the measurement. Dimensions of femo- ral offset, medial offset and ilioischial offset showed a substantial degree of reliability in terms of inter-rater reliability, inter-film correlation, and intra-rater/film reliability.
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16
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Zuo J, Xu M, Zhao X, Shen X, Gao Z, Xiao J. Effects of the depth of the acetabular component during simulated acetabulum reaming in total hip arthroplasty. Sci Rep 2021; 11:9836. [PMID: 33972628 PMCID: PMC8110577 DOI: 10.1038/s41598-021-89292-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/21/2021] [Indexed: 12/05/2022] Open
Abstract
We aimed to evaluate whether there are differences in the rotation center, cup coverage, and biomechanical effects between conventional and anatomical technique. Computed tomography scans of 26 normal hips were used to simulate implantation of acetabular component. The hip rotation center and acetabular component coverage rate were calculated. Moreover, a finite element model of the hip joint was generated to simulate and evaluate the acetabular cup insertion. Micromotion and the peak stress distribution were used to quantify the biomechanical properties. The medial and superior shifts of the rotation center were 5.2 ± 1.8 mm and 1.6 ± 0.7 mm for the conventional reaming technique and 1.1 ± 1.5 mm and 0.8 ± 0.5 mm for anatomical technique, respectively. The acetabular component coverage rates for conventional reaming technique and anatomical technique were 86.8 ± 4% and 70.0 ± 7%, respectively. The micromotion of the cup with conventional reaming technique was greater than that with anatomical technique. The peak stress concentration was highest in the superior portion with conventional reaming technique, whereas with anatomical technique, there was no stress concentration. Paradoxically although the acetabular component coverage rate is larger with conventional reaming technique, anatomical technique provides less micromotion and stress concentration for initial cup stability. Thus, anatomical technique may be more suitable for acetabulum reaming during primary total hip arthroplasty.
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Affiliation(s)
- Jianlin Zuo
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Avenue, Changchun, Jilin, China
| | - Meng Xu
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Road, Changchun, Jilin, China
| | - Xin Zhao
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Road, Changchun, Jilin, China
| | - Xianyue Shen
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Road, Changchun, Jilin, China
| | - Zhongli Gao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Avenue, Changchun, Jilin, China
| | - Jianlin Xiao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Avenue, Changchun, Jilin, China.
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3D Printed Guides and Preoperative Planning for Uncemented Stem Anteversion Reconstruction during Hip Arthroplasty: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6621882. [PMID: 33681357 PMCID: PMC7910057 DOI: 10.1155/2021/6621882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/16/2021] [Accepted: 01/30/2021] [Indexed: 11/24/2022]
Abstract
Objective To investigate if 3D printed guides and preoperative planning can accurately control femoral stem anteversion. Methods A prospective comparative study was carried out from 2018 to 2020, including 53 patients who underwent hip arthroplasty for femoral neck fracture. The target rotation center of the femoral head is determined by three-dimensional planning. In group A, planning was made by 2D templates. In group B, preoperative 3D planning and 3D printed osteotomy/positioning guides were performed. After the operation, 3D model registration was performed to calculate the accuracy of anteversion restoration. Results We screened 60 patients and randomized a total of 53 to 2 parallel study arms: 30 patients to the group A (traditional operation) and 23 patients to the group B (3D preoperative planning and 3D printed guide). There were no significant differences in demographic or perioperative data between study groups. The restoration accuracy of group A was 5.42° ± 3.65° and of group B was 2.32° ± 1.89°. The number and rate of abnormal cases was 15 (50%) and 2 (8.7%), respectively. Significant statistical differences were found in angle change, restoration accuracy, and number of abnormal cases. Conclusion Three-dimensional preoperative planning and 3D printed guides can improve the accuracy of the restoration of femoral anteversion during hip arthroplasty.
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Peng Y, Arauz P, Kwon YM. Gender-specific difference of in-vivo kinematics in patients with unilateral total hip arthroplasty. Hip Int 2021; 31:34-42. [PMID: 32019390 DOI: 10.1177/1120700020903498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Asymmetric gait patterns are known to persist in patients with unilateral total hip arthroplasty (THA). Little is known about the effect of gender on gait asymmetry. This study aimed to determine whether gait asymmetry differs between genders in unilateral THA patients and can be explained by component positioning. METHODS 23 female and 10 male unilateral THA patients were included. Asymmetric hip kinematics during gait and component positioning were quantified using a combined computed tomography-based modelling and dual fluoroscopic imaging system. Multiple regression was performed to examine the unique and mediated contribution of gender to observed gait asymmetry. RESULTS Female and male patients differed most significantly in frontal plane gait asymmetry (p = 0.001) and bilateral difference of vertical femoral offset (p = 0.048). Compared with the native hip, the implanted hip exhibited significantly increased adduction (p = 0.007) in females but significantly increased abduction (p = 0.001) in males. The stem head of the implanted hip was more superiorly positioned compared to the native femoral head in female but more inferiorly positioned in male. Gender accounted for 41.5% variance of frontal plane gait asymmetry and was partially mediated by the bilateral difference of vertical femoral offset. CONCLUSIONS Female unilateral THA patients exhibited significantly increased adduction in the implanted hip compared to the native hip, which is partially attributable to a more superiorly positioned femoral stem centre of rotation. The understanding of gender-specific differences of kinematic patterns may benefit female patients through targeted preoperative planning and postoperative rehabilitation.
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Affiliation(s)
- Yun Peng
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Paul Arauz
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Klemt C, Limmahakhun S, Bounajem G, Xiong L, Yeo I, Kwon YM. Effect of postural changes on in vivo pelvic tilt and functional component anteversion in total hip arthroplasty patients with lumbar disc degenerations. Bone Joint J 2020; 102-B:1505-1510. [DOI: 10.1302/0301-620x.102b11.bjj-2020-0777.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The complex relationship between acetabular component position and spinopelvic mobility in patients following total hip arthroplasty (THA) renders it difficult to optimize acetabular component positioning. Mobility of the normal lumbar spine during postural changes results in alterations in pelvic tilt (PT) to maintain the sagittal balance in each posture and, as a consequence, markedly changes the functional component anteversion (FCA). This study aimed to investigate the in vivo association of lumbar degenerative disc disease (DDD) with the PT angle and with FCA during postural changes in THA patients. Methods A total of 50 patients with unilateral THA underwent CT imaging for radiological evaluation of presence and severity of lumbar DDD. In all, 18 patients with lumbar DDD were compared to 32 patients without lumbar DDD. In vivo PT and FCA, and the magnitudes of changes (ΔPT; ΔFCA) during supine, standing, swing-phase, and stance-phase positions were measured using a validated dual fluoroscopic imaging system. Results PT, FCA, ΔPT, and ΔFCA were significantly correlated with the severity of lumbar DDD. Patients with severe lumbar DDD showed marked differences in PT with changes in posture; there was an anterior tilt (-16.6° vs -12.3°, p = 0.047) in the supine position, but a posterior tilt in an upright posture (1.0° vs -3.6°, p = 0.005). A significant decrease in ΔFCA during stand-to-swing (8.6° vs 12.8°, p = 0.038) and stand-to-stance (7.3° vs 10.6°,p = 0.042) was observed in the severe lumbar DDD group. Conclusion There were marked differences in the relationship between PT and posture in patients with severe lumbar DDD compared with healthy controls. Clinical decision-making should consider the relationship between PT and FCA in order to reduce the risk of impingement at large ranges of motion in THA patients with lumbar DDD. Cite this article: Bone Joint J 2020;102-B(11):1505–1510.
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Affiliation(s)
- Christian Klemt
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sakkadech Limmahakhun
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Georges Bounajem
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Liang Xiong
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ingwon Yeo
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Klemt C, Limmahakhun S, Bounajem G, Xiong L, Yeo I, Kwon YM. Effect of postural changes on in vivo pelvic tilt and functional component anteversion in total hip arthroplasty patients with lumbar disc degenerations. Bone Joint J 2020:1-7. [PMID: 32955350 DOI: 10.1302/0301-620x.102b9.bjj-2020-0777.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The complex relationship between acetabular component position and spinopelvic mobility in patients following total hip arthroplasty (THA) renders it difficult to optimize acetabular component positioning. Mobility of the normal lumbar spine during postural changes results in alterations in pelvic tilt (PT) to maintain the sagittal balance in each posture and, as a consequence, markedly changes the functional component anteversion (FCA). This study aimed to investigate the in vivo association of lumbar degenerative disc disease (DDD) with the PT angle and with FCA during postural changes in THA patients. METHODS A total of 50 patients with unilateral THA underwent CT imaging for radiological evaluation of presence and severity of lumbar DDD. In all, 18 patients with lumbar DDD were compared to 32 patients without lumbar DDD. In vivo PT and FCA, and the magnitudes of changes (ΔPT; ΔFCA) during supine, standing, swing-phase, and stance-phase positions were measured using a validated dual fluoroscopic imaging system. RESULTS PT, FCA, ΔPT, and ΔFCA were significantly correlated with the severity of lumbar DDD. Patients with severe lumbar DDD showed marked differences in PT with changes in posture; there was an anterior tilt (-16.6° vs -12.3°, p = 0.047) in the supine position, but a posterior tilt in an upright posture (1.0° vs -3.6°, p = 0.005). A significant decrease in ΔFCA during stand-to-swing (8.6° vs 12.8°, p = 0.038) and stand-to-stance (7.3° vs 10.6°,p = 0.042) was observed in the severe lumbar DDD group. CONCLUSION There were marked differences in the relationship between PT and posture in patients with severe lumbar DDD compared with healthy controls. Clinical decision-making should consider the relationship between PT and FCA in order to reduce the risk of impingement at large ranges of motion in THA patients with lumbar DDD.
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Affiliation(s)
- Christian Klemt
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sakkadech Limmahakhun
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Georges Bounajem
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Liang Xiong
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ingwon Yeo
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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21
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Li L, Zhang Y, Lin YY, Li ZX, Chen L, Chen DS, Fan P. A Specific Anteversion of Cup and Combined Anteversion for Total Hip Arthroplasty Using Lateral Approach. Orthop Surg 2020; 12:1663-1673. [PMID: 32924261 PMCID: PMC7767786 DOI: 10.1111/os.12790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/27/2020] [Accepted: 06/30/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine the implant orientation, especially the combined anteversion measurements in total hip arthroplasty (THA) using lateral approach, and to compare with implant orientation using posterior-lateral (P-L) approach. The secondary goal was to identify the factors associated with implant orientation. METHODS Five hundred and one patients (545 hips) who underwent primary THA with the modified Hardinge approach between January 2016 and November 2019 by one senior surgeon in our department in a retrospective study were followed up. A survey to inquire about the history of dislocation of the hip after THA was designed and responses were gathered by telephone, WeChat software, and outpatient follow-up. The mean age of the patients was 61.97 ± 11.72 years, and there were 254 males and 247 females. The average follow-up time was 25.2 ± 13.7 months (range, 3.2-49.7 months). Among the patients who were followed up, 97 patients (104 hips) underwent computed tomography (CT) scans from L4 to the tuberosity of the tibia. The implant orientation, including the anteversion and inclination of the cup, anteversion of the stem, combined anteversion, and pelvic tilt were measured based on CT scans of these patients. The results were compared with the implant orientation reported in previous reports measured by CT. Factors that may be associated with implant orientation were investigated, including the patient's age, sex, body mass index (BMI), and diagnosis; size of the cup; diameter of the femoral head component; and pelvic tilt. Data and statistical analyses were performed using SPSS 20.0. RESULTS No cases of dislocation were found in the 501 patients (545 hips) who underwent primary THA during this period. The mean inclination and anteversion of the cups were 38.83° ± 5.04° (24.5°-53.1°) and 9.26° ± 11.19° (-15°-48°), respectively. The mean anteversion of the stem was 13.83° ± 10.7° (-10.2°-42.3°). The combined anteversion was 23.1° ± 13.4° (-7.4°-54.6°). Compared with the reported combined anteversion and anteversion of the cup, the mean anteversion of the cup and combined anteversion using the lateral approach were much lower than the reported values in the literature using the P-L approach. Pelvic tilt was found to be the only independent factor for cup anteversion. Factors including age, sex, BMI, diagnosis, cup size, and diameter of the femoral head component were not associated with implant orientation. CONCLUSION THA using the lateral approach yields smaller cup anteversion and combined anteversion values than using the P-L approach. Pelvic tilt is the only predictor for cup anteversion.
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Affiliation(s)
- Li Li
- Zhejiang Provincial Key Laboratory of Anesthesiology, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Yu Zhang
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Yuan-Yuan Lin
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Zhen-Xing Li
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Liang Chen
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Dao-Sen Chen
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Pei Fan
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China.,Department of Orthopaedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
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22
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吴 东, 刘 星, 张 逸, 陈 继, 唐 佩, 柴 伟. [Research and application of artificial intelligence based three-dimensional preoperative planning system for total hip arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1077-1084. [PMID: 32929897 PMCID: PMC8171718 DOI: 10.7507/1002-1892.202005007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/20/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop an artificial intelligence based three-dimensional (3D) preoperative planning system (AIHIP) for total hip arthroplasty (THA) and verify its accuracy by preliminary clinical application. METHODS The CT image database consisting of manually segmented CT image series was built up to train the independently developed deep learning neural network. The deep learning neural network and preoperative planning module were assembled within a visual interactive interface-AIHIP. After that, 60 patients (60 hips) with unilateral primary THA between March 2017 and May 2020 were enrolled and divided into two groups. The AIHIP system was applied in the trial group ( n=30) and the traditional acetate templating was applied in the control group ( n=30). There was no significant difference in age, gender, operative side, and Association Research Circulation Osseous (ARCO) grading between the two groups ( P>0.05). The coincidence rate, preoperative and postoperative leg length discrepancy, the difference of bilateral femoral offsets, the difference of bilateral combined offsets of two groups were compared to evaluate the accuracy and efficiency of the AIHIP system. RESULTS The preoperative plan by the AIHIP system was completely realized in 27 patients (90.0%) of the trial group and the acetate templating was completely realized in 17 patients (56.7%) of the control group for the cup, showing significant difference ( P<0.05). The preoperative plan by the AIHIP system was completely realized in 25 patients (83.3%) of the trial group and the acetate templating was completely realized in 16 patients (53.3%) of the control group for the stem, showing significant difference ( P<0.05). There was no significant difference in the difference of bilateral femoral offsets, the difference of bilateral combined offsets, and the leg length discrepancy between the two groups before operation ( P>0.05). The difference of bilateral combined offsets at immediate after operation was significantly less in the trial group than in the control group ( t=-2.070, P=0.044); but there was no significant difference in the difference of bilateral femoral offsets and the leg length discrepancy between the two groups ( P>0.05). CONCLUSION Compared with the traditional 2D preoperative plan, the 3D preoperative plan by the AIHIP system is more accurate and detailed, especially in demonstrating the actual anatomical structures. In this study, the working flow of this artificial intelligent preoperative system was illustrated for the first time and preliminarily applied in THA. However, its potential clinical value needs to be discovered by advanced research.
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Affiliation(s)
- 东 吴
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, P.R.China
- 中国人民解放军总医院京南医疗区(北京 100071)The Medical District South of Beijing, Chinese PLA General Hospital, Beijing, 100071, P.R.China
| | - 星宇 刘
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, P.R.China
- 中国人民解放军总医院京南医疗区(北京 100071)The Medical District South of Beijing, Chinese PLA General Hospital, Beijing, 100071, P.R.China
| | - 逸凌 张
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 继营 陈
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 佩福 唐
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, P.R.China
| | - 伟 柴
- 中国人民解放军总医院第一医学中心骨科(北京 100853)Department of Orthopedics, the First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, P.R.China
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23
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Hu X, Zheng N, Hsu WC, Zhang J, Li H, Chen Y, Dai K, Tsai TY. Adverse effects of total hip arthroplasty on the hip abductor and adductor muscle lengths and moment arms during gait. J Orthop Surg Res 2020; 15:315. [PMID: 32787875 PMCID: PMC7424990 DOI: 10.1186/s13018-020-01832-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/29/2020] [Indexed: 12/27/2022] Open
Abstract
Background Precise evaluation of the hip abductor and adductor muscles function in total hip arthroplasty (THA) patients during gait could help prevent postoperative complications and optimize the rehabilitation training program. The purpose of this study was to elucidate the effects of THA on the hip abductor and adductor muscle lengths and moment arms of in vivo patients during gait. Methods Ten unilateral THA patients received CT scans and dual fluoroscopic imaging for the hip kinematics during gait. The hip abductor and adductor muscle insertions were digitized on the 3D hip model for the determination of their dynamic lines of action and moment arms. Changes in the hip abductor and adductor muscle lengths and moment arms of THA patients between the implanted and non-implanted sides were quantified during gait. Results The adductor longus, adductor brevis, and pectineus of the implanted hips had significantly (P < 0.05) less elongation than that of the non-implanted side during the stance phase. The gluteus medius, gluteus minimus, and piriformis moment arms of the implanted side were significantly shorter. The piriformis muscle moment arm was significantly larger. In the double support phase, the adductor magnus and adductor longus moment arms of the implanted sides were significantly decreased. Conclusions Results suggested that the adverse effects of THA on hip stability. Development of a rehabilitation program considering the effects of THA is essential. Accurate surgical techniques may reduce the impact of THA on the peripheral muscles.
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Affiliation(s)
- Xiangjun Hu
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nan Zheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei-Chun Hsu
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Jingwei Zhang
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiwu Li
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunsu Chen
- Department of Orthopaedic, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Kerong Dai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China. .,Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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24
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Wu K, Zhang X, Chen M, Shang X. Restoration of Proximal Femoral Anatomy during Total Hip Arthroplasty for High Developmental Dysplasia of the Hip: An Original Technique. Orthop Surg 2020; 12:343-350. [PMID: 32077256 PMCID: PMC7031569 DOI: 10.1111/os.12614] [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: 06/21/2019] [Revised: 12/07/2019] [Accepted: 12/20/2019] [Indexed: 11/29/2022] Open
Abstract
Objective To introduce a modified osteotomy method for proximal femur reconstruction (PFR) in total hip arthroplasty (THA) for high developmental dysplasia of the hip (DDH). Method A retrospective study was performed in a series of 24 patients (26 hips) with Crowe III/IV DDH who underwent THA and simultaneous PFR. We used an animated video to illustrate and help understand the procedure for this technique. Patients were reviewed clinically and radiographically with an average follow‐up of 31 months. The Harris hip score (HHS) was recorded preoperatively and at 3 and 12 months postoperatively. Results All patients achieved primary bone union. No revision was needed up to the latest follow‐up. One patient had a dislocation due to self‐fall and received manual reduction under general anesthesia. No patient had intraoperative femoral fractures, sciatic nerve injury, or infection. The mean HHS improved from 33.48 ± 9.06 preoperatively to 84.61 ± 4.78 immediately after surgery and 90.84 ± 4.96 at 12 months. Conclusion Proximal femur reconstruction is a simple and practical technique for femoral remolding during THA in patients with high DDH.
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Affiliation(s)
- Kerong Wu
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xianzuo Zhang
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Min Chen
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xifu Shang
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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25
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Kwon YM, Arauz P, Peng Y, Klemt C. In vivo kinematics of deep lunges and sit-to-stand activities in patients with bicruciate-retaining total knee arthroplasty. Bone Joint J 2020; 102-B:59-65. [PMID: 32475273 DOI: 10.1302/0301-620x.102b6.bjj-2019-1552.r2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS The removal of the cruciate ligaments in total knee arthroplasty (TKA) has been suggested as a potential contributing factor to patient dissatisfaction, due to alteration of the in vivo biomechanics of the knee. Bicruciate retaining (BCR) TKA allows the preservation of the cruciate ligaments, thus offering the potential to reproduce healthy kinematics. The aim of this study was to compare in vivo kinematics between the operated and contralateral knee in patients who have undergone TKA with a contemporary BCR design. METHODS A total of 29 patients who underwent unilateral BCR TKA were evaluated during single-leg deep lunges and sit-to-stand tests using a validated computer tomography and fluoroscopic imaging system. In vivo six-degrees of freedom (6DOF) kinematics were compared between the BCR TKA and the contralateral knee. RESULTS During single-leg deep lunge, BCR TKAs showed significantly less mean posterior femoral translation (13 mm; standard deviation (SD) 4) during terminal flexion, compared with the contralateral knee (16.6 mm, SD 3.7; p = 0.001). Similarly, BCR TKAs showed significantly less mean femoral rollback (11.6 mm (SD 4.5) vs 14.4 mm (SD 4.6); p < 0.043) during sit-to-stand. BCR TKAs showed significantly reduced internal rotation during many parts of the strenuous flexion activities particularly during high-flexion lunge (4° (SD 5.6°) vs 6.5° (SD 6.1°); p = 0.051) and during sit-to-stand (4.5° (SD 6°) vs 6.9° (SD 6.3°); p = 0.048). CONCLUSION The contemporary design of BCR TKA showed asymmetrical flexion-extension and internal-external rotation, suggesting that the kinematics are not entirely reproduced during strenuous activities. Future studies are required to establish the importance of patient factors, component orientation and design, in optimizing kinematics in patients who undergo BCR TKA. Cite this article: Bone Joint J 2020;102-B(6 Supple A):59-65.
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Affiliation(s)
- Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Associate Professor, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul Arauz
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yun Peng
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Klemt
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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26
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Esposito CI, Miller TT, Lipman JD, Carroll KM, Padgett DE, Mayman DJ, Jerabek SA. Biplanar Low-Dose Radiography Is Accurate for Measuring Combined Anteversion After Total Hip Arthroplasty. HSS J 2020; 16:23-29. [PMID: 32015737 PMCID: PMC6974156 DOI: 10.1007/s11420-018-09659-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/30/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acetabular component position alone has not been predictive of stability after total hip arthroplasty (THA). Combined anteversion of the acetabulum and femur has the potential of being more predictive of stability. Unfortunately, femoral component position is difficult to measure on plain radiographs. Computed tomography (CT) is the gold standard for measuring implant position post-operatively, but CT exposes patients to a substantial amount of radiation. QUESTIONS/PURPOSES We sought to determine whether biplanar low-dose radiography can be used to accurately measure both acetabular and femoral implant position after THA. METHODS Twenty patients underwent standing low-dose biplanar spine-to-ankle radiographs and supine CT scans 6 weeks after THA. Measurements of acetabular inclination, acetabular anteversion, and femoral anteversion were performed by two blinded observers and compared. RESULTS The average absolute differences between biplanar radiographs and CT scans were 2° ± 2° for acetabular inclination, 3° ± 2° for acetabular anteversion, and 4° ± 4° for femoral anteversion between EOS measurements and CT measurements. Interobserver agreement was good for acetabular inclination, acetabular anteversion, and femoral anteversion (Cronbach's α = 0.90) using biplanar low-dose imaging. CONCLUSION Biplanar radiography is a reliable low-radiation alternative for measuring acetabular inclination, acetabular anteversion, femoral version, and thus combined anteversion compared to CT. Femoral anteversion had the most variability but is still clinically relevant.
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Affiliation(s)
| | - Theodore T. Miller
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Joseph D. Lipman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Kaitlin M. Carroll
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Douglas E. Padgett
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - David J. Mayman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Seth A. Jerabek
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Carmona M, Tzioupis C, LiArno S, Faizan A, Argenson JN, Ollivier M. Upper Femur Anatomy Depends on Age and Gender: A Three-Dimensional Computed Tomography Comparative Bone Morphometric Analysis of 628 Healthy Patients' Hips. J Arthroplasty 2019; 34:2487-2493. [PMID: 31266693 DOI: 10.1016/j.arth.2019.05.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The knowledge of proximal femur geometry is essential in the understanding and treatment of hip pathologies. Our aim is to evaluate the range of "normal anatomical values of the proximal femur" and their relationship to age, gender, and ethnicity in a cohort of healthy population, using a 3-dimensional computed tomography automated software. METHODS The pelvis and bilateral femora of 628 healthy individuals (394 males/234 females, mean age 61.5 ± 16.5 years, mean body mass index [BMI] 26.9 ± 5.2 kg/m2) including 2 ethnicities (226 Asians and 406 Caucasians) were assessed with a 3-dimensional computed tomography scan-based system using algorithm-calculated landmarks. The demographic parameters recorded were age, gender, BMI, and ethnicity. The femoral neck-shaft angle (NSA), femoral neck version, femoral offset (FO), and femoral canal flare index (fCFI) were calculated for each individual. Analyses were performed using SPSS version 22. P-values <.05 were considered to indicate statistical significance. RESULTS Overall, the mean NSA was 124.7° (standard deviation [SD] 6.2), mean femoral neck version was 14.5° (SD 8.1), mean FO was 42.9 mm (SD 6.8), and mean fCFI was 3.4 (SD 0.5). Gender was associated with all parameters, with the females presenting more valgus and anteverted hips. Multivariate analysis revealed a lower NSA and fCFI and a higher FO for older individuals. Ethnicity and BMI were not associated with any parameters. CONCLUSION Our results showed that there is a direct relationship of age and gender to the variations in the investigated proximal femur anatomical parameters in a large cohort of healthy individuals. Those important gender-based and age-based differences might advocate for more varus and lateralized component to reproduce preoperative anatomy of male and patients older than 50 years.
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Affiliation(s)
- Max Carmona
- Department of Orthopedics and Traumatology, Pontificia Universidad Católica de Chile, Santiago, Chile; Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France; Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Chris Tzioupis
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France; Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | | | | | - Jean-Noel Argenson
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France; Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Matthieu Ollivier
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France; Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
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28
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Tsai TY, Liow MHL, Li G, Arauz P, Peng Y, Klemt C, Kwon YM. Bi-Cruciate Retaining Total Knee Arthroplasty Does Not Restore Native Tibiofemoral Articular Contact Kinematics During Gait. J Orthop Res 2019; 37:1929-1937. [PMID: 31062398 DOI: 10.1002/jor.24333] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 04/12/2019] [Indexed: 02/04/2023]
Abstract
Bi-cruciate retaining (BCR) total knee arthroplasty (TKA) design preserves both anterior and posterior cruciate ligaments with the potential to restore normal posterior femoral rollback and joint kinematics. Abnormal knee kinematics and "paradoxical" anterior femoral translation in conventional TKA designs have been suggested as potential causes of patient dissatisfaction. However, there is a paucity of data on the in vivo kinematics and articular contact behavior of BCR-TKA. This study aimed to investigate in vivo kinematics, articular contact position, and pivot point location of the BCR-TKA during gait. In vivo kinematics of 30 patients with unilateral BCR-TKA during treadmill walking was determined using validated dual fluoroscopic imaging tracking technique. The BCR-TKA exhibited less extension than the normal healthy knee between heel strike and 48% of gait cycle. Although the average external rotation trend observed for BCR TKA was similar to the normal healthy knee, the range of motion was not fully comparable. The lowest point of the medial condyle showed longer anteroposterior translation excursion than the lateral condyle, leading to a lateral-pivoting pattern in 60% of BCR TKA patients during stance phase. BCR-TKA demonstrated no statistical significant differences in anterior-posterior translation as well as varus rotation, when compared to normal healthy knees during the stance phase. However, sagittal plane motion and tibiofemoral articular contact characteristics including pivoting patterns were not fully restored in BCR TKA patients during gait, suggesting that BCR TKA does not restore native tibiofemoral articular contact kinematics. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:1929-1937, 2019.
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Affiliation(s)
- Tsung-Yuan Tsai
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts
| | - Guoan Li
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts
| | - Paul Arauz
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts
| | - Yun Peng
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts
| | - Christian Klemt
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts
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Peng Y, Arauz P, Desai P, Byers A, Klemt C, Kwon Y. In vivo kinematic analysis of patients with robotic‐assisted total hip arthroplasty during gait at 1‐year follow‐up. Int J Med Robot 2019; 15:e2021. [DOI: 10.1002/rcs.2021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/15/2019] [Accepted: 05/22/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Yun Peng
- Department of Orthopaedic Surgery, Massachusetts General HospitalHarvard Medical School Boston MA USA
| | - Paul Arauz
- Department of Orthopaedic Surgery, Massachusetts General HospitalHarvard Medical School Boston MA USA
| | - Pooja Desai
- Department of Orthopaedic Surgery, Massachusetts General HospitalHarvard Medical School Boston MA USA
| | - Ashlyn Byers
- Department of Orthopaedic Surgery, Massachusetts General HospitalHarvard Medical School Boston MA USA
| | - Christian Klemt
- Department of Orthopaedic Surgery, Massachusetts General HospitalHarvard Medical School Boston MA USA
| | - Young‐Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General HospitalHarvard Medical School Boston MA USA
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Limmahakhun S, Box HN, Arauz P, Hennessy DW, Klemt C, Kwon YM. In Vivo analysis of spinopelvic kinematics and peak head-cup contact in total hip arthroplasty patients with lumbar degenerative disc disease. J Orthop Res 2019; 37:674-680. [PMID: 30690800 DOI: 10.1002/jor.24234] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/21/2019] [Indexed: 02/04/2023]
Abstract
Anterior instability after total hip arthroplasty (THA) has been described in patients with thoracolumbar kyphotic deformity. Although compensatory posterior pelvic tilt with subsequent increased functional anteversion has been described as the mechanism, there is a paucity of in vivo data. The purpose of our study was to compare pelvic tilt, anteversion, inclination, and position of head-cup contact points in patients with lumbar degenerative disc disease (DDD) and a matched patient cohort without DDD. A total of 50 THA, 18 hips with lumbar DDD and 32 hips without DDD, underwent CT imaging for 3D hip reconstruction. Component orientations and in vivo hip gait kinematics was quantified using a validated dual fluoroscopic imaging system. Hip kinematics and head-cup contact points were compared. Patients with lumbar DDD demonstrated decreased maximum (5.9° ± 4.2° vs. 9.3° ± 5.4°, p = 0.02) and minimum (2.4° ± 4.1° vs. 6.2° ± 5.6°, p = 0.01) anterior pelvic tilt, and increased maximum cup anteversion (29.3° ± 8.7° vs. 25.1° ± 8.1°, p = 0.05). The peak head-cup contact points were shifted closer to the anterior edge of the polyethylene (7.8 ± 1.7 mm vs. 9.6 ± 2.2 mm, p = 0.02). Patients with lumbar degenerative disc disease demonstrated increased posterior pelvic tilt, functional acetabular anteversion, inclination as well as shifting of the peak head-cup contact pattern significantly closer to an anterior edge, suggesting sagittal spinopelvic deformity may predispose to anterior instability in THA patients during upright activities. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Sakkadech Limmahakhun
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey Suite 3B, Boston 02114, Massachusetts
| | - Hayden N Box
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey Suite 3B, Boston 02114, Massachusetts
| | - Paul Arauz
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey Suite 3B, Boston 02114, Massachusetts
| | - David W Hennessy
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey Suite 3B, Boston 02114, Massachusetts
| | - Christian Klemt
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey Suite 3B, Boston 02114, Massachusetts
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey Suite 3B, Boston 02114, Massachusetts
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Peng Y, Arauz P, An S, Kwon YM. In vivo sliding distance on the metal-on-polyethylene total hip arthroplasty articulation using patient-specific gait analysis. J Orthop Res 2018; 36:3151-3160. [PMID: 30035328 DOI: 10.1002/jor.24113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/13/2018] [Indexed: 02/04/2023]
Abstract
Metal-on-polyethylene (MoP) is the most commonly used bearing surface in primary total hip arthroplasty (THA). Polyethylene wear debris remains a major concern. Studies investigating the wear performance based on patient-specific in vivo kinematics and component orientation remains largely lacking. The primary goal of this study was to identify patterns of the distribution of sliding distance and cross-shear ratio among THA patients. A validated approach combining dual fluoroscopic imaging system and computed-tomography was utilized to quantify in vivo gait kinematics and component orientations in 48 total hips. The distribution of accumulated sliding distance and cross-shear ratio over the polyethylene bearing surface was calculated and analyzed using principal component analysis (PCA). Strong patient-specific variation in sliding distance and cross-shear ratio was observed. PCA detected two principal components (PCs) of the sliding distance that together contribute to 94.8% of the total variation. PCA detected four PCs that together contribute to 86% of the total variation of the cross-shear ratio. Regression analysis identified a positive association between cross-shear magnitude and axial and frontal range of motion (RoM). Increased cup inclination, stem anteversion, and reduced cup anteversion may lead to superiorly distributed high cross-shear region, potentially accelerating wear. Our study investigated, in vivo sliding distance and cross-shear pattern using a comprehensive patient-specific dataset and detected several wear indicators under in vivo conditions. These findings provided useful reference values that may help to assess wear in MoP THA patients. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3151-3160, 2018.
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Affiliation(s)
- Yun Peng
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Paul Arauz
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Shuai An
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
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Arauz P, Peng Y, An S, Kwon YM. In-vivo analysis of sliding distance and cross-shear in Bi-cruciate retaining total knee arthroplasty. J Biomech 2018; 77:8-15. [DOI: 10.1016/j.jbiomech.2018.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/16/2018] [Accepted: 06/09/2018] [Indexed: 11/29/2022]
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Topographic Analysis of 2 Alternative Donor Sites of the Ipsilateral Elbow in the Treatment of Capitellar Osteochondritis Dissecans. Arthroscopy 2018; 34:2087-2093. [PMID: 29789253 DOI: 10.1016/j.arthro.2018.02.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 01/25/2018] [Accepted: 02/13/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To find the best topographic subchondral bone match between the capitellum and 2 proposed alternative donor sites of the ipsilateral elbow for capitellar osteochondral autologous transplantation: the non-articulating part of the radial head and the lateral olecranon tip. METHODS In our retrospective database, 20 patients with an unremarkable computed tomography scan of the elbow despite clinical suspicion were identified for analysis. Included were patients aged 11 to 20 years with intact osseous structures and a computed tomography slice thickness of 1.25 mm or less. Three-dimensional polygon models were created using a standard predefined threshold, after which 4 articular surface lesions on the capitellum were created: central 40°, central 60°, lateral 40°, and lateral 60°. In addition, 3 donor locations on the non-articulating part of the radial head (diameter, 5 mm) and the lateral olecranon tip (diameter, 3.5 mm) were created. For each of 24 donor-recipient combinations, the donor graft surface was virtually placed on the recipient surface to quantify the mean distance between surfaces. RESULTS The group of 20 patients consisted of 16 male and 4 female patients with a mean age of 15.9 years (range, 12-18 years). For a central 40° lesion, the mean distance across all 6 donor-recipient combinations ranged from 0.085 ± 0.023 to 0.118 ± 0.036 mm; for a central 60° lesion, the mean distance ranged from 0.075 ± 0.018 to 0.117 ± 0.062 mm; for a lateral 40° lesion, the mean distance ranged from 0.087 ± 0.030 to 0.182 ± 0.226 mm; and for a lateral 60° lesion, the mean distance ranged from 0.084 ± 0.048 to 0.115 ± 0.045 mm. There were no differences in topographic matching between donor-recipient combinations. CONCLUSIONS The findings of this study show a less than 0.2-mm difference in the topographic subchondral bone match between 4 common lesion locations on the capitellum and 2 alternative donor sites of the ipsilateral elbow for capitellar osteochondral autologous transplantation: the non-articulating part of the radial head and the lateral olecranon tip. CLINICAL RELEVANCE These findings suggest that the non-articulating part of the radial head and the lateral olecranon tip may potentially be used as a donor source when treating capitellar osteochondritis dissecans.
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Knee motion symmetry was not restored in patients with unilateral bi-cruciate retaining total knee arthroplasty-in vivo three-dimensional kinematic analysis. INTERNATIONAL ORTHOPAEDICS 2018; 42:2817-2823. [PMID: 29779140 DOI: 10.1007/s00264-018-3986-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/10/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE Although unilateral total knee arthroplasty (TKA) is successful in restoring function, there are concerns in relation to asymmetric gait patterns. Bi-cruciate retaining (BCR) TKA design preserves both anterior and posterior cruciate ligaments with the potential to restore normal joint kinematics. The purpose of this study was to investigate the in vivo three-dimensional (3D) kinematics of the knee in unilateral BCR TKA patients during gait. METHODS Twenty-nine unilateral BCR TKA patients were evaluated for both knees during treadmill gait using a combined computer tomography and dual fluoroscopic imaging system approach. RESULTS Significantly higher flexion (4 ± 6.7°) and internal rotation (4.3 ± 4.7°) and significantly lower adduction (2.5 ± 4.4°) during the stance phase of gait cycle were observed in the implanted side of unilateral BCR TKA patients. Significant asymmetric lateral/medial (3.2 ± 4.8 mm) and anterior/posterior (3.4 ± 4.1 mm) tibial translations were also measured during treadmill gait in this cohort of patients. CONCLUSION Despite maintaining anteroposterior stability, asymmetric knee motion persisted in in vivo unilateral BCR TKA patients during gait. The results of the current study suggested that the knee motion symmetry during gait was not restored in patients with unilateral BCR TKA.
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Myers CA, Laz PJ, Shelburne KB, Judd DL, Huff DN, Winters JD, Stevens-Lapsley JE, Rullkoetter PJ. The impact of hip implant alignment on muscle and joint loading during dynamic activities. Clin Biomech (Bristol, Avon) 2018; 53:93-100. [PMID: 29482087 PMCID: PMC5890933 DOI: 10.1016/j.clinbiomech.2018.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/09/2018] [Accepted: 02/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Component alignment is an important consideration in total hip arthroplasty. The impact of changes in alignment on muscle forces and joint contact forces during dynamic tasks are not well understood, and have the potential to influence surgical decision making. The objectives of this study were to assess the impact of femoral head/stem and cup component placement on hip muscle and joint contact forces during tasks of daily living and to identify which alignment parameters have the greatest impact on joint loading. METHODS Using a series of strength-calibrated, subject-specific musculoskeletal models of patients performing gait, sit-to-stand and step down tasks, component alignments were perturbed and joint contact and muscle forces evaluated. FINDINGS Based on the range of alignments reported clinically, variation in head/stem anteversion-retroversion had the largest impact of any degree of freedom throughout all three tasks; average contact forces 413.5 (319.1) N during gait, 262.7 (256.4) N during sit to stand, and 572.7 (228.1) N during the step down task. The sensitivity of contact force to anteversion-retroversion of the head/stem was 31.5 N/° for gait, which was similar in magnitude to anterior-posterior position of the cup (34.6 N/m for gait). Additionally, superior-inferior cup alignment resulted in 16.4 (4.9)° of variation in the direction of the hip joint contact force across the three tasks, with the most inferior cup placements moving the force vector towards the cup equator at the point of peak joint contact force. INTERPRETATION A quantitative understanding of the impact and potential tradeoffs when altering component alignment is valuable in supporting surgical decision making.
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Affiliation(s)
- Casey A Myers
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA.
| | - Peter J Laz
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Kevin B Shelburne
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Dana L Judd
- Physical Therapy Program, University of Colorado, Aurora, CO, USA
| | | | - Joshua D Winters
- Physical Therapy Program, University of Colorado, Aurora, CO, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, University of Colorado, Aurora, CO, USA; Geriatric Research Education and Clinical Center, VA Eastern Colorado Healthcare System, Denver, CO, USA
| | - Paul J Rullkoetter
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
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Kernkamp WA, Van de Velde SK, Tsai TY, van Arkel ER, Asnis PD, Nelissen RG, LaPrade RF, Zarins B, Li G. An in Vivo Simulation of Isometry of the Anterolateral Aspect of the Healthy Knee. J Bone Joint Surg Am 2017; 99:1111-1118. [PMID: 28678124 PMCID: PMC5490333 DOI: 10.2106/jbjs.16.01139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND To assess the isometry of theoretical lateral extra-articular reconstruction (LER), we evaluated theoretical grafts attached to various points on the lateral femoral condylar area and to either Gerdy's tubercle or the anatomic attachment site of the anterolateral ligament to the tibia. METHODS In 18 subjects, healthy knees with no history of either injury or surgery involving the lower extremity were studied. The subjects performed a sit-to-stand motion (from approximately 90° of flexion to full extension), and each knee was studied using magnetic resonance and dual fluoroscopic imaging techniques. The 3-dimensional wrapping paths of each theoretical LER graft were measured. Grafts showing the least change in length during the sit-to-stand motion were considered to be the most isometric. RESULTS The most isometric attachment site on the lateral femoral epicondyle to either of the studied tibial attachment sites was posterior-distal to the femoral attachment site of the fibular collateral ligament. The LER graft had a mean change in length of approximately 3%. Moving the femoral attachment site anteriorly resulted in increased length of the graft with increasing flexion; more posterior attachment sites resulted in decreased length with increasing flexion. Moving the attachment site in the proximal-distal direction had a less profound effect. Moving the tibial attachment site from Gerdy's tubercle to the tibial attachment site of the anterolateral ligament affected the overall isometric distribution on the lateral femoral epicondyle. CONCLUSIONS The most isometric attachment site on the femur for an LER would be posterior-distal to the femoral attachment site of the fibular collateral ligament. Different length changes for LER grafts were identified with respect to different femoral attachment sites. Desirable graft fixation locations for treating anterolateral rotatory instability were found posterior-proximal to the femoral fibular collateral ligament attachment. CLINICAL RELEVANCE The present data could be used both in biomechanical studies and in clinical studies as guidelines for planning LER surgical procedures.
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Affiliation(s)
- Willem A. Kernkamp
- Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Samuel K. Van de Velde
- Focus Clinic Orthopedic Surgery, Medical Center Haaglanden and Bronovo-Nebo, The Hague, the Netherlands
| | - Tsung-Yuan Tsai
- Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ewoud R.A. van Arkel
- Focus Clinic Orthopedic Surgery, Medical Center Haaglanden and Bronovo-Nebo, The Hague, the Netherlands
| | - Peter D. Asnis
- Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rob G.H.H. Nelissen
- Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Bertram Zarins
- Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Guoan Li
- Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts,E-mail address for G. Li:
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Meermans G, Doorn JV, Kats JJ. Restoration of the centre of rotation in primary total hip arthroplasty: the influence of acetabular floor depth and reaming technique. Bone Joint J 2017; 98-B:1597-1603. [PMID: 27909120 DOI: 10.1302/0301-620x.98b12.bjj-2016-0345.r1] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/16/2016] [Indexed: 01/14/2023]
Abstract
AIMS One goal of total hip arthroplasty is to restore normal hip anatomy. The aim of this study was to compare displacement of the centre of rotation (COR) using a standard reaming technique with a technique in which the acetabulum was reamed immediately peripherally and referenced off the rim. PATIENTS AND METHODS In the first cohort the acetabulum was reamed to the floor followed by sequentially larger reamers. In the second cohort the acetabulum was only reamed peripherally, starting with a reamer the same size as the native femoral head. Anteroposterior pelvic radiographs were analysed for acetabular floor depth and vertical and horizontal position of the COR. RESULTS Horizontally, the mean medial displacement of the COR was 0.8 mm (standard deviation (sd) 1.4) in the peripheral remaing group and 5.0 mm (sd 3.30) in the standard reaming group (p < 0.001). Vertically, the mean superior displacement of the COR was 0.7 mm (sd 1.3) in the peripheral reaming group and 3.7 mm (sd 2.6) in the standard reaming group (p < 0.001). In the standard reaming group, there was a strong correlation between the pre-operative acetabular floor depth and displacement of the COR (p < 0.001). CONCLUSION Reaming the acetabulum to the floor can lead to significant displacement of the COR medially and superiorly. This displacement is related to the pre-operative acetabular floor depth and cannot always be compensated by using a high offset stem. Cite this article: Bone Joint J 2016;98-B:1597-603.
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Affiliation(s)
- G Meermans
- Bravis Hospital, Boerhaaveplein 1, 4624VT Bergen op Zoom, The Netherlands
| | - J Van Doorn
- Bravis Hospital, Boerhaaveplein 1, 4624VT Bergen op Zoom, The Netherlands
| | - J-J Kats
- Bravis Hospital, Boerhaaveplein 1, 4624VT Bergen op Zoom, The Netherlands
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Ipsilateral varus knee alignment correlates with increased femoral stem anteversion in primary total hip arthroplasty. Hip Int 2017; 26:175-9. [PMID: 26951548 DOI: 10.5301/hipint.5000325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of this study was to evaluate whether the ipsilateral knee alignment secondary to knee osteoarthritis affect positioning of the femoral component anteversion during total hip arthroplasty. METHODS Preoperative and postoperative computed tomography-based 3-D femoral models were reconstructed for 20 total hip arthroplasty patients. Prosthetic femoral stem and native femoral anteversion was measured and compared. RESULTS An average increase by 4.5° ± 8.1° in femoral anteversion was found following total hip arthroplasty (p = 0.02). Strong positive correlation was found between the knee varus angle and the changes in femoral anteversion (R = 0.87, p<0.0001). The knee alignment was an independent factor for predicting the intraoperative positioning of femoral stem anteversion. CONCLUSIONS The ipsilateral knee varus deformity should be considered to optimise the femoral component position during contemporary total hip arthroplasty.
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Analysis of acetabular orientation and femoral anteversion using images of three-dimensional reconstructed bone models. Int J Comput Assist Radiol Surg 2017; 12:855-864. [PMID: 28063078 DOI: 10.1007/s11548-016-1514-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Radiographic measurements using two-dimensional (2D) plain radiographs or planes from computed tomography (CT) scans have several drawbacks, while measurements using images of three-dimensional (3D) reconstructed bone models can provide more consistent anthropometric information. We compared the consistency of results using measurements based on images of 3D reconstructed bone models (3D measurements) with those using planes from CT scans (measurements using 2D slice images). METHODS Ninety-six of 561 patients who had undergone deep vein thrombosis-CT between January 2013 and November 2014 were randomly selected. We evaluated measurements using 2D slice images and 3D measurements. The images used for 3D reconstruction of bone models were obtained and measured using [Formula: see text] and [Formula: see text] (Materialize, Leuven, Belgium). RESULTS The mean acetabular inclination, acetabular anteversion and femoral anteversion values on 2D slice images were 42.01[Formula: see text], 18.64[Formula: see text] and 14.44[Formula: see text], respectively, while those using images of 3D reconstructed bone models were 52.80[Formula: see text], 14.98[Formula: see text] and 17.26[Formula: see text]. Intra-rater reliabilities for acetabular inclination, acetabular anteversion, and femoral anteversion on 2D slice images were 0.55, 0.81, and 0.85, respectively, while those for 3D measurements were 0.98, 0.99, and 0.98. Inter-rater reliabilities for acetabular inclination, acetabular anteversion and femoral anteversion on 2D slice images were 0.48, 0.86, and 0.84, respectively, while those for 3D measurements were 0.97, 0.99, and 0.97. CONCLUSION The differences between the two measurements are explained by the use of different tools. However, more consistent measurements were possible using the images of 3D reconstructed bone models. Therefore, 3D measurement can be a good alternative to measurement using 2D slice images.
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Lakstein D, Bachar I, Debi R, Lubovsky O, Cohen O, Tan Z, Atoun E. Radiographic templating of total hip arthroplasty for femoral neck fractures. INTERNATIONAL ORTHOPAEDICS 2016; 41:831-836. [PMID: 27271723 DOI: 10.1007/s00264-016-3235-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/25/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the use of pre-operative digital templating to minimize complications including limb length discrepancy (LLD), intraoperative fractures and early dislocations in patients with intracapsular femoral neck fractures. METHODS We retrospectively compared 23 patients undergoing total hip arthroplasty (THA) for intracapsular femoral fractures with pre-operative digital templating and 48 patients without templating. RESULTS The mean post-operative LLD was significantly lower in patients who had pre-operative templating than in the control group (6.7 vs. 11.5 mm, p = 0.023). Only three patients (13 %) with templating had LLD greater than 1.5 cm, compared to the 15 patients (31 %) without templating (p = 0.17). In eight cases the final femoral stem size matched the templated size, while 19 patients were within two size increments. Complications included one dislocation and one intra-operative fracture in the control group. CONCLUSION The present study demonstrated that careful pre-operative planning may reduce LLD in patients undergoing THA due to intracapsular hip fractures.
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Affiliation(s)
- Dror Lakstein
- Faculty of Medicine, Tel Aviv University, Wolfson Medical Centre, Holon, Israel
| | - Ira Bachar
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Ronen Debi
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Omri Lubovsky
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Ornit Cohen
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel
| | - Zachary Tan
- Faculty of Medicine, Tel Aviv University, Wolfson Medical Centre, Holon, Israel
| | - Ehud Atoun
- Faculty of Health Sciences, Ben-Gurion University, Barzilai Medical Center Campus, Ashkelon, Israel.
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Accuracy of measuring acetabular cup position after total hip arthroplasty: comparison between a radiographic planning software and three-dimensional computed tomography. INTERNATIONAL ORTHOPAEDICS 2016; 41:731-738. [PMID: 27277948 DOI: 10.1007/s00264-016-3240-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/31/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE Various methods are available for measuring acetabular cup position after total hip arthroplasty (THA) on standard anterior-posterior (AP) radiographs. We compared the accuracy of a commercial radiographic planning software program with that of three-dimensional computed tomography (3D-CT) scans. METHODS We obtained plain AP radiographs and 3D-CTs from 65 patients after THA. In addition to calculating cup anteversion and inclination with 3D-CT, we determined the cup position using the radiographic planning software program mediCAD® 2.5 (Hectec, Niederviehbach, Germany). Furthermore, we compared the measurements using the inter-teardrop and bi-ischial lines as pelvic landmarks. RESULTS The mean difference in anteversion between 3D-CT and mediCAD® software was 0.1° using the inter-teardrop line (standard deviation [SD], 8.8°; range, -21° to 23°; p = 0.97) and 0.4° using the bi-ischial line (SD, 8.8°; range, -23° to 21°; p = 0.72). Inclination showed a mean difference of 0.6° using the inter-teardrop line (SD, 4.4°; range, -9° to 21°; p = 0.24) and 0.5° using bi-ischial line (SD, 4.6°; range, -9° to 22°; p = 0.35). The means for absolute differences were 7.2° for anteversion and 3.1° for inclination. With regard to using the bi-ischial or inter-teardrop line, no significant difference was found between the two pelvic landmarks. The intra-class correlation coefficient (ICC) was analysed for anteversion and inclination using either the inter-teardrop line or the bi-ischial line as radiographic baseline. CONCLUSIONS A radiographic planning software program (mediCAD®) is a helpful tool for measuring cup inclination on AP radiographs. With respect to anteversion, measurements are rather susceptible to mistakes with mean inaccuracies of over 7°. Thus, 3D-CT remains the "gold standard" if a lower tolerance limit (±3°) is required for more complex biomechanical evaluations. As a pelvic landmark, the interteardrop line is preferential to the bi-ischial line because of its lower impact on the position of the pelvis.
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Tsai TY, Dimitriou D, Hosseini A, Liow MHL, Torriani M, Li G, Kwon YM. Assessment of accuracy and precision of 3D reconstruction of unicompartmental knee arthroplasty in upright position using biplanar radiography. Med Eng Phys 2016; 38:633-638. [PMID: 27117422 DOI: 10.1016/j.medengphy.2016.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 02/07/2016] [Accepted: 04/02/2016] [Indexed: 11/30/2022]
Abstract
This study aimed to evaluate the precision and accuracy of 3D reconstruction of UKA component position, contact location and lower limb alignment in standing position using biplanar radiograph. Two human specimens with 4 medial UKAs were implanted with beads for radiostereometric analysis (RSA). The specimens were frozen in standing position and CT-scanned to obtain relative positions between the beads, bones and UKA components. The specimens were then imaged using biplanar radiograph (EOS). The positions of the femur, tibia, UKA components and UKA contact locations were obtained using RSA- and EOS-based techniques. Intraclass correlation coefficient (ICC) was calculated for inter-observer reliability of the EOS technique. The average (standard deviation) of the differences between two techniques in translations and rotations were less than 0.18 (0.29) mm and 0.39° (0.66°) for UKA components. The root-mean-square-errors (RMSE) of contact location along the anterior/posterior and medial/lateral directions were 0.84mm and 0.30mm. The RMSEs of the knee rotations were less than 1.70°. The ICCs for the EOS-based segmental orientations between two raters were larger than 0.98. The results suggest the EOS-based 3D reconstruction technique can precisely determine component position, contact location and lower limb alignment for UKA patients in weight-bearing standing position.
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Affiliation(s)
- Tsung-Yuan Tsai
- Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Dimitris Dimitriou
- Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Ali Hosseini
- Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Ming Han Lincoln Liow
- Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Martin Torriani
- Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Guoan Li
- Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Young-Min Kwon
- Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Bonin N, Jacquot L, Boulard L, Reynaud P, Saffarini M, Lustig S. How to best measure femoral length and lateralisation after total hip arthroplasty on antero-posterior pelvic radiographs. INTERNATIONAL ORTHOPAEDICS 2016; 40:2479-2485. [PMID: 26928723 DOI: 10.1007/s00264-016-3145-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/16/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE Various methods exist for measuring limb length and lateralisation after total hip arthroplasty. Most of them utilise standard anteroposterior (AP) pelvic radiographs, but their results can be affected by patient position during imaging and thus the position of the lower limb on the coronal plane. The aim of this study is to evaluate how commonly used measuring methods of limb lengthening and femoral offset are affected by the position of the lower limb in the coronal plane. METHODS A standing pelvic AP radiograph post implantation of a right total hip prosthesis was digitised. The right femur and its femoral stem were digitally segmented, such that they could be positioned orthogonal to the pelvis horizontal reference, with 10° of adduction, and with 10° of abduction, with respect to the centre of rotation. Various limb lengths and implant lateralisation were also digitised. We obtained nine x-rays differing one to three variables. Twice four independent surgeons performed three femoral length measurement methods and femoral offset measurement methods. Intra and inter-observer error as well as the effect of the femoral position on the measurements were studied. RESULTS With respect to length measurements, the distance between the centre of rotation (C) and the tip of the lesser trochanter (LT) increased by 3 mm per cm of lateralisation. This measurement was not affected by the hip position in abduction or adduction. The distance between the tip of the lesser or greater trochanter (GT) and the horizontal passing through the centre of rotation was strongly affected by the hip position in abduction or adduction. With respect to offset, the distance between the centre of rotation and the greater trochanter (C-GT) was the most consistent and was not affected by variations in lengths or femoral axis. At the level of the lesser trochanter, the distance of the femoral anatomical axis and to Perkin's line was heavily influenced by the femoral position. CONCLUSION The C-LT distance was consistent in measuring limb length and the C-GT distance was reliable in determining femoral offset regardless of the relative position of the femur.
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Affiliation(s)
- Nicolas Bonin
- Lyon-Ortho-Clinic, 29B av. des sources, 69009, Lyon, France.
| | - Laurent Jacquot
- Clinique d'Argonay, 685 route de Menthonnex, 74370, Argonnay, France
| | - Laurent Boulard
- Polyclinique de la ligne Bleue, 9 avenue Rose Poirier, 88000, Epinal, France
| | - Patrick Reynaud
- Clinique E. de Vialar, 116 rue A. Charrial, 69003, Lyon, France
| | - Mo Saffarini
- Accelerate Innovation Management SA, 1 rue de la Navigatino, 1201, Geneva, Switzerland
| | - Sébastien Lustig
- Centre Albert TRILLAT, 103 Grande rue de la Croix Rousse, 69004, Lyon, France
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Dimitriou D, Tsai TY, Yue B, Rubash HE, Kwon YM, Li G. Side-to-side variation in normal femoral morphology: 3D CT analysis of 122 femurs. Orthop Traumatol Surg Res 2016; 102:91-7. [PMID: 26867707 DOI: 10.1016/j.otsr.2015.11.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 11/06/2015] [Accepted: 11/13/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The contralateral femur is often used as reference for reconstruction in unilateral hip joint pathology. The objective of this study was to quantify the side-to-side variation in proximal femur. We hypothesized that significant side-to-side differences exist between left and right femur with implications for preoperative planning and leg length discrepancy following hip arthroplasty. MATERIALS AND METHODS CT-based 3D femoral models were reconstructed for 122 paired femurs in 61 young healthy subjects (46.9±6.8 years) with no history of hip pathology. Side-to-side differences of several femoral morphologic parameters, including femoral head diameter, femoral anteversion, horizontal offset and femoral head center location, were compared and correlated with demographic factors using multiple linear regression. RESULTS Significant side-to-side differences (P<0.01) were found in femoral anteversion (4.3±3.8°; range: 0.2° to 17.3°), horizontal offset (2.5±2.1mm; range: 0.1 to 10.3mm), and femoral head center location (7.1±3.8mm; range: 0.5 to 19.4mm). The difference in femoral anteversion was strongly correlated with the difference in neck diameter (R(2)=0.79), whereas the difference in horizontal femoral offset was highly correlated with the head diameter difference (R(2)=0.72). Femoral head center difference was correlated with the femoral anteversion, horizontal offset and neck-shaft-angle difference (R(2)=0.82). DISCUSSION Relying on the anatomic landmarks of the contralateral femur during hip arthroplasty may not necessarily result in restoration of native anatomy and leg-length. Knowledge of the baseline side-to-side asymmetry could provide a range of error that would be tolerable following hip reconstruction. LEVEL OF EVIDENCE Level IV. TYPE OF STUDY Retrospective observational study.
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Affiliation(s)
- D Dimitriou
- Bioengineering laboratory, department of orthopaedic surgery, Massachusetts general hospital/Harvard medical school of Boston, 55, Fruit Street, GRJ 1215, Boston, Massachusetts MA 02114, USA
| | - T-Y Tsai
- Bioengineering laboratory, department of orthopaedic surgery, Massachusetts general hospital/Harvard medical school of Boston, 55, Fruit Street, GRJ 1215, Boston, Massachusetts MA 02114, USA
| | - B Yue
- Department of orthopedics, Ninth People's hospital, Shanghai Jiaotong university school of medicine, Shanghai, China
| | - H E Rubash
- Bioengineering laboratory, department of orthopaedic surgery, Massachusetts general hospital/Harvard medical school of Boston, 55, Fruit Street, GRJ 1215, Boston, Massachusetts MA 02114, USA
| | - Y-M Kwon
- Bioengineering laboratory, department of orthopaedic surgery, Massachusetts general hospital/Harvard medical school of Boston, 55, Fruit Street, GRJ 1215, Boston, Massachusetts MA 02114, USA
| | - G Li
- Bioengineering laboratory, department of orthopaedic surgery, Massachusetts general hospital/Harvard medical school of Boston, 55, Fruit Street, GRJ 1215, Boston, Massachusetts MA 02114, USA.
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Tsuda K, Haraguchi K, Koyanagi J, Takahashi S, Sugama R, Fujiwara K. A forty millimetre head significantly improves range of motion compared with a twenty eight millimetre head in total hip arthroplasty using a computed tomography-based navigation system. INTERNATIONAL ORTHOPAEDICS 2016; 40:2031-2039. [PMID: 26780716 DOI: 10.1007/s00264-015-3095-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/23/2015] [Indexed: 02/06/2023]
Abstract
PURPOSE Larger-diameter (≥40 mm) femoral heads decrease the incidence of post-operative dislocation in total hip arthroplasty (THA). This study was conducted to discover whether larger-diameter femoral heads result in greater range of motion of the hip with the use of a computed tomography (CT)-based navigation system. METHODS Thirty-nine primary THAs were performed via a posterolateral approach using a CT-based navigation system. The stem was inserted in the femur in line with the original femoral neck anteversion. Considering the range of motion during various daily activities which could occur without impingement, the cup anteversion was decided at 10 ° increments according to the stem anteversion. While the cup inclination was set at 40 ° in order to avoid a high inclination angle to prevent the edge roading between the HXLPE liner and ceramic head. After implantation, trial liners and femoral heads were used with either 28 or 40 mm diameter. Maximal hip flexion, extension, abduction, external rotation in extension at 0° and internal rotation angles in flexion at 90 ° were measured. The differences between the ranges of motion with the 40-mm and 28-mm heads were tested. The results were assessed with paired Student t-tests. RESULTS The ranges of motion in flexion, extension, abduction and internal rotation angles improved significantly with the 40-mm heads compared with the 28-mm heads. The ranges of motion of cases where maximal flexion angle was 90° or less were excluded, improved significantly with the 40 mm heads. CONCLUSIONS We concluded that the larger-diameter 40-mm femoral prosthetic heads result in greater ranges of motion in flexion, extension, abduction and internal rotation.
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Affiliation(s)
- Kosuke Tsuda
- Arthroplasty Center, Osaka General Medical Center, 3-1-56, Bandai-higashi, Sumiyoshi, Osaka, Japan. .,Department of Orthopaedic Surgery, Osaka General Medical Center, 3-1-56, Bandai-higashi, Sumiyoshi, Osaka, Japan.
| | - Keiji Haraguchi
- Arthroplasty Center, Osaka General Medical Center, 3-1-56, Bandai-higashi, Sumiyoshi, Osaka, Japan.,Department of Orthopaedic Surgery, Osaka General Medical Center, 3-1-56, Bandai-higashi, Sumiyoshi, Osaka, Japan
| | - Junichiro Koyanagi
- Arthroplasty Center, Osaka General Medical Center, 3-1-56, Bandai-higashi, Sumiyoshi, Osaka, Japan.,Department of Orthopaedic Surgery, Osaka General Medical Center, 3-1-56, Bandai-higashi, Sumiyoshi, Osaka, Japan
| | - Shintaro Takahashi
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Kita, Sakai, Osaka, Japan
| | - Ryo Sugama
- Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, 2-10-39, Shibata, Kita, Osaka, Japan
| | - Keiju Fujiwara
- Department of Orthopaedic Surgery, Osaka General Medical Center, 3-1-56, Bandai-higashi, Sumiyoshi, Osaka, Japan
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Tsai TY, Li JS, Dimitriou D, Kwon YM. Does component alignment affect gait symmetry in unilateral total hip arthroplasty patients? Clin Biomech (Bristol, Avon) 2015; 30:802-7. [PMID: 26117163 DOI: 10.1016/j.clinbiomech.2015.06.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/11/2015] [Accepted: 06/11/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Component malposition in total hip arthroplasty patients has been associated with adverse clinical outcomes. However, whether the component alignment influences hip dynamic performance following total hip arthroplasty remains unclear. The purpose of this study was to investigate the relationship between the component alignment and in vivo hip kinematics during gait. METHODS Nineteen unilateral total hip arthroplasty patients received CT scan for creation of 3D hip models. The component alignment between the non-implanted and implanted hips were measured and compared. Three-dimensional hip kinematics for both hips of the total hip arthroplasty patients during gait was quantified using a dual fluoroscopic imaging technique. The differences between the implanted and non-implanted hip kinematics during gait were calculated. A forward stepwise multiple linear regression was performed to evaluate the relationships between the changes in implanted hip kinematics and the differences in component alignment with respect to the non-implanted hips. FINDINGS An average 5.1° (SD 6.5°; range -11.1° to 18.3°) increase in internal rotation was observed in the implanted hip than the contralateral non-implanted hip and significantly correlated with a linear combination of the increase of cup anteversion, cup medial translation and leg lengthening (R=0.81). INTERPRETATION Results suggested that the total hip arthroplasty patients compensated the changes in hip geometry by altering the dynamic movement during gait. Restoration of the native hip geometry, including acetabular cup anteversion, position and leg length could be one of the factors that influence the hip kinematics symmetry in total hip arthroplasty patients during gait.
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Affiliation(s)
- Tsung-Yuan Tsai
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Jing-Sheng Li
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Dimitris Dimitriou
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Dimitriou D, Tsai TY, Li JS, Nam KW, Park KK, Kwon YM. In vivo kinematic evaluation of total hip arthroplasty during stair climbing. J Orthop Res 2015; 33:1087-93. [PMID: 25626860 DOI: 10.1002/jor.22837] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/19/2014] [Indexed: 02/04/2023]
Abstract
Stair climbing is a physically demanding task and a painful limitation for patients suffering from severe hip osteoarthritis. Although total hip arthroplasty (THA) is the definitive treatment for end-stage osteoarthritis, it is not well understood whether THA restores hip kinematics during strenuous activities. The purpose of this study was to compare the 3D kinematics of THA and native hip during physically demanding tasks and correlate potential differences with THA components orientations/positions in patients with unilateral THA. In vivo hip kinematics were determined during step-up and leg stance activities using a validated combination of 3D CT-based computer modeling and dual fluoroscopic imaging system (DFIS). The THA side demonstrated an average 3.4° (±6.5°, range: -5.9° to 15.2°) greater internal rotation than the contralateral native hip, during the step-up activity but not during leg stance. The difference in internal rotation was highly correlated to the difference in femoral anteversion and anterior translation of hip joint center between implanted and native hip (R(2) = 0.71, p < 0.01). The results suggest the importance of accurate THA component placement in restoring normal hip kinematics during functional activities.
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Affiliation(s)
- Dimitris Dimitriou
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tsung-Yuan Tsai
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jing-Sheng Li
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kwang Woo Nam
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Orthopedic Surgery, Jeju National University, School of Medicine, Jeju, South Korea
| | - Kwan Kyu Park
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Orthopedic Surgery, Yonsei University, College of Medicine, Seoul, South Korea
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Utility of Preoperative Femoral Neck Geometry in Predicting Femoral Stem Anteversion. J Arthroplasty 2015; 30:1079-84. [PMID: 25683295 DOI: 10.1016/j.arth.2015.01.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/01/2015] [Accepted: 01/12/2015] [Indexed: 02/01/2023] Open
Abstract
This study investigated the relationships between the preoperative femoral anteversions and the femoral stem anteversion using CT scans and CT-based 3D models to determine whether any preoperative anteversion measurement correlates with the postoperative stem anteversion. Pre-operative and post-operative CT scans of 19 hips with THAs were evaluated. Five preoperative anatomical femoral anteversion measurements (CT-Head, CT-Below Head, CT-Neck, 3D-Head, and 3D-Neck) were compared with the postoperative femoral stem anteversion. The preoperative CT-Neck anteversion measurement was most correlated with the postoperative stem anteversion (r=0.761, P=0.002) with the narrowest ranges of the differences (-10.2° to 11.0°). The preoperative anteversions using the femoral neck geometry from CT scans can be used for the estimation of the postoperative femoral stem anteversion in THA.
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Tsai TY, Dimitriou D, Li JS, Kwon YM. Does haptic robot-assisted total hip arthroplasty better restore native acetabular and femoral anatomy? Int J Med Robot 2015; 12:288-95. [PMID: 25906764 DOI: 10.1002/rcs.1663] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/08/2015] [Accepted: 03/17/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND The objective was to evaluate whether total hip arthroplasty (THA) using haptic robot assistance restores hip geometry better than the free-hand technique. METHODS Twelve robot-assisted and 14 free-hand unilateral THA patients underwent CT scan for three-dimensional (3D) hip models. The anteversion, inclination and hip joint centre locations of the native and implanted hips in each patient were quantified and compared. RESULTS Significant increase of combined anteversion by 19.1 ± 11.7° and 23.5 ± 23.6° and decrease of cup inclination by 16.5 ± 6.0° and 10.2 ± 6.8° were observed in the robot-assisted and the free-hand THAs, respectively. Less variation in the difference of the component orientations (max 11.1 vs 18.3°) and the femoral head centre (max 4.5 vs 6.3 mm) were found in the robot-assisted group. CONCLUSION This study demonstrated that neither robot-assisted nor free-hand THAs had fully restored native hip geometry. However, the higher precision of the robot-assisted THA suggested that it has potential utility in restoring the native hip geometry. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Tsung-Yuan Tsai
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dimitris Dimitriou
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jing-Sheng Li
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Young-Min Kwon
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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The effect of femoral neck osteotomy on femoral component position of a primary cementless total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2015; 39:2315-21. [PMID: 25787684 DOI: 10.1007/s00264-015-2739-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 03/04/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE The aim of this study was to quantify the femoral canal diameter and version at different femoral neck osteotomy locations, and to investigate the effect of the osteotomy plane on femoral component position in total hip arthroplasty (THA). METHODS Preoperative and postoperative three-dimensional models were reconstructed in 15 patients (19 hips) who underwent primary cementless THA with tapered non-anatomical femoral stem. On the pre-operative models, the osteotomy plane was simulated at different levels (-5, 0, 5, and 10 mm from the femoral saddle [piriformis fossa]) and angles (30, 40, 50, and 60° from the femoral anatomical axis). Medullary canal version and mediolateral diameter were measured on the osteotomy surfaces. On the postoperative models, the femoral neck osteotomy plane, stem anteversion and alignment were measured. RESULTS The average canal diameter ranged from 22.8 to 26.3 mm at different osteotomy levels and from 20.8 to 29.0 mm at different osteotomy angles. The average canal version ranged from 11.4 to 23.2° at different resection levels and from 12.8 to 21° at different resection angles. The femoral stem anteversion was correlated with neck osteotomy angle (R = 0.72), whereas stem alignment in frontal plane (varus/valgus) was correlated with neck osteotomy level (R = 0.87). CONCLUSIONS The femoral neck osteotomy plane in THA affects the postoperative stem position due to the complex morphology of the proximal femoral medullary canal, suggesting that both femoral neck resection level and angle should be considered in optimizing femoral component alignment in THA patients.
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