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Hopkins D, Callary SA, Solomon LB, Woodford SC, Lee PVS, Ackland DC. Computational modeling of revision total hip arthroplasty involving acetabular defects: A systematic review. J Orthop Res 2024. [PMID: 38850264 DOI: 10.1002/jor.25902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/22/2024] [Accepted: 05/07/2024] [Indexed: 06/10/2024]
Abstract
Revision total hip arthroplasty (rTHA) involving acetabular defects is a complex procedure associated with lower rates of success than primary THA. Computational modeling has played a key role in surgical planning and prediction of postoperative outcomes following primary THA, but modeling applications in rTHA for acetabular defects remain poorly understood. This study aimed to systematically review the use of computational modeling in acetabular defect classification, implant selection and placement, implant design, and postoperative joint functional performance evaluation following rTHA involving acetabular defects. The databases of Web of Science, Scopus, Medline, Embase, Global Health and Central were searched. Fifty-three relevant articles met the inclusion criteria, and their quality were evaluated using a modified Downs and Black evaluation criteria framework. Manual image segmentation from computed tomography scans, which is time consuming, remains the primary method used to generate 3D models of hip bone; however, statistical shape models, once developed, can be used to estimate pre-defect anatomy rapidly. Finite element modeling, which has been used to estimate bone stresses and strains, and implant micromotion postoperatively, has played a key role in custom and off-the-shelf implant design, mitigation of stress shielding, and prediction of bone remodeling and implant stability. However, model validation is challenging and requires rigorous evaluation and comparison with respect to mid- to long-term clinical outcomes. Development of fast, accurate methods to model acetabular defects, including statistical shape models and artificial neural networks, may ultimately improve uptake of and expand applications in modeling and simulation of rTHA for the research setting and clinic.
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Affiliation(s)
- Daniel Hopkins
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Stuart A Callary
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - L B Solomon
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sarah C Woodford
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Peter V S Lee
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
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Fan W, Dang S, Tan X, Liu J, Yang YK, Xiang FF. Computational evaluation of wire position using separate vertical wire technique and candy box technique for the fixation of inferior pole patellar fractures: a finite element analysis. Front Bioeng Biotechnol 2024; 12:1353901. [PMID: 38720880 PMCID: PMC11076871 DOI: 10.3389/fbioe.2024.1353901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
The separate vertical wire (SVW) technique and the improved candy box (CB) technique have been proposed for treating inferior pole patellar fractures. However, there is still a lack of clear explanation regarding the location of the wire passing through the patella. Five models of SVW techniques were established in different positions. Finite element analysis was then conducted to determine the optimal bone tunnel position for the SVW technique. Based on these findings, six groups of finite element models were created for CB techniques. The maximum displacement and stress on both the patella and steel wire were compared among these groups under 100-N, 200-N, 300-N, 400-N, and 500-N force loads. The results indicated that, in the SVW technique, the steel wire group near the fracture end of the longitudinal bone tunnel showed minimal displacement and stress on the patella when subjected to different forces. On the other hand, in the CB technique, both the patella and wire experienced minimal stress when a transverse bone tunnel wire was placed near the upper posterior aspect of patella. In conclusion, the SVW technique may require the bone tunnel wire to be positioned near the fractured end of the lower pole of the patella. On the other hand, in CB technique, the transverse bone tunnel wire passing through the patella may be close to its upper posterior aspect. However, further validation is necessary through comprehensive finite element analysis and additional biomechanical experiments.
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Affiliation(s)
- Wei Fan
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China
| | - Shunjie Dang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China
| | - Xiaoqi Tan
- Department of Dermatology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jinhui Liu
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China
| | - Yun-Kang Yang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China
| | - Fei-Fan Xiang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China
- Department of Nuclear Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China
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Chun YS, Lee HH, Lim YW, Kim YS, Kwon SY, Kim SC. Incidence and outcomes of intraoperative periprosthetic acetabular fractures during cementless total hip arthroplasty: a prospective three-dimensional computer tomography-based study. INTERNATIONAL ORTHOPAEDICS 2024; 48:667-674. [PMID: 37723316 DOI: 10.1007/s00264-023-05988-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/13/2023] [Indexed: 09/20/2023]
Abstract
PURPOSE Unlike periprosthetic femoral fractures, periprosthetic acetabular fractures during total hip arthroplasty (THA) have not been evaluated in detail. We prospectively evaluated the incidence, patterns, risk factors, and clinical outcomes of intraoperative periprosthetic acetabular fractures using pre- and postoperative computer tomography (CT). METHODS In this prospective single-centre study, we evaluated 234 consecutive patients (250 hips) who underwent THA and three-dimensional CT before and after the surgery. We assessed the incidence, pattern of fractures, outcomes for each fracture pattern, reoperation and revision rates, Harris hip score, and visual analog scale (VAS) for pain. Multivariate regression models were used to identify risk factors for periprosthetic acetabular fractures. RESULTS In total, 43 periprosthetic acetabular fractures (17.2%) were identified via CT. Fractures occurred most frequently at the superolateral wall. Early cup migration occurred in three hips. None of the patients underwent revision surgery for acetabular loosening. Regression modeling showed that rheumatoid arthritis was a significant predictor of periprosthetic acetabular fractures. CONCLUSIONS Periprosthetic acetabular fractures are not infrequent during cementless THA and are more common in patients with rheumatoid arthritis.
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Affiliation(s)
- You-Seung Chun
- Department of Orthopaedic Surgery, College of Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Chunbo-Ro 271, Uijeongbu, Gyeonggi-Do, South Korea
| | - Hwan-Hee Lee
- Department of Orthopaedic Surgery, College of Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daeheung-Ro 64, Daejeon, South Korea
| | - Young-Wook Lim
- Department of Orthopaedic Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpodae-Ro 222, Seocho-Gu, Seoul, South Korea
| | - Yong-Sik Kim
- Department of Orthopaedic Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpodae-Ro 222, Seocho-Gu, Seoul, South Korea
| | - Soon-Yong Kwon
- Department of Orthopaedic Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpodae-Ro 222, Seocho-Gu, Seoul, South Korea
| | - Seung-Chan Kim
- Department of Orthopaedic Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Tongil-Ro 1021, Eunpyeong-Gu, Seoul, South Korea.
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Fan W, Liu J, Tan X, Wei D, Yang Y, Xiang F. Candy box technique for the fixation of inferior pole patellar fractures: finite element analysis and biomechanical experiments. BMC Musculoskelet Disord 2023; 24:835. [PMID: 37872511 PMCID: PMC10594795 DOI: 10.1186/s12891-023-06946-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/07/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Maintaining effective reduction and firm fixation in inferior pole patellar fractures is a highly challenging task. There are various treatment methods available; although tension-band wiring combined with cerclage wiring (TBWC) is the mainstream approach, its effectiveness is limited. Herein, we propose and evaluate a new technique called candy box (CB), based on separate vertical wiring (SVW), for the treatment of inferior pole patellar fractures. Specifically, we provide biomechanical evidence for its clinical application. METHODS Five fixation models were built: SVW combined with cerclage wiring (SVWC); TBWC; modified SVW with the middle (MSVW-A) or upper (MSVW-B) 1/3 of the steel wire reserved, and CB. A finite element analysis was performed to compare the displacement and stress under 100-N, 200-N, 300-N, 400-N and 500-N force loads. Three-dimensional printing technology was utilized to create fracture models, and the average displacement of each model group was compared under a 500-N force. RESULTS The results of the finite element analysis indicate that CB technology exhibits significantly lower maximum displacement, bone stress, and wire stress compared to that with other technologies under different loads. Additionally, in biomechanical experiments, the average force displacement in the CB group was significantly smaller than that with other methods under a 500-N force (P < 0.05). CONCLUSIONS CB technology has the potential to overcome the limitations of current techniques due to its superior biomechanical characteristics. By incorporating early functional exercise and ensuring strong internal fixation, patient prognosis could be enhanced. However, further clinical trials are needed to fully evaluate the therapeutic effects of CB technology.
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Affiliation(s)
- Wei Fan
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China
| | - Jinhui Liu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China
| | - Xiaoqi Tan
- Department of Dermatology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Daiqing Wei
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China
| | - Yunkang Yang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China.
| | - Feifan Xiang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China.
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Garala K, Remtulla MA, Verma R, Lawrence T. Cemented acetabular components combined with trabecular metal augments provide excellent long-term survivorship for severe acetabular bone loss. Hip Int 2023; 33:833-838. [PMID: 35658637 DOI: 10.1177/11207000221102848] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Acetabular bone loss is a challenging problem for revision hip surgeons. This study aimed to explore long-term outcomes of patients who have undergone cemented acetabular revision in conjunction with trabecular metal augmentation and impaction bone grafting in cases with significant segmental bone loss. METHODS All patients who underwent cemented acetabular revision requiring impaction bone grafting and trabecular metal augments with a minimum Paprosky score of 2B and minimum follow up of 5 years were identified. Pre- and postoperative WOMAC scores were compared. An assessment of pre- and postoperative hip centre of rotation was performed and compared to native centre of rotation. Immediate postoperative centre of rotation was then compared to radiographs at latest follow up to measure for migration of acetabular components. RESULTS 42 patients were identified. Mean age was 53 years old with 7 males and 35 female patients. Mean follow-up was 9.5 years. Preoperative WOMAC score was 30 and there was an increase to 90 (p < 0.01) at latest follow-up. No hips were revised for loosening or infection. There was a mean improvement in centre of rotation of 6.80 mm (CI, 4.57-9.03 mm) which was significant (p < 0.00002). There was no change of position of centre of rotation from immediate postoperative radiographs and those at latest follow up (p = 0.3). CONCLUSIONS Cemented acetabular components work well in conjunction with trabecular metal augments and impacted bone grafts in reconstructing complex acetabular defects. Together they provide immediate and long-term component stability, with excellent long-term clinical and radiological outcomes.
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Affiliation(s)
- Kanai Garala
- University Hospitals Birmingham - Solihull Hospital, Solihull, UK
| | | | - Raghav Verma
- University Hospitals Birmingham - Solihull Hospital, Solihull, UK
| | - Trevor Lawrence
- University Hospitals Birmingham - Solihull Hospital, Solihull, UK
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Duta A, Popa DL, Vintila DD, Buciu G, Dina NA, Ionescu A, Berceanu MC, Calin DC. An Experimental and Virtual Approach to Hip Revision Prostheses. Diagnostics (Basel) 2022; 12:diagnostics12081952. [PMID: 36010302 PMCID: PMC9406961 DOI: 10.3390/diagnostics12081952] [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: 07/12/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Introduction: The changes in the joint morphology inevitably lead to prosthesis, but the hip pathology is complex. The hip arthroplasty is a therapeutic solution and can be caused, most frequently, by primary and secondary coxarthrosis due to or followed by traumatic conditions. The main aim of this study was to find the method of revision hip prosthesis that preserves as much bone material as possible and has sufficiently good mechanical strength. (2) Materials and Methods: In this study, in a first step, the two revision prostheses were performed on bone components taken from an animal (cow), and then, they were tested on a mechanical testing machine until the prostheses physically failed, and the force causing their failure was determined. (3) Results: These prostheses were then modelled in a virtual environment and tested using the finite element method (FEM) in order to determine their behaviour under loading from normal human gait. Displacement, strain, and stress maps were obtained. (4) Discussion: Discussions on hip revision prostheses, method, and theory analysis are presented at the end of the paper. (5) Conclusions: Important conclusions are drawn based on comparative analyses. The main conclusion shows that the both orthopaedic prostheses provide a very good resistance.
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Affiliation(s)
- Alina Duta
- Faculty of Mechanics, University of Craiova, 200512 Craiova, Romania
| | - Dragos-Laurentiu Popa
- Faculty of Mechanics, University of Craiova, 200512 Craiova, Romania
- Correspondence: (D.-L.P.); (G.B.)
| | | | - Gabriel Buciu
- Faculty of Nursing, Titu Maiorescu University, 210102 Targu Jiu, Romania
- Correspondence: (D.-L.P.); (G.B.)
| | | | - Adriana Ionescu
- Faculty of Mechanics, University of Craiova, 200512 Craiova, Romania
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Li X, Pan BQ, Wu XY, Fu M, Liao WM, Wu CH, Sheng PY. Impaction Bone Grafting Combined with Titanium Mesh for Acetabular Bone Defects Reconstruction in Total Hip Arthroplasty Revision: A Retrospective and Mini-Review Study. Orthop Surg 2022; 14:902-910. [PMID: 35441498 PMCID: PMC9087461 DOI: 10.1111/os.13262] [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: 04/27/2021] [Revised: 02/09/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the application of impaction bone grafting (IBG) combined with Ti‐alloy mesh for acetabular bone defect reconstruction in total hip arthroplasty (THA) revision and follow up the clinical outcomes and imaging findings. Methods The clinical and imaging data of patients who were admitted to our hospital from January 2000 to December 2020 and underwent acetabular bone defects reconstruction using IBG combined with titanium mesh were retrospectively analyzed. Preoperative and post‐revision Oxford and Harris scores, and post‐revision complications were evaluated. Radiographs were used to determine center of rotation (COR) of the hip joint, transparency line, bone graft fusion, and bone mineral density (BMD) around the hip joint. Results Significant improvement was observed in both Oxford and Harris scores (P < 0.05). The radiographs taken at the last follow‐up examination showed no significant differences in the acetabulum COR, offsets, inclination angle, mean ratio of vertical value, and BMD analysis between the post‐revision side and contralateral side (P > 0.05). The follow‐up data showed restoration of the mesh implant and graft bone fusion. Conclusions The application of IBG combined with titanium‐alloy mesh in revision THA patients with acetabular defects was found to provide satisfactory outcomes. However, large‐scale studies are still needed to further elucidate the long‐term outcomes.
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Affiliation(s)
- Xiang Li
- Department of Orthopaedic, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bai-Qi Pan
- Department of Orthopaedic, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Yu Wu
- Department of Orthopaedic, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming Fu
- Department of Orthopaedic, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wei-Ming Liao
- Department of Orthopaedic, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chu-Heng Wu
- Department of Orthopaedic, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Pu-Yi Sheng
- Department of Orthopaedic, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Jacob I, Benson J, Shanaghan K, Gonzalez Della Valle A. Acetabular positioning is more consistent with the use of a novel miniature computer-assisted device. INTERNATIONAL ORTHOPAEDICS 2020; 44:429-435. [PMID: 31965312 DOI: 10.1007/s00264-020-04484-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/15/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Computer-assisted surgery (CAS) relying on registration of the anterior pelvic plane (APP) allows precise acetabular component placement. We determined the variability of cup placement in patients who underwent THA with and without the use of CAS that does not rely on the registration of APP. METHODS Fifty-one patients who underwent staged-bilateral THAs, one without CAS (control), and a subsequent one with CAS (study group), were included. Acetabular inclination and anteversion were measured on standardized post-operative radiographs. Variance in cup position and Lewinnek's zone proportionality were compared between the groups. Multiple regressions were performed to identify factors affecting variability in acetabular component placement. RESULTS The mean inclination for the control and study group was 42.7° (SD 4.5) and 42.5° (SD 2.9), respectively. The inclination variance was 20.5° and 8.2° respectively (p = < 0.001). Cup inclination was more consistent in the study than in the control group (deviation from the mean: 2.3° vs. 3.8°, p < 0.001). The mean anteversion for the control and the study group was 25.5° (SD 7.4) and 26.8° (SD 4.3), respectively. The anteversion variance was 54.2° and 18.2° respectively (p = <0.001). Consistency in cup anteversion was significantly improved with CAS (deviation from the mean: 3.4° vs. 5.8°; p = 0.002). Lewinnek's zone proportionality was not affected by the use of CAS. In the linear regression analysis, CAS significantly increased consistency in cup inclination (p = 0.01). Patient's factors including BMI and laterality affected consistency of cup placement. CONCLUSION CAS without referencing the APP allows a more consistent orientation of the acetabular component when compared to freehand placement.
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Affiliation(s)
- Ivan Jacob
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | | | - Kate Shanaghan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Schierjott RA, Hettich G, Graichen H, Jansson V, Rudert M, Traina F, Weber P, Grupp TM. Quantitative assessment of acetabular bone defects: A study of 50 computed tomography data sets. PLoS One 2019; 14:e0222511. [PMID: 31622343 PMCID: PMC6797127 DOI: 10.1371/journal.pone.0222511] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/31/2019] [Indexed: 12/15/2022] Open
Abstract
Objectives Acetabular bone defect quantification and classification is still challenging. The objectives of this study were to suggest and define parameters for the quantification of acetabular bone defects, to analyze 50 bone defects and to present the results and correlations between the defined parameters. Methods The analysis was based on CT-data of pelvises with acetabular bone defects and their reconstruction via a statistical shape model. Based on this data, bone volume loss and new bone formation were analyzed in four sectors (cranial roof, anterior column, posterior column, and medial wall). In addition, ovality of the acetabulum, lateral center-edge angle, implant migration, and presence of wall defects were analyzed and correlations between the different parameters were assessed. Results Bone volume loss was found in all sectors and was multidirectional in most cases. Highest relative bone volume loss was found in the medial wall with median and [25, 75]—percentile values of 72.8 [50.6, 95.0] %. Ovality, given as the length to width ratio of the acetabulum, was 1.3 [1.1, 1.4] with a maximum of 2.0, which indicated an oval shape of the defect acetabulum. Lateral center-edge angle was 30.4° [21.5°, 40.4°], which indicated a wide range of roof coverage in the defect acetabulum. Total implant migration was 25.3 [14.8, 32.7] mm, whereby cranial was the most common direction. 49/50 cases showed a wall defect in at least one sector. It was observed that implant migration in cranial direction was associated with relative bone volume loss in cranial roof (R = 0.74) and ovality (R = 0.67). Conclusion Within this study, 50 pelvises with acetabular bone defects were successfully analyzed using six parameters. This could provide the basis for a novel classification concept which would represent a quantitative, objective, unambiguous, and reproducible classification approach for acetabular bone defects.
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Affiliation(s)
- Ronja A. Schierjott
- Research & Development Department, B.Braun Aesculap AG, Tuttlingen, Germany
- Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Ludwig-Maximilians-University Munich, Campus Grosshadern, Munich, Germany
- * E-mail:
| | - Georg Hettich
- Research & Development Department, B.Braun Aesculap AG, Tuttlingen, Germany
| | - Heiko Graichen
- Department for Arthroplasty and General Orthopaedic Surgery, Orthopaedic Hospital Lindenlohe, Schwandorf, Germany
| | - Volkmar Jansson
- Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Ludwig-Maximilians-University Munich, Campus Grosshadern, Munich, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, König-Ludwig-Haus, Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d'Anca e di Ginocchio, Istituto Ortopedico Rizzoli di Bologna, Bologna, Italy
- Dipartimento di Scienze Biomediche, Odontoiatriche e delle Immagini Morfologiche e Funzionali, Università Degli Studi Di Messina, Messina, Italy
| | - Patrick Weber
- Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Ludwig-Maximilians-University Munich, Campus Grosshadern, Munich, Germany
| | - Thomas M. Grupp
- Research & Development Department, B.Braun Aesculap AG, Tuttlingen, Germany
- Department of Orthopaedic Surgery, Physical Medicine & Rehabilitation, Ludwig-Maximilians-University Munich, Campus Grosshadern, Munich, Germany
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Tikhilov RM, Shubnyakov II, Denisov AO. Classifications of Acetabular Defects: Do They Provide an Objective Evidence for Complexity of Revision Hip Joint Arthroplasty? (Critical Literature Review and Own Cases). TRAUMATOLOGY AND ORTHOPEDICS OF RUSSIA 2019. [DOI: 10.21823/2311-2905-2019-25-1-122-141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- R. M. Tikhilov
- Vreden Russian Research Institute of Traumatology and Orthopedics; Mechnikov North-Western State Medical University
| | - I. I. Shubnyakov
- Vreden Russian Research Institute of Traumatology and Orthopedics
| | - A. O. Denisov
- Vreden Russian Research Institute of Traumatology and Orthopedics
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11
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Reconstruction of Severe Acetabular Bone Defect with 3D Printed Ti6Al4V Augment: A Finite Element Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6367203. [PMID: 30539016 PMCID: PMC6261073 DOI: 10.1155/2018/6367203] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/30/2018] [Accepted: 08/07/2018] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to establish the finite element analysis (FEA) model of acetabular bone defect reconstructed by 3D printed Ti6Al4V augment and TM augment and further to analyze the stress distribution and clinical safety of augments, screws, and bones. Methods The FEA model of acetabular bone defect reconstructed by 3D printed Ti6Al4V augment was established by the CT data of a patient with Paprosky IIIA defect. The von Mises stresses of augments, screws, and bones were analyzed by a single-legged stance loading applied in 3 increments (500 N, 2000 N, and 3000 N). Results The peak von Mises stresses under the maximal loading in the 3D printed augments, screws, and cortical bone were less than the yield strength of the corresponding component. However, the peak stress in the bone was greater than the yield strength of cancellous bone under walking or jogging loading. And under the same loading, the peak compressive and shear stresses in bone contact with TM augment were larger than these with 3D printed augment. Conclusions The FEA results show that all the components will be intact under single-legged standing. However, partial cancellous bone contacted with 3D printed augment and screws will lose efficacy under walking or jogging load. So we recommend that patients can stand under full bearing, but can not walk or jog immediately after surgery.
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Acetabular reinforcement rings associated with allograft for severe acetabular defects. INTERNATIONAL ORTHOPAEDICS 2018; 43:561-571. [PMID: 30218182 DOI: 10.1007/s00264-018-4142-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/03/2018] [Indexed: 02/06/2023]
Abstract
Acetabular revisions with severe bone defects can be challenging procedures. Several grading systems have been set into place to help the surgeon adequately gauge the degree of bone loss within the acetabulum. Internationally innovative research in orthopedics and bio-engineering has helped with progression of successful techniques and rings to re-establish the normal anatomy of the hip. The purpose of this review is to evaluate the outcomes of the different acetabular reinforcement rings in the setting of severe acetabular defects. A successive report of relevant data from the literature of multiple techniques will be provided. The procedures include the cup-cage, the Müller ring, the Ganz Ring, the Kerboull acetabular reinforcement device (KARD), the graft augmentation prosthesis (GAP) ring, and the Burch-Schneider ring. The main focus of this overview is rings only; other devices such as trabecular augments, custom-made cages, or oblong cups are not discussed. Furthermore, a special emphasis on the surgical technique of the KARD is also given. Procedures using these rings are usually associated with bone grafts either bulk or morselized. When considering the available data on these various rings used for reconstruction of the severely damaged acetabulum, the cup-cage, the KARD, and the Burch-Schneider ring appear to be reliable options for more successful long-term outcomes.
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