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Li X, Qu Y, Wang L, Ai S. The accuracy of cup anteversion measurement on postoperative pelvic radiographs: A comparative retrospective cohort study between DDH and non-DDH patients. Heliyon 2024; 10:e31141. [PMID: 38803989 PMCID: PMC11128930 DOI: 10.1016/j.heliyon.2024.e31141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/10/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
Rationale and objectives Postoperative pelvic radiographs remain a vital tool for assessing cup orientation after total hip arthroplasty (THA), with the accuracy influenced by various factors. The objective of this study is to investigate the accuracy of cup anteversion measurement in developmental dysplasia of the hip (DDH) patients and others based on postoperative pelvic radiographs conducted under the current heavy workload conditions. Materials and methods Patients who underwent THA at our hospital with both postoperative X-ray and CT images from January 2020 to December 2022 were included in this retrospective cohort study. Virtual X-ray films were generated using digitally reconstructed radiographs (DRR) technology from CT images, with pelvic position perfectly controlled. Radiographic anteversion (RA) was measured on 3D-CT, virtual X-rays, and actual postoperative X-rays, abbreviated as RA_3D, RA_DRR, and RA_Xray, respectively. A repeated-measures analysis of covariance (ANCOVA) was utilized to evaluate the variations in RA within and between different groups across three methods. The Bland-Altman plot analysis showed the variations among methods in DDH and non-DDH patients, setting a clinically acceptable limits of agreement (LOA) at ±5°. Results This study included 154 hip cases, with 63 DDH and 91 other diseases. Repeated-measures ANCOVA revealed a descending trend in RA across three methods, with differences of 2.64° (DDH) vs. 2.74° (others) from 3D to DRR, and 4.89° (DDH) vs. 1.07° (others) from DRR to X-ray. The group by methods interaction effect were significant (p = 0.002). Significant statistical differences in RA_Xray (P = 0.035) were observed between DDH and non-DDH patients, but not in RA_3D and RA_DRR. Bland-Altman plots showed 71.4 % of DDH patients exceeded the clinically acceptable LOA, compared to 36.3 % of other patients. Conclusion Our study indicated that under the current intense workload, the reliability of assessing cup anteversion using postoperative pelvic radiographs is challenged, especially in patients with DDH.
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Affiliation(s)
- Xiaomin Li
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
| | - Yang Qu
- Department of Radiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
| | - Liao Wang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
| | - Songtao Ai
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, PR China
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2
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Kara GK, Turan K, Eroglu ON, Ozturk C, Ertürer E. Is the Acetabular Cup Orientation Different in Robot-Assisted and Conventional Total Hip Arthroplasty With Right-Handed Surgeons Using an Anterolateral Approach? Cureus 2023; 15:e42335. [PMID: 37614261 PMCID: PMC10443961 DOI: 10.7759/cureus.42335] [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] [Accepted: 07/21/2023] [Indexed: 08/25/2023] Open
Abstract
Introduction Total hip arthroplasty (THA) is one of the most successful orthopaedic procedures. Survival rates from 90% at 10 years to 93% at 20 years have been reported in different studies. Differences in implant and patient characteristics can undoubtedly explain some of this variability observed in prosthesis durability, but the effect of surgical technique and implant orientation cannot be ignored. Therefore, many intraoperative methods (anatomic landmarks, intraoperative x-ray, fluoroscopy, navigation, and robotic surgery) have been attempted to avoid acetabular component malpositioning. Although postoperative computed tomography (CT) is accepted as the gold standard for the measurement of acetabular anteversion, it remains controversial in respect of costs and radiation exposure. The aim of this study was to examine how acetabular component orientation was affected in robotic and conventional THA operations performed by two surgeons with right-hand dominance. Material and methods The study included 113 primary THA operations performed on 113 patients between 2017 and 2022 in two groups: (i) robotic THA (Mako, Stryker Corporation, Kalamazoo, Michigan, United States) (55 patients) and (ii) conventional THA (58 patients). The patients comprised 51 males and 62 females. THA was performed on 54 right-side hips and 59 left-side hips. The operations were performed by two orthopaedic surgeons, each with 20 years of arthroplasty experience, on all the patients in the lateral decubitus position with an anterolateral approach. In all the cases, the orientation of the acetabular component was 40° inclination and 20° anteversion. Difficult THA procedures (patients with developmental dysplasia of the hip (DDH), a history of hip surgery, revision THA, defect or deformity of the acetabulum, a history of scoliosis or lumbar posterior surgery, or those requiring proximal femoral osteotomy) were excluded from the study. Using the Liaw and Lewinnek methods, the acetabular component anteversion was measured on the radiographs taken in the optimal position postoperatively and the acetabular cup inclination angles were measured on the pelvis radiographs. The groups were compared using the Kolmogorov-Smirnov, Pearson Chi-square and Mann-Whitney U statistical tests. The limits were accepted as 40±5° for inclination and 20±5° for anteversion. Results No statistically significant difference was determined between the groups in respect of age, gender, or operated side. No statistically significant difference was determined between the optimal acetabular cup inclination angles of the robotic and conventional THA groups (p = 0.79). No statistically significant difference was determined between the optimal acetabular cup anteversion angles of the left and right conventional THA groups. Statistically significantly better results were determined in the robotic group in respect of acetabular cup anteversion (p<0,001). Conclusion The optimal orientation of the acetabular component is a key factor for successful THA. Otherwise, revision surgery is inevitable for reasons such as instability, impingement, or increased wear. The results of this study demonstrated that robotic surgery was superior to the conventional method in the placement of the acetabular component in the desired orientation.
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Affiliation(s)
| | - Kayhan Turan
- Orthopedics and Traumatology, Atlas University, İstanbul, TUR
| | | | - Cagatay Ozturk
- Orthopedics and Traumatology, Istinye University, Istanbul, TUR
| | - Erden Ertürer
- Orthopedics and Traumatology, Istinye University, İstanbul, TUR
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Budzińska MB, Maciąg BM, Żarnovsky K, Kordyaczny T, Kowalczyk IM, Adamska O, Stolarczyk A. How to analyze postoperative radiographs after total hip replacement. Jpn J Radiol 2023; 41:14-18. [PMID: 36063354 DOI: 10.1007/s11604-022-01332-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/22/2022] [Indexed: 01/07/2023]
Abstract
Total hip replacement is one of the most widely performed surgeries. It is stated as the most efficient method of treating end-stage osteoarthritis of the hip joint. What is more, it significantly improves the quality of patients' lives, relieves them from pain and restores decreased range of motion, provided that is conducted properly. Aim of this article is to indicate which constituents of prosthetic placement can be easily measured on postoperative radiographs and point out how to interpret obtained results. Multiple mechanical factors, such as center of rotation, femoral offset, acetabular offset, acetabular inclination, acetabular anteversion and leg length discrepancy can be measured on postoperative radiographs. To provide a successful surgery and to acquire both radiological and clinical satisfying results, proper prosthetic placement is crucial. Malpositioning of each element, in varying degrees may lead to dislocation or reoperation.
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Affiliation(s)
- Martyna Barbara Budzińska
- Department of Orthopaedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa Str., 04-749, Warsaw, Poland
| | - Bartosz Michał Maciąg
- Department of Orthopaedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa Str., 04-749, Warsaw, Poland.
| | - Krystian Żarnovsky
- Department of Orthopaedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa Str., 04-749, Warsaw, Poland
| | - Tomasz Kordyaczny
- Department of Orthopaedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa Str., 04-749, Warsaw, Poland
| | - Inga Magdalena Kowalczyk
- Department of Orthopaedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa Str., 04-749, Warsaw, Poland
| | - Olga Adamska
- Department of Orthopaedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa Str., 04-749, Warsaw, Poland
| | - Artur Stolarczyk
- Department of Orthopaedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa Str., 04-749, Warsaw, Poland
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Lan Y, Feng E, Lin B, Lu Z, Lin F, Weng Y. Direct anterior versus posteriorlateral approachs for clinical outcomes after total hip arthroplasty in the treatment of severe DDH. BMC Musculoskelet Disord 2022; 23:958. [PMID: 36335347 PMCID: PMC9636645 DOI: 10.1186/s12891-022-05759-y] [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: 06/20/2022] [Accepted: 08/08/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The total hip arthroplasty (THA) has gained popularity in in the treatment of severe developmental dysplasia of the hip (DDH). the posterior lateral approach (PLA) has good clinical efficacy and has been confirmed by the majority clinicians. Nevertheless, controversy exists regarding longer-term benefits of the direct anterior approach (DAA). The objective of this study was to investigate the clinical efficacy and placement of S-ROM prosthesis in the treatment of severe DDH by The total hip arthroplasty (THA) with different surgical approaches. METHODS A retrospective analysis was performed on 42 patients with severe DDH admitted to our hospital from August 2015 to February 2022, who were treated with S-ROM prosthesis for total hip arthroplasty and subtrochanteric osteotomy of the femur. They were divided into DAA group and PLA group according to different surgical approaches. Perioperative indicators and imaging data were collected. RESULTS The surgery time, intraoperative blood loss, and creatine kinase difference in DAA group and PLA group was without a statistically significant difference (P > 0.05). The postoperative length of hospitalization was shorter in the DAA group than in the PLA group (6.50 ± 3.15 vs 9.18 ± 4.93, P = 0.045). The acetabular abduction angles、the acetabular anteversion angles, the safe area ratio, The difference of femoral eccentricity, and the vertical difference of rotation center in DAA group and PLA group, there was no statistical significance (P > 0.05). Statistically significant differences were detected the horizontal difference of rotation center (P = 0.044). CONCLUSIONS Total hip arthroplasty with S-ROM prosthesis is a feasible procedure for severe dysplastic DDH. The clinical efficacy and prosthesis placement parameters of DAA approach are advantage to those of PLA approach.
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Affiliation(s)
- Yiping Lan
- The Third Clinical Medical College, Fujian Medical University, No. 47, Shangteng Road, Cangshan District, Fuzhou, China
- Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Eryou Feng
- The Third Clinical Medical College, Fujian Medical University, No. 47, Shangteng Road, Cangshan District, Fuzhou, China.
| | - Bei Lin
- The Third Clinical Medical College, Fujian Medical University, No. 47, Shangteng Road, Cangshan District, Fuzhou, China
| | - Zhiming Lu
- The Third Clinical Medical College, Fujian Medical University, No. 47, Shangteng Road, Cangshan District, Fuzhou, China
| | - Feitai Lin
- The Third Clinical Medical College, Fujian Medical University, No. 47, Shangteng Road, Cangshan District, Fuzhou, China
| | - Yan Weng
- The Third Clinical Medical College, Fujian Medical University, No. 47, Shangteng Road, Cangshan District, Fuzhou, China
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Zhang S, Liu Y, Yang M, Ma M, Cao Z, Kong X, Chai W. Robotic-assisted versus manual total hip arthroplasty in obese patients: a retrospective case-control study. J Orthop Surg Res 2022; 17:368. [PMID: 35907875 PMCID: PMC9338672 DOI: 10.1186/s13018-022-03263-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/25/2022] [Indexed: 11/12/2022] Open
Abstract
Aims The objective of this study was to evaluate the accuracy of acetabular cup positioning in the obese patients when using robotic-assisted technology during total hip arthroplasty (THA). Methods Data were retrospectively collected from patients who underwent primary (THA) with a body mass index (BMI) ≥ 28 kg/m2 and ≥ 1 year of follow-up between January 2018 and December 2019. Their demographics, diagnosis, acetabular cup positioning, American Society of Anesthesiologists (ASA) score, Harris Hip Score (HHS), and Forgotten Joint Score (FJS) at the final follow-up were recorded for analysis. Results There were no statistically significant differences between the two groups in height, weight, BMI, ASA score, or preoperative Harris Hip Score (HHS). Also, there was no difference in inclination angle between the two groups (R-THA: 41.29° ± 3.04°; manual THA (M-THA): 40.47° ± 5.46°; P = 0.312). However, the mean anteversion angle was greater in the R-THA group (20.71° ± 1.98° vs. 19.08° ± 4.04°; P < 0.001). Compared to M-THA, R-THA more frequently achieved an acetabular cup angle within 5° of the target (anteversion, 98.1% vs. 78.1% P = 0.001; inclination, 88.5% vs. 53.1%, P < 0.001). The R-THA group was more advantageous in restoring the hip center of rotation (COR) and leg length difference (LLD). There was no statistical difference in postoperative HHS (P = 0.404) or FJS (P = 0.497) between the two groups. Conclusions Compared to manual technique, robotic-assisted technique provided more precise acetabular cup positioning and better leg length restoration for obese patients. The robotic-assisted technique was more advantageous in recovering the center of rotation position and achieved a higher proportion of the acetabular cup placed in the target safety zone. Further studies are needed to confirm the clinical outcomes of surgeries in obese patients using robotic-assisted technology.
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Affiliation(s)
- Shuai Zhang
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing, China.,Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Yubo Liu
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, China
| | - Minzhi Yang
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, China
| | - Mingyang Ma
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing, China.,Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Zheng Cao
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, China
| | - Xiangpeng Kong
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China. .,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
| | - Wei Chai
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China. .,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
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6
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Zhang W, Xu J, Li D, Sun H, Cai Z, Chen M, Ma R. Reliability and Validity of Standing Lateral Radiograph Method for Measuring Acetabular Component Version: A Modified Cross-table Lateral Radiograph Method. Orthop Surg 2022; 14:1622-1629. [PMID: 35711111 PMCID: PMC9363715 DOI: 10.1111/os.13373] [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: 01/15/2022] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To investigate the effect of the X-ray incidence angle on cup version measurements and the reliability and validity of standing lateral (SL) radiography for measuring cup versions. METHODS Cup versions under different X-ray incidence angles were investigated by the 3D simulation analysis. Ninety-three patients, who underwent primary total hip arthroplasty (THA) with postoperative SL radiographs and CT scans between April 2020 and December 2021, were retrospectively analyzed. SL radiography was taken under naturally standing position, correcting for the measurement error of pelvic tilt in cross-table lateral (CL) radiography. Cup versions were measured on SL radiographs and CT images by two qualified orthopedic physicians. The intra- and inter-observer reliabilities were assessed by intra-class correlation coefficient. The consistency between radiographic and CT measurements was evaluated using Pearson correlation coefficient. RESULTS No significant differences in cup version measurements were observed between groups of different X-ray incidence angles (P = 0.663) in the 3D simulation analysis. All measurements had excellent intra- and inter-observer reliabilities, with an intraclass correlation coefficient of >0.95. Mean cup version measurements from SL radiographs correlated well with those from CT scans (r = 0.853, P < 0.001). The mean difference between radiographic and CT measurements was -0.49° (range -12.62° to 10.37°, SD 3.95°), and the majority of differences were within the 95% limits of agreement. CONCLUSION The cup versions measured with SL radiography were close to the CT measurements. SL radiograph method is reliable and valid for measuring acetabular component version after THA.
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Affiliation(s)
- Wenhui Zhang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Xu
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Deng Li
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao Sun
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiqing Cai
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Meiyi Chen
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruofan Ma
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Heimer CYW, Göhler F, Vosseller JT, Hardt S, Perka C, Bäcker HC. Rotational abnormalities in dysplastic hips and how to predict acetabular torsion. Eur Radiol 2022; 32:8350-8363. [PMID: 35678855 DOI: 10.1007/s00330-022-08895-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/02/2022] [Accepted: 05/18/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the degree to which conventional radiography can represent the acetabular and femoral rotational alignment profile between dysplastic and borderline-dysplastic hips. METHODS A retrospective trial was conducted including 56 borderline-dysplastic and dysplastic hips at a mean age of 28.9 years (range from 18 to 46). Inclusion criteria consisted of symptomatic patients with hip dysplasia undergoing 2-dimensional radiography as well as computed tomography. On radiography, the lateral center edge angle, acetabular hip index, hip lateralization index, acetabular index angle, and the Sharp angle were measured, and the presence of a crossover sign was noted. In computed tomography, the full rotational profile of the lower limb was measured. RESULTS Significant correlations were observed in the overall analysis between the anteversion of the acetabulum and the hip lateralization index (mean 0.56, coefficient of regression (CoR) -32.35, p = 0.011) as well as the acetabular index angle with a mean of 11.50 (CoR 0.544, p = 0.018). Similar results were found in the subgroup of dysplastic hips with an acetabular index angle of 13.9 (p = 0.013, CoR 0.74). For the borderline-dysplastic group, no significant correlations between the pelvis radiography and rotational CT were seen. CONCLUSION Although the femoral and acetabular torsion cannot be predicted from x-rays, the anteversion of the acetabulum correlates with the acetabular index angle, the hip lateralization index, and eventually the beta angle in dysplastic hips. For borderline-dysplastic hips, such results did not show up, which strongly illustrates the need for computed tomography in these cases. KEY POINTS • Much of the current literature focuses on rotational alignment especially with respect to the femur and tibia in healthy patients, although little is known about the acetabular, femoral, and tibial torsion in dysplastic hips. • This is the first study showing significant correlations between the anteversion of the acetabulum and the hip lateralization index as well as the acetabular inclination angle. Also, it is the first study to provide a mechanism for estimation of the torsion of the acetabulum with plain radiography in dysplastic hips. • In borderline-dysplastic hips, no significant correlation was found, which raises the question if a simple x-ray has enough validity to address the acetabular deformity with surgery.
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Affiliation(s)
- Carsten Y W Heimer
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117, Berlin, Germany
| | - Friedemann Göhler
- Department of Radiology, Charité Berlin, University Hospital, Chariteplatz 1, 10117, Berlin, Germany
| | - J Turner Vosseller
- Jacksonville Orthopaedic Institute, San Marco Blvd, Jacksonville, FL, 32207, USA
| | - Sebastian Hardt
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117, Berlin, Germany
| | - Carsten Perka
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117, Berlin, Germany
| | - Henrik C Bäcker
- Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Chariteplatz 1, 10117, Berlin, Germany.
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8
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Hastie GR, Collinson SC, Aqil A, Basu S, Temperley DE, Board TN, Wynn-Jones H. Study to Assess the Rate of Adverse Reaction to Metal Debris in Hip Resurfacing at a Minimum 13-year Follow-up. J Arthroplasty 2021; 36:1055-1059. [PMID: 33183915 DOI: 10.1016/j.arth.2020.09.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hip Resurfacing (HR), although reducing in popularity, is still used in the younger male population. Excellent medium-term results have been published; however, the use of metal on metal has reduced with increased awareness of adverse reactions to metal debris (ARMD). ARMD has been shown to often be clinically "silent" following large Head MoM total hip replacement (THR). The purpose of our study was to report the incidence of ARMD following HR with a minimum follow-up of 13 years. METHODS We performed a retrospective study of a consecutive series of patients who underwent HR between January 1, 2000 and August 1, 2005. All patients were entered into our hospital MoM hip replacement surveillance program database. Patients were reviewed yearly for symptoms and blood ion levels. Patients had Magnetic Resonance (MR) imaging to assess for ARMD. RESULTS A total of 102 patients with 123 hip replacements were included in the study. Eight hips in 7 patients were revised: two for fracture, one for avascular necrosis, and five for ARMD. A best-case scenario of 109 (93.2%) resurfacings were surviving at 13 years. With regard to the radiological analysis, 34% were found to have ARMD on MR. CONCLUSION While the implant survivorship in our series is acceptable, we found a high incidence of ARMD. Surgeons and patients with or considering a HR should be aware of the risk of ARMD developing. This allows an informed choice as to the best implant for their personal requirement and informs of the potential modes of failure and need for long-term screening.
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Affiliation(s)
- Graham R Hastie
- Wigan and Leigh NHS Trust, Wrightington Hospital, Wigan, United Kingdom, WN6 9EP
| | - Sophie C Collinson
- Wigan and Leigh NHS Trust, Wrightington Hospital, Wigan, United Kingdom, WN6 9EP
| | - Adeel Aqil
- Wigan and Leigh NHS Trust, Wrightington Hospital, Wigan, United Kingdom, WN6 9EP
| | - Subhasis Basu
- Wigan and Leigh NHS Trust, Wrightington Hospital, Wigan, United Kingdom, WN6 9EP
| | - David E Temperley
- Wigan and Leigh NHS Trust, Wrightington Hospital, Wigan, United Kingdom, WN6 9EP
| | - Timothy N Board
- Wigan and Leigh NHS Trust, Wrightington Hospital, Wigan, United Kingdom, WN6 9EP
| | - Henry Wynn-Jones
- Wigan and Leigh NHS Trust, Wrightington Hospital, Wigan, United Kingdom, WN6 9EP
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9
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Burapachaisri A, Elbuluk A, Abotsi E, Pierrepont J, Jerabek SA, Buckland AJ, Vigdorchik JM. Lewinnek Safe Zone References are Frequently Misquoted. Arthroplast Today 2020; 6:945-953. [PMID: 33299915 PMCID: PMC7701843 DOI: 10.1016/j.artd.2020.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/13/2020] [Accepted: 09/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Optimal acetabular component orientation in total hip arthroplasty (THA) is a necessity in achieving a stable implant. Although there has been considerable debate in the literature concerning the safe zone, to date, there has not been any review to determine if these references are consistent with the definition applied by Lewinnek et al. in 1978. Therefore, this article aims to examine the available literature in the PubMed database to determine how often a correct reference to the safe zone as defined by Lewinnek was applied to discussions regarding THA. METHODS A search for literature in the PubMed database was performed for articles from 1978 to 2019. Search criteria included terms 'Lewinnek,' 'safe zone,' and 'total hip arthroplasty.' Exclusions included abstract-only articles, non-English articles, articles unrelated to THA, and those lacking full content. RESULTS A review of literature yielded 147 articles for inclusion. Overall, only 11% (17) cited the Lewinnek article correctly. Forty-five percent (66) of articles referenced measurements in the supine position, 18% (26) referenced other positions, and 37% (55) did not specify. Nineteen percent (28) reported measurements of the acetabular cup orthogonal to the anterior pelvic plane, while 73% (108) did not, and 7% (11) did not specify. Twenty-three percent (34) measured from computed tomography scans instead of other methods. CONCLUSIONS In the discussion of the safe zone regarding THA, only 11% of articles listed are consistent with the definition established by Lewinnek. This warrants further investigation into a consistent application of the term and its implications for THA implant stability and dislocation rates.
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Affiliation(s)
- Aonnicha Burapachaisri
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Ameer Elbuluk
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Edem Abotsi
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Jim Pierrepont
- Chief Innovation Officer, Corin Group, New South Wales, Australia
| | - Seth A. Jerabek
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Aaron J. Buckland
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Jonathan M. Vigdorchik
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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10
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Zhao JX, Su XY, Zhao Z, Xiao RX, Zhang LC, Tang PF. Radiographic assessment of the cup orientation after total hip arthroplasty: a literature review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:130. [PMID: 32175423 DOI: 10.21037/atm.2019.12.150] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Optimal acetabular cup orientation is of substantial importance to good long-term function and low complication rates after total hip arthroplasty (THA). The radiographic anteversion (RA) and inclination (RI) angles of the cup are typically studied due to the practicability, simplicity, and ease of interpretation of their measurements. A great number of methods have been developed to date, most of which have been performed on pelvic or hip anteroposterior radiographs. However, there are primarily two influencing factors for these methods: X-ray offset and pelvic rotation. In addition, there are three types of pelvic rotations about the transverse, longitudinal, and anteroposterior axes of the body. Their effects on the RA and RI angles of the cup are interactively correlated with the position and true orientation of the cup. To date, various fitted or analytical models have been established to disclose the correlations between the X-ray offset and pelvic rotation and the RA and RI angles of the cup. Most of these models do not incorporate all the potential influencing parameters. Advanced methods for performing X-ray offset and pelvic rotation corrections are mainly performed on a single pelvic AP radiograph, two synchronized radiographs, or a two-dimensional/three-dimensional (2D-3D) registration system. Some measurement systems, originally developed for evaluating implant migration or wear, could also be used for correcting the X-ray offset and pelvic rotation simultaneously, but some drawbacks still exist with these systems. Above all, the 2D-3D registration technique might be an alternative and powerful tool for accurately measuring cup orientation. In addition to the current methods used for postoperative assessment, navigation systems and augmented reality are also used for the preoperative planning and intraoperative guidance of cup placement. With the continuing development of artificial intelligence and machine learning, these techniques could be incorporated into robot-assisted orthopaedic surgery in the future.
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Affiliation(s)
- Jing-Xin Zhao
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Xiu-Yun Su
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,Intelligent and Digital Surgery Innovation Center, Southern University of Science and Technology Hospital, Shenzhen, Guangdong 518055, China
| | - Zhe Zhao
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Ruo-Xiu Xiao
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Li-Cheng Zhang
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Pei-Fu Tang
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
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11
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Scarlat MM. Quality of publications in "International Orthopaedics" and projects for the near future. INTERNATIONAL ORTHOPAEDICS 2018; 42:2735-2736. [PMID: 30478626 DOI: 10.1007/s00264-018-4244-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Marius M Scarlat
- Clinique St Michel, Toulon, France. .,Groupe ELSAN, Paris, France.
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