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Chai Y, Boudali AM, Khadra S, Dasgupta A, Maes V, Walter WL. Evaluating Pelvic Tilt Using the Pelvic Antero-Posterior Projection Images: A Systematic Review. J Arthroplasty 2024; 39:1108-1116.e2. [PMID: 37871860 DOI: 10.1016/j.arth.2023.10.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Pelvic tilt (PT) is a routinely evaluated parameter in hip and spine surgeries, and is usually measured on a sagittal pelvic radiograph. This may not always be feasible due to limitations such as landmark visibility, pelvic anomaly, and hardware presence. Tremendous efforts have been dedicated to using pelvic antero-posterior (AP) radiographs for assessing sagittal PT. Thus, this systematic review aimed to collect these methods and evaluate their performances. METHODS Two independent reviewers searched the PubMed, Ovid, Cochrane, and Web of Science databases in June 2023 with backward reference trailing (Google Scholar archive). There were 30 studies recruited. Risk of bias was assessed using the prediction model risk of bias assessment tool. The relevant data were tabulated in a standardized form for evaluating either the absolute PT or relative PT. Disagreement was resolved by discussing with the senior author. RESULTS There were 19 parameters from pelvic AP projection images involved, with 4 studies which used artificial intelligence, eyeball, or statistical shape method not involving a specific parameter. In comparing the PT values from pelvic sagittal images with those extrapolated from antero-posterior projection images, the highest correlation coefficient was found to be 0.91. The mean absolute difference (error) was 2.6°, with a maximum error reaching 10.9°. Most studies supported the feasibility of using AP parameters to calculate changes in PT. CONCLUSIONS No individual AP parameter was found to precisely estimate absolute PT. However, relative PT can be derived by evaluating serial AP radiographs of a patient in varying postures, employing any AP parameters.
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Affiliation(s)
- Yuan Chai
- Sydney Musculoskeletal Health and The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health and the Northern Sydney Local Health District, The University of Sydney, Sydney, New South Wales, Australia
| | - A Mounir Boudali
- Sydney Musculoskeletal Health and The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health and the Northern Sydney Local Health District, The University of Sydney, Sydney, New South Wales, Australia
| | - Sam Khadra
- Faculty of Medicine and Health, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Amrita Dasgupta
- Faculty of Medicine and Health, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Vincent Maes
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia; Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - William L Walter
- Sydney Musculoskeletal Health and The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health and the Northern Sydney Local Health District, The University of Sydney, Sydney, New South Wales, Australia; Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
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2
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Zinner M, Schroeder L, Pumilia CA, Lee EK, Martin G. THA with Use of Patient-Specific Resurfacing Jigs and a Novel Customized Implant Design. JBJS Rev 2022; 10:01874474-202205000-00008. [PMID: 36995410 DOI: 10.2106/jbjs.rvw.21.00078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Conventional total hip arthroplasty (THA) largely remains an unguided procedure dependent on the ability and experience of the surgeon. New technologies, such as patient-specific instrumentation and robotics, have shown promising results in improving implant positioning, which has the potential to improve patient outcomes. » The use of off-the-shelf (OTS) implant designs, however, limits the success of the technological advances since they are unable to recreate the native anatomy of the joint. The inability to restore femoral offset and version or the presence of implant-related leg-length discrepancies often lead to suboptimal surgical results that increase the risk of dislocation, fractures, and component wear, compromising postoperative functional outcomes and implant longevity. » A customized THA system, whereby the femoral stem is designed to restore patient anatomy, has recently been introduced. The THA system uses computed tomography (CT)-derived 3D imaging to create a custom stem, patient-specific component placement, and patient-specific instrumentation that matches the patient's native anatomy. » The purpose of this article is to provide information on the design and manufacturing process of this new THA implant, to illustrate the associated preoperative planning, and to describe the surgical technique; 3 surgical cases are presented.
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Affiliation(s)
- Matthew Zinner
- Charles E. Schmidt College of Medicine, Boca Raton, Florida
| | - Lennart Schroeder
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Cyrus A Pumilia
- College of Medicine, University of Central Florida, Orlando, Florida
| | - Eric K Lee
- Department of Orthopedic Surgery, Personalized Orthopaedics of the Palm Beaches, Boynton Beach, Florida
| | - Gregory Martin
- College of Medicine, University of Central Florida, Orlando, Florida
- Department of Orthopedic Surgery, Personalized Orthopaedics of the Palm Beaches, Boynton Beach, Florida
- University of Miami Leonard M. Miller School of Medicine, Miami, Florida
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3
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Sako N, Kaku N, Kitahara Y, Kubota Y, Tagomori H, Tsumura H. Three-Dimensional Evaluation of Innominate Bone Rotation in Female Patients with Developmental Dysplasia of the Hip. Clin Orthop Surg 2022; 14:196-204. [PMID: 35685970 PMCID: PMC9152894 DOI: 10.4055/cios21032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/11/2022] Open
Abstract
Background Patients with developmental dysplasia of the hip (DDH) are known to have abnormal pelvic morphologies; however, rotation of innominate bone features remains unclear. Thus, we investigated innominate bone rotation in patients with DDH by measuring the associated angles and distances using three-dimensional (3D) computed tomography. Methods We defined four straight lines in pelvic 3D models: from the anterior superior iliac spine to the posterior superior iliac spine, from the anterior inferior iliac spine to the posterior inferior iliac spine, from the pubic tubercle to the ischial spine, and from the pubic tubercle to the ischial tuberosity. Similarly, we measured the angles formed by these lines using the vertical axis of the anterior pelvic plane on the horizontal plane and the horizontal axis on the sagittal plane. Additionally, we measured the distances between the femoral head centers and the acetabular centers in the coronal plane. Results The difference in internal rotation angle between the superior and inferior parts of the iliac bone was significantly lower, by approximately 1.7°, in the DDH group than in the control group (p = 0.007); the difference between the inferior and superior parts of the ischiopubic bone was significantly higher, by approximately 1.5°, in the DDH group (p < 0.001). In the sagittal plane, the sum of the superior aspect of the iliac bone and the inferior aspect of the ischium was significantly lower in the DDH group (p = 0.001) than in the control group. The distances between the femoral heads and the acetabula were significantly greater in the DDH group than in the control group (p = 0.03, p < 0.01, respectively). Conclusions Patients with DDH had a more internally rotated ilium and ischiopubic bone than normal individuals; however, it should be emphasized that internal rotation was reduced near the acetabulum, and the acetabulum was shifted laterally. Similarly, it was shown that patients with DDH had different rotations of the ilium and ischiopubic bone in the sagittal plane.
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Affiliation(s)
- Noriaki Sako
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Nobuhiro Kaku
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Yoshiki Kitahara
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Yuta Kubota
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroaki Tagomori
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroshi Tsumura
- Department of Orthopedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
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4
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Tetsunaga T, Yamada K, Tetsunaga T, Furumatsu T, Sanki T, Kawamura Y, Ozaki T. Comparison of the accuracy of CT- and accelerometer-based navigation systems for cup orientation in total hip arthroplasty. Hip Int 2021; 31:603-608. [PMID: 32019376 DOI: 10.1177/1120700020904940] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The accuracies of various navigation systems in total hip arthroplasty (THA) have been described; however, the accuracy of cup orientation with an accelerometer-based navigation system has not been reported. The purpose of this study was to compare the accuracies of computed tomography (CT)- and accelerometer-based navigation systems for cup orientation in THA. METHODS In this prospective study, 30 patients who underwent cementless THA via anterolateral approach in the lateral decubitus position were analysed. A CT-based navigation system (30 hips) and an accelerometer-based navigation system (30 hips) were used simultaneously. The accuracy of cup orientation (absolute difference between intraoperative vs. postoperative measurements) was compared between the navigation systems using postoperative CT. RESULTS The accuracy of cup inclination was 3.2 ± 2.4° in the CT-based navigation group and 4.1 ± 3.7° in the accelerometer-based navigation group (p = 0.3035). The accuracy of cup anteversion was 3.0° ± 2.5° in the CT-based navigation group and 6.8° ± 4.8° in the accelerometer-based navigation group. Cup anteversion was significantly more accurate with the CT-based navigation system than with accelerometer-based navigation (p = 0.0009). Multiple regression analysis demonstrated that the malposition in cup anteversion was positively correlated with the change in pelvic tilt and loosening of the reference antenna. CONCLUSIONS Although, these results are only true for this specific accelerometer system, cup positioning was significantly more accurate with the CT-based navigation system than an accelerometer-based navigation in the lateral decubitus position. This is because of considerable discrepancies in the sagittal pelvic tilt, resulting in variability in cup anteversion angle with the use of an accelerometer-based navigation system.
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Affiliation(s)
| | - Kazuki Yamada
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
| | - Tomoko Tetsunaga
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
| | | | - Tomoaki Sanki
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
| | - Yoshi Kawamura
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
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Takada R, Jinno T, Miyatake K, Watanabe N, Koga H, Yoshii T, Okawa A. Difference in tapered wedge stem alignment between supine and lateral position in cementless total hip arthroplasty via modified Watson-Jones anterolateral approach. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:497-503. [PMID: 34021789 DOI: 10.1007/s00590-021-03001-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Whether different body positions during surgery affect postoperative stem alignment in total hip arthroplasty (THA) remains unclear. The purpose of this study was to clarify differences in tapered wedge stem alignment between supine and lateral positions in THA under the modified Watson-Jones anterolateral approach. METHODS We reviewed 242 consecutive, primary cementless THAs performed with ceramic-on-cross-linked polyethylene via the modified Watson-Jones approach in either supine or lateral positions between 2009 and 2015 (supine group: 113 cases; lateral group: 129 cases). No specific reasons to select supine or lateral positions for the surgery were given during the study period. Computed tomography was performed pre- and postoperatively to measure preoperative femoral anteversion and postoperative stem anteversion, respectively. Stem alignment in coronal and sagittal planes was also evaluated. RESULTS Mean difference in stem anteversion and femoral anteversion was 8.6 ± 9.4 in the supine position and 13.0 ± 11.4 in the lateral position (p = 0.0013). Although no significant difference was seen between groups for stem alignment in the coronal plane, flexed implantation was more likely in the supine group (46/113, 40.7%) than in the lateral group (20/129, 15.5%). A significant correlation was found between femoral anteversion and stem anteversion in both the supine and lateral groups (r = 0.68, p < 0.0001 and r = 0.52, p < 0.0001, respectively). CONCLUSION Although stem anteversion was more strongly correlated with femoral anteversion in the supine position than in the lateral position, neutral position in the sagittal plane was more likely to be found with the lateral position than with the supine position. Surgeons can achieve ideal stem positioning by considering these results in the modified Watson-Jones approach in both the supine and lateral positions.
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Affiliation(s)
- Ryohei Takada
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kazumasa Miyatake
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Naoto Watanabe
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hideyuki Koga
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Reichert B. Bestimmung einer Beckenasymmetrie – Sinn oder Unsinn. MANUELLE MEDIZIN 2021. [DOI: 10.1007/s00337-020-00703-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ZusammenfassungPathologien des tiefen Rückens, der Becken- sowie Knie- und Hüftgelenke werden immer wieder mit einer Messung der Beinlänge und Feststellung einer Beckenasymmetrie in Verbindung gebracht. Aufgrund dieser Messungen werden therapeutische Wege eingeschlagen. Zu diesem Thema wurden auf der Basis einer systematischen Literatursuche in zwei maßgeblichen Datenbanken 28 Artikel ermittelt. Die inhaltliche Analyse beschäftigt sich v. a. mit der Variationsanatomie des Beckens sowie der Reliabilität palpatorischer und apparativer Bestimmungen von knöchernen Referenzpunkten am Becken. Hieraus ergeben sich maßgebliche Erkenntnisse: Eine Variationsanatomie des Beckens ist häufig und kommt auch bei nichtsymptomatischen Personen vor. Die palpatorische und apparative Bestimmungen der knöchernen Referenzpunkte sind gering bis moderat reliabel. Der Rückschluss von einer festgestellten Beckenasymmetrie auf den Einfluss bestehender oder noch zu erwartender Rücken‑, Hüft- oder Beckengelenkbeschwerden ist nach derzeitiger Studienlage zumindest umstritten und daher nicht empfehlenswert.
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7
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Stadnyk M, Liu T, Arezodar FF, Westover L, Carvajal Alba JA, Masson E, Beaupre L, Jaremko JL, El-Rich M. Analysis of four methods of measuring three-dimensional pelvic tilt in the lateral decubitus position. Med Biol Eng Comput 2020; 58:2387-2396. [PMID: 32725540 DOI: 10.1007/s11517-020-02235-4] [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: 11/26/2019] [Accepted: 07/18/2020] [Indexed: 11/29/2022]
Abstract
Proper alignment of acetabular implantation is necessary for good patient outcomes and preventing complications or additional surgeries in total hip arthroplasty (THA). Rotation of the pelvis in lateral decubitus (LD) is typically not accounted for as surgeons use the surgery table as a reference plane to align implants. This study compared four techniques to measure 3D pelvic rotations in LD position using computer models. CT scans of 19 subjects in LD position were used to create 3D pelvis models. Pelvic rotations were measured by three users using four techniques: landmark (LM), defined plane (DP), anterior pelvic plane (APP), and plane of best symmetry (POBS) methods. Measurements were analysed for intra-user reliability and relationships between methods were assessed using intraclass correlation coefficient, standard error of measurement, and coefficient of determination. The POBS method exhibited the highest inter-observer reliability and is recommended as a new measurement technique to measure pelvic rotations before THA surgery. The LM method exhibited low reliability but may be suitable for expert users familiar with pelvic landmarks. The APP method should only be used when the patients' APP planes are known in neutral standing and side-lying postures. The DP method is not recommended due to substantial individual variability. Graphical abstract.
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Affiliation(s)
- Meredith Stadnyk
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Tao Liu
- Department of Mechanical Engineering, University of Alberta, Edmonton, Canada.,Healthcare Engineering Innovation Center, Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | - Lindsey Westover
- Department of Mechanical Engineering, University of Alberta, Edmonton, Canada
| | | | - Edward Masson
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Lauren Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Marwan El-Rich
- Healthcare Engineering Innovation Center, Department of Mechanical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates.
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Tetsunaga T, Yamada K, Tetsunaga T, Sanki T, Kawamura Y, Ozaki T. An accelerometer-based navigation system provides acetabular cup orientation accuracy comparable to that of computed tomography-based navigation during total hip arthroplasty in the supine position. J Orthop Surg Res 2020; 15:147. [PMID: 32295628 PMCID: PMC7161129 DOI: 10.1186/s13018-020-01673-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/03/2020] [Indexed: 11/21/2022] Open
Abstract
Background Inadequate acetabular component orientation is associated with postoperative impingement, dislocation, and accelerated polyethylene wear. Computed tomography (CT)-based navigation systems provide accuracy for total hip arthroplasty (THA) but are not available in all facilities. Accelerometer-based navigation systems are inexpensive, but their accuracy remains undetermined. This study compares the accuracy of cup orientation in THA using CT-based and accelerometer-based navigation systems. Methods This retrospective study included 35 consecutive patients (11 males, 24 females; mean age, 65 years) who underwent primary cementless THA via an anterolateral approach in the supine position. Both CT-based and accelerometer-based navigation systems were used simultaneously. The accuracy of cup orientation was compared between the two systems using postoperative CT. Results The accuracy of cup inclination was 2.7° ± 2.0° in the CT-based group and 3.3° ± 2.4° in the accelerometer-based group. The accuracy of cup anteversion was 2.8° ± 2.6° in the CT-based group and 3.4° ± 2.2° in the accelerometer-based group. No significant difference was observed in cup inclination (p = 0.29) or cup anteversion (p = 0.34) between CT-based and accelerometer-based navigation. Conclusions The accuracy of cup positioning did not differ significantly between CT-based and accelerometer-based navigation systems.
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Affiliation(s)
- Tomonori Tetsunaga
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
| | - Kazuki Yamada
- Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Tomoko Tetsunaga
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Tomoaki Sanki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yoshi Kawamura
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
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9
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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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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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Snaith B, Field L, Lewis EF, Flintham K. Variation in pelvic radiography practice: Why can we not standardise image acquisition techniques? Radiography (Lond) 2019; 25:374-377. [PMID: 31582247 DOI: 10.1016/j.radi.2019.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Pelvic radiographs remain an essential investigation in orthopaedic practice. Although it is recognised that acquisition techniques can affect image appearances and measurement accuracy, it remains unclear what variation in practice exists and what impact this could have on decision making. METHOD This was a cross sectional survey of UK radiology departments utilising an electronic tool. An introductory letter and link was distributed. Responses were received from 69 unique hospital sites within the specified timeframe, a response rate of 37.9%. RESULTS There was no consistent technique for the positioning of patients for pelvic radiographs. The distance varied between 90 and 115 cm and 10 different centering points were described. In relation to leg position, the feet are usually internally rotated (65 of 69 [94.2%]). Only 1 teaching hospital (1 of 69 [1.4%]) uses a weight-bearing position as standard. Orthopaedic calibration devices were not in routine use, with only 21 using on pelvic x-rays (30.4%). Further, the type of device and application criteria were inconsistent. CONCLUSIONS To our knowledge this is the first study to directly compare radiographic positioning across hospital sites. Our data demonstrated marked variation in technique for pelvis radiographs with associated implications for clinical decision making. Research is required to determine the standard technique and quality outcome measures to provide confidence in diagnostic interpretation particularly for serial radiographs.
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Affiliation(s)
- B Snaith
- Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, UK; Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK.
| | - L Field
- Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, UK
| | - E F Lewis
- Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, UK
| | - K Flintham
- Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, UK
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Augustine AS, Ewen AM, Wallace DT, Picard F. Variations in pelvic dimensions: An anatomical and computed tomography study. Clin Anat 2018; 31:981-987. [PMID: 30203862 DOI: 10.1002/ca.23273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/17/2018] [Accepted: 08/22/2018] [Indexed: 11/09/2022]
Abstract
The anterior pelvic plane (APP) is a useful anatomical reference with both clinical and research applications in orthopedic surgery and rehabilitation medicine. It is used as a marker for computer-assisted total hip replacement and image-guided assessment of the hip center in clinical gait analysis. Despite its common use, no published data exist on the variations in height and width in an adult population. The aim of this study was to determine the range of dimensions for the anterior pelvic plane found in the Scottish adult population. Thirty-five human cadavers and 100 pelvic computed tomography (CT) scans were examined. Pelvic height and width were measured, and the ratios were determined. The mean width and height for combined cadaver and CT pelves were found to be 238.0 mm (SD 20.1, range 188.3-273.8) and 92.7 mm (SD 10.5, range 71.2-114.7), respectively. The mean width-to-height ratio for all pelves was 2.59 (SD 0.31, range 1.73-3.50). There were no statistically significant differences in means between males and females. The variations of APP dimensions within an adult population are presented. These will be of value in the validation of algorithms for computer navigation and hip joint center calculation in total hip arthroplasty and gait analysis. Furthermore, differences in dimensions between cadaveric and CT measurements have been shown which may have implications for further research and the validity of reference data dependent on data-point acquisition. Clin. Anat. 31:981-987, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Angelica S Augustine
- Golden Jubilee National Hospital, Clydebank, West Dunbartonshire, G81 4DY, United Kingdom
| | - Alistair M Ewen
- Golden Jubilee National Hospital, Clydebank, West Dunbartonshire, G81 4DY, United Kingdom
| | - David T Wallace
- Golden Jubilee National Hospital, Clydebank, West Dunbartonshire, G81 4DY, United Kingdom
| | - Frederic Picard
- Golden Jubilee National Hospital, Clydebank, West Dunbartonshire, G81 4DY, United Kingdom
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Gravity-Assisted Navigation System for Total Hip Arthroplasty. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018. [PMID: 30306482 DOI: 10.1007/978-981-13-1396-7_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
In this chapter we propose a new system that allows reliable acetabular cup placement in total hip arthroplasty (THA) when the surgery is operated in lateral approach. Conceptually it combines the accuracy of computer-generated patient-specific morphology information with an easy-to-use mechanical guide, which effectively uses natural gravity as the angular reference. The former is achieved by using a statistical shape model-based 2D-3D reconstruction technique that can generate a scaled, patient-specific 3D shape model of the pelvis from a single conventional anteroposterior (AP) pelvic X-ray radiograph. The reconstructed 3D shape model facilitates a reliable and accurate co-registration of the mechanical guide with the patient's anatomy in the operating theater. We validated the accuracy of our system by conducting experiments on placing seven cups to four pelvises with different morphologies. Taking the measurements from an image-free navigation system as the ground truth, our system showed an average accuracy of 2. 1 ± 0. 7∘ for inclination and an average accuracy of 1. 2 ± 1. 4∘ for anteversion.
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Muir JM, Vincent J, Schipper J, Govindarajan M, Paprosky WG. Evaluation of Tilt-correction of Anteversion on Anteroposterior Pelvic Radiographs in Total Hip Arthroplasty. Cureus 2018; 10:e2647. [PMID: 30034969 PMCID: PMC6051556 DOI: 10.7759/cureus.2647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Despite inaccuracies due to artifact and variations in patient positioning, anteroposterior (AP) radiographs remain the clinical standard for post-operative evaluation of component placement following total hip arthroplasty (THA). However, cup position, specifically anteversion, can be significantly affected by variations in patient positioning on an X-ray. A major cause of such artifact is unaccounted for pelvic tilt. Several methods for correcting the effects of pelvic tilt on radiographic anteversion have been proposed, with varying degrees of accuracy. The purpose of this study was to evaluate the accuracy and reliability of a commonly referenced method for correcting acetabular cup anteversion in a cohort undergoing total hip arthroplasty and determine its appropriateness for use in this population of patients. Radiographs from patients who underwent primary or revision hip arthroplasty between February 2016 and February 2017 were retrospectively reviewed. Corrected anteversion was calculated by measuring the vertical distance between the symphysis pubis and the sacrococcygeal joint, per the method outlined by Tannast et al. This symphococcygeal distance was then applied to Tannast’s nomograms to calculate the magnitude of pelvic tilt. Corrected and uncorrected anteversion values were compared to anteversion values collected intraoperatively using an imageless computer-assisted navigation device. A total of 71 cases were initially eligible for inclusion in the study. The correction method could not be applied in 44% (31/71) of the cases, chiefly due to difficulties in visualizing the required landmarks. In cases where it could be applied, corrected values correlated very poorly with navigation measurements (r = -0.07). Mean corrected anteversion (36.9°, SD: 7.4°) differed from uncorrected anteversion (25.2°, SD: 7.6°) by an average of 13.5° (p<0.001). Mean navigated anteversion (27.4°, SD: 5.7°) differed from corrected values by an average of 10.8° (p=0.16). The evaluated correction method could not be consistently applied to radiographs and did not reliably correct anteversion due to pelvic tilt in this population of patients undergoing hip arthroplasty. This correction method does not appear to be appropriate for use in this patient population.
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Affiliation(s)
| | - John Vincent
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo
| | | | - Meinusha Govindarajan
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo
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A surface-based approach to determine key spatial parameters of the acetabulum in a standardized pelvic coordinate system. Med Eng Phys 2017; 52:22-30. [PMID: 29269225 DOI: 10.1016/j.medengphy.2017.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/20/2017] [Accepted: 11/22/2017] [Indexed: 11/20/2022]
Abstract
Accurately determining the spatial relationship between the pelvis and acetabulum is challenging due to their inherently complex three-dimensional (3D) anatomy. A standardized 3D pelvic coordinate system (PCS) and the precise assessment of acetabular orientation would enable the relationship to be determined. We present a surface-based method to establish a reliable PCS and develop software for semi-automatic measurement of acetabular spatial parameters. Vertices on the acetabular rim were manually extracted as an eigenpoint set after 3D models were imported into the software. A reliable PCS consisting of the anterior pelvic plane, midsagittal pelvic plane, and transverse pelvic plane was then computed by iteration on mesh data. A spatial circle was fitted as a succinct description of the acetabular rim. Finally, a series of mutual spatial parameters between the pelvis and acetabulum were determined semi-automatically, including the center of rotation, radius, and acetabular orientation. Pelvic models were reconstructed based on high-resolution computed tomography images. Inter- and intra-rater correlations for measurements of mutual spatial parameters were almost perfect, showing our method affords very reproducible measurements. The approach will thus be useful for analyzing anatomic data and has potential applications for preoperative planning in individuals receiving total hip arthroplasty.
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Can Surgeons Reduce the Risk for Dislocation After Primary Total Hip Arthroplasty Performed Using the Posterolateral Approach? J Arthroplasty 2017. [PMID: 28625687 DOI: 10.1016/j.arth.2017.04.047] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hip dislocation is one of the most common postoperative complications after total hip arthroplasty (THA). Potential contributors include patient- and surgical-related factors. We performed a retrospective cohort study to identify risk factors for postoperative dislocation in patients receiving THA via the posterolateral approach. METHODS We assessed 1326 consecutive primary THAs performed between 2010 and 2015. Patient information was documented, and plain radiographic films were used to evaluate cup positioning, hip offset, and hip length change. A multiple logistic regression was used to identify risk factors for dislocation. Follow-up was coordinated by the Danish National Patient Registry. RESULTS Age and American Society of Anesthesiologists scores were higher in dislocating THA compared with those in the nondislocating THA. Cup anteversion was less in dislocating THA compared with that in nondislocating THA. Independent risk factors for cup dislocation were increased age, body mass index <25 and >30 kg/m2, and leg shortening of >5 mm. CONCLUSION Surgeons should aim for a shortening of leg length <5 mm to reduce the risk of postoperative dislocation in primary THA. Although anteversion was reduced for dislocating THA, there is likely no universal safe zone for cup positioning. Hip stability is multifactorial, and optimal cup positioning may vary from patient to patient.
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Eschweiler J, Hawlitzky J, Quack V, Tingart M, Rath B. Biomechanical model based evaluation of Total Hip Arthroplasty therapy outcome. J Orthop 2017; 14:582-588. [PMID: 29033502 DOI: 10.1016/j.jor.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/19/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Total-hip-arthroplasties are performed to treat patients with osteoarthritis. Surgical planning is usually based on specific radiographs. These information could also be used as data for biomechanical modelling. METHODS Models are rarely used during clinical practice. Our aim was to analyze model-based the pre- and postoperatively hip-biomechanic. Pre- and postoperative X-rays of 30 patients were examined by using 4 biomechanical-models. RESULTS The received results showed variations e.g. an increase and decrease of hip-load pre- and postoperative. CONCLUSION With the data of these models it would be possible to integrate the amplitude and orientation of the hip-joint-resultant-force into the therapeutical approach.
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Affiliation(s)
- Jörg Eschweiler
- Department for Orthopaedic Surgery, University Hospital RWTH Aachen, Germany
| | - Julia Hawlitzky
- Department for Orthopaedic Surgery, University Hospital RWTH Aachen, Germany
| | - Valentin Quack
- Department for Orthopaedic Surgery, University Hospital RWTH Aachen, Germany
| | - Markus Tingart
- Department for Orthopaedic Surgery, University Hospital RWTH Aachen, Germany
| | - Björn Rath
- Department for Orthopaedic Surgery, University Hospital RWTH Aachen, Germany
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Wang L, Thoreson AR, Trousdale RT, Morrey BF, Dai K, An KN. Radiographic cup anteversion measurement corrected from pelvic tilt. Med Eng Phys 2017; 49:103-108. [PMID: 28888787 DOI: 10.1016/j.medengphy.2017.08.008] [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: 10/19/2016] [Revised: 07/29/2017] [Accepted: 08/12/2017] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to develop a novel technique to improve the accuracy of radiographic cup anteversion measurement by correcting the influence of pelvic tilt. Ninety virtual total hip arthroplasties were simulated from computed tomography data of 6 patients with 15 predetermined cup orientations. For each simulated implantation, anteroposterior (AP) virtual pelvic radiographs were generated for 11 predetermined pelvic tilts. A linear regression model was created to capture the relationship between radiographic cup anteversion angle error measured on AP pelvic radiographs and pelvic tilt. Overall, nine hundred and ninety virtual AP pelvic radiographs were measured, and 90 linear regression models were created. Pearson's correlation analyses confirmed a strong correlation between the errors of conventional radiographic cup anteversion angle measured on AP pelvic radiographs and the magnitude of pelvic tilt (P < 0.001). The mean of 90 slopes and y-intercepts of the regression lines were -0.8 and -2.5°, which were applied as the general correction parameters for the proposed tool to correct conventional cup anteversion angle from the influence of pelvic tilt. The current method proposes to measure the pelvic tilt on a lateral radiograph, and to use it as a correction for the radiographic cup anteversion measurement on an AP pelvic radiograph. Thus, both AP and lateral pelvic radiographs are required for the measurement of pelvic posture-integrated cup anteversion. Compared with conventional radiographic cup anteversion, the errors of pelvic posture-integrated radiographic cup anteversion were reduced from 10.03 (SD = 5.13) degrees to 2.53 (SD = 1.33) degrees. Pelvic posture-integrated cup anteversion measurement improves the accuracy of radiographic cup anteversion measurement, which shows the potential of further clarifying the etiology of postoperative instability based on planar radiographs.
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Affiliation(s)
- Liao Wang
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, PR China; Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA
| | - Andrew R Thoreson
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA
| | | | - Bernard F Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Kerong Dai
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, PR China
| | - Kai-Nan An
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA .
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Davenport D, Kavarthapu V. Computer navigation of the acetabular component in total hip arthroplasty: a narrative review. EFORT Open Rev 2017; 1:279-285. [PMID: 28670481 PMCID: PMC5467635 DOI: 10.1302/2058-5241.1.000050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Total hip arthroplasty (THA) is a common procedure for primary osteoarthritis, but increasing numbers are also being performed for other pathologies such as secondary arthritis, inflammatory arthropathies and trauma. Estimates suggest that around 8.5 million people in the UK are affected by joint pain secondary to arthritis and a rising ageing population has resulted in an increase in THA operations of around 4% per year over the last six years. Multiple studies have shown that THA provides improved quality of life scores, but there remains the burden of complications which account for 15% of £1bn NHS liability payouts. DaPalma et al analysed the financial impact of complications following THA and found the additional cost of a dislocation within six weeks of surgery is 342% of the primary cost. Following primary THA, complications may occur as a result of incorrect component positioning of the femoral stem, the acetabular cup or both. It is known that acetabular malposition may lead to increased rates of dislocation, impingement, edge-loading, polyethylene wear, pelvic osteolysis and prosthesis failure. Acetabular component positioning has been described as the single most important factor in dictating risk of dislocation following THA. Furthermore, instability and dislocation after primary THA is the most common single reason for revision surgery accounting for 22.5% of all revisions and 33% of acetabular revisions. We outline the currently available methods of acetabular navigation comparing freehand techniques with computer and robotic-assisted navigation of the acetabular component.
Cite this article: Davenport D, Kavarthapu V. Computer navigation of the acetabular component in total hip arthroplasty: a narrative review. EFORT Open Rev 2016;1:279-285. DOI: 10.1302/2058-5241.1.000050.
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Affiliation(s)
- Dominic Davenport
- Department of Trauma & Orthopaedics, Princess Royal University Hospital & King's College Hospital, UK
| | - Venu Kavarthapu
- Department of Trauma & Orthopaedics, Princess Royal University Hospital & King's College Hospital, UK
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Haglin JM, Eltorai AEM, Gil JA, Marcaccio SE, Botero-Hincapie J, Daniels AH. Patient-Specific Orthopaedic Implants. Orthop Surg 2017; 8:417-424. [PMID: 28032697 DOI: 10.1111/os.12282] [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: 05/31/2016] [Accepted: 06/13/2016] [Indexed: 12/19/2022] Open
Abstract
Patient-specific orthopaedic implants are emerging as a clinically promising treatment option for a growing number of conditions to better match an individual's anatomy. Patient-specific implant (PSI) technology aims to reduce overall procedural costs, minimize surgical time, and maximize patient outcomes by achieving better biomechanical implant fit. With this commercially-available technology, computed tomography or magnetic resonance images can be used in conjunction with specialized computer programs to create preoperative patient-specific surgical plans and to develop custom cutting guides from 3-D reconstructed images of patient anatomy. Surgeons can then place these temporary guides or "jigs" during the procedure, allowing them to better recreate the exact resections of the computer-generated surgical plan. Over the past decade, patient-specific implants have seen increased use in orthopaedics and they have been widely indicated in total knee arthroplasty, total hip arthroplasty, and corrective osteotomies. Patient-specific implants have also been explored for use in total shoulder arthroplasty and spinal surgery. Despite their increasing popularity, significant support for PSI use in orthopaedics has been lacking in the literature and it is currently uncertain whether the theoretical biomechanical advantages of patient-specific orthopaedic implants carry true advantages in surgical outcomes when compared to standard procedures. The purpose of this review was to assess the current status of patient-specific orthopaedic implants, to explore their future direction, and to summarize any comparative published studies that measure definitive surgical characteristics of patient-specific orthopaedic implant use such as patient outcomes, biomechanical implant alignment, surgical cost, patient blood loss, or patient recovery.
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Affiliation(s)
| | - Adam E M Eltorai
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Joseph A Gil
- Division of Spine Surgery, Department of Orthopaedic Surgery, Providence, Rhode Island, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Stephen E Marcaccio
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Alan H Daniels
- Division of Spine Surgery, Department of Orthopaedic Surgery, Providence, Rhode Island, USA.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Quantifying the Relationship Between the Transverse Acetabular Ligament and the Radiographic Teardrop. J Arthroplasty 2017; 32:296-299. [PMID: 27542856 DOI: 10.1016/j.arth.2016.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/28/2016] [Accepted: 07/01/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The transverse acetabular ligament (TAL) has been described as an anatomic landmark to guide in the positioning of the acetabular component during total hip arthroplasty. On plain films, the radiographic teardrop (RT) has similarly been used as a measure of appropriate cup positioning. The goal of this study is to quantify the distance and location between the anatomic TAL and RT landmarks to aid in the positioning of acetabular component. METHODS Sixteen randomly selected cadaveric pelvises (eight males, eight females) underwent dissection. Radiographic markers were placed bilaterally at the anteromedial insertions of the TAL, and true anteroposterior pelvic radiographs of the cadavers were obtained. Distances between the markers and the lateral borders of the RT were measured. RESULTS The mean distance between the anteromedial insertion of the TAL and the lateral border of the RT in the male specimens was 11.8 (99% confidence interval, 11.4-12.2) mm. In the female specimens, the TAL to RT distance was shorter, with a mean of 8.4 (99% CI, 7.2-9.6) mm. There was a statistically significant difference between male and female cadavers (P < .01). CONCLUSION The distance between the RT and TAL differs between males and females. Understanding the distance between these anatomic and radiographic landmarks should aid surgeons in obtaining a more accurate degree of acetabular component medialization and can serve as a guide to minimize overmedialization in order to achieve more accurate and reproducible placement of acetabular components during a total hip arthroplasty.
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Biomechanical evaluation contribution of the acetabular labrum to hip stability. Knee Surg Sports Traumatol Arthrosc 2016; 24:2338-45. [PMID: 25749654 DOI: 10.1007/s00167-015-3555-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Knowledge of the effect of hip pathologies on hip biomechanics is important to the understanding of the development of osteoarthritis, and the contribution of the labrum to hip joint stability has had limited study. The purpose of this study was to evaluate the effect of labral injury to stability of the femoral head in the acetabular socket. METHODS Ten cadaver hip specimens were tested using a robotic system under four different loading conditions: axial loading (80 N) along the femoral axis and axial loading (80 N) combined with either anterior, posterior or lateral loading (60 N). The hip states were examined were intact, with a 1.5 cm capsulotomy and with a 1 cm resection of the anterosuperior labrum. RESULTS At 30° of flexion, under axial load, the displacement of the hip with capsulotomy and labral resection (9.6 ± 2.5 mm) was significantly larger then the hip with capsulotomy alone (5.6 ± 4.1 mm, p = 0.005) and the intact hip (5.2 ± 3.8 mm, p = 0.005). Also, at 30° of flexion, the displacement under combined axial and anterior/posterior load was increased with capsulotomy and labral resection. CONCLUSION The acetabular labrum provides stability to the hip joint in response to a distraction force and combined distraction and translation forces. One centimetre of labral resection caused significant displacement ("wobbling" effect) of the femoral head within the acetabulum with normal range of motion. Successful labral repair could be crucial for restoration of the hip biomechanics and prevention of coxarthrosis.
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MyHip: supporting planning and surgical guidance for a better total hip arthroplasty : A pilot study. Int J Comput Assist Radiol Surg 2015; 10:1547-56. [PMID: 25877209 DOI: 10.1007/s11548-015-1177-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Total hip arthroplasty (THA) aims to restore patient mobility by providing a pain-free and stable artificial joint. A successful THA depends on the planning and its execution during surgery. Both tasks rely on the experience of the surgeon to understand the complex biomechanical behavior of the hip. We investigate the hypothesis that a computer-assisted solution for THA effectively supports the preparation and execution of the planning. METHODS We devised MyHip as a computer-assisted framework for THA. The framework provides pre-operative planning based on medical imaging and optical motion capture to optimally select and position the implant. The planning considers the morphology and range of motion of the patient's hip to reduce the risk of impingements and joint instability. The framework also provides intra-operative support based on patient-specific surgical guides. We performed a post-operative analysis on three patients who underwent THA. Based on post-operative radiological images, we reconstructed a patient-specific model of the prosthetic hip to compare planned and effective positioning of the implants. RESULTS When the guides were used, we measured non-significant variations of planned executions such as bone cutting. Moreover, patients' hip motions were acquired and used in a dynamic simulation of the prosthetic hip. Conflicts prone to implant failure, such as impingements or subluxations, were not detected. CONCLUSIONS The results show that MyHip provides a promising computer assistance for THA. The results of the dynamic simulation highlighted the quality of the surgery and especially of its planning. The planning was properly executed since non-significant variations were detected during the radiological analysis.
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Standing or supine x-rays after total hip replacement - when is the safe zone not safe? Hip Int 2014; 24:616-23. [PMID: 25096454 DOI: 10.5301/hipint.5000173] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 02/04/2023]
Abstract
An acetabular prosthesis orientated outside the 'safe zone' is one of the key contributing factors in increasing complications after total hip replacement (THR). Although acetabular orientation is routinely assessed using supine x-rays, standing x-rays have been proposed because a change in body position alters pelvic tilt and therefore acetabular orientation. This study aimed to assess whether acetabular components orientated within the 'safe zone' in supine can also be outside the 'safe zone' in standing. Thirty patients (12M, 18F) had lateral and antero-posterior pelvic x-rays taken in standing and supine positions six weeks post THR. Pelvic tilt and acetabular orientation (anteversion and inclination) were measured and compared with respect to the limits of the 'safe zone'. In standing, the pelvis was relatively posteriorly tilted and both acetabular anteversion and inclination increased (p<0.0001). In 16 patients the acetabulum was orientated within the 'safe zone' in supine but outside the 'safe zone' in standing. Patients were significantly more likely to be outside the 'safe zone' in standing than when supine (p<0.0001).
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The reliability of the anterior pelvic plane for computer navigated acetabular component placement during total hip arthroplasty: prospective study with the EOS imaging system. Orthop Traumatol Surg Res 2014; 100:S287-91. [PMID: 25129705 DOI: 10.1016/j.otsr.2014.07.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 07/01/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Computer navigated total hip arthroplasty is mostly based on the use of the anterior pelvic plane (APP) as a reference. EOS is a new imaging system that provides three-dimensional analysis of the pelvis in a functional position with a low dose of radiation. The aim of this study was to evaluate the reliability of the APP for placement of the cup during computer navigated THA using EOS. HYPOTHESIS The reliability of the APP is limited for the placement of the acetabular cup during computer navigated THA. MATERIALS AND METHODS This was a prospective monocentric study using the EOS imaging system evaluating 44 patients in the standing position three months after computer navigated THA (Orthopilot). Reproducibility of EOS measurements were analyzed using SterEOS software and the reliability of the navigation data for the position of the cup were assessed. RESULTS Intra and interobserver reproducibility of the measurements of the orientation of the cup by EOS were good with correlation coefficients above 93% and 95% and confidence intervals of less than ±5°. Mean cup inclination and anteversion were 41.3° and 20.9° and 44.3° and 29.5° respectively in operatively and post-operatively. The differences between measurements of operative cup inclination using computer assisted navigation and the post-operative EOS measurements were significant (P<0.05) with a correlation coefficient of less than 40%. DISCUSSION Our study confirms the lack of precision of the APP as a reference for positioning of the acetabular component, especially in relation to anteversion. Although for many years the APP was considered to be a global reference, in fact, it is subject to significant inter-individual variations and variations during changes in position. These factors, associated with the difficulty of determining the preoperative APP, explain the lack of reliability of this reference. Preoperative evaluation of the orientation of APP by EOS and its integration into the navigation system could help the operator position these components. LEVEL OF EVIDENCE Level III Prospective diagnostic case controlled study.
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Small T, Krebs V, Molloy R, Bryan J, Klika AK, Barsoum WK. Comparison of acetabular shell position using patient specific instruments vs. standard surgical instruments: a randomized clinical trial. J Arthroplasty 2014; 29:1030-7. [PMID: 24231437 DOI: 10.1016/j.arth.2013.10.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/01/2013] [Accepted: 10/07/2013] [Indexed: 02/01/2023] Open
Abstract
Total hip arthroplasty (THA) survivorship relies largely upon appropriate acetabular cup placement. The purpose of this prospective randomized controlled trial was to determine whether the use of a preoperative 3D planning software in combination with patient specific instrumentation (PSI) results in improved cup placement compared with traditional techniques. Thirty-six THA patients were randomized into standard (STD) or PSI technique. Standard approach was completed using traditional techniques, while PSI cases were planned and customized surgical instruments were manufactured. Postoperative CT scans were used to compare planned to actual results. Differences found between planned and actual anteversion were -0.2° ± 6.9° (PSI) and -6.9°±8.9° (STD) (P = 0.018). Use of 3D preoperative planning along with PSIs resulted in significantly greater anteversion accuracy than traditional planning and instrumentation.
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Affiliation(s)
- Travis Small
- Department of Orthopaedic Surgery, Cleveland Clinic-A41, Cleveland, Ohio
| | - Viktor Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic-A41, Cleveland, Ohio
| | - Robert Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic-A41, Cleveland, Ohio
| | - Jason Bryan
- Department of Orthopaedic Surgery, Cleveland Clinic-A41, Cleveland, Ohio
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic-A41, Cleveland, Ohio.
| | - Wael K Barsoum
- Department of Orthopaedic Surgery, Cleveland Clinic-A41, Cleveland, Ohio
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Reikerås O, Gunderson RB. Acetabular component anteversion in primary and revision total hip arthroplasty: an observational study. Open Orthop J 2013; 7:600-4. [PMID: 24133555 PMCID: PMC3795404 DOI: 10.2174/1874325001307010600] [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: 03/05/2013] [Revised: 06/18/2013] [Accepted: 06/23/2013] [Indexed: 11/22/2022] Open
Abstract
PURPOSE In a prospective manner to evaluate the range of acetabular component anteversion actually achieved by the use of a cup positioner in cementless revision and primary THA. METHODS We operated 71 patients with cementless primary THA, and 26 patients with cementless acetabular revision surgery. We aimed to obtain cup anteversion of 10 to 30° with an impactor-positioner. In all cases we used elevated liners and a ceramic head with diameter 28. At 3 months postoperatively the component versions were measured using CT with the patient in supine position. RESULTS The acetabular component version in the primary hips ranged from 28° of retroversion to 42° of anteversion with a mean of 17.4 ± 14.0°, while the cup version in the revision hips ranged from 4° of retroversion to 32° of anteversion with a mean of 15.0 ± 9.6°(p=0.427). The anteversion of 40 (56%) of the primary acetabular components were within the target zone of 10 to 30°, while 19 (27%) were below the target zone and and 12 (17%) were above the target range. The anteversion of 19 (73%) of the revision acetabular components were within the target zone, while 6 (23%) were below the target zone and 1 (4%) were above the target range. The differences in distribution between the primary and revision operations were not significant (p=0.183). CONCLUSIONS The intraoperative estimation of acetabular anteversion by free hand technique in many cases was not within the intended range of 10 to 30° in either primary or revision THA and with no differences between the two series.
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Jeffers JRT. The role of biomechanics and engineering in total hip replacement. Why surgeons need technical help. Proc Inst Mech Eng H 2013; 226:947-54. [PMID: 23636958 DOI: 10.1177/0954411912445735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Implanting the acetabular cup of hard-on-hard bearings, like metal-on-metal or ceramic-on-ceramic, requires considerable surgeon skill to avoid the complications associated with edge loading. Successful cup positioning instruments have been designed in the past by pioneering surgeons, like Peter Ring and Michael Freeman, and these are re-visited in this article. An advantage of these instruments is that they could position the acetabular cup without defining a reference pelvic plane. Computer-assisted cup orientation is able to reduce outliers in cup orientation, but the technology has not been widely adopted. There may be an opportunity to improve the uptake of computer-assisted surgery by incorporating some of the concepts from historically successful manual instruments.
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Amiri S, Masri BA, Garbuz D, Anglin C, Wilson DR. A multiplanar radiography method for assessing cup orientation in total hip arthroplasty. J Biomech Eng 2013; 134:101008. [PMID: 23083199 DOI: 10.1115/1.4007664] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Correct orientation of the acetabular cup considering patient-specific functional pelvic angles is an important factor for improving outcomes and avoiding complications after total hip arthroplasty. This study introduces a new, noninvasive radiographic tool for accurately determining a patient's specific pelvic tilt angle preoperatively, as well as accurately assessing acetabular cup orientation with respect to bony landmarks intraoperatively and postoperatively. The method was validated by imaging a bone replica model of the pelvis with implanted hip components, in comparison to digitized references, and verified with a cadaveric specimen. Pelvic tilt was measured with an accuracy of 0.1 deg and SD of 0.4 deg. Operative cup inclination and anteversion showed accuracies of 0.6 deg and 2.5 deg, with SD of 0.4 deg and 0.6 deg, respectively; these could be improved further by subtracting systematic bias. The method shows accuracy advantages over existing radiographic and fluoroscopic methods and exposes the subjects to a lower radiation dose compared to the similar computed tomography methods. These results suggest that the proposed method is feasible for assessing cup placement with reference to the functional and anatomical references. Furthermore, the ability to reference the same bony landmarks preoperatively, intraoperatively, and postoperatively has important research and clinical advantages.
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Affiliation(s)
- Shahram Amiri
- Department of Orthopaedics, Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
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Polkowski GG, Nunley RM, Ruh EL, Williams BM, Barrack RL. Does standing affect acetabular component inclination and version after THA? Clin Orthop Relat Res 2012; 470:2988-94. [PMID: 22610527 PMCID: PMC3462863 DOI: 10.1007/s11999-012-2391-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Avoiding complications after hip arthroplasty with hard-on-hard bearings, especially metal-on-metal, correlates with the position of the acetabular component. Supine imaging with conventional radiography has traditionally been utilized to assess component inclination (abduction), as well as anteversion, after THA and surface replacement arthroplasty (SRA). However, most adverse events with hard bearings (excessive wear and squeaking) have occurred with loading. Standing imaging, therefore, should provide more appropriate measurements. QUESTIONS/PURPOSES We determined whether standing changed standard measurements of acetabular component position using a novel biplanar imaging system compared to traditional supine imaging. METHODS We performed simultaneous biplanar standing imaging of the lower extremity with a novel imaging system using low radiation collimated beam on 46 patients who underwent THA (23) or SRA (23). Patients who had previously undergone THA had standard CT scans performed. For patients who underwent SRA, we compared acetabular inclination in the supine versus double-limb and single-limb standing. RESULTS Standing anteversion differed from supine anteversion by greater than 5° for 12 of 23 patients who underwent THA (range, 5°-16°). For patients who underwent SRA, 13 of 23 patients exhibited a difference of greater than 3° in inclination between supine and double-limb standing images, and six of 23 patients exhibited a difference of greater than 3° in inclination between supine and single-limb standing images. CONCLUSIONS Standing changed the acetabular inclination and version in a substantial percentage of patients undergoing hip arthroplasty.
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Affiliation(s)
- Gregory G. Polkowski
- Department of Orthopedic Surgery, New England Musculoskeletal Institute, University of Connecticut Health Center, Farmington, CT USA
| | - Ryan M. Nunley
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, Campus Box 8233, St Louis, MO 63110 USA
| | - Erin L. Ruh
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, Campus Box 8233, St Louis, MO 63110 USA
| | - Brandon M. Williams
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, Campus Box 8233, St Louis, MO 63110 USA
| | - Robert L. Barrack
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, Campus Box 8233, St Louis, MO 63110 USA
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Miyoshi H, Mikami H, Oba K, Amari R. Anteversion of the acetabular component aligned with the transverse acetabular ligament in total hip arthroplasty. J Arthroplasty 2012; 27:916-22. [PMID: 22153949 DOI: 10.1016/j.arth.2011.10.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 10/16/2011] [Indexed: 02/01/2023] Open
Abstract
In total hip arthroplasty (THA), accurately positioning the cup is crucial for achieving an adequate postoperative range of motion and stability. For 47 THA cases in which the inferomedial rim of the cup had been positioned parallel to the transverse acetabular ligament, we retrospectively performed the measurements of the radiographic cup anteversion angle relative to the anterior pelvic plane using 3-dimensional reconstruction computed tomography. The mean anteversion angle was 21.2°, with no significant difference detected in mean cup anteversion between the dysplastic hip group (15 hips) and the control group (15 hips). We suggest that the transverse acetabular ligament is a practical anatomical landmark for determining cup anteversion in THA for both dysplastic and nondysplastic hip cases.
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Affiliation(s)
- Hideaki Miyoshi
- Department of Orthopaedic Surgery, Oe-Kyodo Hospital, Tokushima, Japan
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Taki N, Mitsugi N, Mochida Y, Akamatsu Y, Saito T. Change in pelvic tilt angle 2 to 4 years after total hip arthroplasty. J Arthroplasty 2012; 27:940-4. [PMID: 22115765 DOI: 10.1016/j.arth.2011.10.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 10/06/2011] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to evaluate the change in pelvic tilt angle (PA) in the sagittal plane in the standing and supine positions for 2 to 4 years after total hip arthroplasty (THA). Anteroposterior pelvic radiographs of 21 male and 65 female patients were investigated before and after THA yearly over 2 to 4 years. Both the standing and supine PA significantly posteriorly tilted after THA. The difference in PA between the standing and supine positions (dPA) significantly increased after THA. Although the PA in the standing and supine positions plateaued 1 year after THA, the dPA gradually increased. In addition, the percentage of patients who showed a difference of more than 10° in dPA tended to increase yearly. In particular, elderly female patients who showed posterior tilt in PA in the standing or supine positions or a large dPA before THA tended to show a dPA of more than 10° after THA.
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Affiliation(s)
- Naoya Taki
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
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Ultrasound-based computer navigation of the acetabular component: a feasibility study. Arch Orthop Trauma Surg 2012; 132:517-25. [PMID: 22042088 DOI: 10.1007/s00402-011-1412-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Indexed: 10/16/2022]
Abstract
INTRODUCTION This feasibility study investigated the accuracy of anterior pelvic reference plane (APP) registration and acetabular cup orientation in two cadavers with different BMIs. METHOD Five observers each registered the APP five times in the 2 cadavers (BMIs: 32 kg/m(2) and 25 kg/m(2)) using an ultrasound-based navigation system. By comparison against the CT-derived reference landmarks, the errors in determining the individual landmarks defining the APP, as well as the resulting errors in the orientation of the APP and the acetabular cup orientation were determined. RESULTS Across all measurements obtained with the ultrasound navigation system, the errors in rotation and version in determining the APP were 0.5° ± 1.0° and -0.4° ± 2.0°, respectively. The cup abduction and anteversion errors determined from all measurements of the five investigators for both cadavers together were -0.1° ± 1.0° and -0.4° ± 2.7°, respectively. The data further demonstrated a high reproducibility of the measurements for the resulting cup adduction and anteversion angle. CONCLUSION Our preliminary results confirm that ultrasound navigation is a highly accurate tool that allows a reproducible registration of the APP and thereby enables accurate and precise intraoperative determination of the acetabular cup orientation also in patients with increased BMI.
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Wohlrab D, Radetzki F, Noser H, Mendel T. Cup positioning in total hip arthoplasty: spatial alignment of the acetabular entry plane. Arch Orthop Trauma Surg 2012; 132:1-7. [PMID: 21874577 DOI: 10.1007/s00402-011-1379-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Indexed: 02/09/2023]
Abstract
PURPOSE Correct cup positioning is one of the keys for successful total hip replacement. There are mechanical and computer assistant guides for correct cup positioning in the market. To optimize the cup positioning, the use of navigation systems is recommended. The aim of this study was to compare spatial orientation of the acetabulary entry plane in relation to tables plane which is used by mechanical guides as well as anterior pelvic plane used for cup orientation by navigation systems. METHODS CT raw data of 80 Caucasians (160 acetabuli) (done in supine position) with osteoartritic hips were collected. 3-D pelvic reconstruction was generated using Amira software (Visage Imaging Berlin, Germany). Anterior pelvic plane and acetabulary entry plane were defined by reliable anatomical landmarks. Spatial orientation were calculated by a custom made program code for the Amira software. RESULTS There were no differences between anterior pelvic plane and table's plane as well as spatial orientation of acetabulary entry plane of both acetabuli in relation to anterior pelvic plane or table's plane. Furthermore, there was no correlation between age, sex or body mass index and spatial orientation of the acetabulary entry plane as well. CONCLUSIONS The use of mechanical alignment guides for cup orientation during total hip arthroplasty based on table's plane in patient's supine position is a successful method to achieve proper cup orientation.
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Affiliation(s)
- David Wohlrab
- Department of Orthopedic Surgery, Martin Luther University Halle-Wittenberg, Magdeburger Strasse 22, 06112 Halle (Saale), Germany.
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Zheng G, von Recum J, Nolte LP, Grützner PA, Steppacher SD, Franke J. Validation of a statistical shape model-based 2D/3D reconstruction method for determination of cup orientation after THA. Int J Comput Assist Radiol Surg 2011; 7:225-31. [DOI: 10.1007/s11548-011-0644-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 07/04/2011] [Indexed: 10/18/2022]
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Statistically Deformable 2D/3D Registration for Estimating Post-operative Cup Orientation from a Single Standard AP X-ray Radiograph. Ann Biomed Eng 2010; 38:2910-27. [DOI: 10.1007/s10439-010-0060-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2009] [Accepted: 04/30/2010] [Indexed: 10/19/2022]
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Zheng G, Zhang X. Computer assisted determination of acetabular cup orientation using 2D–3D image registration. Int J Comput Assist Radiol Surg 2010; 5:437-47. [DOI: 10.1007/s11548-010-0407-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 02/03/2010] [Indexed: 11/28/2022]
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Abstract
BACKGROUND AND PURPOSE Many studies have suggested that navigation-based implantation can improve cup positioning in total hip arthroplasty (THA). We conducted a systematic review and meta-analysis to compile the best available evidence, and to overcome potential shortcomings because of small sample sizes in individual studies. METHODS The search strategy covered the major medical databases from January 1976 through August 2007, as well as various publishers' databases. The internal validity of individual studies was evaluated independently by 3 reviewers. We used random-effects modeling to obtain mean differences in cup angulation and relative risk (RR) of cup positioning outside Lewinnek's safe zone. RESULTS Of 363 citations originally identified, 5 trials of moderate methodology enrolling a total of 400 patients were included in the analysis. Mean cup inclination and anteversion were not statistically significantly different between the conventional groups and the navigated groups. Navigation reduced the variability in cup positioning and the risk of placing the acetabular component beyond the safe zone (RR = 0.21, CI: 0.13-0.32). INTERPRETATION Based on the current literature, navigation is a reliable tool to optimize cup placement, and to minimize outliers. However, long-term outcomes and cost utility analyses are needed before conclusive statements can be drawn about the value of routine navigation in THA.
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Affiliation(s)
- Johannes Beckmann
- Department of Orthopedic Surgery, University of RegensburgBad AbbachGermany
| | - Dirk Stengel
- Depts f Trauma and Orthopaedic Surgery, Unfallkrankenhaus Berlin and University of GreifswaldGermany
| | - Markus Tingart
- Department of Orthopedic Surgery, University of RegensburgBad AbbachGermany
| | - Jürgen Götz
- Department of Orthopedic Surgery, University of RegensburgBad AbbachGermany
| | - Joachim Grifka
- Department of Orthopedic Surgery, University of RegensburgBad AbbachGermany
| | - Christian Lüring
- Department of Orthopedic Surgery, University of RegensburgBad AbbachGermany
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Zheng G. Assessing the accuracy factors in the determination of postoperative acetabular cup orientation using hybrid 2D-3D registration. J Digit Imaging 2009; 23:769-79. [PMID: 19626370 DOI: 10.1007/s10278-009-9226-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 05/24/2009] [Accepted: 06/23/2009] [Indexed: 11/29/2022] Open
Abstract
Single standard anteroposterior radiograph-based methods for measuring cup orientation following total hip arthroplasty (THA) are subject to substantial errors if the individual pelvic orientation with respect to X-ray plate is not taken into consideration. Previously, we proposed to use a hybrid 2D-3D registration scheme to determine the postoperative acetabular cup orientation and developed an object-oriented cross-program called "HipMatch." However, its accuracy and robustness have not been fully investigated. To assess the potential factors that may affect the accuracy and robustness of the hybrid 2D-3D registration scheme in determining the postoperative acetabular cup orientation, a comprehensive validation study using a cadaver pelvis was performed. Nine X-ray radiographs taken from different pelvic positions relative to the X-ray plate and two computed tomography volumes of the pelvis with one acquired before the cup implantation and the other acquired after the cup implantation were used in the validation study. Potential factors that may affect the accuracy and robustness of the hybrid 2D-3D registration scheme were experimentally determined. Our experimental results demonstrate that (1) the plain radiograph-based method is not accurate; (2) the hybrid 2D-3D registration scheme helps to improve the estimation accuracy; (3) the hybrid 2D-3D registration scheme can robustly and accurately estimate the cup orientation even when a big portion of the radiograph is occluded; and (4) image resolution has minor effect on the estimation accuracy. The hybrid 2D-3D registration scheme is an accurate and robust method to measure exact cup orientation in THA. It holds the promise to be a valuable tool for clinical routine usage for providing evidence-based information.
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Affiliation(s)
- Guoyan Zheng
- ARTORG Research Center-ISTB, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland.
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