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Zampogna B, Parisi FR, Zampoli A, Prezioso A, Vorini F, Laudisio A, Papalia M, Papapietro N, Falez F, Papalia R. Accuracy of two-dimensional digital planning in uncemented primary hip arthroplasty: monocentric analysis of eight hundred implants. INTERNATIONAL ORTHOPAEDICS 2024; 48:1979-1985. [PMID: 38622366 DOI: 10.1007/s00264-024-06172-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE In the last decades, there has been a refinement in total hip arthroplasty, which allowed surgeons to achieve the highest performance and better patient outcomes. Preoperative planning in primary hip arthroplasty is an essential step that guides the surgeon in restoring the anatomy and biomechanics of the joint. This study aims to evaluate the accuracy of the 2D digital planning, considering cup sizing, stem sizing, and limb length discrepancy. Additionally, we conducted a multivariable analysis of demographic data and comorbidities to find factors influencing preoperative planning. METHODS This retrospective study analyzed the planning accuracy in 800 consecutive uncemented primary total hip arthroplasty. We compared the preoperatively planned total hip arthroplasty with postoperative results regarding the planned component size, the implanted size, and the lower limb length restoration. Therefore, we investigated factors influencing planning accuracy: overweight and obesity, sex, age, past medical history, comorbidities, and implant design. All the surgeries were performed in the posterolateral approach by one expert surgeon who did the preoperative planning. The preoperative planning was determined to be (a) exact if the planned and the implanted components were the same size and (b) accurate if exact ± one size. The restoration of postoperative limb length discrepancy was classified into three groups: ± 3 mm, ± 5 mm, and ± 10 mm. This assessment was performed through a digital method 2D based on a standard hip X-ray. RESULTS This court of 800 implants showed that planning was exact in 60% of the cups and 44% of the stems and was accurate in 94% of the cups and 80% of the stems. The postoperative limb length discrepancy was ± 3 mm in 91% and ± 5 mm in 97%. CONCLUSIONS This study showed preoperative 2D digital planning great precision and reliability, and we demonstrated that it was accurate in 94% of the cups and 80% of the stems. Therefore, the preoperative limb length discrepancy analysis was essential to guarantee the recovery of the operated limb's correct length.
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Affiliation(s)
- Biagio Zampogna
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- BIOMORF Department, Biomedical, Dental and Morphological and Functional Images, University of Messina. A.O.U. Policlinico "G.Martino", Messina, Italy
| | - Francesco Rosario Parisi
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Andrea Zampoli
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Anna Prezioso
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Ferruccio Vorini
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Alice Laudisio
- Department of Medicine, Research Unit of Geriatrics, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Roma, Italy.
- Fondazione Policlinico Universitario Campus Bio-Medico, Operative Research Unit of Geriatrics, Via Alvaro del Portillo, 200, 00128, Roma, Italy.
| | - Matteo Papalia
- Orthopaedic and Traumatology Department, Nuova Itor Clinic, Rome, Italy
| | - Nicola Papapietro
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesco Falez
- Department of Orthopaedics and Traumatology, ASL Roma 1, S. Filippo Neri Hospital, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Mickley JP, Kaji ES, Khosravi B, Mulford KL, Taunton MJ, Wyles CC. Overview of Artificial Intelligence Research Within Hip and Knee Arthroplasty. Arthroplast Today 2024; 27:101396. [PMID: 39071822 PMCID: PMC11282426 DOI: 10.1016/j.artd.2024.101396] [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: 09/08/2023] [Revised: 03/14/2024] [Accepted: 04/02/2024] [Indexed: 07/30/2024] Open
Abstract
Hip and knee arthroplasty are high-volume procedures undergoing rapid growth. The large volume of procedures generates a vast amount of data available for next-generation analytics. Techniques in the field of artificial intelligence (AI) can assist in large-scale pattern recognition and lead to clinical insights. AI methodologies have become more prevalent in orthopaedic research. This review will first describe an overview of AI in the medical field, followed by a description of the 3 arthroplasty research areas in which AI is commonly used (risk modeling, automated radiographic measurements, arthroplasty registry construction). Finally, we will discuss the next frontier of AI research focusing on model deployment and uncertainty quantification.
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Affiliation(s)
- John P. Mickley
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth S. Kaji
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Bardia Khosravi
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Radiology Informatics Lab (RIL), Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Kellen L. Mulford
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Michael J. Taunton
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Cody C. Wyles
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Clinical Anatomy, Mayo Clinic, Rochester, MN, USA
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Schweizer C, Niggemeyer O, Jens JH, Junker M. Coxa valga and antetorta configuration leads to underestimation of the femoral component size: a matched case-control study of patients undergoing cementless total hip arthroplasty. Arch Orthop Trauma Surg 2024; 144:2859-2864. [PMID: 38743114 DOI: 10.1007/s00402-024-05373-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Total hip arthroplasty (THA) is the gold standard procedure for patients with end-stage osteoarthritis after failed conservative therapy. Digital templating is commonly employed in preoperative preparation for THA and contributes positively to its outcome. However, the impact of coxa valga and antetorta (CVA) configurations on stem size prediction accuracy remains not reported. Previous studies demonstrated that the size of the lesser trochanter (LT) can be used to determine femoral anteversion on pelvis radiographs. This study investigates the accuracy of preoperative digital templating in predicting stem size in patients with CVA undergoing cementless THA. METHODS Preoperative radiographs of 620 patients undergoing cementless THA were retrospectively investigated. Radiographs were standardized with patients standing and the leg internally rotated by 15°. A CVA group was established including patients with a CCD angle greater than 140° and a lesser trochanter (LT) size of at least 10 mm for men and 8 mm for women. For the control group, radiographs with a CCD angle ranging from 125-135° and LT size 3-10 mm for men and 3-8 mm for women were selected. Preoperative templating was performed using mediCAD. To reduce confounding factors, case-control matching was carried out for BMI and body height. RESULTS After case-control matching, a total of thirty-one matches were analyzed. Stem size was underestimated in 74% (23/31) in the CVA and 13% (4/31) in the control group (p < 0.001). Moreover, patients with CVA were more likely to be underestimated by two sizes compared to controls (p < 0.004). In contrast, the exact stem size was predicted more frequently in the control group (p < 0.001). CONCLUSION Stem size in patients with a CVA configuration are at high risk of being underestimated when using digital templating. These findings can be valuable for guiding in intraoperative decisions and lowering the risk of complications associated with an undersized femoral component.
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Affiliation(s)
- Conradin Schweizer
- Department of Orthopaedic Surgery, Tabea Hospital, Kösterbergstraße 32, 22587, Hamburg, Germany
| | - Oliver Niggemeyer
- Department of Orthopaedic Surgery, Tabea Hospital, Kösterbergstraße 32, 22587, Hamburg, Germany
- Department of Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Hauke Jens
- Department of Orthopaedic Surgery, Tabea Hospital, Kösterbergstraße 32, 22587, Hamburg, Germany
| | - Marius Junker
- Department of Orthopaedic Surgery, Tabea Hospital, Kösterbergstraße 32, 22587, Hamburg, Germany.
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Surroca M, Miguela S, Bartra-Ylla A, Nuñez JH, Angles-Crespo F. Surgeon's Experience and Accuracy of Preoperative Digital Templating in Primary Total Hip Arthroplasty. Hip Pelvis 2024; 36:129-134. [PMID: 38825822 PMCID: PMC11162868 DOI: 10.5371/hp.2024.36.2.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 06/04/2024] Open
Abstract
Purpose Preoperative planning has become essential in performance of total hip arthroplasty (THA). However, data regarding the effect of the planner's experience on the accuracy of digital preoperative planning is limited. The objective of this study was to assess the accuracy of digital templating in THA based on the surgeon's experience. Materials and Methods A retrospective study was conducted. An analysis of 98 anteroposterior pelvic radiographs, which were individually templated by four surgeons (two hip surgeons and two orthopaedic residents) using TraumaCad® digital planning, was performed. A comparison of preoperatively planned sizes with implanted sizes was performed to evaluate the accuracy of predicting component size. The results of preoperative planning performed by hip surgeons and orthopaedic residents were compared for testing of the planner's experience. Results Femoral stem was precisely predicted in 32.4% of cases, acetabular component in 40.3%, and femoral offset in 76.7%. Prediction of cup size showed greater accuracy than femoral size among all observers. No differences in any variable were observed among the four groups (acetabular cup P=0.07, femoral stem P=0.82, femoral offset P=0.06). All measurements showed good reliability (intraclass correlation coefficient [ICC] acetabular cup: 0.76, ICC femoral stem: 0.79). Conclusion The results of this study might suggest that even though a surgeon's experience supports improved precision during the planning stage, it should not be restricted only to surgeons with a high level of experience. We consider preoperative planning an essential part of the surgery, which should be included in training for orthopaedics residents.
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Affiliation(s)
- Maria Surroca
- Hip Unit, Department of Orthopedic Surgery, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
- Department of Surgery, Universitat de Barcelona, Barcelona, Spain
| | - Silvia Miguela
- Hip Unit, Department of Orthopedic Surgery, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
- Department of Surgery, Universitat de Barcelona, Barcelona, Spain
| | - Agustí Bartra-Ylla
- Hip Unit, Department of Orthopedic Surgery, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
- Department of Surgery, Universitat de Barcelona, Barcelona, Spain
| | - Jorge H. Nuñez
- Hip Unit, Department of Orthopedic Surgery, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
- Department of Surgery, Universitat de Barcelona, Barcelona, Spain
| | - Francesc Angles-Crespo
- Hip Unit, Department of Orthopedic Surgery, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
- Department of Surgery, Universitat de Barcelona, Barcelona, Spain
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Fontalis A, Yasen AT, Kayani B, Luo TD, Mancino F, Magan A, Plastow R, Haddad FS. Two-Dimensional Versus Three-Dimensional Preoperative Planning in Total Hip Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00526-6. [PMID: 38810812 DOI: 10.1016/j.arth.2024.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/16/2024] [Accepted: 05/19/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Preoperative planning in total hip arthroplasty (THA) involves utilizing radiographs or advanced imaging modalities, including computerized tomography scans, for precise prediction of implant sizing and positioning. This study aimed to compare 3-dimensional (3D) versus 2-dimensional (2D) preoperative planning in primary THA with respect to key surgical metrics, including restoration of the horizontal and vertical center of rotation (COR), combined offset, and leg length. METHODS This study included 60 patients undergoing primary THA for symptomatic hip osteoarthritis (OA), randomly allocated to either robotic arm-assisted or conventional THA. Digital 2D templating and 3D planning using the robotic software were performed for all patients. All measurements to evaluate the accuracy of templating methods were conducted on the preoperative computerized tomography scanogram, using the contralateral hip as a reference. Sensitivity analyses explored differences between 2D and 3D planning in patients who had superolateral or medial OA patterns. RESULTS Compared to 2D templating, 3D templating was associated with less medialization of the horizontal COR (-1.2 versus -0.2 mm, P = .002) and more accurate restoration of the vertical COR (1.63 versus 0.3 mm, P < .001) with respect to the contralateral side. Furthermore, 3D templating was superior for planned restoration of leg length (+0.23 versus -0.74 mm, P = .019). Sensitivity analyses demonstrated that in patients who had medial OA, 3D planning resulted in less medialization of horizontal COR and less offset reduction. Conversely, in patients who had superolateral OA, there was less lateralization of horizontal COR and less offset increase using 3D planning. Additionally, 3D planning showed superior reproducibility for stem, acetabular cup sizes, and neck angle, while 2D planning often led to smaller stem and cup sizes. CONCLUSIONS Our findings indicated higher accuracy in the planned restoration of native joint mechanics using 3D planning. Additionally, this study highlights distinct variances between the 2 planning methods across different OA pattern subtypes, offering valuable insights for clinicians employing 2D planning.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - Adam T Yasen
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tianyi David Luo
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK; Orthopaedics Northeast, Fort Wayne, Indiana
| | - Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ahmed Magan
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
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Konow T, Glismann K, Lampe F, Ondruschka B, Morlock MM, Huber G. Stem size and stem alignment affects periprosthetic fracture risk and primary stability in cementless total hip arthroplasty. J Orthop Res 2024; 42:829-836. [PMID: 37971200 DOI: 10.1002/jor.25729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/06/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023]
Abstract
The ideal stem size and stem position is important for the success of total hip arthroplasty, since it can affect early implant loosening and periprosthetic fractures (PPF). This study aimed to investigate how small deviations from the ideal stem size and position influences the PPF risk and primary stability. Six experienced surgeons performed preoperative templating based on which the benchmark size for each femur was determined. Consecutive implantations were performed in six cadaveric femur pairs-one side was implanted with an undersized stem followed by the benchmark size and the contralateral side with a benchmark size followed by an oversized stem (Corail, Depuy Synthes). Moreover, three different alignments (six varus, six neutral, six valgus-undersized) were compared using 18 femurs. Cortical strains during broaching and implantation were measured, and laser scans were used to determine final stem position. All specimens underwent dynamic loading. Primary stability was estimated from stem subsidence and pull-out forces. Templated stem size varied between surgeons (±1 size; p = 0.005). Undersizing increased stem subsidence by 320% (p < 0.001). Oversized stems exhibited 52% higher pull-out forces (p = 0.001) and 240% higher cortical strains (p = 0.056). Cortex strains increased with varus alignment (R2 = 0.356, p = 0.011) while primary stability decreased with valgus stem alignment (p = 0.043). Surgeons should be aware that small deviations from the ideal stem size and malalignments of the stem can significantly alter the mechanical situation and affect the success of their surgery.
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Affiliation(s)
- Tobias Konow
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | - Katja Glismann
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | | | - Benjamin Ondruschka
- University Medical Center Hamburg-Eppendorf, Institute of Legal Medicine, Hamburg, Germany
| | - Michael M Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | - Gerd Huber
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
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Rouzrokh P, Khosravi B, Mickley JP, Erickson BJ, Taunton MJ, Wyles CC. THA-Net: A Deep Learning Solution for Next-Generation Templating and Patient-specific Surgical Execution. J Arthroplasty 2024; 39:727-733.e4. [PMID: 37619804 DOI: 10.1016/j.arth.2023.08.063] [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: 06/06/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND This study introduces THA-Net, a deep learning inpainting algorithm for simulating postoperative total hip arthroplasty (THA) radiographs from a single preoperative pelvis radiograph input, while being able to generate predictions either unconditionally (algorithm chooses implants) or conditionally (surgeon chooses implants). METHODS The THA-Net is a deep learning algorithm which receives an input preoperative radiograph and subsequently replaces the target hip joint with THA implants to generate a synthetic yet realistic postoperative radiograph. We trained THA-Net on 356,305 pairs of radiographs from 14,357 patients from a single institution's total joint registry and evaluated the validity (quality of surgical execution) and realism (ability to differentiate real and synthetic radiographs) of its outputs against both human-based and software-based criteria. RESULTS The surgical validity of synthetic postoperative radiographs was significantly higher than their real counterparts (mean difference: 0.8 to 1.1 points on 10-point Likert scale, P < .001), but they were not able to be differentiated in terms of realism in blinded expert review. Synthetic images showed excellent validity and realism when analyzed with already validated deep learning models. CONCLUSION We developed a THA next-generation templating tool that can generate synthetic radiographs graded higher on ultimate surgical execution than real radiographs from training data. Further refinement of this tool may potentiate patient-specific surgical planning and enable technologies such as robotics, navigation, and augmented reality (an online demo of THA-Net is available at: https://demo.osail.ai/tha_net).
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Affiliation(s)
| | | | - John P Mickley
- Department of Orthopedic Surgery, Mayo Clinic, Minnesota
| | | | | | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Minnesota
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Buchan GBJ, Hecht CJ, Rodriguez-Elizalde S, Kabata T, Kamath AF. Automated digital templating of component sizing is accurate in robotic total hip arthroplasty when compared to predicate software. Med Eng Phys 2024; 124:104105. [PMID: 38418018 DOI: 10.1016/j.medengphy.2024.104105] [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: 06/30/2023] [Revised: 10/17/2023] [Accepted: 01/09/2024] [Indexed: 03/01/2024]
Abstract
Accurate pre-operative templating of prosthesis components is an essential factor in successful total hip arthroplasty (THA), including robotically-assisted THA (RA-THA) techniques. We sought to validate the accuracy of a novel, robotic-optimized THA planning software compared to a predicate THA planner for component sizing. We analyzed a series of 199 patients who received manual THA (mTHA) and fluoroscopy-based RA-THA at a single institution. All cases were templated using a predicate pre-operative templating software. For RA-THA cases, the novel robotic-optimized pre-operative planner software was also used for templating. The differences between templated and implanted acetabular cup, femoral head, and stem component sizes were compared based on matching within 1, 2, and ≥3 sizes. Differences in templated and implanted femoral stem implant geometry were also compared. The robot-optimized pre-operative RA-THA plans demonstrated equivalent accuracy to that of predicate pre-operative plans for both RA-THA and mTHA cases. Templated acetabular cups (90.4 vs. 86.8 vs. 82.8; p = 0.421), femoral stems (76.0 vs. 65.1 vs. 67.7; p = 0.096), and femoral heads (91.3 vs. 96.2 vs. 88.2; p = 0.302) were within +/-1 size of implanted components. No significant differences were detected in the proportion of matching templated and implanted stem geometry across the study cohorts.
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Affiliation(s)
- Graham B J Buchan
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Christian J Hecht
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | | | - Tamon Kabata
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Japan
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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Zou ZH, Liu XQ, Li WH, Zhou XT, Li XF. Development and validation of multiple linear regression models for predicting total hip arthroplasty acetabular prosthesis. J Orthop Surg Res 2024; 19:73. [PMID: 38233875 DOI: 10.1186/s13018-024-04526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/01/2024] [Indexed: 01/19/2024] Open
Abstract
PURPOSE To establish a multivariate linear equation to predict the diameter (outer diameter) of the acetabular prosthesis used in total hip arthroplasty. METHODS A cohort of 258 individuals who underwent THA at our medical facility were included in this study. The independent variables encompassed the patients' height, weight, foot length, gender, age, and surgical access. The dependent variable in this study was the diameter of the acetabular prosthesis utilized during the surgical procedure. The entire cohort dataset was randomly partitioned into a training cohort and a validation cohort, with a ratio of 7:3, employing the SPSS 26.0 software. Pearson correlation analysis was conducted to examine the relationships between the patients' height, weight, foot length, gender, age, surgical access, and the diameter of the acetabular prosthesis in the training cohort. Additionally, a multiple linear regression equation was developed using the independent variables from the training cohort and the diameter of the acetabular prosthesis as the dependent variable. This equation aimed to predict the diameter of the acetabular prosthesis based on the patients' characteristics. The accuracy of the equation was evaluated by substituting the data of the validation cohort into the multiple linear equation. The predicted acetabular prosthesis diameters were then compared with the actual diameters used in the operation. RESULTS The correlation analysis conducted on the training cohort revealed that surgical access (r = 0.054) and age (r = -0.120) exhibited no significant correlation with the diameter of the acetabular prosthesis utilized during the intraoperative procedure. Conversely, height (r = 0.687), weight (r = 0.654), foot length (r = 0.687), and sex (r = 0.354) demonstrated a significant correlation with the diameter of the acetabular prosthesis used intraoperatively. Furthermore, a predictive equation, denoted as Y (acetabular prosthesis diameter in mm) = 20.592 + 0.548 × foot length (cm) + 0.083 × height (cm) + 0.077 × weight (kg), was derived. This equation accurately predicted the diameter within one size with an accuracy rate of 64.94% and within two sizes with an accuracy rate of 94.81%. CONCLUSION Anthropometric data can accurately predict the diameter of acetabular prosthesis during total hip arthroplasty.
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Affiliation(s)
- Ze-Hui Zou
- Department of Sports Medicine, Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xu-Qiang Liu
- Department of Sports Medicine, Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Wei-Hua Li
- Department of Sports Medicine, Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xin-Tao Zhou
- Department of Sports Medicine, Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xiao-Feng Li
- Department of Sports Medicine, Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
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Aubert T, Galanzino G, Gerard P, Le Strat V, Rigoulot G, Lhotellier L. Accuracy of Preoperative 3D vs 2D Digital Templating for Cementless Total Hip Arthroplasty Using a Direct Anterior Approach. Arthroplast Today 2023; 24:101260. [PMID: 38023640 PMCID: PMC10652126 DOI: 10.1016/j.artd.2023.101260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/26/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background An important aspect of preoperative planning for total hip arthroplasty is templating. Although two-dimensional (2D) templating remains the gold standard, computerized tomography (CT)-based three-dimensional (3D) templating is a novel preoperative planning technique. This study aims to compare the accuracy of a 2D and 3D plan using an anterior approach for the placement of the same uncemented prosthesis. Methods Two consecutive cohorts of 100 patients each were retrospectively analyzed. We analyzed the accuracy of the size of the implant (stem, cup, head), the length of head, and offset. As a secondary criterion, we analyzed the rates of stems with more than 3° of varus, fracture, and/or subsidence at 3 months postoperatively. Results Within the exact size, the accuracy of the stem and cup size with the 2D plan was 69% and 56%, respectively. With the 3D plan accuracy being 88% (P = .0046) and 96% (P < .0001), respectively. Regarding size and length of the implant head, accuracy was 86% and 82% with the 2D plan and 100% (P < .0001) and 94% (P = .016), respectively, with the 3D plan. The offset of the implants increased beyond 3 mm in 23% of patients in the 2D group and in 5% of patients in the 3D group (P = .0003). The rate of varus stems was 10% in the 2D group and 2% in the 3D group (P = .03). Two fractures and one case of subsidence occurred in the 2D group. None were identified in the 3D cohort. Conclusions A CT-based 3D plan is more accurate for implant size selection, allows better prosthetic offset, and reduces the rate of varus stems.
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Affiliation(s)
- Thomas Aubert
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Giacomo Galanzino
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Philippe Gerard
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Vincent Le Strat
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Guillaume Rigoulot
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Luc Lhotellier
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
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11
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Kim HS, Cho SH, Moon DH, Kim CH. Risk factors for templating mismatch of uncemented stems in bipolar hemiarthroplasty for femoral neck fracture. Sci Rep 2023; 13:21083. [PMID: 38030671 PMCID: PMC10687254 DOI: 10.1038/s41598-023-48538-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/28/2023] [Indexed: 12/01/2023] Open
Abstract
Preoperative templating needs to be precise to optimize hip arthroplasty outcomes. Unexpected implant mismatches can occur despite meticulous planning. We investigated the risk factors for oversized and undersized stem mismatch during uncemented hemiarthroplasty using a double-tapered wedge rectangular stem for femoral neck fracture. Out of 154 consecutive patients who underwent hemiarthroplasty for femoral neck fracture, 104 patients were divided into three groups: (1) oversized (n = 17; 16.3%), (2) matched (n = 80; 76.9%), and (3) undersized stem group (n = 7; 6.7%). A smaller femoral head offset (odds ratio [OR] = 0.89, 95% confidence interval [95% CI] = 0.81-0.98, P = 0.017), smaller isthmus diameter (OR = 0.57, 95% CI = 0.35-0.92, P = 0.021), and smaller canal flare index (OR = 0.20, 95% CI = 0.04-0.98, P = 0.047) were significantly associated with oversized stem insertion, while older age (OR = 1.18, 95% CI = 1.01-1.39, P = 0.037) was associated with undersized stem insertion in logistic regression. In conclusion, when performing hemiarthroplasty for a femoral neck fracture with a double-tapered wedge rectangular stem, surgeons must pay close attention to proximal femoral geometry and patient age during preoperative planning to avoid stem mismatch.
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Affiliation(s)
- Han Soul Kim
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-Gu, Incheon, Republic of Korea
| | - Sung Ha Cho
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-Gu, Incheon, Republic of Korea
| | - Dou Hyun Moon
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-Gu, Incheon, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, Republic of Korea.
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12
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Winter P, Fritsch E, Tschernig T, Goebel L, Wolf M, Müller M, Weise JJ, Orth P, Landgraeber S. Accuracy of Personalized Computed Tomographic 3D Templating for Acetabular Cup Placement in Revision Arthroplasty. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1608. [PMID: 37763727 PMCID: PMC10536197 DOI: 10.3390/medicina59091608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023]
Abstract
Background: Revision hip arthroplasty presents a surgical challenge, necessitating meticulous preoperative planning to avert complications like periprosthetic fractures and aseptic loosening. Historically, assessment of the accuracy of three-dimensional (3D) versus two-dimensional (2D) templating has focused exclusively on primary hip arthroplasty. Materials and Methods: In this retrospective study, we examined the accuracy of 3D templating for acetabular revision cups in 30 patients who underwent revision hip arthroplasty. Utilizing computed tomography scans of the patients' pelvis and 3D templates of the implants (Aesculap Plasmafit, B. Braun; Aesculap Plasmafit Revision, B. Braun; Avantage Acetabular System, Zimmerbiomet, EcoFit 2M, Implantcast; Tritanium Revision, Stryker), we performed 3D templating and positioned the acetabular cup implants accordingly. To evaluate accuracy, we compared the planned sizes of the acetabular cups in 2D and 3D with the sizes implanted during surgery. Results: An analysis was performed to examine potential influences on templating accuracy, specifically considering factors such as gender and body mass index (BMI). Significant statistical differences (p < 0.001) in the accuracy of size prediction were observed between 3D and 2D templating. Personalized 3D templating exhibited an accuracy rate of 66.7% for the correct prediction of the size of the acetabular cup, while 2D templating achieved an exact size prediction in only 26.7% of cases. There were no statistically significant differences between the 2D and 3D templating methods regarding gender or BMI. Conclusion: This study demonstrates that 3D templating improves the accuracy of predicting acetabular cup sizes in revision arthroplasty when compared to 2D templating. However, it should be noted that the predicted implant size generated through 3D templating tended to overestimate the implanted implant size by an average of 1.3 sizes.
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Affiliation(s)
- Philipp Winter
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany; (E.F.); (L.G.); (M.W.); (M.M.); (P.O.); (S.L.)
| | - Ekkehard Fritsch
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany; (E.F.); (L.G.); (M.W.); (M.M.); (P.O.); (S.L.)
| | - Thomas Tschernig
- Institute of Anatomy, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany;
| | - Lars Goebel
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany; (E.F.); (L.G.); (M.W.); (M.M.); (P.O.); (S.L.)
| | - Milan Wolf
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany; (E.F.); (L.G.); (M.W.); (M.M.); (P.O.); (S.L.)
| | - Manuel Müller
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany; (E.F.); (L.G.); (M.W.); (M.M.); (P.O.); (S.L.)
| | - Julius J. Weise
- Department of Medical Biometry, Epidemiology and Medical Informatics, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany;
| | - Patrick Orth
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany; (E.F.); (L.G.); (M.W.); (M.M.); (P.O.); (S.L.)
| | - Stefan Landgraeber
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany; (E.F.); (L.G.); (M.W.); (M.M.); (P.O.); (S.L.)
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13
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Dragosloveanu S, Petre MA, Gherghe ME, Nedelea DG, Scheau C, Cergan R. Overall Accuracy of Radiological Digital Planning for Total Hip Arthroplasty in a Specialized Orthopaedics Hospital. J Clin Med 2023; 12:4503. [PMID: 37445538 DOI: 10.3390/jcm12134503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/13/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023] Open
Abstract
Preoperative radiological planning is a key factor in the prediction of implant size and positioning that influences surgical time, the risk of complications, and functional outcomes. We have tested the accuracy of the digital templating performed in our hospital for a sample of 215 patients that underwent total hip arthroplasty. We assessed the accuracy of correctly predicting implant size for the femoral and acetabular components, as well as the stem neck length. We found that our method of templating proved accurate (within one size) in 95.8% of cases for the stem and 94.9% for the cup when using the anteroposterior view only, while the lateral view was accurate in 95.8% of cases for the stem and 97.2% for the cup. Exact prediction of the stem size was obtained in 77.7% of cases using the anteroposterior view and 67.0% of cases on the lateral view, and 73.0% and 74.4% of cases for the cup on the AP and LL views, respectively. Stem neck size was predicted exactly in 75.35% of cases and within one size in 93.49% of cases. We concluded that our method of digital templating using dedicated software is highly effective in accurately predicting implant size.
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Affiliation(s)
- Serban Dragosloveanu
- Department of Orthopaedics and Traumatology, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Orthopaedics, "Foisor" Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania
| | - Mihnea-Alexandru Petre
- Department of Orthopaedics, "Foisor" Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania
| | - Mihai Emanuel Gherghe
- Department of Orthopaedics, "Foisor" Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania
| | - Dana-Georgiana Nedelea
- Department of Orthopaedics, "Foisor" Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania
| | - Cristian Scheau
- Department of Physiology, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiology and Medical Imaging, "Foisor" Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania
| | - Romica Cergan
- Department of Anatomy, The "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiology and Medical Imaging, "Foisor" Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, 021382 Bucharest, Romania
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14
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Holzer LA. Total Hip Arthroplasty: So Hip It Hurts. J Clin Med 2023; 12:jcm12113849. [PMID: 37298044 DOI: 10.3390/jcm12113849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
Total hip arthroplasty (THA) has become a standard surgical intervention for patients with hip joint disorders [...].
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Affiliation(s)
- Lukas A Holzer
- Department of Orthopaedics, Fiona Stanley Fremantle Hospitals Group, Murdoch, WA 6150, Australia
- Perth Orthopaedic and Sports Medicine Centre, West Perth, WA 6005, Australia
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15
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Pongkunakorn A, Udomluck P, Aksornthung C, Wangjiraphan N. Digital Templating of THA Using PACS and an iPhone or iPad is as Accurate as Commercial Digital Templating Software. Clin Orthop Relat Res 2023; 481:1104-1113. [PMID: 36730564 PMCID: PMC10194723 DOI: 10.1097/corr.0000000000002474] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/07/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Digital templating is a standard preoperative planning method in THA. Unfortunately, many hospitals cannot afford the software or have accessibility barriers owing to a limited number of installed computer workstations. We created a templating method using a picture archiving and communication system and the Keynote program on a mobile phone. The method's accuracy and reliability have not been compared with those of commercial digital templating software. QUESTIONS/PURPOSES (1) How accurate is this novel method on iPhone and iPad mobile devices compared with a commercially available digital templating software program? (2) Is the method reproducible among users with different levels of experience? (3) Are the results similar for different types of femoral prostheses? METHODS Between January 2017 and May 2020, we treated 209 patients for hip disease or trauma with primary cementless THA. We considered patients with a normal contralateral hip as potentially eligible for this retrospective study. Thus, 91% (191 of 209 hips) were eligible; a further 13% (27 hips) were excluded because of postoperative leg length discrepancy > 5 mm, femoral offset discrepancy > 5 mm (9% [18 hips]), intraoperative periprosthetic fracture (4% [eight hips]), and proximal femoral deformity (0.5% [one hip]), leaving 78% (164 hips) for analysis here. Their preoperative radiographs were evaluated by three independent assessors, including one senior orthopaedic surgeon, one senior resident, and one junior resident, using three methods. The first was digital templating using OrthoView software, which is a commercially available digital templating software program used worldwide and known to possess high accuracy. The other two methods were technically similar to one another, with the only difference being the interface: iPhone versus iPad. In both of those approaches, using the picture archiving and communication system measurement tool, we drew a circle on an acetabular radiograph to depict the cup. We took a photograph of the computer display and imported the photograph into slides of the Keynote program, a presentation software application for Mac computers, on both devices. It was then underlaid on transparent digital templates of the femoral stem, which were scanned from plastic templates and positioned at the center of each slide. We scaled the image to the template by adjusting the image size until a 15-cm straight line on the hip photograph was equal to the 15-cm scale markers of the template. All templating results were compared with the actual implanted cementless THA components to assess accuracy. All assessors were blinded to the information about the actual implants, and they were not involved in performing the surgical procedures. The intrarater and interrater reliabilities were analyzed using intraclass correlation coefficients and kappa values. The accuracy for predicting stem size for each type of the four stem designs was compared among the three methods. RESULTS We were able to predict the acetabular cup size within one size in 92% of hips (151 of 164) using OrthoView and in 92% (150 of 164) using the novel method (p > 0.99). The accuracies of the three methods were comparable for predicting a femoral stem size within one size (OrthoView: 90% [148 hips], iPhone: 93% [152 hips], and iPad: 91% [149 hips]; p = 0.78), and neck length (OrthoView: 96% [157 hips], iPhone: 96% [158 hips], and iPad: 97% [159 hips]; p = 0.95). Using OrthoView, the neck offset was correctly predicted in 80% (132 hips), compared to 85% (139 hips) when using the iPhone and 82% (134 hips) when using the iPad (p = 0.57). All methods showed substantial or excellent agreement regarding intrarater and interrater reliability. There was no difference in accuracy regarding any of the four femoral stem designs we evaluated (Avenir, Excia, ML taper, and Metha). CONCLUSION The digital templating technique for THA using an iPhone or iPad combined with a picture archiving and communication system demonstrated high accuracy, comparable to that of commercial digital templating software. This technique is reliable and reproducible for predicting a cementless prosthesis size, neck length, and offset in different types of femoral stems. It may be useful as an alternative in resource-constrained centers where commercial software programs are too expensive to be used in practice. LEVEL OF EVIDENCE Level IV, diagnostic study.
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Affiliation(s)
- Anuwat Pongkunakorn
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | - Phatcharapon Udomluck
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | - Chayanut Aksornthung
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | - Noppadol Wangjiraphan
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
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16
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Adamczyk A, Laboudie P, Nessek H, Kim PR, Gofton WT, Feibel R, Grammatopoulos G. Accuracy of digital templating in uncemented primary total hip arthroplasty: which factors are associated with accuracy of preoperative planning? Hip Int 2023; 33:434-441. [PMID: 35438031 DOI: 10.1177/11207000221082026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Preoperative planning is a fundamental step for successful total hip arthroplasty (THA). Studies have highlighted the accuracy of preoperative digital templating for estimating acetabular cup and stem size. Stem design such as single-wedge metadiaphyseal (Type 1 stem) versus mid-short stem (microplasty) and surgical approach (anterior, direct lateral or posterior) have not been well investigated as predictors of THA templating accuracy. METHODS 204 patients (220 hips) who had undergone elective THA between November 2016 and December 2019 and presented a saved preoperative template were retrospectively reviewed. Templates from 5 different surgeons were involved in the analysis. 3 different approaches were used: direct lateral (DL), posterior (PA), direct anterior (DAA). 2 different stem designs were used: single-wedge metadiaphyseal and single-wedge mid-short (Biomet Taperloc Microplasty), while the acetabular component remained the same. Bivariate and multivariate regression analyses were performed to determine predictors of accuracy. RESULTS Femoral component size templating accuracy was significantly improved when using the single-wedge mid-short stem (Taperloc Microplasty) design when performing bivariate analysis. Although accuracy of cup sizing was not affected by approach, precision was significantly better in the PA group (p < 0.05). Accuracy of templating was found to be independent of BMI and gender but dependent on presence of calibration marker and stem design (p < 0.05). CONCLUSIONS When striving for improved templating accuracy, acetabular and femoral component accuracy were best achieved using a calibration marker and a metaphyseal short femoral stem design.
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Affiliation(s)
- Andrew Adamczyk
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ontario, ON, Canada
| | - Pierre Laboudie
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ontario, ON, Canada
| | - Hamid Nessek
- Faculty of Medicine, University of Ottawa, Ontario, ON, Canada
| | - Paul R Kim
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ontario, ON, Canada
| | - Wade T Gofton
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ontario, ON, Canada
| | - Robert Feibel
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ontario, ON, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ontario, ON, Canada
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17
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Ries C, Baltin CT, Haneder S, Eysel P, Hellmich M, Boese CK. Dual-scale single marker calibration for digital templating of total hip arthroplasty in standing radiographs: a prospective clinical study. Arch Orthop Trauma Surg 2023; 143:1817-1824. [PMID: 35099608 PMCID: PMC10030446 DOI: 10.1007/s00402-022-04355-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 01/06/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Accuracy of calibration of radiographs significantly influences the quality of digital templating for total hip arthroplasty (THA). The standard of care is calibration with external calibration markers (ECM). This method is associated with significant errors. Dual-scale single marker (DSSM) calibration methods may improve accuracy. The present prospective observational study is the first to analyze the application of a DSSM method in standing pelvis radiographs. METHODS 100 patients with unilateral THA underwent antero-posterior pelvis radiographs with ECM and DSSM. The hip components were used as reference calibration factor (internal calibration factor; ICM). Absolute differences of calibration factors for ECM and DSSM from ICM were calculated. Absolute relative deviations (ARD) were calculated. Subgroup analysis for sex and WHO BMI category was performed. Furthermore, patients reported subjective comfort for each marker using a 10-point scale and choosing the preferred marker. RESULTS Maximum magnification factor differences from the ICM were 23.3% and 9.5% and mean absolute differences were 12.5% and 2.1% for the ECM and DSSM, respectively. ARD from ICM was significantly lower for DSSM compared to ECM (p < 0.001). Absolute differences increased with BMI category using ECM; calibration by DSSM was consistent in all subgroups. Patients preferred DSSM over ECM (n = 53) or were indifferent (n = 20). Comfort was rated significantly higher for DSSM versus ECM (p < 0.001). CONCLUSION DSSM method showed superior results in comparison to the ECM method for calibration of digital radiographs. DSSM could be used to improve digital templating in standing radiographs.
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Affiliation(s)
- Christian Ries
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christoph Tobias Baltin
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Str. 24, 50931, Cologne, Germany
| | - Stefan Haneder
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Kerpener Str. 62, 50931, Cologne, Germany
| | - Peer Eysel
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Str. 24, 50931, Cologne, Germany
| | - Martin Hellmich
- IMSB, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Christoph Kolja Boese
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Str. 24, 50931, Cologne, Germany.
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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18
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Winter P, Fritsch E, König J, Wolf M, Landgraeber S, Orth P. Comparison of the Accuracy of 2D and 3D Templating for Revision Total Hip Replacement. J Pers Med 2023; 13:jpm13030510. [PMID: 36983692 PMCID: PMC10053842 DOI: 10.3390/jpm13030510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction: Revision hip arthroplasty is a challenging surgical procedure, especially in cases of advanced acetabular bone loss. Accurate preoperative planning can prevent complications such as periprosthetic fractures or aseptic loosening. To date, the accuracy of three-dimensional (3D) versus two-dimensional (2D) templating has been evaluated only in primary hip and knee arthroplasty. Methods: We retrospectively investigated the accuracy of 3D personalized planning of reinforcement cages (Burch Schneider) in 27 patients who underwent revision hip arthroplasty. Personalized 3D modeling and positioning of the reinforcement cages were performed using computed tomography (CT) of the pelvis of each patient and 3D templates of the implant. To evaluate accuracy, the sizes of the reinforcement cages planned in 2D and 3D were compared with the sizes of the finally implanted cages. Factors that may potentially influence planning accuracy such as gender and body mass index (BMI) were analyzed. Results: There was a significant difference (p = 0.003) in the accuracy of correct size prediction between personalized 3D templating and 2D templating. Personalized 3D templating predicted the exact size of the reinforcement cage in 96.3% of the patients, while the exact size was predicted in only 55.6% by 2D templating. Regarding gender and BMI, no statistically significant differences in planning accuracy either for 2D or 3D templating were observed. Conclusion: Personalized 3D planning of revision hip arthroplasty using Burch Schneider reinforcement cages leads to greater accuracy in the prediction of the required size of implants than conventional 2D templating.
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Affiliation(s)
- Philipp Winter
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany
- Correspondence:
| | - Ekkehard Fritsch
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University, 55131 Mainz, Germany
| | - Milan Wolf
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany
| | - Stefan Landgraeber
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany
| | - Patrick Orth
- Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany
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19
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Luger M, Feldler S, Schauer B, Hochgatterer R, Gotterbarm T, Klasan A. Digital templating cementless short stem total hip arthroplasty: is there a difference in planning adherence between the direct anterior approach and minimally invasive anterolateral approach? Arch Orthop Trauma Surg 2023; 143:1619-1626. [PMID: 35179634 PMCID: PMC9958123 DOI: 10.1007/s00402-022-04374-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/26/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Minimally invasive approaches (MIS) in total hip arthroplasty (THA) show inconsistent findings regarding planning adherence in digital templating. The purpose of this study is to evaluate any difference in planning adherence between the direct anterior approach (DAA) and an anterolateral MIS approach (AL MIS) in cementless short stem THA. METHODS A single surgeon series of 222 THAs in 208 patients with an uncemented short curved stem and a bi-hemispherical acetabular cup were screened for inclusion. A total of 118 THAs were implanted via the DAA and 72 THAs via the AL MIS were included. The planning adherence for the offset option, stem size and the acetabular cup were retrospectively evaluated. RESULTS Planning adherence for cup size (perfect match: p = 0.763; ± 1 size: p = 0.124), offset option (0.125) and stem size (perfect match: p = 0.275; ± 1 size: p = 0.552) did not show any statistical significance. Preoperative diagnosis of avascular necrosis of the femoral head in AL MIS approach (OR 6.045; CI 1.153-31.696) or mild hip dysplasia in the general cohort poses (OR 11.789; CI 1.386-100.293) a significant risk for inadequate prediction of the offset option. CONCLUSION digital templating for THA with an uncemented short curved stem and a bi-hemispherical acetabular cup show comparable results between a direct anterior approach and a minimally invasive anterolateral approach in supine position. Surgeons should be aware of a low planning adherence for this type of short stem in minimally invasive approaches. CONCLUSION Digital templating for THA with an uncemented short curved stem and a bi-hemispherical acetabular cup show comparable results between a direct anterior approach and a minimally invasive anterolateral approach in supine position. Surgeons should be aware of a low planning adherence for this type of short stem in minimally invasive approaches.
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Affiliation(s)
- Matthias Luger
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Sandra Feldler
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Bernhard Schauer
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Rainer Hochgatterer
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Antonio Klasan
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
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Di Martino A, Rossomando V, Brunello M, D'Agostino C, Pederiva D, Frugiuele J, Pilla F, Faldini C. How to perform correct templating in total hip replacement. Musculoskelet Surg 2023; 107:19-28. [PMID: 36630067 DOI: 10.1007/s12306-023-00772-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023]
Abstract
Templating plays a key role in surgery that is often underestimated. There is a difference between planning and templating: in the first not only the hip is considered but involves the evaluation of the patient in its entirety. Templating instead consists of calculating the position of the implant in order to place it in the best possible position. Fundamental is a correct X-ray of the pelvis, which must follow certain standards. For traditional templating, drawings on appropriately enlarged transparent implants were provided by the prosthesis manufacturer. The implementation of digital software into clinical practice has improved the accuracy and reproducibility of templating, which in most surgical units is performed by standard 2D radiographic images. Thanks to digital preoperative templating in a digital radiology environment, the hip reconstructive surgeon can perform preoperative planning and implant sizing quickly, consistently, and affordably. Currently, 3D templating can also be performed by software used initially to create personalized stems for THA. Aim of the current review is to outline the essentials of correct templating in THA performance, and to report the updates since the introduction of digital and 3D technologies in this setting.
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Affiliation(s)
- A Di Martino
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, 40136, Bologna, Italy.
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy.
| | - V Rossomando
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - M Brunello
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - C D'Agostino
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - D Pederiva
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
| | - J Frugiuele
- SC ATIPD (Anesthesia and Post-Operative Intensive Care and Pain Therapy), Department of Specialist Orthopedic-Traumatological Pathologies, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - F Pilla
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, 40136, Bologna, Italy
| | - C Faldini
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Rizzoli Orthopedic Institute, Via G.C. Pupilli 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, Bologna, Italy
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Schapira B, Madanipour S, Iranpour F, Subramanian P. Accuracy of Total Hip Arthroplasty Templating Using Set Calibration Magnifications. Cureus 2023; 15:e34883. [PMID: 36925986 PMCID: PMC10011871 DOI: 10.7759/cureus.34883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2023] [Indexed: 02/13/2023] Open
Abstract
Background Templating for total hip arthroplasty has been adopted over recent decades as a reliable and accurate method for pre-operative planning. The use of calibration markers for this process provides a recognised benefit at the expense of cost, availability and error. Many surgeons use a set magnification of 118% to account for calibration errors when templating total hip arthroplasty. This study aims to assess the accuracy of templating with standardised magnifications and assess the effect of BMI on templating accuracy. Materials and methods A retrospective analysis was performed using a single-surgeon series of 119 consecutive total hip arthroplasties. Anteroposterior radiographs were taken pre- or post-operatively without calibration hardware. Pre-operatively, the total hip arthroplasty was templated on TraumaCad (BrainLab Inc, Westchester, IL) using either 118% or 119% calibration magnification. Post-operative magnification was calibrated using the known femoral head diameter. Templated and implanted prostheses were compared for size. Results At 118%, 61.1% of cups matched those templated with 96.3% of cups within two sizes. At 119%, 52.5% of cups used matched their templates with 100% within two sizes. There was no significant difference between 118% and 119% cup size prediction (p=0.49). A trend was noticed in increasing magnification error with increasing BMI. However, BMI had no significant effect on the accuracy of templating cup size within two cup sizes (p=0.58). Conclusion. Templating acetabular cups using a set magnification of 118% or 119% yields accurate results and provides a reliable method to template without calibration equipment. Whilst BMI can affect magnification error, this has no significant effect on the accuracy of implanted cups and stems within two sizes.
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Affiliation(s)
- Benjamin Schapira
- Trauma and Orthopaedics, Royal Free London NHS Foundation Trust, London, GBR
| | | | - Farhad Iranpour
- Trauma and Orthopaedics, Royal Free London NHS Foundation Trust, London, GBR
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22
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The Adherence of Digital Templating of Cemented Bicondylar Total Knee Arthroplasty Reveals Gender Differences. J Clin Med 2023; 12:jcm12031079. [PMID: 36769727 PMCID: PMC9917635 DOI: 10.3390/jcm12031079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/17/2023] [Accepted: 01/28/2023] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Preoperative digital templating is a standard procedure that should help the operating surgeon to perform an accurate intraoperative procedure. To date, a detailed view considering gender differences in templating total knee arthroplasty (TKA), stage of arthrosis, and the surgeons' experience altogether has not been conducted. METHODS A series of 521 patients who underwent bicondylar total knee arthroplasty was analyzed retrospectively for the planning adherence of digital templating in relation to sex, surgeon experience, and stage of arthrosis. Pre- and postoperative X-rays were comparably investigated for planned and implanted total knee arthroplasties. Digital templating was carried out through mediCAD version 6.5.06 (Hectec GmbH, 84032 Altdorf, Germany). For statistical analyses, IBM SPSS version 28 (IBM, 10504 Armonk, NY, US) was used. RESULTS The general planning adherence was 46.3% for the femur and 41.8% for the tibia. The Mann-Whitney U test revealed a gender difference for templating the femur (z = -5.486; p ≤ 0.001) and tibia (z = -3.139; p = 0.002). The surgeon's experience did not show a significant difference through the Kruskal-Wallis test in the femur (K-W H = 4.123; p = 0.127) and the tibia (K-W H = 2.455; p = 0.293). The stage of arthrosis only revealed a significant difference in the planning of the femur (K-L-score (K-W H = 6.516; p = 0.038) alone. DISCUSSION/CONCLUSION Digital templating for total knee arthroplasty brought up gender differences, with oversized implants for women and undersized implants for men. A high stage of femoral arthrosis can lead to the under and oversized planning of the surgeon. Since the surgeon's experience in planning did not show an effect on the adherence to templating, the beneficial effect of digital templating before surgery should be discussed.
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Al-Ashqar M, Aslam N, Azhar MS, Grayston J, Hahnel J. KingMark's dual-marker versus a conventional single-marker templating system: is there a difference in accuracy of predicting final implant sizes and leg lengths? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:167-175. [PMID: 34842990 DOI: 10.1007/s00590-021-03174-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/19/2021] [Indexed: 01/07/2023]
Abstract
AIMS Pre-operative templating for total hip replacement (THR) surgery leads to more accurate implant sizing and positioning. This study aimed to compare the KingMark™ dual-marker system for magnification calibration to the current gold standard single-marker system in accuracy of predicting implant size and restoration of leg length post-operatively. METHODS This is a retrospective analysis of patients who had primary THR surgery from 2013 to 2019 by a single surgeon. Patients were in two cohorts whose operations were completed at separate healthcare facilities. Patients in the first cohort had pre-operative templating using the KingMark system; patients in the second cohort had templating using a single-marker. For all patients, pre-operative radiographs were reviewed; predicted implants noted; and leg length discrepancies calculated. These were compared to post-operative data. We then tested the null hypothesis that there was no difference between the templating methods for prediction accuracy of implant size and achieving restoration of leg length. RESULTS A total of 121 patients were included in the KingMark cohort, and 104 were included in the single-marker cohort. In the KingMark cohort, 83.5% of patients had implantation of a cup within one size of that predicted, compared to 71.2% of the single-marker cohort. This superiority was statistically significant. There was a greater proportion of exact cup size predictions in the KingMark cohort, but this was not statistically significant. We did not find any significant difference between the cohorts for stem size, or stem placement, or reduction of leg length discrepancy. CONCLUSION We have demonstrated statistically significant superiority of the KingMark over a single-marker templating system for predicting cup size in primary THR surgery. For post-operative restoration of leg length, our study did not show any advantage of KingMark templating compared to single-marker templating.
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Affiliation(s)
- Mohammad Al-Ashqar
- Bradford Royal Infirmary, Bradford, UK.
- Leeds Teaching Hospitals, Leeds, UK.
| | - Nayef Aslam
- Bradford Royal Infirmary, Bradford, UK
- Leeds Teaching Hospitals, Leeds, UK
| | | | - James Grayston
- Bradford Royal Infirmary, Bradford, UK
- Leeds Teaching Hospitals, Leeds, UK
| | - James Hahnel
- Bradford Royal Infirmary, Bradford, UK
- Leeds Teaching Hospitals, Leeds, UK
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Mevorach D, Perets I, Greenberg A, Kandel L, Mattan Y, Liebergall M, Rivkin G. The impact of femoral bone quality on cementless total hip pre-operative templating. INTERNATIONAL ORTHOPAEDICS 2022; 46:1971-1975. [PMID: 35718826 DOI: 10.1007/s00264-022-05482-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/09/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Accurate templating is an integral part of pre-operative planning for total hip arthroplasty (THA). Templating of cementless implant accuracy has been average. The aim of this study was to assess the impact of Dorr femoral classification on the accuracy of pre-operative digital templating. PATIENTS AND METHODS This was a retrospective study of cementless THA pre-operative planning using one implant design. A total of 210 primary THA were reviewed. A total of 102 cementless THAs matched the exclusion and inclusion criteria, using one implant combination, were analyzed by an orthopaedic resident and a fellowship trained arthroplasty surgeon. Each x-ray was evaluated and assigned a femoral Dorr classification. Accuracy of templating was determined by comparing the templated size with the actual implant size both for the femoral and acetabular components. RESULT Out of the 102 cases, exact templating size was achieved in 35.3% for the acetabulum, 25.5% for the femur, and only in 9.8% for both components. Reasonable templating, ± one of the actual size, was achieved in 78.4% for the acetabulum, 74.5% for the femur, and 60.8% for both components. Use of Dorr femoral type classification did not result in better templating accuracy. CONCLUSION Pre-operative hip cementless templating using digital x-rays with double marker method do not improve accuracy compared to other methods available for templating. Accounting for bone quality using the Dorr femoral classification did not improve accuracy.
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Affiliation(s)
- David Mevorach
- Orthopedic Surgery Complex, Hadassah University Hospital, Jerusalem, Israel.
| | - Itay Perets
- Orthopedic Surgery Complex, Hadassah University Hospital, Jerusalem, Israel
| | | | - Leonid Kandel
- Orthopedic Surgery Complex, Hadassah University Hospital, Jerusalem, Israel
| | - Yoav Mattan
- Orthopedic Surgery Complex, Hadassah University Hospital, Jerusalem, Israel
| | - Meir Liebergall
- Orthopedic Surgery Complex, Hadassah University Hospital, Jerusalem, Israel
| | - Gurion Rivkin
- Orthopedic Surgery Complex, Hadassah University Hospital, Jerusalem, Israel
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Konow T, Bätz J, Beverland D, Board T, Lampe F, Püschel K, Morlock MM. Variability in Femoral Preparation and Implantation Between Surgeons Using Manual and Powered Impaction in Total Hip Arthroplasty. Arthroplast Today 2022; 14:14-21. [PMID: 35106353 PMCID: PMC8789517 DOI: 10.1016/j.artd.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 10/25/2022] Open
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Reinbacher P, Smolle MA, Friesenbichler J, Draschl A, Leithner A, Maurer-Ertl W. Pre-operative templating in THA using a short stem system: precision and accuracy of 2D versus 3D planning method. J Orthop Traumatol 2022; 23:16. [PMID: 35318558 PMCID: PMC8941012 DOI: 10.1186/s10195-022-00634-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 02/26/2022] [Indexed: 12/19/2022] Open
Abstract
Background Total hip arthroplasty (THA) is the most successful orthopaedic surgery of the past century. The current study aimed to compare the accuracy of digital planning using 2D versus 3D templating. Materials and methods Ninety-five THAs in 90 patients were included in the current study. Pre- and post-operative X-rays (in two planes) and low-dose rotation computed tomography scans from hip to foot were performed. Paired t-test and regression analyses were conducted to compare 2D and 3D templating accuracy of the definitive implant. Results Cup size planned both with 2D (p < 0.0001) and 3D (p = 0.012) templating was significantly different from the definitively used cup size. The difference between the 2D-planned and implanted stem size (p < 0.0001) was statistically significant. In contrast, there were no significant differences in the 3D-planned and implanted stem size (p = 0.181). Three-dimensional templating showed significantly higher accuracy than 2D templating in terms of cup size (1.1 ± 1.4 versus 1.7 ± 1.8; p = 0.007) and stem size (0.3 ± 0.6 versus 0.7 ± 0.7; p < 0.0001). With increasing body mass index (BMI), 2D templating of the stem became more inaccurate (p = 0.041). Remarkably, 3D templating remained accurate for all components (stem, p = 0.533; cup, p = 0.479) despite increasing BMI. Conclusion Despite extended planning time and increased exposure to radiation, 3D-based planning showed higher accuracy than 2D templating, especially in obese patients. On the basis of our results, we believe that 3D-based pre-operative planning in THA is justifiable and beneficial in patients with increased BMI. Level of Evidence III.
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Affiliation(s)
- Patrick Reinbacher
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Joerg Friesenbichler
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Alexander Draschl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Werner Maurer-Ertl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
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Kutzner KP, Freitag T, Bieger R. Defining 'undersizing' in short-stem total hip arthroplasty: the importance of sufficient contact with the lateral femoral cortex. Hip Int 2022; 32:160-165. [PMID: 32644828 PMCID: PMC8978469 DOI: 10.1177/1120700020940276] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Undersizing is 1 of the main reasons for early implant failure. Adequate sizing in short-stem total hip arthroplasty can be challenging and, so far, lacks key decision criteria. METHODS We included 191 calcar-guided short stems. All patients underwent standardised digital anteroposterior imaging pre- and post-surgery and during follow-up. Preoperative planning was performed digitally. Planned stem sizes were retrospectively assessed and compared with the implanted sizes. Additionally, adequate sizing was analysed by determining whether the stem made intraoperative contact with the lateral distal femoral cortex. Implant migration was assessed by Ein-Bild-Roentgen-Analysis Femoral-Component-Analysis 5 years after surgery. Influence of different Dorr types and postoperative centrum-collum-diaphyseal angle (CCD) categories on lateral femoral cortical contact were analysed. Additionally, the Harris Hip Score (HHS) was assessed at final follow-up. Stem-revision rate was documented. RESULTS Implanted stems were at least 2 sizes smaller than those at the preoperative planning in 49 (25.7%) cases. The stem made contact with the lateral distal femoral cortex in only 130 hips (68.1%). Mean subsidence was significantly higher in the no-contact group (2.07 mm, range -7.7 to 1.7) than in the contact group (1.23 mm, range -4.5 to 1.8) at the final follow-up (p = 0.0018). Stems at least 2 sizes smaller than those at preoperative planning showed a significantly higher prevalence of non-contact (46.9% vs. 26.8%) (p = 0.009). Those undersized stems were more likely found in varus hips. No influence of the Dorr classification and the different CCD categories on the probability of achieving sufficient cortical contact was found. HHS showed no intergroup differences. CONCLUSIONS Stems that did not make intraoperative contact with the lateral femoral cortex showed significantly increased axial migration at mid-term follow-up. Thus, the investigated criteria regarding the definition of undersizing in short-stem THA should be acknowledged. No obvious mid-term consequences were noted regarding revision rate. Long-term results are mandatory.
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Affiliation(s)
- Karl P Kutzner
- Department of Orthopaedic Surgery, St.
Josef’s Hospital Wiesbaden, Wiesbaden, Hessen, Germany,Karl P Kutzner, Department of Orthopaedic
Surgery, St. Josef’s Hospital Wiesbaden, Beethovenstraße 20, Wiesbaden, Hessen
65189, Germany.
| | - Tobias Freitag
- Department of Orthopaedic Surgery,
University of Ulm, Ulm, Baden-Württemberg, Germany
| | - Ralf Bieger
- Department of Orthopaedic Surgery,
University of Ulm, Ulm, Baden-Württemberg, Germany
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Nishihara S, Hayashida K. Comparison between freehand technique and computed tomography-based navigation in acetabular cup placement through direct anterior approach for total hip arthroplasty. Arch Orthop Trauma Surg 2022; 142:323-329. [PMID: 33929597 DOI: 10.1007/s00402-021-03920-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 04/19/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION In total hip arthroplasty (THA), improper cup orientation can result in dislocation, early excessive polyethylene wear, and pain following THA. The supine position during THA provides a more reproducible functional pelvic position than the lateral decubitus position and may allow freehand cup placement as reliable as that obtained by computer navigation. The purpose of this study was to investigate the accuracy of freehand cup placement through a supine direct anterior approach (DAA) compared with computed tomography (CT)-based navigation. MATERIALS AND METHODS The same surgeon performed primary cementless THA through the DAA in 144 supine patients. Seventy-two patients underwent freehand cup placement with standard mechanical guidance-oriented radiographic target cup positioning, and 72 underwent placement with CT-based navigation guidance. Using three-dimensional templating software, the study group calculated cup inclination and anteversion on postoperative CT scans. RESULTS The navigation method resulted in a significantly smaller deviation of inclination from the target (p < 0.05); the difference in anteversion was not significant. In addition, the navigation method resulted in significantly fewer cups placed ± 10° outside the target position (0% for inclination, 0% for anteversion) than did the freehand procedure (26% for inclination, 25% for anteversion) (p < 0.0001). CONCLUSIONS Freehand cup placement is less reliable even in the supine position. Use of a CT-based navigation system can significantly improve cup positioning in THA through the DAA by reducing the incidence of outliers.
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Affiliation(s)
- Shunsaku Nishihara
- Department of Orthopaedic Surgery, Daini Osaka Police Hospital, 2-6-40 Karasugatsuji, Tennouji-ku, Osaka, 543-8922, Japan.
| | - Kenji Hayashida
- Department of Orthopaedic Surgery, Daini Osaka Police Hospital, 2-6-40 Karasugatsuji, Tennouji-ku, Osaka, 543-8922, Japan
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Thakur K, Sharma A, Prasad M, Vig V. Effect of body mass index on the conventional method of templating in uncemented total hip arthroplasty: A prospective study. JOURNAL OF ORTHOPAEDICS AND SPINE 2022. [DOI: 10.4103/joasp.joasp_23_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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30
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Accuracy of digital templating of uncemented total hip arthroplasty at a certified arthroplasty center: a retrospective comparative study. Arch Orthop Trauma Surg 2022; 142:2471-2480. [PMID: 33725193 PMCID: PMC9474525 DOI: 10.1007/s00402-021-03836-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/15/2021] [Indexed: 12/04/2022]
Abstract
INTRODUCTION To investigate the accuracy of preoperative digital templating for total hip arthroplasty (THA) at a certified arthroplasty center (EndoCert EPZmax). MATERIALS AND METHODS In a retrospective study design, we analysed 620 uncemented primary THAs for templating accuracy by comparing the preoperatively planned THA component size and the implanted size as documented by the surgeon. Templating was determined to be a) exact if the planned and the implanted component were the same size and b) accurate if they were exact ± one size. Moreover, we investigated factors that potentially influence templating accuracy: overweight and obesity (WHO criteria), sex, implant design, surgeon experience, preoperative diagnosis. Digital templating was done with MediCAD software. The Mann-Whitney U test and the Kruskal-Wallis test were used for statistical analysis. RESULTS Templating was exact in 52% of stems and 51% of cups and was accurate in 90% of the stems and 85% of the cups. Regarding the factors potentially influencing templating accuracy, the type of cup implant had a significant influence (p = 0.016). Moreover, greater accuracy of stem templating was achieved in female patients (p = 0.004). No such effect was determined for the other factors investigated. CONCLUSIONS We conclude that preoperative 2D templating is accurate in 90% of the stems and 85% of the cups. Greater accuracy may be achieved in female patients. In addition to gender, the type of implant used may influence planning accuracy as well. Surgeon experience, BMI and preoperative diagnosis did not influence templating accuracy. LEVEL OF EVIDENCE Level III (retrospective comparative study with prospective cohort).
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Digital templating for the implantation of a curved short hip stem with an anterolateral MIS approach shows gender differences in digital templating. Arch Orthop Trauma Surg 2022; 142:1661-1668. [PMID: 34169356 PMCID: PMC9217763 DOI: 10.1007/s00402-021-04005-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 06/17/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Digital templating shows reliable accuracy for straight stem systems. In recent years, the implantation of short stems through minimally invasive approaches has gained more popularity. Minimally invasive approaches (MIS) show the risk of undersizing femoral components. Therefore, we questioned the planning adherence for a curved short stem and a bi-hemispherical acetabular cup implanted through an anterolateral MIS approach. METHODS A consecutive series of 964 hips (index surgery between 2014 and 2019) with Fitmore® curved short stem and Allofit/-S® acetabular cup (both ZimmerBiomet Inc, Warsaw, IN) were included. Preoperative digital templating was conducted anterior-posterior (AP) digital radiographs of the hip using mediCAD® version 5.1 (Hectec GmbH, Altdorf, Germany). The templates of acetabular and femoral components (offset option and stem size) were retrospectively evaluated for general adherence, and according to sex, BMI and planner's experience. RESULTS Planning adherence for the exact offset option was 70.6 and 21.6% for exact offset option and stem size. Adherence for acetabular cup ± 1 size was 74.8%. A significant difference between male and female patients for the offset option could be found (p = 0.03, z = -2983). In 22.5% of male patients, an offset option one size higher and in 12.3% of female patients an offset option one size smaller than templated was used intraoperatively CONCLUSION: Digital templating for the Fitmore® stem in cementless THA with a minimally invasive anterolateral approach shows comparable planning adherence to the existing literature for this cementless short stem. However, a lower planning adherence was detected compared to conventional straight stem systems. In male patients, the femoral offset is frequently undersized and in female patients frequently oversized compared to the preoperative plan. Surgeons should be aware of this difficulty in digital templating for Fitmore® hip stem.
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32
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Smith JBV, Bishi H, Wang C, Asopa V, Field RE, Sochart DH. The accuracy and reliability of preoperative digital 2D templating in prosthesis size prediction in uncemented versus cemented total hip arthroplasty: a systematic review and meta-analysis. EFORT Open Rev 2021; 6:1020-1039. [PMID: 34909222 PMCID: PMC8631246 DOI: 10.1302/2058-5241.6.210048] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The purpose of this study was to compare the accuracy and the inter- and intra-observer reliability of preoperative digital 2D templating in prosthesis size prediction for the planning of cemented or uncemented THA. This study was registered in the NIHR PROSPERO database (ID: CRD42020216649) and conducted according to the PRISMA guidelines. A search of electronic databases in March 2021 found 29 papers overall. The quality of evidence was assessed using the IHE Quality Appraisal of Case Series Studies Checklist and the CASP Randomised Controlled Trials Checklist. A meta-analysis was conducted, and the accuracy was presented as proportions and the inter- and intra-observer reliability were measured using intraclass correlation coefficients (ICC). Accuracy within one prosthesis size (±1) for cemented stems was 0.89 (95% confidence interval (CI) 0.83–0.95), cemented cups 0.78 (95% CI 0.67–0.89), uncemented stems 0.74 (95% CI 0.66–0.82) and uncemented cups 0.73 (95% CI 0.67–0.79) (test of group differences: p = 0.010). Inter-observer reliability (ICC) for uncemented cups was 0.88 (95% CI 0.85–0.91), uncemented stems 0.86 (95% CI 0.81–0.91), cemented stems 0.69 (95% CI 0.54–0.84) and cemented cups 0.68 (95% CI 0.55–0.81) (test of group differences: p = 0.004). Due to lack of data, intra-observer reliability (ICC) could only be calculated for uncemented prostheses, which for the stems was 0.90 (95% CI 0.88–0.92) and for the cups was 0.87 (95% CI 0.83–0.90) (test of group differences: p = 0.124). The accuracy of preoperative digital templating is greater for cemented prostheses, but the inter-observer reliability is greater for uncemented prostheses. The intra-observer reliability showed a high level of agreement for uncemented prostheses.
Cite this article: EFORT Open Rev 2021;6:1020-1039. DOI: 10.1302/2058-5241.6.210048
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Affiliation(s)
- Joshua B V Smith
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
| | - Habeeb Bishi
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
| | - Chao Wang
- Kingston University and St George's University of London, Tooting, London, UK
| | - Vipin Asopa
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
| | - Richard E Field
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
| | - David H Sochart
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
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Sahemey R, Moores TS, Meacher H, Youssef B, Khan S, Evans CR. Anthropometric method for estimating component sizes in total hip arthroplasty. World J Orthop 2021; 12:859-866. [PMID: 34888146 PMCID: PMC8613690 DOI: 10.5312/wjo.v12.i11.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/14/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Preoperative templating is essential in total hip arthroplasty (THA) as it not only helps to facilitate the correct implant type and size but also determines the post-operative biomechanics. Templating is also increasingly important from a medico-legal perspective and recommended in the British Orthopaedic Association Guide to Good Practice. Although templating has become increasingly digitised, there are no simple anthropometric models to predict implant sizes in the absence of digital methods.
AIM To assess the accuracy of using an easily obtainable measurement (shoe size) to predict component sizes in THA compared with digital templating.
METHODS Digital radiographs from a cohort of 102 patients (40 male, 62 female) who had undergone uncemented or hybrid THA at a single centre were retrospectively templated to desired cup and stem sizes using TraumaCad®. We compared the templated size to the actual size of the implant and assessed if there was any correlation with the patient’s shoe size.
RESULTS Statistically significant positive correlations were observed between: shoe size and templated cup size (ρ = 0.92, P < 0.001); shoe size with implanted cup size (ρ = 0.71, P < 0.001); shoe size and templated stem size (ρ = 0.87, P < 0.001); and shoe size with implanted stem size (ρ = 0.57, P < 0.001). Templated and implanted acetabular cup sizes were positively correlated (ρ = 0.76, P < 0.001) and were exact in 43.1% cases; 80.4% of implanted cup sizes were within 1 size (+/- 2 mm) of the template and 100% within 2 sizes (+/- 4 mm). Positive correlation was also demonstrated between templated and implanted femoral stem sizes (ρ = 0.69, P < 0.001) and were exact in 52.6% cases; 92.6% were within 1 size of the template and 98% within 2 sizes.
CONCLUSION This study has shown there to be a significant positive correlation between shoe size and templated size. Anthropometric measurements are easily obtainable and can be used to predict uncemented component sizes in the absence of digital methods.
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Affiliation(s)
- Rajpreet Sahemey
- Department of Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry CV2 2DX, United Kingdom
| | - Thomas S Moores
- Department of Trauma and Orthopaedics, Walsall Manor Hospital, Walsall WS2 9PS, United Kingdom
| | - Hannah Meacher
- Department of Trauma and Orthopaedics, Royal Stoke University Hospital, Stoke-on-Trent ST4 6QG, United Kingdom
| | - Bishoy Youssef
- Department of Trauma and Orthopaedics, Royal Stoke University Hospital, Stoke-on-Trent ST4 6QG, United Kingdom
| | - Shehzaad Khan
- Department of Trauma and Orthopaedics, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, United Kingdom
| | - Christopher R Evans
- Department of Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry SY10 7AG, United Kingdom
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Kristoffersson E, Otten V, Crnalic S. The accuracy of digital templating in cementless total hip arthroplasty in dysplastic hips. BMC Musculoskelet Disord 2021; 22:942. [PMID: 34758811 PMCID: PMC8582185 DOI: 10.1186/s12891-021-04793-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) is a complex procedure due to associated anatomical abnormalities. We studied the extent to which preoperative digital templating is reliable when performing cementless THA in patients with DDH. Methods We templated and compared the pre- and postoperative sizes of the acetabular and femoral components and the center of rotation (COR), and analysed the postoperative cup coverage, leg length discrepancy (LLD), and stem alignment in 50 patients (56 hips) with DDH treated with THA. Results The implant size exactly matched the template size in 42.9% of cases for the acetabular component and in 38.2% of cases for the femoral component, whereas the templated ±1 size was used in 80.4 and 81.8% of cases for the acetabular and femoral components, respectively. There were no statistically significant differences between templated and used component sizes among different DDH severity levels (acetabular cup: p = 0.30 under the Crowe classification and p = 0.94 under the Hartofilakidis classification; femoral stem: p = 0.98 and p = 0.74, respectively). There were no statistically significant differences between the planned and postoperative COR (p = 0.14 horizontally and p = 0.52 vertically). The median postoperative LLD was 7 (range 0–37) mm. Conclusion Digital preoperative templating is reliable in the planning of cementless THA in patients with DDH.
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Affiliation(s)
- Emelie Kristoffersson
- Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, 90185, Umeå, Sweden
| | - Volker Otten
- Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, 90185, Umeå, Sweden
| | - Sead Crnalic
- Department of Surgical and Perioperative Sciences (Orthopaedics), Umeå University, 90185, Umeå, Sweden.
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Shichman I, Shaked O, Morgan S, Garceau S, Snir N, Warschawski Y. Digital templating in total hip arthroplasty using contralateral healthy hip results in decreased accuracy. Acta Orthop Belg 2021. [DOI: 10.52628/87.3.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The accuracy of pre-operative digital templating for total hip arthroplasty (THA) using the diseased versus unaffected contralateral joint remains unclear. As such, we devised a study to compare templating precision between the operated hip joint versus the healthy side for patients with osteoarthritis (OA). The study hypothesis was that preoperative templating accuracy of THA on the ipsilateral diseased hip joint would be higher compared to the contralateral healthy hip in patients with OA. We retrospectively reviewed 100 patients who underwent THA for unilateral OA at our center from January 2018 to January 2020. Retrospective preoperative digital templating was performed separately on both the operated hip joint and the healthy contralateral hip joint by a single surgeon who was blinded by the in-situ components sizes. Accuracy of each group was compared to the implanted components. Assessment of the 100 included cases demonstrated superior acetabular component size prediction when templating was performed using the diseased hip compared to the healthy contralateral side (68.0% versus 51.0%, p<0.001). No differences between the cohorts were found regarding templating accuracy of femoral stem sizes (72.0% and 69.0%, p=0.375) or neck offset (73.0% and 69.0%, p=0.289). Templating acetabular cup size using the ipsilateral diseased hip is more accurate than using the contralateral healthy hip in patients with unilateral OA.
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Pongkunakorn A, Aksornthung C, Sritumpinit N. Accuracy of a New Digital Templating Method for Total Hip Arthroplasty Using Picture Archiving and Communication System (PACS) and iPhone Technology: Comparison With Acetate Templating on Digital Radiography. J Arthroplasty 2021; 36:2204-2210. [PMID: 33583670 DOI: 10.1016/j.arth.2021.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Preoperative templating for total hip arthroplasty (THA) on digital radiography can be achieved using templating software or hybrid methods (acetate templates overlaid on digital images). No studies have examined templating with a mobile phone. We evaluated the accuracy and reproducibility of a new digital templating method using the picture archiving and communication system (PACS) and iPhone, compared with the hybrid method for cementless THA. METHODS A total of 113 hip radiographs were retrospectively templated by three observers. For the digital method, a circle was drawn on the acetabulum using PACS to represent the cup. The photograph of the computer screen was taken with an iPhone and imported into the Keynote presentation software. The femoral stem was then templated with transparent digital templates, which had been digitized from acetate templates. For the hybrid method, an acetate template was placed over the onscreen digital radiographs. Templated results were compared with the actual components used. RESULTS The digital method was more accurate than the hybrid method to predict ±1 size of femoral stem [93.8% (106 hips) vs 84.1% (95 hips), P = .032] and offset [90.3% (102 hips) vs 75.2% (85 hips), P = .004)]. The accuracies of digital and hybrid techniques were comparable with predict ±1 size for acetabular cup [92.9% (105 hips) vs 89.4% (101 hips), P = .483] and neck length [98.2% (111 hips) vs 96.5% (109 hips), P = .683]. Both techniques had substantial to almost perfect agreement for intraobserver and interobserver reliability. CONCLUSION Digital templating using PACS and iPhone is accurate and reproducible for predicting implant size of cementless THA.
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Affiliation(s)
- Anuwat Pongkunakorn
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | - Chayanut Aksornthung
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
| | - Nithipat Sritumpinit
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, Lampang, Thailand
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Haversath M, Lichetzki M, Serong S, Busch A, Landgraeber S, Jäger M, Tassemeier T. The direct anterior approach provokes varus stem alignment when using a collarless straight tapered stem. Arch Orthop Trauma Surg 2021; 141:891-897. [PMID: 32474699 DOI: 10.1007/s00402-020-03457-9] [Citation(s) in RCA: 9] [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: 01/28/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Inaccurate stem implantation can cause unsatisfactory offset reconstruction and may result in insufficient gluteal muscle function or aseptic loosening. In this study, stem alignment of a collarless straight tapered HA-coated stem was retrospectively analyzed during the learning phase of the direct anterior approach (DAA) for primary total hip arthroplasty (THA). MATERIAL AND METHODS From Jan 2013 to Jun 2015, a total of 93 cementless THA were implanted in patients with unilateral coxarthrosis via the DAA in a two surgeon setting using the Corail® or Trendhip® stem (DePuy Synthes or Aesculap). Varus(+)/Valgus(-) stem alignment was analyzed in postoperative anteroposterior pelvic radiographs. Effects on femoral offset reconstruction and correlation to patient's individual clinical and radiological parameters were evaluated. RESULTS 55 stems were implanted in varus (59%), 32 in neutral (34%) and 6 in valgus alignment (7%). Mean stem alignment in varus position was + 2.2° (SD ± 1.4°). Varus alignment was associated with male gender and preoperative coxa vara deformity: low CCD, high femoral offset and long thigh neck (p ≤ 0.001). Alignment was not correlated to femoral offset restoration, BMI or leg length difference. Mean cup inclination was 44° (SD ± 4.7°) and 90% matched the coronal Lewinnek safe zone. CONCLUSION In the learning curve, the DAA can be associated with a high incidence of varus stem alignment when using a straight tapered stem, especially in men with coxa vara deformity: low CCD, high femoral offset and long thigh neck. An insufficient capsule release makes femur exposure more difficult and might be an additional factor for this finding. We recommend intraoperative X-ray in the learning phase of the DAA to verify correct implant positioning and to adjust offset options.
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Affiliation(s)
- Marcel Haversath
- Department of Orthopaedics, St. Vinzenz-Krankenhaus, Schloßstraße 85, 40477, Düsseldorf, Germany.
| | - Martin Lichetzki
- Medical Faculty, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Sebastian Serong
- Department of Orthopaedics, St. Vinzenz-Krankenhaus, Schloßstraße 85, 40477, Düsseldorf, Germany
- Department of Orthopaedics and Orthopaedic Surgery, Saarland University, Homburg, Germany
| | - André Busch
- Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien-Hospital Mülheim a.d. Ruhr, 45468, Mülheim an der Ruhr, Germany
| | - Stefan Landgraeber
- Department of Orthopaedics, St. Vinzenz-Krankenhaus, Schloßstraße 85, 40477, Düsseldorf, Germany
- Department of Orthopaedics and Orthopaedic Surgery, Saarland University, Homburg, Germany
| | - Marcus Jäger
- Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien-Hospital Mülheim a.d. Ruhr, 45468, Mülheim an der Ruhr, Germany
| | - Tjark Tassemeier
- Gelenkzentrum Bergisch Land, Freiheitstraße 203, 42853, Remscheid, Germany
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Dutka J, Kiepura S, Bukowczan M. Is analog preoperative planning still applicable?-comparison of accuracy of analog and computer preoperative planning methods in total hip arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:749. [PMID: 34268362 PMCID: PMC8246200 DOI: 10.21037/atm-20-7489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/28/2021] [Indexed: 01/01/2023]
Abstract
Background Preoperative planning is an integral part of total hip arthroplasty and has a significant impact on surgical technique and clinical outcome. The variety of types and sizes of endoprosthesis components makes the procedure more demanding and generates a need for accurate preoperative planning. The objective of this study was to analyze an analog method of preoperative planning of primary total hip arthroplasty based on templates overlaying on preoperative radiograms and compare its accuracy for predicting the size, both the stem and cup, with computer planning methods. Methods A retrospective cohort study based on 360 X-ray images of hip joints in 348 patients qualified for total hip arthroplasty between 2018 and 2019. The study group consisted of 136 men and 212 women, with an average age of 65 years (56 to 85 years). Material included both cementless and cemented endoprostheses. Results In the analyzed material, the accuracy of cup planning using the analog method was 85% (P<0.001) and 77% (P<0.001) in the planning of stem size. However, using the computer method, planning accuracy was 82% (P<0.001) for the cup and 72% (P<0.001) for the stem. Conclusions Both methods of preoperative planning remain effective. The analog method of preoperative planning is simple, precise, and repeatable in choosing the type and size of endoprosthesis components with an accuracy of 85% and 77% for the cup and stem respectively. The accuracy of planning depends on the type of endoprosthesis and in the case of the cemented endoprosthesis, it is lower than in cementless.
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Affiliation(s)
- Julian Dutka
- Department of Orthopedic and Trauma Surgery in Zeromski's Memorial Specialistic Hospital, Krakow, Poland
| | - Slawomir Kiepura
- Department of Orthopedic and Trauma Surgery in Zeromski's Memorial Specialistic Hospital, Krakow, Poland
| | - Mateusz Bukowczan
- Department of Orthopedic and Trauma Surgery in Zeromski's Memorial Specialistic Hospital, Krakow, Poland
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Floerkemeier T. Patientenspezifische Planung in der Hüftendoprothetik. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Boese CK, Rolvien T, Trost M, Frink M, Hubert J, Beil FT, Ries C. Implications of component size and calibration error on digital templating for total hip arthroplasty. A visual matrix from a simple mathematical model. Int J Comput Assist Radiol Surg 2021; 16:1037-1041. [PMID: 33864566 PMCID: PMC8166734 DOI: 10.1007/s11548-021-02367-4] [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: 02/04/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Preoperative digital templating is a standard procedure in total hip arthroplasty. Deviations between template size and final implant size may result from inaccurate calibration, templating as well as intraoperative decisions. So far, the explicit effect of calibration errors on templating has not been addressed adequately. MATERIALS AND METHODS A mathematical simulation of calibration errors up to ± 24% was applied to the templating of acetabular cups (38 to 72 mm diameter). The effect of calibration errors on template component size as deviation from optimal size was calculated. RESULTS The relationship between calibration error and component size deviation is inverse and linear. Calibration errors have a more pronounced effect on larger component sizes. Calibration errors of 2-6% result in templating errors of up to two component sizes. Common errors of up to 12% may result in templating errors of 3-4 sizes for common implant sizes. A tabular matrix visualizes the effect. CONCLUSION Calibration errors play a significant role in component size selection during digital templating. Orthopedic surgeons should be aware of this effect and try to identify and address this source of error.
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Affiliation(s)
- Christoph Kolja Boese
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany. .,Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Tim Rolvien
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Trost
- Department of Orthopaedics and Traumatology, St. Josef-Hospital, University of Bochum, Bochum, Germany
| | - Michael Frink
- Center of Orthopedic and Trauma Surgery, University of Giessen and Marburg, Marburg, Germany
| | - Jan Hubert
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Timo Beil
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Ries
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Brenneis M, Braun S, van Drongelen S, Fey B, Tarhan T, Stief F, Meurer A. Accuracy of Preoperative Templating in Total Hip Arthroplasty With Special Focus on Stem Morphology: A Randomized Comparison Between Common Digital and Three-Dimensional Planning Using Biplanar Radiographs. J Arthroplasty 2021; 36:1149-1155. [PMID: 33160804 DOI: 10.1016/j.arth.2020.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/20/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Accurate preoperative planning is a key component of successful total hip arthroplasty (THA). The purpose of the present study was to compare the accuracy and reliability of three-dimensional (hipEOS) and common digital two-dimensional (TraumaCad) templating with special focus on stem morphology. METHODS 51 patients undergoing THA were randomized to two groups. Preoperative planning was performed on 23 patients with hipEOS (3D) and on 28 patients with TraumaCad (2D) planning software. Planning results were compared with the implanted component size. Inter- and intraobserver reliability as well as planning accuracy of both planning methods with special focus on straight and short stem design were recorded. RESULTS Intraobserver reliability of both planning methods was good for component planning (ICC2,1: 0.835-0.967). Interobserver ICC2,1 for stem and cup planning were higher for 3D templating (3D ICC2,1: 0.906-0.918 vs. 2D ICC2,1: 0.835-0.843). Total stem and cup size predictions were within 2 sizes for 3D and within 3 sizes for 2D planning. Comparing short stem planning accuracy of both planning methods, absolute difference between implanted and planned component size was significantly lower in 3D planning (P = .029). There was no significant difference in straight stem (P = .935) and cup (P = .954) planning accuracy. CONCLUSION Our findings suggest that 3D templating with hipEOS software has a good overall reliability and may have a better planning accuracy of short stem prostheses than digital templating with TraumaCad software. Assuming that the number of implanted short stem prostheses will further increase in coming years, a more precise planning with 3D technique can contribute to improve surgery outcome.
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Affiliation(s)
- Marco Brenneis
- Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt/Main, Germany
| | - Sebastian Braun
- Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt/Main, Germany
| | - Stefan van Drongelen
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt/Main, Germany
| | - Benjamin Fey
- Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt/Main, Germany
| | - Timur Tarhan
- Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt/Main, Germany
| | - Felix Stief
- Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt/Main, Germany
| | - Andrea Meurer
- Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt/Main, Germany
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Huo J, Huang G, Han D, Wang X, Bu Y, Chen Y, Cai D, Zhao C. Value of 3D preoperative planning for primary total hip arthroplasty based on artificial intelligence technology. J Orthop Surg Res 2021; 16:156. [PMID: 33627149 PMCID: PMC7903792 DOI: 10.1186/s13018-021-02294-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/10/2021] [Indexed: 12/18/2022] Open
Abstract
Background Accurate preoperative planning is an important step for accurate reconstruction in total hip arthroplasty (THA). Presently, preoperative planning is completed using either a two-dimensional (2D) template or three-dimensional (3D) mimics software. With the development of artificial intelligence (AI) technology, AI HIP, a planning software based on AI technology, can quickly and automatically identify acetabular and femur morphology, and automatically match the optimal prosthesis size. However, the accuracy and feasibility of its clinical application still needs to be further verified. The purposes of this study were to investigate the accuracy and time efficiency of AI HIP in preoperative planning for primary THA, compared with 3D mimics software and 2D digital template, and further analyze the factors that influence the accuracy of AI HIP. Methods A prospective study was conducted on 53 consecutive patients (59 hips) undergoing primary THA with cementless prostheses in our department. All preoperative planning was completed using AI HIP as well as 3D mimics and 2D digital template. The predicted component size and the actual implantation results were compared to determine the accuracy. The templating time was compared to determine the efficiency. Furthermore, the potential factors influencing the accuracy of AI HIP were analyzed including sex, body mass index (BMI), and hip dysplasia. Results The accuracy of predicting the size of acetabular cup and femoral stem was 74.58% and 71.19%, respectively, for AI HIP; 71.19% (P = 0.743) and 76.27% (P = 0.468), respectively, for 3D mimics; and 40.68% (P < 0.001) and 49.15% (P = 0.021), respectively, for 2D digital templating. The templating time using AI HIP was 3.91 ± 0.64 min, which was equivalent to 2D digital templates (2.96 ± 0.48 min, P < 0.001), but shorter than 3D mimics (32.07 ± 2.41 min, P < 0.001). Acetabular dysplasia (P = 0.021), rather than sex and BMI, was an influential factor in the accuracy of AI HIP templating. Compared to patients with developmental dysplasia of the hip (DDH), the accuracy of acetabular cup in the non-DDH group was better (P = 0.021), but the difference in the accuracy of the femoral stem between the two groups was statistically insignificant (P = 0.062). Conclusion AI HIP showed excellent reliability for component size in THA. Acetabular dysplasia may affect the accuracy of AI HIP templating.
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Affiliation(s)
- Jiabang Huo
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Guangxin Huang
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Dong Han
- Department of Quality Management and Evaluation, Orthopedic Hospital of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xinjie Wang
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Yufan Bu
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China
| | - Ya Chen
- Department of Quality Management and Evaluation, Orthopedic Hospital of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Daozhang Cai
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China.
| | - Chang Zhao
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, The Third Affiliated Hospital of Southern Medical University, No. 183, Zhongshan Rd West, Guangzhou, 510630, China.
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Peng HM, Feng B, Chen X, Wang YO, Bian YY, Wang W, Weng XS, Qian WW. Usefulness of a Simple Preoperative Planning Technique using Plain X-rays for Direct Anterior Approach for Total Hip Arthroplasty. Orthop Surg 2020; 13:145-152. [PMID: 33305484 PMCID: PMC7862183 DOI: 10.1111/os.12854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/20/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022] Open
Abstract
Objective To examine the accuracy, reliability, and reproducibility of a simple preoperative planning technique using plain X‐rays. Methods A retrospective analysis of 96 consecutive cases of primary direct anterior approach (DAA)‐total hip arthroplasty (THA) from July 2015 to December 2018 was performed. The 96 patients included 24 males and 72 females, with an average age of 70 years. The standard AP pelvis radiographs with the patients' hips extended and internally rotated were obtained pre‐ and postoperatively. The preoperative planning was also completed on the standardized AP pelvic radiographs. The prearranged cup positioning was radiologically measured intraoperatively using fluoroscopy. The correct leg length was assessed intraoperatively, which was compared with the preoperative planning. The component positioning was measured by three independent researchers. Two of the researchers completed the measurements three times, and intra‐observer and inter‐observer reliability were calculated. All patients received at least 6 months follow‐up (6 months–4 years). Results In all cases, the median leg length discrepancy (LLD) was 4.4 mm (range 1.6–15.9 mm), and 84 patients had an LLD smaller than 10 mm, of which 58 patients had an LLD of less than 5 mm. None of the patients had a critical LLD of 2 cm or larger. The multivariable logistic regression for LLD (safe range: yes/no) with the co‐variables including gender, ASA classification, type of cup, the surgeon's experience level, and the presence of a total hip arthroplasty (THA) on the contralateral side did not present statistical significance. The median angle of the inclination of the acetabular component (IA) was 42.3° (range: 28.7°–52.2°). Ninety‐one patients were within the defined safe range. The hit ratio for the cup to be within the safe zone was significantly higher for the Pinnacle cups than that for the Continuum cups (P < 0.05). However, there was no significant difference in gender, ASA classification, the surgeon's experience level, and the presence of a total hip arthroplasty (THA) on the contralateral side. The median of its anteversion (AA) was 20.6° (range: 10.6°–40.1°). Only 41 patients were within the defined safe range. None of the co‐variables presented a statistical significance affecting the AA of the cup positioning. Meanwhile, the average fluoroscopy time for the cup positioning (n = 86, missing data in 10 cases) was 4 seconds (range: 1–74), with most of the patients (97.9%) having a fluoroscopy time of fewer than 20 seconds. Conclusions The combination of correct preoperative planning and standardized intraoperative measurements can reestablish right leg length and assure the correct cup positioning.
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Affiliation(s)
- Hui-Ming Peng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(CAMS), Beijing, China
| | - Bin Feng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(CAMS), Beijing, China
| | - Xi Chen
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(CAMS), Beijing, China
| | - Yi-Ou Wang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(CAMS), Beijing, China
| | - Yan-Yan Bian
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(CAMS), Beijing, China
| | - Wei Wang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(CAMS), Beijing, China
| | - Xi-Sheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(CAMS), Beijing, China
| | - Wen-Wei Qian
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences(CAMS), Beijing, China
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Shichman I, Factor S, Shaked O, Morgan S, Amzallag N, Gold A, Snir N, Warschawski Y. Effects of surgeon experience and patient characteristics on accuracy of digital pre-operative planning in total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2020; 44:1951-1956. [PMID: 32699933 DOI: 10.1007/s00264-020-04733-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/14/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND The effect of surgeon experience on accuracy of digital pre-operative planning for total hip arthroplasty (THA) remains unclear. The aims of our study were to compare pre-operative planning accuracy between fellow-trained orthopaedic surgeons and residents and to explore whether surgery indication effects the prediction accuracy. METHODS We prospectively reviewed 101 patients who underwent pre-operative digital templating for THA in our center from January 2019 to January 2020 with King Mark device. Extracted data included baseline characteristics and indication for primary arthroplasty. Pre-operative digital templating was performed separately by both a fellow-trained surgeon and a resident. Accuracy of each group was compared with the implanted components. RESULTS The overall adequate pre-operative planning of the acetabular cup (exact or +/-1 size match) by the fellow-trained group was higher compared with the resident's group (77.2 and 64.3% respectively, p = 0.037), whereas the overall adequate pre-operative planning of the femoral stem (exact or +/-1 size match) was higher in the resident's group compared with the fellow-trained group (83.2 and 61.4% respectively, p < =0.001). The fellow-trained group showed better pre-operative planning of complex cases (developmental dysplasia of the hip and avascular necrosis of femoral head) than the resident's group. CONCLUSIONS The experience of the planner does not significantly affect the accuracy of correctly predicting component sizes. However, in complex cases, fellow-trained surgeons should assist residents in digital pre-operative templating for THA.
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Affiliation(s)
- Ittai Shichman
- Adult Reconstruction Unit, Division of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center,, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Shai Factor
- Adult Reconstruction Unit, Division of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center,, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Or Shaked
- Adult Reconstruction Unit, Division of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center,, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Samuel Morgan
- Adult Reconstruction Unit, Division of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center,, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Nissan Amzallag
- Adult Reconstruction Unit, Division of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center,, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Aviram Gold
- Adult Reconstruction Unit, Division of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center,, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Nimrod Snir
- Adult Reconstruction Unit, Division of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center,, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Yaniv Warschawski
- Adult Reconstruction Unit, Division of Orthopedics, Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center,, Tel Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel.
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Zhang HL, Zheng L, Wang WC, Luo YH, Wang L, Mao XZ. A new and improved acetabular cup digital templating method and its clinical application. Musculoskelet Surg 2020; 106:49-58. [PMID: 32617748 DOI: 10.1007/s12306-020-00671-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 06/05/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Preoperative acetabular cup templating has an important auxiliary effect on hip surgery. The traditional acetabular cup templating method requires the measuring person to have some experience in total hip replacement (THA) surgery since the measurement results vary from person to person with differences between different measuring persons. To obtain stable templating results, we designed a new acetabular cup templating method and tested the inter-person measuring differences and measurement accuracy of this method. Meanwhile, the clinical application of this method was preliminarily explored. MATERIALS AND METHODS The pattern of this new method was manual labeling of imaging characteristic points and then programmed automatic measurements. The measurement process was performed entirely by orthopedic graduate students without any experience in hip replacement surgery. The inter-person measuring difference was evaluated by comparing the templating results of three measuring persons. The accuracy of the templating was evaluated by comparing the templating results with the actual size of the prosthesis in the surgery. The correlation between the position of the acetabular cup and the templating error was analyzed to explore the clinical significance of the templating results. This study was a retrospective study which included templating in a total of 406 cases for total hip replacement with cementless cup prosthesis. Digital measurements were performed using the Matlab software from MathWorks. The statistical comparison was performed using Kendall's W test. RESULTS The results of the three measuring persons were completely identical in 61.8% (251/406) of cases, and the variation in 38.2% (155/406) of cases did not exceed one size of the acetabular cup. The Kendall's W coefficient was 0.977, and p < 0.01. The measurement accuracy is not as good as the traditional method in exactly accurate measurement and ±1 cup size, but it is similar to the traditional method in the ±2 cup sizes. The correlation between the templating error and the position evaluation of the implanted acetabular cups reveals: (1) larger the templating error, larger the proportion of the acetabular cups with poor position; (2) the proportion of acetabular cup with poor position slowly increased when the templating error was from 0 to 1 size, and the proportion rapidly increased when the templating error was from 1 to 2 size. CONCLUSION All the patients with clear teardrop bottom and lateral superior edge of acetabulum were able to use our method to predict the size of the acetabular cup. The method has the following advantages: (1) it does not require the measuring person to have any previous experience of the THA surgery, which reduces the labor cost of the templating; (2) the differences between the measuring persons is small, the measurement result can be repeated; (3) it can predict the probability of acetabular cup with poor positioning according to the templating error, and thereby reminding the surgeon to recheck and correct the position of the acetabular cup in time during the surgery.
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Affiliation(s)
- H-L Zhang
- Operating Room, The Second Xiangya Hospital, Central South University, No. 139, Middle Renmin Road, Changsha, 410011, Hunan, China
| | - L Zheng
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, No. 139, Middle Renmin Road, Changsha, 410011, Hunan, China.
| | - W-C Wang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, No. 139, Middle Renmin Road, Changsha, 410011, Hunan, China
| | - Y-H Luo
- Department of Radiology, The Second Xiangya Hospital, Central South University, No. 139, Middle Renmin Road, Changsha, Hunan, China
| | - L Wang
- School of Information Science and Engineering, Central South University, No. 932, South Lushan Road, Changsha, Hunan, China
| | - X-Z Mao
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, No. 139, Middle Renmin Road, Changsha, 410011, Hunan, China
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Loweg L, Trost M, Kutzner KP, Ries C, Boese CK. A novel calibration method for digital templating of total hip arthroplasty: a prospective clinical study of dual scale type single marker calibration in supine radiographs. INTERNATIONAL ORTHOPAEDICS 2020; 44:1693-1699. [PMID: 32415416 DOI: 10.1007/s00264-020-04597-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/27/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND External calibration markers (ECM) are the standard of care for digital templating in joint replacements. Spherical mono markers are known to be unreliable. Fixed calibration factors (FCF) can reduce the overall error by placement of markers, but do not address individual patient anatomy. Dual scale calibration marker (DSCM) methods were developed to improve precision of calibration but require two markers. This prospective observational study is the first to analyse the application of a dual scale type single marker (DSSM) method in supine radiographs. METHODS One hundred patients with unilateral total hip arthroplasty (THA) underwent anterior-posterior pelvis X-ray with ECM and DSSM. The femoral THA head components were used as internal reference (ICM). An empirical fixed calibration factor (FCF; 120%) was used as comparator. Absolute differences of ICM and both ECM and DSSM were calculated. Absolute relative deviations (ARD) were calculated. RESULTS Mean absolute calibration factor differences of ECM, FCF and DSSM from ICM were 0.105 (0.002-0.182), 0.016 (0.082-0.013) and 0.011 (0.056-0.009), respectively. ARD differences between ECM and DSSM as well as FCF and DSSM were significant (p < 0.001). CONCLUSION The DSSM method showed superior results over ECM and FCF to predict the optimal calibration factor in supine radiographs. The novel DSSM method could be used to improve digital templating in supine radiographs without need for additional markers.
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Affiliation(s)
- Lennard Loweg
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Matthias Trost
- Department of Orthopaedics and Traumatology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Karl Philipp Kutzner
- Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Christian Ries
- Department of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Kolja Boese
- Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann-Str. 9, 50924, Cologne, Germany.
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Bergschmidt P, Maruniewicz JP, Westphal T, Klinder A, Mittelmeier W. Retrospective Comparative Study of the Influence on Quality of Primary Total Hip Arthroplasty by the EndoCert-Certification System in a Communal Hospital. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 159:397-405. [PMID: 32131085 DOI: 10.1055/a-1107-3398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The EndoCert®-Initiative system sets specific requirements for the structural, process and result quality in certified Arthroplasty Centers in Germany. However, it remains unclear to what extent the certification process can increase the quality in total hip and knee arthroplasty. Aim of the comparative retrospective study is to analyse the change in quality of total hip arthroplasty in a communal hospital before and after the certification process. All primary total hip arthroplasties (n = 366) between 2013 and 2016 were included in the study retrospectively and grouped by treatment period. Treatment was performed in group 1 without clinical pathways, in group 2 pathway-controlled without a valid certificate and in group 3 pathway-controlled after final completion of the certification process. Outcome quality was analysed using quality indicators defined by the EndoCert-Initiative and further predefined indicators. Results show quality improvement under certified pathway-controlled treatment, e.g. time of surgery, cup and stem positioning, blood transfusion rate, periprosthetic fractures. However, improvements were not significantly in all cases and limitations must be recognized. Positive effects of the certification process legitimate capital investment and efforts. Further quality indicators may be implemented in the certification process to improve quality of treatment in arthroplasty.
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Affiliation(s)
- Philipp Bergschmidt
- Department for Orthopaedic Surgery, Trauma Surgery and Hand Surgery, Rostock Suedstadt Hospital.,Orthopaedic Clinic and Outpatient Department, University Medical Centre Rostock
| | - Jan Pawel Maruniewicz
- Department for Orthopaedic Surgery, Trauma Surgery and Hand Surgery, Rostock Suedstadt Hospital
| | - Thomas Westphal
- Department for Orthopaedic Surgery, Trauma Surgery and Hand Surgery, Rostock Suedstadt Hospital
| | - Annett Klinder
- Orthopaedic Clinic and Outpatient Department, University Medical Centre Rostock
| | - Wolfram Mittelmeier
- Orthopaedic Clinic and Outpatient Department, University Medical Centre Rostock
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Savov P, Budde S, Tsamassiotis S, Windhagen H, Klintschar M, Ettinger M. Three-dimensional templating in hip arthroplasty: the basis for template-directed instrumentation? Arch Orthop Trauma Surg 2020; 140:827-833. [PMID: 32157370 PMCID: PMC7244460 DOI: 10.1007/s00402-020-03394-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Computed tomography-based three-dimensional models may allow the accurate determination of the center of rotation, lateral and anterior femoral offsets, and the required implant size in total hip arthroplasty. In this cadaver study, the accuracy of anatomical reconstruction was evaluated using a three-dimensional planning tool. MATERIALS AND METHODS A total of eight hip arthroplasties were performed on four bilateral specimens. Based on a computed tomography scan, the position and size of the prosthesis were templated with respect to the anatomical conditions. RESULTS On average, all parameters were reconstructed to an accuracy of 4.5 mm and lie within the limits recommended in the literature. All prostheses were implanted with the templated size. CONCLUSIONS The exact anatomy of the patient and the required size and position of the prosthesis were precisely analyzed using a templating software. Based on the present findings, the development of template-directed instrumentation is conceivable using this method. However, further technical features (e.g., navigation or robot-assisted surgery) are required for improved precision for implant positioning.
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Affiliation(s)
- P. Savov
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
| | - S. Budde
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
| | - S. Tsamassiotis
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
| | - H. Windhagen
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
| | - M. Klintschar
- grid.10423.340000 0000 9529 9877Institute for Forensic Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hanover, Germany
| | - M. Ettinger
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
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Kase M, O'Loughlin PF, Aït-Si-Selmi T, Pagenstert G, Langlois J, Bothorel H, Bonnin MP. Pre-operative templating in THA. Part I: a classification of architectural hip deformities. Arch Orthop Trauma Surg 2020; 140:129-137. [PMID: 31696320 DOI: 10.1007/s00402-019-03298-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION While numerous classifications of hip arthritis have been proposed, none considered the magnitude and direction of femoral head translation relative to the native acetabulum. A more precise classification of architectural hip deformities is necessary to improve preoperative templating and anticipate surgical challenges of total hip arthroplasty (THA). The purpose of the present study was to introduce a classification system to distinguish different types of architectural hip deformities, based on femoral head translation patterns, and to evaluate its repeatability using plain radiographs (qualitative) and Computed Tomography (CT) measurements (quantitative). MATERIALS AND METHODS We studied pre-operative frontal and lateral hip radiographs and CT scans of 191 hips (184 patients) that received primary THA. The distance between the femoral head center (FC) and the acetabular center (AC) was measured, as well as femoral offset, acetabular offset, head center height, acetabular floor distance and femoral neck angle. The hips were classified qualitatively using frontal plain radiographs, and then quantitatively using CT scans (with an arbitrary threshold of 3 mm as Centered, Medialized, Lateralized, Proximalized or Proximo-lateralized. The agreement between qualitative and quantitative classification methods was compared for applying the same classification. RESULTS Qualitative classification identified 120 centered (63%), 8 medialized (4%), 49 lateralized (26%), 3 proximalized (2%), and 11 proximo-lateralized (6%) hips, while quantitative classification identified 116 centered (61%), 8 medialized (4%), 51 lateralized (27%), 5 proximalized (3%), and 11 proximo-lateralized (6%) hips. The agreement between the two methods was excellent (0.94; CI 0.90-0.98). Medialization reached 9.7 mm, while lateralization reached 10.9 mm, and proximalization reached 8.5 mm. Proximalized and proximo-lateralized hips had more valgus necks, while medialized hips had more varus necks (p = 0.003). CONCLUSIONS The classification system enabled repeatable distinction of 5 types of architectural hip deformities. The excellent agreement between quantitative and qualitative methods suggests that plain radiographs are sufficient to classify architectural hip deformities.
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Affiliation(s)
- Masanori Kase
- Department of Orthopaedic Surgery, Nissan Tamagawa Hospital, Setagaya-ku, Tokyo, Japan
| | - Padhraig F O'Loughlin
- Department of Orthopaedic Surgery, Mater Hospital Cork, Cork, Ireland
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Tarik Aït-Si-Selmi
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
- Artro Institute, Lyon, France
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Clarahof Clinic of Orthopaedic Surgery, Merian-Iselin-Hospital Swiss Olympic Medical Center, Basel, Switzerland
- Knee Institute Basel, Basel, Switzerland
| | - Jean Langlois
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Hugo Bothorel
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Michel P Bonnin
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
- Artro Institute, Lyon, France
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