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Rice SJ, D’Abarno A, Luu HH. Robotic-assisted Total Hip Arthroplasty and Spinopelvic Parameters: A Review. Hip Pelvis 2024; 36:87-100. [PMID: 38825818 PMCID: PMC11162869 DOI: 10.5371/hp.2024.36.2.87] [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: 08/01/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 06/04/2024] Open
Abstract
Total hip arthroplasty (THA) is an effective treatment for osteoarthritis, and the popularity of the direct anterior approach has increased due to more rapid recovery and increased stability. Instability, commonly caused by component malposition, remains a significant concern. The dynamic relationship between the pelvis and lumbar spine, deemed spinopelvic motion, is considered an important factor in stability. Various parameters are used in evaluating spinopelvic motion. Understanding spinopelvic motion is critical, and executing a precise plan for positioning the implant can be difficult with manual instrumentation. Robotic and/or navigation systems have been developed in the effort to enhance THA outcomes and for implementing spinopelvic parameters. These systems can be classified into three categories: X-ray/fluoroscopy-based, imageless, and computed tomography (CT)-based. Each system has advantages and limitations. When using CT-based systems, preoperative CT scans are used to assist with preoperative planning and intraoperative execution, providing feedback on implant position and restoration of hip biomechanics within a functional safe zone developed according to each patient's specific spinopelvic parameters. Several studies have demonstrated the accuracy and reproducibility of robotic systems with regard to implant positioning and leg length discrepancy. Some studies have reported better radiographic and clinical outcomes with use of robotic-assisted THA. However, clinical outcomes comparable to those for manual THA have also been reported. Robotic systems offer advantages in terms of accuracy, precision, and potentially reduced rates of dislocation. Additional research, including conduct of randomized controlled trials, will be required in order to evaluate the long-term outcomes and cost-effectiveness of robotic-assisted THA.
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Affiliation(s)
- Steven J. Rice
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago, Chicago, IL, USA
| | | | - Hue H. Luu
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago, Chicago, IL, USA
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Maes V, Cossetto D. Combining inertial navigation with transacetabular ligament in total hip arthroplasty via direct anterior approach results in excellent accuracy compared to standard manual technique - A retrospective cohort study. SICOT J 2024; 10:16. [PMID: 38759152 PMCID: PMC11101203 DOI: 10.1051/sicotj/2024013] [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: 02/05/2024] [Accepted: 04/12/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Correct acetabular component placement plays a critical role in reducing early revisions after dislocations in total hip arthroplasty (THA). Although the transverse acetabular ligament (TAL) guides anteversion, inclination can only be accurately guided by navigation. In order to overcome the initial disadvantages with navigation, an imageless, easy-to-use inertial navigation system has been recently introduced. This study aims to analyze the accuracy of inclination with this navigation system compared to the standard manual technique. METHODS Two cohorts, manual technique (MT) and navigation (NAV) cohorts, consisted of 83 and 95 patients, respectively, after exclusion criteria were applied. Inclination target was 38° and anteversion was guided by TAL. Demographic data were collected, and anteroposterior (AP) pelvic and cross-table lateral radiographs were obtained 6 weeks post-operatively. Inclination and anteversion were determined on the AP pelvic and cross-table lateral radiograph, respectively. RESULTS A mean inclination of 41.8° (±6.8°) and 38.9° (±4.4°) was found in the MT and NAV cohorts, respectively. There was no statistical difference in gender, age, and BMI. If the inclination was set within 10° of the target (i.e., 38°), 88% of the MT cohort and 97% of the NAV cohort were within the target zone. Accuracy decreased to 53% and 83%, respectively, if the target zone range was narrowed down to ± 5°. CONCLUSION Combining inertial imageless navigation for inclination and TAL as a landmark for anteversion is significantly more accurate compared to the manual technique, without having the limitations and disadvantages of current standard navigational techniques.
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Affiliation(s)
- Vincent Maes
- Royal North Shore Hospital, Department of Orthopaedic and Traumatic Surgery Reserve Rd, St Leonards NSW 2065 Sydney Australia
- University Hospitals Leuven, Department of Orthopaedic and Traumatic Surgery 49 Herestraat Leuven 3000 Belgium
| | - David Cossetto
- South Coast Orthopaedic Clinic 70 Bridge Road Nowra NSW 2541 Australia
- Nowra Private Hospital, Department of Orthopaedic Surgery Weeroona PI Nowra NSW 2541 Australia
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熊 昌, 左 云, 严 小, 王 冠, 付 豪, 姜 学. [Application of modified acetabular anteversion and inclination angles test system in patients undergoing total hip arthroplasty after lumbar fusion]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:576-582. [PMID: 38752244 PMCID: PMC11096887 DOI: 10.7507/1002-1892.202401001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024]
Abstract
Objective To investigate the accuracy and effectiveness of acetabular cup placement in total hip arthroplasty (THA) after lumbar fusion applying of modified acetabular anteversion and inclination angles test system. Methods A clinical data of 45 patients undergoing THA for osteoarthritis between January 2018 and June 2023 was retrospectively analyzed. All patients had previously received lumbar fusion. The modified acetabular anteversion and inclination angle test system was used in 26 cases (observation group) and not used in 19 cases (control group) during THA. There was no significant difference in baseline data such as gender, age, body mass index, operative side, number of lumbar fusion segments, and preoperative Harris score between the two groups ( P>0.05). The position of acetabular prosthesis, hip function (Harris score), and incidence of complications were compared between the two groups. Results In the observation group, all acetabular cups were in the safe zone (anteversion angle, 25°-30°) during operation, and 1 acetabular cup (3.85%) was not in the safe zone after operation. In the control group, 9 acetabular cups (47.37%) were not in the safe zone. The postoperative difference between the two groups was significant ( P<0.05). There was no significant difference between intra- and post-operative acetabular inclination angles in the observation group ( P>0.05), and the postoperative acetabular inclination angle was significantly smaller in the observation group than in the control group ( P<0.05). All incisions healed by first intention and no infection occurred. All patients were followed up 6 months. There was no significant difference in Harris score between the two groups at different time point ( P>0.05), and there were significant differences between different time points in the two groups ( P<0.05). No joint dislocation occurred in the observation group during follow-up, while dislocation occurred in 2 cases and femoral impingement syndrome occurred in 1 case of the control group. There was no significant difference in the incidence of complications between the two groups ( P>0.05). Conclusion For THA patients with lumbar fusion, the ideal placement angle of the acetabular cup can be obtained by using the modified acetabular anteversion and inclination angles test system during operation.
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Affiliation(s)
- 昌军 熊
- 武汉中西医结合骨科医院骨关节科(武汉 430079)Department of Joint Surgery, Wuhan Integrated Traditional Chinese and Western Medicine Hospital, Wuhan Hubei, 430079, P. R. China
- 武汉体育学院附属医院骨关节科 (武汉 430079)Department of Joint Surgery, Wuhan Sports University Affiliated Hospital, Wuhan Hubei, 430079, P. R. China
| | - 云周 左
- 武汉中西医结合骨科医院骨关节科(武汉 430079)Department of Joint Surgery, Wuhan Integrated Traditional Chinese and Western Medicine Hospital, Wuhan Hubei, 430079, P. R. China
- 武汉体育学院附属医院骨关节科 (武汉 430079)Department of Joint Surgery, Wuhan Sports University Affiliated Hospital, Wuhan Hubei, 430079, P. R. China
| | - 小康 严
- 武汉中西医结合骨科医院骨关节科(武汉 430079)Department of Joint Surgery, Wuhan Integrated Traditional Chinese and Western Medicine Hospital, Wuhan Hubei, 430079, P. R. China
- 武汉体育学院附属医院骨关节科 (武汉 430079)Department of Joint Surgery, Wuhan Sports University Affiliated Hospital, Wuhan Hubei, 430079, P. R. China
| | - 冠 王
- 武汉中西医结合骨科医院骨关节科(武汉 430079)Department of Joint Surgery, Wuhan Integrated Traditional Chinese and Western Medicine Hospital, Wuhan Hubei, 430079, P. R. China
- 武汉体育学院附属医院骨关节科 (武汉 430079)Department of Joint Surgery, Wuhan Sports University Affiliated Hospital, Wuhan Hubei, 430079, P. R. China
| | - 豪 付
- 武汉中西医结合骨科医院骨关节科(武汉 430079)Department of Joint Surgery, Wuhan Integrated Traditional Chinese and Western Medicine Hospital, Wuhan Hubei, 430079, P. R. China
- 武汉体育学院附属医院骨关节科 (武汉 430079)Department of Joint Surgery, Wuhan Sports University Affiliated Hospital, Wuhan Hubei, 430079, P. R. China
| | - 学明 姜
- 武汉中西医结合骨科医院骨关节科(武汉 430079)Department of Joint Surgery, Wuhan Integrated Traditional Chinese and Western Medicine Hospital, Wuhan Hubei, 430079, P. R. China
- 武汉体育学院附属医院骨关节科 (武汉 430079)Department of Joint Surgery, Wuhan Sports University Affiliated Hospital, Wuhan Hubei, 430079, P. R. China
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Meermans G, Fawley D, Zagra L, Ten Broeke RHM, Johnson K, Bernard T, Thomason HC. Accuracy of cup placement compared with preoperative surgeon targets in primary total hip arthroplasty using standard instrumentation and techniques: a global, multicenter study. J Orthop Traumatol 2024; 25:25. [PMID: 38727945 PMCID: PMC11087417 DOI: 10.1186/s10195-024-00766-2] [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: 09/03/2023] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Acetabular cup positioning in total hip arthroplasty (THA) is closely related to outcomes. The literature has suggested cup parameters defined by the Lewinnek safe zone; however, the validity of such measures is in question. Several studies have raised concerns about the benefits of using the Lewinnek safe zone as a predictor of success. In this study we elected to use prospective surgeon targets as the basis for comparison to see how successful surgeons are positioning their cup using standard instruments and techniques. METHODS A prospective, global, multicenter study was conducted. Cup positioning success was defined as a composite endpoint. Both cup inclination and version needed to be within 10° of the surgeon target to be considered a success. Radiographic analysis was conducted by a third-party reviewer. RESULTS In 170 subjects, inclination, target versus actual, was 44.8° [standard deviation (SD 0.9°)] and 43.1° (SD 7.6°), respectively (p = 0.0029). Inclination was considered successful in 84.1% of cases. Mean version, target versus actual, was 19.4° (SD 3.9°) and 27.2° (SD 5.6°), respectively (p < 0.0001). Version was considered successful in 63.4% of cases, and combined position (inclination and version) was considered successful in 53.1%. CONCLUSION This study shows that with traditional methods of placing the cup intraoperatively, surgeons are only accurate 53.1% of the time compared with a predicted preoperative plan. This study suggests that the inconsistency in cup positioning based on the surgeon's planned target is potentially another important variable to consider while using a mechanical guide or in freehand techniques for cup placement in THA. TRIAL REGISTRATION This study is registered on ClinicalTrials.gov, NCT03189303.
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Affiliation(s)
- Geert Meermans
- Department of Orthopaedics, Bravis Hospital, Bergen op Zoom, Roosendaal, The Netherlands.
| | - David Fawley
- DePuy Synthes, 700 Orthopaedic Drive, Warsaw, IN, USA
| | - Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - René H M Ten Broeke
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, 6202 AZ, Maastricht, The Netherlands
| | - Kory Johnson
- Orthopaedic Associates of Michigan, 555 Mid Towne St Suite 105, Grand Rapids, MI, USA
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Waters GC, Jones C, D'Alessandro P, Yates P. Functional assessment of component positioning in patients with groin pain after total hip arthroplasty as a tool to guide management. Hip Int 2024; 34:336-343. [PMID: 37861204 DOI: 10.1177/11207000231205843] [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: 10/21/2023]
Abstract
BACKGROUND Persisting groin pain post total hip arthroplasty (THA) is a common and complex issue that can be difficult to diagnose and manage. Acetabular component positioning is often implicated. AIMS AND METHODS We used a previously well described and validated functional positioning protocol to determine if functional acetabular malpositioning was a factor in groin pain post THA and hence to determine if acetabular revision would be indicated. We compared patient-specific functional acetabular positioning to traditional CT evaluation of cup position and assessment of anterior cup overhang. RESULTS 39 patients with groin pain post-THA were investigated. Functional acetabular malpositioning was diagnosed in 31% (12/39). Revision THA was performed in those 12 patients, resulting in resolution of functional malpositioning (100%), with an overall accuracy of 5.6° (range 1-12), and resolution of groin pain in 67% (8/12). 33% (4/12) of the revised implants had functional positioning located outside the traditional "40/20 zone". Comparison with CT indicated that 40% (4/10) of implants with anterior overhang were well positioned, however only 50% (6/12) of functionally malpositioned implants had CT evidence of anterior cup prominence. Of the 8/12 revision patients who had resolution of their groin pain, only 1 had cup prominence. CONCLUSIONS This study suggests that the utilisation of a patient specific functional positioning algorithm in the analysis of persistent groin pain following THA can assist in identifying the underlying cause of pain and help to guide treatment. For a functionally malpositioned acetabulum, revision surgery offers a potential resolution of groin pain.
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Affiliation(s)
| | | | | | - Piers Yates
- University of Western Australia, Fremantle Hospital and Health Service, Perth, WA, Australia
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Di Martino A, Geraci G, Brunello M, D'Agostino C, Davico G, Curreli C, Traina F, Faldini C. Hip-spine relationship: clinical evidence and biomechanical issues. Arch Orthop Trauma Surg 2024; 144:1821-1833. [PMID: 38472450 PMCID: PMC10965652 DOI: 10.1007/s00402-024-05227-3] [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: 11/18/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
The hip-spine relationship is a critical consideration in total hip arthroplasty (THA) procedures. While THA is generally successful in patient, complications such as instability and dislocation can arise. These issues are significantly influenced by the alignment of implant components and the overall balance of the spine and pelvis, known as spinopelvic balance. Patients with alteration of those parameters, in particular rigid spines, often due to fusion surgery, face a higher risk of THA complications, with an emphasis on complications in instability, impingement and dislocation. For these reasons, over the years, computer modelling and simulation techniques have been developed to support clinicians in the different steps of surgery. The aim of the current review is to present current knowledge on hip-spine relationship to serve as a common platform of discussion among clinicians and engineers. The offered overview aims to update the reader on the main critical aspects of the issue, from both a theoretical and practical perspective, and to be a valuable introductory tool for those approaching this problem for the first time.
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Affiliation(s)
- Alberto Di Martino
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy.
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy.
| | - Giuseppe Geraci
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Matteo Brunello
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Claudio D'Agostino
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Giorgio Davico
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Cristina Curreli
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Traina
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
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Jodeiri A, Seyedarabi H, Danishvar S, Shafiei SH, Sales JG, Khoori M, Rahimi S, Mortazavi SMJ. Concurrent Learning Approach for Estimation of Pelvic Tilt from Anterior-Posterior Radiograph. Bioengineering (Basel) 2024; 11:194. [PMID: 38391680 PMCID: PMC10886461 DOI: 10.3390/bioengineering11020194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
Accurate and reliable estimation of the pelvic tilt is one of the essential pre-planning factors for total hip arthroplasty to prevent common post-operative complications such as implant impingement and dislocation. Inspired by the latest advances in deep learning-based systems, our focus in this paper has been to present an innovative and accurate method for estimating the functional pelvic tilt (PT) from a standing anterior-posterior (AP) radiography image. We introduce an encoder-decoder-style network based on a concurrent learning approach called VGG-UNET (VGG embedded in U-NET), where a deep fully convolutional network known as VGG is embedded at the encoder part of an image segmentation network, i.e., U-NET. In the bottleneck of the VGG-UNET, in addition to the decoder path, we use another path utilizing light-weight convolutional and fully connected layers to combine all extracted feature maps from the final convolution layer of VGG and thus regress PT. In the test phase, we exclude the decoder path and consider only a single target task i.e., PT estimation. The absolute errors obtained using VGG-UNET, VGG, and Mask R-CNN are 3.04 ± 2.49, 3.92 ± 2.92, and 4.97 ± 3.87, respectively. It is observed that the VGG-UNET leads to a more accurate prediction with a lower standard deviation (STD). Our experimental results demonstrate that the proposed multi-task network leads to a significantly improved performance compared to the best-reported results based on cascaded networks.
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Affiliation(s)
- Ata Jodeiri
- Faculty of Electrical and Computer Engineering, University of Tabriz, Tabriz 51666, Iran
- Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz 51656, Iran
| | - Hadi Seyedarabi
- Faculty of Electrical and Computer Engineering, University of Tabriz, Tabriz 51666, Iran
| | - Sebelan Danishvar
- College of Engineering, Design and Physical Sciences, Brunel University London, Uxbridge UB8 3PH, UK
| | - Seyyed Hossein Shafiei
- Orthopedic Surgery Research Centre, Sina University Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran 51656, Iran
| | - Jafar Ganjpour Sales
- Department of Orthopedic Surgery, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz 51656, Iran
| | - Moein Khoori
- Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran 51656, Iran
| | - Shakiba Rahimi
- Orthopedic Surgery Research Centre, Sina University Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran 51656, Iran
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Moralidou M, Di Laura A, Hothi H, Henckel J, Hart AJ. Cemented or uncemented fixation: Which allows a more acceptable prosthetic femoral version in total hip arthroplasty? J Orthop Surg Res 2023; 18:948. [PMID: 38071336 PMCID: PMC10710710 DOI: 10.1186/s13018-023-04331-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Three-dimensional computed-tomography (3D-CT) planning for primary Total Hip Arthroplasty (THA) typically uses the external femoral surface; as a result, it is difficult to predict the prosthetic femoral version (PFV) for uncemented femoral stems that press-fit to the internal surface of the bone. Cemented fixation allows the surgeon to adjust the version independent of the internal femoral anatomy. We aimed to better understand the effect of the fixation type on PFV. METHODS This was a case series study including a total of 95 consecutive patients (106 hips), who underwent uncemented (n = 81 hips) and cemented (n = 25 hips) primary THA using the posterior approach. The surgeon aimed for a PFV of 20°. Our primary objective was to compare PFV in both groups; our secondary objective was to evaluate the clinical outcomes. RESULTS The mean (± SD) PFV was 13° (± 9°) and 23° (± 8°) for the uncemented and cemented THA groups (P < 0.001), respectively. In the uncemented THA group, 36% of the patients had a PFV of < 10°. In the cemented THA group, this clinically important threshold dropped to 8%. Similarly, the Bland-Altman (BA) plots showed wider 95% limits of agreement for the uncemented group. Satisfactory clinical outcomes were recorded. CONCLUSION We found that the PFV was more clinically acceptable, for the posterior surgical approach, in the cemented group when compared to the uncemented group. Both THA groups reported high variability indicating the need to develop surgical tools to guide the PFV closer to the surgical target.
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Affiliation(s)
- Maria Moralidou
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Anna Di Laura
- The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, HA7 4LP, UK
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Harry Hothi
- The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, HA7 4LP, UK
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Johann Henckel
- The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Brockley Hill, Stanmore, HA7 4LP, UK.
- Cleveland Clinic London Hospital, 33 Grosvenor Pl, London, SW1X 7HY, UK.
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Chen P, Liu W, Wu C, Ruan P, Zeng J, Ji W. Fluoroscopy-guided direct anterior approach total hip arthroplasty provides more accurate component positions in the supine position than in the lateral position. BMC Musculoskelet Disord 2023; 24:884. [PMID: 37957622 PMCID: PMC10644644 DOI: 10.1186/s12891-023-07014-4] [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: 02/23/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
PURPOSE The position of the acetabular and femoral components is critical for stability and wear resistance. The aim of this study is to investigate whether the fluoroscopy-guided direct anterior approach in the supine position (S-DAA) is more helpful in improving the position of acetabular and femoral components than the fluoroscopy-guided direct anterior approach in the lateral decubitus position (L-DAA). METHODS A retrospective analysis of 76 cases of fluoroscopy-guided direct anterior approach total hip arthroplasty (38 cases in the S-DAA and 38 cases in the L-DAA group) was performed in one hospital from 2019 to 2021. The differences in inclination, anteversion, femoral offset (FO), global offset (GO), and leg length discrepancy (LLD) measurements during and after surgery were analyzed. The postoperative femoral offset (FO), global offset (GO), leg length discrepancy (LLD), and preoperative and postoperative Harris hip score were compared between the two groups. RESULTS In the S-DAA group, there were no significant differences in the mean intraoperative inclination angle anteversion angle, FO, GO, and LLD compared to the postoperative values, whereas in the L-DAA group, there were significant differences between the intraoperative and postoperative measurements (P < 0.001, P = 0.009, P<0.001, P<0.001 and P = 0.008, respectively). Additionally, there were significant differences in the accuracy of LLD, FO, and GO between the two groups (P < 0.001). Compared with the L-DAA group, the average differences of inclination, anteversion, LLD, FO, and GO during and after operation in the S-DAA group were smaller, and the consistency was higher. There was a significant difference in Harris hip score between the two groups at 1 week after surgery (P = 0.033). There was no significant difference in Harris hip score between 1 month and 3 months after surgery (P = 0.482 and P = 0.797, respectively). CONCLUSIONS In the supine group, the direct anterior approach (DAA) provides more accurate positioning of the acetabular and femoral components. However, there was no significant difference in hip joint function and activity between the two groups at follow-up.
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Affiliation(s)
- Penglei Chen
- The First Clinical Medical College, Zhejiang Chinese Medical University, 310006, Hangzhou, China
| | - Wangxin Liu
- Chuzhou Hospital of Integrated Chinese and Western Medicine, 788 Huifeng East Road, Langya District, 239000, Chuzhou, Anhui Province, China
| | - Cong Wu
- The First Clinical Medical College, Zhejiang Chinese Medical University, 310006, Hangzhou, China
| | - Pengfei Ruan
- The First Clinical Medical College, Zhejiang Chinese Medical University, 310006, Hangzhou, China
| | - Jicheng Zeng
- The First Clinical Medical College, Zhejiang Chinese Medical University, 310006, Hangzhou, China
| | - Weifeng Ji
- The First Affiliated Hospital of Zhejiang Chinese Medical University, No9,9th Street, Qiantang District, 310020, Hangzhou, Zhejiang Province, China.
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Ramkumar PN, Pang M, Vigdorchik JM, Chen AF, Iorio R, Lange JK. Patient-Specific Safe Zones for Acetabular Component Positioning in Total Hip Arthroplasty: Mathematically Accounting for Spinopelvic Biomechanics. J Arthroplasty 2023; 38:1779-1786. [PMID: 36931359 DOI: 10.1016/j.arth.2023.03.025] [Citation(s) in RCA: 2] [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: 11/25/2022] [Revised: 02/26/2023] [Accepted: 03/05/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Despite a growing understanding of spinopelvic biomechanics in total hip arthroplasty (THA), there is no validated approach for executing patient-specific acetabular component positioning. The purpose of this study was to (1) validate quantitative, patient-specific acetabular "safe zone" component positioning from spinopelvic parameters and (2) characterize differences between quantitative patient-specific acetabular targets and qualitative hip-spine classification targets. METHODS From 2,457 consecutive primary THA patients, 22 (0.88%) underwent revision for instability. Spinopelvic parameters were measured prior to index THA. Acetabular position was measured following index and revision arthroplasty. Using a mathematical proof, we developed an open-source tool translating a surgeon-selected, preoperative standing acetabular target to a patient-specific safe zone intraoperative acetabular target. Difference between the patient-specific safe zone and the actual component position was compared before and after revision. Hip-spine classification targets were compared to patient-specific safe zone targets. RESULTS Of the 22 who underwent revision, none dislocated at follow-up (4.6 [range, 1 to 6.9]). Patient-specific safe zone targets differed from prerevision acetabular component position by 9.1 ± 4.2° inclination/13.3 ± 6.7° version; after revision, the mean difference was 3.2 ± 3.0° inclination/5.3 ± 2.7° version. Differences between patient-specific safe zones and the median and extremes of recommended hip-spine classification targets were 2.2 ± 1.9° inclination/5.6 ± 3.7° version and 3.0 ± 2.3° inclination/7.9 ± 3.5° version, respectively. CONCLUSION A mathematically derived, patient-specific approach accommodating spinopelvic biomechanics for acetabular component positioning was validated by approximating revised, now-stable hips within 5° version and 3° inclination. These patient-specific safe zones augment the hip-spine classification with prescriptive quantitative targets for nuanced preoperative planning.
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Affiliation(s)
- Prem N Ramkumar
- Hospital for Special Surgery, New York, New York; Department of Orthopaedic Surgery, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts; Long Beach Orthopaedic Institute, Long Beach, California
| | - Michael Pang
- Department of Orthopaedic Surgery, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts
| | | | - Antonia F Chen
- Department of Orthopaedic Surgery, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts
| | - Richard Iorio
- Department of Orthopaedic Surgery, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts
| | - Jeffrey K Lange
- Department of Orthopaedic Surgery, Harvard Medical School and Brigham & Women's Hospital, Boston, Massachusetts
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11
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Kamihata S, Ando W, Takao M, Hamada H, Uemura K, Sugano N. Effect of hip flexion contracture on the pelvic sagittal tilt in the supine position: A retrospective case-series study. Mod Rheumatol 2023; 33:1052-1057. [PMID: 36083017 DOI: 10.1093/mr/roac110] [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: 04/20/2022] [Revised: 07/20/2022] [Accepted: 08/30/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVES The functional pelvic plane, which adopts the natural pelvic sagittal tilt in the supine position, is a good reference for determining the cup angle in total hip arthroplasty. However, hip flexion contracture may change pelvic tilt postoperatively by the release of contracture. This study investigated the influence of hip flexion contracture on pelvic sagittal tilt in the supine position. METHODS This study included 300 patients who underwent primary unilateral total hip arthroplasty. We divided the participants into two groups: with a preoperative hip extension angle of <0° (hip flexion contracture group) and without (non-contracture group). The pelvic sagittal tilt and femoral flexion angle were investigated using computed tomography or pelvic radiographs performed preoperatively and postoperatively. RESULTS The femoral flexion angle had significantly reduced postoperatively in the hip flexion contracture group but remained unchanged in the non-contracture group. The preoperative and postoperative pelvic sagittal tilt showed no significant differences between the two groups up to 1 year postoperatively. CONCLUSIONS The influence of hip flexion contracture on the pelvic sagittal tilt in the supine position was minimal. The functional pelvic plane in the supine position could be a good reference to ascertain the cup orientation, even in hip flexion contracture cases.
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Affiliation(s)
- Satoshi Kamihata
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Japan
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12
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Jacob AM, Yadav SK, Elhence A, Banerjee S, Gahlot N, Gupta S, Rajnish RK, Kantiwal P, Tiwari S. Evaluation of spinopelvic parameters in patients with lumbosacral transitional vertebra: a cross sectional and comparative study. AMERICAN JOURNAL OF NEURODEGENERATIVE DISEASE 2023; 12:123-132. [PMID: 37736164 PMCID: PMC10509491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/10/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Lumbosacral transitional vertebra (LSTV) is the most common congenital anomaly of the lumbosacral junction and is a frequent cause of back pain in young patients with a prevalence of 4.6% to 36% in different regions. OBJECTIVE The objective of this study was to evaluate spinopelvic parameters in patients with lumbosacral transitional vertebra and to compare them with the same parameters of low back ache patients without lumbosacral transitional vertebra. METHODS This was a cross-sectional and comparative study conducted among low back ache patients presenting to our tertiary care center. Low back ache patients presenting to the outpatient department of AIIMS Jodhpur were screened for LSTV using radiographs. The spinopelvic parameters of those with LSTV were measured using Surgimap software and compared with the parameters of low back ache patients without LSTV. An Independent sample t-test was done and p-values were calculated. RESULTS The spinopelvic parameters, pelvic incidence, pelvic tilt and lumbar lordosis differed significantly in the patients with LSTV. Pelvic incidence was higher in the group with LSTV (58.5+9.3) when compared to the group without LSTV (50+8.8) with a p-value (<0.001). Pelvic tilt was higher in the group with LSTV (19.4+8.8) when compared to the group without LSTV (13.6+7.8) with a p-value (0.001). Lumbar lordosis was significantly higher in the group with LSTV (57.6+13.2) when compared to the group without LSTV (50.7+12.2) with a p-value (0.007). No significant differences were obtained in sacral slope and Pelvic-incidence and lumbar lordosis mismatch. CONCLUSION LSTV alters the spinopelvic parameters. Altered spinopelvic parameters predispose to spondylolisthesis, degenerative disc disease, and facet joint arthritis and are important in preoperative planning in spine and pelvic surgeries.
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Affiliation(s)
- Akhil Mathew Jacob
- Department of Orthopedics, All India Institute of Medical Sciences, Marudhar Industrial Area2nd Phase, M.I.A. 1st Phase, Basni, Jodhpur 342005, Rajasthan, India
| | - Sandeep Kumar Yadav
- Department of Orthopedics, All India Institute of Medical Sciences, Marudhar Industrial Area2nd Phase, M.I.A. 1st Phase, Basni, Jodhpur 342005, Rajasthan, India
| | - Abhay Elhence
- Department of Orthopedics, All India Institute of Medical Sciences, Marudhar Industrial Area2nd Phase, M.I.A. 1st Phase, Basni, Jodhpur 342005, Rajasthan, India
| | - Sumit Banerjee
- Department of Orthopedics, All India Institute of Medical Sciences, Marudhar Industrial Area2nd Phase, M.I.A. 1st Phase, Basni, Jodhpur 342005, Rajasthan, India
| | - Nitesh Gahlot
- Department of Orthopedics, All India Institute of Medical Sciences, Marudhar Industrial Area2nd Phase, M.I.A. 1st Phase, Basni, Jodhpur 342005, Rajasthan, India
| | - Saurabh Gupta
- Department of Orthopedics, All India Institute of Medical Sciences, Marudhar Industrial Area2nd Phase, M.I.A. 1st Phase, Basni, Jodhpur 342005, Rajasthan, India
| | - Rajesh Kumar Rajnish
- Department of Orthopedics, All India Institute of Medical Sciences, Marudhar Industrial Area2nd Phase, M.I.A. 1st Phase, Basni, Jodhpur 342005, Rajasthan, India
| | - Prabodh Kantiwal
- Department of Orthopedics, All India Institute of Medical Sciences, Marudhar Industrial Area2nd Phase, M.I.A. 1st Phase, Basni, Jodhpur 342005, Rajasthan, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical SciencesJodhpur 342005, Rajasthan, India
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Moralidou M, Di Laura A, Henckel J, Hart AJ. Can version of the proximal femur be used for CT planning uncemented femoral stems? Med Eng Phys 2023; 116:103985. [PMID: 37230697 DOI: 10.1016/j.medengphy.2023.103985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023]
Abstract
Three-Dimensional Computed Tomography (3D-CT) planning can predict the prosthetic femoral size in uncemented primary Total Hip Arthroplasty (THA). Correct sizing usually results in optimal varus/valgus femoral alignment; however, its effect on the Prosthetic Femoral Version (PFV) is poorly understood. Most 3D-CT planning systems use Native Femoral Version (NFV) to plan PFV. We aimed to assess the relationship between PFV and NFV in primary uncemented THA using 3D-CT analysis. Pre- and post-operative CT data was retrospectively collected from 73 patients (81 hips) undergoing primary uncemented THA with a straight-tapered stem. 3D-CT models were used to measure PFV and NFV. The clinical outcomes were evaluated. The discrepancy between PFV and NFV was low (<5°) in 43%, moderate (5-10°) in 40%, high (10-15°) in 11% and very high (>15°) in 6% of the cases. We found that NFV is not a useable guide for planning PFV. The 95% limits of agreement were both high at 17° and 15°, respectively. Satisfactory clinical outcomes were recorded. The discrepancy was large enough to recommend against the use of NFV for planning PFV when using straight-tapered uncemented stems. Further work should focus on the internal bony anatomy and the influence of stem design when planning uncemented femoral stems.
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Affiliation(s)
- Maria Moralidou
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Brockley Hill, Stanmore HA7 4LP, United Kingdom
| | - Anna Di Laura
- The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, United Kingdom; Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, United Kingdom
| | - Johann Henckel
- The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, United Kingdom
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Brockley Hill, Stanmore HA7 4LP, United Kingdom; The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, United Kingdom.
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Buchalter DB, Gall AM, Buckland AJ, Schwarzkopf R, Meftah M, Hepinstall MS. Creating Consensus in the Definition of Spinopelvic Mobility. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202306000-00005. [PMID: 37294841 PMCID: PMC10256344 DOI: 10.5435/jaaosglobal-d-22-00290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/29/2023] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The term "spinopelvic mobility" is most often applied to motion within the spinopelvic segment. It has also been used to describe changes in pelvic tilt between various functional positions, which is influenced by motion at the hip, knee, ankle and spinopelvic segment. In the interest of establishing a consistent language for spinopelvic mobility, we sought to clarify and simplify its definition to create consensus, improve communication, and increase consistency with research into the hip-spine relationship. METHODS A literature search was performed using the Medline (PubMed) library to identify all existing articles pertaining to spinopelvic mobility. We reported on the varying definitions of spinopelvic mobility including how different radiographic imaging techniques are used to define mobility. RESULTS The search term "spinopelvic mobility" returned a total of 72 articles. The frequency and context for the varying definitions of mobility were reported. 41 papers used standing and upright relaxed-seated radiographs without the use of extreme positioning, and 17 papers discussed the use of extreme positioning to define spinopelvic mobility. DISCUSSION Our review suggests that the definitions of spinopelvic mobility is not consistent in the majority of published literature. We suggest descriptions of spinopelvic mobility independently consider spinal motion, hip motion, and pelvic position, while recognizing and describing their interdependence.
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Affiliation(s)
- Daniel B. Buchalter
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Ashley M. Gall
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Aaron J. Buckland
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Ran Schwarzkopf
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Morteza Meftah
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Matthew S. Hepinstall
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
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15
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Fontalis A, Putzeys P, Plastow R, Giebaly DE, Kayani B, Glod F, Haddad FS. Functional Component Positioning in Total Hip Arthroplasty and the Role of Robotic-Arm Assistance in Addressing Spinopelvic Pathology. Orthop Clin North Am 2023; 54:121-140. [PMID: 36894286 DOI: 10.1016/j.ocl.2022.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Hip, spine, and pelvis function as a unified kinetic chain. Any spinal pathology, results in compensatory changes in the other components to accommodate for the reduced spinopelvic motion. The complex relationship between spinopelvic mobility and component positioning in total hip arthroplasty presents a challenge in achieving functional implant positioning. Patients with spinal pathology, especially those with stiff spines and little change in sacral slope, are at high instability risk. In this challenging subgroup, robotic-arm assistance enables the execution of a patient specific plan, avoiding impingement and maximizing range of motion; especially utilizing virtual range of motion to dynamically assess impingement.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London NW1 2BU, UK; Division of Surgery and Interventional Science, University College London, Gower Street, London WC1E 6BT, UK.
| | - Pierre Putzeys
- Hôpitaux Robert Schuman, 9 Rue Edward Steichen, Luxembourg-City 2540, Luxembourg
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London NW1 2BU, UK
| | - Dia Eldean Giebaly
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London NW1 2BU, UK; Division of Surgery and Interventional Science, University College London, Gower Street, London WC1E 6BT, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London NW1 2BU, UK
| | - Fabrice Glod
- Hôpitaux Robert Schuman, 9 Rue Edward Steichen, Luxembourg-City 2540, Luxembourg
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London NW1 2BU, UK; Division of Surgery and Interventional Science, University College London, Gower Street, London WC1E 6BT, UK
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16
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LeBrun DG, Ondeck NT, Nessler JP, Marchand RC, Illgen RL, Westrich GH. Variability of pre-operative functional pelvic tilt in total hip arthroplasty patients. INTERNATIONAL ORTHOPAEDICS 2023; 47:1243-1247. [PMID: 36864185 DOI: 10.1007/s00264-023-05748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE Pelvic tilt (PT) is important to consider when planning total hip arthroplasty (THA) due to its dynamic impact on acetabular orientation. The degree of sagittal pelvic rotation varies during functional activities and can be difficult to measure without proper imaging. The purpose of this study was to evaluate PT variation in the supine, standing, and seated positions. METHODS A multi-centre cross-sectional study was performed that included 358 THA patients who had preo-perative PT measured from supine CT scan and standing and upright seated lateral radiographs. Supine, standing, and seated PT and associated changes between functional positions were evaluated. Anterior PT was assigned a positive value. RESULTS In the supine position, mean PT was 4° (range, -35° to 20°), where 23% had posterior PT and 69% anterior PT. In the standing position, mean PT was 1° (range, -23° to 29°), where 40% had posterior PT and 54% anterior PT. In the seated position, mean PT was -18° (range, -43° to 47°), where 95% had posterior PT and 4% anterior PT. From standing to seated, the pelvis rotated posteriorly in 97% of cases (maximum 60°) with 16% of cases considered stiff (change ≤ 10°) and 18% of cases considered hypermobile (change ≥ 30°). CONCLUSION Patients undergoing THA have marked PT variation in the supine, standing, and seated positions. There was wide variability in PT change from standing to seated, with 16% of patients considered stiff and 18% considered hypermobile. Functional imaging should be performed on patients prior to THA to allow for more accurate planning.
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Affiliation(s)
- Drake G LeBrun
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, 535 East 70 th Street, New York, NY, 10021, USA.
| | - Nathaniel T Ondeck
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, 535 East 70 th Street, New York, NY, 10021, USA
| | - Joseph P Nessler
- St. Cloud Orthopedics, 1901 Connecticut Ave S, MN, 56377, Sartell, USA
| | - Robert C Marchand
- Ortho Rhode Island, 285 Promenade Street, RI, 02908, Providence, USA
| | - Richard L Illgen
- University of Wisconsin-Madison, 4602 Eastpark Blvd, Madison, WI, 53706, USA
| | - Geoffrey H Westrich
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, 535 East 70 th Street, New York, NY, 10021, USA
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Mitsutake R, Tanino H, Ito H. The effect of range of motion simulated with a patient-specific three-dimensional simulation analysis on dislocation after total hip arthroplasty. Hip Int 2023; 33:313-322. [PMID: 34538126 DOI: 10.1177/11207000211044807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Dislocation continues to be a common complication following total hip arthroplasty (THA). Although previous studies of computed simulation analysis investigated the range of motion (ROM), it is unclear whether the ROM before impingement simulated using computed tomography-based 3-dimensional simulation analysis (simulated ROM) is related to dislocation after THA. It is also unclear what angles are required in computed simulation analyses for stable hips after THA. In this study, we compared the simulated ROM in patients with and without dislocation. METHODS 16 patients with posterior dislocation were compared with 48 matched patients without dislocation. Risk factors including preoperative bone morphology of the hip, implant position, change of femoral offset, change of leg length, anterior aspect of the greater trochanter (GTa) length, and anterior inferior iliac spine length were also compared. RESULTS The mean flexion angle, internal-rotation at 90° flexion (IR) angle, cup anteversion based on the anterior pelvic plane (APP), tilt-adjusted cup anteversion and GTa length were significantly different between patients with dislocation and patients without dislocation (p = 0.033, 0.002, 0.010, 0.047, 0.046). A receiver-operating characteristic curve analysis suggested cutoff points for flexion angle, IR angle, cup anteversion based on the APP, tilt-adjusted cup anteversion and GTa length, of 114.5°, 45.5°, 19.5°, 12.0° and 15.3 mm. CONCLUSIONS This study suggests that preoperative planning to achieve a larger simulated ROM, flexion angle and IR angle, may reduce the risk of posterior dislocation. This study also suggests that fine-tuning of cup anteversion and/or trimming of the overhanging GTa during preoperative planning may reduce the risk of posterior dislocation.
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Affiliation(s)
- Ryo Mitsutake
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiromasa Tanino
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiroshi Ito
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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Total Hip Arthroplasty Imageless Navigation Does Not Reduce 90-Day Adverse Events or Five-Year Revisions in a Large National Cohort. J Arthroplasty 2022; 38:862-867. [PMID: 36529197 DOI: 10.1016/j.arth.2022.12.012] [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: 08/28/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Computer navigation is an increasingly utilized technology that is considered with total hip arthroplasty (THA). However, the evidence to support this practice is mixed. The current study leveraged a large national administrative database to compare 90-day adverse events as well as 5-year all-cause revision and dislocation rates following THA performed with and without imageless navigation. METHODS From 2010 to 2020, a large national database was queried for THA cases performed for osteoarthritis. Cases with or without imageless navigation were matched at 1:4 based on age, sex, and Elixhauser Comorbidity Index (ECI) score. Ninety-day adverse events were assessed and compared with multivariate analyses. Five-year incidence of revision and dislocation were also assessed between cohorts. RESULTS Use of THA imageless navigation increased from 2010 (2.5% of cases) to 2020 (5.5% of cases; P < .001). After matching, 11,990 THA patients with navigation and 47,948 without navigation were identified. Overall, 90-day adverse events were observed in 7.0% of the population. Multivariate analysis controlling for age, sex, and ECI demonstrated a difference in only one 90-day adverse event; wound dehiscence, which had higher odds in the navigation group (odds ratio, 1.60, P < .001). At 5 years, revisions for the navigated group were higher (4.4 versus 3.6%: P = .006), while dislocations were not significantly different. CONCLUSION THA imageless navigation was not found to be associated with improved 90-day postoperative adverse events or differences in the 5-year rates of revision or dislocation. The current data were unable to identify clear advantages of this evolving technology for primary THA.
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Stolarczyk A, Stolarczyk M, Oleksy Ł, Maciąg GJ, Stępiński P, Szymczak J, Świercz M, Żarnovsky K, Mostowy M, Maciąg BM. Analysis of biomechanical gait parameters in patients after total hip replacement operated via anterolateral approach depending on size of the femoral head implant: retrospective matched-cohort study. Arch Orthop Trauma Surg 2022; 142:4015-4023. [PMID: 34837506 PMCID: PMC9596593 DOI: 10.1007/s00402-021-04264-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 11/14/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Total hip replacement (THR) is considered one of the most effective medical procedures in treatment of osteoarthritis. Since its introduction, there has been a worldwide debate over proper implant selection in terms of size, bearing type and shape. Following study was designed to assess the importance of femoral head size in long-term follow-up. MATERIALS AND METHODS A cohort of 30 patients with primary end stage osteoarthritis who underwent total hip replacement was analysed retrospectively. A homogenous group was chosen with no major differences in BMI. Patients' gait parameters were measured in a biomechanics laboratory using the 3D BTS Smart system. WOMAC and VAS questionnaires were used to assess patient reported outcome. RESULTS The subgroup with larger implant head size had several outcomes significantly superior to the subgroup with standard head size and non-inferior to healthy hips. Following variables were measured during this study: time of support phase, time of swing phase, double support time, walking hip extension angle. CONCLUSIONS Use of larger sized femoral heads during THR gives better results in terms of gait pattern. Since restoring the gait pattern is one of the aspects of rehabilitation and returning to daily activities it seems to be an important observation.
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Affiliation(s)
- Artur Stolarczyk
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Magda Stolarczyk
- 3rd Clinic of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Oleksy
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz J. Maciąg
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Stępiński
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Jakub Szymczak
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Świercz
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Krystian Żarnovsky
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | | | - Bartosz M. Maciąg
- Department of Orthopedics and Rehabilitation, Medical University of Warsaw, Warsaw, Poland
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20
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The Functional Mechanics of the Acetabular Component in Total Hip Arthroplasty. J Arthroplasty 2022; 37:2199-2207.e1. [PMID: 35643259 DOI: 10.1016/j.arth.2022.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/06/2022] [Accepted: 05/08/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty functional safe zones match postural hip changes to dynamic positioning of the acetabular component. We studied integrating the Anteinclination (AI) cup angle into the spinopelvic environment, defining normative values for all parameters and calculating adjustments to AI for each degree of altered standing pelvic position and postural mobility from these values. A sagittal geometric model was employed to determine these values using established spinopelvic parameter angles. METHODS Theoretical normative Pelvic Incidence (PI) specific values were calculated using a triangular construct employing a linear equation describing the functional relationship between the pelvic parameters at a mobility producing an isosceles solution for normative acetabular angles. Individual optimal AI cup values for altered Sacral Slope (SS)/pelvic tilt (sPT) and mobility (dSS) were calculated using specific ratios of angular change between parameters correcting from these normative values. RESULTS A PI:SS:sPT ratio of angular change of 3:2:1 at dSS = 25° mobility creates an isosceles condition solving for PI specific theoretical normative values for all construct parameters. Individualized tilt correction applies to each posture a +0.25° AI alteration for each +1° sPT increase from this architectural value. Mobility correction applies a +0.5° standing AI and -0.5° sitting AI alteration for each -1° dSS < 25°, the opposite for each +1° dSS > 25°. The Sacroacetabular angle/Pelvic acetabular angle (SAA/PAA) index describes the underlying spinopelvic environment the cup functions within. CONCLUSION This model quantitatively integrates an implanted acetabular component into the host spinopelvic environment. Theoretical normative and individual optimal cup orientations are passively determined by these conditions of standing pelvic position and mobility.
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Fischer MCM, Tokunaga K, Okamoto M, Habor J, Radermacher K. Implications of the uncertainty of postoperative functional parameters for the preoperative planning of total hip arthroplasty. J Orthop Res 2022; 40:2656-2662. [PMID: 35266575 DOI: 10.1002/jor.25291] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/23/2021] [Accepted: 01/30/2022] [Indexed: 02/04/2023]
Abstract
The functional parameters pelvic tilt (PT) and hip joint force (HJF) are required to calculate patient-specific target zones based on the range of motion (ROM) and implant loading for preoperative planning of total hip arthroplasty (THA). Both functional parameters may change after THA. The preoperative prediction of the postoperative PT and HJF is associated with a specific amount of uncertainty. The prediction uncertainty has to be considered in the preoperative planning process to avoid a suboptimal implantation. So far, very little attention has been paid to the necessary reduction of patient-specific target zones by the prediction uncertainties of postoperative functional parameters. Prediction models for the postoperative PT in standing position and for the HJF during one-leg stance as a surrogate for the peak force phase during level walking were used to quantify the reduction of the ROM- and load-based target zones of 196 Japanese THA patients. The prediction uncertainty was about 14° for the postoperative standing PT and ranged from 17% body weight to 37% body weight for the components of the HJF. On average, the prosthetic ROM-based target zone had to be significantly reduced by 43% and the load-based target zone by 39%. This led to a median reduction of the combined prosthetic ROM- and load-based target zone of 96%. The study sharpens the awareness for the substantial reduction of ROM- and load-based target zones by prediction uncertainties of the postoperative PT and HJF and highlights the importance of further research to improve prediction models for both functional parameters.
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Affiliation(s)
- Maximilian C M Fischer
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Kunihiko Tokunaga
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City, Japan
| | - Masashi Okamoto
- Department of Radiology, Kameda Daiichi Hospital, Niigata City, Japan
| | - Juliana Habor
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Klaus Radermacher
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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22
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Chen WC, Wu TY, Chi KY, Weng PW, Huang YM, Lin YC, Liaw CK. Laser projector method for measuring postoperative acetabular anteversion after total hip replacement. Front Surg 2022; 9:1033453. [PMID: 36353614 PMCID: PMC9637855 DOI: 10.3389/fsurg.2022.1033453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/30/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION For patients undergoing THR, measuring the postoperative acetabular anteversion precisely plays a pivotal role in the prognosis. However, using elliptical methods mandates computerized equipment that is frequently in shortage in remote areas and developing countries. We invented a laser projector utilizing the ellipse method to measure the acetabular anteversion directly. The aim is to examine the consistency and validity of the laser projector as compared to our original software, Elliversion. MATERIALS AND METHODS We retrospectively collected 50 postoperative pelvis radiographs including acetabulum from our institution. One investigator first measured the anteversion of included radiographs through Elliversion software as the control group. Subsequently, two operators independently used the laser projector for measurements in two separate periods with 1-day intervals as the experimental group. Our analysis was comprised of intra- and inter-observer comparisons and reliability, which investigated both the consistency and validity, by using two-sample student's t-test and intraclass correlation coefficient. RESULTS There was no significant difference in measuring the anteversion through laser projectors between two operators (p = 0.54), with excellent inter-observer reliability (ICC, 0.967). The estimated effect in the anteversion measurement between the Elliversion and laser projector was also comparable, with the ICC level of 0.984, indicating excellent reliability. CONCLUSION Our study reported the consistency and validity of this laser projector as there is no significant difference between Elliversion and Laser projector, notably with excellent intra- and inter-observer reliability. We look forward to helping elevate clinical acumen when doctors provide care to patients after THR, especially in remote areas.
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Affiliation(s)
- Wei-Cheng Chen
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tai-Yin Wu
- Department of Family Medicine, Taipei City Hospital, Taipei, Taiwan,Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuan-Yu Chi
- Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan,Department of Education, Center for Evidence-Based Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Pei-Wei Weng
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yu-Min Huang
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yi-Chia Lin
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Chen-Kun Liaw
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan,Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan,Correspondence: Chen-Kun Liaw
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Ma Z, Tang H, Zhou Y, Wang S, Yang D, Guo S. Assessing component orientation of total hip arthroplasty using the low-dose bi-planar radiographs. BMC Musculoskelet Disord 2022; 23:886. [PMID: 36154920 PMCID: PMC9511787 DOI: 10.1186/s12891-022-05835-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/16/2022] [Indexed: 12/04/2022] Open
Abstract
Background Three-dimensional computed tomography (3D CT) reconstruction is the reference standard for measuring component orientation. However, functional cup orientation in standing position is preferable compared with supine position. The low-dose bi-planar radiographs can be used to analyze standing cup component orientation. We aimed to assess the validity and reliability of the component orientation using the low-dose bi-planar radiographs compared with the 3D CT reconstruction, and explore the differences between the functional cup orientation in standing radiographs and supine CT scans. Methods A retrospective study, including 44 patients (50 hips) with total hip arthroplasty (THA), was conducted. CT scans were taken 1 week after surgery and the low-dose bi-planar radiographs were taken in the follow-up 6 weeks later. Component orientation measurement was performed using the anterior pelvic plane and the radiographic coronal plane as reference, respectively. Results The study showed no significant difference in cup anteversion (p = 0.160), cup inclination (p = 0.486), and stem anteversion (p = 0.219) measured by the low-dose bi-planar radiographs and 3D reconstruction. The differences calculated by the Bland–Altman analysis ranged from − 0.4° to 0.6° for the three measured angles. However, the mean absolute error was 4.76 ± 1.07° for functional anteversion (p = 0.035) and 4.02 ± 1.08° for functional inclination (p = 0.030) measured by the bi-planar radiographs and supine CT scans. Conclusions The low-dose bi-planar radiographs are the same reliable and accurate as 3D CT reconstruction to assess post-THA patients’ component orientation, while providing more valuable functional component orientation than supine CT scans.
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Affiliation(s)
- Zhuyi Ma
- Department of Orthopaedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Hao Tang
- Department of Orthopaedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Yixin Zhou
- Department of Orthopaedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, China.
| | - Siyuan Wang
- Department of Orthopaedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Dejin Yang
- Department of Orthopaedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, China
| | - Shaoyi Guo
- Department of Orthopaedics, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, China
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Reichert JC, Wassilew GI, von Rottkay E, Noeth U. Compared learning curves of the direct anterior and anterolateral approach for minimally invasive hip replacement. Orthop Rev (Pavia) 2022; 14:37500. [PMID: 36034727 PMCID: PMC9404252 DOI: 10.52965/001c.37500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
Minimally invasive hip arthroplasty becomes increasingly popular. It is technically challenging and the approaches used are associated with a considerable learning curve. This nurtures concerns regarding patient safety, surgical training, and cost effectiveness. Consequently, we initiated a study comparing the learning curves of a supervised trainee surgeon utilizing both the anterolateral and direct anterior approach (DAA) when introduced to minimally invasive hip replacement surgery. Outcome measurements included the Harris hip score (HHS), cup inclination and anteversion, offset and leg length, stem placement, surgical time and complications. Time from incision to suture decreased significantly over time but did not differ between both groups. The functional outcomes (HHS) after six weeks and three months were comparable (p=0.069 and 0.557) and within the expected range equalling 90.3 (anterior) and 89.2 (anterolateral) points. With both approaches safe component placement was readily achieved. Both offset and leg length, however, were reconstructed more reliably with the DAA (p=0.02 and 0.001). A higher rate of dislocations was seen with the anterior, more perioperative infections with the anterolateral approach. We suggest that supervision by an experienced surgeon favourably influences the learning curves for both the minimally invasive DAA and anterolateral approach and conclude that the greatest improvement is seen within the first 60 cases.
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Affiliation(s)
- Johannes C Reichert
- Department of Orthopedics and Orthopaedic Surgery, University Medicine Greifswald; Department of Orthopaedic and Trauma Surgery, Evangelisches Waldkrankenhaus Spandau
| | - Georgi I Wassilew
- Department of Orthopedics and Orthopaedic Surgery, University Medicine Greifswald
| | - Eberhard von Rottkay
- Department of Orthopaedic and Trauma Surgery, Evangelisches Waldkrankenhaus Spandau
| | - Ulrich Noeth
- Department of Orthopaedic and Trauma Surgery, Evangelisches Waldkrankenhaus Spandau
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25
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Shatrov J, Marsden-Jones D, Lyons M, Walter WL. Improving Acetabular Component Positioning in Total Hip Arthroplasty: A Cadaveric Study of an Inertial Navigation Tool and a Novel Registration Method. HSS J 2022; 18:358-367. [PMID: 35846262 PMCID: PMC9247599 DOI: 10.1177/15563316211051727] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/24/2021] [Indexed: 02/01/2023]
Abstract
Background: Incorrect acetabular component positioning in total hip arthroplasty (THA) has been associated with poor outcomes. Computer-assisted hip arthroplasty increases accuracy and consistency of cup positioning compared to conventional methods. Traditional navigation units have been associated with problems such as bulkiness of equipment and reproducibility of anatomical landmarks, particularly in obese patients or the lateral position. Purpose: We sought to evaluate the accuracy of a novel miniature inertial measurement system, the Navbit Sprint navigation device (Navbit, Sydney, Australia), to navigate acetabular component positioning in both the supine and lateral decubitus positions. We also aimed to validate a new method of patient registration that does not require acquisition of anatomical landmarks for navigation. Methods: We performed THA in a cadaveric study in supine and lateral positions using Navbit navigation to record cup position and compared mean scores from 3 Navbit devices for each cup position on post-implantation CT scans. Results: A total of 11 cups (5 supine and 6 lateral) were available for comparison. A difference of 2.34° in the supine direct anterior approach when assessing acetabular version was deemed to be statistically but not clinically significant. There was no statistically significant difference between CT and navigation measurements of cup position in the lateral position. Conclusion: This cadaveric study suggests that a novel inertial-based navigation tool is accurate for cup positioning in THA in the supine and lateral positions. Furthermore, it validates a novel registration method that does not require the identification of anatomical landmarks.
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Affiliation(s)
- Jobe Shatrov
- Royal North Shore Hospital, St
Leonards, NSW, Australia,The University of Notre Dame Australia,
Sydney, NSW, Australia
| | | | - Matt Lyons
- The Mater Hospital, North Sydney, NSW,
Australia
| | - William L. Walter
- Orthopaedic Department, Royal North
Shore Hospital and Institute of Bone and Joint Research, Kolling Institute,
University of Sydney, Sydney, NSW, Australia,William L. Walter, PhD, FRACS, Professor of
Orthopaedics and Traumatic Surgery, Royal North Shore Hospital and Institute of
Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, NSW
2065, Australia.
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26
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Kaiser M, Renkawitz T, Benditz A, König M, Thieme M, Weber M. Pelvic tilt impacts cup orientation on CT: how accurate is the gold standard? ACTA RADIOLOGICA (STOCKHOLM, SWEDEN : 1987) 2022; 63:698-705. [PMID: 33982602 DOI: 10.1177/02841851211009466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Computed tomography (CT) is the gold standard for the accurate measurement of cup inclination and anteversion in total hip arthroplasty (THA). However, functional cup position strongly depends on the tilt of the pelvis and thus pelvic tilt in the supine position on the CT table harbors the risk of misinterpretation. PURPOSE To evaluate the influence of pelvic tilt on cup measurements in postoperative CT scans. MATERIAL AND METHODS This is a secondary outcome analysis of a prospective study. In 123 patients undergoing THA, anatomic cup inclination and anteversion as measured on postoperative 3D-CT scans were compared between: (i) the anterior pelvic plane (APP) resembling neutral pelvic tilt; and (ii) the coronal plane representing the standard planes on CT. Furthermore, the effect of the variation on cup positions within Lewinnek's safe zone in relation to the applied reference plane was assessed. RESULTS Mean pelvic tilt in supine position was -3.5° ± 5.6°. This resulted in a mean difference for anteversion between APP und coronal plane of 2.1° ± 3.7° and of 2.1° ± 1.9° for cup inclination, respectively. The change varied up to 20.2° for cup inclination and up 12.2° for cup anteversion. The overall conversion rate for inclination and/or anteversion regarding Lewinnek's safe zone was high at 23.6% (29/123). CONCLUSION Pelvic tilt affects cup orientation on CT scans depending on the applied reference plane. Standard CT planes should be corrected regarding pelvic tilt before measurements to avoid errors in measurement.
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Affiliation(s)
- Moritz Kaiser
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Tobias Renkawitz
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Achim Benditz
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Matthias König
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Max Thieme
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Markus Weber
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
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27
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Liu C, Hu F, Li Z, Wang Y, Zhang X. Anterior Pelvic Plane: A Potentially Useful Pelvic Anatomical Reference Plane in Assessing the Patients' Ideal Pelvic Parameters Without the Influence of Spinal Sagittal Deformity. Global Spine J 2022; 12:567-572. [PMID: 32996359 PMCID: PMC9109563 DOI: 10.1177/2192568220958676] [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] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Observational study. OBJECTIVE This study was aimed at investigating the reliability of anterior pelvic plane (APP) as an anatomical reference plane for assessing the patients' pelvic incidence in patients with ankylosing spondylitis kyphosis deformity. METHODS The globe kyphosis (GK), lumber lordosis (LL), thoracolumbar kyphosis (TLK), thoracic kyphosis (TK), anatomical cervical 7 sacrum angle (aC7SA), and cervical 7 sacrum angle (C7SA) were measured on full-length spine radiography imagines. The pelvic incidence (PI), anatomical pelvic tilt (aPT), and anatomical sacral slope (aSS) were measured on the pelvic synthesized 2D lateral radiography imagines. Because the angle between APP and vertical line was about 4°, Angle1 and tPT were calculated using the following formulas: Angle1 = aC7SA - 4; PT = aPT + 4. According to the study conducted by Vialle, traditional PT (tPT) was calculated using the following widely accepted formula: tPT = PI * 0.37 - 7. Measured PT (mPT) was also measured on the full-length spine radiography imagines. RESULTS The data analysis showed that PI, mPT, aSS, aPT, and APPA were 50.83 ± 13.44°, 32.52 ± 4.64°, 41.36 ± 9.46°, 8.56 ± 6.80°, and 23.95 ± 5.17°, respectively. There was no significant difference between the PT and tPT (12.56 ± 6.80, 11.49 ± 4.73; P = .152). So, the results demonstrated that the PT could play the equivalent effect as tPT did for making surgical plans in patients with kyphosis deformity. CONCLUSION The pelvic anatomical reference plane had potential to be used in assessing the patients' ideal pelvic incident without the influence of spinal sagittal deformity. The aPT+4 may represent patients' postoperative ideal PT.
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Affiliation(s)
- Chao Liu
- The First Affiliated Hospital of
Jinan University, Guangzhou, People’s Republic of China
| | - Fanqi Hu
- Chinese People’s Liberation Army
General Hospital (301 Hospital), Beijing, People’s Republic of China,Co-first author
| | - Zhizhong Li
- The First Affiliated Hospital of
Jinan University, Guangzhou, People’s Republic of China,Zhizhong Li, Department of Orthopaedics, The
First Affiliated Hospital of Jinan, University, Huangpu Avenue West Road,
Guangzhou 510632, People’s Republic of China.
| | - Yan Wang
- Chinese People’s Liberation Army
General Hospital (301 Hospital), Beijing, People’s Republic of China
| | - Xuesong Zhang
- Chinese People’s Liberation Army
General Hospital (301 Hospital), Beijing, People’s Republic of China,Xuesong Zhang, Department of Orthopaedics,
Chinese People’s Liberation Army General Hospital (301 Hospital), Fuxing road
28, Beijing 100853, People’s Republic of China.
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28
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Tang H, Zhao Y, Wang S, Ma Z, Li Y, Shi H, Zhou Y. Conversion of the Sagittal Functional Safe Zone to the Coronal Plane Using a Mathematical Algorithm: The Reason for Failure of the Lewinnek Safe Zone. J Bone Joint Surg Am 2022; 104:641-648. [PMID: 35139043 DOI: 10.2106/jbjs.21.00840] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ante-inclination (AI) of the cup is a key component of the combined sagittal index (CSI) for predicting joint stability after total hip arthroplasty (THA). We aimed to (1) validate a mathematical algorithm relating AI to radiographic anteversion (RA), radiographic inclination (RI), and pelvic tilt (PT); (2) convert the AI criterion of the CSI into the coronal functional safe zone (CFSZ) and explore the influences of standing-to-sitting pelvic motion (PM) and pelvic incidence (PI) on the CFSZ; and (3) attempt to locate a universal cup orientation that always fulfills the AI criterion of the CSI for all patients. METHODS In the first phase, a phantom pelvis was designed to simulate a range of PT values, and an acetabular cup was implanted with different RA, RI, and PT settings using a robot-assisted technique and scanned using the EOS imaging system. The second phase involved patient radiographs. We enrolled 100 patients who underwent robot-assisted THA from April 2019 to December 2019, and EOS images before THA and at the 12-month follow-up were recorded. The AI was measured on a lateral radiograph; this angle was used as the reference and compared with the calculated AI to assess the accuracy of the algorithm. Linear regression was conducted to explore the relationship between the size of the CFSZ and the values of PM and PI. We calculated the intersection of the CFSZs of the patients to find a universal cup orientation (RA and RI) for the CSI. RESULTS The algorithm was accurate according to both the phantom study and patient radiographs using PT at the time of follow-up, with mean absolute errors (MAEs) of 1.5° (width of 95% confidence interval [CI], 2.2°) and 2.8° (width of 95% CI, 3.0°), respectively. However, the preoperatively predicted AI had an MAE of 9.0° (width of 95% CI, 10.5°). In patient subgroups with lower PM or PI, the sizes of the CFSZ and of its intersection with the Lewinnek safe zone were significantly smaller (p < 0.017). No universal cup orientation existed to fulfill the CSI criteria for all patients or for any of the PM or PI subgroups. CONCLUSIONS The target orientation for the cup in THA should be individualized. Our validated algorithm may serve as a quantitative tool for the patient-specific optimization of cup AI on the basis of the functional safe zone. CLINICAL RELEVANCE The Lewinnek safe zone fails because it cannot predict the functional orientation of the cup. The concept of a universal safe zone of cup orientation should be abandoned and replaced by a patient-specific surgical target.
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Affiliation(s)
- Hao Tang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, People's Republic of China
| | - Yongqiang Zhao
- Tian Ji Laboratory, Beijing Tinavi Medical Technology Co., Ltd, Beijing, People's Republic of China
| | - Siyuan Wang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, People's Republic of China
| | - Zhuyi Ma
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, People's Republic of China
| | - Ya Li
- Tian Ji Laboratory, Beijing Tinavi Medical Technology Co., Ltd, Beijing, People's Republic of China
| | - Hongwei Shi
- Tian Ji Laboratory, Beijing Tinavi Medical Technology Co., Ltd, Beijing, People's Republic of China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, People's Republic of China
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29
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Weber M, Suess F, Jerabek SA, Meyer M, Grifka J, Renkawitz T, Dendorfer S. Kinematic pelvic tilt during gait alters functional cup position in total hip arthroplasty. J Orthop Res 2022; 40:846-853. [PMID: 34057752 DOI: 10.1002/jor.25106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/21/2021] [Accepted: 05/25/2021] [Indexed: 02/04/2023]
Abstract
Static pelvic tilt impacts functional cup position in total hip arthroplasty (THA). In the current study we investigated the effect of kinematic pelvic changes on cup position. In the course of a prospective controlled trial postoperative 3D-computed tomography (CT) and gait analysis before and 6 and 12 months after THA were obtained in 60 patients. Kinematic pelvic motion during gait was measured using Anybody Modeling System. By fusion with 3D-CT, the impact of kinematic pelvic tilt alterations on cup anteversion and inclination was calculated. Furthermore, risk factors correlating with high pelvic mobility were evaluated. During gait a high pelvic range of motion up to 15.6° exceeding 5° in 61.7% (37/60) of patients before THA was found. After surgery, the pelvis tilted posteriorly by a mean of 4.0 ± 6.6° (p < .001). The pelvic anteflexion led to a mean decrease of -1.9 ± 2.2° (p < .001) for cup inclination and -15.1 ± 6.1° (p < .001) for anteversion in relation to the anterior pelvic plane (APP). Kinematic pelvic changes resulted in a further change up to 2.3° for inclination and up to 12.3° for anteversion. In relation to the preoperative situation differences in postoperative cup position ranged from -4.4 to 4.6° for inclination and from -7.8 to 17.9° for anteversion, respectively. Female sex (p < .001) and normal body weight (p < .001) correlated with high alterations in pelvic tilt. Kinematic pelvic changes highly impact cup anteversion in THA. Surgeons using the APP as reference should aim for a higher anteversion of about 15° due to the functional anteflexion of the pelvis during gait.
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Affiliation(s)
- Markus Weber
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Franz Suess
- Department of Orthopaedic Surgery, Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Seth A Jerabek
- Faculty of Mechanical Engineering, Laboratory for Biomechanics, Ostbayerische Technische Hochschule, Regensburg, Germany
| | - Matthias Meyer
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Tobias Renkawitz
- Department of Orthopaedic and Trauma Surgery, Heidelberg University Medical Center, Heidelberg, Germany
| | - Sebastian Dendorfer
- Department of Orthopaedic Surgery, Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
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30
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Pourahmadi M, Sahebalam M, Dommerholt J, Delavari S, Mohseni-Bandpei MA, Keshtkar A, Fernández-de-Las-Peñas C, Mansournia MA. Spinopelvic alignment and low back pain after total hip arthroplasty: a scoping review. BMC Musculoskelet Disord 2022; 23:250. [PMID: 35291992 PMCID: PMC8925238 DOI: 10.1186/s12891-022-05154-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/28/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Spinopelvic alignment is increasingly considered as an essential factor for maintaining an energy-efficient posture in individuals with normal or pathological status. Although several previous studies have shown that changes in the sagittal spinopelvic alignment may occur in patients undergoing total hip arthroplasty (THA), no review of this area has been completed so far. Thus, the objective of this scoping review was to summarize the evidence investigating changes in spinopelvic alignment and low back pain (LBP) following THA. Data sources We adhered to the established methodology for scoping reviews. Four electronic databases were systematically searched from inception-December 31, 2021. Study selection We selected prospective or retrospective observational or intervention studies that included patients with THA. Data extraction Data extraction and levels of evidence were independently performed using standardized checklists. Data synthesis A total of 45 papers were included in this scoping review, involving 5185 participants with THA. Pelvic tilt was the most common parameter measured in the eligible studies (n = 26). The results were not consistent across all studies; however, it was demonstrated that the distribution of pelvic tilt following THA had a range of 25° posterior to 20° anterior. Moreover, decreased sacral slope and lower pelvic incidence were associated with increased risk of dislocation in patients with THA. Lumbar spine scoliosis did not change significantly after THA in patients with bilateral hip osteoarthritis (5.50°(1.16°) vs. 3.73°(1.16°); P-value = 0.29). Finally, one study indicated that LBP improvement was not correlated with postoperative changes in spinopelvic alignment parameters. Several methodological issues were addressed in this study, including no sample size calculation and no type-I error adjustment for outcome multiplicity. Conclusions Changes in spinopelvic alignment may occur after THA and may improve with time. Patients with a THA dislocation usually show abnormal spinopelvic alignment compared to patients without a THA dislocation. LBP usually improves markedly over time following THA. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05154-7.
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Affiliation(s)
- Mohammadreza Pourahmadi
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sahebalam
- Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Jan Dommerholt
- Bethesda Physiocare, Bethesda, MD, USA.,Myopain Seminars, Bethesda, MD, USA.,Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Somayeh Delavari
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mohseni-Bandpei
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan
| | - Abbasali Keshtkar
- Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Poursina St., Shanzdah-e Azar St., P. O. Box: 6446-14155, Tehran, Iran.
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Tsukada S, Ogawa H, Hirasawa N, Nishino M, Aoyama H, Kurosaka K. Augmented Reality- vs Accelerometer-Based Portable Navigation System to Improve the Accuracy of Acetabular Cup Placement During Total Hip Arthroplasty in the Lateral Decubitus Position. J Arthroplasty 2022; 37:488-494. [PMID: 34763049 DOI: 10.1016/j.arth.2021.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/23/2021] [Accepted: 11/01/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There have been no studies regarding the effectiveness of augmented reality (AR)-based portable navigation systems compared with accelerometer-based portable navigation systems in total hip arthroplasty (THA). METHODS We retrospectively compared THAs performed using an AR-based portable navigation system (n = 45) and those performed using an accelerometer-based portable navigation system (n = 42). All THAs were performed with the patient in the lateral decubitus position. The primary outcome was the absolute difference between cup placement angles displayed on the navigation screen and those measured on postoperative X-ray. RESULTS The mean absolute differences were significantly smaller in the AR-based portable navigation system group than the accelerometer-based portable navigation system group in radiographic inclination (2.5° ± 1.7° vs 4.6° ± 3.1°; 95% confidence interval 1.1°-3.2°, P < .0001). Similarly, the mean absolute differences were significantly better in the AR-based portable navigation system group in radiographic anteversion (2.1° ± 1.8° vs 6.4° ± 4.2°; 95% confidence interval 3.0°-5.7°, P < .0001). Neither hip dislocation, surgical site infection, nor other complications associated with use of the navigation system occurred in either group. CONCLUSION The AR-based portable navigation system may provide more precise acetabular cup placement compared with the accelerometer-based portable navigation system in THA.
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Affiliation(s)
- Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Hiroyuki Ogawa
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Naoyuki Hirasawa
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Masahiro Nishino
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Hiromichi Aoyama
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Kenji Kurosaka
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
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Windsor EN, Sharma AK, Premkumar A, Gkiatas I, Sculco PK, Vigdorchik JM. The Use of Technology to Achieve the Functional Acetabular Safe Zone in Total Hip Arthroplasty. JBJS Rev 2022; 10:01874474-202202000-00001. [PMID: 35113821 DOI: 10.2106/jbjs.rvw.21.00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Functional acetabular safe zones based on patient-specific factors during total hip arthroplasty are theorized to result in more optimal component stability than the use of traditional safe zones based on static targets. » Preoperative planning that takes into account functional pelvic positions and spinopelvic mobility is increasingly recommended. » Computer navigation and robotics can be utilized to help accurately achieve the targeted cup position within the functional safe zone. » Each technology platform (imageless and image-based computer navigation and robotics) utilizes a specific referencing method for the pelvis, which influences anteversion and inclination values. » The purpose of this article is to summarize how these different systems reconcile differences in pelvic referencing to ensure that the surgeon achieves the targeted functional cup position.
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Affiliation(s)
- Eric N Windsor
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Abhinav K Sharma
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Ajay Premkumar
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Ioannis Gkiatas
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
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33
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Walter WL, Baker NA, Marsden-Jones D, Sadeghpour A. Novel Measure of Acetabular Cup Inclination and Anteversion During Total Hip Arthroplasty. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2022; 15:1-14. [PMID: 35115849 PMCID: PMC8806051 DOI: 10.2147/mder.s339669] [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: 09/16/2021] [Accepted: 12/20/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE The purposes of the present research were to assess the accuracy and usability of the inertial navigation system (INS). MATERIALS AND METHODS The accuracy of the device navigation subsystem was assessed using benchtop testing. The usability was assessed through simulated use with surgeons. These results were compared to recent cadaveric results for the same system. RESULTS The navigation subsystem had an overall mean absolute error of 1.21° and a maximum absolute error across all devices of 4.79°. The device was found to be usable and to add an estimated 7 minutes to surgery time. CONCLUSION The INS uses a novel approach to provide the surgeon with accurate and fast acetabular cup inclination and anteversion angles during THA.
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Affiliation(s)
- William L Walter
- Orthopaedics and Traumatic Surgery, University of Sydney, Sydney, New South Wales, Australia
| | - Neri A Baker
- Innovation Department, Navbit, Sydney, New South Wales, Australia
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34
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Tian R, Lei Y, Wang K, Yang P. [Comparative study of intra- and post-operative inclination and anteversion angles of acetabular cup in robot-assisted total hip arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1246-1250. [PMID: 34651476 DOI: 10.7507/1002-1892.202107037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the difference in the inclination and anteversion angles of the acetabular cup measured by intraoperative robot-assisted total hip arthroplasty (THA) and postoperative X-ray films and CT imaging. Methods The clinical data of 54 patients (54 hips) who underwent robot-assisted THA between May 2020 and December 2020 were retrospectively analyzed. Among them, there were 26 males (26 hips) and 28 females (28 hips), with an average age of 58.4 years (range, 39-71 years). The body mass index was 19.2-29.3 kg/m 2, with an average of 25.2 kg/m 2. All the patients had their first THA, including 31 cases of osteonecrosis of the femoral head, 12 cases of hip arthritis, 8 cases of femoral neck fracture, and 3 cases of developmental dysplasia of the hip. The anteversion and inclination angles of the acetabular cup were obtained through the surgical data in the robot host system. All patients underwent X-ray and CT scan examination within 2-7 days after operation to obtain the postoperative anteversion and inclination angles of the acetabular cup. According to the concept of "Lewinnek safe zone", the proportion of acetabular in the safe zone intra- and post-operation were compared. Results The operation time was 57.8-89.2 minutes, with an average of 68.3 minutes; the intraoperative blood loss was 125.0-450.0 mL, with an average of 204.8 mL. No adverse events such as dislocation of hip joint and infection occurred during hospitalization. The anteversion angle of acetabular cup was (40.8±0.6)° during operation and (41.2±2.8)° after operation, with no significant difference ( t=1.026, P=0.307). The anteversion angle of acetabular cup measured during operation was (17.6±1.4)°, which was significantly smaller than that measured after operation (23.4±3.8)°( t=10.520, P=0.000). According to "Lewinnek safe zone", 54 hips (100%) were in the safety zone during operation, and 16 hips were out of the safety zone, 38 hips were in the safty zone after operation, the ratio of the hips in the safty zone was 70.4%, showing a significant difference ( χ 2=18.783, P=0.000). Conclusion Robot-assisted THA can obtain accurate placement of the acetabular cup, but there is a large deviation between the anteversion angle of the acetabular cup in the lateral position during operation and the supine position after operation. Further study is needed to define the intraoperative placement position of the acetabular cup.
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Affiliation(s)
- Run Tian
- Department of Bone and Joint Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Shaanxi, 710004, P.R.China
| | - Yutian Lei
- Department of Bone and Joint Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Shaanxi, 710004, P.R.China
| | - Kunzheng Wang
- Department of Bone and Joint Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Shaanxi, 710004, P.R.China
| | - Pei Yang
- Department of Bone and Joint Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Shaanxi, 710004, P.R.China
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35
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Spinopelvic Biomechanics and Total Hip Arthroplasty: A Primer for Clinical Practice. J Am Acad Orthop Surg 2021; 29:e888-e903. [PMID: 34077399 DOI: 10.5435/jaaos-d-20-00953] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 05/11/2021] [Indexed: 02/01/2023] Open
Abstract
Abnormal spinopelvic motion from spine pathology is associated with inferior outcomes after total hip arthroplasty, including inferior patient-reported outcomes, increased rates of instability, and higher revision rates. Identifying these high-risk patients preoperatively is important to conduct the appropriate workup and formulate a surgical plan. Standing and sitting lateral spinopelvic radiographs are able to identify and quantify abnormal spinopelvic motion. Depending on the type of spinopelvic deformity, some patients may require increased anteversion, increased offset, and large diameter heads or dual mobility articulations to prevent dislocation. This review article will provide the reader with practical information that can be applied to patients regarding the terminology, pathophysiology, evaluation, and management of total hip arthroplasty patients with spinopelvic pathology.
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36
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Sharma AK, Cizmic Z, Dennis DA, Kreuzer SW, Miranda MA, Vigdorchik JM. Low dislocation rates with the use of patient specific "Safe zones" in total hip arthroplasty. J Orthop 2021; 27:41-48. [PMID: 34483549 DOI: 10.1016/j.jor.2021.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/06/2021] [Accepted: 08/15/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction The purpose of this study was to compare patient-specific acetabular cup target orientation using functional simulation to the Lewinnek Safe Zone (LSZ) and determine associated rates of postoperative dislocation. Methods A retrospective review of 1500 consecutive primary THAs was performed. Inclination, anteversion, pelvic tilt, pelvic incidence, lumbar flexion, and dislocation rates were recorded. Results 56% of dynamically planned cups were within LSZ (p < 0.05). 6/1500 (0.4%) of these cups dislocated at two year follow-up, and all were within LSZ. Conclusion Optimal acetabular cup positioning using dynamic imaging differs significantly from historical target parameters but results in low rates of dislocation. Level of evidence Level III: Retrospective.
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Affiliation(s)
- Abhinav K Sharma
- University of California, Irvine, School of Medicine, Department of Orthopaedic Surgery, Orange, CA 92868, USA
| | - Zlatan Cizmic
- Ascension Providence Hospital Southfield Campus, Department of Orthopaedic Surgery, 16001 W Nine Mile Rd., Southfield, MI, 48075, USA
| | | | | | | | - Jonathan M Vigdorchik
- Hospital for Special Surgery, Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, New York, NY 10021, USA
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37
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Zhao JX, Su XY, Zhao Z, Zhang LC, Tang PF. Letter to the Editor: The Effect of Postural Pelvic Dynamics on the Three-dimensional Orientation of the Acetabular Cup in THA Is Patient Specific. Clin Orthop Relat Res 2021; 479:1871-1872. [PMID: 34156392 PMCID: PMC8277264 DOI: 10.1097/corr.0000000000001870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/04/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Jing-Xin Zhao
- The Faculty of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Xiu-Yun Su
- Intelligent and Digital Surgery Innovation Center, Southern University of Science and Technology Hospital, Shenzhen, Guangdong, China
| | - Zhe Zhao
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Li-Cheng Zhang
- The Faculty of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Pei-Fu Tang
- The Faculty of Orthopaedics, the Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
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38
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Darrith B, Nelson FR, Davis JJ, Silverton CD. Letter to the Editor: The Effect of Postural Pelvic Dynamics on the Three-dimensional Orientation of the Acetabular Cup in THA Is Patient Specific. Clin Orthop Relat Res 2021; 479:1873-1875. [PMID: 34213513 PMCID: PMC8277257 DOI: 10.1097/corr.0000000000001871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/04/2021] [Indexed: 01/31/2023]
Affiliation(s)
| | - Fred R. Nelson
- Clinical Associate Professor, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Orthopaedics, Henry Ford Hospital, Detroit, MI, USA
| | - Jason J. Davis
- Clinical Assistant Professor, Wayne State University School of Medicine, Detroit, MI, USA
- Associate Residency Program Director, Department. of Orthopaedics, Henry Ford Hospital, Detroit, MI, USA
| | - Craig D. Silverton
- Adult Reconstructive Surgery Division Head, Henry Ford Hospital, Detroit, MI, USA
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39
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Bracey DN, Hegde V, Shimmin AJ, Jennings JM, Pierrepont JW, Dennis DA. Spinopelvic mobility affects accuracy of acetabular anteversion measurements on cross-table lateral radiographs. Bone Joint J 2021; 103-B:59-65. [PMID: 34192919 DOI: 10.1302/0301-620x.103b7.bjj-2020-2284.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Cross-table lateral (CTL) radiographs are commonly used to measure acetabular component anteversion after total hip arthroplasty (THA). The CTL measurements may differ by > 10° from CT scan measurements but the reasons for this discrepancy are poorly understood. Anteversion measurements from CTL radiographs and CT scans are compared to identify spinopelvic parameters predictive of inaccuracy. METHODS THA patients (n = 47; 27 males, 20 females; mean age 62.9 years (SD 6.95)) with preoperative spinopelvic mobility, radiological analysis, and postoperative CT scans were retrospectively reviewed. Acetabular component anteversion was measured on postoperative CTL radiographs and CT scans using 3D reconstructions of the pelvis. Two cohorts were identified based on a CTL-CT error of ≥ 10° (n = 11) or < 10° (n = 36). Spinopelvic mobility parameters were compared using independent-samples t-tests. Correlation between error and mobility parameters were assessed with Pearson's coefficient. RESULTS Patients with CTL error > 10° (10° to 14°) had stiffer lumbar spines with less mean lumbar flexion (38.9°(SD 11.6°) vs 47.4° (SD 13.1°); p = 0.030), different sagittal balance measured by pelvic incidence-lumbar lordosis mismatch (5.9° (SD 18.8°) vs -1.7° (SD 9.8°); p = 0.042), more pelvic extension when seated (pelvic tilt -9.7° (SD 14.1°) vs -2.2° (SD 13.2°); p = 0.050), and greater change in pelvic tilt between supine and seated positions (12.6° (SD 12.1°) vs 4.7° (SD 12.5°); p = 0.036). The CTL measurement error showed a positive correlation with increased CTL anteversion (r = 0.5; p = 0.001), standing lordosis (r = 0.23; p = 0.050), seated lordosis (r = 0.4; p = 0.009), and pelvic tilt change between supine and step-up positions (r = 0.34; p = 0.010). CONCLUSION Differences in spinopelvic mobility may explain the variability of acetabular anteversion measurements made on CTL radiographs. Patients with stiff spines and increased compensatory pelvic movement have less accurate measurements on CTL radiographs. Flexion of the contralateral hip is required to obtain clear CTL radiographs. In patients with lumbar stiffness, this movement may extend the pelvis and increase anteversion of the acetabulum on CTL views. Reliable analysis of acetabular component anteversion in this patient population may require advanced imaging with a CT scan. Cite this article: Bone Joint J 2021;103-B(7 Supple B):59-65.
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Affiliation(s)
- Daniel N Bracey
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina, USA.,Colorado Joint Replacement, Denver, Colorado, USA
| | - Vishal Hegde
- Colorado Joint Replacement, Denver, Colorado, USA.,Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Jason M Jennings
- Colorado Joint Replacement, Denver, Colorado, USA.,Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado, USA
| | | | - Douglas A Dennis
- Colorado Joint Replacement, Denver, Colorado, USA.,Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado, USA.,Department of Biomedical Engineering, University of Tennessee, Knoxville, Tennessee, USA.,Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
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40
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Muir JM, Foley KA, Fiaes K, Wagler JB, Galaszewicz M, Benson JR, Bradley MP. Validation of a Novel Software Measurement Tool for Total Hip Arthroplasty. Cureus 2021; 13:e15544. [PMID: 34277169 PMCID: PMC8269987 DOI: 10.7759/cureus.15544] [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] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background
Preoperative planning and postoperative evaluation of component position in total hip arthroplasty (THA) utilize specialized software that must be able to provide measurements that are both accurate and precise. A new software program for use in THA has recently been developed. We sought to evaluate the accuracy of this new software in comparison with two current, widely used software programs. Methodology
Postoperative anteroposterior (AP) pelvic radiographs from 135 THA patients were retrospectively reviewed. Reference values for acetabular anteversion, inclination, and leg length were established using validated software programs (TraumaCad® as the primary reference value [PRV] and OsiriX LiteTM as the secondary reference value [SRV]). Measurements from the new software program (Intellijoint VIEWTM) were compared with reference values using Student’s t-test and chi-square test. Results For anteversion, mean values for the PRV (27.34° ± 7.27°) and the new software (27.29° ± 7.21°) were not significantly different (p = 0.49). The new software differed from the PRV by a mean of 0.05° ± 0.93°. Similar results were noted for inclination, where the new software differed from the PRV and SRV by -0.13° ± 0.65° and 0.25° ± 1.26°, respectively (mean values: PRV: 43.62° ± 6.02°; SRV: 43.99° ± 6.27°; new software: 43.74° ± 6.17°; p = 0.87), and for leg length, where the new software differed from the PRV and SRV by 0.05 mm ± 0.46 mm and 0.22 mm ± 0.52 mm, respectively (mean values: PRV: 10.61 mm ± 11.60 mm; SRV: 10.77 mm ± 11.70 mm; new software: 10.56 mm ± 11.61 mm; p = 0.98). Measurements were highly correlated across multiple reviewers (intraclass correlation coefficient ≥0.987). Conclusions The new software measurement tool is accurate and precise for assessing the acetabular component position and leg length measurements following THA in AP pelvic radiographs compared to currently used image measurement software.
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Affiliation(s)
- Jeffrey M Muir
- Clinical Research, Intellijoint Surgical, Kitchener, CAN
| | - Kelly A Foley
- Clinical Research, Intellijoint Surgical, Kitchener, CAN
| | - Karlina Fiaes
- Epidemiology and Public Health, Physician Assistant Education Program, McMaster University, Hamilton, CAN
| | - Justin B Wagler
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, CAN
| | - Milena Galaszewicz
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, CAN
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41
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[The superiority of navigation and robotics in hip arthroplasty: fact or myth?]. DER ORTHOPADE 2021; 50:270-277. [PMID: 33666672 DOI: 10.1007/s00132-021-04079-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
Computer-assisted surgery represents a relatively novel treatment option in total hip arthroplasty, which has been supported by the technological progress over the latest decades. Navigation and robotics enable increasing the precision of cup positioning, as well as successful biomechanical restoration of leg length and offset. However, the intended target area is still one of debate in literature. Besides the learning curve, the use of navigation and robotics requires additional time and financial expense, which has not yet been addressed in the German healthcare system. This is one reason why computer-assisted surgery has not fully attained everyday routine. The number of comparative studies is limited, but the results are promising. However, if these surrogate measures will end in reduced revision rates or better outcome is unclear. Further prospective studies and register analysis might illuminate the potential benefit of navigation and robotics.
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42
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Kang JS. In Memory of Dr. Lawrence D. Dorr (April 13, 1941 - December 28, 2020). Hip Pelvis 2021; 33:1-2. [PMID: 33748019 PMCID: PMC7952274 DOI: 10.5371/hp.2021.33.1.1] [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: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Joon Soon Kang
- Department of Orthopaedic Surgery, Inha University Hospital, Incheon, Korea
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43
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A New Technique for Patient Registration During Navigated Total Hip Arthroplasty. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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44
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Kievit AJ, Dobbe JGG, Mallee WH, Blankevoort L, Streekstra GJ, Schafroth MU. Accuracy of cup placement in total hip arthroplasty by means of a mechanical positioning device: a comprehensive cadaveric 3d analysis of 16 specimens. Hip Int 2021; 31:58-65. [PMID: 31506002 PMCID: PMC7797610 DOI: 10.1177/1120700019874822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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 We tested whether a mechanical device (such as Hipsecure) to pinpoint the anterior pelvic plane (APP) as a guide can improve acetabular cup placement. To assess accuracy we asked: (1) is the APP an effective guide to position acetabular cup placement within acceptable ° of divergence from the optimal 40° inclination and 15° anteversion; (2) could a mechanical device increase the number of acetabular cup placements within Lewinnek's safe zone (i.e. inclination 30° to 50°; anteversion 5° to 25°)? METHODS 16 cadaveric specimens were used to assess the 3D surgical success of using a mechanical device APP to guide acetabular cup placement along the APP. We used the Hipsecure mechanical device to implant acetabular cups at 40° inclination and 15° anteversion. Subequently, all cadaveric specimens with implants were scanned with a CT and 3D models were created of the pelvis and acetabular cups to assess the outcome in terms of Lewinnek's safe zones. RESULTS The mean inclination of the 16 implants was 40.6° (95% CI, 37.7-43.4) and the mean anteversion angle was 13.4° (95% CI, 10.7-16.1). All 16 cup placements were within Lewinnek's safe zone for inclination (between 30° and 50°) and all but 2 were within Lewinnek's safe zone for anteversion (between 5° and 25°). CONCLUSION In cadaveric specimens, the use of a mechanical device and the APP as a guide for acetabular cup placement resulted in good positioning with respect to both of Lewinnek's safe zones.
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Affiliation(s)
- Arthur J Kievit
- Orthopaedic Research Centre Amsterdam, Department of Orthopaedics of the Amsterdam University Medical Centre, University of Amsterdam, The Netherlands,Arthur J Kievit, Orthopaedic Research Centre Amsterdam, Department of Orthopaedics of the Amsterdam University Medical Centre, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands.
| | - Johannes G G Dobbe
- Department of Biomedical Engineering and Physics of the Amsterdam University Medical Centre, University of Amsterdam, The Netherlands
| | - Wouter H Mallee
- Orthopaedic Research Centre Amsterdam, Department of Orthopaedics of the Amsterdam University Medical Centre, University of Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Orthopaedic Research Centre Amsterdam, Department of Orthopaedics of the Amsterdam University Medical Centre, University of Amsterdam, The Netherlands
| | - Geert J Streekstra
- Department of Biomedical Engineering and Physics of the Amsterdam University Medical Centre, University of Amsterdam, The Netherlands
| | - Matthias U Schafroth
- Orthopaedic Research Centre Amsterdam, Department of Orthopaedics of the Amsterdam University Medical Centre, University of Amsterdam, The Netherlands
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Durand-Hill M, Henckel J, Di Laura A, Hart AJ. Can custom 3D printed implants successfully reconstruct massive acetabular defects? A 3D-CT assessment. J Orthop Res 2020; 38:2640-2648. [PMID: 32427351 DOI: 10.1002/jor.24752] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/28/2020] [Accepted: 05/08/2020] [Indexed: 02/04/2023]
Abstract
We report on the accuracy, measured with three-dimensional (3D) computed tomography (CT) postoperatively, in positioning custom 3D printed titanium components in patients with large acetabular defects. Twenty patients (13 females and 7 males) received custom-made acetabular implants between 2016 and 2018; the mean age was 66 years (SD = 11.6) and their mean body mass index was 28 (SD = 6.1). The median time to follow up was 25.5 months, range: 12 to 40 months. We describe a comparison method that uses the 3D models of CT-generated preoperative plans and the postoperative CT scans to quantify the discrepancy between planned and achieved component positions. Our primary outcome measures were the 3D-CT-measured difference between planned and achieved a component position in six degrees of freedom: center of rotation (CoR), component rotation, inclination (INC), and version (VER) of the cup. Our secondary outcome measures were: Oxford hip score, walking status, and complication rate. All components (100%) were positioned within 10 mm of planned CoR (in the three planes). Eighteen (95%) components were not rotated by more than 10° compared to the plan. Eleven (58%) components were positioned within 5° of planned cup angle (INC and VER). To date one complication has occurred, a periprosthetic fracture. This is the largest study in which postoperative 3D-CT measurements and clinical outcomes of custom-made acetabular components have been assessed. Accurate pre-op planning and the adoption of custom 3D printed implants show promising results in complex hip revision surgery.
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Affiliation(s)
- Matthieu Durand-Hill
- Institute of Orthopaedics and Musculoskeletal Science, University College London
| | | | - Anna Di Laura
- Institute of Orthopaedics and Musculoskeletal Science, University College London
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London.,Royal National Orthopaedic Hospital, Stanmore, UK
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Vigdorchik JM, Sharma AK, Aggarwal VK, Carroll KM, Jerabek SA. The Use of Robotic-Assisted Total Hip Arthroplasty in Developmental Dysplasia of the Hip. Arthroplast Today 2020; 6:770-776. [PMID: 32964085 PMCID: PMC7490591 DOI: 10.1016/j.artd.2020.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is an effective operation for patients with hip osteoarthritis; however, patients with hip dysplasia present a particular challenge. Our novel study examined the effect of robot-assisted THA in patients with hip dysplasia. METHODS We retrospectively reviewed patients with developmental dysplasia of the hip undergoing primary THA using robotic arm assistance at 2 institutions from January 2010 to January 2017. Patients undergoing revision arthroplasty were excluded. Preoperatively, all patients underwent a computed tomography scan so that 3-dimensional templating could be performed. Hip range of motion (ROM) and clinical leg length discrepancy were recorded preoperatively. Two independent observers calculated Crowe and Hartofilakidis grades for each operative hip. At the final follow-up, hip ROM, postoperative complications, and modified Harris Hip scores were obtained. RESULTS Seventy-nine patients underwent THA because of degenerative joint disease in the setting of developmental dysplasia of the hip. There were 56 females and 23 males with a mean age of 45 years (range: 26-64 years). We found that components were placed according to the preoperative plan, that there was an improvement in the modified Harris hip score from 29 to 86 (P < .001), an improvement in the hip ROM (flexion improvement from 66° to 91°, P < .0001), and a correction of leg length discrepancy (17.1 vs 4 mm, P < .0002). There were no complications during the short-term interim follow-up (mean: 3.1 years). CONCLUSIONS Robot-assisted THA can be a useful method to ensure adequate component positioning and excellent outcomes in patients with hip dysplasia. LEVEL OF EVIDENCE Level III, Retrospective.
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Affiliation(s)
- Jonathan M. Vigdorchik
- Department of Orthopedic Surgery, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Service, New York, NY, USA
| | - Abhinav K. Sharma
- Department of Orthopedic Surgery, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Service, New York, NY, USA
| | - Vinay K. Aggarwal
- Department of Orthopedic Surgery, NYU Langone Health, Division of Adult Reconstruction, New York, NY, USA
| | - Kaitlin M. Carroll
- Department of Orthopedic Surgery, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Service, New York, NY, USA
| | - Seth A. Jerabek
- Department of Orthopedic Surgery, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Service, New York, NY, USA
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Burapachaisri A, Elbuluk A, Abotsi E, Pierrepont J, Jerabek SA, Buckland AJ, Vigdorchik JM. Lewinnek Safe Zone References are Frequently Misquoted. Arthroplast Today 2020; 6:945-953. [PMID: 33299915 PMCID: PMC7701843 DOI: 10.1016/j.artd.2020.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/13/2020] [Accepted: 09/27/2020] [Indexed: 12/14/2022] Open
Abstract
Background Optimal acetabular component orientation in total hip arthroplasty (THA) is a necessity in achieving a stable implant. Although there has been considerable debate in the literature concerning the safe zone, to date, there has not been any review to determine if these references are consistent with the definition applied by Lewinnek et al. in 1978. Therefore, this article aims to examine the available literature in the PubMed database to determine how often a correct reference to the safe zone as defined by Lewinnek was applied to discussions regarding THA. Methods A search for literature in the PubMed database was performed for articles from 1978 to 2019. Search criteria included terms ‘Lewinnek,’ ‘safe zone,’ and ‘total hip arthroplasty.’ Exclusions included abstract-only articles, non-English articles, articles unrelated to THA, and those lacking full content. Results A review of literature yielded 147 articles for inclusion. Overall, only 11% (17) cited the Lewinnek article correctly. Forty-five percent (66) of articles referenced measurements in the supine position, 18% (26) referenced other positions, and 37% (55) did not specify. Nineteen percent (28) reported measurements of the acetabular cup orthogonal to the anterior pelvic plane, while 73% (108) did not, and 7% (11) did not specify. Twenty-three percent (34) measured from computed tomography scans instead of other methods. Conclusions In the discussion of the safe zone regarding THA, only 11% of articles listed are consistent with the definition established by Lewinnek. This warrants further investigation into a consistent application of the term and its implications for THA implant stability and dislocation rates.
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Affiliation(s)
- Aonnicha Burapachaisri
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Ameer Elbuluk
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Edem Abotsi
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Jim Pierrepont
- Chief Innovation Officer, Corin Group, New South Wales, Australia
| | - Seth A Jerabek
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Aaron J Buckland
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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Waters G, D'Alessandro P, Yates P. Functional navigation in hip resurfacing. ANZ J Surg 2020; 91:168-173. [PMID: 33164345 DOI: 10.1111/ans.16312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/21/2020] [Accepted: 08/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acetabular malpositioning in total hip arthroplasty (THA) can result in edge loading, leading to increased wear, pseudotumours and bearing failure. Historically Lewinnek's safe zone has been the goal for optimal THA cup positioning; however, research indicates that one generic safe zone is not ideal. In hip resurfacing (HR) there is a lack of data regarding optimal position, and studies indicate that edge loading is related to increased inclination. METHODS We used a functional positioning protocol to produce patient-specific (PS) dynamic analyses, identifying individual functional ideal acetabular zones. We hypothesized that identifying and implanting into PS functional ideal zones would result in decreased edge loading and improved clinical outcomes. Fifteen adept HRs were implanted using a PS functional positioning protocol. As plans were created for standard THA acetabular position, adjustments were made intra-operatively. RESULTS Dynamic post-operative analyses showed 80% of implants were appropriately positioned. The remaining 20% had edge loading, where implants had inclination ≤5° of planned positioning and 10° of planned anteversion. 60% were ≤10° of planned inclination and anteversion. No pre-operative planned positions were within 'Lewinneks's zone', indicating its questionable relevance, especially in HR. A total of 20% of patients developed pain; however, at 1 year post-operatively all patients recorded improved Oxford hip scores. CONCLUSION This study confirms that functional positioning in HR consistently results in improved precision and accuracy in achieving the functional acetabular ideal zone, leading to improved clinical outcomes and prevention of edge loading.
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Affiliation(s)
- Georgina Waters
- Department of Orthopaedic Surgery, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia.,Orthopaedic Research Foundation of Western Australia, Perth, Western Australia, Australia
| | - Peter D'Alessandro
- Department of Orthopaedic Surgery, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia.,Orthopaedic Research Foundation of Western Australia, Perth, Western Australia, Australia.,University of Western Australia, Perth, Western Australia, Australia
| | - Piers Yates
- Department of Orthopaedic Surgery, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia.,Orthopaedic Research Foundation of Western Australia, Perth, Western Australia, Australia.,University of Western Australia, Perth, Western Australia, Australia
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[Hip-spine syndrome-current developments and state of the evidence]. DER ORTHOPADE 2020; 49:841-848. [PMID: 32857167 DOI: 10.1007/s00132-020-03972-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The movements between the spine, pelvis and hip joints are coordinated to allow for a physiological balance of the upper body and the pelvis during sitting and standing. Degenerative changes or spondylodesis of the spine result in decreased pelvic mobility and can lead to increased rates of instability in the presence of total hip arthroplasty (THA). To reduce the risk of THA dislocation several authors have recently recommended functional radiographs of the spine and pelvis, as well as individual safe zones for THA components. The aim of this article is to summarize the current body of knowledge regarding the influence of spinopelvic alignment on THA and provide recommendations for everyday clinical practice.
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Jackson JB, Martin JR, Christal A, Masonis JL, Springer BD, Mason JB. The Direct Anterior Approach Total Hip Arthroplasty Reliably Achieves "Safe Zones" for Combined Anteversion. Arthroplast Today 2020; 6:651-654. [PMID: 32875014 PMCID: PMC7451890 DOI: 10.1016/j.artd.2020.07.023] [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: 03/11/2020] [Revised: 06/19/2020] [Accepted: 07/11/2020] [Indexed: 11/26/2022] Open
Abstract
Background In total hip arthroplasty (THA), component position is critical to avoid instability and improve longevity. Appropriate combined femoral and acetabular component anteversion is important for improved THA stability and increased impingement-free range of motion. In direct anterior THA (DA-THA), concern has been expressed regarding the accuracy of femoral component positioning. This study seeks to quantify acetabular, femoral, and combined component orientation relative to the accepted “safe zones” in patients who have undergone DA-THA. Methods Twenty-nine patients who had THA performed via direct anterior approach had postoperative computerized tomography scans done to assess femoral anteversion. Stem rotational alignment was measured relative to the transepicondylar axis (TEA) and the posterior condylar axis (PCA) of the femur at the knee. Acetabular abduction and version were recorded on anteroposterior pelvis radiographs. Results The mean stem anteversion was 17.5° (standard deviation = 10.8°) from the TEA and 21.7° (standard deviation = 11.3°) from the PCA. Ten of 30 cups were appropriately anteverted; however, all the cups had appropriate abduction. Combined version when using the TEA resulted in 79% (23/29) of patients within the “safe zone” of 25°-50°. Pearson correlation coefficients were high for both stem anteversion from the TEA (R = 0.96) and PCA (R = 0.98); however, interobserver reliability for combined component anteversion was greater for the TEA (kappa, 0.83 vs 0.65). Conclusions Combined anteversion within the “safe zone” was achieved 79% of the time with DA-THA. Interestingly, most of the “excessive” combined anteversion appears to be related to increased anteversion of the acetabular component with only 10 patients within the acetabular cup “safe zone” of 5°-25°.
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