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Heinz T, Vasilev H, Anderson PM, Stratos I, Jakuscheit A, Horas K, Holzapfel BM, Rudert M, Weißenberger M. Functional Outcome after Direct Anterior Approach Total Hip Arthroplasty (DAA-THA) for Coxa Profunda and Protrusio Acetabuli-A Retrospective Study. J Clin Med 2024; 13:4596. [PMID: 39200738 PMCID: PMC11354966 DOI: 10.3390/jcm13164596] [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: 06/20/2024] [Revised: 07/16/2024] [Accepted: 08/01/2024] [Indexed: 09/02/2024] Open
Abstract
Objective: The direct anterior approach (DAA) is a recognized technique for total hip arthroplasty (THA) that spares soft tissue. Functional and clinical outcomes following THA via the DAA in patients with complex acetabular deformities, specifically coxa profunda (CP) and protrusio acetabuli (PA), have yet to be determined. Methods: A retrospective analysis was conducted on 188 primary THA cases, including 100 CP hips and 88 PA hips, performed via the DAA. Functional and clinical outcomes were evaluated by means of the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Harris Hip Score (HHS) preoperatively and at a mean follow-up of 46 ± 14 months. Furthermore, potential complications were assessed. Results: From the preoperative to the latest postoperative visit, a significant improvement in the WOMAC total score was observed (CP: -34.89 ± 20.66; PA: -40.38 ± 21.11). The length of stay (LOS) was the only parameter predictive of the postoperative WOMAC total score, with each day of LOS increasing the postoperative WOMAC by a mean of 1.77 points (p < 0.01). The HHS improved by 38.37 ± 14.23 (PA-group) and 32.79 ± 14.89 points (CP-group). No significant difference in the patient-reported outcome measures (PROMs) between the CP- and PA-group was found. The survival rate for any revision was 97.70% (PA-group) and 92.80% (CP-group). Conclusion: The results of this study indicate that the minimally invasive DAA was not predictive of the functional and clinical outcome following DAA-THA in patients with CP and PA. Improvements in the mean WOMAC and HHS scores were above or within the reported MCID. Additionally, revision rates were well below those reported in the literature for short and intermediate follow-up periods.
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Affiliation(s)
- Tizian Heinz
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany; (T.H.); (H.V.); (P.M.A.); (I.S.); (A.J.); (K.H.); (M.R.)
| | - Hristo Vasilev
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany; (T.H.); (H.V.); (P.M.A.); (I.S.); (A.J.); (K.H.); (M.R.)
| | - Philip Mark Anderson
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany; (T.H.); (H.V.); (P.M.A.); (I.S.); (A.J.); (K.H.); (M.R.)
| | - Ioannis Stratos
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany; (T.H.); (H.V.); (P.M.A.); (I.S.); (A.J.); (K.H.); (M.R.)
| | - Axel Jakuscheit
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany; (T.H.); (H.V.); (P.M.A.); (I.S.); (A.J.); (K.H.); (M.R.)
| | - Konstantin Horas
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany; (T.H.); (H.V.); (P.M.A.); (I.S.); (A.J.); (K.H.); (M.R.)
| | - Boris Michael Holzapfel
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center, Munich (MUM), University Hospital, LMU Munich, Marchioninistr 15, 81377 Munich, Germany;
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany; (T.H.); (H.V.); (P.M.A.); (I.S.); (A.J.); (K.H.); (M.R.)
| | - Manuel Weißenberger
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany; (T.H.); (H.V.); (P.M.A.); (I.S.); (A.J.); (K.H.); (M.R.)
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Ansari S, Gupta K, Gupta T, Raja BS, J P, Kalia RB. Total Hip Arthroplasty in Protrusio Acetabuli: A Systematic Review. Hip Pelvis 2024; 36:12-25. [PMID: 38420735 DOI: 10.5371/hp.2024.36.1.12] [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: 07/17/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 03/02/2024] Open
Abstract
Protrusio acetabuli, or abnormal protrusion of the femoral head into the acetabulum, requires performance of a total hip arthroplasty (THA) for which various reconstruction techniques and outcomes have been described. The aim of this systematic review is to provide a comprehensive analysis of the current evidence, evaluate treatment efficacy, compare surgical techniques, and identify topics for future research along with improving evidence-based decision-making, improving patient outcomes in the management of this condition. A thorough systematic review of the PubMed, Embase, Cochrane Library databases, and Scopus library was conducted, and articles describing techniques of THA for treatment of protrusion acetabuli were extracted. The initial search generated 751 results. After exclusion, 18 articles were included. Of these, eight were prospective studies and 10 were retrospective. Surgery was performed on 783 hips with a mean age of 60 years; 80% of females who mostly had inflammatory arthritis were followed up for 8.86 years (range, 2-15.4 years). Good outcomes have been achieved with THA using uncemented cups with bone graft; however, no conclusion could be drawn with regard to the femoral side. It can be concluded that the concept of restoration of the anatomical hip center of rotation is paramount for good outcome and better survival of the implant is important when using uncemented cups with a bone graft. In addition, screw augmentation for fixation is not recommended unless absolutely necessary. The most common complications were aseptic loosening and heterotopic ossification. While the former required revision, conservative management was administered for the latter.
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Affiliation(s)
- Sajid Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Kshitij Gupta
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Tushar Gupta
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Balgovind S Raja
- Department of Orthopaedics, All India Institute of Medical Sciences, Patna, India
| | - Pranav J
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Roop Bhushan Kalia
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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Kobayashi K, Tsurumoto N, Tsuda S, Shiraishi K, Chiba K, Osaki M. The Anterior Position of the Hip Center of Rotation Is Related to Anterior Cup Protrusion Length and Symptomatic Iliopsoas Impingement in Primary Total Hip Arthroplasty. J Arthroplasty 2023; 38:2366-2372. [PMID: 37271227 DOI: 10.1016/j.arth.2023.05.047] [Citation(s) in RCA: 1] [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: 02/10/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Iliopsoas impingement (IPI) is an important complication after total hip arthroplasty (THA), and anterior cup protrusion is believed to be its main cause; however, the relationship between the hip center of rotation (COR) and symptomatic IPI or cup protrusion remains poorly understood. Therefore, the present study investigated these relationships. METHODS The medical records of 138 patients who underwent unilateral primary THA were retrospectively reviewed. There were 8 patients (5.8%) who had symptomatic IPI. The COR and cup protrusion length measured with 2 methods were assessed on computed tomography. Risk factors for symptomatic IPI and the relationship between the COR and protrusion length were evaluated. RESULTS Logistic regression analyses showed that anteroposterior position of the COR, sagittal cup protrusion length (SCPL) at the COR, and both axial and SCPLs at the most anterior margin of the cup were related to symptomatic IPI. Multivariable regression analyses showed that acetabular offset was related to axial protrusion length at the COR, and anteroposterior position of the COR was related to both axial and sagittal protrusion lengths at the most anterior margin of the cup. CONCLUSION Anterior position of the cup was related to symptomatic IPI and both axial and sagittal protrusion lengths at the most anterior margin of the cup. Anterior reaming and cup protrusion should be avoided as much as possible to prevent symptomatic IPI.
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Affiliation(s)
- Kyosuke Kobayashi
- Department of Orthopaedic Surgery, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Naoji Tsurumoto
- Department of Orthopaedic Surgery, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Soichiro Tsuda
- Department of Orthopaedic Surgery, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Kazuteru Shiraishi
- Department of Orthopaedic Surgery, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Ko Chiba
- Department of Orthopaedic Surgery, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Makoto Osaki
- Department of Orthopaedic Surgery, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
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Romagnoli M, Zaffagnini M, Carillo E, Raggi F, Casali M, Leardini A, Marcheggiani Muccioli GM, Grassi A, Zaffagnini S. Custom-made implants for massive acetabular bone loss: accuracy with CT assessment. J Orthop Surg Res 2023; 18:742. [PMID: 37777776 PMCID: PMC10544156 DOI: 10.1186/s13018-023-04230-5] [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: 07/07/2023] [Accepted: 09/22/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND Custom-made implants are a valid option in revision total hip arthroplasty to address massive acetabular bone loss. The aim of this study was to assess the accuracy of custom-made acetabular implants between preoperative planning and postoperative positioning using CT scans. METHODS In a retrospective analysis, three patients who underwent an acetabular custom-made prosthesis were identified. The custom-made designs were planned through 3D CT analysis considering surgical points of attention. The accuracy of intended implants positioning was assessed by comparing pre- and postoperative CT analyzing the center of rotation (CoR), anteversion, inclination, screws, and implant surface in contact with the bone. RESULTS The three cases presented satisfactory accuracy in positioning. A malpositioning in the third case was observed due to the posterization of the CoR of the implant of more than 10 mm. The other CoR vectors considered in the third patient and all vectors in the other two cases fall within 10 mm. All the cases were positioned with a difference of less than 10° of anteversion and inclination with respect to the planning. CONCLUSIONS The current case series revealed promising accuracy in the positioning of custom-made acetabular prosthesis comparing the planned implant in preoperative CT with postoperative CT.
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Affiliation(s)
- Matteo Romagnoli
- Ortopedia e Traumatologia Rizzoli Argenta, Via Nazionale Ponente 5, 44011, Argenta, FE, Italy
| | - Marco Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy.
| | - Eleonora Carillo
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | - Federico Raggi
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | - Marco Casali
- Ortopedia e Traumatologia Rizzoli Argenta, Via Nazionale Ponente 5, 44011, Argenta, FE, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano, 1/10, 40136, Bologna, Italy
| | | | - Alberto Grassi
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
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Cursaru A, Iordache S, Costache M, Serban B, Popa M, Cretu B, Cirstoiu C. Management of Acetabular Bone Loss in Hip Revision Arthroplasty: Case Series Presentation. Cureus 2023; 15:e45432. [PMID: 37859882 PMCID: PMC10582587 DOI: 10.7759/cureus.45432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2023] [Indexed: 10/21/2023] Open
Abstract
Considering the increase in life expectancy in the general population and the need for a more active lifestyle, total hip arthroplasty has become an absolutely necessary surgical intervention to maintain these desired results. Along with the evolution of medicine and the increase in the quality and performance of the materials used to make prostheses, the number of patients who benefit from total hip replacement is constantly increasing, and proportionally, the number of patients who will require revision arthroplasty is increasing. Before discussing the need for hip arthroplasty revision, it is necessary to carry out a rigorous clinical and imaging examination for differential diagnosis with other pathologies such as low back pain, the presence of bone or soft tissue tumors, arterial occlusions and claudication, or other systemic diseases. One of the biggest challenges for the orthopedic surgeon in planning a hip revision is the compensation of the remaining acetabular bone defect, either as a result of the osteolysis process or following the process of removing the acetabular component, which in some cases can lead to severe bone loss that is difficult to anticipate in the preoperative planning. In this paper, we will present the short-term results of the use of reinforcement cages fixed with screws and cemented retentive acetabular cups in the case of hip revisions with extensive bone loss. The discussions that derive from the presented series of cases are related to the use of reinforcement cages, which are based on the principle of primary stability obtained with the help of screw fixation but whose risk of osteolysis and implant fixation damage is greater than in the case of implants that also associate biological integration at bone level. The use of reinforcement cages together with the retentive acetabular cup in the case of elderly patients with associated comorbidities, a moderate level of physical activity, and severe muscle insufficiency at the hip level as a result of not using the affected pelvic limb is still a viable solution that allows the patient to walk immediately after the surgery, avoiding the risk of dislocation (especially in patients who use the posterolateral approach) and avoiding morbidity induced by prolonged bed rest.
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Affiliation(s)
- Adrian Cursaru
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Sergiu Iordache
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Mihai Costache
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Bogdan Serban
- Orthopedics and Trauma, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
- Orthopedics and Traumatology, University Emergency Hospital, Bucharest, ROU
| | - Mihnea Popa
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
| | - Bogdan Cretu
- Orthopedics, Bucharest Emergency University Hospital, Bucharest, ROU
| | - Catalin Cirstoiu
- Orthopedics and Traumatology Department, University Emergency Hospital, Bucharest, ROU
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Heinz T, Vasilev H, Anderson PM, Stratos I, Jakuscheit A, Horas K, Holzapfel BM, Rudert M, Weißenberger M. The Direct Anterior Approach (DAA) as a Standard Approach for Total Hip Arthroplasty (THA) in Coxa Profunda and Protrusio Acetabuli? A Radiographic Analysis of 188 Cases. J Clin Med 2023; 12:3941. [PMID: 37373635 DOI: 10.3390/jcm12123941] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION The direct anterior approach (DAA) represents a well-recognized soft tissue sparing technique for primary total hip arthroplasty (THA). The feasibility and suitability of the DAA in cases of complex acetabular deformities, namely coxa profunda (CP) and protrusio acetabuli (PA), remain to be determined. METHODS A total of 188 cases of CP (100 cases) and PA (88 cases) hips undergoing primary THA via the DAA were retrospectively analyzed. Surgical and radiographic parameters were evaluated and potential complications were assessed. Finally, successful implantation was defined if surgical and radiographic parameters were well within established values of non-complex primary THA. RESULTS In 159 hips, the medial border of the acetabular component was transferred laterally to the ilioischial line, corresponding to a fully treated acetabular protrusion. In 23 (12.23%) cases, mild, and in 5 (2.66%) cases, moderate residual acetabular protrusion remained after THA. Postoperatively, 11.40% (PA group) and 9.00% (CP group) had a leg length discrepancy (LLD) greater than 10 mm. The mean operative time was significantly less than 60 min. A linear relationship between the BMI and operative time was observed, with an additional 0.9 min of operative time per BMI unit. Overall, complications were rare and did not differ between the two groups. CONCLUSION The results of this study suggest that the DAA is a suitable approach for primary THA in patients with coxa profunda and acetabular protrusion if performed by experienced surgeons familiar with the DAA. Obese patients with acetabular protrusion may pose a significant limitation to the DAA and caution should be advised in cases of obesity.
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Affiliation(s)
- Tizian Heinz
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany
| | - Hristo Vasilev
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany
| | - Philip Mark Anderson
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany
| | - Ioannis Stratos
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany
| | - Axel Jakuscheit
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany
| | - Konstantin Horas
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany
| | - Boris Michael Holzapfel
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr 15, 81377 Munich, Germany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany
| | - Manuel Weißenberger
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany
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Liu P, Qiao YJ, Lou JP, Cao G, Chang Y, Zhou SH. Cementless total hip arthroplasty for treatment of acetabular protrusion secondary to rheumatoid arthritis. J Orthop Surg Res 2023; 18:282. [PMID: 37024933 PMCID: PMC10080900 DOI: 10.1186/s13018-023-03764-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND To explore the surgical technique and clinical outcomes of cementless total hip arthroplasty (THA) combined with impacted bone grafting for the treatment of moderate and severe acetabular protrusion with rheumatoid arthritis (RA). METHODS From January 2010 to October 2020, 45 patients (56 hips), including 17 men (22 hips) and 28 women (34 hips) with acetabular impingement secondary to RA, were treated with bioprosthetic THA combined with autologous bone grafting at our hospital. According to the Sotello-Garza and Charnley classification criteria, there were 40 cases (49 hips) of type II (protrusio acetabuli 6-15 mm) and 5 cases (7 hips) of type III (protrusio acetabuli > 15 mm). At the postoperative follow-up, the ROM of the hip joint, the VAS score, and the Harris score were evaluated. The healing of the bone graft, the restoration of the hip rotation center, and the prosthesis loosening were assessed by plain anteroposterior radiographs. RESULTS The average operation time was 95.53 ± 22.45 min, and the mean blood loss was 156.16 ± 69.25 mL. There were no neurovascular complications during the operation. The mean follow-up duration was 5.20 ± 1.20 years. The horizontal distance of the hip rotation center increased from preoperative 10.40 ± 2.50 mm to postoperative 24.03 ± 1.77 mm, and the vertical distance increased from preoperative 72.36 ± 3.10 mm to postoperative 92.48 ± 5.31 mm. The range of flexion motion of the hip joint increased from 39.48 ± 8.36° preoperatively to 103.07 ± 7.64° postoperatively, and the range of abduction motion increased from 10.86 ± 4.34° preoperatively to 36.75 ± 3.99° postoperatively. At the last follow-up, the Harris score increased from 37.84 ± 4.74 to 89.55 ± 4.05. All patients were able to move independently without assistance. CONCLUSIONS Cementless THA combined with impacted grafting granule bone of the autogenous femoral head and biological acetabular cup can reconstruct the acetabulum, restore the rotation center of the hip joint, and achieve good medium-term outcomes in the treatment of moderate to severe acetabular herniation secondary to RA.
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Affiliation(s)
- Peng Liu
- Department of Joint Surgery, The 940Th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, South Binhe Road, No. 333, Lanzhou City, 730050, Gansu Province, People's Republic of China
| | - Yong-Jie Qiao
- Department of Joint Surgery, The 940Th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, South Binhe Road, No. 333, Lanzhou City, 730050, Gansu Province, People's Republic of China
| | - Jin-Peng Lou
- Department of Joint Surgery, The 940Th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, South Binhe Road, No. 333, Lanzhou City, 730050, Gansu Province, People's Republic of China
| | - Guoding Cao
- Department of Orthopaedics, Lanzhou University Second Hospital, Cuiying Gate, No. 82, Chengguan District, Lanzhou City, 730030, Gansu Province, People's Republic of China
| | - Yanfeng Chang
- Department of Joint Surgery, The 940Th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, South Binhe Road, No. 333, Lanzhou City, 730050, Gansu Province, People's Republic of China
| | - Sheng-Hu Zhou
- Department of Joint Surgery, The 940Th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, South Binhe Road, No. 333, Lanzhou City, 730050, Gansu Province, People's Republic of China.
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Is simultaneous bilateral total hip arthroplasty deleterious in a biomechanical point of view? A comparative gait analysis study. BMC Musculoskelet Disord 2022; 23:903. [PMID: 36217164 PMCID: PMC9549045 DOI: 10.1186/s12891-022-05856-y] [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: 08/01/2022] [Accepted: 09/22/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose Uni- or bilateral hip osteoarthritis is a common disease generating pain, stiffness, and functional disabilities. Changes in the normal walking with higher energy expenditures are observed. Facing a cruel lack of biomechanical data, we decided to analyse the impact on the walking of single and simultaneous bilateral total hip arthroplasties (THA). Method We conducted a prospective monocentric study, comparing two matched groups of 15 patients able to walk with symptomatic isolated uni- (group 1) or bilateral HO (group 2) and treated respectively by unilateral THA (UTHA) or simultaneous bilateral THA (SBTHA). Surgery was performed by a single surgeon with a direct anterior approach and approved by local ethical committee. Walking was assessed by a « 3D Gait analysis motion» pre and at 6 months post operatively. Result In the UTHA group, recovery, i.e., efficiency of locomotor mechanism (p < 0.001) and pelvis sagittal balance (p = 0.031) improved, while external and total work (p = 0.010) decreased post operatively. In the SBTHA group, speed (p = 0.035), step length (p = 0.046), range of motion of knee sagittal stance (p = 0.009) and hip frontal (p = 0.031), and internal work are significatively higher (p < 0.001) post operatively. Conclusions This original study attests that THA has a positive impact on walking and energetics outcome in UTHA and SBTHA.
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Kaiser D, Ried E, Zingg PO, Rahm S. Acetabular reconstruction with femoral head autograft in primary total hip arthroplasty through a direct anterior approach is a reliable option for patients with secondary osteoarthritis due to developmental dysplasia of the hip. Arch Orthop Trauma Surg 2022; 142:2957-2964. [PMID: 34581861 PMCID: PMC9474438 DOI: 10.1007/s00402-021-04187-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 09/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Developmental dysplasia is challenging to treat with total hip arthroplasty via the direct anterior approach (DAA). Reconstructing the former anatomy while restoring the acetabular bone stock for future revisions in this young patient collective combined with the known advantages of the DAA would be desirable. The purpose of this study was to analyze the feasibility, radiographic outcome and clinical outcome of primary uncemented total hip arthroplasty with bulk femoral head autograft for acetabular augmentation through a DAA with a minimal follow-up of 12 months. METHODS A retrospective, consecutive series from March 2006 to March 2018 of 29 primary total hip arthroplasty with acetabular augmentation with bulk femoral head autograft through a direct anterior approach was identified. All complications, reoperations and failures were analyzed. Radiographic and clinical outcome was measured. RESULTS 24 patients (29 hips) with a mean age of 43 (18-75) years and a mean follow-up of 35 months (12-137) were included. Surgical indication was secondary osteoarthritis for developmental dysplasia of the hip (Hartofilakidis Grade A (n = 19), B (n = 10)) in all cases. We noted no conversion of the approach, no dislocation and no acetabular loosening. The center of rotation was significantly distalized by a mean of 9 mm (0-23) and significantly medialized by a mean of 18 mm (6-29). The bone graft was fully integrated after 12 months in all cases. CONCLUSION Acetabular reconstruction with femoral head autograft in primary THA through a direct anterior approach seems to be a reliable option for the treatment of secondary osteoarthritis in patients with DDH Hartofilakidis grade A and B. Prospective cohort studies with a large sample population and a long-term follow-up are necessary to confirm our findings.
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Affiliation(s)
- Dominik Kaiser
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland.
| | - Emanuel Ried
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
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Wessling M, Gebert C, Hakenes T, Dudda M, Hardes J, Frieler S, Jeys LM, Hanusrichter Y. Reconstruction of Paprosky III defects with custom-made implants: do we get them in the correct position? : short-term radiological results. Bone Joint J 2022; 104-B:1110-1117. [PMID: 36177641 DOI: 10.1302/0301-620x.104b10.bjj-2022-0508.r1] [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: 11/05/2022]
Abstract
AIMS The aim of this study was to examine the implant accuracy of custom-made partial pelvis replacements (PPRs) in revision total hip arthroplasty (rTHA). Custom-made implants offer an option to achieve a reconstruction in cases with severe acetabular bone loss. By analyzing implant deviation in CT and radiograph imaging and correlating early clinical complications, we aimed to optimize the usage of custom-made implants. METHODS A consecutive series of 45 (2014 to 2019) PPRs for Paprosky III defects at rTHA were analyzed comparing the preoperative planning CT scans used to manufacture the implants with postoperative CT scans and radiographs. The anteversion (AV), inclination (IC), deviation from the preoperatively planned implant position, and deviation of the centre of rotation (COR) were explored. Early postoperative complications were recorded, and factors for malpositioning were sought. The mean follow-up was 30 months (SD 19; 6 to 74), with four patients lost to follow-up. RESULTS Mean CT defined discrepancy (Δ) between planned and achieved AV and IC was 4.5° (SD 3°; 0° to 12°) and 4° (SD 3.5°; 1° to 12°), respectively. Malpositioning (Δ > 10°) occurred in five hips (10.6%). Native COR reconstruction was planned in 42 cases (93%), and the mean 3D deviation vector was 15.5 mm (SD 8.5; 4 to 35). There was no significant influence in malpositioning found for femoral stem retention, surgical approach, or fixation method. CONCLUSION At short-term follow-up, we found that PPR offers a viable solution for rTHA in cases with massive acetabular bone loss, as highly accurate positioning can be accomplished with meticulous planning, achieving anatomical reconstruction. Accuracy of achieved placement contributed to reduced complications with no injury to vital structures by screw fixation.Cite this article: Bone Joint J 2022;104-B(10):1110-1117.
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Affiliation(s)
- Martin Wessling
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Wetter, Germany.,Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany
| | - Carsten Gebert
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Wetter, Germany.,Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Tilmann Hakenes
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Wetter, Germany
| | - Marcel Dudda
- Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany
| | - Jendrik Hardes
- Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany.,Department of Trauma Surgery, University Hospital Essen, Essen, Germany
| | - Sven Frieler
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Wetter, Germany.,Seattle Science Foundation, Seattle, Washington, USA.,Department of Trauma and Orthopedic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Lee M Jeys
- Oncology Department, The Royal Orthopaedic Hospital, Birmingham, UK.,Faculty of Health Sciences, Aston University, Birmingham, UK
| | - Yannik Hanusrichter
- Department of Tumour Orthopaedics and Revision Arthroplasty, Orthopaedic Hospital Volmarstein, Wetter, Germany.,Center for Musculoskeletal Surgery, University Hospital of Essen, Essen, Germany.,Department of Trauma and Orthopedic Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
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11
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Sculco PK, Wright T, Malahias MA, Gu A, Bostrom M, Haddad F, Jerabek S, Bolognesi M, Fehring T, Gonzalez DellaValle A, Jiranek W, Walter W, Paprosky W, Garbuz D, Sculco T, Abdel M, Boettner F, Benazzo F, Buttaro M, Choi D, Engh CA, Garcia-Cimbrelo E, Garcia-Rey E, Gehrke T, Griffin WL, Hansen E, Hozack WJ, Jones S, Lee GC, Lipman J, Manktelow A, McLaren AC, Nelissen R, O’Hara L, Perka C, Sporer S. The Diagnosis and Treatment of Acetabular Bone Loss in Revision Hip Arthroplasty: An International Consensus Symposium. HSS J 2022; 18:8-41. [PMID: 35082557 PMCID: PMC8753540 DOI: 10.1177/15563316211034850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/21/2022]
Abstract
Despite growing evidence supporting the evaluation, classification, and treatment of acetabular bone loss in revision hip replacement, advancements have not been systematically incorporated into a single document, and therefore, a comprehensive review of the treatment of severe acetabular bone loss is needed. The Stavros Niarchos Foundation Complex Joint Reconstruction Center at Hospital for Special Surgery held an Acetabular Bone Loss Symposium on June 21, 2019, to answer the following questions: What are the trends, emerging technologies, and areas of future research related to the evaluation and management of acetabular bone loss in revision hip replacement? What constitutes the optimal workup and management strategies for acetabular bone loss? The 36 international experts convened were divided into groups, each assigned to discuss 1 of 4 topics: (1) preoperative planning and postoperative assessment; (2) implant selection, management of osteolysis, and management of massive bone loss; (3) the treatment challenges of pelvic discontinuity, periprosthetic joint infection, instability, and poor bone biology; and (4) the principles of reconstruction and classification of acetabular bone loss. Each group came to consensus, when possible, based on an extensive literature review. This document provides an overview of these 4 areas, the consensus each group arrived at, and directions for future research.
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Affiliation(s)
- Peter K. Sculco
- Hospital for Special Surgery, New York, NY, USA,Peter K. Sculco, MD, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021, USA.
| | | | | | - Alexander Gu
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | | | - Fares Haddad
- University College London Hospitals NHS Foundation Trust and Institute of Sport, Exercise & Health, London, UK
| | | | | | | | | | | | - William Walter
- Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Wayne Paprosky
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Donald Garbuz
- Department of Orthopaedics, The University of British Columbia, Vancouver, BC, Canada
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12
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Polesello GC, Salerno TT, Queiroz MCD, Ricioli Junior W, Rabelo NDA, Honda EK. Existe alguma diferença entre um marcador esférico e uma moeda simples para planejamento digital de substituição de quadril? Rev Bras Ortop 2022; 57:560-568. [PMID: 35966431 PMCID: PMC9365464 DOI: 10.1055/s-0041-1724079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/14/2020] [Indexed: 11/29/2022] Open
Abstract
Objective
To evaluate the accuracy and differences between 2 types of metallic markers, sphere, and coin, for radiographic calibration in the preoperative planning of hip arthroplasty.
Methods
Four spherical metallic markers and four coins, both 25 mm in diameter, were placed on the greater trochanter, pubic symphysis, between the thighs, and on the table of the exam, for radiographic examination of the hip in 33 patients with hip prosthesis. The prosthesis head was used for calibration and two examiners measured the markers' image diameters, and the results were analyzed statistically.
Results
In the greater trochanter, the sphere and the coin were not visualized in 19 radiographs (57.6%). Between the thighs, the coin marker was not visualized in 13 radiographs (39.4%). In the greater trochanter, the 25-mm accuracy of the coin and the sphere was, respectively, between 57.1 and 63.3% and between 64.3 and 92.9%. The coin between the thighs reached 25-mm accuracy in between 50 and 60% of cases. Over the exam table, the coin and sphere markers reached, respectively, the mean diameters of 22.91 mm and 23 mm, the lowest coefficient of variation, the lowest confidence interval, and the easiest positioning. There was statistical difference between the evaluations of the markers (coin vs. sphere) in all positions (
p
< 0.032), except for the exam table position (
p
= 0.083).
Conclusions
The coin between the thighs is the best marker for radiographic calibration in the preoperative planning of hip arthroplasty, and we suggest the use of another coin on the exam table for comparison, considering the 8% reduction in relation to its real size.
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Affiliation(s)
- Giancarlo Cavalli Polesello
- Departamento de Ortopedia e Traumatologia da Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, SP, Brasil
| | - Thiago Tronco Salerno
- Departamento de Ortopedia e Traumatologia da Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, SP, Brasil
| | - Marcelo Cavalheiro de Queiroz
- Departamento de Ortopedia e Traumatologia da Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, SP, Brasil
| | - Walter Ricioli Junior
- Departamento de Ortopedia e Traumatologia da Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, SP, Brasil
| | - Nayra Deise Anjos Rabelo
- Departamento de Ortopedia e Traumatologia da Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, SP, Brasil
| | - Emerson Kyioshi Honda
- Departamento de Ortopedia e Traumatologia da Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), São Paulo, SP, Brasil
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13
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Lee BS, Kim HS, Kwon OS, Lee YK, Ha YC, Koo KH. Is Restoration of Hip Center Mandatory for Total Hip Arthroplasty of Protrusio Acetabuli? Hip Pelvis 2022; 34:106-114. [PMID: 35800128 PMCID: PMC9204237 DOI: 10.5371/hp.2022.34.2.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/24/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose While initial fixation using a press-fit of the acetabular cup is critical for the durability of the component, restoration of the hip center is regarded as an attributable factor for implant survival and successful outcome. In protrusio acetabuli (PA), obtaining both restoration of the hip center and the press-fit of the acetabular cup simultaneously might be difficult during total hip arthroplasty (THA). We tested the hypothesis that use of a medialized cup, if press-fitted, will not result in compromise of the implant stability and outcome after cementless THA of PA. Materials and Methods A total of 26 cementless THAs of 22 patients with PA were reviewed. During THA, press-fit of the cup was prioritized rather than hip center restoration. A press-fit was obtained in 24 hips. A press-fit could not be obtained in the two remaining hips; therefore, reinforcement acetabular components were used. Restoration of the hip center was achieved in 17 cups; 15 primary cups and two reinforcement components; it was medialized in nine cups. Implant stability and modified Harris hip score (mHHS) between the two groups were compared at a mean follow-up of 5.1 years (range, 2-16 years). Results Twenty-six cups; 17 restored cups and nine medialized press-fitted cups, remained stable at the latest follow-up. A similar final mHHS was observed between the restored group and the medialized group (83.6±12.1 vs 83.8±10.4, P=0.786). Conclusion Implant stability and favorable results were obtained by press-fitted cups, irrespective of hip center restoration. THA in PA patients showed promising clinical and radiological results.
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Affiliation(s)
- Beom Seok Lee
- Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea
| | - Hong Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - O Sang Kwon
- Department of Orthopaedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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14
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Faraj A, Andrews M, Li W. Inter and intra-observer errors for postoperative total hip radiographic assessment using computer aided design. Acta Orthop Belg 2021. [DOI: 10.52628/87.1.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Plain radiographic assessment of primary total hip arthroplasty following surgery remains to be the commonest radiological assessment. The current paper, studies the accuracy and concordance between observers reviewing these radiographs.
A prospective radiographic and medical note review of ten patients who underwent total hip replacement for primary osteoarthritis, with a mean age of 69 years. Early and 6 weeks postoperative x-rays were assessed for hip profile and version profile using computer aided design (CAD) by two observers on two different occasions. The observers were Orthopaedic surgeons who perform arthroplasty of the hip. The results were analyzed statistically.
Dimensions, including Femoral offset, medial offset and ilioischial offset showed a high degree of inter- film and intra-film correlation, with inter-class correlation (ICC) over 0.8. Except of the intra-film correlation of ilioischial offset measured on the post- operative films (p=0.067) by the first rater, all the intra and inter film correlation were significantly over the benchmark of 0.6. In terms of stem alignment, cup inclination and cup version, the intra-film correlation by rater n°2 ranges from 0.574 to 0.975 and were significantly over the benchmark of 0.6, except in the case of cup inclination measured on the 6 th? week follow-up ; meanwhile the intra-film correlation by rater n°1 ranges from 0.581 to 0.819 and none were significantly over the benchmark of 0.6.
The inter-rater reliability and inter-film correlation showed a dichotomy of results among different dimensions of the measurement. Dimensions of femo- ral offset, medial offset and ilioischial offset showed a substantial degree of reliability in terms of inter-rater reliability, inter-film correlation, and intra-rater/film reliability.
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15
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Is Ranawat triangle method accurate in estimating hip joint center in Japanese population? J Orthop Sci 2021; 26:219-224. [PMID: 32245695 DOI: 10.1016/j.jos.2020.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/26/2020] [Accepted: 03/10/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Little information has been available regarding the usefulness of Ranawat triangle method in estimating anatomical hip joint center in the Japanese population. In this study, we aimed to determine the accuracy of the method in estimating hip joint center. METHODS Using digitally reconstructed radiographs of 123 normal hips (123 patients), we measured the hip joint center coordinates (Cx, Cy) with reference to the ipsilateral lowest point of the teardrop, the pelvic width, and the pelvic height. Using these measurement values, we performed the following analyses: (1) the relationship of hip joint center location with pelvic dimensions; (2) accuracy of Ranawat method in estimating hip joint center; (3) alternative methods to estimate hip joint center using pelvic height. RESULTS The mean Cx and Cy were 32 ± 3.0 mm and 13 ± 2.1 mm, respectively. Pelvic height was positively correlated with Cx (r = 0.51, p < 0.001) and Cy (r = 0.69, p < 0.001), but the correlations of pelvic width with Cx and Cy were negligible. The mean estimation error of the Ranawat method was -6.7 ± 2.6 mm in x-axis and 6.6 ± 1.9 mm in y-axis, respectively. The hip joint center was estimated within a 5 mm error in both axes in only 8 hips (6.5%). Thus, we developed two estimating methods using pelvic height, modified Ranawat method and pelvic height ratio method, and the estimation errors of these methods were within 5 mm in both axes in 118 hips (96%) and 116 hips (94%), respectively. CONCLUSIONS Ranawat method showed poor accuracy in estimating anatomical hip joint center and is not recommended for clinical use. Our alternative methods may be useful for surgeons planning the position of the acetabular component in total hip arthroplasty.
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16
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Rodriguez HA, Viña F, Muskus MA. Partial resection of the posterior wall for hip dislocation in severe acetabular protrusio: a useful surgical option. Bone Jt Open 2020; 1:431-437. [PMID: 33215135 PMCID: PMC7659662 DOI: 10.1302/2633-1462.17.bjo-2020-0058.r1] [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] [Indexed: 11/15/2022] Open
Abstract
Aims In elderly patients with osteoarthritis and protrusio who require arthroplasty, dislocation of the hip is difficult due to migration of the femoral head. Traditionally, neck osteotomy is performed in situ, so this is not always achieved. Therefore, the purpose of this study is to describe a partial resection of the posterior wall in severe protrusio. Methods This is a descriptive observational study, which describes the surgical technique of the partial resection of the posterior wall during hip arthroplasty in patients with severe acetabular protrusio operated on between January 2007 and February 2017. Results In all, 49 hip arthroplasties were performed. The average age of patients was 60 years, and idiopathic was the most frequent aetiology of protrusio. All patients were treated with femoral head autograft and no intra- or postoperative complications were reported. No patients required revision surgery. Conclusion Partial resection of the posterior wall demonstrated to be a safe surgical technique with 100% survival in a follow-up to ten years in total hip arthroplasty due to severe acetabular protrusio. Cite this article: Bone Joint Open 2020;1-7:431–437.
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Affiliation(s)
- Hugo A Rodriguez
- Department of Orthopedics and Traumatology, Hospital Universitario Infantil de San José - Fundacion Universitaria de Ciencias de la Salud, Bogotá, Colombia
| | - Felipe Viña
- Medical Surgeon, Fundación Universitaria de Ciencias de La Salud, Bogotá, Colombia
| | - Meilyn A Muskus
- Department of Orthopedics and Traumatology, Hospital Universitario Infantil de San José - Fundacion Universitaria de Ciencias de la Salud, Bogotá, Colombia
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17
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Haniball J, Howe LB, Guoping KT. Robotic-Assisted Acetabular Cup Placement in Severe Intrapelvic Acetabular Protrusio: A Case Report. JBJS Case Connect 2020; 10:e20.00026. [PMID: 33021517 DOI: 10.2106/jbjs.cc.20.00026] [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
CASE We present a patient with a 30-year history of severe intrapelvic acetabular protrusio. As far as we know, this is the first case report on the use of robotic technology in total hip arthroplasty for severe acetabular protrusion. We also discuss the challenges and lessons learned from this technically demanding case. CONCLUSION Robotic assistance has its advantages in the accurate templating of the optimal cup dimensions, orientation, and location. However, the surgeon may still need to manually restore the offset because the center of rotation is not re-established and must be mindful of the severity and chronicity of the soft-tissue contractures.
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Affiliation(s)
- Jikku Haniball
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
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18
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Meynen A, Matthews H, Nauwelaers N, Claes P, Mulier M, Scheys L. Accurate reconstructions of pelvic defects and discontinuities using statistical shape models. Comput Methods Biomech Biomed Engin 2020; 23:1026-1033. [PMID: 32619099 DOI: 10.1080/10255842.2020.1784404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Treatment of large acetabular defects and discontinuities remains challenging and relies on the accurate restoration of the native anatomy of the patient. This study introduces and validates a statistical shape model for the reconstruction of acetabular discontinuities with severe bone loss through a two-sided Markov Chain Monte Carlo reconstruction method. The performance of the reconstruction algorithm was evaluated using leave-one-out cross-validation in three defect types with varying severity as well as severe defects with discontinuities. The two-sided reconstruction method was compared to a one-sided methodology. Although, reconstruction errors increased with defect size and this increase was most pronounced for pelvic discontinuities, the two-sided reconstruction method was able to reconstruct the native anatomy with higher accuracy than the one-sided reconstruction method. These findings can improve the preoperative planning and custom implant design in patients with large pelvic defects, both with and without discontinuities.
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Affiliation(s)
- Alexander Meynen
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Harold Matthews
- Department of Human Genetics, Faculty of Medicine, KU Leuven, Leuven, Belgium.,OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium.,Facial Sciences Research Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Nele Nauwelaers
- Department of Human Genetics, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium.,Department of Electrical Engineering ESAT/PSI, KU Leuven, Leuven, Belgium
| | - Peter Claes
- Department of Human Genetics, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium.,Facial Sciences Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Electrical Engineering ESAT/PSI, KU Leuven, Leuven, Belgium
| | - Michiel Mulier
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Lennart Scheys
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
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19
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Outcomes of Total Hip Arthroplasty in Patients With Acetabular Protrusio. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e2000121. [PMID: 33969953 PMCID: PMC7375486 DOI: 10.5435/jaaosglobal-d-20-00121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Acetabular protrusio (AP) is associated with distorted anatomic landmarks and insufficient bone stock that increases complexity of total hip arthroplasty (THA). This study used a large national database to compare outcomes after THA in patients with and without AP. Methods: The Nationwide Readmissions Database was used to identify patients with and without AP who underwent THA from 2010 to 2014. Primary outcomes analyzed included complications during index hospitalization and within 90 days of THA. Results: Propensity score matching generated 4,395 patients without AP and 4,603 patients with AP. Patients with AP were older (68.1 versus 65.2 years, P < 0.0001), more predominantly women (82.1% versus 55.9%), and had more medical comorbidities as measured by the Elixhauser Comorbidity Index (2.29 versus 1.89, P < 0.0001). Patients with AP had an increased risk of requiring bone graft (odds ratio [OR] = 47.97, 95% confidence interval [CI]: 14.27 to 161.22), receiving a blood transfusion (OR = 1.90, 95% CI: 1.57 to 2.29), and suffering a periprosthetic fracture (OR = 2.56, 95% CI: 1.10 to 5.97) within 90 days of THA. Length and cost of index hospitalization were greater for patients with AP (5.0 versus 4.3 days, P = 0.002; $19,211.88 versus $27,736.30, P < 0.0001). Conclusion: Given the current emphasis on hospital cost optimization, it is important to ensure that patients with AP are managed appropriately. Attention should be placed on comprehensive preoperative planning and postoperative monitoring in this population.
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20
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Polesello GC, Salerno TT, Rezende JHZ, Ricioli Junior W, Rabelo ND, de Queiroz MC. É importante saber onde posicionar o marcador esférico para o planejamento digital de artroplastia de quadril? Rev Bras Ortop 2020; 55:353-359. [PMID: 32616982 PMCID: PMC7316537 DOI: 10.1055/s-0039-1693052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 01/22/2019] [Indexed: 11/02/2022] Open
Abstract
Resumo
Objetivo Os objetivos desse artigo são avaliar as influências das características pessoais na magnificação radiográfica e identificar o método de maior acurácia e o mais adequado.
Métodos Durante o exame radiográfico em 50 pacientes com prótese de quadril, foram coletados dados antropométricos e posicionados quatro marcadores metálicos esféricos: ao nível e lateral ao trocânter maior, na sínfise púbica, ao nível do trocânter maior entre as coxas, sobre a mesa do exame. A cabeça da prótese é o melhor marcador radiográfico interno e foi o nosso parâmetro de calibragem. Dois avaliadores mediram as imagens desses marcadores para análise de resultados.
Resultados Foram selecionados 50 participantes, sendo 19 do sexo masculino. Houve diferença de magnificação entre os sexos na posição sínfise púbica. As outras características pessoais avaliadas (peso, altura e índice de massa corpórea) tiveram correlação fraca. A maior acurácia do marcador foi no trocânter maior, entre 68,4 e 78,9%, visualizado em apenas 19 radiografias. O marcador entre as coxas obteve acurácia entre 30 e 46% e foi visualizado em todas as radiografias.
Conclusão Das características pessoais, apenas o sexo influencia a magnificação e somente na posição da sínfise púbica. Sugerimos padronizar o uso de duas esferas: no trocanter maior, pela maior acurácia, e entre as coxas, por ser o mais adequado e com melhor visibilidade em todas radiografias.
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Affiliation(s)
- Giancarlo Cavalli Polesello
- Grupo de Quadril, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), Irmandade Santa Casa de Misericórdia, São Paulo, SP, Brasil
| | - Thiago Tronco Salerno
- Grupo de Quadril, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), Irmandade Santa Casa de Misericórdia, São Paulo, SP, Brasil
| | - João Hélio Zucarelli Rezende
- Grupo de Quadril, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), Irmandade Santa Casa de Misericórdia, São Paulo, SP, Brasil
| | - Walter Ricioli Junior
- Grupo de Quadril, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), Irmandade Santa Casa de Misericórdia, São Paulo, SP, Brasil
| | - Nayra Deise Rabelo
- Grupo de Quadril, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), Irmandade Santa Casa de Misericórdia, São Paulo, SP, Brasil
- Laboratório de Análise do Movimento Humano, Departamento de Ciências da Reabilitação, Universidade Nove de Julho - UNINOVE, São Paulo, SP, Brasil
| | - Marcelo Cavalheiro de Queiroz
- Grupo de Quadril, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), Irmandade Santa Casa de Misericórdia, São Paulo, SP, Brasil
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Maillot C, Auvinet E, Harman C, Cobb J, Rivière C. Hip resurfacing generates a more physiological gait than total hip replacement: A case-control study. Orthop Traumatol Surg Res 2020; 106:527-534. [PMID: 32265178 DOI: 10.1016/j.otsr.2019.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 12/01/2019] [Accepted: 12/04/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Restoration of the constitutional joint anatomy after hip replacement favours physiological peri-articular soft-tissue tension and kinematics, and is likely to be functionally beneficial. Hip resurfacing (HR) and conventional total hip replacement (THR) are two different options for replacing degenerated hips, and are likely to result in different anatomical reconstruction. We initiated this study to investigate the differences in gait performance between these two prosthetic options, and aimed to answer the following questions: (1) does HR result in better restoration of the frontal hip anatomical parameters, (2) and generate a more physiological gait compared to THR? (3) Does the quality of the anatomical restoration after THR influence gait performance? HYPOTHESES Our hypothesis was that a better anatomical restoration using HR versus THR would produce more physiological (symmetric) gait. METHODS We retrospectively reviewed 52 patients who had unilateral primary osteoarthritis successfully treated by replacement (40 THRs and 12 HRs). Hip anatomical parameters were measured on standing pelvic radiographs on both the prosthetic and the contralateral healthy hips. Patients undertook gait assessment under both normal and stress conditions at a mean follow-up of 14 months (7 to 16 months). Gait performances were compared between HR and THR, and the relationship between gait performances and quality of frontal anatomical restoration (estimated on radiograph) were assessed. RESULTS Compared to the native contralateral side, the HR procedure tended to decrease all independent anatomical radiographic parameters with the exception of the vertical centre of rotation offset, whilst the THR procedure tended to increase them; the difference between HR and THR was only statistically significant for femoral offset and global horizontal offset (increased after THR while reduced after HR). Only 50% of THR and 25% of HR procedures closely anatomically (±15%) recreated both global horizontal offset and global vertical offset. Under normal conditions (normal walking speed and flat ramp), the gait was fairly symmetric for both the HR and the THR patients with a symmetry index of 0.62% and 3.14% respectively. At high walking speed (stress conditions), the symmetry index degraded for both groups, but the gait remained more symmetric in the HR group (2.09%), compared to the THR group (5.74%); nevertheless, the difference remained not statistically significant (p=0.159). We were unable to detect any significant relationship between gait performances and radiographically measured hip frontal anatomical parameters. DISCUSSION/CONCLUSIONS HR procedure is more consistent than conventional THR in generating a more physiological gait under stress conditions. Radiographic estimation of the quality of the frontal anatomical hip restoration is of poor value to predict gait performances of THR patients. LEVEL OF EVIDENCE III - retrospective case-control study with prospective data collection.
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Affiliation(s)
- Cedric Maillot
- Laboratory Block, MSK Lab, Imperial college London, White City Campus, W12 0BZ London, United Kingdom
| | - Edouard Auvinet
- Laboratory Block, MSK Lab, Imperial college London, White City Campus, W12 0BZ London, United Kingdom
| | - Ciara Harman
- South West London Elective Orthopaedic Centre, Dorking road, KT18 7EG Epsom, United Kingdom
| | - Justin Cobb
- Laboratory Block, MSK Lab, Imperial college London, White City Campus, W12 0BZ London, United Kingdom
| | - Charles Rivière
- Laboratory Block, MSK Lab, Imperial college London, White City Campus, W12 0BZ London, United Kingdom; South West London Elective Orthopaedic Centre, Dorking road, KT18 7EG Epsom, United Kingdom.
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22
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Kobayashi H, Cech A, Kase M, Pagenstart G, Carrillon Y, O'Loughlin PF, Bothorel H, Aït-Si-Selmi T, Bonnin MP. Pre-operative templating in THA. Part II: a CT-based strategy to correct architectural hip deformities. Arch Orthop Trauma Surg 2020; 140:551-562. [PMID: 31974697 DOI: 10.1007/s00402-020-03341-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Pre-operative templating for total hip arthroplasty (THA) remains inaccurate due to improper magnification and alignment. We aimed to describe an improved templating strategy using computed tomography (CT) to predict component sizes and offsets with greater accuracy. MATERIALS AND METHODS We analysed 184 CT images acquired for pre-operative templating of primary THA. We aimed to restore native (pre-arthritic) femoral offset and limb length, by raising the head center to the level of the templated cup center cranio-caudally, but maintaining the pathologic (pre-operative) head center medio-laterally (except in medialized hips). Acetabular offset (AO) and femoral offset (FO) were measured on pre-operative CT scans, during acetate templating, and on post-operative true antero-posterior radiographs. RESULTS The post-operative offsets were within ± 5 mm from templated estimates in 174 hips (91%) for AO, in 116 hips (61%) for FO, in 111 hips (58%) for GO, and in 134 hips (70%) for neck cut level. The post-operative hip architecture reproduced the templated hip architecture within ±5 mm in 77 hips (40%). The agreement between planned and post-operative parameters was moderate for stem size (0.57), cup size (0.62), AO (0.50), but fair for FO (0.45). The AO decreased in most arthritic types, notably in lateralized hips (6.6 mm), but remained unchanged in medialized hips. The FO increased in most arthritic types (1.8-3.1 mm) but remained unchanged in medialized and lateralized hips. CONCLUSIONS We described a strategy for pre-operative templating in THA. Despite the accuracy of CT, the authors found significant variations between planned and post-operative reconstructions, which suggest that pre-operative templating should only be used as an approximate guide.
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Affiliation(s)
- Hideo Kobayashi
- Department of Orthopaedic Surgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Alexandre Cech
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Masanori Kase
- Department of Orthopaedic Surgery, Nissan Tamagawa Hospital, Setagayaku, Tokyo, Japan
| | - Geert Pagenstart
- Department of Clinical Research, University of Basel, Basel, Switzerland.,Clarahof Clinic of Orthopaedic Surgery, Merian-Iselin-Hospital Swiss Olympic Medical Center, Basel, Switzerland.,Knee Institute Basel, Basel, Switzerland
| | - Yannick Carrillon
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Padhraig F O'Loughlin
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.,Cork University Hospital, South Infirmary, Victoria University Hospital, Mater Private Cork, Cork, Ireland
| | - Hugo Bothorel
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Tarik Aït-Si-Selmi
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.,Artro Institute, Lyon, France
| | - Michel P Bonnin
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.,Artro Institute, Lyon, France
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23
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Pre-operative planning in THA. Part III: do implant size prediction and offset restoration influence functional outcomes after THA? Arch Orthop Trauma Surg 2020; 140:563-573. [PMID: 31974695 DOI: 10.1007/s00402-020-03342-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Few studies evaluated clinical benefits of pre-operative templating in total hip arthroplasty (THA). We investigated whether mismatch between planned and real implant sizes and medio-lateral offsets compromises THA outcomes. MATERIALS AND METHODS We reviewed records of 184 primary THAs with pre-operative CT scans used for templating. Acetabular offset (AO), femoral offset (FO) and global offset (GO) were measured on pre-operative CT scans, during acetate templating, and post-operative antero-posterior radiographs. Multivariable analyses were performed to determine if Forgotten Joint Score (FJS) and Oxford Hip Score (OHS) at > 2 years were associated with differences between post-operative and planned parameters. RESULTS The FJS and OHS were not influenced by mismatch of component sizes nor of FO and GO. The FJS was better when the post-operative AO was greater than planned (p = 0.050). The FJS differed among arthritic types (p = 0.015). Multivariable analyses confirmed that older patients had better OHS (beta - 0.16; p = 0.033) and FJS (beta 0.74; p = 0.002), medialized hips had worse FJS (beta - 20.1; p = 0.041) and hips with greater AO than planned had better FJS (beta 1.71; p = 0.024) CONCLUSIONS: Implanting a component of different size than planned did not compromise THA outcomes, but medialized hips had worse scores, and conservative acetabular reaming improved scores.
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Kase M, O'Loughlin PF, Aït-Si-Selmi T, Pagenstert G, Langlois J, Bothorel H, Bonnin MP. Pre-operative templating in THA. Part I: a classification of architectural hip deformities. Arch Orthop Trauma Surg 2020; 140:129-137. [PMID: 31696320 DOI: 10.1007/s00402-019-03298-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION While numerous classifications of hip arthritis have been proposed, none considered the magnitude and direction of femoral head translation relative to the native acetabulum. A more precise classification of architectural hip deformities is necessary to improve preoperative templating and anticipate surgical challenges of total hip arthroplasty (THA). The purpose of the present study was to introduce a classification system to distinguish different types of architectural hip deformities, based on femoral head translation patterns, and to evaluate its repeatability using plain radiographs (qualitative) and Computed Tomography (CT) measurements (quantitative). MATERIALS AND METHODS We studied pre-operative frontal and lateral hip radiographs and CT scans of 191 hips (184 patients) that received primary THA. The distance between the femoral head center (FC) and the acetabular center (AC) was measured, as well as femoral offset, acetabular offset, head center height, acetabular floor distance and femoral neck angle. The hips were classified qualitatively using frontal plain radiographs, and then quantitatively using CT scans (with an arbitrary threshold of 3 mm as Centered, Medialized, Lateralized, Proximalized or Proximo-lateralized. The agreement between qualitative and quantitative classification methods was compared for applying the same classification. RESULTS Qualitative classification identified 120 centered (63%), 8 medialized (4%), 49 lateralized (26%), 3 proximalized (2%), and 11 proximo-lateralized (6%) hips, while quantitative classification identified 116 centered (61%), 8 medialized (4%), 51 lateralized (27%), 5 proximalized (3%), and 11 proximo-lateralized (6%) hips. The agreement between the two methods was excellent (0.94; CI 0.90-0.98). Medialization reached 9.7 mm, while lateralization reached 10.9 mm, and proximalization reached 8.5 mm. Proximalized and proximo-lateralized hips had more valgus necks, while medialized hips had more varus necks (p = 0.003). CONCLUSIONS The classification system enabled repeatable distinction of 5 types of architectural hip deformities. The excellent agreement between quantitative and qualitative methods suggests that plain radiographs are sufficient to classify architectural hip deformities.
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Affiliation(s)
- Masanori Kase
- Department of Orthopaedic Surgery, Nissan Tamagawa Hospital, Setagaya-ku, Tokyo, Japan
| | - Padhraig F O'Loughlin
- Department of Orthopaedic Surgery, Mater Hospital Cork, Cork, Ireland
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Tarik Aït-Si-Selmi
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
- Artro Institute, Lyon, France
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Clarahof Clinic of Orthopaedic Surgery, Merian-Iselin-Hospital Swiss Olympic Medical Center, Basel, Switzerland
- Knee Institute Basel, Basel, Switzerland
| | - Jean Langlois
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Hugo Bothorel
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Michel P Bonnin
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
- Artro Institute, Lyon, France
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Cao L, Wang Y, Zou S, Cheng H. A novel positioner for accurately sitting the acetabular component: a retrospective comparative study. J Orthop Surg Res 2019; 14:279. [PMID: 31462276 PMCID: PMC6714239 DOI: 10.1186/s13018-019-1331-6] [Citation(s) in RCA: 4] [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: 05/10/2019] [Accepted: 08/19/2019] [Indexed: 02/02/2023] Open
Abstract
Introduction In this study, we described a positioner which allows a combination of preoperative plan and intraoperative insertion of the cup to improve the reconstruction of the rotation center of the hip. Materials and methods A retrospective study was conducted on 32 consecutive patients (group A) using this positioner and 40 consecutive patients (group B) using conventional method; radiological parameters and clinical measurements before operation and at last follow-up were collected and evaluated. Results Group A had a reconstructed center of rotation (COR) that was 0.19 mm closer to the anatomic COR in height (P < 0.005), compared with group B with 3.45 mm vertical dislocation. There were no statistically significant differences in the horizontal displacement between the two groups. The accuracy of cup inclination was 42.14 ± 3.57 in the group A and 38.73 ± 7.65 in the group B (P = 0.015). The accuracy of cup anteversion was 14.82 ± 1.44 in the group A and 13.08 ± 5.95 in the group B (P = 0.082). All cups in the group A were radiologically stable, while one cup in the group B was radiologically unstable and was successfully treated with second-stage revision. Both of the groups obtained a higher mean postoperative Harris Hip Score. Conclusions Utilizing this positioner helps to restore the COR position more precisely and provides satisfactory radiological and clinical outcomes in the short term, and more studies are required before its widespread adoption for complicated cases.
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Affiliation(s)
- Liangliang Cao
- Department of Joint Surgery, Zhengzhou Orthopaedic Hospital, 58 Longhai Middle Road, Zhengzhou City, Henan Province, China
| | - Yuehui Wang
- Department of Joint Surgery, Zhengzhou Orthopaedic Hospital, 58 Longhai Middle Road, Zhengzhou City, Henan Province, China.
| | - Shiping Zou
- Department of Joint Surgery, Zhengzhou Orthopaedic Hospital, 58 Longhai Middle Road, Zhengzhou City, Henan Province, China
| | - Hui Cheng
- Department of Joint Surgery, Zhengzhou Orthopaedic Hospital, 58 Longhai Middle Road, Zhengzhou City, Henan Province, China
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Zhou B, Zhou Y, Yang D, Tang H, Shao H, Huang Y. The Utilization of Metal Augments Allows Better Biomechanical Reconstruction of the Hip in Revision Total Hip Arthroplasty With Severe Acetabular Defects: A Comparative Study. J Arthroplasty 2018; 33:3724-3733. [PMID: 30243881 DOI: 10.1016/j.arth.2018.08.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Reconstructing the normal hip biomechanics is important for a successful revision total hip arthroplasty (THA). Little is known about whether using metal augments in revision THA is biomechanically superior to traditional techniques. METHODS A retrospective review was conducted on 74 consecutive THAs revised using metal augments with a cementless hemispherical cup and 77 consecutive THAs revised using the jumbo cup, all with a minimum 2-year follow-up. Biomechanical parameters were measured before and immediately after the revision. Radiological and clinical outcomes at follow-ups were also evaluated. RESULTS The metal augment group had a reconstructed center of rotation (COR) that was 6.5 mm closer to the anatomic COR in height (P < .001), had 3.6 m smaller cup size (P < .001), and had 5.7 mm less head-cup difference (P < .001). Moreover, there was a reconstructed COR that was much closer to the anatomic COR (vertical distance: 1.8 vs 14.1 mm, P < .001; horizontal distance: -2.1 vs 7.9 mm, P = .013), had 4.1 mm greater femoral offset (P = .006), and had 8 mm less leg length discrepancy (P = .035) in the subgroup of Paprosky type III bone defects when compared to the jumbo cup group. All cup-augment constructs were radiologically stable with a higher mean postoperative Harris Hip Score (P = .012). One jumbo cup was radiologically unstable. CONCLUSION In revision THA, utilizing metal augments helps to restore the COR position more precisely, avoid using a larger cup, reduce head-cup difference, rebuild femoral offset, and decrease leg length discrepancy, particularly with Paprosky type III bone defects. Moreover, it provides satisfactory radiological and clinical outcomes in the short term.
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Affiliation(s)
- Baochun Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, 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
| | - Dejin Yang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, People's Republic of China
| | - Hao Tang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, People's Republic of China
| | - Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, People's Republic of China
| | - Yong Huang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, People's Republic of China
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27
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Torres-Campos A, Albareda Albareda J, Seral García B, Blanco Rubio N, Gómez Vallejo J, Ezquerra Herrando L. Burch-Schneider ring associated with morselized bone allografts, survival and clinical outcomes after acetabular revision surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Mandelli F, Tiziani S, Schmitt J, Werner CML, Simmen HP, Osterhoff G. Medial acetabular wall breach in total hip arthroplasty - is full-weight-bearing possible? Orthop Traumatol Surg Res 2018; 104:675-679. [PMID: 29908355 DOI: 10.1016/j.otsr.2018.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/21/2018] [Accepted: 04/26/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND A breach of the medial acetabular wall is a phenomenon seen frequently due to over-reaming during total hip arthroplasty (THA). The consequences of this issue are not fully understood particularly in cementless THA. A retrospective study was performed to answer whether: immediate postoperative full-weight-bearing in the presence of a medial acetabular wall breach after THA results in more short-term revisions of the acetabular component, and increases the risk for migration of the acetabular component? HYPOTHESIS Immediate full-weight-bearing in the presence of a medial breach is not associated with an increased likelihood for acetabular-related revision surgery or migration of the cup. PATIENTS AND METHODS In this retrospective cohort study, consecutive patients (n=95; mean age 68±13 years; 67 female) who underwent THA with an uncemented acetabular component were identified and a retrospective chart review was performed (follow-up 23±17 months, range 6 to 79 months). The presence of a postoperative radiographic medial acetabular breach was documented and the need for revision surgery and the rate of acetabular component migration were assessed during follow-up. RESULTS Some extent of radiographic medial acetabular wall breach was seen in 26/95 patients (27%). With regard to the primary outcome, 2/95 patients (2%) required revision surgery during follow-up. All revision surgeries occurred in the group without a medial breach (p=0.280) for causes related to the femoral or the head components. Persistent pain was present in 1/26 patients (3.8%) in the medial breach group and 8/69 patients in the control group (11.6%; p=0.436). In the radiographic follow-up (n=81), there was no significant difference between the control group and the medial breach group with regard to cup migration (Δ ilio-ischial overlap [distance between the ilio-ischial line and a parallel line tangential to the acetabular cup on AP views]: -0.5±0.9mm [range, -2.9 to 0.8] vs. -0.3±1.7mm [range, -1.9 to 2.2], Δ overlap tangent [defined as the distance between the two crossings of ilio-ischial line and the acetabular component on AP views]: -2.2±6.1mm [range, -21.4 to 0.0] vs. 0.4±6.9mm [range, -6.2 to 17.6]). Similarly, according to variation in the ilio-ischial overlap distance between postoperative and follow-up on pelvic AP views, 0/56 hips (0%) had cup migration ≥ 5mm in the control group versus 1/25 (4%) in the medial breach cohort (p=0.3). DISCUSSION In this retrospective observation of patients with immediate postoperative full-weight-bearing after THA, a radiographic breach of the medial acetabular wall was not associated with an increased risk for short-term revision surgery or radiographic migration at follow-up. According to the findings of this study and in the light of previous biomechanical studies, there is no clear evidence for postoperative partial weight-bearing in case of a medial breach as far as the surgeon feels that the acetabular component is stable. LEVEL OF EVIDENCE IV, Retrospective cohort study.
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Affiliation(s)
- Filippo Mandelli
- Department of Trauma, University Hospital of Zurich, 100, Raemistrasse, 8091 Zurich, Switzerland
| | - Simon Tiziani
- Department of Trauma, University Hospital of Zurich, 100, Raemistrasse, 8091 Zurich, Switzerland
| | - Jürgen Schmitt
- Department of Trauma, University Hospital of Zurich, 100, Raemistrasse, 8091 Zurich, Switzerland
| | - Clément M L Werner
- Department of Trauma, University Hospital of Zurich, 100, Raemistrasse, 8091 Zurich, Switzerland
| | - Hans-Peter Simmen
- Department of Trauma, University Hospital of Zurich, 100, Raemistrasse, 8091 Zurich, Switzerland
| | - Georg Osterhoff
- Department of Trauma, University Hospital of Zurich, 100, Raemistrasse, 8091 Zurich, Switzerland.
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Shoji T, Yamasaki T, Izumi S, Kenji M, Sawa M, Yasunaga Y, Adachi N. The effect of cup medialization and lateralization on hip range of motion in total hip arthroplasty. Clin Biomech (Bristol, Avon) 2018; 57:121-128. [PMID: 29986274 DOI: 10.1016/j.clinbiomech.2018.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 06/18/2018] [Accepted: 06/22/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is little description of the effect of cup position on the hip range of motion in total hip arthroplasty. The purpose is to evaluate the effect of cup medialization/lateralization with a compensatory increase/decrease in femoral offset on the hip range of motion, and whether the bone morphology of the anterior inferior iliac spine affects hip range of motion in total hip arthroplasty. METHODS Using the CT data of 100 patients (male; 30, female; 70), 3D-dynamic motion analysis was performed in four scenarios with cup medialization/lateralization with the same/decreased global offset. We calculated the range of motion before component impingement and bony impingement in flexion, internal rotation and external rotation using the software. Furthermore, we measured bony morphological features of anterior inferior iliac spine, and we analyzed the correlations among them. FINDINGS We found that the cup medialization with the same stem offset had negative effects on hip range of motion in flexion and internal rotation due to bony impingement, whereas cup medialization caused external rotation to significantly decrease with the same global offset. On the other hand, cup lateralization with the same global offset had negative effects on flexion and internal rotation, whereas external rotation increased. Furthermore, there were negative correlations among flexion and laterally large and steep anterior inferior iliac spine. INTERPRETATION Our results demonstrated that the advantage of cup medialization can depend on the individual anatomy such as bony morphology of anterior inferior iliac spine in flexion.
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Affiliation(s)
- Takeshi Shoji
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Soutarou Izumi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Mifuji Kenji
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Mikiya Sawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-town, Higashi-hiroshima 739-0036, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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30
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Torres-Campos A, Albareda Albareda J, Seral García B, Blanco Rubio N, Gómez Vallejo J, Ezquerra Herrando L. Burch-Schneider ring associated with morselized bone allografts, survival and clinical outcomes after acetabular revision surgery. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 62:428-435. [PMID: 29776890 DOI: 10.1016/j.recot.2018.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 01/28/2018] [Accepted: 02/24/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Acetabular revision surgery is a challenge due to the appearance of bone defects that make primary fixation of implants difficult when extracting loosened components. Reinforcement rings, such as Burch-Schneider (BS), have been shown to be allies in moderate or severe bone defects. The objective of the study is to evaluate the results and survival of these types of implants in acetabular revision surgery in the medium follow-up. MATERIAL AND METHODS Retrospective study on a cohort of 64 patients (67 replacements) with BS rings associated with morselized bone allografts in a 2 years minimum follow-up. Data were collected regarding clinical outcomes, graft incorporation, implant mobilization, survival and complications. RESULTS The mean follow-up was 5.06 years (R=2.2-12). The Merle scale improved from 8 points to 15 points at the end of follow-up (P<.0001) with 76.11% of good or excellent results. Reproduction of the anatomical centre of rotation was associated with a better result (P<.05). There was total or subtotal incorporation of the bone allograft in 97% of the patients, although this did not prevent a significant migration of the ring according to Gill criteria in 6 cases. We observed an overall survival of the implant for any cause of 93.4% at 5 years, and 84.6% at 10 years. CONCLUSIONS The BS reinforcement ring shows good results in the medium and long term enabling anatomical reconstruction in revision surgery as well as replacement of the bone stock. These results are also comparable and are a vast improvement on other rings.
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Affiliation(s)
- A Torres-Campos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | - J Albareda Albareda
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - B Seral García
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - N Blanco Rubio
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - J Gómez Vallejo
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - L Ezquerra Herrando
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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Abstract
INTRODUCTION Total hip arthroplasty (THA) is 1 of the most successful and frequent orthopaedic procedures around the world. Leg length discrepancy is reported in 1% to 60% of cases and is 1 of the most frequent causes of patient dissatisfaction and a common reason for litigation. The aim of this study was to compare leg length discrepancies following THA using 3 different intraoperative measuring methods. MATERIAL AND METHODS We present a prospective cohort study of 454 hips undergoing THA for osteoarthritis between January 2009 and August 2016. We compared postoperative leg length discrepancy using 1 of the following 3 measurement methods: (1A) direct intraoperative comparison of the legs; (1B) measurement with a compass-like device with supra-acetabular fixation, involving length and offset; (1C, D) an intraoperative device that measures the trochanteric/joint ratio. RESULTS Leg length discrepancy >5 mm was present in 26% of the total study population. Direct intraoperative leg-to-leg assessment resulted in the greatest proportion of leg length discrepancy >5 mm (31%), followed by the compass group (27%) and the least discrepancy was observed in the trochanteric/joint ratio group (15%). The trochanteric/joint ratio assessment method resulted in the greatest reduction in discrepancy when compared to the other methods: discrepancies of 5-10 mm fell by 48% (relative risk [RR] 0.40 CI [confidence interval [CI] 95%, 0.22-0.74), and discrepancies of ≥10 mm fell by 59% (RR 0.52; CI 95%, 0.32-0.84). CONCLUSIONS We conclude that the use of an intraoperative measurement device can reduce the leg length discrepancy, with best results when using the trochanteric/joint ratio device.
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The impact of trabecular metal on hip centre of rotation in revision and complex primary hip arthroplasty, a radiological review. Hip Int 2017; 27:500-504. [PMID: 28708201 DOI: 10.5301/hipint.5000503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Total hip arthroplasty (THA) is a very successful procedure. Revision THA is becoming increasingly common. Recent developments to improve outcomes include the development of large trabecular metal (TM) acetabular cups and augments. There is a paucity of data on the benefit of these new techniques. METHODS A single-centre retrospective review consisting of a radiological review of post-op revision THA anteroposterior pelvis. Data collection was performed using the Irish National Orthopaedic Register (INOR) and from a previous project. We used a technique developed by Fessy et al in 1999 to measure the centre of rotation (COR) of the hip. We then compared our study to that of a study measuring the COR of healthy native hips. RESULTS 127 revision THA analysed. Native COR calculated by Fessy et al showed a mean horizontal (x) axis 33.6 mm (standard deviation [SD] 5.74) and a vertical (y) axis 16.4 mm (SD 4.67). Non-TM revisions showed a mean x axis of 29 mm (SD 3.9) and y axis 17.9 (SD 5.9). TM Augments had a mean x axis 29.2 mm (SD 7.9) and y axis of 21.5 (SD 8.4). TM Cups alone had a mean x axis 27 mm (SD 6.9) and y axis 22 mm (SD 10.18). CONCLUSIONS COR of TM implants showed considerable deviation from the norm. Non-TM implants showed a COR within acceptable physiological range. TM components consistently failed to restore a natural COR in our cohort. The implications of this remain uncertain but must be considered in any decision to use TM.
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33
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Abstract
Navigation in primary total hip arthroplasty has a history of over 20 years. During this process, imageless computer navigation can be particularly helpful in optimally restoring the hip’s biomechanics. This involves the accurate placement of the acetabular component with the determination of the anteversion and abduction, whereby the navigated femur-first technique also allows for a calculation of the combined anteversion. Additional critical parameters such as the reconstruction of the rotation centre, as well as the femoral and acetabular offset, can also be optimally adjusted. Last but not least, an intra-operative evaluation and equalisation of the leg length is possible. Nonetheless, the disadvantages of this surgical technique in terms of the high costs in the acquisition and preservation of the necessary devices, as well as the longer operation time, must be taken into account. However, economic aspects are not the only thing preventing widespread use of the navigation technique. Determining the plane of reference (APP) for the optimal orientation of the implants is based on palpation of the bony landmarks – and this is influenced by the thickness of the soft tissue layer. Furthermore, the experience of the surgeon constitutes a variable that influences the accuracy of navigation. In summary, hip navigation certainly offers an interesting technique for the optimisation of total hip arthroplasty with reconstruction of proper biomechanics. At the same time, there is currently a lack of high-quality randomised controlled long-term trials that evaluate the clinical advantage for the patients, together with cost utility and survival rates.
Cite this article: Renner L, Janz V, Perka C, Wassilew GI. What do we get from navigation in primary THA? EFORT Open Rev 2016;1:205-210. 10.1302/2058-5241.1.000034.
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Affiliation(s)
- Lisa Renner
- Centre for Musculoskeletal Surgery, Charité Universitätsmedizin, Berlin, Germany
| | - Viktor Janz
- Centre for Musculoskeletal Surgery, Charité Universitätsmedizin, Berlin, Germany
| | - Carsten Perka
- Centre for Musculoskeletal Surgery, Charité Universitätsmedizin, Berlin, Germany
| | - Georgi I Wassilew
- Centre for Musculoskeletal Surgery, Charité Universitätsmedizin, Berlin, Germany
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Meermans G, Doorn JV, Kats JJ. Restoration of the centre of rotation in primary total hip arthroplasty: the influence of acetabular floor depth and reaming technique. Bone Joint J 2017; 98-B:1597-1603. [PMID: 27909120 DOI: 10.1302/0301-620x.98b12.bjj-2016-0345.r1] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/16/2016] [Indexed: 01/14/2023]
Abstract
AIMS One goal of total hip arthroplasty is to restore normal hip anatomy. The aim of this study was to compare displacement of the centre of rotation (COR) using a standard reaming technique with a technique in which the acetabulum was reamed immediately peripherally and referenced off the rim. PATIENTS AND METHODS In the first cohort the acetabulum was reamed to the floor followed by sequentially larger reamers. In the second cohort the acetabulum was only reamed peripherally, starting with a reamer the same size as the native femoral head. Anteroposterior pelvic radiographs were analysed for acetabular floor depth and vertical and horizontal position of the COR. RESULTS Horizontally, the mean medial displacement of the COR was 0.8 mm (standard deviation (sd) 1.4) in the peripheral remaing group and 5.0 mm (sd 3.30) in the standard reaming group (p < 0.001). Vertically, the mean superior displacement of the COR was 0.7 mm (sd 1.3) in the peripheral reaming group and 3.7 mm (sd 2.6) in the standard reaming group (p < 0.001). In the standard reaming group, there was a strong correlation between the pre-operative acetabular floor depth and displacement of the COR (p < 0.001). CONCLUSION Reaming the acetabulum to the floor can lead to significant displacement of the COR medially and superiorly. This displacement is related to the pre-operative acetabular floor depth and cannot always be compensated by using a high offset stem. Cite this article: Bone Joint J 2016;98-B:1597-603.
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Affiliation(s)
- G Meermans
- Bravis Hospital, Boerhaaveplein 1, 4624VT Bergen op Zoom, The Netherlands
| | - J Van Doorn
- Bravis Hospital, Boerhaaveplein 1, 4624VT Bergen op Zoom, The Netherlands
| | - J-J Kats
- Bravis Hospital, Boerhaaveplein 1, 4624VT Bergen op Zoom, The Netherlands
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What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position. Clin Orthop Relat Res 2016; 474:386-91. [PMID: 26150264 PMCID: PMC4709312 DOI: 10.1007/s11999-015-4432-5] [Citation(s) in RCA: 373] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Numerous factors influence total hip arthroplasty (THA) stability including surgical approach and soft tissue tension, patient compliance, and component position. One long-held tenet regarding component position is that cup inclination and anteversion of 40° ± 10° and 15° ± 10°, respectively, represent a "safe zone" as defined by Lewinnek that minimizes dislocation after primary THA; however, it is clear that components positioned in this zone can and do dislocate. QUESTIONS/PURPOSES We sought to determine if these classic radiographic targets for cup inclination and anteversion accurately predicted a safe zone limiting dislocation in a contemporary THA practice. METHODS From a cohort of 9784 primary THAs performed between 2003 and 2012 at one institution, we retrospectively identified 206 THAs (2%) that subsequently dislocated. Radiographic parameters including inclination, anteversion, center of rotation, and limb length discrepancy were analyzed. Mean followup was 27 months (range, 0-133 months). RESULTS The majority (58% [120 of 206]) of dislocated THAs had a socket within the Lewinnek safe zone. Mean cup inclination was 44° ± 8° with 84% within the safe zone for inclination. Mean anteversion was 15° ± 9° with 69% within the safe zone for anteversion. Sixty-five percent of dislocated THAs that were performed through a posterior approach had an acetabular component within the combined acetabular safe zones, whereas this was true for only 33% performed through an anterolateral approach. An acetabular component performed through a posterior approach was three times as likely to be within the combined acetabular safe zones (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.6) than after an anterolateral approach (OR, 0.4; 95% CI, 0.2-0.7; p < 0.0001). In contrast, acetabular components performed through a posterior approach (OR, 1.6; 95% CI, 1.2-1.9) had an increased risk of dislocation compared with those performed through an anterolateral approach (OR, 0.8; 95% CI, 0.7-0.9; p < 0.0001). CONCLUSIONS The historical target values for cup inclination and anteversion may be useful but should not be considered a safe zone given that the majority of these contemporary THAs that dislocated were within those target values. Stability is likely multifactorial; the ideal cup position for some patients may lie outside the Lewinnek safe zone and more advanced analysis is required to identify the right target in that subgroup. LEVEL OF EVIDENCE Level III, therapeutic study.
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36
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Bjarnason JA, Reikeras O. Changes of center of rotation and femoral offset in total hip arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2016; 3:355. [PMID: 26807410 DOI: 10.3978/j.issn.2305-5839.2015.12.37] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND It is a challenge to reconstruct the center of rotation (COR) and femoroacetabular offset anatomically in total hip arthroplasty (THA). We addressed the controversy how we manage to preserve the COR and femoroacetabular offset with an uncemented total hip prosthesis implanted with free hand technique. METHODS We analyzed a prospective series of 73 patients who underwent primary THA. The series was composed of 40 females and 33 males, mean age 64 years (range, 35-90 years). The reasons for THA were primary osteoarthritis (n=63) and developmental dysplasia of the hip (n=10). Pre- and postoperative X-rays were done in a standardized format for anterior-posterior (AP) radiographs of the pelvis, and digitalized measurements were done using SectraTM. We compared preoperative measurements with the final outcome to determine changes in COR and femoral offset. RESULTS We found that 40 patients had their COR and 34 patients had their femoral offset preserved within preoperative 5.0 mm limits. Twenty-three patients had both their values of COR and femoral offset preserved within 5.0 mm limits. While a significant correlation was found between changes of femoral and global offset (r=0.786, P<0.001), there were no correlation between changes of acetabular and femoral offset (r=-0.027, P=0.822). CONCLUSIONS Using an uncemented THA and free hand technique, there is a fair reproducibility of anatomy. The variations were mostly minor, but our results indicate a potential for better restoring the location of COR and femoral offset when planning and implanting an uncemented THA.
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Affiliation(s)
- Jon A Bjarnason
- Department of Orthopedics, Rikshospitalet, Oslo University Hospital, N-0027 Oslo, Norway
| | - Olav Reikeras
- Department of Orthopedics, Rikshospitalet, Oslo University Hospital, N-0027 Oslo, Norway
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37
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Busch V. The young osteoarthritic hip: Clinical outcome of total hip arthroplasty and a cost-effectiveness analysis. Acta Orthop 2015; 86:1-21. [PMID: 25898151 DOI: 10.3109/17453674.2015.1041354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Affiliation(s)
- Vincent Busch
- Sint Maartenskliniek Orthopaedic surgery P.O. Box 9011, 6500 GM Nijmegen The Netherlands
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Baauw M, van Hellemondt GG, van Hooff ML, Spruit M. The accuracy of positioning of a custom-made implant within a large acetabular defect at revision arthroplasty of the hip. Bone Joint J 2015; 97-B:780-5. [DOI: 10.1302/0301-620x.97b6.35129] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We evaluated the accuracy with which a custom-made acetabular component could be positioned at revision arthroplasty of the hip in patients with a Paprosky type 3 acetabular defect. A total of 16 patients with a Paprosky type 3 defect underwent revision surgery using a custom-made trabecular titanium implant. There were four men and 12 women with a median age of 67 years (48 to 79). The planned inclination (INCL), anteversion (AV), rotation and centre of rotation (COR) of the implant were compared with the post-operative position using CT scans. A total of seven implants were malpositioned in one or more parameters: one with respect to INCL, three with respect to AV, four with respect to rotation and five with respect to the COR. To the best of our knowledge, this is the first study in which CT data acquired for the pre-operative planning of a custom-made revision acetabular implant have been compared with CT data on the post-operative position. The results are encouraging. Cite this article: Bone Joint J 2015; 97-B:780–5.
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Affiliation(s)
- M. Baauw
- Sint Maartenskliniek, P.
O. Box 9011, 6500 GM Nijmegen, The
Netherlands
| | | | - M. L. van Hooff
- Sint Maartenskliniek, P.
O. Box 9011, 6500 GM Nijmegen, The
Netherlands
| | - M. Spruit
- Sint Maartenskliniek, P.
O. Box 9011, 6500 GM Nijmegen, The
Netherlands
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39
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Acetabuloplasty with bone grafting in uncemented hip replacement for protrusion. INTERNATIONAL ORTHOPAEDICS 2015; 39:1757-63. [PMID: 26021269 DOI: 10.1007/s00264-015-2804-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This retrospective study investigated midterm outcomes of uncemented total hip replacement with acetabuloplasty using impacted bone grafts in acetabular protrusion or primary hip arthritis with an inadequate thickness of the medial acetabular wall. METHODS The medial acetabular wall was augmented by impaction bone grafting, and an uncemented cup was implanted in all cases. Hip centre of rotation, medial acetabular wall thickness and cup positioning were evaluated radiologically, with the Harris Hip Score determined at each follow-up. RESULTS A total of 32 patients (39 hips) were followed for a mean of 4.5 years, with significant improvement of the Harris Hip Score at the last follow-up. Hip centre of rotation was restored close to the optimal position. Medial acetabular wall thickness and cup position obtained immediately postoperatively were maintained up to the last follow-up, without statistically significant differences. Bone graft integration was observed in all cases by one or two years postoperatively, with no signs of loosening or cup migration at the last follow-up. Heterotopic ossification was identified in 15.4% of cases, without clinical evidence of hip mobility impairment or pain. CONCLUSIONS Impaction bone grafting for acetabuloplasty, associated with the implantation of an uncemented cup, yields good midterm results in patients with acetabular protrusion and with primary hip arthrosis with a thinned medial acetabular wall. The restored bone stock and medial acetabular wall thickness enable the placement of the hip centre of rotation close to the optimal location, which could offer further long-term benefits.
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40
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Abstract
Because of the recent trend for total hip arthroplasty in younger patients, more bone-preserving implants have been designed, based partly on the premise that maintenance of more bone stock would allow revision with standard primary implants. Another possible advantage of an implant that retains the femoral neck is that it may allow anatomical recreation of the center of the femoral head, femoral neck anteversion, anterior tilt, and caput-collum-diaphysis (CCD) angle, as well as femoral offset and leg length, without the use of modular implants. To determine whether the proximal femoral anatomy could be recreated, this study used computed tomography data and 3-dimensional modeling from 10 cadaver hips in 6 whole body specimens. Three femoral neck resection levels were investigated: 2 mm, 5 mm (recommended resection), and 10 mm from the base of the femoral neck. Results showed that the center of the femoral head, femoral neck anteversion, and CCD angle could all be recreated with available implant sizes, without modularity, within 2° and 1 mm on average. The addition of a modular neck provided no advantage in recreation of the hip center or other anatomical parameters. Use of a short metaphyseal femoral neck retaining-type of stem should allow restoration of anatomical parameters without the use of an exchangeable modular femoral neck.
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41
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Baghdadi YMK, Larson AN, Sierra RJ. Long-term results of the uncemented acetabular component in a primary total hip arthroplasty performed for protrusio acetabuli: a fifteen year median follow-up. INTERNATIONAL ORTHOPAEDICS 2014; 39:839-45. [PMID: 25381592 DOI: 10.1007/s00264-014-2580-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Protrusio acetabuli is an uncommon finding that can be seen in patients undergoing primary total hip arthroplasty for arthritis. Uncemented fixation of the acetabular component and bone grafting of the protrusio defect is commonly used as a reconstruction method and has shown good mid-term results. The long-term outcome of these reconstructions warrants further study. The objective of this study was to determine the results of primary total hip arthroplasty (THA) with use of an uncemented acetabular component for protrusio acetabuli in patients followed for a minimum of ten years. METHODS Sixty-five hips in 53 patients had a primary THA with uncemented acetabular component for the protrusio acetabuli between 1984 and 2001. There were 53 procedures performed in females (82%) and 12 in males (18%). The mean age at the procedure was 66 years. Acetabular floor reconstruction with use of bone graft was performed in 58 hips (89%). Four patients (five hips) were lost to follow-up less than ten years after the procedure and 25 patients (31 hips) had died during the follow-up period. The median follow-up of living patients that did not have revisions for acetabular component was 15.4 years (range, ten to 24 years). RESULTS During the study duration, six hips underwent acetabular component revision: aseptic loosening (three hips), polyethylene wear (two hips), and recurrent instability (one hip). The median Harris hip score for the living patients who did not have an acetabular component revision improved from 55 points pre-operatively to 82 points at the latest follow-up. At 15 years, the estimated survival rate from revision was 70% for the THA: 85.4% for the acetabular component, and 83% for the femoral component. Five unrevised acetabular components had evidence of non-progressive radiolucency. CONCLUSIONS In patients undergoing THA with acetabular protrusio, fixation of an uncemented hemispherical shell and use of bone graft as necessary provided satisfactory clinical and radiographic results as well as satisfactory survivorship rates at a median follow-up of 15 years.
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Affiliation(s)
- Yaser M K Baghdadi
- Department of Orthopaedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
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