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Van Ravestyn A, Frantz T, Vandemeulebroucke J, Jansen B, Duerinck J, Scheerlinck T. Determination of rotation center and diameter of femoral heads using off-the-shelf augmented reality hardware for navigation. Sci Rep 2024; 14:15458. [PMID: 38965266 PMCID: PMC11224340 DOI: 10.1038/s41598-024-64957-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 06/14/2024] [Indexed: 07/06/2024] Open
Abstract
In total hip arthroplasty (THA), determining the center of rotation (COR) and diameter of the hip joint (acetabulum and femoral head) is essential to restore patient biomechanics. This study investigates on-the-fly determination of hip COR and size, using off-the-shelf augmented reality (AR) hardware. An AR head-mounted device (HMD) was configured with inside-out infrared tracking enabling the determination of surface coordinates using a handheld stylus. Two investigators examined 10 prosthetic femoral heads and cups, and 10 human femurs. The HMD calculated the diameter and COR through sphere fitting. Results were compared to data obtained from either verified prosthetic geometry or post-hoc CT analysis. Repeated single-observer measurements showed a mean diameter error of 0.63 mm ± 0.48 mm for the prosthetic heads and 0.54 mm ± 0.39 mm for the cups. Inter-observer comparison yielded mean diameter errors of 0.28 mm ± 0.71 mm and 1.82 mm ± 1.42 mm for the heads and cups, respectively. Cadaver testing found a mean COR error of 3.09 mm ± 1.18 mm and a diameter error of 1.10 mm ± 0.90 mm. Intra- and inter-observer reliability averaged below 2 mm. AR-based surface mapping using HMD proved accurate and reliable in determining the diameter of THA components with promise in identifying COR and diameter of osteoarthritic femoral heads.
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Affiliation(s)
- Antoine Van Ravestyn
- Department of Orthopedic Surgery and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
- Vrije Universiteit Brussel (VUB), Research Group BEFY-ORTHO, Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Taylor Frantz
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium
- IMEC, Kapeldreef 75, 3001, Leuven, Belgium
| | - Jef Vandemeulebroucke
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium
- IMEC, Kapeldreef 75, 3001, Leuven, Belgium
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Bart Jansen
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium
- IMEC, Kapeldreef 75, 3001, Leuven, Belgium
| | - Johnny Duerinck
- Department of Neurosurgery, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Thierry Scheerlinck
- Department of Orthopedic Surgery and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
- Vrije Universiteit Brussel (VUB), Research Group BEFY-ORTHO, Laarbeeklaan 103, 1090, Brussels, Belgium
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Sang W, Lai P, Xu X, Liu Y, Ma J, Zhu L. Radiographic study of direct anterior approach hip arthroplasty: a 10-15 year follow-up of Chinese patients. ARTHROPLASTY 2024; 6:25. [PMID: 38698494 PMCID: PMC11067169 DOI: 10.1186/s42836-024-00249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/12/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Controversy remains over whether different surgical approaches exert an impact on the component positioning in total hip arthroplasty. We conducted a retrospective study to reveal the long-term position of prostheses in the first group of patients in China who underwent direct anterior hip arthroplasty. METHODS Collected were data from 350 patients who underwent direct anterior hip arthroplasty between 2008 and 2013, including demographic information, imaging data, Harris hip scores, and surgical complications. Variables, measured radiographically or by CT, included hip offset, leg length discrepancy, component position, and stability within one week after surgery and at the last follow-up. The data were subjected to statistical analysis by using paired t-tests and Pearson chi-square tests. RESULTS Data were harvested by follow-up and self-reported questionnaires. The postoperative follow-up lasted for 13.1 years on average (minimum, 10 years; maximum, 15 years), and the overall survival rate of hip prostheses was 96.3%. The mean Harris score at the final follow-up was 91.8 points. After excluding patients with significant preoperative hip deformities, the incidence of postoperative limb inequality (> 5 mm) was 4.9% at the last follow-up, and the incidence of hip offset discrepancy (> 5 mm) was 14.6%. The overall proportion of the acetabular components located in the Lewinnek safe zone was 77.7%, whereas the proportion of femoral prostheses in the safe zone (< 3° inclination) was 94.0%. Based on the revised data and the last follow-up imaging, the total proportion of acetabular and femoral prostheses with a radiolucence of > 2 mm was 5.1%. CONCLUSION Direct anterior approach hip arthroplasty could achieve excellent component positioning and long-term prosthesis survival in patients without severe hip deformities.
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Affiliation(s)
- Weilin Sang
- Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China
| | - Peng Lai
- Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China
| | - Xun Xu
- Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China
| | - Yu Liu
- Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China
| | - Jinzhong Ma
- Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China.
| | - Libo Zhu
- Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China.
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Aubert T, Rigoulot G, Gerard P, Auberger G, Leclerc P. Restoration of hip anatomy using computer modelling prior to total hip arthroplasty and its potential consequences in terms of lower limb-length difference. Hip Int 2024; 34:344-349. [PMID: 38095189 DOI: 10.1177/11207000231216937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Restoring hip anatomy during total hip arthroplasty (THA) is the gold standard. The general goal is for hips to be symmetrical in terms of height. This study aimed to analyse the effect of simulating hip length (HL) equalisation on leg-length difference (LLD) before and after THA with a computerised plan. METHODS 141 consecutive patients were enrolled following THA. Outcomes of interest were preoperative hip-length difference (HLD) and LLD as determined on CT and final LLD as determined by simulating HL equalisation. We divided patients into 3 groups: no LLD, LLD >5 mm and LLD ⩾10 mm. RESULTS The rate of preoperative LLD >5 mm and LLD ⩾10 mm was 37.5% and 14.8%, respectively. HL equalisation did not change LLD distribution in the overall cohort. Among patients with smaller preoperative HLs and LLDs, HL equalisation changed the rate of LLD >5 mm from 100% (n = 24) to 41.7% (n = 10) (p < 0.0001) and of LLD ⩾10 mm from 100% (n = 12) to 16.7% (n = 2) (p < 0.0001). Among patients with no preoperative LLD, HL equalisation changed the rate of LLD ⩽5 mm from 100% (n = 64) to 59.3% (n = 38) (p < 0.0001) and of LLD<10 mm from 100% (n = 76) to 89.5% (n = 68) (p = 0.006). CONCLUSIONS Restoring biomechanical hip anatomy by HL equalisation may not be the correct goal for all patients. In patients with no LLD and shorter HLs, equalisation could result in LLD >5 mm in 40% of patients and LLD >10 mm in 10%, demonstrating the necessity to further analyse individuals and propose a personalised stem position.
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Affiliation(s)
- Thomas Aubert
- Orthopaedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Guillaume Rigoulot
- Orthopaedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Philippe Gerard
- Orthopaedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Guillaume Auberger
- Orthopaedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Philippe Leclerc
- Orthopaedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
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Aubert T, Galanzino G, Gerard P, Le Strat V, Rigoulot G, Lhotellier L. Accuracy of Preoperative 3D vs 2D Digital Templating for Cementless Total Hip Arthroplasty Using a Direct Anterior Approach. Arthroplast Today 2023; 24:101260. [PMID: 38023640 PMCID: PMC10652126 DOI: 10.1016/j.artd.2023.101260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/26/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background An important aspect of preoperative planning for total hip arthroplasty is templating. Although two-dimensional (2D) templating remains the gold standard, computerized tomography (CT)-based three-dimensional (3D) templating is a novel preoperative planning technique. This study aims to compare the accuracy of a 2D and 3D plan using an anterior approach for the placement of the same uncemented prosthesis. Methods Two consecutive cohorts of 100 patients each were retrospectively analyzed. We analyzed the accuracy of the size of the implant (stem, cup, head), the length of head, and offset. As a secondary criterion, we analyzed the rates of stems with more than 3° of varus, fracture, and/or subsidence at 3 months postoperatively. Results Within the exact size, the accuracy of the stem and cup size with the 2D plan was 69% and 56%, respectively. With the 3D plan accuracy being 88% (P = .0046) and 96% (P < .0001), respectively. Regarding size and length of the implant head, accuracy was 86% and 82% with the 2D plan and 100% (P < .0001) and 94% (P = .016), respectively, with the 3D plan. The offset of the implants increased beyond 3 mm in 23% of patients in the 2D group and in 5% of patients in the 3D group (P = .0003). The rate of varus stems was 10% in the 2D group and 2% in the 3D group (P = .03). Two fractures and one case of subsidence occurred in the 2D group. None were identified in the 3D cohort. Conclusions A CT-based 3D plan is more accurate for implant size selection, allows better prosthetic offset, and reduces the rate of varus stems.
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Affiliation(s)
- Thomas Aubert
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Giacomo Galanzino
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Philippe Gerard
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Vincent Le Strat
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Guillaume Rigoulot
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Luc Lhotellier
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
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McGoldrick NP, Antoniades S, El Meniawy S, Kreviazuk C, Beaulé PE, Grammatopoulos G. Supine versus lateral position for total hip replacement: accuracy of biomechanical reconstruction. Arch Orthop Trauma Surg 2022; 142:2945-2955. [PMID: 34557958 DOI: 10.1007/s00402-021-04179-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/09/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Restoration of normal hip anatomy and biomechanics is a key surgical goal for success in total hip arthroplasty. The aim of this study was to evaluate the influence, if any, that patient positioning in the supine and lateral decubitus positions has in achieving this goal. MATERIALS AND METHODS A single center multi-surgeon case-matched series from a tertiary level referral center of patients undergoing primary unilateral THA for osteoarthritis between April 2018 and December 2019 was retrospectively analyzed. Patients (n = 200) were divided into two matched groups: supine (anterior approach, n = 100) and lateral decubitus (direct lateral or posterior/SuperPATH™ approaches, n = 100). Post-operative anteroposterior pelvic radiographs were analyzed using a previously validated software (SurgiMap, Nemaris Inc., USA) for parameters of reconstruction of the hip in the coronal plane; leg length discrepancy, vertical and horizontal displacement of the center of rotation, femoral offset, and total offset. RESULTS Mean absolute leg length discrepancy in the supine group was 0.6 ± 3.3 mm (95% [CI] - 0.1 to 1.2 mm) versus 2.4 ± 3.8 mm (95% [CI] 1.6 to 3.1) in the lateral decubitus position (p < 0.001). The center of rotation was displaced medially by a mean of 3.2 ± 2.7 mm in the supine group versus 1.3 ± 4.0 mm in the lateral decubitus group (p < 0.001). For a surgical target of reconstructing both leg length and total offset within 5 mm of native anatomy, the supine group was more than twice as likely to achieve these goals with fewer outliers (OR 2.631, 95% [CI] 1.901-3.643) (76% v 30%, p < 0.001). CONCLUSION Total hip arthroplasty through the anterior approach in the supine position is more consistent and accurate for the restoration of leg length and total offset. Further study is required to assess how this translates with outcome. LEVEL OF EVIDENCE III-retrospective cohort study.
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Affiliation(s)
- Niall P McGoldrick
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Stephanie Antoniades
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Sherif El Meniawy
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Cheryl Kreviazuk
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada.
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Meermans G, Grammatopoulos G, Innmann M, Beverland D. Cup placement in primary total hip arthroplasty: how to get it right without navigation or robotics. EFORT Open Rev 2022; 7:365-374. [PMID: 35638598 PMCID: PMC9257731 DOI: 10.1530/eor-22-0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Acetabular component orientation and position are important factors in the short- and long-term outcomes of total hip arthroplasty. Different definitions of inclination and anteversion are used in the orthopaedic literature and surgeons should be aware of these differences and understand their relationships. There is no universal safe zone. Preoperative planning should be used to determine the optimum position and orientation of the cup and assess spinopelvic characteristics to adjust cup orientation accordingly. A peripheral reaming technique leads to a more accurate restoration of the centre of rotation with less variability compared with a standard reaming technique. Several intraoperative landmarks can be used to control the version of the cup, the most commonly used and studied is the transverse acetabular ligament. The use of an inclinometer reduces the variability associated with the use of freehand or mechanical alignment guides.
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Kaszuba SV, Behrens KM, Anderson CB, Gordon AC. A Workflow Change in Anterior Approach Total Hip Arthroplasty Leads to Improved Accuracy of Biomechanical Reconstruction Without Increased Risk of Complications. Arthroplast Today 2021; 10:99-104. [PMID: 34337115 PMCID: PMC8318915 DOI: 10.1016/j.artd.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/26/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background During anterior approach total hip arthroplasty (THA), the femur may be an impediment for acetabular access, pushing reamers proximally and consequently altering the hip center. In an effort to address this, the senior author changed the surgical workflow from acetabulum first (AF) to femur first (FF). The objective of this study was to compare the precision of biomechanical hip reconstruction and clinical outcomes between the FF and AF techniques. Methods This is a retrospective, case-control study of 267 anterior THAs (132 AF and 135 FF). A normal, contralateral hip was used to determine the native biomechanical parameters. Using a calibrated software program, radiographic measurements were performed to calculate the hip center position, femoral offset, global offset, and leg length of the operative and native hips using 2-week postoperative anteroposterior pelvis radiographs. Demographics, operative information, hemoglobin change, and complication data were obtained. Functional outcomes were assessed with the Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement survey at 1 year postoperatively. Results The groups exhibited similar demographic characteristics. The FF group demonstrated significantly more accurate and more precise reconstruction of horizontal and vertical hip centers, femoral offset, and leg length. There was no significant difference in operative time, hemoglobin change, complication rate, or Hip Disability and Osteoarthritis Outcome Score, Joint Replacement scores between groups. Conclusions The FF technique allowed for more accurate and precise reconstruction of the hip center, leg length, and offset in THA than the AF workflow. Furthermore, the FF approach demonstrated no significant differences in complication rate or blood loss, nor in clinical outcomes. Level of Evidence Therapeutic Study Level III.
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Affiliation(s)
- Stephanie V. Kaszuba
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Department of Orthopedic Surgery, Illinois Bone & Joint Institute, Morton Grove, IL, USA
| | - Kyle M. Behrens
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Department of Orthopedic Surgery, Illinois Bone & Joint Institute, Morton Grove, IL, USA
| | - Chad B. Anderson
- Department of Orthopedic Surgery, Illinois Bone & Joint Institute, Morton Grove, IL, USA
- Department of Orthopedic Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA
- Department of Orthopedic Surgery, NorthShore Skokie Hospital, Skokie, IL, USA
| | - Alexander C. Gordon
- Department of Orthopedic Surgery, Illinois Bone & Joint Institute, Morton Grove, IL, USA
- Department of Orthopedic Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA
- Department of Orthopedic Surgery, NorthShore Skokie Hospital, Skokie, IL, USA
- Corresponding author. Department of Orthopedic Surgery, Illinois Bone & Joint Institute, 9000 Waukegan Road, Suite 200, Morton Grove, IL 60053, USA. Tel.: +1 847-375-3000.
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Pujol O, Soza D, Lara Y, Castellanos S, Hernández A, Barro V. Restoring hip biomechanics during the learning curve of a novice surgeon: Direct anterior approach vs posterior approach. J Orthop 2021; 26:72-78. [PMID: 34349397 DOI: 10.1016/j.jor.2021.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/11/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction It remains controversial whether the direct anterior approach (DAA) or the posterior approach (PA) allows better restoration of hip biomechanics after total hip arthroplasty (THA). Besides, it is not certain which approach is best for a novice surgeon to avoid implant malposition, neither during the learning curve nor once the curve plateau has been reached. Methods We performed a retrospective cohort study of THAs operated on between 2014 and 2019 by a single novice surgeon (DAA, n = 187; PA, n = 184). The surgeon used both approaches, and thus went through parallel learning curves. Results While the DAA presented a greater number of acetabular cup implantations within Lewinnek's "safe zone" for inclination (84.5% vs. 79.3%; p = 0.003), the PA returned superior results for anteversion (77.7% vs. 68.4%; p = 0.000). The PA showed a tendency to verticalize acetabular cups, while the DAA tended to antevert them. The DAA resulted in fewer patients with leg length discrepancy (3.2% vs. 8.2%, p = 0.041). No differences were found in stem coronal alignment or femoral offset. Conclusion Both approaches are safe and reliable for restoring hip biomechanics through THA surgery during the learning curve of a novice hip surgeon. Similar radiological outcomes are also seen once the surgeon has reached the learning curve plateau.
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Affiliation(s)
- Oriol Pujol
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Barcelona, Spain
| | - Diego Soza
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Barcelona, Spain
| | - Yuri Lara
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Barcelona, Spain
| | - Sara Castellanos
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Barcelona, Spain
| | - Alejandro Hernández
- Hip Surgery Unit, Orthopedic Surgery Department, Josep Trueta University Hospital, Girona, Spain
| | - Víctor Barro
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Barcelona, Spain
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Tran G, Khalil LS, Wrubel A, Klochko CL, Davis JJ, Soliman SB. Incidental findings detected on preoperative CT imaging obtained for robotic-assisted joint replacements: clinical importance and the effect on the scheduled arthroplasty. Skeletal Radiol 2021; 50:1151-1161. [PMID: 33140168 DOI: 10.1007/s00256-020-03660-0] [Citation(s) in RCA: 3] [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: 08/25/2020] [Revised: 10/18/2020] [Accepted: 10/25/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the type and frequency of incidental findings detected on preoperative computed tomography (CT) imaging obtained for robotic-assisted joint replacements and their effect on the planned arthroplasty. MATERIALS AND METHODS All preoperative CT examinations performed for a robotic-assisted knee or total hip arthroplasty were obtained. This resulted in 1432 examinations performed between September 2016 and February 2020 at our institution. These examinations were initially interpreted by 1 of 9 fellowship-trained musculoskeletal radiologists. Using a diagnosis search, the examination reports were then reviewed to catalog all incidental findings and further classify as significant or non-significant findings. Demographic information was obtained. In those with significant findings, a chart review was performed to record the relevant workup, outcomes, and if the planned arthroplasty was affected. RESULTS Incidental findings were diagnosed in 740 (51.7%) patients. Of those with incidental findings, 41 (5.5%) were considered significant. A significant finding was more likely to be detected in males (P = 0.007) and on the hip protocol CT (P = 0.014). In 8 patients, these diagnoses resulted in either delay or cancelation of the arthroplasty. A planned total hip arthroplasty was more likely to be altered as compared to a knee arthroplasty (P = 0.018). CONCLUSION Incidental findings are commonly detected by radiologists on preoperative CT imaging obtained for robotic-assisted joint replacement. Several were valuable findings and resulted in a delay or even cancelation of the planned arthroplasty after the detection of critical diagnoses, which if not identified may have resulted in devastating outcomes.
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Affiliation(s)
- Gary Tran
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Lafi S Khalil
- Division of Orthopedic Surgery, Department of Orthopedics, Henry Ford Hospital, Detroit, MI, USA
| | - Allen Wrubel
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Chad L Klochko
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Jason J Davis
- Division of Orthopedic Surgery, Department of Orthopedics, Henry Ford Hospital, Detroit, MI, USA
| | - Steven B Soliman
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA.
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