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Di Gangi C, Prinos A, Buehring W, Meere P, Meftah M, Hepinstall MS. Fewer Dislocations after Total Hip Arthroplasty with Robotic Assistance or Fluoroscopic Guidance. J Arthroplasty 2024:S0883-5403(24)00688-0. [PMID: 39002766 DOI: 10.1016/j.arth.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND Computer navigation and robotic assistance may reduce total hip arthroplasty (THA) dislocations by improving the accuracy and precision of component positioning. We investigated dislocation rates for THAs using conventional techniques, robotic assistance, and computer navigation, while controlling for surgical approach, dual mobility (DM) use, and fluoroscopic guidance. METHODS We reviewed 11,740 primary THAs performed between June 2016 and December 2022, including 5,873 conventional, 1,293 with robotic-arm assistance, and 4,574 with navigation. The approach was posterior in 6,580 (56.0%), anterior in 4,342 (37.0%), and lateral in 818 (7.0%). Dual mobility was used in 10.4%. Fluoroscopy was used in 3,653 cases, and only with the anterior approach. Multivariate analyses yielded odds ratios (OR) for dislocation and revision. Additional regression analyses for dislocation were performed for approach and DM. RESULTS Raw dislocation rates were: conventional 1.2%, robotic 0.4%, navigation 0.9%, anterior with fluoroscopy 0.4%, anterior without fluoroscopy 2.3%, posterior 1.3%, and lateral 0.5%. Upon multivariate analysis, use of robotics was found to be associated with significantly reduced dislocation risk compared to conventional (OR: 0.3), as did anterior (OR: 0.6) compared to posterior approach; navigation and lateral approach were not found to be associated with a significant reduction in risk. For the anterior approach, multivariate analysis demonstrated fluoroscopy significantly reduced dislocation risk (OR: 0.1), while DM, robotics, and navigation were not significant. For the posterior approach, the dislocation risk was lower with robotics than with conventional (OR: 0.2); use of navigation or DM did not demonstrate a significant reduction in risk. CONCLUSION The use of robotics was associated with a reduction in dislocations for this cohort overall. Further, fluoroscopy in the anterior approach and robotic assistance in the posterior approach were both associated with decreased dislocation risk. The role of imageless computer navigation and DM implants requires further study.
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Affiliation(s)
- Catherine Di Gangi
- Department of Orthopaedic Surgery, NYU Langone Health, New-York, NY, USA.
| | - Alana Prinos
- Department of Orthopaedic Surgery, NYU Langone Health, New-York, NY, USA
| | - Weston Buehring
- Department of Orthopaedic Surgery, NYU Langone Health, New-York, NY, USA
| | - Patrick Meere
- Department of Orthopaedic Surgery, NYU Langone Health, New-York, NY, USA
| | - Morteza Meftah
- Department of Orthopaedic Surgery, NYU Langone Health, New-York, NY, USA
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Constantinescu DS, Costello JP, Yakkanti RR, Vanden Berge DJ, Carvajal Alba JA, Hernandez VH, D'Apuzzo MR. Varying Complication Rates and Increased Costs in Technology-Assisted Total Hip Arthroplasty Versus Conventional Instrumentation in 1,372,300 Primary Total Hips. J Arthroplasty 2024; 39:1771-1776. [PMID: 38103802 DOI: 10.1016/j.arth.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The use of technology allows surgeons increased precision in component positioning in total hip arthroplasty (THA). The objective of this study was to compare (1) perioperative complications and (2) resource utilizations between robotic-assisted (RA) and computer-navigated (CN) versus conventional instrumenttaion (CI) THA. METHODS A retrospective cohort study was performed using a large national database to identify patients undergoing unilateral, primary elective THA from January 1, 2016 to December 31, 2019 using RA, CN, or CI. There were 1,372,300 total patients identified and included RA (29,735), CN (28,480), and CI (1,314,085) THA. Demographics, complications, lengths of stay, dispositions, and costs were compared between the cohorts. Binary logistic regression analyses were performed. RESULTS The use of RA THA led to lower rates of intraoperative fracture (0.22% versus 0.39%), delirium (0.1% versus 0.2%), postoperative anemia (14.4% versus 16.7%), higher myocardial infarction (0.13% versus 0.08%), renal failure (1.7% versus 1.6%), blood transfusion (2.0% versus 1.9%), and wound dehiscence (0.02% versus 0.01%) compared to CI THA. The use of CN led to lower rates of respiratory complication (0.5% versus 0.8%), renal failure (1.1% versus 1.6%), blood transfusion (1.3% versus 1.9%), and pulmonary embolism (0.02% versus 0.1%) compared to CI THA. Total costs were increased in RA ($17,729 versus $15,977) and CN ($22,529 versus $15,977). Lengths of hospital stay were decreased in RA (1.8 versus 1.9 days) and CN (1.7 versus 1.9 days). CONCLUSIONS Perioperative complication rates vary in technology-assisted THA, with higher rates in RA THA and lower rates in CN THA, relative to CI THA. Both RA THA and CN THA were associated with more costs, shorter postoperative hospital stays, and higher rates of discharge home compared to CI THA.
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Affiliation(s)
- David S Constantinescu
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery, Miami, Florida
| | - Joseph P Costello
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery, Miami, Florida
| | - Ramakanth R Yakkanti
- Rothman Orthopaedic Institute at Jefferson Health, Department of Orthopaedic Surgery, Philadelphia, Pennsylvania
| | - Dennis J Vanden Berge
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery, Miami, Florida
| | - Jaime A Carvajal Alba
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery, Miami, Florida
| | - Victor H Hernandez
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery, Miami, Florida
| | - Michele R D'Apuzzo
- University of Miami Miller School of Medicine, Department of Orthopedic Surgery, Miami, Florida
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Hecht Ii CJ, Porto JR, Sanghvi PA, Homma Y, Sculco PK, Kamath AF. Navigating the learning curve: assessing caseload and comparing outcomes before and after the learning curve of computer-navigated total hip arthroplasty. J Robot Surg 2024; 18:104. [PMID: 38430388 PMCID: PMC10908601 DOI: 10.1007/s11701-024-01855-4] [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: 01/14/2024] [Accepted: 01/29/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Computer-navigated (CN) total hip arthroplasty (THA) offers improved acetabular component placement and radiographic outcomes, but inconsistent assessment methods of its learning curves render the evaluation of adopting a novel platform challenging. Therefore, we conducted a systematic review to assess the learning curve associated with CN-THA, both tracking a surgeon's performance across initial cases and comparing their performance to manual THA (M-THA). METHODS A search was conducted using PubMed, MEDLINE, EBSCOhost, and Google Scholar on June 16, 2023 to find research articles published after January 1, 2000 (PROSPERO registration: CRD4202339403) that investigated the learning curve associated with CN-THA. 655 distinct articles were retrieved and subsequently screened for eligibility. In the final analysis, nine publications totaling 847 THAs were evaluated. The Methodological Index for Nonrandomized Studies (MINORS) tool was utilized to evaluate the potential for bias, with the mean MINORS score of 21.3 ± 1.2. RESULTS CN-THA showed early advantages to M-THA for component placement accuracy and radiographic outcomes but longer operative times (+ 3- 20 min). There was a learning curve required to achieve peak proficiency in these metrics, though mixed methodologies made the required caseload unclear. CONCLUSIONS CN-THA offers immediate advantages to M-THA for component placement accuracy and radiographic outcomes, though CN-THA's advantages become more pronounced with experience. Surgeons should anticipate longer operative times during the learning curve for CN-THA, which lessen following a modest caseload. A more thorough evaluation of novel computer-navigated technologies would be enhanced by adopting a more uniform method of defining learning curves for outcomes of interest. Registration PROSPERO registration of the study protocol: CRD42023394031, 27 June 2023.
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Affiliation(s)
- Christian J Hecht Ii
- Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code A41, Cleveland, OH, 44195, USA
| | - Joshua R Porto
- Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code A41, Cleveland, OH, 44195, USA
| | - Parshva A Sanghvi
- Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code A41, Cleveland, OH, 44195, USA
| | - Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organs, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, 10021, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Center for Hip Preservation, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Mail Code A41, Cleveland, OH, 44195, USA.
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Ong CB, Ong JM, Grubel J, Chiu YF, Premkumar A, Lee GC, Della Valle AG. Defining the Learning Period of a Novel Imageless Navigation System for Posterior Approach Total Hip Arthroplasty: Analysis of Surgical Time and Accuracy. Indian J Orthop 2024; 58:121-126. [PMID: 38312909 PMCID: PMC10830994 DOI: 10.1007/s43465-023-01060-9] [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: 01/09/2023] [Accepted: 11/14/2023] [Indexed: 02/06/2024]
Abstract
Introduction The use of imageless navigation in total hip arthroplasty (THA) is frequently associated with prolonged surgical times, predominantly during the learning period. The purpose of the present study was to characterize the learning period of a novel imageless navigation system, specifically as it related to surgical time and acetabular navigation accuracy. Materials and Methods This was a retrospective observational study of a consecutive group of 158 patients who underwent primary unilateral THA for osteoarthritis by a team headed by a single surgeon. All procedures used an imageless navigation system to measure acetabular cup inclination and anteversion angles, referencing a generic sagittal and frontal plane. Navigation accuracy was determined by assessing differences between intraoperative inclination and anteversion values and those obtained from standardized 6-week follow-up radiographs. Operative time and navigation accuracy were assessed by plotting moving averages of 7 consecutive cases. The learning period was defined using Mann-Kendall trend analyses, student t-tests and nonlinear regression modeling based on surgical time and navigation accuracy. Alpha error was 0.05. Results The average surgical time was 67.3 min (SD:9.2) (range 45-95). The average navigation accuracy for inclination was 0.01° (SD:4.2) (range - 10 to 10), and that for anteversion was - 4.9° (SD:3.8) (range - 14 to 5). Average surgical time and navigation accuracy were similar between the first and final cases in the series with no learning period detected. Conclusions There was no discernible learning period effect on surgical time or system measurement accuracy during the early phases of adoption for this imageless navigation system.
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Affiliation(s)
- Christian B. Ong
- The Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Justin M. Ong
- The Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Jacqueline Grubel
- The Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Yu-Fen Chiu
- The Department of Biostatistics, Hospital for Special Surgery, New York, NY USA
| | - Ajay Premkumar
- The Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Gwo-Chin Lee
- The Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Migliorini F, Cuozzo F, Oliva F, Eschweiler J, Hildebrand F, Maffulli N. CT-based navigation for total hip arthroplasty: a meta-analysis. Eur J Med Res 2023; 28:443. [PMID: 37853456 PMCID: PMC10583311 DOI: 10.1186/s40001-023-01437-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 10/07/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Computer tomography (CT) based navigation is considered by some authors as an advance in total hip arthroplasty (THA). A meta-analysis was conducted to compare CT based versus conventional THA in terms of surgical duration of the procedure, leg length difference, acetabular cup position, and rate of dislocation. MATERIAL AND METHODS The present study was conducted according to the PRISMA 2020. In December 2022, the following databases were accessed: PubMed, Web of Science, Google Scholar, Embase with no time constrain. All the clinical studies comparing CT based navigation versus the conventional THA were accessed. RESULTS Data from 1801 procedures were collected. The mean age of the patients was 61.6 ± 5.3 years, and the mean BMI was 26.9 ± 2.3 kg/m2. There was between studies comparability at baseline in terms of age, BMI, pain score, Harris hip score, leg length discrepancy (P > 0.1). The navigated group demonstrated lower leg length discrepancy (P = 0.02), and lower degrees of cup anteversion (P = 0.002). Similarity was found in cup inclination (P = 0.98), surgical duration (P = 0.3), and the rate of dislocation (P = 0.6). CONCLUSION CT guided THA may have the potential to increase the accuracy of acetabular positioning and reduce the leg length discrepancy. Current evidence is very limited and heterogeneous, and no recommendations can be inferred. Further investigations are required to definitely clarify the role of CT based THA in current practice.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
| | - Francesco Cuozzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
| | - Francesco Oliva
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University , Rome, Italy
| | - Joerg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Nicola Maffulli
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, ST4 7QB, Stoke On Trent, England
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, E1 4DG, London, England
- Faculty of Medicine and Psychology , Univeristy of Rome La Sapienza , Rome , Italy
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Li H, Wang D, Zhang W, Xu G, Xu C, Zhang H, Zhang L, Li J, Tang P. Does computer-assisted orthopaedics system (ADAPT system) improve outcomes of intertrochanteric hip fractures? Injury 2023; 54:1047-1054. [PMID: 36759309 DOI: 10.1016/j.injury.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Intramedullary nailing (IMN) is a general treatment for intertrochanteric hip fractures. The computer-assisted orthopaedics system (CAOS), ADAPT system (Stryker, NJ), has been developed to facilitate lag screw insertion. When compared to the conventional freehand method, the efficacy of CAOS has not been clearly clarified. Therefore, we conducted this systematic review and meta-analysis to answer: does the CAOS performed better than freehand method in IMN. MATERIALS AND METHODS Studies published up to January 2023 were searched in the PubMed, Embase, Web of Science and Cochrane Library databases with predetermined key words. Comparative clinical studies between CAOS (ADAPT system) and freehand method were included. The primary outcomes of interest were the tip-apex-distance (TAD) and positions of lag screw. Fluoroscopy use, operation duration and intraoperative/postoperative complications were also extracted. A meta-analysis was performed for pooled analysis. RESULTS There were seven studies with 326 fractures in CAOS group and 325 fractures in Freehand group. All studies included presented high qualities. The CAOS group showed a statistically smaller TAD than Freehand group (weighted mean difference = -3.24 mm; 95% confidence interval [CI] -5.10 to -1.37 mm; p = 0.0007) and a better lag screw position (83/92 [90.2%] VS 64/92 [69.6%]; RR = 1.3; 95% CI 1.12 to 1.51; p = 0.0007). The operative time and radiation use revealed no difference between two groups. CONCLUSIONS The current evidence indicated that ADAPT system could help to perform a more accurate lag screw than freehand manipulation while the operative time and radiation time was not reduced as expectations on such new technique. Long-term follow-up studies are appealed.
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Affiliation(s)
- Hua Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Daofeng Wang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Wupeng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China; School of Medicine, Nankai University, No.94 Weijin Road, Tianjin, 300071, China
| | - Gaoxiang Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Cheng Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Hao Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Licheng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
| | - Jiantao Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
| | - Peifu Tang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, 100048, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China.
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Torini AP, Barsotti CE, Andrade RM, Nali LHDS, Ribeiro AP. Effect of Total Hip Arthroplasty with Ceramic Acetabular Component on Clinical, Radiographic and Functional Parameters in Older Patients with Hip Osteoarthritis: Two-Year Follow-Up. J Clin Med 2023; 12:jcm12020670. [PMID: 36675598 PMCID: PMC9866041 DOI: 10.3390/jcm12020670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/04/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Background: Total hip arthroplasty (THA) is a widely used surgical procedure to reduce pain and improve function and quality of life in patients with hip disorders. The most common condition that leads to THA is osteoarthritis, with most surgeries being performed to treat severe osteoarthritis with pain and functional limitations. Despite the evident success of THA, the search for its improvement and better results, especially in the long term, continues, especially in older patients, for which there is still little scientific evidence. Objective: To evaluate the clinical, radiological, and functional aspects preoperatively and two years after THA with a ceramic acetabular component device in older patients with hip osteoarthritis. Methods: A retrospective cohort study was conducted to evaluate 65 older individuals who underwent THA of the hip with an acetabular component (MD® ceramic head with a ceramic acetabular insert) associated with the MD6® Phenom® femoral rod type, in Hospital of the Luz, São Paulo/SP, between 2018 and 2019. Anthropometric and clinical information about the operative procedure and two years follow-up were collected from the patients’ medical records. For the clinical-functional evaluation, the Harris Hip Score (HHS) questionnaire and hip movement goniometry were applied. For the radiographic parameters, the following were evaluated: the positioning of the acetabular component, the Zone of DeLee and the offset of the femoroacetabular component. Results: There was a higher prevalence of performing THA in males (53.8%). Preoperative and two-year postoperative radiographic parameters of surgical treatment for THA showed maintenance of the acetabular (p = 0.083) and femoral (p = 0.102) positioning angles and increased functionality (p < 0.001) and joint mobility of the hip (p = 0.001) with reduced pain after two years of THA. Complications related to dislocation, loosening, infection, and inadequate positioning of the implant were low, ranging from 1.5 to 3%. Conclusion: Older people who underwent cementless THA with an ceramic acetabular component device, in a two-year follow-up, showed effectiveness in improved clinical, radiological, and functional aspects.
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Affiliation(s)
- Alexandre Penna Torini
- Biomechanics and Musculoskeletal Rehabilitation Laboratory, Health Science Post-Graduate Department, School of Medicine, University Santo Amaro, São Paulo 04829-300, Brazil
- Spine and Hip Group, Hospital Beneficência Portuguesa, São Paulo 01323-001, Brazil
| | | | - Rodrigo Mantelatto Andrade
- Medicine and Physical Therapy Department, School of Medicine, University of Sao Paulo, São Paulo 05360-160, Brazil
| | - Luiz Henrique da Silva Nali
- Biomechanics and Musculoskeletal Rehabilitation Laboratory, Health Science Post-Graduate Department, School of Medicine, University Santo Amaro, São Paulo 04829-300, Brazil
| | - Ana Paula Ribeiro
- Biomechanics and Musculoskeletal Rehabilitation Laboratory, Health Science Post-Graduate Department, School of Medicine, University Santo Amaro, São Paulo 04829-300, Brazil
- Medicine and Physical Therapy Department, School of Medicine, University of Sao Paulo, São Paulo 05360-160, Brazil
- Correspondence: or ; Tel.: +55-11-99139-2168
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Total Hip Arthroplasty Imageless Navigation Does Not Reduce 90-Day Adverse Events or Five-Year Revisions in a Large National Cohort. J Arthroplasty 2022; 38:862-867. [PMID: 36529197 DOI: 10.1016/j.arth.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Computer navigation is an increasingly utilized technology that is considered with total hip arthroplasty (THA). However, the evidence to support this practice is mixed. The current study leveraged a large national administrative database to compare 90-day adverse events as well as 5-year all-cause revision and dislocation rates following THA performed with and without imageless navigation. METHODS From 2010 to 2020, a large national database was queried for THA cases performed for osteoarthritis. Cases with or without imageless navigation were matched at 1:4 based on age, sex, and Elixhauser Comorbidity Index (ECI) score. Ninety-day adverse events were assessed and compared with multivariate analyses. Five-year incidence of revision and dislocation were also assessed between cohorts. RESULTS Use of THA imageless navigation increased from 2010 (2.5% of cases) to 2020 (5.5% of cases; P < .001). After matching, 11,990 THA patients with navigation and 47,948 without navigation were identified. Overall, 90-day adverse events were observed in 7.0% of the population. Multivariate analysis controlling for age, sex, and ECI demonstrated a difference in only one 90-day adverse event; wound dehiscence, which had higher odds in the navigation group (odds ratio, 1.60, P < .001). At 5 years, revisions for the navigated group were higher (4.4 versus 3.6%: P = .006), while dislocations were not significantly different. CONCLUSION THA imageless navigation was not found to be associated with improved 90-day postoperative adverse events or differences in the 5-year rates of revision or dislocation. The current data were unable to identify clear advantages of this evolving technology for primary THA.
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ÇATALTEPE A. The length of distal skin incision of the postero-lateral approach affects the cup inclination during the total hip arthroplasty. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1071852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: The primary aim of the study was to determine whether the length of the distal skin incision of the posterolateral approach affects the cup inclination during total hip arthroplasty (THA).
Material and Method: In this study, a cohort of 71 consecutive patients who performed between January 2017 and December 2021 with unilateral THA using a posterolateral approach was retrospectively assessed. Two groups were formed according to acetabular cup inclination with normal anteversion angle. There were 56 hips in the inside group and 17 in the outside group. A curvilinear skin incision of around 13 cm was performed. Component position evaluation was carried out through a radiographic assessment of the acetabular component on an anteroposterior pelvis radiograph. The rate of an outlier was compared between groups according to the safe zone defined as 30° to 50° of inclination and 5° to 25° of anteversion, which was described by Lewinnek et al.
Results: No significant difference in the average total incision length was found between the two groups (p=0.207). While the average distal incision length was 7.91±0.62 cm (range, 6.8-9 cm) in the inside group and 6.37±0.21 cm (range, 6-6.7 cm) in the outside group. According to ROC analysis, a patient with ≤6.7 cm of the distal length of incision (DLI) was 5.71 times more likely to be outside than a patient with >6.7 cm of DLI. Seventeen hips (23.3%) were found outside the safe range. Substantial differences were observed regarding radiographic cup inclination between the two groups (p=0.0001). In the inside group, the average cup inclination was 44.11°±3.44° (range, 37°-50°), whereas, in the outside group, it was 55.41°±2.5° (range, 52°-59°). However, there were no significant differences in the average radiographic cup anteversion between the two groups (p=0.960). Although 11 of 17 (64.5%) patients were classified as obese (BMI ≥30) in the outside group experienced higher rates of inaccurate cup orientation, logistic regression analysis showed that the individual effects of obesity on the occurrence of the inaccurate cup position were not observed (p=0.884). One posterior hip dislocation occurred after one month postoperative in the outside group.
Conclusions: Longer distal portion of the skin incision of the posterolateral approach should be performed to achieve optimal operative inclination angles of the acetabular cup during THA. The surgeon must have no hesitation in extending the distal skin incision when adopting the posterolateral approach.
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Tang A, Singh V, Sharan M, Roof MA, Mercuri JJ, Meftah M, Schwarzkopf R. The accuracy of component positioning during revision total hip arthroplasty using 3D optical computer-assisted navigation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03383-z. [PMID: 36074304 DOI: 10.1007/s00590-022-03383-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Despite the excellent outcomes associated with primary total hip arthroplasty (THA), implant failure and revision continue to burden the healthcare system. The use of computer-assisted navigation (CAN) offers the potential for more accurate placement of hip components during surgery. While intraoperative CAN systems have been shown to improve outcomes in primary THA, their use in the context of revision total hip arthroplasty (rTHA) has not been elucidated. We sought to investigate the validity of using CAN during rTHA. METHODS A retrospective analysis was performed at an academic medical institution identifying all patients who underwent rTHA using CAN from 2016-2019. Patients were 1:1 matched with patients undergoing rTHA without CAN (control) based on demographic data. Cup anteversion, inclination, change in leg length discrepancy (ΔLLD) and change in femoral offset between pre- and post-operative plain weight-bearing radiographic images were measured and compared between both groups. A safety target zone of 15-25° for anteversion and 30-50° for inclination was used as a reference for precision analysis of cup position. RESULTS Eighty-four patients were included: 42 CAN cases and 42 control cases. CAN cases displayed a lower ΔLLD (5.74 ± 7.0 mm vs 9.13 ± 7.9 mm, p = 0.04) and greater anteversion (23.4 ± 8.53° vs 19.76 ± 8.36°, p = 0.0468). There was no statistical difference between the proportion of CAN or control cases that fell within the target safe zone (40% vs 20.9%, p = 0.06). Femoral offset was similar in CAN and control cases (7.63 ± 5.84 mm vs 7.14 ± 4.8 mm, p = 0.68). CONCLUSION Our findings suggest that the use of CAN may improve accuracy in cup placement compared to conventional methodology, but our numbers are underpowered to show a statistical difference. However, with a ΔLLD of ~ 3.4 mm, CAN may be useful in facilitating the successful restoration of pre-operative leg length following rTHA. Therefore, CAN may be a helpful tool for orthopedic surgeons to assist in cup placement and LLD during complex revision cases.
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Affiliation(s)
- Alex Tang
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
- Department of Orthopaedic Surgery, Geisinger Health, Scranton, PA, USA
| | - Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Mohamad Sharan
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Mackenzie A Roof
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
| | - John J Mercuri
- Department of Orthopaedic Surgery, Geisinger Health, Scranton, PA, USA
| | - Morteza Meftah
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA.
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Guo DH, Li XM, Ma SQ, Zhao YC, Qi C, Xue Y. Total Hip Arthroplasty with Robotic Arm Assistance for Precise Cup Positioning: A Case-Control Study. Orthop Surg 2022; 14:1498-1505. [PMID: 35701994 PMCID: PMC9251322 DOI: 10.1111/os.13334] [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: 11/21/2021] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine whether more precise cup positioning can be achieved with robot-assisted total hip arthroplasty (THA) as compared to conventional THA. METHODS In this study, between July 2019 and May 2021, 93 patients aged 23-75 years with osteonecrosis of the femoral head (ONFH) and adult developmental dysplasia of hip who underwent first hip surgery were included in the study. They were randomly assigned to either the robotic-assisted THA group (n = 45) or the conventional THA group (n = 48). After the operation, all patients were given routine rapid rehabilitation guidance. The duration of operation was recorded to estimate the learning curve through cumulative summation analysis. We compared the demographics, duration of operation, cup positioning, leg length discrepancy, hip offset, and Harris Hip Score between robot-assisted THA and manual THA. Precision in the positioning of the acetabular prosthesis using the MAKO system was also compared between the two groups. RESULTS The mean duration of operation for the robot-assisted THA group was 91.37 ± 17.34 min (range: 63 to 135 min), which was significantly higher than that for the conventional THA group. When the number of procedures was increased to 13, the duration of operation in the robot-assisted group decreased significantly and gradually became stable. In terms of duration of operation, robot-assisted THA was associated with a learning curve of 13 cases. The mean amount of bleeding in the robot-assisted THA group was not significantly different from that in conventional THA group (328 ± 210 ml vs 315 ± 205 ml) (p = 0.741). There was no significant difference in the proportion of prostheses located within Lewinnek's safe zone between robot-assisted THA group and conventional THA group (69.81% vs 64.41%). The leg length discrepancy (LLD) was significantly smaller in the robot-assisted THA group than in the conventional THA group (p < 0.001), but both were within acceptable limits (10 mm). The inclination and anteversion angles of the acetabular prosthesis planned before operations were correlated with the actual measurement (r = 0.857 p < 0.001, r = 0.830, p < 0.001). After surgery, none of the patients experienced hip dislocation, aseptic loosening, or periprosthetic infection during the 3 months of follow-up. CONCLUSION The proportion of acetabular prostheses in the Lewinnek's safety zone was higher and the extent of LLD was significantly lower in the robot-assisted THA group, as compared to the same metrics in the conventional THA group. The MAKO robot improved the accuracy of implant placement in THA.
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Affiliation(s)
- Dong-Hui Guo
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Department of Orthopaedic Surgery, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province, Cangzhou, China
| | - Xiao-Ming Li
- Department of Orthopaedic Surgery, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province, Cangzhou, China
| | - Shi-Qiang Ma
- Department of Orthopaedic Surgery, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province, Cangzhou, China
| | - Yun-Chao Zhao
- Department of Orthopaedic Surgery, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province, Cangzhou, China
| | - Chao Qi
- Department of Orthopaedic Surgery, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine of Hebei Province, Cangzhou, China
| | - Yuan Xue
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
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12
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Bendich I, Vigdorchik JM, Sharma AK, Mayman DJ, Sculco PK, Anderson C, Della Valle AG, Su EP, Jerabek SA. Robotic Assistance for Posterior Approach Total Hip Arthroplasty Is Associated With Lower Risk of Revision for Dislocation When Compared to Manual Techniques. J Arthroplasty 2022; 37:1124-1129. [PMID: 35124193 DOI: 10.1016/j.arth.2022.01.085] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Robotic-assistance total hip arthroplasty (RA-THA) and computer navigation THA (CN-THA) have been shown to improve accuracy of component positioning compared to manual techniques; however, controversy exists regarding clinical benefit. Moreover, these technologies may expose patients to risks. The purpose of this study is to compare rates of intraoperative fracture and complications requiring reoperation within 1 year for posterior approach RA-THA, CN-THA, and THA with no technology (Manual-THA). METHODS In total, 13,802 primary, unilateral, elective, posterior approach THAs (1770 RA-THAs, 3155 CN-THAs, and 8877 Manual-THAs) were performed at a single institution between 2016 and 2020. Intraoperative fractures and reoperations within 1 year of the index procedure were identified. Cohorts were balanced using inverse probability of treatment weight based on age, gender, body mass index, femoral cementation, history of spine fusion, and Charlson Comorbidity Index. Logistic regression was performed to create odds ratios for complications. Additional regression analysis for dislocation was performed, adjusting for dual mobility and femoral head size. RESULTS There were no differences in intraoperative fracture and postoperative complication rates between the groups (P = .521). RA-THA had a 0.3 odds ratio (95% confidence interval 0.1-0.9, P = .046) compared to Manual-THA for reoperation due to dislocation. CN-THA had an odds ratio of 3.0 for reoperation due to dislocation (95% confidence interval 0.8-11.3, P = .114) compared to RA-THA. The remaining complication odds ratios, including those for infection, loosening, dehiscence, and "other" were similar between the groups. CONCLUSION RA-THA is associated with lower risk of revision for dislocation within 1 year of index surgery, when compared to Manual-THA performed through the posterior approach.
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Affiliation(s)
| | | | | | | | | | | | | | - Edwin P Su
- Hospital for Special Surgery, New York, NY
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13
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Migliorini F, Cuozzo F, Oliva F, Eschweiler J, Hildebrand F, Maffulli N. Imageless navigation for primary total hip arthroplasty: a meta-analysis study. J Orthop Traumatol 2022; 23:21. [PMID: 35426527 PMCID: PMC9012775 DOI: 10.1186/s10195-022-00636-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been a growing interest in imageless navigation for primary total hip arthroplasty (THA). Its superiority over standard THA is debated. This meta-analysis compared surgical duration, implant positioning, Harris Hip Score and rate of dislocation of imageless navigation versus conventional THA. METHODS The present study was conducted according to the PRISMA 2020 guidelines. All the clinical trials comparing imageless navigation versus conventional for primary THA were accessed. In January 2022, the following databases were accessed: PubMed, Web of Science, Google Scholar and Embase. No time constraints were used for the search. The outcomes of interest were to compare cup inclination and anteversion, leg length discrepancy, surgical duration, Harris Hip Score and rate of dislocation of imageless navigation versus conventional THA. RESULTS Twenty-one studies (2706 procedures) were retrieved. Fifty-two percent of patients were women. There was between-group comparability at baseline in terms of age, body mass index (BMI), visual analogue scale, Harris Hip Score and leg length discrepancy (P > 0.1). Compared with conventional THA, the navigated group demonstrated slightly lower leg length discrepancy (P = 0.02) but longer duration of the surgical procedure (P < 0.0001). Cup anteversion (P = 0.6) and inclination (P = 0.5), Harris Hip Score (P = 0.1) and rate of dislocation (P = 0.98) were similar between the two interventions. CONCLUSION Imageless navigation may represent a viable option for THA.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany.
| | - Francesco Cuozzo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy
| | - Joerg Eschweiler
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.,School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Stoke on Trent, ST4 7QB, UK.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, E1 4DG, UK
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14
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Comparison of Utilization and Short-term Complications Between Technology-assisted and Conventional Total Hip Arthroplasty. J Am Acad Orthop Surg 2022; 30:e673-e682. [PMID: 35139053 DOI: 10.5435/jaaos-d-21-00698] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 01/02/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Although technology-assisted total hip arthroplasty (TA-THA) may improve implant positioning, it remains unknown whether TA-THA confers improved clinical outcomes. We sought to examine national TA-THA utilization trends and compare clinical outcomes between TA-THA and unassisted THA (U-THA). METHODS Patients who underwent primary, elective THA from 2010 to 2018 were identified using the American College of Surgeons National Surgical Quality Improvement Program database. Demographic, perioperative, and 30-day outcomes were queried and collected. Patients were stratified based on whether they underwent TA-THA, which included computer navigation or robotics, and U-THA. Propensity score matching paired patients undergoing TA-THA or U-THA on a 1:1 basis. RESULTS Of the 238,755 THA patients, 3,149 cases (1.3%) were done using TA-THA. Comparing the unmatched TA-THA and U-THA groups, race distribution (P < 0.001) and baseline functional status (P < 0.001) differed. Propensity score matching yielded 2,335 TA-THA and U-THA pairs. Perioperatively, the TA-THA cohort had longer mean surgical times (101.0 ± 34.0 versus 91.9 ± 38.8 minutes, P < 0.001), but lower transfusion rates (5.7% versus 7.8%, P = 0.005). As compared with the U-THA group, the TA-THA group had a shorter mean hospital length of stay (2.0 ± 1.1 versus 2.5 ± 2.0 days, P < 0.001) and a higher proportion of patients discharged home (85.8% versus 75.7%, P < 0.001). Notably, the TA-THA cohort had higher readmission rates (3.8% versus 2.4%, P < 0.001). Major complication and revision surgery rates did not markedly differ between groups. DISCUSSION TA-THA utilization rates remain low among orthopaedic surgeons. As compared with U-THA, TA-THA yield mixed perioperative and 30-day outcomes. Surgeons must consider the clinical benefits and drawbacks of TA-THA when determining the proper surgical technique and technology for each patient. Clinical trials assessing long-term functional and clinical outcomes between U-THA and TA-THA are required to further elucidate the utility of assistive technologies in THA. LEVEL III EVIDENCE Retrospective Cohort Study.
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15
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Does accelerometer-based portable navigation provide more accurate and precise cup orientation without prosthetic impingement than conventional total hip arthroplasty? A randomized controlled study. Int J Comput Assist Radiol Surg 2022; 17:1007-1015. [DOI: 10.1007/s11548-022-02592-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/04/2022] [Indexed: 11/05/2022]
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16
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Computer Navigation for Revision Total Hip Arthroplasty Reduces Dislocation Rates. Indian J Orthop 2022; 56:1061-1065. [PMID: 35669033 PMCID: PMC9123110 DOI: 10.1007/s43465-022-00606-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/26/2022] [Indexed: 02/04/2023]
Abstract
Purpose Computer navigation in total hip arthroplasty (THA) offers potential for more accurate placement of acetabular components, avoiding impingement, edge loading, and dislocation, all of which can necessitate revision THA (rTHA). Therefore, the use of computer navigation may be particularly beneficial in patients undergoing rTHA. The purpose of this study was to determine if the use of computer-assisted hip navigation reduces the rate of dislocation in patients undergoing rTHA. Methods A retrospective review of 72 patients undergoing computer-navigated rTHA between February 2016 and May 2017 was performed. Demographics, indications for revision, type of procedure performed, and incidence of postoperative dislocation were collected for all patients. Clinical follow-up was recorded at 3 months, 1 year and 2 years. Results All 72 patients (48% female; 52% male) were included for analysis. The mean age was 70.4 ± 11.2 years and mean BMI was 26.4 ± 5.2 kg/m2. 22 of 72 patients (31%) required a rTHA procedure due to instability resulting in dislocation. At 3 months, 1 year, and 2 years, there were no dislocations (0%). There was a significant reduction in dislocation rate after computer-navigated rTHA (0%) relative to that following primary THA in the same patient cohort (31%; p < 0.05). Conclusion Our study demonstrates a significant reduction in dislocation rate following rTHA with computer navigation. Although the cause of postoperative dislocation is often multifactorial, the use of computer navigation may help to curtail femoral and acetabular malalignment in rTHA. Level of Evidence Level III: retrospective.
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17
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Mihalko WM, Urish K, Haider H. Optimal designs and surgical technique for hip and knee joint replacement: The best is yet to come! J Orthop Res 2021; 39:1851-1859. [PMID: 33002224 DOI: 10.1002/jor.24873] [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: 04/30/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 02/04/2023]
Abstract
Over the last three decades, there have been significant advancements in knee and hip replacement technology. The implants and the surgical technology we now have to aid in their implantation are advancing and improving functional outcomes and survivorship. Despite these advancements, there are still issues with patient satisfaction, functional limitations, and early revisions due to instability and aseptic loosening. This article reviews the state of current technology in hip and knee replacement implant design and surgical technique, and reviews some of the current implant designs and surgical technologies that may be able to solve some of the most common issues in the knee and hip replacement surgery.
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Affiliation(s)
- William M Mihalko
- Campbell Clinic Department of Orthopaedic Surgery and Biomedical Engineering, Chair Joint Graduate Program in Biomedical Engineering, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kenneth Urish
- Arthritis and Arthroplasty Design Group, The Bone and Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Hani Haider
- Arthritis and Arthroplasty Design Group, The Bone and Joint Center, Magee Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
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18
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Singh V, Realyvasquez J, Simcox T, Rozell JC, Schwarzkopf R, Davidovitch RI. Robotics Versus Navigation Versus Conventional Total Hip Arthroplasty: Does the Use of Technology Yield Superior Outcomes? J Arthroplasty 2021; 36:2801-2807. [PMID: 33773864 DOI: 10.1016/j.arth.2021.02.074] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/15/2021] [Accepted: 02/27/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The use of technology such as navigation and robotic systems may improve the accuracy of component positioning in total hip arthroplasty (THA), but its impact on patient-reported outcome measures (PROMs) remains unclear. This study aims to elucidate the association between the use of intraoperative technology and PROMs in patients who underwent primary THA. METHODS We retrospectively reviewed a consecutive series of patients who underwent primary THA between 2016 and 2020 and answered PROM questionnaires. Patients were separated into 3 groups depending on intraoperative technology utilization: computer-assisted navigation, robotic-assisted, or no technology (conventional) THA. Forgotten Joint Score-12 and Hip disability and Osteoarthritis Outcome Score, Joint Replacemen scores were collected at various time points. Demographic differences were assessed with chi-square and analysis of variance. Mean scores between groups were compared using univariate analysis of covariance, controlling for all significant demographic differences. RESULTS Of the 1960 cases identified, 896 used navigation, 135 used robotics, and 929 used no technology. There were significant statistical differences in one-year Hip disability and Osteoarthritis Outcome Score, Joint Replacement scores (85.23 vs 85.95 vs 86.76, respectively; P = .014) and two-year Forgotten Joint Score-12 scores (64.72 vs 73.35 vs 74.63, respectively; P = .004) between the 3 groups. However, these differences did not exceed the mean clinically important differences. Length of stay was statistically longest for patients who underwent conventionally performed THA versus navigation and robotics (2.22 vs 1.46 vs 1.91, respectively; P < .001). Surgical time was significantly longer for cases performed using robotics versus navigation and conventionally (119.61 vs 90.35 vs 95.35, respectively; P < .001). CONCLUSION Statistical differences observed between all modalities are not likely to be clinically meaningful with regard to early patient-reported outcomes. Although intraoperative use of technology may improve the accuracy of implant placement, these modalities have not yet translated into improved early reported functional outcomes. LEVEL III EVIDENCE Retrospective cohort.
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Affiliation(s)
- Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | | | - Trevor Simcox
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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Davis ET, McKinney KD, Kamali A, Kuljaca S, Pagkalos J. Reduced Risk of Revision with Computer-Guided Versus Non-Computer-Guided THA: An Analysis of Manufacturer-Specific Data from the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man. JB JS Open Access 2021; 6:JBJSOA-D-21-00006. [PMID: 34337286 PMCID: PMC8318654 DOI: 10.2106/jbjs.oa.21.00006] [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] [Indexed: 11/14/2022] Open
Abstract
Computer-assisted total hip arthroplasty (THA) is known to improve implantation precision, but clinical data demonstrating an improvement in survivorship and patient-reported outcome measures (PROMs) are lacking. Our aim was to compare the risk of revision, PROMs, and patient satisfaction between cohorts who underwent THA with and without the use of computer guidance. Methods We used the data set and linked PROM data of the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man. Our sample included THAs performed for osteoarthritis using cementless acetabular components from a single manufacturer (cementless and hybrid THAs). An additional analysis was performed limiting the sample size to cementless-only THAs. The primary end point was revision (any component) for any reason. Kaplan-Meier survivorship analysis and an adjusted Cox proportional-hazards model were used. Results There were 41,683 non-computer-guided and 871 (2%) computer-guided cases included in our analysis of the cementless and hybrid group. There were 943 revisions in the non-computer-guided group and 7 in the computer-guided group. The cumulative revision rate at 10 years was 3.88% (95% confidence interval [CI]: 3.59% to 4.18%) for the non-computer-guided group and 1.06% (95% CI: 0.45% to 2.76%) for the computer-guided group. The Cox proportional-hazards model yielded a hazard ratio of 0.45 (95% CI: 0.21 to 0.96; p = 0.038). In the analysis of the cementless-only group, the cumulative revision rate at 10 years was 3.99% (95% CI: 3.62% to 4.38%) and 1.20% (95% CI: 0.52% to 3.12%) for the 2 groups, respectively. The Cox proportional-hazards model yielded a hazard ratio of 0.47 (95% CI: 0.22 to 1.01; p = 0.053). There was no significant difference in the 6-month Oxford Hip Score, the EuroQol-5 Dimension (EQ-5D) and EQ-VAS (Visual Analogue Scale) scores, and patient-reported success rates. Patient satisfaction (single-item satisfaction outcome measure) was higher in the computer-guided group, but this finding was limited by a reduced number of responses. Conclusions In our analysis, the use of computer-guided surgery was associated with a lower rate of revision at mean follow-up of 5.6 years. This finding was upheld when the sample was restricted to cementless-only THAs. Causality cannot be inferred in view of the observational nature of the study, and additional studies are recommended to validate these findings. Level of Evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Edward T Davis
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | | | | | | | - Joseph Pagkalos
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
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20
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Templating for Total Hip Arthroplasty in the Modern Age. J Am Acad Orthop Surg 2021; 29:e208-e216. [PMID: 33543909 DOI: 10.5435/jaaos-d-20-00693] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/19/2020] [Indexed: 02/01/2023] Open
Abstract
Preoperative templating provides several benefits to the patient, surgeon, and hospital. Appropriate implant selection and sizing optimizes surgical workflow and leads to efficient care-delivery systems. Accurate templating establishes intraoperative targets for component position and reduces complications such as leg length inequality, impingement, wear, dislocation, and fracture, all of which lead to decreased patient satisfaction. Recent technological advances in preoperative imaging include a better understanding of patient-specific pelvic motion allowing the surgeon to preoperatively address the risk of lumbar pathology with adjustments in component placement and bearing choice. The introduction of two-dimensional to three-dimensional (3D) radiographs, biplanar low-dose radiographs, and computed tomography scans with 3D reconstructions have all allowed for a more comprehensive preoperative planning in 3D. This article will review the fundamentals of templating before total hip arthroplasty with an emphasis on how to incorporate and implement patient-specific pelvic motion and 3D templating into practice.
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21
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Shigemura T, Baba Y, Murata Y, Yamamoto Y, Shiratani Y, Hamano H, Wada Y. Is a portable accelerometer-based navigation system useful in total hip arthroplasty?: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2021; 107:102742. [PMID: 33358026 DOI: 10.1016/j.otsr.2020.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/31/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Precise implant alignment is a crucial prognostic factor for successful outcomes following total hip arthroplasty (THA). A portable accelerometer-based navigation (PN) device may achieve the same accuracy as that achieved by the computer-assisted navigation surgery technique, with the convenience of a conventional technique. Although the usefulness of PN in THA (PN-THA) has been reported, whether it is more accurate than performing THA with a conventional technique (CON-THA) remains controversial. The difference in surgical time between PN-THA and CON-THA is also unclear. Therefore, we conducted a systematic review and meta-analysis of studies comparing results of PN-THA with those of CON-THA. We focused on the following question: is PN-THA superior to CON-THA in terms of radiological parameters and surgical time? PATIENTS AND METHODS A literature search was conducted in PubMed, Web of Science, and Cochrane Library, to identify studies that met the following inclusion criteria: randomised controlled trials (RCT) or non-RCT, studies involving patients who underwent PN-THA and patients who underwent CON-THA, studies including data on radiological parameters and surgical outcomes. Author names, publication year, country, study design, surgical approach, demographic characteristics of the participants (diagnosis, gender, age, and body mass index), and surgical outcomes (the radiological parameters and the surgical time) were extracted. We calculated the mean differences (MDs) for continuous data with 95% confidence intervals (CIs) for each outcome. p<0.05 was considered significant. RESULTS Three studies were included in this meta-analysis. The meta-analysis showed that absolute deviation of the postoperative measured angles from the target position for the cup anteversion was significantly smaller in PN-THA than in CON-THA (MD=-1.70, 95% CI=-2.91 to -0.50, [p=0.005]). There was no significant difference in the absolute deviation of the postoperative measured angles from the target position for cup abduction between the groups (MD=-1.82, 95% CI=-4.32-0.67, [p=0.15]). The surgical time was significantly longer in PN-THA than in CON-THA (MD=8.58, 95% CI=4.05-13.10, [p=0.0002]). DISCUSSION This systematic review and meta-analysis of studies comparing the results of PN-THA with those of CON-THA showed that the PN-THA is advantageous for precise cup implantation compared to CON-THA, although PN-THA has a longer surgical time compared to CON-THA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tomonori Shigemura
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan.
| | - Yoshihiko Baba
- Department of English, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yasuaki Murata
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Yohei Yamamoto
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Yuki Shiratani
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Hiroyuki Hamano
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Yuichi Wada
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
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Mihalič R, Zdovc J, Mohar J, Trebše R. Electromagnetic navigation system for acetabular component placement in total hip arthroplasty is more precise and accurate than the freehand technique: a randomized, controlled trial with 84 patients. Acta Orthop 2020; 91:675-681. [PMID: 32608315 PMCID: PMC8023939 DOI: 10.1080/17453674.2020.1783073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The accuracy of conventional navigation systems depends on precise registration of bony landmarks. We investigated the clinical use of electromagnetic navigation (EMN), with a unique device for precise determination of the anterior pelvic plane. Patients and methods - We randomly allocated patients scheduled for total hip arthroplasty into 2 groups of 42 patients each. In the study group, cups were placed at the predetermined target angles (inclination: 42.5°; anteversion: 15°) with the support of EMN. In the control group, cups were placed freehand aiming at the same target angles. Postoperatively the true position of the cup was determined using computed tomography scan of the pelvis. Precision (root mean squared error, RMSE) bias (mean bias error, ME), accuracy, and duration of surgery were compared between the methods. Results - Cup anteversion was more accurate and precise in the navigated group. The ME in the navigated and freehand group was -1.7° (95% CI -2.4 to 1.1) and -4.5° (CI -6.5 to 2.5), respectively. The RMSE in the navigated and freehand group was 2.8° (CI 2.3-3.2) and 8.0° (CI 6.3-9.5), respectively. The inclination was also more precise in the navigated group, with the RMSE in the navigated and freehand group at 4.6° (CI 3.4-5.9) and 6.5° (CI 5.4-7.5), respectively. The accuracy of the inclination and the duration of surgeries were similar between the groups. Interpretation - Cup placement with the help of EMN is more precise than the freehand technique and it does not affect the duration of surgery.
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Affiliation(s)
- Rene Mihalič
- Valdoltra Orthopaedic Hospital, Ankaran,Correspondence:
| | - Jurij Zdovc
- University of Ljubljana, Faculty of Pharmacy, Ljubljana
| | | | - Rihard Trebše
- Valdoltra Orthopaedic Hospital, Ankaran,University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
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Gao YY, Zhang R, Che XD, Wang CF, Shi DP, Liang B, Li PH, Liang SF, Li PC. WITHDRAWN: Comparison of the accuracy between imageless navigation and manual freehand approaches for total hip arthroplasty: a systematic review and meta-analysis. Chin J Traumatol 2020:S1008-1275(20)30180-2. [PMID: 33008740 DOI: 10.1016/j.cjtee.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/07/2020] [Accepted: 06/06/2020] [Indexed: 02/04/2023] Open
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Yang-Yang Gao
- Department of Orthopaedic Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Rong Zhang
- Department of Oncology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, 046000, Shanxi, China
| | - Xian-Da Che
- Department of Orthopaedic Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Chun-Fang Wang
- Department of Experimental Animal Center, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Dong-Ping Shi
- Department of Nephrology, Fenyang Hospital of Shanxi Province, Fenyang, 032200, Shanxi, China
| | - Bin Liang
- Department of Orthopaedic Surgery, Fenyang Hospital of Shanxi Province, Fenyang, 032200, Shanxi, China
| | - Peng-Hua Li
- Department of Laboratory, Fenyang Hospital of Shanxi Province, Fenyang, 032200, Shanxi, China
| | - Shu-Fen Liang
- Department of Laboratory, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Peng-Cui Li
- Department of Orthopaedic Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
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Widmer KH. The Impingement-free, Prosthesis-specific, and Anatomy-adjusted Combined Target Zone for Component Positioning in THA Depends on Design and Implantation Parameters of both Components. Clin Orthop Relat Res 2020; 478:1904-1918. [PMID: 32732575 PMCID: PMC7371099 DOI: 10.1097/corr.0000000000001233] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/04/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lewinnek's recommendation for orienting the cup in THA is criticized because it involves a static assessment of the safe zone and because it does not consider stem geometry. A revised concept of the safe zone should consider those factors, but to our knowledge, this has not been assessed. QUESTIONS/PURPOSES (1) To determine the shape, size, and location of target zones for combined cup and stem orientation for a straight stem/hemispheric cup THA to maximize the impingement-free ROM and (2) To determine whether and how these implant positions change as stem anteversion, neck-shaft angle, prosthetic head size and target range of movements are varied. METHODS A three-dimensional computer-assisted design model, in which design geometry was expressed in terms of parameters, of a straight stem/hemispheric cup hip prosthesis was designed, its design parameters modified systematically, and each prosthesis model was implanted virtually at predefined component orientations. Functional component orientation referencing to body planes was used: cups were abducted from 20° to 70°, and anteverted from -10° to 40°. Stems were rotated from -10° to 40° anteversion, neck-shaft angles varied from 115° to 143°, and head sizes varied from 28 to 40 mm. Hip movements up to the point of prosthetic impingement were tested, including simple flexion/extension, internal/external rotation, ab/adduction, combinations of these, and activities of daily living that were known to trigger dislocation. For each combination of parameters, the impingement-free combined target zone was determined. Maximizing the size of the combined target zone was the optimization criterion. RESULTS The combined target zones for impingement-free cup orientation had polygonal boundaries. Their size and position in the diagram changed with stem anteversion, neck-shaft angle, head size, and target ROM. The largest target zones were at neck-shaft angles from 125° to 127°, at stem anteversions from 10° to 20°, and at radiographic cup anteversions between 17° and 25°. Cup anteversion and stem anteversion were inverse-linearly correlated supporting the combined-anteversion concept. The range of impingement-free cup inclinations depended on head size, stem anteversion, and neck-shaft angle. For a 127°-neck-shaft angle, the lowest cup inclinations that fell within the target zone were 42° for the 28-mm and 35° for the 40-mm head. Cup anteversion and combined version depended on neck-shaft angle. For head size 32-mm cup, anteversion was 6° for a 115° neck-shaft angle and 25° for a 135°-neck-shaft angle, and combined version was 15° and 34° respectively. CONCLUSIONS The shape, size, and location of the combined target zones were dependent on design and implantation parameters of both components. Changing the prosthesis design or changing implantation parameters also changed the combined target zone. A maximized combined target zone was found. It is mandatory to consider both components to determine the accurate impingement-free prosthetic ROM in THA. CLINICAL RELEVANCE This study accurately defines the hypothetical impingement-free, design-specific component orientation in THA. Transforming it into clinical precision may be the case for navigation and/or robotics, but this is speculative, and as of now, unproven.
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Affiliation(s)
- Karl-Heinz Widmer
- K.-H. Widmer, Medical Faculty University of Basel, Basel, Switzerland
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Hazratwala K, Brereton SG, Grant A, Dlaska CE. Computer-Assisted Technologies in Arthroplasty: Navigating Your Way Today. JBJS Rev 2020; 8:e0157. [PMID: 32224641 DOI: 10.2106/jbjs.rvw.19.00157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Computer-assisted technologies that are used in arthroplasty include navigation, image-derived instrumentation (IDI), and robotics. Computer-assisted navigation improves accuracy and allows for real-time assessment of component positioning and soft-tissue tension. It is not clear whether the implementation of these technologies improves the clinical outcome of surgery. High cost and time demands have prevented the global implementation of computer-assisted technologies.
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Affiliation(s)
- Kaushik Hazratwala
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia.,Mater Health Services North Queensland, Townsville, Queensland, Australia.,Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | - Sarah G Brereton
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia.,Mater Health Services North Queensland, Townsville, Queensland, Australia
| | - Andrea Grant
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia
| | - Constantin E Dlaska
- Orthopaedic Research Institute of Queensland (ORIQL), Townsville, Queensland, Australia.,Mackay Hospital and Health Services, Mackay, Queensland, Australia
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Kamenaga T, Hayashi S, Hashimoto S, Matsumoto T, Takayama K, Fujishiro T, Hiranaka T, Niikura T, Kuroda R. Accuracy of cup orientation and learning curve of the accelerometer-based portable navigation system for total hip arthroplasty in the supine position. J Orthop Surg (Hong Kong) 2020; 27:2309499019848871. [PMID: 31104563 DOI: 10.1177/2309499019848871] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To assess the accuracy of cup orientation and learning curve of the disposable accelerometer-based portable navigation system for total hip arthroplasty (THA) in the supine position. METHODS A total of 75 patients who underwent THA through the anterolateral supine approach (ALS) with an accelerometer-based portable navigation system for the supine position (HipAlign®) between July 2017 and October 2018 were analyzed in this study. We compared the intraoperative cup angles using navigation records with the postoperative angles using postoperative computed tomography (CT) data. All patients were categorized into the following groups according to the course of three discrete, sequential operative time periods: 1-25 (initial group), 26-50 (intermediate group), and 51-75 (recent group). We compared the accuracy of cup inclination and anteversion among the three groups. The time required for navigation and the operative time of all patients were measured. RESULTS The average absolute error in measurement (postoperative CT-navigation record) was 2.6° ± 2.7° (inclination) and 2.8° ± 2.7° (anteversion). There were no significant differences among the three groups. The average time required for navigation and the operative time were 365.1 ± 90.3 s and 76.1 ± 1.6 min, respectively. The required time for HipAlign® navigation and operative time were constant in most patients, except for those of the initial five cases. CONCLUSION The accelerometer-based portable navigation system provides good accuracy of cup orientation, has a short learning curve, and requires a minimal surgical time for THA in supine position.
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Affiliation(s)
- Tomoyuki Kamenaga
- 1 Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Shinya Hayashi
- 1 Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Shingo Hashimoto
- 1 Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Tomoyuki Matsumoto
- 1 Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Koji Takayama
- 1 Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takaaki Fujishiro
- 2 Department of Orthopaedic Surgery, Takatsuki General Hospital, Osaka, Japan
| | - Takafumi Hiranaka
- 2 Department of Orthopaedic Surgery, Takatsuki General Hospital, Osaka, Japan
| | - Takahiro Niikura
- 1 Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Ryosuke Kuroda
- 1 Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
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Gausden EB, Popper JE, Sculco PK, Rush B. Computerized navigation for total hip arthroplasty is associated with lower complications and ninety-day readmissions: a nationwide linked analysis. INTERNATIONAL ORTHOPAEDICS 2020; 44:471-476. [PMID: 31919568 DOI: 10.1007/s00264-019-04475-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/23/2019] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The objective was to evaluate if the use of CA-THA was associated with lower complications in the first 90 days following THA compared with conventional THA. METHODS The Nationwide Readmission Database (NRD) was queried to identify patients who underwent THA between 2012 and 2014. The primary outcome was arthroplasty-related complications within the first 90 days following THA. Multivariate models predicting the risk of complications, readmission, and revision-related readmission within 90 days of discharge were created. RESULTS A total of 309,252 patients with a minimum 90-day follow-up following elective primary THA were identified. After controlling for age, sex, comorbidities, indication, income, and type of insurance, the use of CA during THA resulted in a 12% reduced odds of 90-day complications (OR 0.88, 95% CI 0.77-0.99, p = 0.04). DISCUSSION The use of CA-THA resulted in lower 90-day complication rates and readmission rates compared with traditional THA after controlling for confounding variables. There was no significant difference in the rates of revision surgery between the groups within the first 90 days.
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Affiliation(s)
- Elizabeth B Gausden
- Department of Orthopedics, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA.
| | | | - Peter K Sculco
- Department of Orthopedics, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA
| | - Barret Rush
- Division of Critical Care Medicine, University of Manitoba, Winnipeg, Canada
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Jacob I, Benson J, Shanaghan K, Gonzalez Della Valle A. Acetabular positioning is more consistent with the use of a novel miniature computer-assisted device. INTERNATIONAL ORTHOPAEDICS 2020; 44:429-435. [PMID: 31965312 DOI: 10.1007/s00264-020-04484-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/15/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Computer-assisted surgery (CAS) relying on registration of the anterior pelvic plane (APP) allows precise acetabular component placement. We determined the variability of cup placement in patients who underwent THA with and without the use of CAS that does not rely on the registration of APP. METHODS Fifty-one patients who underwent staged-bilateral THAs, one without CAS (control), and a subsequent one with CAS (study group), were included. Acetabular inclination and anteversion were measured on standardized post-operative radiographs. Variance in cup position and Lewinnek's zone proportionality were compared between the groups. Multiple regressions were performed to identify factors affecting variability in acetabular component placement. RESULTS The mean inclination for the control and study group was 42.7° (SD 4.5) and 42.5° (SD 2.9), respectively. The inclination variance was 20.5° and 8.2° respectively (p = < 0.001). Cup inclination was more consistent in the study than in the control group (deviation from the mean: 2.3° vs. 3.8°, p < 0.001). The mean anteversion for the control and the study group was 25.5° (SD 7.4) and 26.8° (SD 4.3), respectively. The anteversion variance was 54.2° and 18.2° respectively (p = <0.001). Consistency in cup anteversion was significantly improved with CAS (deviation from the mean: 3.4° vs. 5.8°; p = 0.002). Lewinnek's zone proportionality was not affected by the use of CAS. In the linear regression analysis, CAS significantly increased consistency in cup inclination (p = 0.01). Patient's factors including BMI and laterality affected consistency of cup placement. CONCLUSION CAS without referencing the APP allows a more consistent orientation of the acetabular component when compared to freehand placement.
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Affiliation(s)
- Ivan Jacob
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | | | - Kate Shanaghan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Buller LT, McLawhorn AS, Romero JA, Sculco PK, Mayman DJ. Accuracy and Precision of Acetabular Component Placement With Imageless Navigation in Obese Patients. J Arthroplasty 2019; 34:693-699. [PMID: 30616976 DOI: 10.1016/j.arth.2018.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Obesity is a risk factor for acetabular component malposition when total hip arthroplasty is performed with manual techniques. The utility of imageless navigation in obese patients remains unknown. This study compared the accuracy and precision of imageless navigation for component orientation between obese and nonobese patients. METHODS A total of 459 total hip arthroplasties performed for osteoarthritis using imageless navigation were reviewed from a single surgeon's institutional review board-approved database. Einzel-Bild-Roentgen Analyse determined component orientation on 6-week postoperative anteroposterior radiographs. Mean orientation error (accuracy) and precision were compared between obese (body mass index ≥ 30 kg/m2) and nonobese patients. Regression analysis evaluated the influence of obesity on component position. RESULTS The difference in mean inclination and anteversion between obese and nonobese groups was 1.1° (43.0° ± 3.5°; range, 35.8°-57.8° vs 41.9° ± 4.4°; range, 33.0°-57.1° and 24.9° ± 6.3°; range, 14.2°-44.3° vs 23.8° ± 6.6°; range, 7.0°-38.6°, respectively). Inclination precision was better for nonobese patients. No difference in inclination accuracy or anteversion accuracy or precision was detected between groups. And 83% of components were placed within the target range. There was no relationship between obesity (dichotomized) and component placement outside the target ranges for inclination, anteversion, or both. As a continuous variable, increased body mass index correlated with higher odds of inclination outside the target zone (odds ratio, 1.06; P = .001). CONCLUSION Using imageless navigation, inclination orientation was less precise for obese patients, but the observed difference is likely not clinically relevant. Accurate superficial registration of landmarks in obese patients is achievable, and the use of imageless navigation similarly improves acetabular component positioning in obese and nonobese patients. LEVEL OF EVIDENCE Therapeutic Level IV.
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Affiliation(s)
- Leonard T Buller
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | | | - Jose A Romero
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - David J Mayman
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
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Bohl DD, Nolte MT, Ong K, Lau E, Calkins TE, Della Valle CJ. Computer-Assisted Navigation Is Associated with Reductions in the Rates of Dislocation and Acetabular Component Revision Following Primary Total Hip Arthroplasty. J Bone Joint Surg Am 2019; 101:250-256. [PMID: 30730484 DOI: 10.2106/jbjs.18.00108] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Prior work suggests that computer-assisted navigation improves acetabular component position during primary total hip arthroplasty (THA). However, it is not known whether this translates to improvements in clinical outcomes. The purpose of this study was to test for associations between navigation use and the risk of dislocation, aseptic revision of the acetabular component, aseptic revision of the femoral component, aseptic revision of either component, and acute periprosthetic joint infection (PJI). METHODS This was a retrospective cohort study, conducted using the 100% Medicare Part A claims data set. Inclusion criteria were an age of ≥65 years and primary THA for osteoarthritis. First, the association between navigation use and patient and hospital characteristics was assessed. Second, while controlling for these characteristics, multivariate regression was used to test for the association of navigation use and the outcomes listed above. RESULTS A total of 803,732 primary THA procedures were identified; 14,540 (1.81%) involved the use of navigation. Navigation use was associated with younger age, other/unknown race, the Western census region, higher socioeconomic status, lower Charlson Comorbidity Index, shorter length of stay, private hospitals, teaching hospitals, and larger hospitals (p < 0.05 for each). Navigation use was associated with a lower rate of dislocation (1.00% versus 1.70% for no navigation; adjusted hazard ratio [HR] = 0.69; 95% confidence interval [CI] = 0.58 to 0.82; p < 0.001) and aseptic revision of the acetabular component (1.03% versus 1.55%; adjusted HR = 0.75; 95% CI = 0.64 to 0.88; p < 0.001). Navigation was not associated with aseptic revision of the femoral component (1.54% versus 1.87%; p = 0.064), aseptic revision of either component (1.91% versus 2.31%; p = 0.077), acute PJI at 6 weeks (0.34% versus 0.45%; p = 0.121), or acute PJI at 90 days (0.50% versus 0.66%; p = 0.458). CONCLUSIONS The findings of this study suggest that navigation is associated with reductions in the rates of dislocation and aseptic acetabular revision following primary THA. However, these results should be interpreted carefully in the setting of potential confounding by unmeasured variables, such as surgeon volume, family support, and patient compliance. Causality cannot be inferred until further prospective trials can vet this technology. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Michael T Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Kevin Ong
- Exponent, Inc., Philadelphia, Pennsylvania
| | | | - Tyler E Calkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Rutherford M, O'Connor JD, Gill HS, Hill J, Beverland D, Lennon AB, Dunne NJ. Operative and radiographic acetabular component orientation in total hip replacement: Influence of pelvic orientation and surgical positioning technique. Med Eng Phys 2019; 64:7-14. [DOI: 10.1016/j.medengphy.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/12/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
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Gonzalez Della Valle A, Shanaghan K, Benson JR, Carroll K, Cross M, McLawhorn A, Sculco PK. Pelvic pitch and roll during total hip arthroplasty performed through a posterolateral approach. A potential source of error in free-hand cup positioning. INTERNATIONAL ORTHOPAEDICS 2018; 43:1823-1829. [DOI: 10.1007/s00264-018-4141-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
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Valsamis EM, Ricketts D, Hussain A, Jenabzadeh AR. Imageless navigation total hip arthroplasty - an evaluation of operative time. SICOT J 2018; 4:18. [PMID: 29792786 PMCID: PMC5967858 DOI: 10.1051/sicotj/2018016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 04/15/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction: Imageless navigation has been successfully integrated in knee arthroplasty but its effectiveness in total hip arthroplasty (THA) has been debated. It has consistently been shown that navigation adds significant time and cost to the operation. Further, the relative success of traditional hip replacements has impeded the adoption of new techniques. Methods: We compared the operative time between fifty total hip replacements with and without the use of imageless navigation by a single senior surgeon in a retrospective study. We employed standard statistical tools to compare the two methods. A correlation-based analysis was used to delimit the “learned” phase of imageless navigation to make comparisons meaningful. Results: Contrary to what has previously been reported, there was no significant difference between operative time in navigated, when compared to traditional operations (p = 0.498). Only fourteen operations were required to delimit the learning phase of this operation. Discussion: This is the first study that demonstrates no added operative time when using imageless navigation in THA, achieved with an improved workflow. The results also demonstrate a very reasonable learning curve.
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Affiliation(s)
| | - David Ricketts
- Brighton and Sussex University Hospitals, Brighton BN2 5BE, UK
| | - Adnan Hussain
- Hinchingbrooke Hospital NHS Trust, Huntingdon PE29 6NT, UK
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Penenberg BL, Samagh SP, Rajaee SS, Woehnl A, Brien WW. Digital Radiography in Total Hip Arthroplasty: Technique and Radiographic Results. J Bone Joint Surg Am 2018; 100:226-235. [PMID: 29406344 DOI: 10.2106/jbjs.16.01501] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Obtaining the ideal acetabular cup position in total hip arthroplasty remains a challenge. Advancements in digital radiography and image analysis software allow the assessment of the cup position during the surgical procedure. This study describes a validated technique for evaluating cup position during total hip arthroplasty using digital radiography. METHODS Three hundred and sixty-nine consecutive patients undergoing total hip arthroplasty were prospectively enrolled. Preoperative supine anteroposterior pelvic radiographs were made. Intraoperative anteroposterior pelvic radiographs were made with the patient in the lateral decubitus position. Radiographic beam angle adjustments and operative table adjustments were made to approximate rotation and tilt of the preoperative radiograph. The target for cup position was 30° to 50° abduction and 15° to 35° anteversion. Intraoperative radiographic measurements were calculated and final cup position was determined after strict impingement and range-of-motion testing. Postoperative anteroposterior pelvic radiographs were made. Two independent observers remeasured all abduction and anteversion angles. RESULTS Of the cups, 97.8% were placed within 30° to 50° of abduction, with a mean angle (and standard deviation) of 39.5° ± 4.6°. The 2.2% of cups placed outside the target zone were placed so purposefully on the basis of intraoperative range-of-motion testing and patient factors, and 97.6% of cups were placed between 15° and 35° of anteversion, with a mean angle of 26.6° ± 4.7°. Twenty-eight percent of cups were repositioned on the basis of intraoperative measurements. Subluxation during range-of-motion testing occurred in 3% of hips despite acceptable measurements, necessitating cup repositioning. There was 1 early anterior dislocation. CONCLUSIONS Placing the acetabular component within a target range is a critical component to minimizing dislocation and polyethylene wear in total hip arthroplasty. Using digital radiography, we positioned the acetabular component in our desired target zone in 97.8% of cases and outside the target zone, purposefully, in 2.2% of cases. When used in conjunction with strict impingement testing, digital radiography allows for predictable cup placement in total hip arthroplasty.
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Affiliation(s)
- Brad L Penenberg
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sanjum P Samagh
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sean S Rajaee
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Antonia Woehnl
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Iwakiri K, Kobayashi A, Ohta Y, Takaoka K. Efficacy of the Anatomical-Pelvic-Plane Positioner in Total Hip Arthroplasty in the Lateral Decubitus Position. J Arthroplasty 2017; 32:1520-1524. [PMID: 28041773 DOI: 10.1016/j.arth.2016.11.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 11/09/2016] [Accepted: 11/30/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total hip arthroplasty in the lateral position involves particularly large variance in the sagittal tilt of pelvis fixation, which affects the imprecision of the cup anteversion leading to poor outcomes. We have added an additional compression pad to an existing device, also to be used in the lateral position, but theoretically enabling fixation on the anatomical pelvic plane (APP) serving as the reference plane. The present study aims to evaluate the usefulness of this device in comparison with the conventional device. METHODS We have studied 141 patients who underwent total hip arthroplasty at our hospital. Two frontal plain x-rays of the pelvis were obtained preoperatively for each patient after pelvis fixation; one with the conventional lateral fixation device and the other with an APP lateral fixation device. The sagittal tilt of the pelvis in each position was measured with 3D templating software, and variance in the sagittal tilt was compared between the 2 devices. RESULTS The mean bias in sagittal tilt relative to the functional pelvic plane (FPP) in the conventional device was -5.0° ± 4.8° (minus mean backward tilt) and was within 5° relative to the functional pelvic plane in 43%. The mean bias in the sagittal tilt relative to the APP in the APP lateral position device was 1.7° ± 3.1° (forward tilt) and was within 5° relative to the APP in 89%. The APP lateral device significantly reduced the variance in the sagittal tilt. CONCLUSION This device holds promise as a means of reducing the sagittal tilt in a simple, minimally invasive, and highly cost-effective manner.
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Affiliation(s)
- Kentaro Iwakiri
- Department of Orthopaedic Surgery, Shiraniwa Hospital, Ikoma City, Nara, Japan
| | - Akio Kobayashi
- Department of Orthopaedic Surgery, Shiraniwa Hospital, Ikoma City, Nara, Japan
| | - Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan
| | - Kunio Takaoka
- Department of Orthopaedic Surgery, Shiraniwa Hospital, Ikoma City, Nara, Japan
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Chang JD, Kim IS, Prabhakar S, Mansukhani SA, Lee SS, Yoo JH. Revision Total Hip Arthroplasty Using Imageless Navigation With the Concept of Combined Anteversion. J Arthroplasty 2017; 32:1576-1580. [PMID: 28139342 DOI: 10.1016/j.arth.2016.12.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/14/2016] [Accepted: 12/16/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of the study was to evaluate the implant positions and clinical results of revision total hip arthroplasty (THA) using an imageless navigation with the concept of combined anteversion. METHODS A total of 40 cementless revision THAs (24 men and 16 women) using an imageless navigation with the concept of combined anteversion were retrospectively evaluated. The concept of combined anteversion was applied in cup positioning based on Widmer's equation (cup anteversion + 0.7 × stem anteversion). The mean follow-up period was 80.7 months. Postoperatively, the inclination of the cup was evaluated on standard anteroposterior view of the radiograph, and the anteversion of the cup and femoral stem was evaluated using computed tomography scan. A cup inclination of 40° ± 10° and combined anteversion of the cup and femoral stem of 37° ± 10° based on Widmer's equation were regarded as the "safe zone." RESULTS The average anteversion of the revised femoral stems was 15.3° ± 2.9° (range, 9.5°-21.5°), whereas that of the remained femoral stems was 17.4° ± 9.7° (range, 4.2°-29.8°). The inclination, anteversion of the cup, and combined anteversion after revision THA were 42.3° ± 3.1° (range, 32.1°-48.2°), 25.0° ± 2.9° (range, 16.9°-29.5°), and 36.1° ± 3.4° (range, 27.2°-42.9°), respectively. Therefore, the position of the implants, relative to the safe zone, showed no outliers after the revision surgery. Neither dislocation nor osteolysis was observed after the surgery. CONCLUSION Favorable results of this study indicate that imageless navigation helps the surgeon in placing the components of revision THA in the safe zone. This study also shows that when this safe zone is consistently obtained, then no postoperative dislocations were observed in these patients over the 6-year follow-up period.
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Affiliation(s)
- Jun-Dong Chang
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - In-Sung Kim
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Sharad Prabhakar
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Sameer A Mansukhani
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Sang-Soo Lee
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Je-Hyun Yoo
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
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Chang JD, Kim IS, Bhardwaj AM, Badami RN. The Evolution of Computer-Assisted Total Hip Arthroplasty and Relevant Applications. Hip Pelvis 2017; 29:1-14. [PMID: 28316957 PMCID: PMC5352720 DOI: 10.5371/hp.2017.29.1.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 01/31/2017] [Accepted: 02/09/2017] [Indexed: 12/27/2022] Open
Abstract
In total hip arthroplasty (THA), the accurate positioning of implants is the key to achieve a good clinical outcome. Computer-assisted orthopaedic surgery (CAOS) has been developed for more accurate positioning of implants during the THA. There are passive, semi-active, and active systems in CAOS for THA. Navigation is a passive system that only provides information and guidance to the surgeon. There are 3 types of navigation: imageless navigation, computed tomography (CT)-based navigation, and fluoroscopy-based navigation. In imageless navigation system, a new method of registration without the need to register the anterior pelvic plane was introduced. CT-based navigation can be efficiently used for pelvic plane reference, the functional pelvic plane in supine which adjusts anterior pelvic plane sagittal tilt for targeting the cup orientation. Robot-assisted system can be either active or semi-active. The active robotic system performs the preparation for implant positioning as programmed preoperatively. It has been used for only femoral implant cavity preparation. Recently, program for cup positioning was additionally developed. Alternatively, for ease of surgeon acceptance, semi-active robot systems are developed. It was initially applied only for cup positioning. However, with the development of enhanced femoral workflows, this system can now be used to position both cup and stem. Though there have been substantial advancements in computer-assisted THA, its use can still be controversial at present due to the steep learning curve, intraoperative technical issues, high cost and etc. However, in the future, CAOS will certainly enable the surgeon to operate more accurately and lead to improved outcomes in THA as the technology continues to evolve rapidly.
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Affiliation(s)
- Jun-Dong Chang
- Arthroplasty Center, Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - In-Sung Kim
- Arthroplasty Center, Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Atul M Bhardwaj
- Arthroplasty Center, Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Ramachandra N Badami
- Arthroplasty Center, Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
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Thirty-Day Complications of Conventional and Computer-Assisted Total Knee and Total Hip Arthroplasty: Analysis of 103,855 Patients in the American College of Surgeons National Surgical Quality Improvement Program Database. J Arthroplasty 2016; 31:1674-9. [PMID: 26923496 DOI: 10.1016/j.arth.2016.01.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/25/2016] [Accepted: 01/27/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Computer-assisted surgery (CAS) has gained popularity in orthopedics for both total knee arthroplasty (TKA) and total hip arthroplasty (THA) in the past decades. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who underwent a primary, unilateral THA and TKA from 2011 to 2013. Multivariate analysis was conducted to compare the postoperative complications in patients whose surgery involved the use of CAS with those by conventional techniques. RESULTS We identified 103,855 patients who had THA and TKA in the database between 2011 and 2013. There were higher overall adverse events (odds ratio [OR], 1.40; CI, 1.22-1.59), minor events (OR, 1.38; CI, 1.21-1.58), and requirements for blood transfusion (OR, 1.44; CI, 1.25-1.67) in the conventional group when compared with CAS for TKA. However, rate of reoperation was higher in the CAS group for TKA (OR, 1.60; CI, 1.15-2.25). The results also showed higher overall adverse events (OR, 2.61; CI, 2.09-3.26), minor events (OR, 2.82; CI, 2.24-3.42), and requirements for blood transfusion (OR, 3.41; CI, 2.62-4.44) in the conventional group when compared to CAS for THA. Nevertheless, superficial wound infections (OR, 0.46; CI, 0.26-0.81) were shown to be higher in the CAS group undergoing THA. CONCLUSION The use of CAS in THA and TKA reduced the number of minor adverse events in the first 30 days postoperatively. However, CAS was associated with an increased number of reoperations and superficial infections. The clinical benefits and disadvantages of CAS should be considered when determining the potential benefit-cost ratio of this technology.
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Morvan A, Moreau S, Combourieu B, Pansard E, Marmorat JL, Carlier R, Judet T, Lonjon G. Standing radiological analysis with a low-dose biplanar imaging system (EOS system) of the position of the components in total hip arthroplasty using an anterior approach. Bone Joint J 2016; 98-B:326-33. [DOI: 10.1302/0301-620x.98b3.36289] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The primary aim of this study was to analyse the position of the acetabular and femoral components in total hip arthroplasty undertaken using an anterior surgical approach. Patients and Methods In a prospective, single centre study, we used the EOS imaging system to analyse the position of components following THA performed via the anterior approach in 102 patients (103 hips) with a mean age of 64.7 years (sd 12.6). Images were taken with patients in the standing position, allowing measurement of both anatomical and functional anteversion of the acetabular component. Results The mean inclination of the acetabular component was 39° (standard deviation (sd) 6), the mean anatomical anteversion was 30° (sd 10), and the mean functional anteversion was 31° (sd 8) five days after surgery. The mean anteversion of the femoral component was 20° (sd 11). Anatomical and functional anteversion of the acetabular component differed by > 10° in 23 (22%) cases. Pelvic tilt was the only pre-operative predictive factor of this difference. Conclusion Our study showed that anteversion of the acetabular component following THA using the anterior approach was greater than the recommended target value, and that substantial differences were observed in some patients when measured using two different measurement planes. If these results are confirmed by further studies, and considering that the anterior approach is intended to limit the incidence of dislocation, a new correlation study for each reference plane (anatomical and functional) will be necessary to define a ‘safe zone’ for use with the anterior approach. Take home message: EOS imaging system is helpful in the pre-operative and post-operative radiological analysis of total hip arthroplasty. Cite this article: Bone Joint J 2016;98-B:326–333.
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Affiliation(s)
- A. Morvan
- Hôpital Raymond Poincaré, Service
othopédie, 104 bd raymond Poincare, 92380 Garches, France
| | - S. Moreau
- Hôpital Européen George Pompidou, Service
orthopédie, 20 rue Leblanc, 75015
Paris, France
| | - B. Combourieu
- Hôpital Raymond Poincaré, Service
othopédie, 104 bd raymond Poincare, 92380 Garches, France
| | - E. Pansard
- Hôpital Raymond Poincaré, Service
othopédie, 104 bd raymond Poincare, 92380 Garches, France
| | - J. L. Marmorat
- Hôpital Raymond Poincaré, Service
othopédie, 104 bd raymond Poincare, 92380 Garches, France
| | - R. Carlier
- Hôpital Raymond Poincaré, Service
othopédie, 104 bd raymond Poincare, 92380 Garches, France
| | - T. Judet
- Hôpital Raymond Poincaré, Service
othopédie, 104 bd raymond Poincare, 92380 Garches, France
| | - G. Lonjon
- Hôpital Européen George Pompidou, Service
orthopédie, 20 rue Leblanc, 75015
Paris, France
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Jennings JM, Randell TR, Green CL, Zheng G, Wellman SS. Independent Evaluation of a Mechanical Hip Socket Navigation System in Total Hip Arthroplasty. J Arthroplasty 2016; 31:658-61. [PMID: 26614747 DOI: 10.1016/j.arth.2015.09.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 09/23/2015] [Accepted: 09/28/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Acetabular cup malpositioning during total hip arthroplasty may lead to impingement, instability, wear-induced osteolysis, and increased rates of revision surgery. The purpose of this study was to independently evaluate the accuracy of acetabular cup orientation using a novel mechanical navigation device. METHODS An adjustable, reusable mechanical navigation device was used in a consecutive series of patients. Angles (inclination and anteversion) were measured by 2 independent reviewers with a validated 2-dimensional/3-dimensional matching application using a preoperative computed tomographic scan and a postoperative plain film. RESULTS There were no outliers for inclination or anteversion for errors within 10° of the preoperative plan. There were 6 (12.8%) outliers for inclination and 11 (23.4%) for anteversion for errors within 5° of the preoperative plan. All patients simultaneously met both targets when an outlier was considered 10°, whereas 30 (63.8%) simultaneously met both targets when the criteria was tightened to 5°. The absolute errors for both inclination and anteversion were significantly less than both 5° and 10° (P<.001). CONCLUSION This device reliably navigates acetabular cup inclination and anteversion individualized for each patient to within 10° of a preoperative plan. Outliers increased when this criteria is tightened to 5° but still appears to be more accurate than conventional acetabular cup component placement. Further research is warranted to assess the clinical impact of reducing outliers using this device.
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Affiliation(s)
| | - Timmothy R Randell
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Guoyan Zheng
- Institute for Surgical Technology and Biomechanics University of Bern Stauffacherstrasse 78, CH-3014 Bern Switzerland
| | - Samuel S Wellman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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Xu J, Li D, Ma RF, Barden B, Ding Y. Application of Rapid Prototyping Pelvic Model for Patients with DDH to Facilitate Arthroplasty Planning: A Pilot Study. J Arthroplasty 2015; 30:1963-70. [PMID: 26129852 DOI: 10.1016/j.arth.2015.05.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 05/13/2015] [Accepted: 05/15/2015] [Indexed: 02/01/2023] Open
Abstract
Total hip arthroplasty (THA) is challenging in cases of osteoarthritis secondary to developmental dysplasia of the hip (DDH). Acetabular deficiency makes the positioning of the acetabular component difficult. Computer tomography based, patient-individual three dimensional (3-D) rapid prototype technology (RPT)-models were used to plan the placement of acetabular cup so that a surgeon was able to identify pelvic structures, assess the ideal extent of reaming and determine the size of cup after a reconstructive procedure. Intraclass correlation coefficients (ICCs) were used to analyze the agreement between the sizes of chosen components on the basis of preoperative planning and the actual sizes used in the operation. The use of the 3-D RPT-model facilitates the surgical procedures due to better planning and improved orientation.
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Affiliation(s)
- Jie Xu
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Deng Li
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruo-fan Ma
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bertram Barden
- Department of Orthopaedic Surgery, Düren Hospital, Academic Hospital of University of RWTH Aachen, Düren, Germany
| | - Yue Ding
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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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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Loftus M, Ma Y, Ghelman B. Acetabular Version Measurement in Total Hip Arthroplasty: the Impact of Inclination and the Value of Multi-Planar CT Reformation. HSS J 2015; 11:65-70. [PMID: 25737671 PMCID: PMC4342403 DOI: 10.1007/s11420-014-9416-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 09/03/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The orientation of the acetabular cup component of a total hip arthroplasty can be evaluated in a number of ways, utilizing a myriad of imaging techniques and measurement parameters, including intraoperative surgical estimates, postoperative radiographs, and cross-sectional imaging such as computed tomography (CT) and magnetic resonance imaging (MRI). QUESTIONS/PURPOSES How do traditional versus corrected measurements of acetabular version vary from one another based on the inclination of the cup? What is the reliability of the corrected acetabular version measurements based on interobserver and intraobserver consistency? PATIENTS AND METHODS Two fellowship-trained musculoskeletal radiologists reviewed CT scans on 60 total hip arthroplasties. Acetabular inclination, traditional CT acetabular version, and CT acetabular version corrected for inclination (by utilizing multi-planar reformations to measure in the plane of the cup face) were each measured. The difference was then calculated between the "traditional" axial CT and "corrected" acetabular version measurements, and the association between this difference and the acetabular inclination was assessed. RESULTS The "traditional" axial CT and "corrected" acetabular version measurements differed from one another in every case, with the traditional method yielding a version measurement that was on average 9.5° higher than the corrected technique. However, as the acetabular cup inclination angle decreased, the "traditional" measurement became more variable and increasingly discordant with the "corrected" version measurement. CONCLUSIONS There is inherent variability between the many methods utilized for defining and measuring acetabular version, with axial CT measurements often used as an accepted proxy for true cup anteversion. However, the variability between different measurement techniques is correlated with acetabular inclination, and this variability is most pronounced when acetabular inclination is low, ultimately leading to potential confusion in measurement terminology. The increasingly widespread availability of multi-planar CT reformations provides an opportunity to standardize methodology, eliminate the impact of inclination on acetabular version measurements, and potentially provide a more reliable comparison of the impact of cup orientation on surgical outcomes.
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Affiliation(s)
- Michael Loftus
- />Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medical College, 525 E 68th St, Box 141, New York, NY 10065 USA
| | - Yan Ma
- />Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Bernard Ghelman
- />Department of Radiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Abstract
Objectives Acetabular component orientation in total hip arthroplasty (THA)
influences results. Intra-operatively, the natural arthritic acetabulum
is often used as a reference to position the acetabular component.
Detailed information regarding its orientation is therefore essential. The
aim of this study was to identify the acetabular inclination and
anteversion in arthritic hips. Methods Acetabular inclination and anteversion in 65 symptomatic arthritic
hips requiring THA were measured using a computer navigation system.
All patients were Caucasian with primary osteoarthritis (29 men,
36 women). The mean age was 68 years (SD 8). Mean inclination was
50.5° (SD 7.8) in men and 52.1° (SD 6.7) in women. Mean anteversion
was 8.3° (SD 8.7) in men and 14.4° (SD 11.6) in women. Results The difference between men and women in terms of anteversion
was significant (p = 0.022). In 75% of hips, the natural orientation
was outside the safe zone described by Lewinnek et al (anteversion
15° ± 10°; inclination 40° ± 10°). Conclusion When using the natural acetabular orientation to guide component
placement, it is important to be aware of the differences between
men and women, and that in up to 75% of hips natural orientation
may be out of what many consider to be a safe zone. Cite this article: Bone Joint Res 2015;4:6–10.
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Affiliation(s)
- S T Goudie
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, Glasgow, G81 4DY, UK
| | - A H Deakin
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, Glasgow, G81 4DY, UK
| | - K Deep
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, Glasgow, G81 4DY, UK
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Xie W, Franke J, Chen C, Grützner PA, Schumann S, Nolte LP, Zheng G. A complete-pelvis segmentation framework for image-free total hip arthroplasty (THA): methodology and clinical study. Int J Med Robot 2014; 11:166-80. [PMID: 25258044 DOI: 10.1002/rcs.1619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 08/25/2014] [Accepted: 08/27/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Complete-pelvis segmentation in antero-posterior pelvic radiographs is required to create a patient-specific three-dimensional pelvis model for surgical planning and postoperative assessment in image-free navigation of total hip arthroplasty. METHODS A fast and robust framework for accurately segmenting the complete pelvis is presented, consisting of two consecutive modules. In the first module, a three-stage method was developed to delineate the left hemi-pelvis based on statistical appearance and shape models. To handle complex pelvic structures, anatomy-specific information processing techniques were employed. As the input to the second module, the delineated left hemi-pelvis was then reflected about an estimated symmetry line of the radiograph to initialize the right hemi-pelvis segmentation. The right hemi-pelvis was segmented by the same three-stage method, RESULTS Two experiments conducted on respectively 143 and 40 AP radiographs demonstrated a mean segmentation accuracy of 1.61±0.68 mm. A clinical study to investigate the postoperative assessment of acetabular cup orientations based on the proposed framework revealed an average accuracy of 1.2°±0.9° and 1.6°±1.4° for anteversion and inclination, respectively. Delineation of each radiograph costs less than one minute. CONCLUSIONS Despite further validation needed, the preliminary results implied the underlying clinical applicability of the proposed framework for image-free THA.
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Affiliation(s)
- Weiguo Xie
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Switzerland.,BG Trauma Centre Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Jochen Franke
- BG Trauma Centre Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Cheng Chen
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland
| | - Paul A Grützner
- BG Trauma Centre Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Steffen Schumann
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland
| | - Lutz-P Nolte
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland
| | - Guoyan Zheng
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland
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Xu K, Li YM, Zhang HF, Wang CG, Xu YQ, Li ZJ. Computer navigation in total hip arthroplasty: A meta-analysis of randomized controlled trials. Int J Surg 2014; 12:528-33. [DOI: 10.1016/j.ijsu.2014.02.014] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 01/03/2014] [Accepted: 02/25/2014] [Indexed: 11/29/2022]
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48
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Small T, Krebs V, Molloy R, Bryan J, Klika AK, Barsoum WK. Comparison of acetabular shell position using patient specific instruments vs. standard surgical instruments: a randomized clinical trial. J Arthroplasty 2014; 29:1030-7. [PMID: 24231437 DOI: 10.1016/j.arth.2013.10.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/01/2013] [Accepted: 10/07/2013] [Indexed: 02/01/2023] Open
Abstract
Total hip arthroplasty (THA) survivorship relies largely upon appropriate acetabular cup placement. The purpose of this prospective randomized controlled trial was to determine whether the use of a preoperative 3D planning software in combination with patient specific instrumentation (PSI) results in improved cup placement compared with traditional techniques. Thirty-six THA patients were randomized into standard (STD) or PSI technique. Standard approach was completed using traditional techniques, while PSI cases were planned and customized surgical instruments were manufactured. Postoperative CT scans were used to compare planned to actual results. Differences found between planned and actual anteversion were -0.2° ± 6.9° (PSI) and -6.9°±8.9° (STD) (P = 0.018). Use of 3D preoperative planning along with PSIs resulted in significantly greater anteversion accuracy than traditional planning and instrumentation.
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Affiliation(s)
- Travis Small
- Department of Orthopaedic Surgery, Cleveland Clinic-A41, Cleveland, Ohio
| | - Viktor Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic-A41, Cleveland, Ohio
| | - Robert Molloy
- Department of Orthopaedic Surgery, Cleveland Clinic-A41, Cleveland, Ohio
| | - Jason Bryan
- Department of Orthopaedic Surgery, Cleveland Clinic-A41, Cleveland, Ohio
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic-A41, Cleveland, Ohio.
| | - Wael K Barsoum
- Department of Orthopaedic Surgery, Cleveland Clinic-A41, Cleveland, Ohio
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Harrison CL, Thomson AI, Cutts S, Rowe PJ, Riches PE. Research synthesis of recommended acetabular cup orientations for total hip arthroplasty. J Arthroplasty 2014; 29:377-82. [PMID: 23958234 DOI: 10.1016/j.arth.2013.06.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/13/2013] [Accepted: 06/15/2013] [Indexed: 02/01/2023] Open
Abstract
Total hip arthroplasty (THA) is regarded as one of the most successful surgical procedures of modern times yet continues to be associated with a small but significant complication rate. Many early failures may be associated with poor component positioning with, in particular, acetabular component orientation dependent on the subjective judgement of the surgeon. In this paper, we compare the manufacturers' instructions on acetabular cup orientation with the literature-based recommended safety zones and surgical technique, by transforming them onto a single, clinically-relevant framework in which the different reference systems, safety guidelines and current instrumentation surgical techniques can be evaluated. The observed limited consensus between results reflects ongoing uncertainty regarding the optimum acetabular component positioning. As malpositioning of the acetabular cup increases the risk of revision surgery, any ambiguity over the correct position can have a causal effect. Our analysis highlights the need for a surgical reference system which can be used to describe the position of the acetabular cup intra-operatively.
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Affiliation(s)
- Claire L Harrison
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Avril I Thomson
- Department of Design Manufacture and Engineering Management, University of Strathclyde, Glasgow, UK
| | - Steven Cutts
- James Paget University Hospital, Great Yarmouth, UK
| | - Philip J Rowe
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Philip E Riches
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
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Gurgel HMC, Croci AT, Cabrita HABA, Vicente JRN, Leonhardt MC, Rodrigues JC. Acetabular component positioning in total hip arthroplasty with and without a computer-assisted system: a prospective, randomized and controlled study. J Arthroplasty 2014; 29:167-71. [PMID: 23711798 DOI: 10.1016/j.arth.2013.04.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 02/20/2013] [Accepted: 04/12/2013] [Indexed: 02/01/2023] Open
Abstract
In a study of the acetabular component in total hip arthroplasty, 20 hips were operated on using imageless navigation and 20 hips were operated on using the conventional method. The correct position of the acetabular component was evaluated with computed tomography, measuring the operative anteversion and the operative inclination and determining the cases inside Lewinnek's safe zone. The results were similar in all the analyses: a mean anteversion of 17.4° in the navigated group and 14.5° in the control group (P=.215); a mean inclination of 41.7° and 42.2° (P=.633); a mean deviation from the desired anteversion (15°) of 5.5° and 6.6° (P=.429); a mean deviation from the desired inclination of 3° and 3.2° (P=.783); and location inside the safe zone of 90% and 80% (P=.661). The acetabular component position's tomography analyses were similar whether using the imageless navigation or performing it conventionally.
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Affiliation(s)
- Henrique M C Gurgel
- Department of Orthopedics and Traumatology, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas, Faculty of Medicine, University of São Paulo, Brazil
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