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Van Ravestyn A, Frantz T, Vandemeulebroucke J, Jansen B, Duerinck J, Scheerlinck T. Determination of rotation center and diameter of femoral heads using off-the-shelf augmented reality hardware for navigation. Sci Rep 2024; 14:15458. [PMID: 38965266 PMCID: PMC11224340 DOI: 10.1038/s41598-024-64957-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 06/14/2024] [Indexed: 07/06/2024] Open
Abstract
In total hip arthroplasty (THA), determining the center of rotation (COR) and diameter of the hip joint (acetabulum and femoral head) is essential to restore patient biomechanics. This study investigates on-the-fly determination of hip COR and size, using off-the-shelf augmented reality (AR) hardware. An AR head-mounted device (HMD) was configured with inside-out infrared tracking enabling the determination of surface coordinates using a handheld stylus. Two investigators examined 10 prosthetic femoral heads and cups, and 10 human femurs. The HMD calculated the diameter and COR through sphere fitting. Results were compared to data obtained from either verified prosthetic geometry or post-hoc CT analysis. Repeated single-observer measurements showed a mean diameter error of 0.63 mm ± 0.48 mm for the prosthetic heads and 0.54 mm ± 0.39 mm for the cups. Inter-observer comparison yielded mean diameter errors of 0.28 mm ± 0.71 mm and 1.82 mm ± 1.42 mm for the heads and cups, respectively. Cadaver testing found a mean COR error of 3.09 mm ± 1.18 mm and a diameter error of 1.10 mm ± 0.90 mm. Intra- and inter-observer reliability averaged below 2 mm. AR-based surface mapping using HMD proved accurate and reliable in determining the diameter of THA components with promise in identifying COR and diameter of osteoarthritic femoral heads.
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Affiliation(s)
- Antoine Van Ravestyn
- Department of Orthopedic Surgery and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
- Vrije Universiteit Brussel (VUB), Research Group BEFY-ORTHO, Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Taylor Frantz
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium
- IMEC, Kapeldreef 75, 3001, Leuven, Belgium
| | - Jef Vandemeulebroucke
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium
- IMEC, Kapeldreef 75, 3001, Leuven, Belgium
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Bart Jansen
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium
- IMEC, Kapeldreef 75, 3001, Leuven, Belgium
| | - Johnny Duerinck
- Department of Neurosurgery, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Thierry Scheerlinck
- Department of Orthopedic Surgery and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
- Vrije Universiteit Brussel (VUB), Research Group BEFY-ORTHO, Laarbeeklaan 103, 1090, Brussels, Belgium
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Ong J, Ong CB, Grubel J, Chiu YF, Lee GC, Gonzalez Della Valle A. Body morphometry did not affect the accuracy of a second-generation, miniature imageless navigation system for total hip arthroplasty (THA) using a posterior approach. J Clin Orthop Trauma 2024; 51:102404. [PMID: 38638118 PMCID: PMC11021363 DOI: 10.1016/j.jcot.2024.102404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 01/31/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Some modern imageless navigation platforms for total hip arthroplasty (THA) rely on virtual frontal and sagittal planes determined with the patient in the lateral decubitus position. Body morphometry that changes with gender, body mass index, and other demographic factors may affect accuracy in patient positioning and consequently, navigation accuracy. The objective of this study was to analyze the influence of patient factors on the intraoperative accuracy of a second-generation imageless computer-assisted surgery platform. Methods 325 consecutive patients undergoing posterior approach, navigated THA arthroplasty for primary osteoarthritis by a single surgeon were retrospectively reviewed. An optic-based imageless navigation system referenced off a generic sagittal and coronal plane was used to determine acetabular inclination and anteversion. Acetabular accuracy was determined by assessing differences between intraoperative values and those obtained from measuring standardized 6-week follow-up radiographs. The effect of age, gender, BMI, race, ethnicity, and laterality on acetabular accuracy was assessed via t-tests, Pearson correlation and ANOVA. Results Gender had a significant impact on raw inclination accuracy (females and males had an average error of 1.41° and -1.03°, respectively - p < 0.001). There was a weak correlation between acetabular accuracy and patient age and BMI as a continuous variable (both absolute γ < 0.2). No difference was found between acetabular accuracy and BMI groups. Conclusion This second-generation imageless computer assisted device provided accurate cup positioning regardless of patient's BMI. Gender was the only factor impacting inclination accuracy.
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Affiliation(s)
- Justin Ong
- The Department of Orthopaedic Surgery at Hospital for Special Surgery, New York, NY, USA
| | - Christian B. Ong
- The Department of Orthopaedic Surgery at Hospital for Special Surgery, New York, NY, USA
| | - Jacqueline Grubel
- The Department of Orthopaedic Surgery at Hospital for Special Surgery, New York, NY, USA
| | - Yu-Fen Chiu
- The Department of Biostatistics at Hospital for Special Surgery, New York, NY, USA
| | - Gwo-Chin Lee
- The Department of Orthopaedic Surgery at Hospital for Special Surgery, New York, NY, USA
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Scholes CJ, Fatima M, Schwagli T, Liu D. Imageless navigation system (Naviswiss) provides accurate component position in total hip arthroplasty with lateral decubitus position for end-stage hip osteoarthritis: a prospective cohort study with CT-validation. ARTHROPLASTY 2024; 6:3. [PMID: 38191491 PMCID: PMC10773062 DOI: 10.1186/s42836-023-00224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
AIMS The Naviswiss system (Naviswiss AG, Brugg, Switzerland) is a handheld imageless navigation device used to improve the accuracy of implant positioning in total hip arthroplasty (THA). However, clinical data for leg length discrepancy and femoral offset is lacking, and the validity of the system has not been reported for patients undergoing THA in the lateral decubitus position. This study aimed to report the accuracy of the device in this patient population. METHODS Patients underwent THA in the lateral decubitus position performed by a single surgeon. Component position measured by the device intraoperatively was compared to postoperative measurements on computed tomography (CT) scans. Agreement between the navigation system and postoperative measurements was reported for acetabular cup inclination, acetabular cup version, femoral offset, and leg length discrepancy. RESULTS Thirty-three patients were included in the analysis. The mean difference between intraoperative and postoperative CT measurements was within 2° for angular measurements and 2 mm for leg length. Absolute differences in the two indices were up to 4° and 3 mm. The mean bias was 1°-2° overestimation for cup orientation and up to 2 mm overestimation for leg length change. However, 95% limits of agreement did not exceed absolute thresholds of 10° and 10 mm, especially after correction for bias. One case (3%) was declared intraoperatively for issues with fixation on the greater trochanter. CONCLUSIONS The accuracy of the Naviswiss system falls within clinically acceptable recommendations for acetabular cup placement, femoral offset, and leg length for total hip arthroplasty with a anterolateral approach in lateral decubitus position. The system could be further improved with regression-based bias correction.
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Affiliation(s)
| | | | | | - David Liu
- Gold Coast Centre for Bone and Joint Surgery, Palm Beach, QLD, 4221, Australia.
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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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Image-Less THA Cup Navigation in Clinical Routine Setup: Individual Adjustments, Accuracy, Precision, and Robustness. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060832. [PMID: 35744095 PMCID: PMC9227241 DOI: 10.3390/medicina58060832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 12/13/2022]
Abstract
Background and Objectives: Even after the ‘death’ of Lewinnek’s safe zone, the orientation of the prosthetic cup in total hip arthroplasty is crucial for success. Accurate cup placement can be achieved with surgical navigation systems. The literature lacks study cohorts with large numbers of hips because postoperative computer tomography is required for the reproducible evaluation of the acetabular component position. To overcome this limitation, we used a validated software program, HipMatch, to accurately assess the cup orientation based on an anterior-posterior pelvic X-ray. The aim of this study were to (1) determine the intraoperative ‘individual adjustment’ of the cup positioning compared to the widely suggested target values of 40° of inclination and 15° of anteversion, and evaluate the (2) ‘accuracy’, (3) ‘precision’, and (4) robustness, regarding systematic errors, of an image-free navigation system in routine clinical use. Material and Methods: We performed a retrospective, accuracy study in a single surgeon case series of 367 navigated primary total hip arthroplasties (PiGalileoTM, Smith+Nephew) through an anterolateral approach performed between January 2011 and August 2018. The individual adjustments were defined as the differences between the target cup orientation (40° of inclination, 15° of anteversion) and the intraoperative registration with the navigation software. The accuracy was the difference between the intraoperative captured cup orientation and the actual postoperative cup orientation determined by HipMatch. The precision was analyzed by the standard deviation of the difference between the intraoperative registered and the actual cup orientation. The outliers were detected using the Tukey method. Results: Compared to the target value (40° inclination, 15° anteversion), the individual adjustments showed that the cups are impacted in higher inclination (mean 3.2° ± 1.6°, range, (−2)−18°) and higher anteversion (mean 5.0° ± 7.0°, range, (−15)−23°) (p < 0.001). The accuracy of the navigated cup placement was −1.7° ± 3.0°, ((−15)−11°) for inclination, and −4.9° ± 6.2° ((−28)−18°) for anteversion (p < 0.001). Precision of the system was higher for inclination (standard deviation SD 3.0°) compared to anteversion (SD 6.2°) (p < 0.001). We found no difference in the prevalence of outliers for inclination (1.9% (7 out of 367)) compared to anteversion (1.63% (6 out of 367), p = 0.78). The Bland-Altman analysis showed that the differences between the intraoperatively captured final position and the postoperatively determined actual position were spread evenly and randomly for inclination and anteversion. Conclusion: The evaluation of an image-less navigation system in this large study cohort provides accurate and reliable intraoperative feedback. The accuracy and the precision were inferior compared to CT-based navigation systems particularly regarding the anteversion. However the assessed values are certainly within a clinically acceptable range. This use of image-less navigation offers an additional tool to address challenging hip prothesis in the context of the hip−spine relationship to achieve adequate placement of the acetabular components with a minimum of outliers.
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Rankin KA, Petit L, Nasreddine A, Minotti P, Leslie M, Wiznia DH. Computer-Assisted Navigation for Complex Revision of Unstable Total Hip Replacement in a Patient With Post-traumatic Arthritis. Arthroplast Today 2022; 15:153-158. [PMID: 35586609 PMCID: PMC9108506 DOI: 10.1016/j.artd.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 12/05/2022] Open
Abstract
Imageless computer-assisted navigation (CAN) excels in the post-traumatic arthritis and complex revision case setting when altered anatomy and landmarks are inaccurate references for cup positioning. We describe the case of an adult male patient who suffered an acetabular fracture which was treated nonoperatively. He subsequently developed post-traumatic arthritis and underwent an anterior approach total hip arthroplasty 25 years later. Postoperatively, he developed recurrent hip instability due to malpositioned components. We describe the use of imageless CAN during revision total hip arthroplasty to correct malpositioned components, with 3-year follow-up without dislocation. In these complex cases, CAN reduces the risk of component malpositioning and joint instability.
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Affiliation(s)
| | - Logan Petit
- Yale Department of Orthopaedics and Rehabilitation, New Haven, CT, USA
| | - Adam Nasreddine
- Yale Department of Orthopaedics and Rehabilitation, New Haven, CT, USA
| | - Phil Minotti
- Yale Department of Orthopaedics and Rehabilitation, New Haven, CT, USA
| | - Michael Leslie
- Yale Department of Orthopaedics and Rehabilitation, New Haven, CT, USA
| | - Daniel H. Wiznia
- Yale Department of Orthopaedics and Rehabilitation, New Haven, CT, USA
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Walter WL, Baker NA, Marsden-Jones D, Sadeghpour A. Novel Measure of Acetabular Cup Inclination and Anteversion During Total Hip Arthroplasty. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2022; 15:1-14. [PMID: 35115849 PMCID: PMC8806051 DOI: 10.2147/mder.s339669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/20/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE The purposes of the present research were to assess the accuracy and usability of the inertial navigation system (INS). MATERIALS AND METHODS The accuracy of the device navigation subsystem was assessed using benchtop testing. The usability was assessed through simulated use with surgeons. These results were compared to recent cadaveric results for the same system. RESULTS The navigation subsystem had an overall mean absolute error of 1.21° and a maximum absolute error across all devices of 4.79°. The device was found to be usable and to add an estimated 7 minutes to surgery time. CONCLUSION The INS uses a novel approach to provide the surgeon with accurate and fast acetabular cup inclination and anteversion angles during THA.
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Affiliation(s)
- William L Walter
- Orthopaedics and Traumatic Surgery, University of Sydney, Sydney, New South Wales, Australia
| | - Neri A Baker
- Innovation Department, Navbit, Sydney, New South Wales, Australia
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Vigdorchik JM, Sculco PK, Inglis AE, Schwarzkopf R, Muir JM. Evaluating Alternate Registration Planes for Imageless, Computer-Assisted Navigation During Total Hip Arthroplasty. J Arthroplasty 2021; 36:3527-3533. [PMID: 34154856 DOI: 10.1016/j.arth.2021.05.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/28/2021] [Accepted: 05/26/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Imageless computer navigation improves component placement accuracy in total hip arthroplasty (THA), but variations in the registration process are known to impact final accuracy measurements. We sought to evaluate the registration accuracy of an imageless navigation device during THA performed in the lateral decubitus position. METHODS A prospective, observational study of 94 patients undergoing a primary THA with imageless navigation assistance was conducted. Patient position was registered using 4 planes of reference: the patient's coronal plane (standard method), the long axis of the surgical table (longitudinal plane), the lumbosacral spine (lumbosacral plane), and the plane intersecting the greater trochanter and glenoid fossa (hip-shoulder plane). Navigation measurements of cup position for each plane were compared to measurements from postoperative radiographs. RESULTS Mean inclination from radiographs (41.5° ± 5.6°) did not differ significantly from inclination using the coronal plane (40.9° ± 3.9°, P = .39), the hip-shoulder plane (42.4° ± 4.7°, P = .26), or the longitudinal plane (41.2° ± 4.3°, P = .66). Inclination measured using the lumbosacral plane (45.8° ± 4.3°) differed significantly from radiographic measurements (P < .0001). Anteversion measured from radiographs (mean: 26.1° ± 5.4°) did not differ significantly from the hip-shoulder plane (26.6° ± 5.2°, P = .50). All other planes differed significantly from radiographs: coronal (22.6° ± 6.8°, P = .001), lumbosacral (32.5° ± 6.4°, P < .0001), and longitudinal (23.7° ± 5.2°, P < .0001). CONCLUSION Patient registration using any plane approximating the long axis of the body provided a frame of reference that accurately measured intraoperative cup position. Registration using a plane approximating the hip-shoulder axis, however, provided the most accurate and consistent measurement of acetabular component position.
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Affiliation(s)
| | - Peter K Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Allan E Inglis
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Jeffrey M Muir
- Department of Clinical Research, Intellijoint Surgical, Kitchener, Ontario, Canada
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Okamoto M, Kawasaki M, Okura T, Ochiai S, Yokoi H. Comparison of accuracy of cup position using portable navigation versus alignment guide in total hip arthroplasty in supine position. Hip Int 2021; 31:492-499. [PMID: 32126836 DOI: 10.1177/1120700020908788] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Accelerometer-based portable navigation systems in supine total hip arthroplasty (THA) have been developed, but there are no reports on the accuracy of cup placement. We aimed to investigate and compare the accuracy of the accelerometer-based portable navigation system versus the acetabular alignment guide placed on the pelvis in THA using the direct anterior approach (DAA). Both devices tracked changes in the pelvic position. METHODS In this single-centre, retrospective study, we reviewed 115 hips in 113 patients who underwent primary THA via the DAA using an accelerometer-based portable navigation system in the supine position (portable navigation group) and 106 hips in 101 patients who underwent THA using an acetabular alignment guide (alignment guide group) as controls. Hips were evaluated postoperatively using computed tomography to measure cup orientation. The accuracy of cup orientation was compared between the 2 groups. RESULTS Absolute values of inclination error were 3.1° ± 2.2° and 2.9° ± 2.3° (p = 0.708) in the portable navigation and alignment guide groups and those of anteversion error were 2.8° ± 2.3° and 3.7° ± 2.7°, respectively (p = 0.005). The number of cups placed within 10° of error was 98.3% and 96.2% in the portable navigation and alignment guide groups, respectively (p = 0.304). The portable navigation group had significantly more hips (72.2%) placed within a 5° margin of error than did the alignment guide group (56.6%) (p = 0.016). CONCLUSION High accuracy in cup placement was achieved using accelerometer-based portable navigation in supine THA. Using a navigation system may contribute to improved long-term outcomes.
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Affiliation(s)
- Masanori Okamoto
- Department of Orthopaedic Surgery, Aichi Koseiren Konan Kosei Hospital, Konan, Aichi, Japan
| | - Masashi Kawasaki
- Department of Orthopaedic Surgery, Aichi Koseiren Konan Kosei Hospital, Konan, Aichi, Japan
| | - Toshiaki Okura
- Department of Orthopaedic Surgery, Aichi Koseiren Konan Kosei Hospital, Konan, Aichi, Japan
| | - Satoshi Ochiai
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Yokoi
- Department of Orthopaedic Surgery, Aichi Koseiren Konan Kosei Hospital, Konan, Aichi, Japan
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Ando W, Takao M, Hamada H, Uemura K, Sugano N. Comparison of the accuracy of the cup position and orientation in total hip arthroplasty for osteoarthritis secondary to developmental dysplasia of the hip between the Mako robotic arm-assisted system and computed tomography-based navigation. INTERNATIONAL ORTHOPAEDICS 2021; 45:1719-1725. [PMID: 33880612 DOI: 10.1007/s00264-021-05015-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/17/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE We investigated the accuracy of the acetabular cup position and orientation in robotic-assisted total hip arthroplasty (rTHA) compared to navigated THA (nTHA) using computed tomography (CT) for patients with osteoarthritis secondary to developmental dysplasia of the hip (DDH). METHODS We studied 31 hips of 28 patients who underwent rTHA and 119 hips of 112 patients who underwent nTHA with the same target cup orientation. After propensity score matching, each group comprised 29 hips. Post-operative cup position and orientation were measured from the postoperative CT data. Errors from the target cup position and orientation were compared between the two groups. RESULTS Post-operatively, the absolute error of the anteroposterior and superoinferior cup positions from the target position was significantly lower in the rTHA group than in the nTHA group. The change in the post-operative radiographic inclination from the target orientation was lower in the rTHA group than in the nTHA group. Screw fixation for cup implantation was required for three hips in the nTHA group but not in the rTHA group. CONCLUSION rTHA achieved more precise cup implantation with reduced variation from the target orientation compared to nTHA in patients with osteoarthritis secondary to DDH.
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Affiliation(s)
- Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Okanoue Y, Aso K, Dan J, Takaya S, Izumi M, Kawakami T, Ikeuchi M. Accuracy of acetabular cup placement using an angle-adjusting alignment guide with laser pointer in total hip arthroplasty. J Orthop Surg (Hong Kong) 2021; 28:2309499020962860. [PMID: 33078676 DOI: 10.1177/2309499020962860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To evaluate cup-positioning accuracy in total hip arthroplasty (THA) using a novel angle-adjusting alignment guide with laser pointer and determine whether level of surgical experience affects accuracy of cup placement or not. METHODS We included 117 hips in 104 patients who underwent THA using the novel guide. We retrospectively reviewed 44 hips in 40 patients who underwent THA before the novel guide was introduced. We compared differences in cup angles between the novel guide group and the conventional guide group as well as the discrepancies in targeted angles between the experienced surgeon group and the inexperienced surgeon group. RESULTS There were 114/117 hips (97.4%) within the Lewinnek safe zone in the novel guide group and 32/44 hips (72.7%) within the safe zone in the conventional guide group. There were significantly fewer outliers in the novel guide group (p < 0.001). In the experienced surgeon group, the mean absolute errors in inclination and anteversion were 2.0 ± 1.7° and 2.1 ± 2.3°, respectively; which were not significantly different from those in the inexperienced surgeon group (2.3 ± 2.1° and 2.8 ± 2.3°, respectively). CONCLUSION The novel angle-adjusting alignment guide with laser pointer is a simple tool that provides better accuracy of cup position than that obtained using conventional guides. Accurate cup placement is possible using the novel guide, regardless of surgeons' experience.
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Affiliation(s)
- Yusuke Okanoue
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Koji Aso
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Junpei Dan
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Shogo Takaya
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Masashi Izumi
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Teruhiko Kawakami
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Masahiko Ikeuchi
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
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Kaku N, Tagomori H, Tsumura H. Comparison of Cup Setting Angle Accuracy between Computed Tomography-Based and Computed Tomography-Free Navigation in the Same Patients with Crowe's Classification I or II Hip Dysplasia. Clin Orthop Surg 2021; 13:144-151. [PMID: 34094004 PMCID: PMC8173244 DOI: 10.4055/cios20145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/28/2020] [Accepted: 11/25/2020] [Indexed: 12/21/2022] Open
Abstract
Backgroud In total hip arthroplasty, the cup setting angle may affect the postoperative results. In recent years, both computed tomography-based navigation and computed tomography-free (imageless) navigation have been reported to produce high accuracy in cup installation; however, no direct comparison between these two methods has been performed. The present study aimed to directly compare the cup installation angle accuracy between computed tomography-based navigation and computed tomography-free navigation in patients with Crowe's classification stage I or II dysplastic osteoarthritis and to examine the factors affecting the cup installation accuracy. Methods Using both navigation systems for the same technique, primary total hip arthroplasty was performed by the same surgeon in 36 patients. A cup was installed using computed tomography-based navigation, and the installed cup was measured again using computed tomography-free navigation. We compared the error between the target angle and the intraoperative installation angle for each navigation method by performing statistical analyses. Results For computed tomography-based navigation, errors in the inclination and the anteversion angles compared to the target angle were 3.14° ± 1.55° and 1.47° ± 0.99°, respectively. For computed tomography-free navigation, the inclination and anteversion angle errors were significantly larger, i.e., 6.84° ± 4.78° and 5.43° ± 5.22°, respectively (p < 0.01). The inclination and anteversion angles of computed tomography-free navigation were correlated, and there were no significant factors influencing the error. Conclusions Computed tomography-based navigation is more accurate for cup installation than computed tomography-free navigation. When using computed tomography-free navigation, it is necessary to add technical schemes before and during surgery to improve the cup installation accuracy.
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Affiliation(s)
- Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroaki Tagomori
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
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13
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Reichert B. Bestimmung einer Beckenasymmetrie – Sinn oder Unsinn. MANUELLE MEDIZIN 2021. [DOI: 10.1007/s00337-020-00703-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ZusammenfassungPathologien des tiefen Rückens, der Becken- sowie Knie- und Hüftgelenke werden immer wieder mit einer Messung der Beinlänge und Feststellung einer Beckenasymmetrie in Verbindung gebracht. Aufgrund dieser Messungen werden therapeutische Wege eingeschlagen. Zu diesem Thema wurden auf der Basis einer systematischen Literatursuche in zwei maßgeblichen Datenbanken 28 Artikel ermittelt. Die inhaltliche Analyse beschäftigt sich v. a. mit der Variationsanatomie des Beckens sowie der Reliabilität palpatorischer und apparativer Bestimmungen von knöchernen Referenzpunkten am Becken. Hieraus ergeben sich maßgebliche Erkenntnisse: Eine Variationsanatomie des Beckens ist häufig und kommt auch bei nichtsymptomatischen Personen vor. Die palpatorische und apparative Bestimmungen der knöchernen Referenzpunkte sind gering bis moderat reliabel. Der Rückschluss von einer festgestellten Beckenasymmetrie auf den Einfluss bestehender oder noch zu erwartender Rücken‑, Hüft- oder Beckengelenkbeschwerden ist nach derzeitiger Studienlage zumindest umstritten und daher nicht empfehlenswert.
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14
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Accuracy of imageless navigation for functional cup positioning and restoration of leg length in total hip arthroplasty: a matched comparative analysis. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000000952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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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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16
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Wang M, Li D, Shang X, Wang J. A review of computer-assisted orthopaedic surgery systems. Int J Med Robot 2020; 16:1-28. [PMID: 32362063 DOI: 10.1002/rcs.2118] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/07/2020] [Accepted: 04/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Computer-assisted orthopaedic surgery systems have great potential, but no review has focused on computer-assisted surgery systems for the spine, hip, and knee. METHODS A systematic search was performed in Web of Science and PubMed. We searched the literature on computer-assisted orthopaedic surgery systems from 2008 to the present and focused on three aspects of systems: training, planning, and intraoperative navigation. RESULTS AND DISCUSSION In this review study, we reviewed 34 surgical training systems, 31 surgical planning systems, and 41 surgical navigation systems. The functions and characteristics of the surgical systems were compared and analysed, and the current concerns about and the impact of the surgical systems on doctors and surgery were clarified. CONCLUSION Computer-assisted orthopaedic surgery systems are still in the development stage. Future surgical training systems should include synthetic models with patient anatomy. Surgical planning systems with automatic planning should be developed, and surgical navigation systems with multimodal fusion, robotic assistance and imaging should be developed.
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Affiliation(s)
- Monan Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Donghui Li
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Xiping Shang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Jian Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
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Hayashi S, Hashimoto S, Takayama K, Matsumoto T, Kamenaga T, Fujishiro T, Hiranaka T, Niikura T, Kuroda R. Evaluation of the accuracy of acetabular cup orientation using the accelerometer-based portable navigation system. J Orthop Sci 2020; 25:612-617. [PMID: 31619323 DOI: 10.1016/j.jos.2019.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/14/2019] [Accepted: 09/19/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Accurate orientation of acetabular and femoral components is important during total hip arthroplasty (THA). In recent years, several navigation systems have been developed. However, these navigation systems for THA are unpopular worldwide because of their high cost. We assessed the orientation accuracy of cups inserted using a disposable accelerometer-based portable navigation system for THAs. METHODS This was a prospective cohort study. We analyzed 63 hips with navigation prospectively and 30 hips without navigation retrospectively as historical control. The patients underwent THA via the mini anterolateral approach in the supine position using an accelerometer-based portable navigation system. We compared the preoperative target angles, intraoperative cup angles using navigation records, postoperative angles using postoperative CT data, measurement errors of cup angles, and clinical parameters such as sex, treated side, age at surgery, and body mass index (BMI). RESULTS The average absolute error (postoperative CT-navigation record) was 2.7 ± 2.1° (inclination) and 2.7 ± 1.8° (anteversion), and the absolute error (postoperative CT-preoperative target angle) was 2.6 ± 1.9° (inclination) and 2.7 ± 2.2° (anteversion). The absolute error between postoperative CT and target angle with navigation was significantly lower than the error without navigation (inclination; p = 0.025, anteversion; p = 0.005). Cup malalignment (absolute difference of inclination or anteversion between postoperative CT and preoperative target angle of over 5°) was significantly associated with BMI value (OR: 1.3, 95% CI: 1.1-1.7). The absolute measurement error of cup inclination and anteversion was significantly correlated with patients' BMI (inclination error: correlation coefficient = 0.53, p < 0.001, anteversion error: correlation coefficient = 0.58, p < 0.001). CONCLUSIONS The clinical accuracy of accelerometer-based portable navigation is precise for the orientation of cup placement, although accurate cup placement was affected by high BMI. This is the first study to report the accuracy of accelerometer-based portable navigation for THA in the supine position.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe Univ. Graduate School of Med., Kobe, Japan.
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe Univ. Graduate School of Med., Kobe, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe Univ. Graduate School of Med., Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe Univ. Graduate School of Med., Kobe, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe Univ. Graduate School of Med., Kobe, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery, Takatsuki General Hospital, Osaka, Japan
| | - Takafumi Hiranaka
- Department of Orthopaedic Surgery, Takatsuki General Hospital, Osaka, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe Univ. Graduate School of Med., Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe Univ. Graduate School of Med., Kobe, Japan
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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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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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Tanino H, Nishida Y, Mitsutake R, Ito H. Portable Accelerometer-Based Navigation System for Cup Placement of Total Hip Arthroplasty: A Prospective, Randomized, Controlled Study. J Arthroplasty 2020; 35:172-177. [PMID: 31563396 DOI: 10.1016/j.arth.2019.08.044] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/12/2019] [Accepted: 08/20/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Malposition of the acetabular component during total hip arthroplasty (THA) is associated with increased risk of dislocation, reduced range of motion, and accelerated wear. The purpose of this study is to compare cup positioning with a portable, accelerometer-based hip navigation system and conventional surgical technique. METHODS In a prospective, randomized, clinical study, cups were implanted with a portable, accelerometer-based hip navigation system (navigation group; n = 55) or conventional technique (conventional group; n = 55). THA was conducted in the lateral position and through posterior approach. The cup position was determined postoperatively on pelvic radiograph and computed tomography scans. RESULTS An average cup abduction of 39.2° ± 4.6° (range, 27° to 50°) and an average cup anteversion of 14.6° ± 6.1° (range, 1° to 27.5°) were found in the navigation group, and an average cup abduction of 42.9° ± 8.0° (range, 23° to 73°) and an average cup anteversion of 11.6° ± 7.7° (range, -12.1° to 25°) in the conventional group. A smaller variation in the navigation group was indicated for cup abduction (P = .001). The deviations from the target cup position were significantly lower in the navigation group (P = .001, .016). While only 37 of 55 cups in the conventional group were inside the Lewinnek safe zone, 51 of 55 cups in the navigation group were placed inside this safe zone (P = .006). The navigation procedure took a mean of 10 minutes longer than the conventional technique. CONCLUSION Use of the portable, accelerometer-based hip navigation system can improve cup positioning in THA.
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Affiliation(s)
- Hiromasa Tanino
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Yasuhiro Nishida
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Ryo Mitsutake
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroshi Ito
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Japan
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Recent Trends, Technical Concepts and Components of Computer-Assisted Orthopedic Surgery Systems: A Comprehensive Review. SENSORS 2019; 19:s19235199. [PMID: 31783631 PMCID: PMC6929084 DOI: 10.3390/s19235199] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/08/2019] [Accepted: 11/12/2019] [Indexed: 12/17/2022]
Abstract
Computer-assisted orthopedic surgery (CAOS) systems have become one of the most important and challenging types of system in clinical orthopedics, as they enable precise treatment of musculoskeletal diseases, employing modern clinical navigation systems and surgical tools. This paper brings a comprehensive review of recent trends and possibilities of CAOS systems. There are three types of the surgical planning systems, including: systems based on the volumetric images (computer tomography (CT), magnetic resonance imaging (MRI) or ultrasound images), further systems utilize either 2D or 3D fluoroscopic images, and the last one utilizes the kinetic information about the joints and morphological information about the target bones. This complex review is focused on three fundamental aspects of CAOS systems: their essential components, types of CAOS systems, and mechanical tools used in CAOS systems. In this review, we also outline the possibilities for using ultrasound computer-assisted orthopedic surgery (UCAOS) systems as an alternative to conventionally used CAOS systems.
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Oh KJ, Kim BK, Jo MI, Ahn BM. Which one is more affected by navigation-assisted cup positioning in total hip arthroplasty: Anteversion or inclination? A retrospective matched-pair cohort study in Asian physique. J Orthop Surg (Hong Kong) 2019; 26:2309499018780755. [PMID: 29890935 DOI: 10.1177/2309499018780755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The purpose of this study was to compare acetabular cup positioning using an imageless navigation-assisted total hip arthroplasty (THA) to a case-matched control group using the conventional technique in Asian physique. METHODS Case matching controlled study using retrospectively collected data for THAs was done. Matching criteria were gender, age ± 5 years, and body mass index ± 5 kg/m2. Thirty patients who had navigation THAs were manually matched to a conventional group of 30 patients. After measuring anteversion and inclination on 3-D CT, final cup anteversion was calculated using the mathematical formula (anteversion = arctan [tan (anatomic anteversion) × sin (inclination)]). RESULTS No significant difference was observed between mean inclination ( p = 0.420), anteversion ( p = 0.697), and the mean deviation from 15° for anteversion ( p = 0.649). However, there was a statistical significant difference for mean deviation from 40° for inclination ( p = 0.027). There was a significant difference in the percentage of correctly placed acetabular cup in safe zones with inclination ( p = 0.039). CONCLUSIONS Although soft tissue overlying the pubic tubercle interfered with registration of the bony landmark and thereby induced inaccuracy of anteversion angles in the navigation group, the use of imageless navigation-assisted technique increases the placement within the safe zone for inclination and enhances the accuracy and the precision of inclination of the acetabular cup relative to the conventional THA rather than anteversion. This finding may be due to the effect of the patient's physique on the anterior pelvic plane (APP)-based reference system of imageless navigation.
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Affiliation(s)
- Kwang Jun Oh
- Department of Orthopaedic Surgery, Joint Center, Sungmin General Hospital, Incheon City, Republic of Korea
| | - Byung Kag Kim
- Department of Orthopaedic Surgery, Joint Center, Sungmin General Hospital, Incheon City, Republic of Korea
| | - Myung Il Jo
- Department of Orthopaedic Surgery, Joint Center, Sungmin General Hospital, Incheon City, Republic of Korea
| | - Byung Mun Ahn
- Department of Orthopaedic Surgery, Joint Center, Sungmin General Hospital, Incheon City, Republic of Korea
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Wasterlain AS, Buza JA, Thakkar SC, Schwarzkopf R, Vigdorchik J. Navigation and Robotics in Total Hip Arthroplasty. JBJS Rev 2019; 5:01874474-201703000-00002. [PMID: 28359074 DOI: 10.2106/jbjs.rvw.16.00046] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Amy S Wasterlain
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
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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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Chen CL, Han PF, Zhang ZL, Sun XJ, Lv Z. Clinical efficacy of OrthoPilot navigation system versus conventional manual total hip arthroplasty: A systematic review and meta-analysis. J Int Med Res 2019; 47:505-514. [PMID: 30616454 PMCID: PMC6381494 DOI: 10.1177/0300060518819378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective This study was performed to compare the clinical efficacy between the OrthoPilot navigation system and conventional manual surgery in patients undergoing total hip arthroplasty. Methods The Embase, PubMed, CINAHL, and Cochrane databases were searched for clinical trials. The outcome measurements were the anteversion angle, inclination angle, and complications. Review Manager 5.3 statistical software was used for the data analysis. Results Significant differences were found in the femoral offset and overall complication rate between the conventional and navigation groups. Additionally, the conventional group had significantly less anteversion than the navigation group. However, the navigation group had significantly better inclination. The operation time was significantly shorter in the conventional than navigation group. Conclusion Both the OrthoPilot navigation system and conventional total hip arthroplasty result in significant improvements in patient function with similar overall complication rates and have their own advantages in achieving good cup position. The conventional procedure has a shorter operation time than does use of a navigation system.
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Affiliation(s)
- Cheng-Long Chen
- 1 Department of Orthopaedic Surgery, the Second Clinical Medical College of Shanxi Medical University, TaiYuan, China.,These authors contributed equally to this work
| | - Peng-Fei Han
- 1 Department of Orthopaedic Surgery, the Second Clinical Medical College of Shanxi Medical University, TaiYuan, China.,These authors contributed equally to this work
| | - Zhi-Liang Zhang
- 1 Department of Orthopaedic Surgery, the Second Clinical Medical College of Shanxi Medical University, TaiYuan, China
| | - Xiao-Juan Sun
- 2 Department of Orthopaedics, The Alpert Medical School of Brown University, Providence, RI, USA.,3 Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, TaiYuan, China
| | - Zhi Lv
- 4 Department of Orthopaedics, the Second Hospital of Shanxi Medical University, TaiYuan, China
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Nakahara I, Kyo T, Kuroda Y, Miki H. Effect of improved navigation performance on the accuracy of implant placement in total hip arthroplasty with a CT-based navigation system. J Artif Organs 2018; 21:340-347. [PMID: 29611147 DOI: 10.1007/s10047-018-1041-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 03/27/2018] [Indexed: 12/28/2022]
Abstract
A computed tomography (CT)-based navigation system is one of the support tools to place implant with appropriate alignment and position in total hip arthroplasty (THA). To determine whether the higher performance of the navigation would further improve the accuracy of implant placement in the clinical setting, we retrospectively compared the navigation accuracy of two different versions of a navigation system. The newer version of the navigation system had an upgraded optical sensor with superior positional accuracy. Navigation accuracy, defined as differences between postoperative measurements on CT images and intraoperative records on the navigation system, of 49 THAs performed with the newer version of the navigation system was compared with that of 49 THAs performed with the older version. With the newer version, the mean absolute accuracy (95% limits of agreement) of implant alignment was 1.2° (± 3.3°) for cup inclination, 1.0° (± 2.4°) for cup anteversion, 2.0° (± 4.9°) for stem anteversion, and 1.1° (± 2.4°) for stem valgus angle. The accuracy of the implant position was 1.5 mm (± 3.1 mm), 1.3 mm (± 3.0 mm), and 1.5 mm (± 3.1 mm) for cup x-, y-, and z-axes, respectively, 1.6 mm (± 3.2 mm), 1.4 mm (± 2.9 mm), and 1.5 mm (± 2.7 mm) for stem x-, y-, and z-axes, respectively, and 2.4 mm (± 4.5 mm) for leg length discrepancy. The values for the newer version were significantly more accurate with less variation compared to those of the older version. With upgraded navigation performance, more accurate implant placement was demonstrated in the clinical setting.
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Affiliation(s)
- Ichiro Nakahara
- Department of Orthopaedic Surgery, Osaka National Hospital, 2-1-14 oenzaka, Chuo-ku, Osaka, 5400006, Japan.
| | - Takayuki Kyo
- Department of Orthopaedic Surgery, Bellland General Hospital, 500-3 Higashiyama, Naka-ku, Sakai-city, Osaka, Japan
| | - Yasuo Kuroda
- Department of Orthopaedic Surgery, Osaka National Hospital, 2-1-14 oenzaka, Chuo-ku, Osaka, 5400006, Japan
| | - Hidenobu Miki
- Department of Orthopaedic Surgery, Osaka National Hospital, 2-1-14 oenzaka, Chuo-ku, Osaka, 5400006, Japan
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Tsutsui T, Goto T, Wada K, Takasago T, Hamada D, Sairyo K. Efficacy of a computed tomography-based navigation system for placement of the acetabular component in total hip arthroplasty for developmental dysplasia of the hip. J Orthop Surg (Hong Kong) 2018; 25:2309499017727954. [PMID: 28851263 DOI: 10.1177/2309499017727954] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Developmental dysplasia of the hip (DDH) presents a considerable surgical challenge in total hip arthroplasty (THA). Although the usefulness of computed tomography (CT)-based navigation in cup alignment has been reported, few reports have evaluated three-dimensional (3-D) cup positioning against the acetabulum specifically in patients with DDH. The purpose of this study was to evaluate the efficacy of a CT-based navigation system for alignment and spatial positioning of the cup in THA for patients with DDH. METHODS We reviewed 174 DDH THA cases in which CT-based navigation was used, and 75 cases in which a mechanical guide was used as a control group. Postoperative cup alignment and spatial positioning were evaluated by superimposition of a 3-D cup template onto the actual implanted cup using postoperative CT images, with pelvic coordinates matching the preoperative planning. RESULTS The proportion within the combined target zone (inclination and anteversion) was 97.7% in the navigation group and 61.3% in the non-navigation group. The mean absolute error between the intraoperative record and the postoperative measurement was 1.5° ± 1.3° for inclination and 2.1° ± 1.8° for anteversion in the navigation group. For acetabular cup positioning, the mean discrepancy between the preoperative planning and the postoperative measurements was 1.9 ± 1.6 mm on the transverse axis, 2.8 ± 2.3 mm on the longitudinal axis, and 1.7 ± 1.3 mm on the sagittal axis. CONCLUSION THA using a CT-based navigation system achieved quite high accuracy of cup alignment angles and spatial cup positioning in primary THA for patients with DDH.
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Affiliation(s)
- Takahiko Tsutsui
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tomohiro Goto
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Keizo Wada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tomoya Takasago
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Daisuke Hamada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Fotouhi J, Alexander CP, Unberath M, Taylor G, Lee SC, Fuerst B, Johnson A, Osgood G, Taylor RH, Khanuja H, Armand M, Navab N. Plan in 2-D, execute in 3-D: an augmented reality solution for cup placement in total hip arthroplasty. J Med Imaging (Bellingham) 2018; 5:021205. [PMID: 29322072 DOI: 10.1117/1.jmi.5.2.021205] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/12/2017] [Indexed: 01/15/2023] Open
Abstract
Reproducibly achieving proper implant alignment is a critical step in total hip arthroplasty procedures that has been shown to substantially affect patient outcome. In current practice, correct alignment of the acetabular cup is verified in C-arm x-ray images that are acquired in an anterior-posterior (AP) view. Favorable surgical outcome is, therefore, heavily dependent on the surgeon's experience in understanding the 3-D orientation of a hemispheric implant from 2-D AP projection images. This work proposes an easy to use intraoperative component planning system based on two C-arm x-ray images that are combined with 3-D augmented reality (AR) visualization that simplifies impactor and cup placement according to the planning by providing a real-time RGBD data overlay. We evaluate the feasibility of our system in a user study comprising four orthopedic surgeons at the Johns Hopkins Hospital and report errors in translation, anteversion, and abduction as low as 1.98 mm, 1.10 deg, and 0.53 deg, respectively. The promising performance of this AR solution shows that deploying this system could eliminate the need for excessive radiation, simplify the intervention, and enable reproducibly accurate placement of acetabular implants.
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Affiliation(s)
- Javad Fotouhi
- Johns Hopkins University, Computer Aided Medical Procedures, Baltimore, United States
| | - Clayton P Alexander
- Johns Hopkins Hospital, Department of Orthopaedic Surgery, Baltimore, United States
| | - Mathias Unberath
- Johns Hopkins University, Computer Aided Medical Procedures, Baltimore, United States
| | - Giacomo Taylor
- Johns Hopkins University, Computer Aided Medical Procedures, Baltimore, United States
| | - Sing Chun Lee
- Johns Hopkins University, Computer Aided Medical Procedures, Baltimore, United States
| | - Bernhard Fuerst
- Johns Hopkins University, Computer Aided Medical Procedures, Baltimore, United States
| | - Alex Johnson
- Johns Hopkins Hospital, Department of Orthopaedic Surgery, Baltimore, United States
| | - Greg Osgood
- Johns Hopkins Hospital, Department of Orthopaedic Surgery, Baltimore, United States
| | - Russell H Taylor
- Johns Hopkins University, Laboratory for Computational Sensing and Robotics, Baltimore, United States
| | - Harpal Khanuja
- Johns Hopkins Hospital, Department of Orthopaedic Surgery, Baltimore, United States
| | - Mehran Armand
- Johns Hopkins University, Laboratory for Computational Sensing and Robotics, Baltimore, United States.,Johns Hopkins University, Applied Physics Laboratory, Laurel, Maryland, United States
| | - Nassir Navab
- Johns Hopkins University, Computer Aided Medical Procedures, Baltimore, United States.,Technische Universität München, Computer Aided Medical Procedures, Munich, Germany
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Yamada K, Endo H, Tetsunaga T, Miyake T, Sanki T, Ozaki T. Accuracy of Cup Positioning With the Computed Tomography-Based Two-dimensional to Three-Dimensional Matched Navigation System: A Prospective, Randomized Controlled Study. J Arthroplasty 2018; 33:136-143. [PMID: 28870743 DOI: 10.1016/j.arth.2017.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The accuracy of various navigation systems used for total hip arthroplasty has been described, but no publications reported the accuracy of cup orientation in computed tomography (CT)-based 2D-3D (two-dimensional to three-dimensional) matched navigation. METHODS In a prospective, randomized controlled study, 80 hips including 44 with developmental dysplasia of the hips were divided into a CT-based 2D-3D matched navigation group (2D-3D group) and a paired-point matched navigation group (PPM group). The accuracy of cup orientation (absolute difference between the intraoperative record and the postoperative measurement) was compared between groups. Additionally, multiple logistic regression analysis was performed to evaluate patient factors affecting the accuracy of cup orientation in each navigation. RESULTS The accuracy of cup inclination was 2.5° ± 2.2° in the 2D-3D group and 4.6° ± 3.3° in the PPM group (P = .0016). The accuracy of cup anteversion was 2.3° ± 1.7° in the 2D-3D group and 4.4° ± 3.3° in the PPM group (P = .0009). In the PPM group, the presence of roof osteophytes decreased the accuracy of cup inclination (odds ratio 8.27, P = .0140) and the absolute value of pelvic tilt had a negative influence on the accuracy of cup anteversion (odds ratio 1.27, P = .0222). In the 2D-3D group, patient factors had no effect on the accuracy of cup orientation. CONCLUSION The accuracy of cup positioning in CT-based 2D-3D matched navigation was better than in paired-point matched navigation, and was not affected by patient factors. It is a useful system for even severely deformed pelvises such as developmental dysplasia of the hips.
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Affiliation(s)
- Kazuki Yamada
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Hirosuke Endo
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Tomonori Tetsunaga
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Takamasa Miyake
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Tomoaki Sanki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Okayama, Japan
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Davenport D, Kavarthapu V. Computer navigation of the acetabular component in total hip arthroplasty: a narrative review. EFORT Open Rev 2017; 1:279-285. [PMID: 28670481 PMCID: PMC5467635 DOI: 10.1302/2058-5241.1.000050] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Total hip arthroplasty (THA) is a common procedure for primary osteoarthritis, but increasing numbers are also being performed for other pathologies such as secondary arthritis, inflammatory arthropathies and trauma. Estimates suggest that around 8.5 million people in the UK are affected by joint pain secondary to arthritis and a rising ageing population has resulted in an increase in THA operations of around 4% per year over the last six years. Multiple studies have shown that THA provides improved quality of life scores, but there remains the burden of complications which account for 15% of £1bn NHS liability payouts. DaPalma et al analysed the financial impact of complications following THA and found the additional cost of a dislocation within six weeks of surgery is 342% of the primary cost. Following primary THA, complications may occur as a result of incorrect component positioning of the femoral stem, the acetabular cup or both. It is known that acetabular malposition may lead to increased rates of dislocation, impingement, edge-loading, polyethylene wear, pelvic osteolysis and prosthesis failure. Acetabular component positioning has been described as the single most important factor in dictating risk of dislocation following THA. Furthermore, instability and dislocation after primary THA is the most common single reason for revision surgery accounting for 22.5% of all revisions and 33% of acetabular revisions. We outline the currently available methods of acetabular navigation comparing freehand techniques with computer and robotic-assisted navigation of the acetabular component.
Cite this article: Davenport D, Kavarthapu V. Computer navigation of the acetabular component in total hip arthroplasty: a narrative review. EFORT Open Rev 2016;1:279-285. DOI: 10.1302/2058-5241.1.000050.
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Affiliation(s)
- Dominic Davenport
- Department of Trauma & Orthopaedics, Princess Royal University Hospital & King's College Hospital, UK
| | - Venu Kavarthapu
- Department of Trauma & Orthopaedics, Princess Royal University Hospital & King's College Hospital, UK
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Snijders T, van Gaalen S, de Gast A. Precision and accuracy of imageless navigation versus freehand implantation of total hip arthroplasty: A systematic review and meta-analysis. Int J Med Robot 2017; 13. [DOI: 10.1002/rcs.1843] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 03/27/2017] [Accepted: 04/24/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Thom Snijders
- Clinical Orthopedic Research Center - mN, Orthopedics; Zeist 3707 HL Netherlands
- Diakonessenhuis Utrecht Zeist Doorn - Locatie Zeist; Zeist 3700 BA Netherlands
| | - S.M. van Gaalen
- Clinical Orthopedic Research Center - mN, Orthopedics; Zeist 3707 HL Netherlands
| | - A. de Gast
- Clinical Orthopedic Research Center - mN, Orthopedics; Zeist 3707 HL Netherlands
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Davis ET, Schubert M, Wegner M, Haimerl M. A new method of registration in navigated hip arthroplasty without the need to register the anterior pelvic plane. J Arthroplasty 2015; 30:55-60. [PMID: 25311163 DOI: 10.1016/j.arth.2014.08.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 05/28/2014] [Accepted: 08/15/2014] [Indexed: 02/01/2023] Open
Abstract
A prospective clinical study of 50 patients was conducted to validate a new method of imageless computer navigated hip arthroplasty. The new method enables the surgeon to acquire all registration points with the patient positioned and draped in lateral decubitus position. The final component orientation was measured from post-operative CT scans. The mean error in component position was -1.1° (SD 3.1°) for inclination and 0.9° (SD 4.3°) for anteversion. This compared favourably with the error of -1.8° (SD 1.8°) for inclination and -4.8° (SD 2.7°) for anteversion when using the traditional APP registration. Results show that one can expect the acetabular component to be within a safe zone of ±10° in 99.8% for inclination and 97.7% for anteversion when using the new lateral registration method. Level of Evidence Level II, Prognostic study.
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Affiliation(s)
- Edward T Davis
- The Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, Birmingham, UK; The Dudley Group NHS Foundation Trust, Dudley, West Midlands, UK
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Tischler EH, Orozco F, Aggarwal VK, Pacheco H, Post Z, Ong A. Does intraoperative fluoroscopy improve component positioning in total hip arthroplasty? Orthopedics 2015; 38:e1-6. [PMID: 25611413 DOI: 10.3928/01477447-20150105-52] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 03/25/2014] [Indexed: 02/03/2023]
Abstract
Accurate placement of components is imperative for successful outcomes after total hip arthroplasty (THA). Although technology-assisted techniques offer the potential for greater accuracy in prosthesis positioning, the need for additional resources prevents their widespread use. The goal of this study was to compare primary THA procedures performed with and without intraoperative fluoroscopic guidance with regard to accuracy of prosthesis placement, operative time, and postoperative complications. The authors reviewed 341 consecutive cases (330 patients) undergoing primary THA at the authors' institution from September 2007 to January 2010. Postoperative anteroposterior radiographs were used to measure acetabular inclination angle, leg length discrepancy, and femoral offset discrepancy. Operative time and postoperative complications related to implant positioning were recorded. Mean acetabular inclination angle, leg length discrepancy, and offset discrepancy for control vs study groups were 43.0° (range, 32.2°-61.4°) vs 43.8° (range, 29.0°-55.1°), 4.75 mm (range, 0-25) vs 4.24 mm (range, 0-27), and 8.47 mm (range, 0-9.7) vs 7.70 mm (range, 0-31), respectively. Complication rates were not significantly different between the control (8.1%) and study (5.3%) groups. Mean operative time was significantly higher in the study group compared with the control group (59.8 vs 52.8 minutes) (P<.0001). The findings showed that intraoperative fluoroscopy may not improve prosthesis accuracy or decrease postoperative complication rates compared with a freehand technique. Because of significantly increased operative time and cost associated with fluoroscopic guidance, the authors discourage the use of this technique in uncomplicated primary THA performed at high-volume arthroplasty institutions.
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Murayama T, Ohnishi H, Mori T, Okazaki Y, Sujita K, Sakai A. A novel non-invasive mechanical technique of cup and stem placement and leg length adjustment in total hip arthroplasty for dysplastic hips. INTERNATIONAL ORTHOPAEDICS 2014; 39:1057-64. [PMID: 25488511 DOI: 10.1007/s00264-014-2613-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 11/23/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE This study assessed the accuracy of cup and stem positioning and limb length adjustment for developmental dysplasia of the hip (DDH) using our new mechanical technique compared with imageless navigation or a computed tomography (CT)-based navigation system. METHODS One hundred thirteen primary total hip arthroplasties (THAs) for DDH were evaluated. At pre-operative positioning, patients were placed in a precise lateral decubitus position by tilting the surgical table using simple ready-made devices (two shot pipe, metal chain, level gauge and goniometer). During surgery, cups were intentionally placed at 45° inclination and 15° anteversion on radiograph by using a level gauge and goniometer. RESULTS Cup inclination was 44.2° ± 3.4° (range, 32.0-51.2°), cup anteversion was 19.6° ± 6.1° (range, 3.0-33.1°), stem alignment was 0.04° ± 0.8° valgus (range, 2.1° varus to 1.9° valgus), and leg length discrepancy was -0.37 ± 3.7 mm (range, -12.8 to 8.8 mm) in postoperative radiographs. Outliers (outside ±10° from intentional position) occurred in 15 cases (13.3 %) in inclination or anteversion. Postoperative dislocation did not occur in any cases. CONCLUSIONS Cup and stem positioning in THAs with our new mechanical technique yielded satisfactory results compared with previously reported imageless navigation or CT-based navigation. Our results were superior with regard to being non-invasive and low cost and involving minimum radiation exposure.
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Affiliation(s)
- Takashi Murayama
- Orthopaedic Surgery, Makiyama Central Hospital, 13-13 Hatsunechou, Tobata-ku, Kitakyushu, 804-0066, Japan,
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Hassani H, Cherix S, Ek ET, Rüdiger HA. Comparisons of preoperative three-dimensional planning and surgical reconstruction in primary cementless total hip arthroplasty. J Arthroplasty 2014; 29:1273-7. [PMID: 24502952 DOI: 10.1016/j.arth.2013.12.033] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 12/15/2013] [Accepted: 12/30/2013] [Indexed: 02/01/2023] Open
Abstract
Reconstruction of important parameters such as femoral offset and torsion is inaccurate, when templating is based on plain x-rays. We evaluate intraoperative reproducibility of pre-operative CT-based 3D-templating in a consecutive series of 50 patients undergoing primary cementless THA through an anterior approach. Pre-operative planning was compared to a postoperative CT scan by image fusion. The implant size was correctly predicted in 100% of the stems, 94% of the cups and 88% of the heads (length). The difference between the planned and the postoperative leg length was 0.3 + 2.3 mm. Values for overall offset, femoral anteversion, cup inclination and anteversion were 1.4 mm ± 3.1, 0.6° ± 3.3°, -0.4° ± 5° and 6.9° ± 11.4°, respectively. This planning allows accurate implant size prediction. Stem position and cup inclination are accurately reproducible.
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Affiliation(s)
- Hassen Hassani
- Department of Orthopaedics Hôpital Orthopédique-Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland
| | - Stéphane Cherix
- Department of Orthopaedics Hôpital Orthopédique-Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland
| | - Eugene T Ek
- Melbourne Orthopaedic Group and Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Melbourne, Australia
| | - Hannes A Rüdiger
- Department of Orthopaedics Hôpital Orthopédique-Centre Hospitalier Universitaire Vaudois, University of Lausanne, 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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Griffin AR, Perriman DM, Bolton CJ, Smith PN. An in vivo comparison of the orientation of the transverse acetabular ligament and the acetabulum. J Arthroplasty 2014; 29:574-9. [PMID: 24051239 DOI: 10.1016/j.arth.2013.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 06/28/2013] [Accepted: 08/01/2013] [Indexed: 02/01/2023] Open
Abstract
Aligning the acetabular component with the Transverse Acetabular Ligament (TAL) to ensure optimal anteversion has been reported to reduce dislocation rates. However, to our knowledge in vivo measurement of the TAL angle has not yet been reported in a large cohort of normal hips. CT scans of 218 normal hips were analyzed. The TAL and four acetabular rim anteversion angles were measured (superiorly to inferiorly) relative to the anterior pelvic plane. The mean TAL anteversion angle was 20.5° ± 7.0°, and the acetabular rim angles from superior to inferior were 11.0° ± 12.9°, 19.9° ± 8.8°, 20.9° ± 6.2° and 25.1° ± 6.2° respectively. Both the TAL and the acetabular rim were significantly more anteverted in females than in males. The TAL anteversion angle was comparable to the predominant orientation (central rim section) of the native acetabulum while the superior acetabulum was comparatively retroverted and the inferior was relatively more anteverted.
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Affiliation(s)
- Andrew R Griffin
- Trauma and Orthopaedic Research Unit, The Canberra Hospital, Canberra, Australia; Department of Medicine, Australian National University, Canberra, Australia
| | - Diana M Perriman
- Trauma and Orthopaedic Research Unit, The Canberra Hospital, Canberra, Australia; Department of Medicine, Australian National University, Canberra, Australia
| | - Claire J Bolton
- Trauma and Orthopaedic Research Unit, The Canberra Hospital, Canberra, Australia; Department of Medicine, Australian National University, Canberra, Australia
| | - Paul N Smith
- Trauma and Orthopaedic Research Unit, The Canberra Hospital, Canberra, Australia; Department of Medicine, Australian National University, Canberra, Australia
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Mavrogenis AF, Savvidou OD, Mimidis G, Papanastasiou J, Koulalis D, Demertzis N, Papagelopoulos PJ. Computer-assisted navigation in orthopedic surgery. Orthopedics 2013; 36:631-42. [PMID: 23937743 DOI: 10.3928/01477447-20130724-10] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Computer-assisted navigation has a role in some orthopedic procedures. It allows the surgeons to obtain real-time feedback and offers the potential to decrease intra-operative errors and optimize the surgical result. Computer-assisted navigation systems can be active or passive. Active navigation systems can either perform surgical tasks or prohibit the surgeon from moving past a predefined zone. Passive navigation systems provide intraoperative information, which is displayed on a monitor, but the surgeon is free to make any decisions he or she deems necessary. This article reviews the available types of computer-assisted navigation, summarizes the clinical applications and reviews the results of related series using navigation, and informs surgeons of the disadvantages and pitfalls of computer-assisted navigation in orthopedic surgery.
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39
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Li YL, Jia J, Wu Q, Ning GZ, Wu QL, Feng SQ. Evidence-based computer-navigated total hip arthroplasty: an updated analysis of randomized controlled trials. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:531-8. [DOI: 10.1007/s00590-013-1222-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/07/2013] [Indexed: 11/28/2022]
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40
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Sugano N. Computer-assisted orthopaedic surgery and robotic surgery in total hip arthroplasty. Clin Orthop Surg 2013; 5:1-9. [PMID: 23467021 PMCID: PMC3582865 DOI: 10.4055/cios.2013.5.1.1] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 07/23/2012] [Indexed: 11/30/2022] Open
Abstract
Various systems of computer-assisted orthopaedic surgery (CAOS) in total hip arthroplasty (THA) were reviewed. The first clinically applied system was an active robotic system (ROBODOC), which performed femoral implant cavity preparation as programmed preoperatively. Several reports on cementless THA with ROBODOC showed better stem alignment and less variance in limb-length inequality on radiographic evaluation, less incidence of pulmonary embolic events on transesophageal cardioechogram, and less stress shielding on the dual energy X-ray absorptiometry analysis than conventional manual methods. On the other hand, some studies raise issues with active systems, including a steep learning curve, muscle and nerve damage, and technical complications, such as a procedure stop due to a bone motion during cutting, requiring re-registration and registration failure. Semi-active robotic systems, such as Acrobot and Rio, were developed for ease of surgeon acceptance. The drill bit at the tip of the robotic arm is moved by a surgeon's hand, but it does not move outside of a milling path boundary, which is defined according to three-dimensional (3D) image-based preoperative planning. However, there are still few reports on THA with these semi-active systems. Thanks to the advancements in 3D sensor technology, navigation systems were developed. Navigation is a passive system, which does not perform any actions on patients. It only provides information and guidance to the surgeon who still uses conventional tools to perform the surgery. There are three types of navigation: computed tomography (CT)-based navigation, imageless navigation, and fluoro-navigation. CT-based navigation is the most accurate, but the preoperative planning on CT images takes time that increases cost and radiation exposure. Imageless navigation does not use CT images, but its accuracy depends on the technique of landmark pointing, and it does not take into account the individual uniqueness of the anatomy. Fluoroscopic navigation is good for trauma and spine surgeries, but its benefits are limited in the hip and knee reconstruction surgeries. Several studies have shown that the cup alignment with navigation is more precise than that of the conventional mechanical instruments, and that it is useful for optimizing limb length, range of motion, and stability. Recently, patient specific templates, based on CT images, have attracted attention and some early reports on cup placement, and resurfacing showed improved accuracy of the procedures. These various CAOS systems have pros and cons. Nonetheless, CAOS is a useful tool to help surgeons perform accurately what surgeons want to do in order to better achieve their clinical objectives. Thus, it is important that the surgeon fully understands what he or she should be trying to achieve in THA for each patient.
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Affiliation(s)
- Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan.
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Kajino Y, Kabata T, Maeda T, Iwai S, Kuroda K, Tsuchiya H. Does degree of the pelvic deformity affect the accuracy of computed tomography-based hip navigation? J Arthroplasty 2012; 27:1651-7. [PMID: 22552221 DOI: 10.1016/j.arth.2012.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 03/08/2012] [Indexed: 02/01/2023] Open
Abstract
Although some navigation systems have been used for improvement of component positioning, there have been few reports regarding cases of severe pelvic deformity. We performed a retrospective review of 25 cases of total hip arthroplasty with a computed tomography-based navigation system in patients with severe pelvic deformities and estimated acetabular component position and angle between severe deformity group and mild dysplastic group as a control. There were no significant differences in accuracy of navigation system between 2 groups in terms of 3-dimensional component position or angle. Accuracy of computed tomography-based hip navigation does not depend on the degree of pelvic deformity, and this system is also useful to identify acetabular orientation and for precise component implantation in cases of pelvic deformity.
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Affiliation(s)
- Yoshitomo Kajino
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
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Hausselle J, Moreau PE, Wessely L, de Thomasson E, Assi A, Parratte S, Essig J, Skalli W. Intra- and extra-articular planes of reference for use in total hip arthroplasty: a preliminary study. INTERNATIONAL ORTHOPAEDICS 2012; 36:1567-73. [PMID: 22434132 PMCID: PMC3535022 DOI: 10.1007/s00264-012-1516-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 02/13/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Acetabular component malalignment in total hip arthroplasty can lead to potential complications such as dislocation, component impingement and excessive wear. Computer-assisted orthopaedic surgery systems generally use the anterior pelvic plane (APP). Our aim was to investigate the reliability of anatomical landmarks accessible during surgery and to define new potential planes of reference. METHODS Three types of palpations were performed: virtual, on dry bones and on two cadaveric specimens. Four landmarks were selected, the reproducibility of their positioning ranging from 0.9 to 2.3 mm. We then defined five planes and tested them during palpations on two cadaveric specimens. RESULTS Two planes produced a mean orientation error of 5.0° [standard deviation (SD 3.3°)] and 5.6° (SD 2.7°). CONCLUSIONS Even if further studies are needed to test the reliability of such planes on a larger scale in vivo during surgery, these results demonstrated the feasibility of defining a new plane of reference as an alternative to the APP.
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Affiliation(s)
- Jerome Hausselle
- />LBM, Arts et Metiers ParisTech, 151 bd de l’Hôpital, 75013 Paris, France
| | - Pierre Etienne Moreau
- />Polyclinique Saint Roch, 43 rue du Faubourg Saint Jaumes, 34000 Montpellier, France
| | - Loic Wessely
- />Polyclinique Keraudren, rue Ernestine de Tremaudan, 29200 Brest, France
| | | | - Ayman Assi
- />LBM, Arts et Metiers ParisTech, 151 bd de l’Hôpital, 75013 Paris, France
| | - Sebastien Parratte
- />Institut du Mouvement et de l’Appareil Locomoteur, 270 bd Sainte marguerite, 13009 Marseille, France
| | - Jerome Essig
- />Clinique Médipôle Garonne, 45 rue de Gironis, 31100 Toulouse, France
| | - Wafa Skalli
- />LBM, Arts et Metiers ParisTech, 151 bd de l’Hôpital, 75013 Paris, France
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Hirschmann MT, Afifi FK, Helfrich C, Wirz D, Schwägli T, Overhoff HM, Moser W, Friederich NF. Navigated total hip arthroplasty using a 3-D freehand ultrasound system: technical note and preliminary results. Orthopedics 2011; 34:e816-20. [PMID: 22146195 DOI: 10.3928/01477447-20111021-08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ultrasound-navigated cementless total hip arthroplasty (THA) was performed in 10 consecutive patients with primary osteoarthritis of the hip between August 2008 and October 2009 (M:F, 6:4; median age, 61 years; age range, 30-86 years). The pelvic orientation was defined by preoperative digitization and registration of bony landmarks. Cup inclination and anteversion were documented for each patient intraoperatively (epidigitized vs ultrasound-assessed landmarks). The median difference between the palpated and ultrasound anterior pelvic plane was 8° (range, 4°-18°) for pelvic tilt (rotation around the transversal axis), 1° (range, -3° to 2°) for rotation around the longitudinal axis, and 0.25° (range, -2.0° to 5.0°) for rotation around the sagittal axis. The median difference in cup orientation resulting from pelvic tilt error was 6° (range, 3°-13°) for anteversion and 3° (range, -1° to 5°) for inclination. There were no intra- or postoperative complications. The measured width of soft tissue layer anterior to the pelvic symphysis correlated significantly with the measured difference in cup inclination and anteversion. One centimeter of soft tissue anterior to the symphysis resulted in a median 2° (range, 1.75°-2.3°) difference in pelvic tilt. Ultrasound-assisted navigation in THA is a promising technology able to eliminate systematic errors in anterior pelvic plane orientation, in contrast to conventionally navigated THA using percutaneous palpation of landmarks or THA without navigational support.
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Affiliation(s)
- Michael T Hirschmann
- Department of OrthopaedicSurgery and Traumatology, Kantonsspital Bruderholz, CH-4101 Bruderholz, Switzerland.
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Schumann S, Nolte LP, Zheng G. Determination of pelvic orientation from sparse ultrasound data for THA operated in the lateral position. Int J Med Robot 2011; 8:107-13. [DOI: 10.1002/rcs.443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2011] [Indexed: 11/07/2022]
Affiliation(s)
- 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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