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García-Rey E, Saldaña L. Spinopelvic interactions in total hip arthroplasty: 295 patients followed for a minimum follow-up of 10 years. Hip Int 2024; 34:487-497. [PMID: 38695378 DOI: 10.1177/11207000241248074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND Concurrent spinal pathology is frequent in patients undergoing total hip arthroplasty (THA). In this study we examined whether spinopelvic interactions affect THA outcomes at a minimum follow-up of 10 years. PATIENTS AND METHODS 295 patients with a mean age of 63.3 (range 56‒80) years receiving a THA between 2006 and 2009 were assessed. Of these, 195 had mild lumbar disc degeneration and 100 had advanced lumbar spondylosis. We analysed the changes in the Harris Hip Score (HHS) and the survival rate for postoperative low back pain (LBP) and dislocation. Changes in acetabular component position, sacro-femoral-pubic (SFP) and pelvic obliquity (PO) angles were assessed with radiological images. RESULTS The mean HHS was lower in female patients (p = 0.009), patients >65 years of age (p < 0.001) and those with advanced lumbar spondylosis (p = 0.002). 52 (71.2%) of the patients reporting preoperative LBP experienced improvement after THA while 47 (21.1%) of those without preoperative LBP postoperatively reported new onset LBP. Female patients (p = 0.025; hazard ratio [HR]: 1.831; 95% CI, 1.081-3.101) and those with preoperative LBP (p = 0.007; HR 2.068; 95% CI, 1.221-3.504) were at a higher risk of developing postoperative LBP at 10 years. 4 out of 9 THA dislocations were late and had shown decreasing SFP angle values over time. Acetabular component inclination and anteversion angles increased over time, whereas the SFP angle was associated with sex and age and the PO angle with age and the severity of any preoperative lumbar degeneration. CONCLUSIONS Concurrent spinal pathology influences THA outcomes at a minimum follow-up of 10 years. Sex, age, and associated lumbar degeneration can affect clinical and radiological changes over time. A decrease in SFP angle values over time was found in patients sustaining late dislocation.
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Affiliation(s)
- Eduardo García-Rey
- Orthopaedics Department, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
- Biomedical Research Networking Center-Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Laura Saldaña
- Biomedical Research Networking Center-Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- Bone Pathophysiology and Biomaterials Group, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
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Rogers N, Rullán PJ, Pasqualini I, Khan ST, Klika AK, Surace PA, Molloy RM, Piuzzi NS, Bloomfield M. Lower 90-day inpatient readmission and 1-year reoperation in patients undergoing robotic versus manual total hip arthroplasty through an anterior approach. Technol Health Care 2024; 32:3769-3781. [PMID: 38393864 DOI: 10.3233/thc-231646] [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] [Indexed: 02/25/2024]
Abstract
BACKGROUND The value of robotic-assisted total hip arthroplasty (rTHA) has yet to be determined compared to conventional manual THA (mTHA). OBJECTIVE Evaluate 90-day inpatient readmission rates, rates of reoperation, and clinically significant improvement of patient-reported outcome measures (PROMs) at 1-year in a cohort of patients who underwent mTHA or rTHA through a direct anterior (DA) approach. METHODS A single-surgeon, prospective institutional cohort of 362 patients who underwent primary THA for osteoarthritis via the DA approach between February 2019 and November 2020 were included. Patient demographics, surgical time, discharge disposition, length of stay, acetabular cup size, 90-day inpatient readmission, 1-year reoperation, and 1-year PROMs were collected for 148 manual and 214 robotic THAs, respectively. RESULTS Patients undergoing rTHA had lower 90-day readmission (3.74% vs 9.46%, p= 0.04) and lower 1-year reoperation (0.93% vs 4.73% mTHA, p= 0.04). rTHA acetabular cup sizes were smaller (rTHA median 52, interquartile range [IQR] 50; 54, mTHA median 54, IQR 52; 58, p< 0.001). Surgical time was longer for rTHA (114 minutes vs 101 minutes, p< 0.001). At 1-year post-operatively, there was no difference in any of the PROMs evaluated. CONCLUSION Robotic THA demonstrated lower 90-day readmissions and 1-year reoperation rates than manual THA via the DA approach. PROMs were not significantly different between the two groups at one year.
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Sun Z, Li N, Yang Z, Zhang W, Liu J. Anatomical cup implantation assisted with dynamic 3D planning improves functional outcomes in primary total hip arthroplasty: A retrospective study. J Back Musculoskelet Rehabil 2024; 37:295-304. [PMID: 37980641 DOI: 10.3233/bmr-230004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND Anatomical cup implantation is a promising approach in primary total hip arthroplasty (THA) and improves functional outcomes. OBJECTIVE We aimed to evaluate the cup position and functional outcomes in primary THA with preoperative dynamic 3D planning. METHODS We retrospectively reviewed 54 hips in 48 patients who underwent primary THA with anatomical cup implantation (mean follow-up time: 52 months). Cup positions were evaluated based on patient-specific morphology, the acetabular fossa and the combined anteversion test. Functional outcomes were assessed after THA. The paired-sample t-test was performed for surgical and contralateral native hips among 42 patients who underwent unilateral THA. RESULTS Two hips suffered intraoperative trochanteric fracture, but no hip dislocations occurred. No patients reported groin or thigh pain, and all patients were capable of deep squatting and one-leg standing. The mean Harris hip score, WOMAC score, and physical SF-36 score were 94.46 ± 6.16, 10.41 ± 3.62, and 95.19 ± 8.74, respectively. Except for acetabular offset, THA restored biomechanics to those of contralateral native hip, including cup anteversion, abduction, femoral offset and acetabular height (P> 0.05). CONCLUSION This study provided evidence for the application of anatomical cup implantation assisted with dynamic 3D planning in primary THA, which restored morphology and improved functional outcomes.
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Affiliation(s)
- Zhenhui Sun
- Department of Orthopaedics, Tianjin Hospital of Tianjin University, Tianjin, China
| | - Nan Li
- Department of Orthopaedics, Tianjin Hospital of Tianjin University, Tianjin, China
| | - Zhi Yang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Wenhui Zhang
- Department of Orthopaedics, People's Hospital of Gansu Province, Lanzhou, Gansu, China
| | - Jie Liu
- Department of Orthopaedics, People's Hospital of Gansu Province, Lanzhou, Gansu, China
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Heinz K, Nowack D, von Eisenhart-Rothe R, Wassilew G, Matziolis G, Brodt S. "Koehlers teardrop is not a reliable landmark for assessing the centre of rotation after Total hip arthroplasty" - a retrospective radiological study. Arch Orthop Trauma Surg 2023; 143:5671-5676. [PMID: 37099164 PMCID: PMC10449955 DOI: 10.1007/s00402-023-04859-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/25/2023] [Indexed: 04/27/2023]
Abstract
PURPOSE Various anatomical landmarks have become established in radiography for the assessment of cup positioning after total hip arthroplasty (THA). The most important one is Koehler's teardrop figure (KTF). However, there is a lack of data on the validity of this landmark, which is widely used clinically for assessing the centre of rotation of the hip. METHOD A retrospective measurement of the lateral and cranial distance of the KTF to the centre of hip rotation was performed on the basis of 250 X-ray images of patients who had undergone THA. In addition, the dependence of these distances on pelvic tilt was determined in 16 patients by means of virtual X-ray projections based on pelvic CTs. RESULTS It was shown that the distance of the KTF from the centre of hip rotation in the horizontal plane is gender-dependent (men: 42.8 ± 6.0 mm vs. women: 37.4 ± 4.7 mm; p < 0.001) and age-dependent (Pearson correlation - 0.114; p < 0.05). Furthermore, the vertical and horizontal distances are subject to variation depending on height (Pearson correlation 0.14; p < 0.05 and 0.40; p < 0.001, respectively) and weight (Pearson correlation 0.158; p < 0.05). The distance between the KTF and the centre of hip rotation varies slightly depending on pelvic tilt. CONCLUSION The KTF is not a sufficiently valid landmark for assessing the centre of rotation after THA. It is influenced by many different disturbance variables. However, it is largely robust against changes in pelvic tilt, so that it can be used as a reference point when comparing different intraindividual radiographs to assess the change in the centre of rotation due to implantation or to detect cup migration.
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Affiliation(s)
- Kristian Heinz
- Orthopaedic Department, Jena Universitiy Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany.
| | - Dimitri Nowack
- Orthopaedic Department, Jena Universitiy Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | | | - Georgi Wassilew
- Orthopaedic Department, Greifswald Universitiy, Greifswald, Germany
| | - Georg Matziolis
- Orthopaedic Department, Jena Universitiy Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
| | - Steffen Brodt
- Orthopaedic Department, Jena Universitiy Hospital, Campus Eisenberg, Klosterlausnitzer Straße 81, 07607, Eisenberg, Germany
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Buchalter DB, Gall AM, Buckland AJ, Schwarzkopf R, Meftah M, Hepinstall MS. Creating Consensus in the Definition of Spinopelvic Mobility. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202306000-00005. [PMID: 37294841 PMCID: PMC10256344 DOI: 10.5435/jaaosglobal-d-22-00290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/29/2023] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The term "spinopelvic mobility" is most often applied to motion within the spinopelvic segment. It has also been used to describe changes in pelvic tilt between various functional positions, which is influenced by motion at the hip, knee, ankle and spinopelvic segment. In the interest of establishing a consistent language for spinopelvic mobility, we sought to clarify and simplify its definition to create consensus, improve communication, and increase consistency with research into the hip-spine relationship. METHODS A literature search was performed using the Medline (PubMed) library to identify all existing articles pertaining to spinopelvic mobility. We reported on the varying definitions of spinopelvic mobility including how different radiographic imaging techniques are used to define mobility. RESULTS The search term "spinopelvic mobility" returned a total of 72 articles. The frequency and context for the varying definitions of mobility were reported. 41 papers used standing and upright relaxed-seated radiographs without the use of extreme positioning, and 17 papers discussed the use of extreme positioning to define spinopelvic mobility. DISCUSSION Our review suggests that the definitions of spinopelvic mobility is not consistent in the majority of published literature. We suggest descriptions of spinopelvic mobility independently consider spinal motion, hip motion, and pelvic position, while recognizing and describing their interdependence.
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Affiliation(s)
- Daniel B. Buchalter
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Ashley M. Gall
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Aaron J. Buckland
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Ran Schwarzkopf
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Morteza Meftah
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Matthew S. Hepinstall
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
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Characteristics of hip joint reaction forces during a range of activities. Med Eng Phys 2022; 108:103894. [DOI: 10.1016/j.medengphy.2022.103894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 11/23/2022]
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Tang A, Singh V, Sharan M, Roof MA, Mercuri JJ, Meftah M, Schwarzkopf R. The accuracy of component positioning during revision total hip arthroplasty using 3D optical computer-assisted navigation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03383-z. [PMID: 36074304 DOI: 10.1007/s00590-022-03383-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Despite the excellent outcomes associated with primary total hip arthroplasty (THA), implant failure and revision continue to burden the healthcare system. The use of computer-assisted navigation (CAN) offers the potential for more accurate placement of hip components during surgery. While intraoperative CAN systems have been shown to improve outcomes in primary THA, their use in the context of revision total hip arthroplasty (rTHA) has not been elucidated. We sought to investigate the validity of using CAN during rTHA. METHODS A retrospective analysis was performed at an academic medical institution identifying all patients who underwent rTHA using CAN from 2016-2019. Patients were 1:1 matched with patients undergoing rTHA without CAN (control) based on demographic data. Cup anteversion, inclination, change in leg length discrepancy (ΔLLD) and change in femoral offset between pre- and post-operative plain weight-bearing radiographic images were measured and compared between both groups. A safety target zone of 15-25° for anteversion and 30-50° for inclination was used as a reference for precision analysis of cup position. RESULTS Eighty-four patients were included: 42 CAN cases and 42 control cases. CAN cases displayed a lower ΔLLD (5.74 ± 7.0 mm vs 9.13 ± 7.9 mm, p = 0.04) and greater anteversion (23.4 ± 8.53° vs 19.76 ± 8.36°, p = 0.0468). There was no statistical difference between the proportion of CAN or control cases that fell within the target safe zone (40% vs 20.9%, p = 0.06). Femoral offset was similar in CAN and control cases (7.63 ± 5.84 mm vs 7.14 ± 4.8 mm, p = 0.68). CONCLUSION Our findings suggest that the use of CAN may improve accuracy in cup placement compared to conventional methodology, but our numbers are underpowered to show a statistical difference. However, with a ΔLLD of ~ 3.4 mm, CAN may be useful in facilitating the successful restoration of pre-operative leg length following rTHA. Therefore, CAN may be a helpful tool for orthopedic surgeons to assist in cup placement and LLD during complex revision cases.
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Affiliation(s)
- Alex Tang
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
- Department of Orthopaedic Surgery, Geisinger Health, Scranton, PA, USA
| | - Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Mohamad Sharan
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Mackenzie A Roof
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
| | - John J Mercuri
- Department of Orthopaedic Surgery, Geisinger Health, Scranton, PA, USA
| | - Morteza Meftah
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Orthopedic Health, 301 East 17th Street, New York, NY, 10003, USA.
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Lourens E, Kurmis AP, Lim WY. Clinical Impact of Pelvic Malrotation on Radiograph-Based Preoperative Planning for Total Hip Arthroplasty: A Proof-of-Concept and Prudent Prediction of Acceptable Rotation. Indian J Orthop 2022; 56:1053-1060. [PMID: 35669020 PMCID: PMC9123151 DOI: 10.1007/s43465-022-00626-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/10/2022] [Indexed: 02/04/2023]
Abstract
Introduction Pelvic rotation (PR) on preoperative radiograph templating can affect various critical measured acetabular angles and potentially outcomes of successful total hip arthroplasty (THA). Optimising anatomical reconstruction of the joint is essential to achieve function, longevity and prevention of complications following surgery. There is limited literature that standardises the degree of acceptable PR on radiograph or its effects on the fitting of acetabular prostheses. Objective This study aimed to develop a proof-of-concept that quantifies how PR can affect various acetabular angles used in pre-operative THA templating and to formulate a practicable method of determining if the preoperative PR is acceptable. Materials and methods Computerised tomography (CT) models from three control and two THA patients were generated and manipulated in various degrees of PR. CT slices were thickened to simulate radiographs and acetabular angles measured. Results The acetabular anteversion distance (AAD) and lateral opening angle (LOA) demonstrated a linear and quadratic relationship with good correlation (R 2 = 0.923, R 2 = 0.710 respectively, p < 0.0001) in relation to PR. Change in area of prosthesis (AOP) demonstrated a good linear correlation (r 2 = 0.774 and r 2 = 0.875, p < 0.0001) with PR. Two novel measurements were used to estimate the degree of PR from a pelvic radiograph; the horizontal distance between pubic symphysis and middle of sacrococcygeal joint (PSSC) and the simplified pelvic rotation ratio (SPRR). A strong correlation between PSSC and SPRR with change in PR was observed (R 2 = 0.970, R 2 = 0.953, p < 0.001). Conclusion Preliminary result suggests that an SPRR > 2.0 correlates to PR > 20° with potential to have a clinical impact on preoperative measurements.
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Affiliation(s)
- Ernest Lourens
- Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA 5112 Australia
| | - Andrew P. Kurmis
- Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA 5112 Australia
| | - Wan Yin Lim
- Royal Adelaide Hospital, Port Rd, Adelaide, SA 5000 Australia
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Anatomic Navigation Using the Transverse Acetabular Ligament for Acetabular Component Positioning in Total Hip Arthroplasty Through the Direct Anterior Approach. J Am Acad Orthop Surg 2022; 30:100-103. [PMID: 35772088 DOI: 10.5435/jaaos-d-20-00839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 03/04/2021] [Indexed: 02/01/2023] Open
Abstract
The transverse acetabular ligament (TAL) is a reliable native anatomic landmark that can be used to guide accurate acetabular implant positioning during total hip arthroplasty through the direct anterior approach. The accurate acetabular implant position is defined by the preoperative plan, which corresponds to the Lewinnek safe zone. This article describes the anatomy of the TAL , exposure of the TAL, and pearls and pitfalls for exposure of the acetabulum during total hip arthroplasty through the direct anterior approach. This article discusses how the TAL is used to guide acetabular implant positioning and describes pilot data from our single surgeon case series (n = 31).
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Iwai C, Fushimi K, Nozawa S, Kato K, Miyagawa T, Takigami I, Akiyama H. Surgical Management of Thoracolumbar Scoliosis Secondary to Hip Joint Ankylosis and Severe Pelvic Obliquity. Cureus 2021; 13:e19744. [PMID: 34938622 PMCID: PMC8684777 DOI: 10.7759/cureus.19744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/05/2022] Open
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Killen CJ, Murphy MP, Ralles SJ, Khayatzadeh S, Brown NM, Patwardhan AG, Havey RM, Wu K. Characterising acetabular component orientation with pelvic motion during total hip arthroplasty. Hip Int 2021; 31:743-750. [PMID: 32375525 DOI: 10.1177/1120700020925013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Suboptimal acetabular component position can result in impingement, dislocation, and accelerated wear. Intraoperative pelvic motion has led to surgeon error and acetabular cup malposition. This study characterises the relationship between pelvic rotation and postoperative acetabular cup orientation. METHODS A device was constructed to allow cadaveric pelvis rotation along three axes about an acetabular cup in fixed orientation. The acetabular cup was fixed in space at 40° of radiographic inclination and 15° of anteversion relative to the anterior pelvic plane to represent consistent surgeon intraoperative placement. Active marker clusters were fixed to surgical equipment while the cadaveric pelvis was cemented with passive reflective markers, both identified with the Optotrak Certus motion capture system. The reamed cadaveric pelvis was rotated along three axes from -45° to 45° of roll, -30° to 30° of tilt, and -35° to 35° of pitch. The change in component inclination and anteversion was recorded at each 5° interval. Using computed tomography 3D reconstruction, the experimental setup was duplicated computationally to assess against a greater range of pelvis and implant sizes. RESULTS Radiographic anteversion and inclination showed a non-linear relationship dependent on pelvic roll, tilt, and pitch. Radiographic anteversion changed -0.59°, 0.76° and 0.01° while radiographic inclination changed 0.23°, 0.18° and 1.00° for every 1° of pelvic roll, tilt and pitch, respectively. Computationally, anteversion changed -0.61°, 0.75° and 0.00° while inclination changed 0.22°, 0.19° and 1.00° for every 1° of pelvic roll, tilt and pitch, respectively. These results were independent of cup and pelvis size. CONCLUSIONS Intraoperative pelvic motion can significantly affect final cup position, and this should be accounted for when placing acetabular components during total hip arthroplasty. Based on this study, intraoperative adjustment of the acetabular component position based on pelvis motion may be implemented to improve postoperative component position.
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Affiliation(s)
- Cameron J Killen
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Michael P Murphy
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Steven J Ralles
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Saeed Khayatzadeh
- Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. V.A. Hospital, Hines, IL, USA
| | - Nicholas M Brown
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Avinash G Patwardhan
- Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. V.A. Hospital, Hines, IL, USA
| | - Robert M Havey
- Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. V.A. Hospital, Hines, IL, USA
| | - Karen Wu
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
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Sun JY, Ma HY, Shen JM, Du YQ, Dong Y, Zhang YC, Zhou YG, Wang Y. Factors influencing knee valgus alignment in Crowe type IV hip dysplasia after total hip arthroplasty. J Orthop Traumatol 2021; 22:41. [PMID: 34655357 PMCID: PMC8520551 DOI: 10.1186/s10195-021-00601-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/26/2021] [Indexed: 11/20/2022] Open
Abstract
Background Valgus deformity of the knee remains a complaint after total hip arthroplasty (THA) among some patients with Crowe type IV hip dysplasia. We aimed to identify the knee alignment in these patients before and after surgery, and to explore the factors contributing to postoperative knee valgus alignment. Materials and methods We retrospectively reviewed a series of Crowe type IV patients who received THA between February 2010 and May 2019 in our hospital. The patients’ medical data were collected from the hospital information system. On both preoperative and postoperative full limb length standing radiographs, the following parameters were measured: hip–knee–ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle, anatomical tibiofemoral angle, anatomical lateral distal femoral angle, femoral neck-shaft angle, pelvic obliquity, limb length, height and lateral distance of hip center, and femoral offset. Univariate and multivariate binary logistic regression were used to identify the factors influencing postoperative knee valgus alignment. Results A total of 64 Crowe type IV patients (87 hips) were included in the study. Overall, HKA improved from 176.54 ± 3.52° preoperatively to 179.45 ± 4.31° at the last follow-up. Those hips were subdivided into non-valgus group (≥ 177.0°, n = 65) and valgus group (< 177.0°, n = 22) according to postoperative HKA. Only postoperative mLDFA was a significant factor in the multivariate regression model. Conclusions The postoperative mLDFA is a major factor related to knee valgus alignment after THA, which combines the preoperative anatomy and surgical reconstruction. Other factors previously published were found to have no significance. Level of evidence III.
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Affiliation(s)
- Jing-Yang Sun
- Medical School of Chinese PLA, Beijing, 100853, China.,Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Hai-Yang Ma
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Jun-Min Shen
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yin-Qiao Du
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yu Dong
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yan-Chao Zhang
- Medical School of Chinese PLA, Beijing, 100853, China.,Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Yong-Gang Zhou
- Medical School of Chinese PLA, Beijing, 100853, China. .,Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Yan Wang
- Medical School of Chinese PLA, Beijing, 100853, China. .,Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Fuxing Road, Haidian District, Beijing, 100853, China.
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Muir JM, Foley KA, Fiaes K, Wagler JB, Galaszewicz M, Benson JR, Bradley MP. Validation of a Novel Software Measurement Tool for Total Hip Arthroplasty. Cureus 2021; 13:e15544. [PMID: 34277169 PMCID: PMC8269987 DOI: 10.7759/cureus.15544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background
Preoperative planning and postoperative evaluation of component position in total hip arthroplasty (THA) utilize specialized software that must be able to provide measurements that are both accurate and precise. A new software program for use in THA has recently been developed. We sought to evaluate the accuracy of this new software in comparison with two current, widely used software programs. Methodology
Postoperative anteroposterior (AP) pelvic radiographs from 135 THA patients were retrospectively reviewed. Reference values for acetabular anteversion, inclination, and leg length were established using validated software programs (TraumaCad® as the primary reference value [PRV] and OsiriX LiteTM as the secondary reference value [SRV]). Measurements from the new software program (Intellijoint VIEWTM) were compared with reference values using Student’s t-test and chi-square test. Results For anteversion, mean values for the PRV (27.34° ± 7.27°) and the new software (27.29° ± 7.21°) were not significantly different (p = 0.49). The new software differed from the PRV by a mean of 0.05° ± 0.93°. Similar results were noted for inclination, where the new software differed from the PRV and SRV by -0.13° ± 0.65° and 0.25° ± 1.26°, respectively (mean values: PRV: 43.62° ± 6.02°; SRV: 43.99° ± 6.27°; new software: 43.74° ± 6.17°; p = 0.87), and for leg length, where the new software differed from the PRV and SRV by 0.05 mm ± 0.46 mm and 0.22 mm ± 0.52 mm, respectively (mean values: PRV: 10.61 mm ± 11.60 mm; SRV: 10.77 mm ± 11.70 mm; new software: 10.56 mm ± 11.61 mm; p = 0.98). Measurements were highly correlated across multiple reviewers (intraclass correlation coefficient ≥0.987). Conclusions The new software measurement tool is accurate and precise for assessing the acetabular component position and leg length measurements following THA in AP pelvic radiographs compared to currently used image measurement software.
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Affiliation(s)
- Jeffrey M Muir
- Clinical Research, Intellijoint Surgical, Kitchener, CAN
| | - Kelly A Foley
- Clinical Research, Intellijoint Surgical, Kitchener, CAN
| | - Karlina Fiaes
- Epidemiology and Public Health, Physician Assistant Education Program, McMaster University, Hamilton, CAN
| | - Justin B Wagler
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, CAN
| | - Milena Galaszewicz
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, CAN
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Kay A, Klavas D, Haghshenas V, Phan M, Le D. Two year follow up of supercapsular percutaneously assisted total hip arthroplasty. BMC Musculoskelet Disord 2021; 22:478. [PMID: 34030681 PMCID: PMC8147097 DOI: 10.1186/s12891-021-04351-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dislocation after primary total hip arthroplasty (THA) has an incidence of 2-3%. Approximately 77% of dislocations occur within the first year after surgery. The SuperPATH technique is a minimally invasive approach for THA that preserves soft tissue attachments. The purpose of this study is to describe the dislocation rate at 1 year after SuperPATH primary THA. METHODS All elective primary THAs performed by the senior author using the SuperPATH approach. Exclusion criteria were acute femoral neck fracture, revision surgery, or malignancy. There were 214 of 279 eligible patients available for telephone interviews (76.7%). Medical records were reviewed for secondary outcomes including early and late complications, cup positioning, distance ambulated on postoperative day one, discharge destination, and blood transfusions. RESULTS Mean age at surgery was 64 ± 10.8 years and mean time to telephone follow up was 773 ± 269.7 days. There were 104 female and 110 male patients. There were zero dislocations reported. Blood transfusions were performed in 3.7% of patients, and 75.7% were discharged to home at an average of 2.3 ± 1.0 days. Cup position averaged 43.6 ± 5.2° abduction and 20.9 ± 6.2° anteversion, with an average leg length discrepancy of 3.6 ± 3.32 mm. Complications included three intraoperative calcar fractures, one periprosthetic femur fracture, one early femoral revision, three superficial infections, and one instance of wound necrosis. CONCLUSION SuperPATH approach is safe for use in primary THA resulting in a low dislocation rate.
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Affiliation(s)
- Andrew Kay
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Fannin St. Suite 2500, Houston, TX, 77030, USA
| | - Derek Klavas
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Fannin St. Suite 2500, Houston, TX, 77030, USA
| | - Varan Haghshenas
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Fannin St. Suite 2500, Houston, TX, 77030, USA.
| | - Mimi Phan
- Texas A&M College of Medicine, 8447 Bryan Rd, Bryan, TX, 77807, USA
| | - Daniel Le
- Department of Orthopedics and Sports Medicine, Houston Methodist Willowbrook Hospital, 18220 TX-249, Houston, TX, 77070, USA
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15
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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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16
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Burapachaisri A, Elbuluk A, Abotsi E, Pierrepont J, Jerabek SA, Buckland AJ, Vigdorchik JM. Lewinnek Safe Zone References are Frequently Misquoted. Arthroplast Today 2020; 6:945-953. [PMID: 33299915 PMCID: PMC7701843 DOI: 10.1016/j.artd.2020.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/13/2020] [Accepted: 09/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Optimal acetabular component orientation in total hip arthroplasty (THA) is a necessity in achieving a stable implant. Although there has been considerable debate in the literature concerning the safe zone, to date, there has not been any review to determine if these references are consistent with the definition applied by Lewinnek et al. in 1978. Therefore, this article aims to examine the available literature in the PubMed database to determine how often a correct reference to the safe zone as defined by Lewinnek was applied to discussions regarding THA. METHODS A search for literature in the PubMed database was performed for articles from 1978 to 2019. Search criteria included terms 'Lewinnek,' 'safe zone,' and 'total hip arthroplasty.' Exclusions included abstract-only articles, non-English articles, articles unrelated to THA, and those lacking full content. RESULTS A review of literature yielded 147 articles for inclusion. Overall, only 11% (17) cited the Lewinnek article correctly. Forty-five percent (66) of articles referenced measurements in the supine position, 18% (26) referenced other positions, and 37% (55) did not specify. Nineteen percent (28) reported measurements of the acetabular cup orthogonal to the anterior pelvic plane, while 73% (108) did not, and 7% (11) did not specify. Twenty-three percent (34) measured from computed tomography scans instead of other methods. CONCLUSIONS In the discussion of the safe zone regarding THA, only 11% of articles listed are consistent with the definition established by Lewinnek. This warrants further investigation into a consistent application of the term and its implications for THA implant stability and dislocation rates.
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Affiliation(s)
- Aonnicha Burapachaisri
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Ameer Elbuluk
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Edem Abotsi
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Jim Pierrepont
- Chief Innovation Officer, Corin Group, New South Wales, Australia
| | - Seth A. Jerabek
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Aaron J. Buckland
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Jonathan M. Vigdorchik
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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Klemt C, Limmahakhun S, Bounajem G, Xiong L, Yeo I, Kwon YM. Effect of postural changes on in vivo pelvic tilt and functional component anteversion in total hip arthroplasty patients with lumbar disc degenerations. Bone Joint J 2020; 102-B:1505-1510. [DOI: 10.1302/0301-620x.102b11.bjj-2020-0777.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The complex relationship between acetabular component position and spinopelvic mobility in patients following total hip arthroplasty (THA) renders it difficult to optimize acetabular component positioning. Mobility of the normal lumbar spine during postural changes results in alterations in pelvic tilt (PT) to maintain the sagittal balance in each posture and, as a consequence, markedly changes the functional component anteversion (FCA). This study aimed to investigate the in vivo association of lumbar degenerative disc disease (DDD) with the PT angle and with FCA during postural changes in THA patients. Methods A total of 50 patients with unilateral THA underwent CT imaging for radiological evaluation of presence and severity of lumbar DDD. In all, 18 patients with lumbar DDD were compared to 32 patients without lumbar DDD. In vivo PT and FCA, and the magnitudes of changes (ΔPT; ΔFCA) during supine, standing, swing-phase, and stance-phase positions were measured using a validated dual fluoroscopic imaging system. Results PT, FCA, ΔPT, and ΔFCA were significantly correlated with the severity of lumbar DDD. Patients with severe lumbar DDD showed marked differences in PT with changes in posture; there was an anterior tilt (-16.6° vs -12.3°, p = 0.047) in the supine position, but a posterior tilt in an upright posture (1.0° vs -3.6°, p = 0.005). A significant decrease in ΔFCA during stand-to-swing (8.6° vs 12.8°, p = 0.038) and stand-to-stance (7.3° vs 10.6°,p = 0.042) was observed in the severe lumbar DDD group. Conclusion There were marked differences in the relationship between PT and posture in patients with severe lumbar DDD compared with healthy controls. Clinical decision-making should consider the relationship between PT and FCA in order to reduce the risk of impingement at large ranges of motion in THA patients with lumbar DDD. Cite this article: Bone Joint J 2020;102-B(11):1505–1510.
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Affiliation(s)
- Christian Klemt
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sakkadech Limmahakhun
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Georges Bounajem
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Liang Xiong
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ingwon Yeo
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Fischer MCM, Tokunaga K, Okamoto M, Habor J, Radermacher K. Preoperative factors improving the prediction of the postoperative sagittal orientation of the pelvis in standing position after total hip arthroplasty. Sci Rep 2020; 10:15944. [PMID: 32994419 PMCID: PMC7524714 DOI: 10.1038/s41598-020-72782-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/02/2020] [Indexed: 11/09/2022] Open
Abstract
The aims of this study were to investigate if the sagittal orientation of the pelvis (SOP) in the standing position changes after total hip arthroplasty (THA) and evaluate what preoperative factors may improve the prediction of the postoperative standing SOP in the context of a patient-specific functional cup orientation. 196 primary THA patients from Japan were retrospectively selected for this study. Computed tomography imaging of the pelvis, EOS imaging of the lower body and lateral radiographs of the lumbar spine in the standing position were taken preoperatively. Common biometrics and preoperative Harris Hip Score were recorded. The EOS imaging in the standing position was repeated three months following THA. A 3D/2.5D registration process was used to determine the standing SOP. Thirty-three preoperative biometric, morphological and functional parameters were measured. Important preoperative parameters were identified that significantly improve the prediction of the postoperative standing SOP by using multiple linear LASSO regression. On average, the SOP changed significantly (p < 0.001) between the preoperative and postoperative standing position three months after THA by 3° ± 4° in the posterior direction. The age, standing lumbar lordosis angle (LLA) and preoperative supine and standing SOP significantly (p < 0.001) improve the prediction of the postoperative standing SOP. The linear regression model for the prediction of the postoperative standing SOP is significantly (p < 0.001) improved by adding the parameters preoperative standing SOP and LLA, in addition to the preoperative supine SOP, reducing the root mean square error derived from a leave-one-out cross-validation by more than 1°. The mean standing SOP in Japanese patients changes already three months after THA in comparison to the preoperative value. The preoperative factors age, LLA, supine and standing SOP can significantly improve the prediction of the postoperative standing SOP and should be considered within the preoperative planning process of a patient-specific functional cup orientation.
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Affiliation(s)
- Maximilian C M Fischer
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany.
| | - Kunihiko Tokunaga
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City, Japan
| | - Masashi Okamoto
- Department of Radiology, Kameda Daiichi Hospital, Niigata City, Japan
| | - Juliana Habor
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Klaus Radermacher
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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19
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Klemt C, Limmahakhun S, Bounajem G, Xiong L, Yeo I, Kwon YM. Effect of postural changes on in vivo pelvic tilt and functional component anteversion in total hip arthroplasty patients with lumbar disc degenerations. Bone Joint J 2020:1-7. [PMID: 32955350 DOI: 10.1302/0301-620x.102b9.bjj-2020-0777.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The complex relationship between acetabular component position and spinopelvic mobility in patients following total hip arthroplasty (THA) renders it difficult to optimize acetabular component positioning. Mobility of the normal lumbar spine during postural changes results in alterations in pelvic tilt (PT) to maintain the sagittal balance in each posture and, as a consequence, markedly changes the functional component anteversion (FCA). This study aimed to investigate the in vivo association of lumbar degenerative disc disease (DDD) with the PT angle and with FCA during postural changes in THA patients. METHODS A total of 50 patients with unilateral THA underwent CT imaging for radiological evaluation of presence and severity of lumbar DDD. In all, 18 patients with lumbar DDD were compared to 32 patients without lumbar DDD. In vivo PT and FCA, and the magnitudes of changes (ΔPT; ΔFCA) during supine, standing, swing-phase, and stance-phase positions were measured using a validated dual fluoroscopic imaging system. RESULTS PT, FCA, ΔPT, and ΔFCA were significantly correlated with the severity of lumbar DDD. Patients with severe lumbar DDD showed marked differences in PT with changes in posture; there was an anterior tilt (-16.6° vs -12.3°, p = 0.047) in the supine position, but a posterior tilt in an upright posture (1.0° vs -3.6°, p = 0.005). A significant decrease in ΔFCA during stand-to-swing (8.6° vs 12.8°, p = 0.038) and stand-to-stance (7.3° vs 10.6°,p = 0.042) was observed in the severe lumbar DDD group. CONCLUSION There were marked differences in the relationship between PT and posture in patients with severe lumbar DDD compared with healthy controls. Clinical decision-making should consider the relationship between PT and FCA in order to reduce the risk of impingement at large ranges of motion in THA patients with lumbar DDD.
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Affiliation(s)
- Christian Klemt
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sakkadech Limmahakhun
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Georges Bounajem
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Liang Xiong
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ingwon Yeo
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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20
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Trends in cup position utilizing computer-assisted navigation during total hip arthroplasty: A retrospective observational study. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Onggo JR, Nambiar M, Onggo JD, Phan K, Ambikaipalan A, Babazadeh S, Hau R. Clinical outcomes and complication profile of total hip arthroplasty after lumbar spine fusion: a meta-analysis and systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:282-294. [PMID: 31676947 DOI: 10.1007/s00586-019-06201-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/20/2019] [Accepted: 10/24/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hip and spine pathology can alter the biomechanics of spino-pelvic mobility. Lumbar spine fusions can reduce the mobility of the lumbar spine and therefore result in compensatory femoral motion, contributing towards dislocations of THA. PURPOSE This meta-analysis aims to determine the effect of pre-existing spine fusions on THA outcomes, and complication profile including hip dislocations, all-cause revisions and all complications. METHODS A multi-database search was performed according to PRISMA guidelines. All studies that compared patients who underwent THA with and without prior SF were included in the analysis. RESULTS Ten studies were included in this review, consisting of 28,396 SF THA patients and 1,550,291 non-SF THA patients. There were statistically significant higher rates of hip dislocation (OR 2.20, 95% CI 1.71-2.85, p < 0.001), all-cause revision (OR 3.43, 95% CI 1.96-6.00, p < 0.001) and all complications (OR 2.83, 95% CI 1.28-6.24, p = 0.01) in SF than in non-SF THA patients. When registry data were excluded, these rates were approximately doubled. Subgroup analysis of revisions for dislocations was not statistically significant (OR 5.28, 95% CI 0.76-36.87, p = 0.09). While no meta-analysis was performed on clinical outcomes due to heterogeneous parameter reporting, individual studies reported significantly poorer outcomes in SF patients than in non-SF patients. CONCLUSION THA patients with SF are at higher risks of hip dislocations, all-cause revisions and all complications, which may adversely affect patient-reported outcomes. Surgeons should be aware of these risks and appropriately plan to account for altered spino-pelvic biomechanics, in order to reduce the risks of hip dislocations and other complications. LEVEL OF EVIDENCE II (Meta-analysis of non-homogeneous studies). These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
| | - Mithun Nambiar
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, VIC, Australia.,Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
| | - Jason Derry Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, VIC, Australia.,School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Kevin Phan
- NeuroSpine Research Group, Sydney, NSW, Australia
| | | | - Sina Babazadeh
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, VIC, Australia.,Department of Orthopaedic Surgery, St Vincent's Hospital, East Melbourne, VIC, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, VIC, Australia.,Epworth Eastern Hospital, Box Hill, VIC, Australia
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Modern cup alignment techniques in total hip arthroplasty: A systematic review. Orthop Traumatol Surg Res 2019; 105:907-913. [PMID: 31054840 DOI: 10.1016/j.otsr.2019.03.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 03/05/2019] [Accepted: 03/14/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A systematic review was conducted to assess the clinical and radiological outcomes of the alternative surgical techniques that consider the dynamic aspect of the acetabular orientation when aligning a cup (pelvic tilt-, lumbo-pelvic kinematics-, and spine-hip relationship-adjusted cup alignment techniques). METHOD Eight eligible articles reported the outcomes of total hip arthroplasty (THA) performed with alternative techniques. Clinical and radiological data were extracted. One study had a control group of patients who underwent conventional THAs (level III) while the seven other studies were level IV. Computer navigation system (CAS), Optimized Positioning System (OPS™), and manual instrumentation were used to align components in four, two, and two studies, respectively. A meta-analysis was not carried out because there was a lack of homogeneity between included articles regarding the method to position the cup and the nature of the reported data. RESULTS THA performed with alternative techniques had an early dislocation rate ranging from 0 to 1.9%, no unexpected catastrophic failure, and acceptable radiographic cup orientations. One study compared kinematically and mechanically aligned THAs and found no dislocation in either groups, similar patient reported outcome measures (43 Oxford-12 Score for both groups), and similar proportions of cup in the Lewinnek zone (respectively 65% and 70%). DISCUSSION/CONCLUSION Alternative methods accounting for the functional acetabular orientation seem to be clinically safe and effective in the early-term, and generate acceptable cup orientation on radiographs. Their values compare to those of more conventional techniques for cup implantation remain to be determined. We developed a classification of the multiple methods for aligning an acetabular component. LEVEL OF EVIDENCE IV, systematic review of level III and IV studies.
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Rivière C, Harman C, Parsons T, Villet L, Cobb J, Maillot C. Kinematic alignment versus conventional techniques for total hip arthroplasty: A retrospective case control study. Orthop Traumatol Surg Res 2019; 105:895-905. [PMID: 30930093 DOI: 10.1016/j.otsr.2019.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 11/20/2018] [Accepted: 02/11/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Residual complications of conventionally implanted hip components have only been partially reduced by improved implant design and higher surgical precision, and their occurrence is poorly predicted by the radiographic standing/supine cup orientation. This has raised awareness that conventional techniques may not aim for the correct component orientation target, and the lumbo-pelvic kinematics, which influences the functional acetabular orientation, may be of interest to further improve THA clinical outcomes. This has led to the development of the Lumbo-Pelvic kinematic alignment (KA) technique for THA that aims to anatomically position and kinematically align hip implants (acetabular and femoral, total and resurfacing components), in order to optimise prosthetic hip biomechanics and hopefully improve prosthetic function, patient satisfaction, and components' lifespan. Therefore, we conducted a case control investigation to assess the early-term safety and efficacy of this new technique by answering the following questions: does the KA technique for THA: (1) better restore the native hip anatomy, (2) generate a different radiographic supine cup position, and (3) improve clinical outcomes in comparison to the conventional mechanical alignment technique? HYPOTHESES Using KA technique allows there is no statistically significant difference between the pre to postoperative differential for acetabular medial and vertical offsets, femoral offset, and leg length. METHODS We led a case control retrospective study with prospectively collected clinical data. Forty-one consecutive unselected KA-THAs performed with manual instrumentation were paired with 41 mechanically aligned THAs. The 1-year clinical outcomes and radiographical measurements were compared. RESULTS Compared to the mechanical alignment technique, the KA technique resulted in a more anatomical restoration of the prosthetic hip centre of rotation with a lower delta pre- to post-operative horizontal acetabular offset (1.47mm for KA versus -5.1mm for MA, p=0.001), and with 74% of KA versus 50% of MA cups (p=0.044) being within 15% of native anatomy for the horizontal acetabular offset. In addition, the KA technique resulted in a higher cup anteversion (22°±7° vs 15°±8°, p<0.001) but similar cup inclination (41°±6° vs. 42°±7°, p=0.25), a similar proportion of cups within the Lewinnek zone (65% vs. 70%, p=0.8), similar excellent functional outcomes (delta Oxford score pre- to follow-up of 24.3 and 23.5 points for KA and MA groups, respectively, p=0.88), similar patient satisfaction scores of 95.4/100 and 89.5/100 for KA and MA groups, respectively, and the same absence of aseptic complications. CONCLUSION The KA technique for THA has been demonstrated to be safe, efficacious, and not inferior to the conventional MA technique at early-term. As the concept of the KA technique for THA is only at an early stage, its influence on mid to long-term clinical outcomes remains to be determined and further refinements of the concept are yet to be made. LEVEL OF EVIDENCE III; case-control retrospective study.
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Affiliation(s)
- Charles Rivière
- South West London Elective Orthopaedic Centre, MSK Lab - Imperial College London, Dorking Road, KT18 7EG Epsom, United Kingdom.
| | - Ciara Harman
- SWLEOC Research centre, Dorking Road, KT18 7EG Epsom, United Kingdom
| | - Thomas Parsons
- SWLEOC Research centre, Dorking Road, KT18 7EG Epsom, United Kingdom
| | - Loic Villet
- Clinique du Sport, Centre de l'arthrose, 4, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Justin Cobb
- Laboratory Block, MSK Lab - Imperial College London, Charing Cross Campus, St Dunstan's Road, W6 8RP Hammersmith, London United Kingdom
| | - Cedric Maillot
- South West London Elective Orthopaedic Centre, MSK Lab - Imperial College London, Dorking Road, KT18 7EG Epsom, United Kingdom
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Guo HZ, Yang CX, Tang ZP, Wang CX. The effects of total hip arthroplasty in treating hip bony fusion in young and middle-aged patients with ankylosing spondylitis. J Orthop Surg Res 2019; 14:253. [PMID: 31395063 PMCID: PMC6686551 DOI: 10.1186/s13018-019-1288-5] [Citation(s) in RCA: 8] [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] [Received: 05/11/2018] [Accepted: 07/23/2019] [Indexed: 02/28/2023] Open
Abstract
Background This study aims to investigate the curative effects of total hip arthroplasty (THA) in treating hip bony fusion for young and middle-aged patients with ankylosing spondylitis (AS). Methods The clinical data of 26 young and middle-aged patients with AS (31 coxae), who were treated with THA and followed-up for more than 3 years in the period between February 1998 and May 2013, were retrospectively analyzed. Among these patients, 22 patients were male (25 coxae) and 4 patients were female (6 coxae). Patients’ age ranged within 19–50 years old, with an average of 31.5 years old. The intervals from arthroplasty to the occurrence of hip joint lesions caused by AS ranged within 2–26 years, with an average of 11.2 years. The average Harris score before the surgery was 19.0 ± 11.5 points. Results Femoral proximal cleavage fracture occurred in one coxa during the surgery and was fixed by the steel wire cerclage. Sciatic nerve traction injury occurred in one coxa after the surgery, which recovered after 6 months. Posterior hip dislocation occurred in one coxa and was immediately treated with manual reduction. All patients were followed-up, and follow-up duration ranged within 36–123 months, with an average of 46.5 months. In the last follow-up, the average Harris score was 87.1 ± 13.1 points, total passive range of motion was 215.0 ± 22.0°, and passive range of flexion was 90.8 ± 9.3°. All these indexes significantly increased compared with pretreatment (P < 0.01). A periacetabular radiolucent line occurred in one coxa with a width of < 2 mm, and no femoral radiolucent line was found during follow-ups in any patient. Heterotopic ossification occurred in four coxae. Conclusion THA treatment for hip bony fusion caused by AS can achieve satisfactory hip function recovery and excellent prosthesis survival rate.
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Affiliation(s)
- Hong-Zhang Guo
- Department of Orthopaedics, Gansu Provincial Hospital of TCM, Lanzhou, 730050, China
| | - Chen-Xu Yang
- Department of Orthopaedics, Gansu Provincial Hospital of TCM, Lanzhou, 730050, China
| | - Zhao-Peng Tang
- Department of Orthopaedics, Gansu Provincial Hospital of TCM, Lanzhou, 730050, China.
| | - Cheng-Xiang Wang
- Department of Orthopaedics, Gansu Provincial Hospital of TCM, Lanzhou, 730050, China
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A Geometric Model to Determine Patient-Specific Cup Anteversion Based on Pelvic Motion in Total Hip Arthroplasty. Adv Orthop 2019; 2019:4780280. [PMID: 31186967 PMCID: PMC6521545 DOI: 10.1155/2019/4780280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/28/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Cup position is critical to stability in total hip arthroplasty and is affected by pelvis motion during positions of daily life. The purpose of this study was to explicitly define the relationship between sagittal pelvic motion and resultant cup functional anteversion and create a tool to guide the surgeon to a patient-specific intra-operative anteversion. Materials and Methods 10,560 combinations of inclination, anteversion, and pelvic tilt were generated using a geometric model. Resultant functional anteversion was calculated for each iteration and variables were correlated. An electronic mobile tool was created that compares inputted patient-specific values to population-based averages to determine pelvic positions and dynamics that may lead to instability. Results A third-degree polynomial equation was used to describe the relationship between variables. The freely downloadable mobile tool uses input from pre-operative plain radiographic measurements to provide the surgeon a quantitative correction to intra-operative cup anteversion based on differences in functional anteversion compared to population-based averages. Conclusion This study provides a geometric relationship between planned cup position, pelvic position and motion, and the resultant functional anteversion. This mathematical model was applied to an electronic tool that seeks to determine an individualized intra-operative cup anteversion based on measured patient-specific pelvic dynamics.
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Mercer N, Hawkins E, Menken L, Deshmukh A, Rathod P, Rodriguez JA. Optimum anatomic socket position and sizing for the direct anterior approach: impingement and instability. Arthroplast Today 2019; 5:154-158. [PMID: 31286036 PMCID: PMC6588686 DOI: 10.1016/j.artd.2019.01.003] [Citation(s) in RCA: 5] [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: 11/01/2018] [Revised: 01/08/2019] [Accepted: 01/13/2019] [Indexed: 11/23/2022] Open
Abstract
A comprehensive strategy is important for ensuring reproducible and safe acetabular component sizing and positioning. Presented here is our approach for anatomic acetabular component positioning in direct anterior total hip arthroplasty. This strategy has evolved with our understanding of the ramifications of socket sizing and positioning on instability and impingement. Data collected by a single surgeon (J.A.R.) between 2009 and 2011 influenced our current paradigm. We compare the sizing and positioning parameters of the anterior and posterior approach, thus demonstrating how the 2 are different. By highlighting these differences, we hope to provide a clear, defined approach to acetabular placement and sizing for direct anterior-approach total hip arthroplasty.
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Affiliation(s)
- Nathaniel Mercer
- SUNY Upstate Medical University, Syracuse, NY, USA
- Corresponding author. Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA. Tel.: +1 516 455 7553.
| | - Evan Hawkins
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Luke Menken
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ajit Deshmukh
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Parthiv Rathod
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jose A. Rodriguez
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
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"Channel Lines": A Simple Surgical Technique to Aid in Achieving Patient-specific Ante-version During Implantation of Uncemented Acetabular Cups. Tech Orthop 2018; 33:264-266. [PMID: 30542228 PMCID: PMC6250260 DOI: 10.1097/bto.0000000000000256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Accurate acetabular cup placement is a crucial step for a successful total hip replacement. Transverse acetabular ligament is an important and reliable landmark that helps in determining the version during the placement of acetabular cups. However, the visualization of transverse acetabular ligament may not be easy as the view may be blocked by the implants and the instruments. We have devised a simple technique to aid in achieving patient-specific ante-version during implantation of uncemented acetabular cups by using "channel lines."
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Darrith B, Bell JA, Culvern C, Della Valle CJ. Can the use of an inclinometer improve the positioning of the acetabular component in total hip arthroplasty? Bone Joint J 2018; 100-B:862-866. [PMID: 29954211 DOI: 10.1302/0301-620x.100b7.bjj-2017-1607.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Accurate placement of the acetabular component is essential in total hip arthroplasty (THA). The purpose of this study was to determine if the ability to achieve inclination of the acetabular component within the 'safe-zone' of 30° to 50° could be improved with the use of an inclinometer. Patients and Methods We reviewed 167 primary THAs performed by a single surgeon over a period of 14 months. Procedures were performed at two institutions: an inpatient hospital, where an inclinometer was used (inclinometer group); and an ambulatory centre, where an inclinometer was not used as it could not be adequately sterilized (control group). We excluded 47 patients with a body mass index (BMI) of > 40 kg/m2, age of > 68 years, or a surgical indication other than osteoarthritis whose treatment could not be undertaken in the ambulatory centre. There were thus 120 patients in the study, 68 in the inclinometer group and 52 in the control group. The inclination angles of the acetabular component were measured from de-identified plain radiographs by two blinded investigators who were not involved in the surgery. The effect of the use of the inclinometer on the inclination angle was determined using multivariate regression analysis. Results The mean inclination angle for the THAs in the inclinometer group was 42.9° (95% confidence interval (CI) 41.7° to 44.0°; range 29.0° to 63.8°) and 46.5° (95% CI 45.2° to 47.7°; range 32.8° to 63.2°) in the control group (p < 0.001). Regression analysis identified a 9.1% difference in inclination due to the use of an inclinometer (p < 0.001), and THAs performed without the inclinometer were three times more likely to result in inclination angles of > 50° (odds ratio (OR) 2.8, p = 0.036). The correlation coefficient for the interobserver reliability of the measurement of the two investigators was 0.95 (95% CI 0.93 to 0.97). Conclusion The use of a simple inclinometer resulted in a significant reduction in the number of outliers compared with a freehand technique. Cite this article: Bone Joint J 2018;100-B:862-6.
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Affiliation(s)
- B Darrith
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - J A Bell
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - C Culvern
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Ililnois, USA
| | - C J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Sultan AA, Khlopas A, Piuzzi NS, Chughtai M, Sodhi N, Mont MA. The Impact of Spino-Pelvic Alignment on Total Hip Arthroplasty Outcomes: A Critical Analysis of Current Evidence. J Arthroplasty 2018; 33:1606-1616. [PMID: 29233568 DOI: 10.1016/j.arth.2017.11.021] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/29/2017] [Accepted: 11/08/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND In this review, we (1) evaluated the effect of adult spine deformity (ASD) and its surgical correction on patients who had a total hip arthroplasty (THA); (2) evaluated the outcomes of THA in patients who have had previous spinal fusion; and (3) we presented an algorithm on how to surgically address patients who simultaneously require THA and ASD correction. METHODS A comprehensive literature search was conducted. Our final analysis included 14 studies. Overall, there were 3 studies that reported on the impact of ASD on THA outcomes, 6 studies reported on the effect of ASD correction on THA outcomes, and 5 studies reported on the effect of spinal fusion on THA outcomes. RESULTS Patients with concurrent ASD and THA are at increased risk of THA dislocations and revisions with studies reporting a compiled 2.9% dislocation rate in 1167 patients. Patients who underwent ASD correction demonstrated a post-operative reduction of acetabular anteversion (mean reduction range 4.96°-11.2°, P < .001) and tilt (mean -7° ± 10°, P < .001). In THA patients with concurrent lumbosacral fusion, dislocation rates ranged between 3% at 1 year and 7.5% at 2 years compared to 0.4%-2.1% dislocation rates in matching cohorts (P < .001). CONCLUSION Spine balance can alter THA outcomes, but the exact mechanism is yet to be elucidated. We aimed at bridging the gap between hip and spine surgeons with an up-to-date analysis of the best available evidence and presented an algorithm for approaching patients who may simultaneously need ASD correction and THA.
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Affiliation(s)
- Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nipun Sodhi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Rivière C, Lazic S, Villet L, Wiart Y, Allwood SM, Cobb J. Kinematic alignment technique for total hip and knee arthroplasty: The personalized implant positioning surgery. EFORT Open Rev 2018; 3:98-105. [PMID: 29657851 PMCID: PMC5890135 DOI: 10.1302/2058-5241.3.170022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Conventional techniques for hip and knee arthroplasty have led to good long-term clinical outcomes, but complications remain despite better surgical precision and improvements in implant design and quality. Technological improvements and a better understanding of joint kinematics have facilitated the progression to ‘personalized’ implant positioning (kinematic alignment) for total hip (THA) and knee (TKA) arthroplasty, the true value of which remains to be determined. By achieving a true knee resurfacing, the kinematic alignment (KA) technique for TKA aims at aligning the components with the physiological kinematic axes of the knee and restoring the constitutional tibio-femoral joint line frontal and axial orientation and soft-tissue laxity. The KA technique for THA aims at restoring the native ‘combined femoro-acetabular anteversion’ and the hip’s centre of rotation, and occasionally adjusting the cup position and design based on the assessment of the individual spine-hip relation. The key element for optimal prosthetic joint kinematics (hip or knee) is to reproduce the femoral anatomy. The transverse acetabular ligament (TAL) is the reference landmark to adjust the cup position.
Cite this article: EFORT Open Rev 2018;3:98-105. DOI: 10.1302/2058-5241.3.170022
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Affiliation(s)
- Charles Rivière
- MSK Lab, Imperial College London, UK; South West London Elective Orthopaedic Center, UK
| | - Stefan Lazic
- South West London Elective Orthopaedic Center, UK
| | | | - Yann Wiart
- Unfallchirurgie, Theresienkrankenhauss Mannheim, Germany
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Schwarzkopf R, Muir JM, Paprosky WG, Seymour S, Cross MB, Vigdorchik JM. Quantifying Pelvic Motion During Total Hip Arthroplasty Using a New Surgical Navigation Device. J Arthroplasty 2017; 32:3056-3060. [PMID: 28559196 DOI: 10.1016/j.arth.2017.04.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/21/2017] [Accepted: 04/24/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Accurate cup positioning is one of the most challenging aspects of total hip arthroplasty (THA). Undetected movement of the patient during THA surgery can lead to inaccuracies in cup anteversion and inclination, increasing the potential for dislocation and revision surgery. Investigations into the magnitude of patient motion during THA are not well represented in the literature. METHODS We analyzed intraoperative pelvic motion using a novel navigation device used to assist surgeons with cup position, leg length, and offset during THA. This device uses an integrated accelerometer to measure motion in 2 orthogonal degrees of freedom. We reviewed the data from 99 cases completed between February and September 2016. RESULTS The mean amount of pitch recorded per patient was 2.7° (standard deviation, 2.2; range, 0.1°-9.9°), whereas mean roll per patient was 7.3° (standard deviation, 5.5; range, 0.3°-31.3°). Twenty-one percent (21 of 99) of patients demonstrated pitch of >4°. Sixty-nine percent (68 of 99) of patients demonstrated >4° of roll, and 25% (25 of 99) of patients demonstrated roll of ≥10°. CONCLUSION Our findings indicate that while the majority of intraoperative motion is <4°, many patients experience significant roll, with a large proportion rolling >10°. This degree of movement has implications for acetabular cup position, as failure to compensate for this motion can result in placement of the cup outside the planned safe zone, thus, increasing the potential for dislocation. Further study is warranted to determine the effect of this motion on cup position, leg length, and offset.
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Affiliation(s)
- Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Medical Center-Hospital for Joint Diseases, New York, New York
| | - Jeffrey M Muir
- Department of Clinical Research, Intellijoint Surgical, Inc, Waterloo, Ontario, Canada
| | - Wayne G Paprosky
- Department of Orthopedics, Central DuPage Hospital, Winfield, Illinois
| | - Scott Seymour
- Department of Orthopedics, MacNeal Hospital, Berwyn, Illinois
| | - Michael B Cross
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Jonathan M Vigdorchik
- Department of Orthopaedic Surgery, NYU Langone Medical Center-Hospital for Joint Diseases, New York, New York
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32
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Chronological changes in functional cup position at 10 years after total hip arthroplasty. Hip Int 2017; 27:477-482. [PMID: 28218372 DOI: 10.5301/hipint.5000487] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aims to clarify the chronological changes in functional cup position at a minimum follow-up of 10 years after total hip arthroplasty (THA), and to identify the risk factors influencing a significant difference in functional cup position during the postoperative follow-up period. METHODS We evaluated the chronological changes in functional cup position at a minimum follow-up of 10 years after THA in 58 patients with unilateral hip osteoarthritis. Radiographic cup position was measured on anteroposterior pelvic radiographs with the patient in the supine position, whereas functional cup position was recorded in the standing position. Radiographs were obtained before, 3 weeks after, and every 1 year after surgery. RESULTS Functional cup anteversion (F-Ant) increased over time, and was found to have significantly increased at final follow-up compared to that at 3 weeks after surgery (p<0.01). The maximum postoperative change in F-Ant was 17.0° anteriorly; 12 cases (21%) showed a postoperative change in F-Ant by >10° anteriorly. Preoperative posterior pelvic tilt in the standing position and vertebral fractures after THA were significant predictors of increasing functional cup anteversion. CONCLUSIONS Although chronological changes in functional cup position do occur after THA, their magnitude is relatively low. However, posterior impingement is likely to occur, which may cause edge loading, wear of the polyethylene liner, and anterior dislocation of the hip. We believe that, for the combined anteversion technique, the safe zone should probably be 5°-10° narrower in patients predicted to show considerable changes in functional cup position compared with standard cases.
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Rojas J, Bautista M, Bonilla G, Amado O, Huerfano E, Monsalvo D, Llinás A, Navas J. A retrospective study on the relationship between altered native acetabular angle and vertical implant malpositioning. INTERNATIONAL ORTHOPAEDICS 2017; 42:769-775. [PMID: 28782077 DOI: 10.1007/s00264-017-3584-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/10/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE Acetabular cup positioning in extreme angles of vertical position affects both stability and long-term survivorship of total hip arthroplasty. The purpose of this study is to determine whether native Sharp's angle is associated with an increased abduction angle of the acetabular component. METHODS Consecutive patients who underwent primary total hip replacement between February 2012 and August 2015 were included. Vertical positioning of acetabular implant in the antero-posterior post-operative radiographs were measured. The proportion of implants positioned outside the safe zone (40° ± 10°) was calculated and through a multivariate analysis, Sharp's angle and other factors possibly associated with cup malpositioning were evaluated. RESULTS Five hundred twenty-eight hip arthroplasties were analyzed. Prevalence of cup malpositioning was 7.6% and 25 patients had an altered native acetabular angle. An altered pre-operative Sharp's angle was associated with a higher risk of vertical malpositioning of the acetabular component (OR 2.51 IC 95%: 1.17-5.39) (p = 0.02). Body mass index, surgeon's volume, size of the implant, gender, pre-operative diagnose and age, were not associated with the position of the cup. CONCLUSIONS The alteration of the Sharp's angle as an indicator of hip dysplasia in native hips increases the odds of acetabular cup malpositioning. Other factors explored did not correlate with the position of the acetabular prosthesis. Systematic assessment of Sharp's angle should be included in the pre-operative planning of primary hip arthroplasty.
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Affiliation(s)
- Jorge Rojas
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia
| | - Maria Bautista
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, School of Medicine, Universidad del Rosario, Bogotá, D.C., Colombia
| | - Guillermo Bonilla
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, School of Medicine, Universidad de los Andes. School of Medicine, Universidad del Rosario, Carrera 7 No. 117 - 15, Zip Code: 110111186, Bogotá, D.C., Colombia.
| | - Omar Amado
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia
| | - Elina Huerfano
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia
| | - Daniel Monsalvo
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia
| | - Adolfo Llinás
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, School of Medicine, Universidad de los Andes. School of Medicine, Universidad del Rosario, Carrera 7 No. 117 - 15, Zip Code: 110111186, Bogotá, D.C., Colombia
| | - José Navas
- Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, D.C., Colombia
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Rivière C, Lazennec JY, Van Der Straeten C, Auvinet E, Cobb J, Muirhead-Allwood S. The influence of spine-hip relations on total hip replacement: A systematic review. Orthop Traumatol Surg Res 2017; 103:559-568. [PMID: 28373138 DOI: 10.1016/j.otsr.2017.02.014] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 02/02/2023]
Abstract
Sagittal pelvic kinematics along with spino-pelvic angular parameters have recently been studied by numerous investigators for their effect on total hip replacement (THR) clinical outcomes, but many issue of spine-hip relations (SHR) are currently unexplored. Therefore, our review aims at clarifying the following questions: is there any evidence of a relationship between articular impingement/dislocation risk in primary THR and (1) certain sagittal pelvic kinematics patterns, (2) pelvic incidence, and (3) types of SHRs? A systematic review of the existing literature utilising PubMed and Google search engines was performed in January 2017. Only clinical or computational studies published in peer-reviewed journals over the last five years in either English or French were reviewed. We identified 769 reports, of which 12 met our eligibility criteria. A review of literature shows that sagittal pelvic kinematics, but not the pelvic incidence, influences the risk of prosthetic impingement/dislocation. We found no study having assessed the relationship between this risk and the types of SHRs. Sagittal pelvic kinematics is highly variable among individuals and certain kinematic patterns substantially influences the risk of prosthetic impingement/dislocation. Recommendations for cup positioning are therefore switching from a systematic to a patient-specific approach, with the standing cup orientation Lewinneck safe zone progressively giving way to a new parameter of interest: the functional orientation of the cup. Based on a recently published classification for SHRs, We propose a new concept of "kinematically aligned THR" for the purposes of THR planning. Further studies are needed to investigate the relevance of such a classification towards the assumptions and hypothesis we have made. Level of evidence,- Level IV, systematic review of level III and IV studies.
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Affiliation(s)
- C Rivière
- MSK Lab, 7, Laboratory Block, Charing Cross Campus, Imperial college of London, W6 8RP London, UK.
| | - J-Y Lazennec
- Service de chirurgie orthopédique, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie, 47-83, boulevard de l'Hôpital, 75634 Paris cedex 13, France
| | - C Van Der Straeten
- MSK Lab, 7, Laboratory Block, Charing Cross Campus, Imperial college of London, W6 8RP London, UK
| | - E Auvinet
- MSK Lab, 7, Laboratory Block, Charing Cross Campus, Imperial college of London, W6 8RP London, UK
| | - J Cobb
- MSK Lab, 7, Laboratory Block, Charing Cross Campus, Imperial college of London, W6 8RP London, UK
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Ragsdale MI, Wong FS, Boutin RD, Meehan JP. Pelvic Tilt Evaluation From Frontal Radiographs: The Validity, Interobserver Reliability and Intraobserver Reproducibility of the Sacro-Femoral-Pubic Parameter. J Arthroplasty 2017; 32:1665-1669. [PMID: 28012720 DOI: 10.1016/j.arth.2016.11.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 10/24/2016] [Accepted: 11/15/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The sacro-femoral-pubic (SFP) parameter, calculated using the SFP angle measured on a frontal pelvis radiograph, has previously been shown to have a strong correlation with sagittal pelvic tilt (PT) measured on a lateral x-ray. The purpose of this study is to assess the validity, interobserver reliability and intraobserver reproducibility of the SFP parameter in predicting the sagittal PT. METHODS This is a retrospective study of 100 patients with frontal and lateral radiographs of the pelvis. Two observers independently measured the SFP angle on frontal x-ray (midpoint of S1 end plate to centroid of acetabula to upper midpoint of the pubic symphysis) and PT on lateral x-ray (midpoint of sacral plate to the centroid of acetabula to vertical plane). The SFP parameter was defined using the equation: SFP parameter = 75 - SFP angle. The interobserver reliability and intraobserver reproducibility were calculated using interclass correlation coefficient (ICC). Validity of the SFP parameter was calculated using Pearson correlation coefficient. RESULTS The intraobserver reproducibility of the SFP parameter was excellent (ICC >0.90) for both observers. The interobserver reliability of all measurements was substantial for the SFP parameter (ICC >0.80) and PT (ICC >0.70). The concurrent validity of the SFP parameter was substantial (r = 0.70). CONCLUSION Calculating PT from a frontal radiograph using the equation for the SFP parameter is a valid, reliable, and reproducible formula that may be used to predict sagittal PT.
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Affiliation(s)
- Mary I Ragsdale
- Department of Orthopedic Surgery, University of California, Davis, Sacramento, California
| | - Felix S Wong
- Department of Radiology, University of California, Davis, Sacramento, California
| | - Robert D Boutin
- Department of Radiology, University of California, Davis, Sacramento, California
| | - John P Meehan
- Department of Orthopedic Surgery, University of California, Davis, Sacramento, California
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Huang GY, Zhao GL, Xia J, Wei YB, Wang SQ, Wu JG. An Alternative Intraoperative Radiographic Method for Optimizing Cup Inclination during Total Hip Arthroplasty. Orthop Surg 2016; 8:345-51. [PMID: 27627718 DOI: 10.1111/os.12272] [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: 02/24/2016] [Accepted: 06/16/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE During total hip arthroplasty (THA), the location of the acetabular prosthesis is very important for guaranteeing successful surgery. However, this remains a challenge for many surgeons. This study aimed to investigate the feasibility of using the intraoperative fluoroscopic iliopubic tangential angle (IPTA) to determine the valgus angles of acetabular prostheses. METHODS In the first stage, the IPTA and valgus angles of native acetabula were defined and measured in 102 THAs obtained from the picture archiving and communication systems of our hospital. Obturator foramen morphology was also measured and divided into groups according to the axial length ratio. Correlations between obturator foramen morphology and IPTA and valgus angles of native acetabula were then determined. In the second stage, angular differences (angle θ) between the IPTA and valgus angles of native acetabula were measured during unilateral THA in 136 patients to determine whether this is a stable value that could be used as a reference for placement of acetabular prostheses. Postoperative data such as Harris Hip Score (HHS) scores and complications were collected and evaluated. RESULTS The average IPTA at the apex of the true acetabulum was 58.8° ± 4.1°. The average valgus angle of native acetabula was 43.1° ± 3.9° and angle θ was 15.7° ± 1.3°. Obturator foramen morphology was divided into five groups according to the axial length ratio. IPTA was closely related to obturator foramen morphology (Pearson r = 0.489, P ≈ 0.000). Angle θ was stable and independent of obturator foramen morphology. When the IPTA and angle θ were used as references for placing acetabular prostheses in 136 THAs, the average postoperative valgus angles of acetabular prostheses was 45.13° ± 4.07° and the good-to-excellent rate was 97.05%. There were no short-term complications such as fracture, dislocation or infection. The average HHS score 6 months after surgery was 37.2 higher than the preoperative score, this difference being significant (P < 0.01). Neither infection nor dislocation was found 6 months after surgery. CONCLUSIONS The IPTA (at the apex of the true acetabulum) and angle θ (obtained by intraoperative fluoroscopy) are consistent in determining the postoperative valgus angle of acetabular prosthesis during THA. Thus, IPTA and angle θ are of value in guiding placement of acetabular prostheses; in particular, this method can facilitate the learning of young surgeons.
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Affiliation(s)
- Gang-Yong Huang
- Division of Orthopaedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Guang-Lei Zhao
- Division of Orthopaedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Xia
- Division of Orthopaedic Surgery, Huashan Hospital, Fudan University, Shanghai, China.
| | - Yi-Bing Wei
- Division of Orthopaedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Si-Qun Wang
- Division of Orthopaedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian-Guo Wu
- Division of Orthopaedic Surgery, Huashan Hospital, Fudan University, Shanghai, China
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IDRISSI MOHAMMEDEL, ELIBRAHIMI ABDELHALIM, SHIMI MOHAMMED, ELMRINI ABDELMAJID. ACETABULAR COMPONENT ORIENTATION IN TOTAL HIP ARTHROPLASTY: THE ROLE OF ACETABULAR TRANSVERSE LIGAMENT. ACTA ORTOPEDICA BRASILEIRA 2016; 24:267-269. [PMID: 28149194 PMCID: PMC5266659 DOI: 10.1590/1413-785220162405158405] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective: The aim of our study is to present the benefit of using the transvers acetabular ligament for intraoperative determination of the anteversion of acetabular component. Methods: Twenty-one total hip arthroplasties were performed. The transverse acetabular ligament was identified and used as a guide to position the acetabular component. Results: The mean anteversion angle was 16.9. None of the patients studied sustained a postoperative dislocation during this short follow-up period. Conclusion: We conclude from this preliminary study that the transverse acetabular ligament can aid positioning of the acetabular component of a THR. It defines the version of the acetabular component without the need for external instrumentation, and is independent of the position of the patient. Level of Evidence IV; Prospective Study.
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Hiddema WB, van der Merwe JF, van der Merwe W. The Transverse Acetabular Ligament as an Intraoperative Guide to Cup Abduction. J Arthroplasty 2016; 31:1609-13. [PMID: 26897492 DOI: 10.1016/j.arth.2016.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/08/2016] [Accepted: 01/11/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The success of a total hip arthroplasty relies on optimal acetabular cup placement to ensure mating of the femoral head and acetabular cup throughout all positions of the hip joint. Poor cup placement is associated with dislocation, impingement, microseparation, component loosening, and accelerated wear due to rim loading. This study examined a novel method of using the transverse acetabular ligament (TAL) to guide cup inclination during primary total hip arthroplasty. METHODS A descriptive study using 16 hips from 9 cadavers. A computer navigation system measured inclination and version of the acetabular component in 3 positions with the lower edge of cup: (1) flush with, (2) 5 mm proximal to, and (3) 5 mm distal to free border of the TAL. RESULTS The median inclination angles were 44° in position (1), 30° in position (2), and 64° in position (3). The median anteversion angle for all positions was 19°. CONCLUSION Cup inclination was acceptable when the lower edge of the cup was flush or within 5 mm proximal to the TAL.
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Affiliation(s)
- Willem B Hiddema
- Department of Orthopedic Surgery, University of the Free State, Universitas Academic Hospital, Bloemfontein, South Africa
| | - Johan F van der Merwe
- Department of Orthopedic Surgery, University of the Free State, Universitas Academic Hospital, Bloemfontein, South Africa
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Ranawat CS, Ranawat AS, Lipman JD, White PB, Meftah M. Effect of Spinal Deformity on Pelvic Orientation from Standing to Sitting Position. J Arthroplasty 2016; 31:1222-1227. [PMID: 26725131 DOI: 10.1016/j.arth.2015.11.035] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 11/19/2015] [Accepted: 11/23/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The effect of fixed spinal deformities on a functional pelvis from standing to sitting is not fully understood. We aimed to assess the change in preoperative sagittal pelvic tilt angle (SPTA) from standing to sitting in patients undergoing total hip arthroplasty, comparing flexible and fixed spinal deformities. METHODS Between July 2011 and October 2011, 68 consecutive unilateral total hip arthroplasties were implanted in 68 patients with a mean age of 71 ± 6 years. Fixed spinal deformity was defined as <10° of the change in SPTA from standing to sitting. Preoperative radiographic evaluation included standing (weight-bearing) anteroposterior and lateral pelvic and lumbosacral radiographs and a sitting lateral pelvic radiograph. RESULTS The mean standing and sitting SPTA was 3.7° of anterior tilt and 17.7° of posterior tilt, respectively (change of 21.4 ± 12.5°). Seventy-five percent had flexible pelvises, all of which had a posterior tilt from standing to sitting. One patient in the fixed pelvis (1.4%) had a loss of posterior tilt from standing to sitting. The mean change of SPTA from standing to sitting in the fixed and flexible pelvis groups was 5.9 ± 3.5° to 26.7 ± 9.6° of posterior tilt, which was statistically significant (P < .05). CONCLUSION There was a significant change in sagittal pelvic tilt from standing to sitting, especially in patients with a flexible spine, in which the functional anteversion increases with sitting. The patients with a fixed pelvis had significantly less SPTA in standing (less anteversion) with less posterior sagittal tilt in sitting, which should be incorporated in cup positioning.
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Affiliation(s)
| | - Amar S Ranawat
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Joseph D Lipman
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Peter B White
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Morteza Meftah
- Department of Orthopaedics, NYU Langone Medical Center, Hospital for Joint Disease, New York, New York
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Maheshwari AV. Letter to the Editor Regarding Ben Lulu O, Rubin G, Krasnyansky S, et al. Measuring the Femoral Head Size-An Additional Real-Time Intraoperative Monitoring Tool for the Accuracy of the Preoperative Process and Implant Selection. J Arthroplasty 2015;30(12):2201. J Arthroplasty 2016; 31:1132-3. [PMID: 26928183 DOI: 10.1016/j.arth.2016.01.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 01/27/2016] [Indexed: 02/01/2023] Open
Affiliation(s)
- Aditya V Maheshwari
- Department of Orthopaedics, SUNY Downstate Medical Center, Brooklyn, New York
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Surgical technique and outcome of uncemented THR using HA coated stems in fused and deformed hips due to ankylosing spondylitis. Hip Int 2016; 25:142-5. [PMID: 25362871 DOI: 10.5301/hipint.5000197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Uncemented Total Hip Replacement (THR) is at present an accepted treatment in patients with severe deformity of the hip caused by advanced ankylosing spondylitis. MATERIALS AND METHODS We studied 20 patients, 2 female and 18 male, who had 29 THRs, all through a posterior approach. The patient's age at index surgery ranged from 20 to 47 years (mean 35.1). No trochanteric osteotomy was performed in any patient. A double cut of the femoral neck was performed for hips which were ankylosed in external rotation and flexion. Follow-up ranged from 18 to 46 months (mean 22.2 months). RESULTS The mean preoperative Harris Hip Score (HHS) was 34.6. At last follow-up all hips were considered excellent, with a mean HHS of 90. Radiographs revealed that the acetabular and femoral components were satisfactorily positioned with no radiographic evidence of loosening. No heterotrophic ossification was found. CONCLUSIONS 1) Trochanteric Osteotomy was not found necessary to expose the hip through the posterior approach. 2) Uncemented THR using HA coated stem in the treatment of severe deformity of the hip caused by advanced ankylosing spondylitis allowed good lower limb function.
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Blizzard DJ, Nickel BT, Seyler TM, Bolognesi MP. The Impact of Lumbar Spine Disease and Deformity on Total Hip Arthroplasty Outcomes. Orthop Clin North Am 2016; 47:19-28. [PMID: 26614917 DOI: 10.1016/j.ocl.2015.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Concurrent spine and hip disease is common. Spinal deformities can restrict lumbar range of motion and lumbar lordosis, leading to pelvic obliquity and increased pelvic tilt. A comprehensive preoperative workup and component templating ensure appropriate compensation for altered pelvic parameters for implantation of components according to functional positioning. Pelvic obliquity from scoliosis must be measured to calculate appropriate leg length. Cup positioning should be templated on standing radiograph to limit impingement from cup malposition. In spinal deformity, the optimal position of the cup that accommodates pelvic parameters and limits impingement may lie outside the classic parameters of the safe zone.
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Affiliation(s)
- Daniel J Blizzard
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Brian T Nickel
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Fluoroscopy assessment during anterior minimally invasive hip replacement is more accurate than with the posterior approach. INTERNATIONAL ORTHOPAEDICS 2015; 40:21-7. [DOI: 10.1007/s00264-015-2803-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 04/27/2015] [Indexed: 12/14/2022]
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Does stem design influence component positioning in total hip arthroplasty using a minimal invasive posterolateral approach? INTERNATIONAL ORTHOPAEDICS 2014; 38:1347-52. [PMID: 24604620 DOI: 10.1007/s00264-014-2299-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 02/07/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Limited data exist for the reconstructive potential of short bone-preserving stems in THA using a minimal invasive posterolateral approach. Our study aim was to assess the effect of stem design on the reconstruction of hip offset and leg length in MIS posterolateral THA. METHODS This retrospective consecutive single-surgeon study compares hip offset and leg length, as well as acetabular component positioning (cup anteversion; inclination) of 129 THAs with a cementless standard-length stem (Synergy®) and 143 THAs with a cementless short bone-preserving stem (Trilock®). RESULTS In reference to the contralateral side, the mean difference in hip offset was 0.9 mm (p = 0.067) for the standard stem and 0.1 mm (p = 0.793) for the short stem, respectively. Leg-length discrepancy was 0.7 mm (Synergy®) and 0.9 mm (Trilock®), respectively. A total of 233 (86 %) acetabular components fell within the target zone for anteversion and inclination. CONCLUSION Accurate component positioning in MIS posterolateral approach THA is possible and is not influenced by the type of stem.
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Meermans G, Van Doorn WJ, Koenraadt K, Kats J. The use of the transverse acetabular ligament for determining the orientation of the components in total hip replacement. Bone Joint J 2014; 96-B:312-8. [DOI: 10.1302/0301-620x.96b3.32989] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The orientation of the acetabular component can influence both the short- and long-term outcomes of total hip replacement (THR). We performed a prospective, randomised, controlled trial of two groups, comprising of 40 patients each, in order to compare freehand introduction of the component with introduction using the transverse acetabular ligament (TAL) as a reference for anteversion. Anteversion and inclination were measured on pelvic radiographs. With respect to anteversion, in the freehand group 22.5% of the components were outside the safe zone versus 0% in the transverse acetabular ligament group (p = 0.002). The mean angle of anteversion in the freehand group was 21° (2° to 35°) which was significantly higher compared with 17° (2° to 25°) in the TAL group (p = 0.004). There was a significant difference comparing the variations of both groups (p = 0.008). With respect to inclination, in the freehand group 37.5% of the components were outside the safe zone versus 20% in the TAL group (p = 0.14). There was no significant difference regarding the accuracy or variation of the angle of inclination when comparing the two groups. The transverse acetabular ligament may be used to obtain the appropriate anteversion when introducing the acetabular component during THR, but not acetabular component inclination. Cite this article: Bone Joint J 2014;96-B:312–18.
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Affiliation(s)
- G. Meermans
- Lievensberg Hospital, Boerhaaveplein
1, 4624 VT Bergen Op Zoom, the
Netherlands
| | | | - K. Koenraadt
- Lievensberg Hospital, Bergen
Op Zoom, the Netherlands
| | - J. Kats
- Lievensberg Hospital, Bergen
Op Zoom, the Netherlands
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Abstract
Dislocation remains one of the most common complications after total hip arthroplasty, regardless of the surgical approach. While multiple reasons as laxity, implant position, improper implant choice, and impingement etc. might be leading factors for dislocation, an exact identification of the exact reason is of major importance, to plan for a proper surgical or nonsurgical correction. This article describes in detail the definition, etiology, reduction, and possible treatment options for dislocation after primary and revision total hip arthroplasty that are currently used at the Endo Klinik in Hamburg. It furthermore includes a distinct overview of possible surgical treatment options, based on the main pathology leading to dislocation.
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