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Rezaei A, Michael S, Eldib A, Puri L. Relative Acetabular Retroversion and Its Association With Earlier-Onset Symptomatic Osteoarthritis of the Hip. Arthroplast Today 2024; 26:101322. [PMID: 38455866 PMCID: PMC10918484 DOI: 10.1016/j.artd.2024.101322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/23/2023] [Accepted: 01/21/2024] [Indexed: 03/09/2024] Open
Abstract
Background Hip osteoarthritis is associated with an aging population with the average total hip arthroplasty patient in the U.S. approximately 65 years of age. Although there is an association between femoroacetabular impingement and early arthritis, there is a paucity of data attributed to variation in native acetabular version and early onset osteoarthritis. We investigated that whether patients with relative acetabular retroversion are predisposed to earlier hip osteoarthritis. Methods Five hundred sixteen charts of patients undergoing THA by a single surgeon between March 2018 and May 2022 were reviewed (221 male and 295 female subjects; mean age 66.7 years [standard deviation (SD) 9.8]). Patients with advanced dysplasia, who are post-traumatic, septic, have inflammatory arthritis, and osteonecrosis were excluded. Operative hip anteversion was measured using three-dimensional computed tomography. A univariate analysis was used to correlate the age of male and female subjects with anteversion angles of ≤15° and >15°. The effect of age and gender on version angle was studied using a multivariate linear regression model. Results In patients with anteversion ≤15°, both male (P = .006) and female subjects (P = .015) presented at significantly lesser age (male: 98, avg. age: 63.7, SD: 8.7; female: 62, avg. age: 64.8, SD: 9.8) than those with anteversion >15° (male: 123, avg. age: 67.2, SD: 10.2; female: 233, avg. age: 68.2, SD: 9.8). Male subjects had lower anteversion than female subjects with age held constant (P < .001), and older patients had increased anteversion with gender held constant (P < .001). Conclusions This study suggests that patients with a relatively decreased version angle (≤15°) are more likely to present with earlier-onset symptomatic hip osteoarthritis.
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Affiliation(s)
- Arash Rezaei
- Department of Orthopedic Surgery, University of Illinois – Chicago, Chicago, IL, USA
| | - Stojanovic Michael
- Department of Orthopaedic Surgery, NorthShore Orthopaedic & Spine Institute, Skokie, IL, USA
| | - Ahmed Eldib
- Department of Orthopaedic Surgery, NorthShore Orthopaedic & Spine Institute, Skokie, IL, USA
| | - Lalit Puri
- Department of Orthopaedic Surgery, NorthShore Orthopaedic & Spine Institute, Skokie, IL, USA
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Stegelmann SD, Butler JT, Hiatt JL, Bullock MW. Safe Sex After Total Hip Arthroplasty: Using Computed Tomography-Based Robotics to Evaluate "At-Risk" Sexual Positions. J Arthroplasty 2024; 39:433-440.e4. [PMID: 37572725 DOI: 10.1016/j.arth.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) can improve sexual satisfaction, but fear of dislocation can lead to sexual difficulties following this procedure. Previous kinematic research identified 4 sexual positions in women and 2 in men that were considered at risk for impingement. This study aimed to validate these findings using current robotic THA simulations. METHODS The 3-dimensional renderings from 12 patients who received computed tomography (CT)-based robotic THA were used to assess for prosthetic and/or bony impingement among 12 popular sexual positions. There were 9 cup orientations tested for each position (a combination of anteversion [0 °, 15 °, and 30 °] and inclination [40 °, 45 °, and 60 °]). The at-risk positions were tested again using the unique hip positions and cup orientations where previous geometric modeling data found impingement to occur. RESULTS Using mean hip positions, impingement occurred in at least 1 patient in 1 of the 12 positions for women (position 5) and 5 of the 12 positions for men (positions 1, 5, 8, 10, and 11). Among the at-risk positions, impingement occurred in none of the 2 at-risk women positions (0 of 17 cup orientations) and in both at-risk men positions (9 of 9 cup orientations for position 8 and 1 of 1 for position 11). CONCLUSION Recreating popular and at-risk sexual positions following THA with a CT-based robotics system yielded results that were inconsistent with previous geometric modeling data. Resolving these discrepancies is crucial for surgeons to provide accurate postoperative patient education. The CT-based robotic systems may provide necessary input to feasibly individualize such recommendations, but current limitations in CT-based robotics require continued attention and innovation.
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Affiliation(s)
| | - Justin T Butler
- Department of Orthopedic Surgery, Mercy Health Saint Vincent Medical Center, Toledo, Ohio
| | - John L Hiatt
- Department of Orthopedic Surgery, Mercy Health Saint Vincent Medical Center, Toledo, Ohio
| | - Matthew W Bullock
- Department of Orthopaedic Surgery, Marshall University, Joan C. Edwards School of Medicine, Huntington, West Virginia
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Kaddick C, Schmidt C, Grupp TM, Steffens J. Impingement testing of total hip replacements according to ASTM F2582 - Implant wear, resistance to damage and acceptance criteria. J Mech Behav Biomed Mater 2024; 150:106270. [PMID: 38056402 DOI: 10.1016/j.jmbbm.2023.106270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES The aim of this study was to determine the resistance to impingement damage of three different artificially aged UHMWPE materials used for total hip joint replacement. The results obtained can be used as a basis for an acceptance criterion for testing according to ASTM F2582-20. METHODS Three different polyethylene liner materials, standard polyethylene (UHMWPE), moderately crosslinked (XLPE) and vitamin E stabilized crosslinked (XLPE-VE) polyethylene of the same design and manufacturer were tested up to one million impingement cycles according to ASTM F2582-20. The liners were artificially oxygen aged for two and three weeks according to ASTM F2003-02. The wear volumes of the liner, acetabular shells, and hip endoprosthesis stems were determined. Each of the six impingement test groups consisted of three samples. For each test group, a reference group was subjected to the same conditioning and loading conditions but without impingement between the hip stem and the liner. The force needed to disassemble the liner from the acetabular shell (push-out force) was determined according to ASTM F1820-22 for the test and the reference groups. RESULTS XLPE and XLPE-VE polyethylene groups showed less impingement wear when compared to the standard UHMWPE material. Similarly, the protective function of the liner against direct metal-on-metal contact was greater, resulting in less wear on the acetabular shell and the stem neck. The three weeks aged standard UHMWPE group showed early onset of fatigue delamination wear. The push-out values remained unchanged for all XLPE liners and the 3-week aged XLPE-VE liners. The aged UHMWPE liners showed low push-out strength due to component shrinkage caused by aging in combination with the tapered fixation used for this specific design. SIGNIFICANCE The largest polyethylene wear volume measured of XLPE and XLPE-VE polyethylene aged for two and three weeks was 15.05 mm³ (SD 0.56 mm³). The corresponding metal wear volume was 1.23 mm³ (SD 0.19 mm³) for the acetabular cup and 1.33 mm³ (SD 0.20 mm³) for the stem neck. Those values can support the definition of an acceptance criteria for impingement testing. The results of the push-out test required by ASTM F2582-20 should be evaluated with respect to geometry changes caused by aging. The protective effect of the polyethylene liner against metal-on-metal contact should be considered in the implant design phase in order to avoid implant failure due to metal debris.
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Affiliation(s)
- C Kaddick
- Endolab Mechanical Engineering, Riedering, Germany.
| | - C Schmidt
- Endolab Mechanical Engineering, Riedering, Germany
| | - T M Grupp
- Aesculap AG Research & Development, Tuttlingen, Germany; Ludwig Maximilians University Munich, Department of Orthopaedic and Trauma Surgery, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, Munich, Germany
| | - J Steffens
- Endolab Mechanical Engineering, Riedering, Germany
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Hasegawa M, Naito Y, Tone S, Sudo A. Two- and three-dimensional measurements of leg length change using an accelerometer-based portable navigation system in total hip arthroplasty. BMC Musculoskelet Disord 2023; 24:872. [PMID: 37946152 PMCID: PMC10633959 DOI: 10.1186/s12891-023-07006-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 10/31/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The aim of this study was examining the accuracy of accelerometer-based portable navigation systems (HipAlign) when measuring leg length changes using two-dimensional (2D) and three-dimensional (3D) methods. METHODS Inclusion criteria were patients ≥ 20 years old with symptomatic hip disease who underwent primary total hip arthroplasty (THA) in the supine position using HipAlign between June 2019 and April 2020. The exclusion criteria were patients who underwent THA via a posterior approach. We examined correlations between the leg length change measurement with HipAlign and either 2D or 3D measurement. We performed a multivariate analysis to determine which factors may have influenced the absolute error results. RESULTS This study included 34 patients. The absolute error in leg length change between the HipAlign and 3D measurement (4.0 mm) was greater than the HipAlign and 2D measurement (1.7 mm). There were positive correlations between leg length change with HipAlign and 2D and 3D measurements. Male patients had larger errors with 2D measurement. No significant factors were identified for 3D measurement. CONCLUSION HipAlign provided acceptable measurement accuracy for leg length changes.
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Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
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Tsai CJ, Yang ZY, Wu TY, Tsai YT, Wang JJ, Liaw CK. The Transverse Mechanical Axis of the Pelvis for Post-Operative Evaluation of Total Hip Arthroplasty. Biomedicines 2023; 11:biomedicines11051397. [PMID: 37239066 DOI: 10.3390/biomedicines11051397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/12/2023] [Accepted: 05/01/2023] [Indexed: 05/28/2023] Open
Abstract
Currently, orthopedic surgeons mainly use the inter-teardrop line (IT-line) as the transverse mechanical axis of the pelvis (TAP) for postoperative evaluation of total hip arthroplasty (THA). However, the teardrop is often unclear in the pelvis anteroposterior (AP) radiographs, which makes postoperative evaluation of THA difficult. In this study, we attempted to identify other clear and accurate axes for postoperative evaluation of THA. We calculated the mean and standard deviation of these angles and tested the significance of these angles using t-tests. The inter-teardrops line (IT line) and the upper rim of the obturator foramen (UOF) had smaller angles with the IFH line. The bi-ischial line (BI line) was relatively inaccurate in measurements. We recommend using the IT line as the TAP when the lower boundary of the teardrops is clear and the shapes of the teardrops on both sides of the pelvis are symmetrical. When there is no deformation of the obturator foramen on pelvic AP radiographs, the UOF is also a good choice for the TAP. We do not recommend the BI line as the TAP.
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Affiliation(s)
- Cheng-Jui Tsai
- School of Medicine, College of Medicine, Taipei Medical University, Taipei City 11031, Taiwan
| | - Zong-Yan Yang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei City 11031, Taiwan
| | - Tai-Yin Wu
- Department of Family Medicine, Zhongxing Branch, Taipei City Hospital, Taipei City 10341, Taiwan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei City 10055, Taiwan
- General Education Center, University of Taipei, Taipei City 10023, Taiwan
| | - Ya-Ting Tsai
- School of Medicine, China Medical University, Taichung City 404333, Taiwan
| | - Juyn-Jhe Wang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei City 11031, Taiwan
| | - Chen-Kun Liaw
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 11031, Taiwan
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe Dist, New Taipei City 23561, Taiwan
- Research Center of Biomedical Device, College of Biomedical Engineering, Graduate Institute of Biomedical Optomechatronics, Taipei Medical University, Taipei City 11031, Taiwan
- TMU Biodesign Center, Taipei Medical University, Taipei 11031, Taiwan
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Aubert T, Bouche PA. Combined kinematic cup alignment reduces the rate of impingement and edge loading compared to mechanical and anatomical alignment. An in-vitro case-control study. Orthop Traumatol Surg Res 2023; 109:103468. [PMID: 36441035 DOI: 10.1016/j.otsr.2022.103468] [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: 02/15/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In recent years, different alignments have been described for acetabular components in total hip arthroplasty (THA), to reduce the risk of impingement and edge loading. Currently there are 3 main options: mechanical (40° inclination/15° anteversion relative to the anterior pelvic plane), anatomic (40° inclination/anteversion parallel to the transverse ligament) and combined kinematic (according to spinal-pelvic parameters). There are no studies comparing all three in terms of impingement and edge loading. We therefore performed a retrospective case-control in-vitro study comparing risk of impingement and edge loading between the three alignments. HYPOTHESIS The study hypothesis was that combined kinematic alignment incurs significantly less risk of impingement and edge loading than do the other two types of alignment. METHODS Using a THA planning system, we simulated the 3 alignments for 90 patients undergoing THA with a ceramic-on-ceramic bearing between November 2019 and January 2022; for each simulation, we recorded any prosthetic impingement or edge loading. The study endpoint was the rate of prosthetic impingement or edge loading between the 3 alignments. RESULTS With the mechanical alignment, 31% of patients (28/90) showed risk of impingement and 22% (20/90) risk of edge loading. With the anatomic alignment, 31% of patients (28/90) showed risk of impingement and 23.3% (21/90) risk of edge loading. With the combined kinematic alignment, 12.2% of patients (11/90) showed risk of impingement and 8.9% (8/90) risk of edge loading. Pairwise comparison showed that the combined kinematic alignment was associated with significantly less impingement and edge loading than the mechanical alignment (respectively, p=0.03 and p=0.022) or the anatomic alignment (respectively, p=0.03 and p=0.014), while the mechanical and anatomic alignments did not differ. CONCLUSION A combined kinematic cup alignment in THA significantly reduced the risk of impingement and edge loading compared to mechanical and anatomic alignments. LEVEL OF EVIDENCE III, retrospective case-control study.
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Affiliation(s)
- Thomas Aubert
- Orthopaedic Department, Croix Saint Simon Hospital, 125 Rue d'Avron, 75020 Paris, France
| | - Pierre-Alban Bouche
- Orthopaedic Department, Croix Saint Simon Hospital, 125 Rue d'Avron, 75020 Paris, France; Orthopaedic Department, Lariboisière Hospital, APHP, 2 Rue Ambroise Paré, 75010 Paris, France.
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Influence of kinematics of the lumbopelvic complex in hip arthroplasty dislocation: from assessment to recommendations. Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04722-9. [PMID: 36717435 DOI: 10.1007/s00402-022-04722-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/29/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION In total hip arthroplasty (THA), misplacement of the implant can provide instability. Adequate orientation of the acetabular cup is a challenge due to variations in inter-individual anatomy and kinematics of the pelvis in everyday life. The aim of this study was to characterize the kinematic factors influencing the risk of dislocation in order to give recommendations for optimal placement of the cup. We hypothesized that the lack of pelvic adaptation would influence the risk of prosthetic instability and motivate adapted. MATERIALS AND METHODS Eighty patients with primary unilateral THA were included in a matched case-control study. Seventy-four patients were divided into two groups: group 1 (G1) consisting of patients with postoperative THA dislocation (37 patients) and group 2 (G2), without episodes of dislocation within two years postoperatively (37 patients). In both groups, spino-pelvic parameters and cup orientation were measured in standing and sitting positions with EOS® X-ray imaging and compared to each other between 12 and 24 months post-operatively. RESULTS No significant difference between the two groups was found for static parameters. In a sitting position, a lack of pelvic retroversion with a significant lower variation in sacral slope was observed in group 1 (8.0° ± 9.3 for G1 versus 14.7° ± 6.2 for G2, p < 0.01). Twenty-two (59%) patients with THA instability had sacral slope variations of less than 10° versus eight (21% of patients) with stable THA (p < 0.01). Cup orientation in the Lewinnek safe zone was not significantly different (59% vs 67%, p = 0.62), and the spino-pelvic parameters and cup orientation measured did not change between the standing and sitting positions. However, only 14 (37%) cups in G1 were in the functional safe zone versus 24 (67%) in G2 (p = 0.03). CONCLUSION Static parameters of the sagittal spinopelvic balance have a low predictive value for prosthetic instability. Dynamic analysis is essential. Kinematic parameters must be taken into account in determining the ideal position of the cup or stem. Stiffness with locked standing or sitting pelvis must be integrated in order to determine a personalized safe zone. LEVEL OF EVIDENCE Level III (matched case-control study).
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Imaging in Hip Arthroplasty Management-Part 1: Templating: Past, Present and Future. J Clin Med 2022; 11:jcm11185465. [PMID: 36143112 PMCID: PMC9503653 DOI: 10.3390/jcm11185465] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/11/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022] Open
Abstract
Hip arthroplasty is a frequently used procedure with high success rates. Its main indications are primary or secondary advanced osteoarthritis, due to acute fracture, osteonecrosis of the femoral head, and hip dysplasia. The goals of HA are to reduce pain and restore normal hip biomechanics, allowing a return to the patient’s normal activities. To reach those goals, the size of implants must suit, and their positioning must meet, quality criteria, which can be determined by preoperative imaging. Moreover, mechanical complications can be influenced by implant size and position, and could be avoided by precise preoperative templating. Templating used to rely on standard radiographs, but recently the use of EOS® imaging and CT has been growing, given the 3D approach provided by these methods. However, there is no consensus on the optimal imaging work-up, which may have an impact on the outcomes of the procedure. This article reviews the current principles of templating, the various imaging techniques used for it, as well as their advantages and drawbacks, and their expected results.
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Kirchner GJ, Smith NP, Dunleavy ML, Nikkel LE. Intraoperative Imaging in Total Hip Arthroplasty Is Cost-Effective Regardless of Surgical Approach. J Arthroplasty 2022; 37:S803-S806. [PMID: 34998907 DOI: 10.1016/j.arth.2021.12.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/30/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Component positioning in total hip arthroplasty (THA) may be improved with utilization of intraoperative imaging. The purpose of this study is to determine if intraoperative imaging during THA is cost-effective. METHODS A break-even analysis was used as a model for cost-effectiveness, which incorporates cost of imaging (including direct charges and the additional time required for imaging), rate of revision surgery, and cost of revision surgery, yielding a final revision rate that needs to be achieved with use of intraoperative imaging in order for its use to be cost-effective. Absolute risk reduction (ARR) is determined by the difference between the initial revision rate and final revision rate. RESULTS At an anticipated institutional cost of $120 and requiring 4 additional minutes, intraoperative fluoroscopy would be cost-effective if the baseline rate of revision due to component mispositioning (0.62%) is reduced to 0.46%. Intraoperative flat plate radiographs ($127) are cost-effective at an ARR of 0.16%. Cost-effectiveness is achieved with lower ARR in the setting of lower imaging costs ($15, ARR 0.02%), and higher ARR with higher imaging costs ($225, ARR 0.29%). ARR for cost-effectiveness is independent of baseline revision rate, but varies with the cost of revision procedures. CONCLUSION At current revision rates for component malpositioning, only 1 revision among 400 THAs needs to be prevented for the utilization of fluoroscopy (or 1 in 385 THAs with flat plate imaging), to achieve cost-effectiveness.
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Affiliation(s)
- Gregory J Kirchner
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Nathan P Smith
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Mark L Dunleavy
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Lucas E Nikkel
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA
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Comparison of a Minimally Invasive Tissue-Sparing Posterior Superior (TSPS) Approach and the Standard Posterior Approach for Hip Replacement. BIOMED RESEARCH INTERNATIONAL 2022; 2022:3248526. [PMID: 35813233 PMCID: PMC9262546 DOI: 10.1155/2022/3248526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 02/10/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study is to compare the functional and clinical outcomes, blood loss, complication rate, and hospital length of stay (LOS) of total hip replacement (THR) using a minimally invasive tissue-sparing posterior superior (TSPS) approach and the standard posterior approach. Materials and Methods This retrospective, observational, double-centered study included 38 patients undergoing hip replacement. The patents were divided into two groups: control group (19 patients), who underwent surgery with the standard posterior approach, and treatment group (19 patients), who received the same type of implant with ceramic-on-ceramic bearing via the TSPS approach. Hemoglobin level was assessed preoperatively, on first and second postoperative days, and on discharge day. Harris hip score and Western Ontario and McMaster Universities Arthritis Index were used to measure the clinical and functional outcomes. Hospital LOS and incidence of early and late complications were assessed in both groups. Postoperative anteroposterior pelvis X-ray was performed to assess the correct positioning of implants. Results Better early clinical outcomes (p = 0.0155), lesser blood loss (p < 0.0001), and reduced hospital LOS (p < 0.0001) were observed in the TSPS group than in the control group. No major adverse effects occurred in both groups, and a satisfactory implant orientation was achieved in all patients. Conclusions The TSPS approach is a reliable minimally invasive procedure for THR as it allows an accurate orientation of the components and provides better early postoperative functional outcomes, faster recovery, significantly lower blood loss, and shorter hospital LOS than the standard posterior approach. However, further research is needed to confirm the promising results and cost-effectiveness of the TSPS approach in larger cohorts with a longer follow-up period.
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Accuracy of a novel accelerometer-based navigation (Naviswiss) for total hip arthroplasty in the supine position. BMC Musculoskelet Disord 2022; 23:537. [PMID: 35658945 PMCID: PMC9166425 DOI: 10.1186/s12891-022-05495-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/31/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND This study aimed to determine the accuracy of acetabular cup insertion using a novel accelerometer-based navigation system in total hip arthroplasty (THA). METHODS A single-surgeon study was conducted in which 62 prospective patients with navigation and 42 retrospective patients without navigation in a supine position were compared. Absolute values for errors of radiographic inclination and anteversion were calculated. Navigation error was also calculated. Factors that affected absolute value of navigation error in cup alignment were determined. RESULTS In the navigation group, mean absolute errors for radiographic inclination and anteversion were 4.1° and 4.3°, respectively. In the control group, mean absolute errors were 6.6° in inclination (p < 0.01) and 5.9° in anteversion (p = 0.04). Mean absolute values of navigation error were 2.8° in inclination and 2.8°in anteversion. Factors affecting navigation errors were not found. CONCLUSION This novel accelerometer-based navigation system significantly increased the accuracy of cup placement during THA in the supine position.
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Marcovigi A, Sandoni D, Ciampalini L, Perazzini P, Zambianchi F, Hozack WJ, Catani F. Dislocation risk after robotic arm-assisted total hip arthroplasty: a comparison of anterior, lateral and posterolateral approaches. Hip Int 2022; 33:426-433. [PMID: 35504896 DOI: 10.1177/11207000221094513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIMS Dislocation is a major cause of early failure after THA and is highly influenced by surgical approach and component positioning. Robotic-arm assisted arthroplasty has been developed in an attempt to improve component positioning and reduce postoperative complications.The purpose of this study was to compare the rate of dislocation after robotic total hip arthroplasty through 3 different surgical approaches. MATERIALS AND METHODS All patients who had undergone robotic arm-assisted THA at 3 centres between 2014 and 2019 were reviewed. After applying exclusion criteria, 1059 patients were included in the study. An anterior approach was used in 323 patients, a lateral approach in 394 and a posterior approach in 342 patients.Episodes of dislocation were recorded after 6 months follow-up. Stem anteversion, cup anteversion, cup inclination and combined anteversion were collected using the integrated navigation system.Cumulative incidence (CI), incidence rate (IR) and risk ratio (RR) were calculated with a confidence interval of 95%. RESULTS 3 cases of dislocation (2 posterior approach, 1 anterior approach) were recorded, with a dislocation rate of 0.28% and an IR of 0.14%.The rate of placement of the cup in the Lewinnek safe zone was 82.2% for the posterior approach, 82.0% for the lateral approach and 95.4% for the anterior approach.The rate of placement in the combined version safe zone was 98.0% for the posterior approach, 73.0% for the lateral approach and 47.1% for the anterior approach.The incidence rate of dislocation was 0.30% for the anterior approach, 0.34% for the posterior approach and 0% for the lateral approach. CONCLUSIONS The robotic arm-assisted technique is associated with a low risk of dislocation. The combined version technique appears to be a reliable way to reduce the risk of dislocation through the posterolateral approach but does not appear to be essential when using the lateral and anterior approaches.
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Affiliation(s)
- Andrea Marcovigi
- Department of Orthopaedic Surgery, University Hospital Policlinico di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Dario Sandoni
- Department of Orthopaedic Surgery, University Hospital Policlinico di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Luigi Ciampalini
- U.O.S.D. Orthopaedics and Traumatology, Hospital Valdarno "La Gruccia", Montevarchi, Italy
| | | | - Francesco Zambianchi
- Department of Orthopaedic Surgery, University Hospital Policlinico di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - William J Hozack
- The Rothman Institute of Orthopedics at Thomas Jefferson University, PA, USA
| | - Fabio Catani
- Department of Orthopaedic Surgery, University Hospital Policlinico di Modena, University of Modena and Reggio-Emilia, Modena, Italy
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Batra S, Khare T, Kabra AP, Malhotra R. Hip-spine relationship in total hip arthroplasty - Simplifying the concepts. J Clin Orthop Trauma 2022; 29:101877. [PMID: 35515342 PMCID: PMC9065712 DOI: 10.1016/j.jcot.2022.101877] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/05/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Total hip arthroplasty (THA) has been described as the operation of the century. Despite significant advancement in the field of technology, hip instability remains second most common cause of revision hip surgery after infection. There is garning interest to identify role of hip-spine relationship in order to identify high-risk patients for instability after THA. Acetabular component position varies according to spinal alignment and mobility in order to decrease risk of impingement and instability. Preoperative work up includes standing pelvis anteroposterior radiograph and lateral spino-pelvic radiograph in standing and sitting position. The focus of this review is to develop an algorithm to address the spino-pelvic pathology and guide the treatment on the basis of sagittal movement of the spine-pelvis-hip complex and to minimise the rate of dislocation following THA.
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14
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Hu Y, Zhou X, Qiao H, Zhu Z, Li H, Zhang J. Computer simulation of optimal lipped polyethylene liner orientation against prosthetic impingement. J Orthop Surg Res 2022; 17:204. [PMID: 35379266 PMCID: PMC8981617 DOI: 10.1186/s13018-022-03093-6] [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: 12/13/2021] [Accepted: 03/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background Lipped or elevated acetabular liners are to improve posterior stability and are widely used in hip arthroplasty. However, concerns of increasing impingement exist when using such liners and optimal orientation of the elevated rim remains unknown. We aimed to identify the impact of lipped liner on the range of motion (ROM) before impingement and propose its optimal orientation. Methods An isochoric three-dimensional model of a general hip-replacement prosthesis was generated, and flex-extension, add-abduction and axial rotation were simulated on a computer. The maximum ROM of the hip was measured before the neck impinged on the liner. Different combinations of acetabular anteversion angles ranging from 5 to 30 degrees, and lipped liner orientations from posterior to anterior were tested. Results When acetabular anteversion was 10 or 15 degrees, placing the lip of the liner in the posterosuperior of the acetabulum allowed satisfactory ROM in all directions. When acetabular anteversion was 20 degrees, extension and external rotation were restricted. Adjusting the lip to the superior restored satisfactory ROM. When acetabular anteversion was 25 degrees, only placing the lip into the anterosuperior could increase extension and external rotation to maintain satisfactory ROM. Conclusions This study showed that optimal lipped liner orientation should depend on acetabular anteversion. When acetabular anteversion was smaller than 20 degrees, placing lip in the posterior allowed an optimally ROM. When acetabular anteversion was greater than 20 degrees, adjusting lip to the anterior allowed a comprehensive larger ROM to avoid early impingement. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03093-6.
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Affiliation(s)
- Yi Hu
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639# Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Xianhao Zhou
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639# Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Hua Qiao
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639# Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Zhenan Zhu
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639# Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Huiwu Li
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639# Zhizaoju Road, Shanghai, 200011, People's Republic of China.
| | - Jingwei Zhang
- Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639# Zhizaoju Road, Shanghai, 200011, People's Republic of China.
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15
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Iturriaga CR, Jung B, Mont MA, Rasquinha VJ, Boraiah S. Variability in Acetabular Component Position in Patients Undergoing Direct Anterior Approach Total Hip Arthroplasty Who Have Concomitant Spine Pathology. J Arthroplasty 2022; 37:501-506.e1. [PMID: 34822930 DOI: 10.1016/j.arth.2021.11.025] [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: 03/19/2021] [Revised: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hip instability following total hip arthroplasty (THA) can be a major cause of revision surgery. Physiological patient position impacts acetabular anteversion and abduction, and influences the functional component positioning. Osteoarthritis of the spine leads to abnormal spinopelvic biomechanics and motion, but there is no consensus on the degree of component variability for THAs performed by anterior approach. Therefore, we sought to present guidelines for changes in acetabular component positioning between supine and standing positions for patients undergoing primary THA by a uniform anterior approach. METHODS Perioperative patient radiographs of the pelvis and lumbar spine were collected. Images were used to determine acetabular component positioning and degree of coexisting spinal pathology, categorized as a Lane Grade (LG). Final analysis of variance was performed on a sample size of 643 anterior primary THAs. RESULTS From supine to standing position, as the severity of lumbar pathology increased the change in anteversion also increased (LG:0 = -0.11° ± 4.65°, LG:1 = 2.02° ± 4.09°, LG:2-3 = 5.78° ± 5.72°, P < .001). The mean supine anteversion in patients with absent lumbar pathology was 19.72° ± 5.05° and was lower in patients with worsening lumbar pathology (LG:1 = 18.25° ± 4.81°, LG:2-3 = 16.73° ± 5.28°, P < .001). CONCLUSION Patients undergoing primary THA by anterior approach with worsening spinal pathology have larger increases in component anteversion when transitioning from supine to standing positions. Consideration should be given to this expected variability when placing the patient's acetabular component.
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Affiliation(s)
- Cesar R Iturriaga
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY; Department of Orthopaedic Surgery, Plainview Hospital, Northwell Health, Plainview, NY
| | - Byeongho Jung
- Donald and Barbara Zucker School of Medicine, Hofstra University, Hempstead, NY
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
| | - Vijay J Rasquinha
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY
| | - Sreevathsa Boraiah
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY
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16
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Pryce GM, Sabu B, Al-Hajjar M, Wilcox RK, Thompson J, Isaac GH, Board T, Williams S. Impingement in total hip arthroplasty: A geometric model. Proc Inst Mech Eng H 2022; 236:9544119211069472. [PMID: 35147063 PMCID: PMC8915222 DOI: 10.1177/09544119211069472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022]
Abstract
Total Hip Arthroplasty (THA) is one of the most common and successful surgical interventions. The survivorship at 10 years for the most commonly used systems is over 95%. However, the incidence of revision is usually much higher in the 0-1 year time period following the intervention. The most common reason for revision in this early time period is dislocation and subluxation, which may be defined as complete or permanent, and partial or temporary loss of contact between the bearing surfaces respectively. This study comprises the development of a geometric model of bone and an in situ total hip replacement, to predict the occurrence and location of bone and component impingement for a wide range of acetabular cup positions and for a series of frequently practiced activities of daily living. The model developed predicts that anterior-superior component impingement is associated with activities that result in posterior dislocation. The incidence may be reduced by increased cup anteversion and inclination. Posterior-inferior component impingement is associated with anterior dislocation activities. Its incidence may be reduced by decreased cup anteversion and inclination. A component impingement-free range was identified, running from when the cup was positioned with 45° inclination and 25° anteversion to 70° inclination and 15°-20° anteversion.
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Affiliation(s)
- Gregory M Pryce
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Bismaya Sabu
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Mazen Al-Hajjar
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
- DePuy Synthes Joint Reconstruction, Leeds, UK
| | - Ruth K Wilcox
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Jonathan Thompson
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
- DePuy Synthes Joint Reconstruction, Leeds, UK
| | - Graham H Isaac
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Tim Board
- Wrightington Wigan and Leigh NHS Trust, Wigan, UK
| | - Sophie Williams
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
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17
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Hasegawa M, Tone S, Naito Y, Wakabayashi H, Sudo A. Comparison of the accuracies of computed tomography-based navigation and image-free navigation for acetabular cup insertion in total hip arthroplasty in the lateral decubitus position. Comput Assist Surg (Abingdon) 2021; 26:69-76. [PMID: 34874219 DOI: 10.1080/24699322.2021.1949494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Image-free navigation has been proven as reliable as that using computed tomography (CT) in positioning the acetabular cup in total hip arthroplasty (THA), but previous studies rarely included hip dysplasia cases. The purpose of the present study was to determine the accuracies of CT-based navigation and image-free navigation for acetabular cup insertion, including hip dysplasia cases. Sixty-three hips were studied, including 57 with hip dysplasia. The hips were divided into two groups based on the registration point of image-free navigation. In Group I, the ipsilateral anterior superior iliac spine (ASIS) and the L5 spinous process were registered in 31 hips. In Group II, bilateral ASIS points were registered in 32 hips. Final component orientation was measured from postoperative CT scans. The accuracy of cup orientation was compared between CT-based and image-free navigation. In Group I, the cup inclination was more accurate with CT-based navigation (1.9°) than with image-free navigation (4.4°, p=.009). Cup anteversion was also more accurate with CT-based navigation (2.9°) than with image-free navigation (7.1°, p<.001). In Group II, the accuracies of cup inclination and anteversion showed no differences between CT-based and image-free navigation. The accuracy of cup positioning was better with CT-based navigation than with image-free navigation when the ipsilateral ASIS and L5 spinous process were digitized. However, accuracy was similar when bilateral ASIS points were digitized.
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Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Japan
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Japan
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Japan
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18
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Naito Y, Hasegawa M, Tone S, Wakabayashi H, Sudo A. The accuracy of acetabular cup placement in primary total hip arthroplasty using an image-free navigation system. BMC Musculoskelet Disord 2021; 22:1016. [PMID: 34863119 PMCID: PMC8645094 DOI: 10.1186/s12891-021-04902-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intraoperative navigation systems have been shown to improve the accuracy of acetabular component insertion in total hip arthroplasty (THA). The purpose of this study was to investigate the accuracy of cup orientation in primary THA using an image-free navigation system. METHODS A total of 107 consecutive cementless THAs using an image-free navigation system were performed from February 2017 to March 2020 (the navigation group). As a control group, 77 retrospective consecutive cases who underwent THAs with manual implant-techniques between February 2012 and April 2017 were included. Postoperative cup radiographic inclination and radiographic anteversion relative to the functional pelvic plane were assessed using a 3D-template system after computed tomography (CT) examination. RESULTS The mean absolute errors of the postoperative measured angles from the target angles in inclination were 3.4° ± 3.0° in the navigation group and 8.4° ± 6.6° in the control group (p < 0.001). The mean absolute errors in anteversion were 5.1° ± 3.6° in the navigation group and 10.8° ± 6.5° in the control group (p < 0.001). The percentage of cups inside the Lewinnek safe zone was 93% in the navigation group and 44% in the control group (p < 0.001). The mean absolute values of navigation error were 3.3° ± 2.8° in inclination and 5.8° ± 4.9° in anteversion. Among the cases of osteoarthritis, the inclination error was significantly higher in Crowe group 2 to 4 than in Crowe group 1 (5.1° ± 3.5° and 3.0° ± 2.5°, respectively, p < 0.05). The percentage of hips with inclination error over 10° in Crowe group 2 to 4 was significantly higher than in Crowe group 1 (17 and 1%, respectively, p < 0.05). CONCLUSIONS The image-free navigation system improved the accuracy of cup orientation. The accuracy of cup position was less in Crowe group 2 to 4 than in Crowe group 1.
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Affiliation(s)
- Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
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19
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Miura T, Miyakoshi N, Saito K, Kijima H, Iida J, Hatakeyama K, Suzuki K, Komatsu A, Iwami T, Matsunaga T, Shimada Y. Association between global sagittal malalignment and increasing hip joint contact force, analyzed by a novel musculoskeletal modeling system. PLoS One 2021; 16:e0259049. [PMID: 34710144 PMCID: PMC8553155 DOI: 10.1371/journal.pone.0259049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 10/11/2021] [Indexed: 01/02/2023] Open
Abstract
Patients with adult spinal deformity have various standing postures. Although several studies have reported a relationship between sagittal alignment and exacerbation of hip osteoarthritis, information is limited regarding how spinopelvic sagittal alignment changes affect hip joint loading. This study aimed to investigate the relationship between sagittal spinopelvic-lower limb alignment and the hip joint contact force (HCF) using a novel musculoskeletal model. We enrolled 20 women (78.3±6.7 years) from a single institution. Standing lateral radiographs were acquired to measure thoracic kyphosis, lumbar lordosis, the pelvic tilt, sacral slope, sagittal vertical axis (SVA), femur obliquity angle, and knee flexion angle. In the model simulation, the Anybody Modeling System was used, which alters muscle pathways using magnetic resonance imaging data. Each patient’s alignment was entered into the model; the HCF and hip moment in the standing posture were calculated using inverse dynamics analysis. The relationship between the HCF and each parameter was examined using Spearman’s correlation coefficient (r). The patients were divided into low SVA and high SVA groups, with a cutoff value of 50 mm for the SVA. The HCF was 168.2±60.1 N (%BW) and positively correlated with the SVA (r = 0.6343, p<0.01) and femur obliquity angle (r = 0.4670, p = 0.03). The HCF were 122.2 and 214.1 N (75.2% difference) in the low SVA and high SVA groups, respectively (p<0.01). The flexion moment was also increased in the high SVA group compared with that in the low SVA group (p = 0.03). The SVA and femur obliquity angle are factors related to the HCF, suggesting an association between adult spinal deformity and the exacerbation of hip osteoarthritis. Future studies will need to assess the relationship between the hip joint load and sagittal spinopelvic parameters in dynamic conditions.
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Affiliation(s)
- Takanori Miura
- Department of Orthopedic Surgery, Kakunodate General Hospital, Akita, Japan
- * E-mail:
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kimio Saito
- Department of Rehabilitation Medicine, Akita University Hospital, Akita, Japan
| | - Hiroaki Kijima
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Jumpei Iida
- Department of Orthopedic Surgery, Omagari Kousei Medical Center, Akita, Japan
| | | | - Kotaro Suzuki
- Department of Mechanical Engineering, Akita University Faculty of Engineering Science, Akita, Japan
| | - Akira Komatsu
- National Institute of Technology (KOSEN), Sendai College, Sendai-shi, Miyagi, Japan
| | - Takehiro Iwami
- Department of Mechanical Engineering, Akita University Faculty of Engineering Science, Akita, Japan
| | - Tosiki Matsunaga
- Department of Rehabilitation Medicine, Akita University Hospital, Akita, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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20
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FALOTICO GUILHERMEGUADAGNINI, ROMERO VALÉRIA, BASILE RICARDO, TAKATA EDMILSONTAKEHIRO. EVALUATION OF THE RANGE OF MOTION OF A HIP ARTHROPLASTY SYSTEM: A COMPUTER SIMULATION STUDY. ACTA ORTOPEDICA BRASILEIRA 2021; 29:246-248. [PMID: 34629947 PMCID: PMC8478435 DOI: 10.1590/1413-785220212905240525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/24/2020] [Indexed: 11/29/2022]
Abstract
Objective: To date, the literature lacks consensus on the most efficient method to measure the range of motion of an in vitro prosthetic system. In this study, we propose the use of a relatively low-cost online software to measure the range of motion of hip prosthetic implants manufactured in Brazil and compare its results with the current technical standards for hip arthroplasty. Methods: Three different diameters of femoral heads were evaluated (28 mm, 32 mm, and 36 mm). The mean values of the angular displacement of the prosthesis in each motion axis were obtained by computer simulations. Results: The range of motion with each femoral head was 28mm (extension/flexion: 148°, internal/external rotation: 179°, adduction/abduction: 107°), 32 mm (152°/185°/114°), and 36 mm (158°/193°/120°). Conclusion: The computational method showed that the larger the femoral head, the greater the range of motion of the hip joint prosthetic system. Additional clinical studies are necessary to compare the physical results obtained with the values found in this study by computational modeling.Level of evidence V, Experimental study.
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21
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Tetsunaga T, Yamada K, Tetsunaga T, Furumatsu T, Sanki T, Kawamura Y, Ozaki T. Comparison of the accuracy of CT- and accelerometer-based navigation systems for cup orientation in total hip arthroplasty. Hip Int 2021; 31:603-608. [PMID: 32019376 DOI: 10.1177/1120700020904940] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The accuracies of various navigation systems in total hip arthroplasty (THA) have been described; however, the accuracy of cup orientation with an accelerometer-based navigation system has not been reported. The purpose of this study was to compare the accuracies of computed tomography (CT)- and accelerometer-based navigation systems for cup orientation in THA. METHODS In this prospective study, 30 patients who underwent cementless THA via anterolateral approach in the lateral decubitus position were analysed. A CT-based navigation system (30 hips) and an accelerometer-based navigation system (30 hips) were used simultaneously. The accuracy of cup orientation (absolute difference between intraoperative vs. postoperative measurements) was compared between the navigation systems using postoperative CT. RESULTS The accuracy of cup inclination was 3.2 ± 2.4° in the CT-based navigation group and 4.1 ± 3.7° in the accelerometer-based navigation group (p = 0.3035). The accuracy of cup anteversion was 3.0° ± 2.5° in the CT-based navigation group and 6.8° ± 4.8° in the accelerometer-based navigation group. Cup anteversion was significantly more accurate with the CT-based navigation system than with accelerometer-based navigation (p = 0.0009). Multiple regression analysis demonstrated that the malposition in cup anteversion was positively correlated with the change in pelvic tilt and loosening of the reference antenna. CONCLUSIONS Although, these results are only true for this specific accelerometer system, cup positioning was significantly more accurate with the CT-based navigation system than an accelerometer-based navigation in the lateral decubitus position. This is because of considerable discrepancies in the sagittal pelvic tilt, resulting in variability in cup anteversion angle with the use of an accelerometer-based navigation system.
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Affiliation(s)
| | - Kazuki Yamada
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
| | - Tomoko Tetsunaga
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
| | | | - Tomoaki Sanki
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
| | - Yoshi Kawamura
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
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22
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Okamoto M, Kawasaki M, Okura T, Ochiai S, Yokoi H. Comparison of accuracy of cup position using portable navigation versus alignment guide in total hip arthroplasty in supine position. Hip Int 2021; 31:492-499. [PMID: 32126836 DOI: 10.1177/1120700020908788] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Accelerometer-based portable navigation systems in supine total hip arthroplasty (THA) have been developed, but there are no reports on the accuracy of cup placement. We aimed to investigate and compare the accuracy of the accelerometer-based portable navigation system versus the acetabular alignment guide placed on the pelvis in THA using the direct anterior approach (DAA). Both devices tracked changes in the pelvic position. METHODS In this single-centre, retrospective study, we reviewed 115 hips in 113 patients who underwent primary THA via the DAA using an accelerometer-based portable navigation system in the supine position (portable navigation group) and 106 hips in 101 patients who underwent THA using an acetabular alignment guide (alignment guide group) as controls. Hips were evaluated postoperatively using computed tomography to measure cup orientation. The accuracy of cup orientation was compared between the 2 groups. RESULTS Absolute values of inclination error were 3.1° ± 2.2° and 2.9° ± 2.3° (p = 0.708) in the portable navigation and alignment guide groups and those of anteversion error were 2.8° ± 2.3° and 3.7° ± 2.7°, respectively (p = 0.005). The number of cups placed within 10° of error was 98.3% and 96.2% in the portable navigation and alignment guide groups, respectively (p = 0.304). The portable navigation group had significantly more hips (72.2%) placed within a 5° margin of error than did the alignment guide group (56.6%) (p = 0.016). CONCLUSION High accuracy in cup placement was achieved using accelerometer-based portable navigation in supine THA. Using a navigation system may contribute to improved long-term outcomes.
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Affiliation(s)
- Masanori Okamoto
- Department of Orthopaedic Surgery, Aichi Koseiren Konan Kosei Hospital, Konan, Aichi, Japan
| | - Masashi Kawasaki
- Department of Orthopaedic Surgery, Aichi Koseiren Konan Kosei Hospital, Konan, Aichi, Japan
| | - Toshiaki Okura
- Department of Orthopaedic Surgery, Aichi Koseiren Konan Kosei Hospital, Konan, Aichi, Japan
| | - Satoshi Ochiai
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Yokoi
- Department of Orthopaedic Surgery, Aichi Koseiren Konan Kosei Hospital, Konan, Aichi, Japan
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23
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McCarthy TF, Thompson MT, Nevelos J, Salem HS, Naylor BH, Mont MA. Range of Motion to Impingement Curves Create a New Patient-Specific Impingement-Free Zone for Acetabular Cup Placement. Surg Technol Int 2021; 38:400-406. [PMID: 33565600 DOI: 10.52198/21.sti.38.os1399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The acetabular "safe zone" has recently been questioned as a reliable reference for predicting total hip arthroplasty impingement and instability as many dislocations occur within the described parameters. Recently, an improved understanding of spino-pelvic mechanics has provided surgeons useful information to both identify those at a higher risk of dislocation and, in some cases, allows altering component positioning to accommodate the patient's individual "functional" range of motion. The purpose of this study was to create a new patient-specific impingement-free zone by considering range of motion (ROM) to prosthetic impingement for both high flexion and extension poses, thus demarcating a zone that avoids both anterior and posterior impingement, thereby creating an objective approach to identifying a patient's ideal functional safe zone. MATERIALS AND METHODS A validated hip ROM three-dimensional simulator was utilized to create ROM-to-impingement curves for both high flexion as well as pivot and turn poses. The user imported a computerized tomography (CT) with a supine pelvic tilt (PT) value of zero and implant models (tapered wedge stem, 132° neck angle, 15° stem version, 36mm femoral head). Femur-to-pelvis relative motions were determined for three upright seated poses (femur flexed at 90° and 40° internal rotation, with 0°, 10°, and 20° posterior PT), one chair rise pose (femur flexed at 90° and 0° internal rotation, with the pelvis flexed anteriorly until the pelvis made contact with the femur), and three standing pivot and turn poses (femur set at 5° extension, and 35° external rotation, with 5° posterior PT, 0°, and 5° anterior PT). ROM-to-impingement curves for cup inclination versus anteversion were graphed and compared against the Lewinnek safe zone. RESULTS The ROM-to-impingement curves provide an objective assessment of potential impingement sites as they relate to femoral rotation and pelvic tilt. The area between the stand and sit curves is the impingement-free area. A sitting erect pose with a simulated stiff spine (0° PT) yielded less impingement-free combinations of cup inclination and version than poses with greater than 0° posterior pelvic tilt. CONCLUSION The results demonstrate that the acetabular target zone has a relatively small margin for error between the sitting and standing ROM curves to impingement. Importantly, anterior and posterior pelvic tilt can markedly increase the risk of impingement, potentially leading to posterior or anterior dislocations, respectively. This study highlights the importance of correctly identifying the patient-specific functional range of motion to execute optimal component positioning.
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Affiliation(s)
- Thomas F McCarthy
- Implant and Robotics Research, Stryker Orthopaedics, Mahwah, New Jersey
| | | | - Jim Nevelos
- Implant and Robotics Research, Stryker Orthopaedics, Mahwah, New Jersey
| | - Hytham S Salem
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
| | - Brandon H Naylor
- Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
| | - Michael A Mont
- Northwell Health, Lenox Hill Hospital, New York, New York
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Boe RA, Selemon NA, Eachempati KK, Paprosky WG, Sheth NP. Soft-Tissue Balancing in Total Hip Arthroplasty. JBJS Rev 2021; 9:e20.00116. [PMID: 33591131 DOI: 10.2106/jbjs.rvw.20.00116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Appropriate total hip arthroplasty (THA) reconstruction must simultaneously address component position, restoration of biomechanics, and soft-tissue balance. » Preoperative planning for complex THA cases should include radiographic templating, a detailed case plan that contains backup implant options, and a thorough understanding of the patient's preoperative examination. » Using a systematic approach to soft-tissue balancing in THA enhances the ability to intraoperatively execute the preoperative plan. » In patients with preexisting deformities (e.g., dysplasia or prior surgery), increased attention to abductor function is necessary when assessing acetabular component placement and offset.
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Affiliation(s)
- Richard A Boe
- Department of Orthopaedic Surgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicolas A Selemon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Wayne G Paprosky
- Department of Orthopaedic Surgery, Rush University and Central DuPage Hospital-Northwestern University, Chicago, Illinois
| | - Neil P Sheth
- Department of Orthopaedic Surgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania
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25
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Onggo JR, Nambiar M, Onggo JD, Phan K, Ambikaipalan A, Babazadeh S, Hau R. Comparable dislocation and revision rates for patients undergoing total hip arthroplasty with subsequent or prior lumbar spinal 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 2021; 30:63-70. [PMID: 33104880 DOI: 10.1007/s00586-020-06635-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is a known correlation between the procedures of lumbar spinal fusion (LSF), total hip arthroplasty (THA) and the complication of hip dislocation and revision occurring in patients. However there is no consensus as to whether the risk of this complication is higher if THA is performed before or after LSF. This meta-analysis aims to determine the influence of surgical sequence of lumbar spinal fusion and total hip arthroplasty on the rates of hip dislocation and revisions. METHODS A meta-analysis was conducted with a multi-database search (PubMed, OVID, EMBASE, Medline) according to PRISMA guidelines on 27th May 2020. Data from all published literature meeting inclusion criteria were extracted and analyzed with an inverse variance statistical model. FINDINGS A total of 25,558 subsequent LSF and 43,880 prior LSF THA patients were included in this study. There was no statistically significant difference in all-cause revisions (OR = 0.86, 95%CI: 0.48-1.54, p = 0.61), dislocation (OR = 0.82, 95%CI: 0.25-2.72, p = 0.75) or aseptic loosening (OR = 1.14, 95%CI: 0.94-1.38, p = 0.17) when comparing patients receiving LSF subsequent versus prior to THA. CONCLUSION Lumbar spinal fusion remains a risk factor for dislocation and revision of total hip arthroplasties regardless of whether it is performed prior to or after THA. Further preoperative assessment and altered surgical technique may be required in patients having THA who have previously undergone or are likely to undergo LSF in the future. EVIDENCE LEVEL Level II, Meta-analysis of homogeneous studies.
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Affiliation(s)
- James Randolph Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC, 3128, Australia.
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash University Clayton Campus, Clayton, VIC, 3168, Australia.
| | - Mithun Nambiar
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC, 3128, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash University Clayton Campus, Clayton, VIC, 3168, Australia
| | - Jason Derry Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC, 3128, Australia
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Kevin Phan
- NeuroSpine Surgery Research Group, 320-346 Barker St, Sydney, NSW, 2031, Australia
| | - Anuruban Ambikaipalan
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC, 3128, Australia
| | - Sina Babazadeh
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC, 3128, Australia
- Department of Surgery, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC, 3128, Australia
- Eastern Health Clinical School, Monash University, 5 Arnold Street, Melbourne, VIC, 3128, Australia
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Wang R, Zheng X, Xu T, Gong S, Liu S, Han L, Yang S, Xu W. Personalized Cup Positioning Guides Improved Cup Positioning and Hip Ranges of Motion in Robotic Assisted Total Hip Arthroplasty. Front Bioeng Biotechnol 2020; 8:988. [PMID: 32974316 PMCID: PMC7471602 DOI: 10.3389/fbioe.2020.00988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/29/2020] [Indexed: 11/13/2022] Open
Abstract
Objective Precise hip cup positioning is essential for the prevention of component impingement and dislocation in robotic assisted total hip arthroplasty (THA). Currently, the robotic system uses a mechanical alignment guide (MAG) for cup placement, which is one-size-fits-all, and the optimal cup positioning is controversial. Robotic assisted THA has not used any personalized cup positioning guides. The goal of this study was to identify an optimal guide for cup placement in robotic assisted THA to improve prognosis and life quality after THA. Materials and Methods Pelvis and femoral CT data of 47 participants were retrospectively collected for preoperative planning of robotic THA. The universal MAG guide and three personalized guides, including acetabular rim labrum guide (ARLG), transverse acetabular ligament guide (TALG), and ischiatic-pubis line guide (IPLG), were used to pose cups in the acetabulum of each participant. The position of cups was evaluated by inclination and anteversion; the function of hip joints was evaluated by hip ranges of motion, including abduction, adduction, extension, flexion, internal rotation, and external rotation. Results In terms of cup positioning, ARLG provided a bigger cup inclination (p < 0.0001), while IPLG and TALG provided smaller cup inclination (p < 0.001) than MAG; the three personalized guides provided larger cup anteversion (p < 0.0001) than MAG. In terms of HROMs, compared with the use of MAG, the use of three personalized guides significantly decreased abduction (p < 0.0001), extension (p < 0.0001), and external rotation (p < 0.0001), but increased significantly flexion (p < 0.0001) and internal rotation (p < 0.0001); the use of ARLG significantly reduced adduction (p < 0.0001), but the use of IPLG and TALG increased adduction (p < 0.0001). Conclusion Compared with MAG, personalized guides provided greater flexion and internal rotation, which may reduce the risk of posterior dislocation. Among the three personalized guides, IPLG is the most reliable one for the preoperative planning of robotic assisted THA.
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Affiliation(s)
- Ruoyu Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaojing Zheng
- Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tianze Xu
- Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,College of ACES, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Song Gong
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaokai Liu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lizhi Han
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuhua Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weihua Xu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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[Biomechanical compensatory mechanisms of hips and spine : The essentials for spine and hip surgeons]. DER ORTHOPADE 2020; 49:870-876. [PMID: 32926204 DOI: 10.1007/s00132-020-03980-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Spinal alignment changes with age and degeneration. Different compensatory mechanisms of the spine are necessary to preserve spinal balance. The capacity of compensation of the spine decreases with age. Thus, the pelvis and the lower limbs become involved in the compensatory mechanism. Concomitant osteoarthritis of the hip could impair this capacity. The biomechanical principles of compensation are described with respect to planning reconstructive hip and spine surgery.
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Hasegawa M, Naito Y, Tone S, Wakabayashi H, Sudo A. Accuracy of acetabular cup insertion in an anterolateral supine approach using an accelerometer-based portable navigation system. J Artif Organs 2020; 24:82-89. [PMID: 32880017 DOI: 10.1007/s10047-020-01206-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/24/2020] [Indexed: 01/07/2023]
Abstract
The purpose of this study was to determine the accuracy of acetabular cup insertion during total hip arthroplasty (THA) in a supine position using an accelerometer-based portable navigation system. A single-surgeon study was conducted in which 62 prospective patients with navigation and 42 retrospective patients without navigation as historical controls were compared. The patients underwent THA via an anterolateral supine approach. The absolute values of errors of radiographic inclination and anteversion were calculated. The navigation error was also calculated. The factors that affected the absolute values of errors of cup alignment were determined. The mean absolute error of the postoperative CT measurement from the target angle for radiographic inclination was 3.8° in the navigation group and 6.6° in the control group (P < 0.001). The mean absolute error for anteversion was 3.3° in the navigation group and 5.9° in the control group (P < 0.001). The mean absolute values of navigation error were 3.7° ± 2.8° in inclination and 3.0° ± 2.6° in anteversion. Changes in the pelvic tilt angle among preoperative, intraoperative, and postoperative were the significant risk factors for the absolute values of navigation error of anteversion relative to the anterior pelvic plane. Other factors affecting the absolute values of errors in the navigation group were not found for radiographic inclination and anteversion. The portable navigation system significantly improved the accuracy of cup inclination and anteversion. Changes in the pelvic tilt were the risk factors for the error of anteversion relative to the anterior pelvic plane.
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Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
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29
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Kawahara S, Hara T, Sato T, Kitade K, Shimoto T, Nakamura T, Mawatari T, Higaki H, Nakashima Y. Digitalized analyses of intraoperative acetabular component position using image-matching technique in total hip arthroplasty. Bone Joint Res 2020; 9:360-367. [PMID: 32728432 PMCID: PMC7376306 DOI: 10.1302/2046-3758.97.bjr-2019-0260.r2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aims Appropriate acetabular component placement has been proposed for prevention of postoperative dislocation in total hip arthroplasty (THA). Manual placements often cause outliers in spite of attempts to insert the component within the intended safe zone; therefore, some surgeons routinely evaluate intraoperative pelvic radiographs to exclude excessive acetabular component malposition. However, their evaluation is often ambiguous in case of the tilted or rotated pelvic position. The purpose of this study was to develop the computational analysis to digitalize the acetabular component orientation regardless of the pelvic tilt or rotation. Methods Intraoperative pelvic radiographs of 50 patients who underwent THA were collected retrospectively. The 3D pelvic bone model and the acetabular component were image-matched to the intraoperative pelvic radiograph. The radiological anteversion (RA) and radiological inclination (RI) of the acetabular component were calculated and those measurement errors from the postoperative CT data were compared relative to those of the 2D measurements. In addition, the intra- and interobserver differences of the image-matching analysis were evaluated. Results Mean measurement errors of the image-matching analyses were significantly small (2.5° (SD 1.4°) and 0.1° (SD 0.9°) in the RA and RI, respectively) relative to those of the 2D measurements. Intra- and interobserver differences were similarly small from the clinical perspective. Conclusion We have developed a computational analysis of acetabular component orientation using an image-matching technique with small measurement errors compared to visual evaluations regardless of the pelvic tilt or rotation.Cite this article: Bone Joint Res 2020;9(7):360-367.
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Affiliation(s)
- Shinya Kawahara
- Department of Orthopaedic Surgery, Aso-Iizuka Hospital, Iizuka, Japan
| | - Toshihiko Hara
- Department of Orthopaedic Surgery, Aso-Iizuka Hospital, Iizuka, Japan
| | - Taishi Sato
- Department of Orthopaedic Surgery, Aso-Iizuka Hospital, Iizuka, Japan
| | - Kazuki Kitade
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Shimoto
- Faculty of Information Engineering, Fukuoka Institute of Technology, Fukuoka, Japan
| | - Tetsuro Nakamura
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Kyushu Hospital, Kitakyushu, Japan
| | - Taro Mawatari
- Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka, Japan
| | - Hidehiko Higaki
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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30
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Putame G, Pascoletti G, Franceschini G, Dichio G, Terzini M. Prosthetic Hip ROM from Multibody Software Simulation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:5386-5389. [PMID: 31947073 DOI: 10.1109/embc.2019.8856993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The pre-operative planning of a hip arthroplasty entails the choice of the prosthetic hip model and of the position of both joint components with reference to bone. Assessing the impact of geometrical factors on the final hip range of motion (ROM) is not trivial, since it requires performing 3D evaluations. Nonetheless, it deserves to be studied since hip impingement and dislocation are still relevant complications in hip arthroplasty. This work pertains a numerical model for the assessment of the hip ROM in relation to cotyle position. External/internal rotation is considered as a benchmark, and multiple combinations of acetabular anteversion/inclination are considered. According to results, over two hundred different geometric configurations can be examined in few minutes, and the cotyle position can be so optimized with relevant benefits in term of hip ROM.
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31
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Sagittal Pelvic Kinematics in Hip Arthroplasty. Curr Rev Musculoskelet Med 2020; 13:240-246. [PMID: 32318965 DOI: 10.1007/s12178-020-09628-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW The orientation of the spine relative to the pelvis-particularly that in the sagittal plane-has been shown in both kinematic and radiographic studies to be paramount in governance of acetabular alignment during normal bodily motion. The purpose of this review is to better understand the challenges faced by arthroplasty surgeons in treating patients that have concurrent lumbar disease and are therefore more likely to have poorer clinical outcomes after THA than in patients without disease. RECENT FINDINGS The concept of an "acetabular safe zone" has been well described in the past regarding the appropriate orientation of acetabular component in THA. However, this concept is now under scrutiny, and rising forth is a concept of functional acetabular orientation that is based on clinically evaluable factors that are patient and motion specific. The interplay between the functional position of the acetabulum and the lumbar spine is complex. The challenges that are thereby faced by arthroplasty surgeons in terms of proper acetabular cup positioning when treating patients with concomitant lumbar disease need to be better understood and studied, so as to prevent catastrophic and costly complications such as periprosthetic joint dislocations and revision surgeries.
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32
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Tetsunaga T, Yamada K, Tetsunaga T, Sanki T, Kawamura Y, Ozaki T. An accelerometer-based navigation system provides acetabular cup orientation accuracy comparable to that of computed tomography-based navigation during total hip arthroplasty in the supine position. J Orthop Surg Res 2020; 15:147. [PMID: 32295628 PMCID: PMC7161129 DOI: 10.1186/s13018-020-01673-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/03/2020] [Indexed: 11/21/2022] Open
Abstract
Background Inadequate acetabular component orientation is associated with postoperative impingement, dislocation, and accelerated polyethylene wear. Computed tomography (CT)-based navigation systems provide accuracy for total hip arthroplasty (THA) but are not available in all facilities. Accelerometer-based navigation systems are inexpensive, but their accuracy remains undetermined. This study compares the accuracy of cup orientation in THA using CT-based and accelerometer-based navigation systems. Methods This retrospective study included 35 consecutive patients (11 males, 24 females; mean age, 65 years) who underwent primary cementless THA via an anterolateral approach in the supine position. Both CT-based and accelerometer-based navigation systems were used simultaneously. The accuracy of cup orientation was compared between the two systems using postoperative CT. Results The accuracy of cup inclination was 2.7° ± 2.0° in the CT-based group and 3.3° ± 2.4° in the accelerometer-based group. The accuracy of cup anteversion was 2.8° ± 2.6° in the CT-based group and 3.4° ± 2.2° in the accelerometer-based group. No significant difference was observed in cup inclination (p = 0.29) or cup anteversion (p = 0.34) between CT-based and accelerometer-based navigation. Conclusions The accuracy of cup positioning did not differ significantly between CT-based and accelerometer-based navigation systems.
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Affiliation(s)
- Tomonori Tetsunaga
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
| | - Kazuki Yamada
- Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Tomoko Tetsunaga
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Tomoaki Sanki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yoshi Kawamura
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
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A Preoperative Analytical Model for Patient-Specific Impingement Analysis in Total Hip Arthroplasty. Adv Orthop 2019; 2019:6293916. [PMID: 31355005 PMCID: PMC6634079 DOI: 10.1155/2019/6293916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/16/2019] [Indexed: 11/17/2022] Open
Abstract
Prosthetic impingement is important to consider during total hip arthroplasty planning to minimise the risk of joint instability. Modelling impingement preoperatively can assist in defining the required component alignment for each individual. We developed an analytical impingement model utilising a combination of mathematical calculations and an automated computational simulation to determine the risk of prosthetic impingement. The model assesses cup inclination and anteversion angles that are associated with prosthetic impingement using patient-specific inputs, such as stem anteversion, planned implant types, and target Range of Motion (ROM). The analysed results are presented as a range of cup inclination and anteversion angles over which a colour map indicates an impingement-free safe zone in green and impingement risk zones in red. A validation of the model demonstrates accuracy within +/- 1.4° of cup inclination and anteversion. The study further investigated the impact of changes in stem anteversion, femoral head size, and head offset on prosthetic impingement, as an example of the application of the model.
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Eftekhary N, Shimmin A, Lazennec JY, Buckland A, Schwarzkopf R, Dorr LD, Mayman D, Padgett D, Vigdorchik J. A systematic approach to the hip-spine relationship and its applications to total hip arthroplasty. Bone Joint J 2019; 101-B:808-816. [DOI: 10.1302/0301-620x.101b7.bjj-2018-1188.r1] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There remains confusion in the literature with regard to the spinopelvic relationship, and its contribution to ideal acetabular component position. Critical assessment of the literature has been limited by use of conflicting terminology and definitions of new concepts that further confuse the topic. In 2017, the concept of a Hip-Spine Workgroup was created with the first meeting held at the American Academy of Orthopedic Surgeons Annual Meeting in 2018. The goal of this workgroup was to first help standardize terminology across the literature so that as a topic, multiple groups could produce literature that is immediately understandable and applicable. This consensus review from the Hip-Spine Workgroup aims to simplify the spinopelvic relationship, offer hip surgeons a concise summary of available literature, and select common terminology approved by both hip surgeons and spine surgeons for future research. Cite this article: Bone Joint J 2019;101-B:808–816.
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Affiliation(s)
- N. Eftekhary
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
| | - A. Shimmin
- Melbourne Orthopaedic Group, Windsor, Australia
| | - J. Y. Lazennec
- Pitié-Salpêtrière Hospital, Pierre-and-Marie-Curie University, Paris, France
| | - A. Buckland
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
| | - R. Schwarzkopf
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, New York, USA
| | - L. D. Dorr
- Keck Medical Center of USC, Los Angeles, California, USA
| | - D. Mayman
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - D. Padgett
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
| | - J. Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York, USA
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Lee SH, Lim CW, Choi KY, Jo S. Effect of Spine-Pelvis Relationship in Total Hip Arthroplasty. Hip Pelvis 2019; 31:4-10. [PMID: 30899709 PMCID: PMC6414403 DOI: 10.5371/hp.2019.31.1.4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 11/24/2022] Open
Abstract
When spine-pelvic motion is normally coordinated, the pelvis may tilt posteriorly and acetabular anteversion may increase as the patient's position changes from standing to sitting; this scenario allows for improved clearance of the femoral head and neck during hip flexion. However, changes in the mobility of the spine and pelvis may result in impingement after total hip arthroplasty (THA), with the most obvious complication being dislocation. Understanding the spinal-pelvic relationship in the sagittal plane is essential for planning THA in patients with spinal fusion or a known spine disease. Careful attention should be payed to the cup position when performing THA on patients with an increased risk of dynamic impingement.
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Affiliation(s)
- Sang Hong Lee
- Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Chae Won Lim
- Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Kwi Youn Choi
- Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Suenghwan Jo
- Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju, Korea
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36
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Peng Y, Arauz P, An S, Kwon YM. In vivo sliding distance on the metal-on-polyethylene total hip arthroplasty articulation using patient-specific gait analysis. J Orthop Res 2018; 36:3151-3160. [PMID: 30035328 DOI: 10.1002/jor.24113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/13/2018] [Indexed: 02/04/2023]
Abstract
Metal-on-polyethylene (MoP) is the most commonly used bearing surface in primary total hip arthroplasty (THA). Polyethylene wear debris remains a major concern. Studies investigating the wear performance based on patient-specific in vivo kinematics and component orientation remains largely lacking. The primary goal of this study was to identify patterns of the distribution of sliding distance and cross-shear ratio among THA patients. A validated approach combining dual fluoroscopic imaging system and computed-tomography was utilized to quantify in vivo gait kinematics and component orientations in 48 total hips. The distribution of accumulated sliding distance and cross-shear ratio over the polyethylene bearing surface was calculated and analyzed using principal component analysis (PCA). Strong patient-specific variation in sliding distance and cross-shear ratio was observed. PCA detected two principal components (PCs) of the sliding distance that together contribute to 94.8% of the total variation. PCA detected four PCs that together contribute to 86% of the total variation of the cross-shear ratio. Regression analysis identified a positive association between cross-shear magnitude and axial and frontal range of motion (RoM). Increased cup inclination, stem anteversion, and reduced cup anteversion may lead to superiorly distributed high cross-shear region, potentially accelerating wear. Our study investigated, in vivo sliding distance and cross-shear pattern using a comprehensive patient-specific dataset and detected several wear indicators under in vivo conditions. These findings provided useful reference values that may help to assess wear in MoP THA patients. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3151-3160, 2018.
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Affiliation(s)
- Yun Peng
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Paul Arauz
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Shuai An
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
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Ike H, Dorr LD, Trasolini N, Stefl M, McKnight B, Heckmann N. Spine-Pelvis-Hip Relationship in the Functioning of a Total Hip Replacement. J Bone Joint Surg Am 2018; 100:1606-1615. [PMID: 30234627 DOI: 10.2106/jbjs.17.00403] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Hiroyuki Ike
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Lawrence D Dorr
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Nicholas Trasolini
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Michael Stefl
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Braden McKnight
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Nathanael Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California
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Alzohiry MA, Abdelnasser MK, Moustafa M, Mahran M, Bakr H, Khalifa Y, Abelaal A, Atta H, Said GZ. Accuracy of plain antero-posterior radiographic-based methods for measurement of acetabular cup version. INTERNATIONAL ORTHOPAEDICS 2018; 42:2777-2785. [PMID: 29869012 DOI: 10.1007/s00264-018-3984-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 05/10/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Acetabular cup version is crucial for successful total hip arthroplasty (THA). Many methods have been described for measurement of cup version angle. The aim of this study is to assess the accuracy of five commonly used methods for measurement of acetabular cup version in plain antero-posterior views of the pelvis and hip. MATERIAL AND METHODS Sixty primary THA cases were subjected postoperatively to plain A-P of the pelvis (AP-P), A-P view of the hip (AP-H), and computed tomography (CT) imaging. The acetabular cup version was measured in AP-P and AP-H by five methods (Lewinnek, Widmer, Hassan et al., Ackland et al., and Liaw et al.). These measurements were compared to the CT measurement. RESULTS All plain X-ray methods showed no significant differences from the CT, except those of Hassan et al. in AP-H, and Widmer and Ackland et al. in AP-P. CONCLUSIONS AND RECOMMENDATIONS For measurement of acetabular cup version angle, we recommend the use of Lewinnek and Liaw et al. methods both in AP-P and in AP-H, while Hassan et al.'s method is recommended in AP-P only, and Widmer and Ackland et al.'s methods in AP-H only.
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Affiliation(s)
| | | | - Mohamed Moustafa
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Mohamed Mahran
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Hatem Bakr
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Yaser Khalifa
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Ahmed Abelaal
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Haisam Atta
- Radiology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Galal Zaki Said
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
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Abstract
BACKGROUND Prevention of dislocation after primary total hip arthroplasty (THA) begins with patient preoperative assessment and planning. METHODS We performed a literature search to assess historical perspectives and current strategies to prevent dislocation after primary THA. The search yielded 3458 articles, and 154 articles are presented. RESULTS Extremes of age, body mass index >30 kg/m2, lumbosacral pathology, surgeon experience, and femoral head size influence dislocation rates after THA. There is mixed evidence regarding the effect of neuromuscular disease, sequelae of pediatric hip conditions, and surgical approach on THA instability. Sex, simultaneous bilateral THA, and restrictive postoperative precautions do not influence the dislocation rates of THA. Navigation, robotics, lipped liners, and dual-mobility acetabular components may improve dislocation rates. CONCLUSIONS Risks for dislocation should be identified, and measures should be taken to mitigate the risk. Reliance on safe zones of acetabular component positioning is historical. We are in an era of bespoke THA surgery.
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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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Han SB, Oh JK, Jang WY, Choudhary N, Kim HG, Shon WY. Increased Serum Ion Levels After Ceramic-on-Metal Bearing Total Hip Arthroplasty: Influence of an Asian Lifestyle. J Arthroplasty 2018; 33:887-892. [PMID: 29174760 DOI: 10.1016/j.arth.2017.10.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 10/10/2017] [Accepted: 10/16/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recent clinical studies have suggested that systemic metal ion levels are significantly elevated at midterm follow-up in patients with ceramic-on-metal (COM) bearing. However, it is not clear whether there is a correlation between patient-related factors including the lifestyle and elevated levels of serum metal ions following COM total hip arthroplasty (THA). METHODS Serum metal levels were measured in 201 patients (234 hips) including 121 COM patients (140 hips) and 80 non-COM patients (94 hips). The Harris Hip Score, University of California, Los Angeles activity scale score, and Western Ontario and McMaster Universities Osteoarthritis Index score were measured and radiographs were obtained for the analysis. RESULTS Significantly higher levels of cobalt (Co) and chromium (Cr) were detected in the serum of the COM THA group (Co: 1.86 ± 4.0 μg/L; Cr: 1.81 ± 2.87 μg/L) than those of the non-COM THA group (Co: 0.27 ± 0.14 μg/L; Cr: 0.19 ± 0.25 μg/L; P < .001). The serum metal levels of patients who achieved the squatting position and the kneeling position were significantly higher than those of patients who could not squat (Co: P = .033; Cr: P = .074) and kneel (Co: P = .049; Cr: P = .031). The metal ion levels of the COM THA group correlated with the total range of motion (Co: P = .0293; Cr: P = .0399). CONCLUSION Patients who underwent a 36-mm COM THA showed high serum metal levels although good clinical outcomes at the midterm follow-up. We found that COM THA patients who were capable of greater range of motion, squatting, and kneeling are at risk of metal ion-related problems.
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Affiliation(s)
- Seung-Beom Han
- Department of Orthopedics, Korea University Anam Hospital, Korea University College of Medicine, Seongbuk-gu, Seoul, Korea
| | - Jong Keon Oh
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Guro-gu, Seoul, Korea
| | - Woo Young Jang
- Department of Orthopedics, Korea University Anam Hospital, Korea University College of Medicine, Seongbuk-gu, Seoul, Korea
| | - Nishant Choudhary
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Guro-gu, Seoul, Korea
| | - Hyun Gon Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Guro-gu, Seoul, Korea
| | - Won Yong Shon
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Guro-gu, Seoul, Korea
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Rivière C, Lazic S, Dagneaux L, Van Der Straeten C, Cobb J, Muirhead-Allwood S. Spine-hip relations in patients with hip osteoarthritis. EFORT Open Rev 2018; 3:39-44. [PMID: 29657844 PMCID: PMC5890167 DOI: 10.1302/2058-5241.3.170020] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Patients with hip osteoarthritis often have an abnormal spine-hip relation (SHR), meaning the presence of a clinically deleterious spine-hip and/or hip-spine syndrome. Definition of the individual SHR is ideally done using the EOS® imaging system or, if not available, with conventional lumbopelvic lateral radiographs. By pre-operatively screening patients with abnormal SHR, it is possible to refine total hip replacement (THR) surgical planning, which may improve outcomes. An important component of the concept of kinematically aligned total hip arthroplasty (KA THA) consists of defining the optimal acetabular cup design and orientation based on the assessment of an individual’s SHR, and use of the transverse acetabular ligament to adjust the cup positioning. The Bordeaux classification might advance the understanding of SHR and hopefully help improve THR outcomes.
Cite this article: EFORT Open Rev 2018;3:39-44. DOI: 10.1302/2058-5241.3.170020
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Affiliation(s)
- Charles Rivière
- MSK Lab, Imperial College London, UK.,South West London Elective Orthopaedic Centre, UK
| | - Stefan Lazic
- South West London Elective Orthopaedic Centre, UK
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Abstract
BACKGROUND Cup malposition is a common cause of impingement, limitation of ROM, acceleration of bearing wear, liner fracture, and instability in THA. Previous studies of the safe zone based on plain radiographs have limitations inherent to measuring angles from two-dimensional projections. The current study uses CT to measure component position in stable and unstable hips to assess the presence of a safe zone for cup position in THA. QUESTIONS/PURPOSES (1) Does acetabular component orientation, when measured on CT, differ in stable components and those revised for recurrent instability? (2) Do CT data support historic safe zone definitions for component orientation in THA? METHODS We identified 34 hips that had undergone revision of the acetabulum for recurrent instability that also had a CT scan of the pelvis between August 2003 and February 2017. We also identified 175 patients with stable hip replacements who also had a CT study for preoperative planning and intraoperative navigation of the contralateral side. For each CT study, one observer analyzed major factors including acetabular orientation, femoral anteversion, combined anteversion (the sum of femoral and anatomic anteversion), pelvic tilt, total offset difference, head diameter, age, sex, and body mass index. These measures were then compared among stable hips, hips with cup revision for anterior instability, and hips with cup revision for posterior instability. We used a clinically relevant measurement of operative anteversion and inclination as opposed to the historic use of radiographic anteversion and inclination. The percentage of unstable hips in the historic Lewinnek safe zone was calculated, and a new safe zone was proposed based on an area with no unstable hips. RESULTS Anteriorly unstable hips compared with stable hips had higher operative anteversion of the cup (44° ± 12° versus 31° ± 11°, respectively; mean difference, 13°; 95% confidence interval [CI], 5°-21°; p = 0.003), tilt-adjusted operative anteversion of the cup (40° ± 6° versus 26° ± 10°, respectively; mean difference, 14°; 95% CI, 10°-18°; p < 0.001), and combined tilt-adjusted anteversion of the cup (64° ± 10° versus 54° ± 19°, respectively; mean difference, 10°; 95% CI, 1°-19°; p = 0.028). Posteriorly unstable hips compared with stable hips had lower operative anteversion of the cup (19° ± 15° versus 31° ± 11°, respectively; mean difference, -12°; 95% CI, -5° to -18°; p = 0.001), tilt-adjusted operative anteversion of the cup (19° ± 13° versus 26° ± 10°, respectively; mean difference, -8°; 95% CI, -14° to -2°; p = 0.014), pelvic tilt (0° ± 6° versus 4° ± 6°, respectively; mean difference, -4°; 95% CI, -7° to -1°; p = 0.007), and anatomic cup anteversion (25° ± 18° versus 34° ± 12°, respectively; mean difference, -9°; 95% CI, -1° to -17°; p = 0.033). Thirty-two percent of the unstable hips were located in the Lewinnek safe zone (11 of 34; 10 posterior dislocations, one anterior dislocation). In addition, a safe zone with no unstable hips was identified within 43° ± 12° of operative inclination and 31° ± 8° of tilt-adjusted operative anteversion. CONCLUSIONS The current study supports the notion of a safe zone for acetabular component orientation based on CT. However, the results demonstrate that the historic Lewinnek safe zone is not a reliable predictor of future stability. Analysis of tilt-adjusted operative anteversion and operative inclination demonstrates a new safe zone where no hips were revised for recurrent instability that is narrower for tilt-adjusted operative anteversion than for operative inclination. Tilt-adjusted operative anteversion is significantly different between stable and unstable hips, and surgeons should therefore prioritize assessment of preoperative pelvic tilt and accurate placement in operative anteversion. With improvements in patient-specific cup orientation goals and acetabular component placement, further refinement of a safe zone with CT data may reduce the incidence of cup malposition and its associated complications. LEVEL OF EVIDENCE Level III, diagnostic study.
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McCarthy TF, Nevelos J, Elmallah RK, Chughtai M, Khlopas A, Alipit V, Wagner TC, Mont MA. The Effect of Pelvic Tilt and Femoral Head Size on Hip Range-of-Motion to Impingement. J Arthroplasty 2017; 32:3544-3549. [PMID: 28712801 DOI: 10.1016/j.arth.2017.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/18/2017] [Accepted: 06/06/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND About 50%-70% of dislocators have cups placed within so-called "safe zones." It has been postulated that factors such as femoral head size and pelvic tilt, obliquity, or rotation may influence postoperative stability. Therefore, we assessed varying degrees of pelvic tilt and head sizes on the range of motion (ROM) to impingement. METHODS A hip simulator was used to import models of 10 subjects who performed object pickup, squatting, and low-chair rising. Parameters were set for pelvic tilt, stem version, and the specific motions as defined by the subjects. Femur-to-pelvis relative motions were determined for abduction/adduction, internal/external rotation, and flexion/extension. Varying tilt angles were tested. Thirty-two millimeter and 36-mm head with a standard cup and 42-mm dual mobility cup were tested. Cup orientations for abduction and anteversion combinations were chosen, and computations of minimum clearances or impingement between components were made. RESULTS The ROM to impingement varied with the different pelvic tilts and femoral head sizes and with the different motions. The larger the head size, the larger the impingement-free ROM. Negative 10° of pelvic tilt led to the largest impingement-free zone, whereas 10° of forward tilt was associated with fewer impingement-free cup anteversion and abduction angle combinations. Variations in pelvic tilt had the greatest influence on object pickup and affected the impingement-free "safe zone." CONCLUSION Targets for impingement-free motion may be smaller when considering varying pelvic tilts and femoral head sizes, particularly for certain activities, such as object pickup. These findings may indicate the need for more individualized patient planning.
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Affiliation(s)
| | | | - Randa K Elmallah
- Department of Orthopaedic Surgery, University of Mississippi, Jackson, Mississippi
| | - Morad Chughtai
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Anton Khlopas
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Timothy C Wagner
- 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, 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: 107] [Impact Index Per Article: 15.3] [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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