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Cypel S, Bouche PA, Heliere G, David G, Rony L. Junior surgeon learning curve for performing digital planning of a first-line uncemented total hip prothesis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-03986-8. [PMID: 38758389 DOI: 10.1007/s00590-024-03986-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE Preoperative digital planning of total hip arthroplasty (THA) anticipates difficulties while increasing implant survival. The objective was to establish the learning curve to produce a reliable and reproducible preoperative planning for THA. We hypothesize that a learning curve exists for planning, and we want to determine the number of procedures required to accomplish it. METHODS This prospective study included patients for THA from 02/11/2019 to 01/11/2022. Ten junior (Juniors) and senior surgeons (Seniors) had received dedicated training in the use of the software. Modeling was done blindly by Juniors and Senior before surgery on a standardized front pelvis X-ray (mediCAD 2D Classic Hospital software). Statistical analyses to establish the learning curve were done to compare the Juniors and Seniors. RESULTS 60% of the Juniors achieved competence after 31.5 ± 12.9 [14-54] planning sessions for the acetabular implant, and 80% after 30.3 ± 8.3 [17-40] planning sessions for the femoral implant. Femoral neck size was achieved by all ten Juniors after 23.1 ± 6.8 [17-38] planning. The offset was correctly restored on the plan by 30% of the Juniors after 33.5 ± 11.6 [18-46] planning. CONCLUSION There is a learning curve for 2D planning of uncemented THA. The different planning items seem to have different learning curves. Compared to Seniors, the completion of 75 planning sessions is not sufficient in totality. The competence of the Juniors for the acetabular implant, the length of the neck and the size of the femoral stem are mostly acquired before 75 sessions. LEVEL OF EVIDENCE Prospective study-Level II.
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Affiliation(s)
- S Cypel
- Département de Chirurgie Osseuse, CHU-Angers, 4, rue Larrey, 49933, Angers Cedex 9, France
| | - P-A Bouche
- Service d'orthopédie, Hopital Lariboisière, 2 rue Ambroise Paré, 75015, Paris, France
| | - G Heliere
- Département de Chirurgie Osseuse, CHU-Angers, 4, rue Larrey, 49933, Angers Cedex 9, France
| | - G David
- Département de Chirurgie Osseuse, CHU-Angers, 4, rue Larrey, 49933, Angers Cedex 9, France
| | - L Rony
- Département de Chirurgie Osseuse, CHU-Angers, 4, rue Larrey, 49933, Angers Cedex 9, France.
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Zampogna B, Parisi FR, Zampoli A, Prezioso A, Vorini F, Laudisio A, Papalia M, Papapietro N, Falez F, Papalia R. Accuracy of two-dimensional digital planning in uncemented primary hip arthroplasty: monocentric analysis of eight hundred implants. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06172-x. [PMID: 38622366 DOI: 10.1007/s00264-024-06172-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE In the last decades, there has been a refinement in total hip arthroplasty, which allowed surgeons to achieve the highest performance and better patient outcomes. Preoperative planning in primary hip arthroplasty is an essential step that guides the surgeon in restoring the anatomy and biomechanics of the joint. This study aims to evaluate the accuracy of the 2D digital planning, considering cup sizing, stem sizing, and limb length discrepancy. Additionally, we conducted a multivariable analysis of demographic data and comorbidities to find factors influencing preoperative planning. METHODS This retrospective study analyzed the planning accuracy in 800 consecutive uncemented primary total hip arthroplasty. We compared the preoperatively planned total hip arthroplasty with postoperative results regarding the planned component size, the implanted size, and the lower limb length restoration. Therefore, we investigated factors influencing planning accuracy: overweight and obesity, sex, age, past medical history, comorbidities, and implant design. All the surgeries were performed in the posterolateral approach by one expert surgeon who did the preoperative planning. The preoperative planning was determined to be (a) exact if the planned and the implanted components were the same size and (b) accurate if exact ± one size. The restoration of postoperative limb length discrepancy was classified into three groups: ± 3 mm, ± 5 mm, and ± 10 mm. This assessment was performed through a digital method 2D based on a standard hip X-ray. RESULTS This court of 800 implants showed that planning was exact in 60% of the cups and 44% of the stems and was accurate in 94% of the cups and 80% of the stems. The postoperative limb length discrepancy was ± 3 mm in 91% and ± 5 mm in 97%. CONCLUSIONS This study showed preoperative 2D digital planning great precision and reliability, and we demonstrated that it was accurate in 94% of the cups and 80% of the stems. Therefore, the preoperative limb length discrepancy analysis was essential to guarantee the recovery of the operated limb's correct length.
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Affiliation(s)
- Biagio Zampogna
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- BIOMORF Department, Biomedical, Dental and Morphological and Functional Images, University of Messina. A.O.U. Policlinico "G.Martino", Messina, Italy
| | - Francesco Rosario Parisi
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Andrea Zampoli
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Anna Prezioso
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Ferruccio Vorini
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Alice Laudisio
- Department of Medicine, Research Unit of Geriatrics, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Roma, Italy.
- Fondazione Policlinico Universitario Campus Bio-Medico, Operative Research Unit of Geriatrics, Via Alvaro del Portillo, 200, 00128, Roma, Italy.
| | - Matteo Papalia
- Orthopaedic and Traumatology Department, Nuova Itor Clinic, Rome, Italy
| | - Nicola Papapietro
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesco Falez
- Department of Orthopaedics and Traumatology, ASL Roma 1, S. Filippo Neri Hospital, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Kim HS, Cho SH, Moon DH, Kim CH. Risk factors for templating mismatch of uncemented stems in bipolar hemiarthroplasty for femoral neck fracture. Sci Rep 2023; 13:21083. [PMID: 38030671 PMCID: PMC10687254 DOI: 10.1038/s41598-023-48538-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/28/2023] [Indexed: 12/01/2023] Open
Abstract
Preoperative templating needs to be precise to optimize hip arthroplasty outcomes. Unexpected implant mismatches can occur despite meticulous planning. We investigated the risk factors for oversized and undersized stem mismatch during uncemented hemiarthroplasty using a double-tapered wedge rectangular stem for femoral neck fracture. Out of 154 consecutive patients who underwent hemiarthroplasty for femoral neck fracture, 104 patients were divided into three groups: (1) oversized (n = 17; 16.3%), (2) matched (n = 80; 76.9%), and (3) undersized stem group (n = 7; 6.7%). A smaller femoral head offset (odds ratio [OR] = 0.89, 95% confidence interval [95% CI] = 0.81-0.98, P = 0.017), smaller isthmus diameter (OR = 0.57, 95% CI = 0.35-0.92, P = 0.021), and smaller canal flare index (OR = 0.20, 95% CI = 0.04-0.98, P = 0.047) were significantly associated with oversized stem insertion, while older age (OR = 1.18, 95% CI = 1.01-1.39, P = 0.037) was associated with undersized stem insertion in logistic regression. In conclusion, when performing hemiarthroplasty for a femoral neck fracture with a double-tapered wedge rectangular stem, surgeons must pay close attention to proximal femoral geometry and patient age during preoperative planning to avoid stem mismatch.
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Affiliation(s)
- Han Soul Kim
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-Gu, Incheon, Republic of Korea
| | - Sung Ha Cho
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-Gu, Incheon, Republic of Korea
| | - Dou Hyun Moon
- Department of Orthopedic Surgery, Gachon University Gil Medical Center, Namdong-Gu, Incheon, Republic of Korea
| | - Chul-Ho Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, Republic of Korea.
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Luger M, Feldler S, Schauer B, Hochgatterer R, Gotterbarm T, Klasan A. Digital templating cementless short stem total hip arthroplasty: is there a difference in planning adherence between the direct anterior approach and minimally invasive anterolateral approach? Arch Orthop Trauma Surg 2023; 143:1619-1626. [PMID: 35179634 PMCID: PMC9958123 DOI: 10.1007/s00402-022-04374-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/26/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Minimally invasive approaches (MIS) in total hip arthroplasty (THA) show inconsistent findings regarding planning adherence in digital templating. The purpose of this study is to evaluate any difference in planning adherence between the direct anterior approach (DAA) and an anterolateral MIS approach (AL MIS) in cementless short stem THA. METHODS A single surgeon series of 222 THAs in 208 patients with an uncemented short curved stem and a bi-hemispherical acetabular cup were screened for inclusion. A total of 118 THAs were implanted via the DAA and 72 THAs via the AL MIS were included. The planning adherence for the offset option, stem size and the acetabular cup were retrospectively evaluated. RESULTS Planning adherence for cup size (perfect match: p = 0.763; ± 1 size: p = 0.124), offset option (0.125) and stem size (perfect match: p = 0.275; ± 1 size: p = 0.552) did not show any statistical significance. Preoperative diagnosis of avascular necrosis of the femoral head in AL MIS approach (OR 6.045; CI 1.153-31.696) or mild hip dysplasia in the general cohort poses (OR 11.789; CI 1.386-100.293) a significant risk for inadequate prediction of the offset option. CONCLUSION digital templating for THA with an uncemented short curved stem and a bi-hemispherical acetabular cup show comparable results between a direct anterior approach and a minimally invasive anterolateral approach in supine position. Surgeons should be aware of a low planning adherence for this type of short stem in minimally invasive approaches. CONCLUSION Digital templating for THA with an uncemented short curved stem and a bi-hemispherical acetabular cup show comparable results between a direct anterior approach and a minimally invasive anterolateral approach in supine position. Surgeons should be aware of a low planning adherence for this type of short stem in minimally invasive approaches.
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Affiliation(s)
- Matthias Luger
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Sandra Feldler
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Bernhard Schauer
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Rainer Hochgatterer
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Antonio Klasan
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
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Schapira B, Madanipour S, Iranpour F, Subramanian P. Accuracy of Total Hip Arthroplasty Templating Using Set Calibration Magnifications. Cureus 2023; 15:e34883. [PMID: 36925986 PMCID: PMC10011871 DOI: 10.7759/cureus.34883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2023] [Indexed: 02/13/2023] Open
Abstract
Background Templating for total hip arthroplasty has been adopted over recent decades as a reliable and accurate method for pre-operative planning. The use of calibration markers for this process provides a recognised benefit at the expense of cost, availability and error. Many surgeons use a set magnification of 118% to account for calibration errors when templating total hip arthroplasty. This study aims to assess the accuracy of templating with standardised magnifications and assess the effect of BMI on templating accuracy. Materials and methods A retrospective analysis was performed using a single-surgeon series of 119 consecutive total hip arthroplasties. Anteroposterior radiographs were taken pre- or post-operatively without calibration hardware. Pre-operatively, the total hip arthroplasty was templated on TraumaCad (BrainLab Inc, Westchester, IL) using either 118% or 119% calibration magnification. Post-operative magnification was calibrated using the known femoral head diameter. Templated and implanted prostheses were compared for size. Results At 118%, 61.1% of cups matched those templated with 96.3% of cups within two sizes. At 119%, 52.5% of cups used matched their templates with 100% within two sizes. There was no significant difference between 118% and 119% cup size prediction (p=0.49). A trend was noticed in increasing magnification error with increasing BMI. However, BMI had no significant effect on the accuracy of templating cup size within two cup sizes (p=0.58). Conclusion. Templating acetabular cups using a set magnification of 118% or 119% yields accurate results and provides a reliable method to template without calibration equipment. Whilst BMI can affect magnification error, this has no significant effect on the accuracy of implanted cups and stems within two sizes.
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Affiliation(s)
- Benjamin Schapira
- Trauma and Orthopaedics, Royal Free London NHS Foundation Trust, London, GBR
| | | | - Farhad Iranpour
- Trauma and Orthopaedics, Royal Free London NHS Foundation Trust, London, GBR
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Al-Ashqar M, Aslam N, Azhar MS, Grayston J, Hahnel J. KingMark's dual-marker versus a conventional single-marker templating system: is there a difference in accuracy of predicting final implant sizes and leg lengths? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:167-175. [PMID: 34842990 DOI: 10.1007/s00590-021-03174-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/19/2021] [Indexed: 01/07/2023]
Abstract
AIMS Pre-operative templating for total hip replacement (THR) surgery leads to more accurate implant sizing and positioning. This study aimed to compare the KingMark™ dual-marker system for magnification calibration to the current gold standard single-marker system in accuracy of predicting implant size and restoration of leg length post-operatively. METHODS This is a retrospective analysis of patients who had primary THR surgery from 2013 to 2019 by a single surgeon. Patients were in two cohorts whose operations were completed at separate healthcare facilities. Patients in the first cohort had pre-operative templating using the KingMark system; patients in the second cohort had templating using a single-marker. For all patients, pre-operative radiographs were reviewed; predicted implants noted; and leg length discrepancies calculated. These were compared to post-operative data. We then tested the null hypothesis that there was no difference between the templating methods for prediction accuracy of implant size and achieving restoration of leg length. RESULTS A total of 121 patients were included in the KingMark cohort, and 104 were included in the single-marker cohort. In the KingMark cohort, 83.5% of patients had implantation of a cup within one size of that predicted, compared to 71.2% of the single-marker cohort. This superiority was statistically significant. There was a greater proportion of exact cup size predictions in the KingMark cohort, but this was not statistically significant. We did not find any significant difference between the cohorts for stem size, or stem placement, or reduction of leg length discrepancy. CONCLUSION We have demonstrated statistically significant superiority of the KingMark over a single-marker templating system for predicting cup size in primary THR surgery. For post-operative restoration of leg length, our study did not show any advantage of KingMark templating compared to single-marker templating.
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Affiliation(s)
- Mohammad Al-Ashqar
- Bradford Royal Infirmary, Bradford, UK.
- Leeds Teaching Hospitals, Leeds, UK.
| | - Nayef Aslam
- Bradford Royal Infirmary, Bradford, UK
- Leeds Teaching Hospitals, Leeds, UK
| | | | - James Grayston
- Bradford Royal Infirmary, Bradford, UK
- Leeds Teaching Hospitals, Leeds, UK
| | - James Hahnel
- Bradford Royal Infirmary, Bradford, UK
- Leeds Teaching Hospitals, Leeds, UK
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Siemon HK, Liska WD, Israel SK. Evaluation of a stepped, fixed-height magnification marker stand for use with a 100-mm marker in implant sizing prediction in 52 total hip replacement procedures in dogs. PLoS One 2023; 18:e0280334. [PMID: 36626397 PMCID: PMC9831306 DOI: 10.1371/journal.pone.0280334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To describe the use of a 100-millimeter marker placed on a stepped, fixed-height magnification marker stand to measure radiographic magnification on accuracy of implant size prediction when used for canine total hip replacement (THR) implant size selection. STUDY DESIGN Retrospective study. ANIMALS Fifty-two hips in 45 dogs. METHODS This study evaluated 52 consecutive canine total hip replacement surgery pre-planning procedures involving 45 dogs with 7 undergoing staged bilateral THRs. Data collected included demographic information, measured radiographic magnification for magnification recalibration, implant size prediction of the cups (52) and the stems (52) based on digital templates superimposed on digital radiographs, and the actual implant sizes used during surgery. RESULTS Use of the magnification marker stand (MMS) and template application system resulted in an accurate prediction of implant size of 98/104 implants (94.2%) implants. CONCLUSION A 100-mm marker placed on a magnification marker stand was a viable method to measure and recalibrate for magnification on digital radiographs during the template process to predict the THR implant sizes that should be available when the surgery begins. CLINICAL SIGNIFICANCE This stepped calibration marker stand is helpful in determination of an accurate preoperative THR implant size prediction, lowering implant stock thresholds, operating time, and associated complications. Additionally, the radiographic documentation of the marker's step height allows for indefinite confirmation of the magnification marker height used and for accurate repeatability for all follow-up imaging examinations and contralateral procedure planning.
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Affiliation(s)
- Heather K. Siemon
- Department of Surgery, Bluepearl Veterinary Partners, Tampa, Florida, United States of America
| | - William D. Liska
- Global Veterinary Specialists PLLC, Sugar Land, Texas, United States of America
| | - Sarah K. Israel
- Department of Surgery, Bluepearl Veterinary Partners, San Antonio, Texas, United States of America
- * E-mail:
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Thakur K, Sharma A, Prasad M, Vig V. Effect of body mass index on the conventional method of templating in uncemented total hip arthroplasty: A prospective study. JOURNAL OF ORTHOPAEDICS AND SPINE 2022. [DOI: 10.4103/joasp.joasp_23_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
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Accuracy of digital templating of uncemented total hip arthroplasty at a certified arthroplasty center: a retrospective comparative study. Arch Orthop Trauma Surg 2022; 142:2471-2480. [PMID: 33725193 PMCID: PMC9474525 DOI: 10.1007/s00402-021-03836-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/15/2021] [Indexed: 12/04/2022]
Abstract
INTRODUCTION To investigate the accuracy of preoperative digital templating for total hip arthroplasty (THA) at a certified arthroplasty center (EndoCert EPZmax). MATERIALS AND METHODS In a retrospective study design, we analysed 620 uncemented primary THAs for templating accuracy by comparing the preoperatively planned THA component size and the implanted size as documented by the surgeon. Templating was determined to be a) exact if the planned and the implanted component were the same size and b) accurate if they were exact ± one size. Moreover, we investigated factors that potentially influence templating accuracy: overweight and obesity (WHO criteria), sex, implant design, surgeon experience, preoperative diagnosis. Digital templating was done with MediCAD software. The Mann-Whitney U test and the Kruskal-Wallis test were used for statistical analysis. RESULTS Templating was exact in 52% of stems and 51% of cups and was accurate in 90% of the stems and 85% of the cups. Regarding the factors potentially influencing templating accuracy, the type of cup implant had a significant influence (p = 0.016). Moreover, greater accuracy of stem templating was achieved in female patients (p = 0.004). No such effect was determined for the other factors investigated. CONCLUSIONS We conclude that preoperative 2D templating is accurate in 90% of the stems and 85% of the cups. Greater accuracy may be achieved in female patients. In addition to gender, the type of implant used may influence planning accuracy as well. Surgeon experience, BMI and preoperative diagnosis did not influence templating accuracy. LEVEL OF EVIDENCE Level III (retrospective comparative study with prospective cohort).
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Digital templating for the implantation of a curved short hip stem with an anterolateral MIS approach shows gender differences in digital templating. Arch Orthop Trauma Surg 2022; 142:1661-1668. [PMID: 34169356 PMCID: PMC9217763 DOI: 10.1007/s00402-021-04005-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 06/17/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Digital templating shows reliable accuracy for straight stem systems. In recent years, the implantation of short stems through minimally invasive approaches has gained more popularity. Minimally invasive approaches (MIS) show the risk of undersizing femoral components. Therefore, we questioned the planning adherence for a curved short stem and a bi-hemispherical acetabular cup implanted through an anterolateral MIS approach. METHODS A consecutive series of 964 hips (index surgery between 2014 and 2019) with Fitmore® curved short stem and Allofit/-S® acetabular cup (both ZimmerBiomet Inc, Warsaw, IN) were included. Preoperative digital templating was conducted anterior-posterior (AP) digital radiographs of the hip using mediCAD® version 5.1 (Hectec GmbH, Altdorf, Germany). The templates of acetabular and femoral components (offset option and stem size) were retrospectively evaluated for general adherence, and according to sex, BMI and planner's experience. RESULTS Planning adherence for the exact offset option was 70.6 and 21.6% for exact offset option and stem size. Adherence for acetabular cup ± 1 size was 74.8%. A significant difference between male and female patients for the offset option could be found (p = 0.03, z = -2983). In 22.5% of male patients, an offset option one size higher and in 12.3% of female patients an offset option one size smaller than templated was used intraoperatively CONCLUSION: Digital templating for the Fitmore® stem in cementless THA with a minimally invasive anterolateral approach shows comparable planning adherence to the existing literature for this cementless short stem. However, a lower planning adherence was detected compared to conventional straight stem systems. In male patients, the femoral offset is frequently undersized and in female patients frequently oversized compared to the preoperative plan. Surgeons should be aware of this difficulty in digital templating for Fitmore® hip stem.
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Klever J, de Motte A, Meyer-Lindenberg A, Brühschwein A. Evaluation and Comparison of Self-Made and Commercial Calibration Markers for Radiographic Magnification Correction in Veterinary Digital Radiography. Vet Comp Orthop Traumatol 2021; 35:10-17. [PMID: 34547786 DOI: 10.1055/s-0041-1735316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Magnification error is always present in radiography and calibration is necessary, if high accuracy is required in pre-surgical planning. The goal of this study was to verify the use of self-made markers and calibration techniques and to establish guidelines for magnification correction. METHODS We evaluated and compared spherical and linear markers of different sizes with focus on practicability, accuracy and precision. Markers were placed on foam pads or attached to flexible arms. RESULTS Vertical marker deviation of 1 cm from the anatomical reference point corresponded to ∼1% of magnification error in our setting. Marker placement along the horizontal plane showed no significant magnification in the periphery of the radiograph. All markers showed good accuracy and the commercial spherical marker with a flexible segment arm had the best results regarding practicability. DISCUSSION Our study suggests that marker type is not solely responsible for usability and accuracy but also the type of fixation. In the absence of a calibration marker, calculation of the magnification factor using a measurement tape during radiography is equally reliable. Use of a fixed averaged calculated calibration factor showed poor agreement compared with the marker calibration, probably due to variability in size of the animals. In conclusion, if precision matters, use of a calibration marker, which could be purchased or self-made, is advised.
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Affiliation(s)
- Julius Klever
- Clinic of Small Animal Surgery and Reproduction, Center of Veterinary Clinical Medicine, LMU Munich, Munich, Germany
| | - Anastasia de Motte
- Clinic of Small Animal Surgery and Reproduction, Center of Veterinary Clinical Medicine, LMU Munich, Munich, Germany
| | - Andrea Meyer-Lindenberg
- Clinic of Small Animal Surgery and Reproduction, Center of Veterinary Clinical Medicine, LMU Munich, Munich, Germany
| | - Andreas Brühschwein
- Clinic of Small Animal Surgery and Reproduction, Center of Veterinary Clinical Medicine, LMU Munich, Munich, Germany
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Holliday M, Steward A. Pre-operative templating for total hip arthroplasty: How does radiographic technique and calibration marker placement affect image magnification? J Med Radiat Sci 2021; 68:228-236. [PMID: 33590673 PMCID: PMC8424328 DOI: 10.1002/jmrs.461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/19/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Pre-operative templating using digital radiography is an effective method of planning for total hip arthroplasty (THA) and requires a generalised fixed magnification factor (MF) or external calibration markers (ECM). The effect on image magnification when changing source-to-image distance (SID), object-to-image distance (OID) and different imaging conditions is not well described. This study aims to quantify the range of effects manipulation of radiographic parameters can have on image magnification across different body habitus and imaging conditions. METHODS A simple phantom study was performed. A 25 mm ECM was placed at eight different OID values along the anterior-posterior phantom plane at three different SID values and imaging conditions, and X-rays were obtained. On each radiograph, the ECM was measured using a line calliper tool by three radiographers and recorded. The MF was calculated and recorded. RESULTS The smallest observed image MF was 1.16, for an 8 cm OID, 120 cm SID with the ECM placed within the central ray and the X-ray detector in bucky underneath the X-ray table. The largest image MF was 1.40 for a 15 cm OID, 100 cm SID with the X-ray detector placed underneath an emergency department imaging trolley. CONCLUSIONS Digital pre-operative templating for THA relies on accurate radiographic positioning and is dependent of the patient body habitus, radiographic parameters and imaging conditions selected by the radiographer. The use of appropriately positioned ECMs - placed medially between the patient's internally rotated legs at the level of the greater trochanter, lowers the potential for magnification inaccuracies.
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Affiliation(s)
- Mia Holliday
- Western HealthFootscrayVictoriaAustralia
- Deakin UniversityGeelongVictoriaAustralia
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The accuracy of external calibration markers in digital templating using the double marker and single marker method: a comparative study. Arch Orthop Trauma Surg 2020; 140:1559-1565. [PMID: 32794149 DOI: 10.1007/s00402-020-03569-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/02/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Digital templating is an essential step in the preoperative planning of total hip arthroplasty (THA). Previous studies have suggested that templating with the double marker method may be more accurate than a single marker method in the general population and in obese patients. The purpose of this study was to compare the accuracy in the preoperative component selection between the King Mark calibration device and the conventional metal ball method. Additionally, we examined whether King Mark offered any advantage over the standard metal ball in the preoperative selection of component sizes for obese patients. METHODS We retrospectively reviewed patients who underwent preoperative digital templating for THA in our center from January 2014 to January 2016 with King Mark device and marker ball. We compared the preoperative template component size and offset with the intraoperative definite implant size. The accuracy was defined as the difference between preoperative and intraoperative component sizes. The overall accepted calibration was defined as an exact match ± one size. Patients were stratified into two cohorts according to the calibration method: standard marker ball technique and King Mark technique. RESULTS 126 THA underwent digital calibration. 79 patients underwent a preoperative templating using the King Mark calibration device. 47 patients were templated using a conventional marker ball. The overall adequate preoperative planning of the acetabular cup (exact or ± 1 size match) in the King Mark group did not differ from the single marker method (74.7% and 74.5%, respectively, p = 0.979). No significant difference was noted in the overall accepted calibration of the femoral stem (exact or ± 1 size match) between the marker ball group and the King Mark group (58.2% and 70.2%, respectively, p = 0.179). The King Mark group showed a better preoperative planning for the stem's offset compared to the marker ball group (77.2% % and 61.7%, respectively, p = 0.062). For the obese patient cohort, no significant difference was noted between the King Mark group and the marker ball group in the exact prediction of the acetabular cup and the femoral stem, (p = 0.31 and p = 0.15, respectively). CONCLUSIONS Our study found no difference between the King Mark method and the conventional metal ball method in the ability to accurately predict component sizes. In the subgroup of obese patients, the King Mark technique offered no advantage for accurately predicting component sizes.
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Pachter CS, Garfinkel JH, Romness DW, Gladnick BP. Radiographic Calibration With a Prosthetic Femoral Head Allows Accurate Preoperative Templating for Total Hip Arthroplasty. Orthopedics 2019; 42:e346-e349. [PMID: 30913298 DOI: 10.3928/01477447-20190321-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/10/2018] [Indexed: 02/03/2023]
Abstract
Templating for total hip arthroplasty requires proper radiographic calibration. One option for radiograph calibration is using a cobalt-chrome femoral head ball. The authors reviewed radiographs and clinical data for patients undergoing primary total hip arthroplasty. Radiographs were calibrated using a 28-mm cobalt-chrome femoral head ball. Agreements between templated and actual implant size were calculated. The templated acetabulum matched within one size of the actual acetabulum in 76.7% to 80.0% of cases. The templated femur matched within one size of the actual femur in 83.3% to 93.3% of cases. This technique is an attractive option when a standardized calibration marker is unavailable. [Orthopedics. 2019; 42(3):e346-e349.].
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Hornová J, Růžička P, Hrubina M, Šťastný E, Košková A, Fulín P, Gallo J, Daniel M. Magnification of digital hip radiographs differs between clinical workplaces. PLoS One 2017; 12:e0188743. [PMID: 29190787 PMCID: PMC5708766 DOI: 10.1371/journal.pone.0188743] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 11/13/2017] [Indexed: 11/26/2022] Open
Abstract
Preoperative planning for total hip arthroplasty includes templating on anteroposterior radiographs. It is necessary to consider radiographic magnification in order to scale templates accurately. Studies dealing with hip templating report different values of radiographic magnification. It is not clear if the observed difference in magnification between the studies is caused by variability in studied groups, methodology or instrumentation. We hypothesize that there is a difference in magnification between clinical workplaces. Within this study, radiographic magnification was estimated on 337 radiographs of patients after total hip surgery from five orthopaedic departments in the Czech Republic. Magnification was determined for each patient as a ratio between diameter of implanted femoral head measured on radiogram and its true size. One-way ANOVA revealed significant differences in magnification between workplaces (F(4,332) = 132, p≤0.001). These results suggest that radiographic magnification depends on the workplace where it is taken or more precisely on radiographic device. It indicates potential limits in generalizability of results of studies dealing with preoperative planning accuracy to other institutions.
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Affiliation(s)
- Jana Hornová
- Laboratory of Biomechanics, Faculty of Mechanical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Pavel Růžička
- Laboratory of Biomechanics, Faculty of Mechanical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Maroš Hrubina
- Department of Orthopaedics, Hospital Pelhřimov, Pelhřimov, Czech Republic
| | - Eduard Šťastný
- Department of Paediatric and Adult Orthopaedic Surgery and Traumatology, Second Faculty of Medicine Charles University and Teaching Hospital Motol in Prague, Prague, Czech Republic
| | - Andrea Košková
- Department of Radiology, Hospital Jablonec nad Nisou, Jablonec nad Nisou, Czech Republic
| | - Petr Fulín
- Department of Orthopaedic, First Faculty of Medicine Charles University and Teaching Hospital Motol in Prague, Prague, Czech Republic
| | - Jiří Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacký University Olomouc, Teaching Hospital Olomouc, Olomouc, Czech Republic
| | - Matej Daniel
- Laboratory of Biomechanics, Faculty of Mechanical Engineering, Czech Technical University in Prague, Prague, Czech Republic
- * E-mail:
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