Computer Navigation Helps Reduce the Incidence of Noise After Ceramic-on-Ceramic Total Hip Arthroplasty

CT-based navigation for total hip arthroplasty: a meta-analysis

INTRODUCTION

Computer tomography (CT) based navigation is considered by some authors as an advance in total hip arthroplasty (THA). A meta-analysis was conducted to compare CT based versus conventional THA in terms of surgical duration of the procedure, leg length difference, acetabular cup position, and rate of dislocation.

MATERIAL AND METHODS

The present study was conducted according to the PRISMA 2020. In December 2022, the following databases were accessed: PubMed, Web of Science, Google Scholar, Embase with no time constrain. All the clinical studies comparing CT based navigation versus the conventional THA were accessed.

RESULTS

Data from 1801 procedures were collected. The mean age of the patients was 61.6 ± 5.3 years, and the mean BMI was 26.9 ± 2.3 kg/m2. There was between studies comparability at baseline in terms of age, BMI, pain score, Harris hip score, leg length discrepancy (P > 0.1). The navigated group demonstrated lower leg length discrepancy (P = 0.02), and lower degrees of cup anteversion (P = 0.002). Similarity was found in cup inclination (P = 0.98), surgical duration (P = 0.3), and the rate of dislocation (P = 0.6).

CONCLUSION

CT guided THA may have the potential to increase the accuracy of acetabular positioning and reduce the leg length discrepancy. Current evidence is very limited and heterogeneous, and no recommendations can be inferred. Further investigations are required to definitely clarify the role of CT based THA in current practice.

Outcomes of Ceramic-On-Ceramic Bearing Total Hip Arthroplasty: A Minimum 10-Year Follow-Up Study

BACKGROUND

Although the fourth generation of ceramics has demonstrated excellent clinical results 5 to 6 years postoperatively, concerns over ceramic fracture and squeaking persist and longer-term follow-up (minimum 10 years) studies are warranted. Our study aimed to evaluate the minimum 10-year clinical outcomes and bearing-specific complications of ceramic-on-ceramic (CoC) total hip arthroplasties.

METHODS

We retrospectively evaluated all patients who underwent primary delta CoC total hip arthroplasty in our institution between January 2004 and February 2013. Demographics, surgical techniques, complications, patient-reported outcomes, and radiographic outcomes were collected and analyzed. For continuous variables, the comparison between groups was conducted using a one-way analysis of variance. Of all 235 patients included in the study, 70.5% were women (190 hips). The mean follow-up period was 12 years (range, 10 to 18). The femoral head sizes of 28- mm, 32 mm, and 36 mm were used in 50, 26, and 197 cases, respectively. Mean acetabular inclination and anteversion angles were 39.2 ± 7.1° and 14.9 ± 3.5°.

RESULTS

There were 5 hips revised at a mean 4.6 years (range, 0.1 to 7.1). One revision was squeaking-related. Squeaking was also reported by 8 other patients, but did not require revision. Other reasons for revision were early infection in 2 cases, stem loosening in 1 case, and stem fracture in 2 cases. The survival analysis for any causes for revision as an endpoint was 96.7% (95% confidence interval 0.313%-2.57%).

CONCLUSION

We report excellent mean 12-year follow-up results regarding the complications and survivorship of the fourth generation CoC bearings.

A 10- to 12-year follow-up study of delta ceramic-on-ceramic total hip arthroplasty

BACKGROUND

We previously reported five-to-seven-year results of total hip arthroplasty (THA) with the use of delta ceramic-on-ceramic (CoC) bearing. We conducted an extension study with a CT scan at a minimum of 10 years after surgery.

METHODS

From March 2009 to March 2011, 273 patients (310 hips) received cementless THA with delta CoC bearing, porous-coated cup and hydroxyapatite-coated stem. In this extended study, 252 patients (144 men and 108 women) (288 hips) with a mean age of 49.7 years (16-83) at surgery were followed for a mean of 10.4 years (10-12) with CT scans in 133 hips (46.2%, 133/288). Clinical and radiographic evaluations were made at each follow-up and Kaplan-Meier survival analysis was performed with revision and reoperation as endpoints.

RESULTS

There were no more ceramic fractures. Compared to mid-term results, the incidence of squeaking and RLLs increased to 3.1% (9/288) and 19.4% (56/288), respectively. The RLL progressed to focal osteolysis in 3 hips (5.4%, 3/56). No hip had detectable wear or prosthetic loosening. Two hips were reoperated due to periprosthetic joint infection and periprosthetic femoral fracture in each. The survivorship decreased to 98.3% (96.7-99.9%) at 12 years.

CONCLUSION

During the extended follow-up, no additional ceramic fracture occurred, and the incidence of squeak increased by 0.7%. The long-term survivorship of Delta CoC THA was encouraging. However, focal osteolysis occurred around the hydroxyapatite-coated stem in 1% (3/288).

LEVEL OF EVIDENCE

II (Prospective cohort study).

Quality Assessment of Computed Tomography Images using a Channelized Hoteling Observer: Optimization of Protocols in Clinical Practice

Background

This study investigated the feasibility of channelized hoteling observer (CHO) model in computed tomography (CT) protocol optimization regarding the image quality and patient exposure. While the utility of using model observers such as to optimize the clinical protocol is evident, the pitfalls associated with the use of this method in practice require investigation.

Materials and Methods

This study was performed using variable tube current and adaptive statistical iterative reconstruction (ASIR) level (ASIR 10% to ASIR 100%). Various criteria including noise, high-contrast spatial resolution, CHOs model were used to compare image quality at different captured levels. For the implementation of CHO, we first tuned the model in a restricted dataset and then it to the evaluation of a large dataset of images obtained with different reconstruction ASIR and filtered back projection (FBP) levels.

Results

The results were promising in terms of CHO use for the stated purposes. Comparisons of the noise of reconstructed images with 30% ASIR and higher levels of noise in rebuilding images using the FBP approach showed a significant difference (P < 0.05). The spatial resolution obtained using various ASIR levels and tube currents were 0.8 pairs of lines per millimeter, which did not differ significantly from the FBP method (P > 0.05).

Conclusions

Based on the results, using 80% ASIR can reduce the radiation dose on lungs, abdomen, and pelvis CT scans while maintaining image quality. Furthermore using ASIR 60% only for the reconstruction of lungs, abdomen, and pelvis images at standard radiation dose leads to optimal image quality.

Imageless navigation for primary total hip arthroplasty: a meta-analysis study

BACKGROUND

There has been a growing interest in imageless navigation for primary total hip arthroplasty (THA). Its superiority over standard THA is debated. This meta-analysis compared surgical duration, implant positioning, Harris Hip Score and rate of dislocation of imageless navigation versus conventional THA.

METHODS

The present study was conducted according to the PRISMA 2020 guidelines. All the clinical trials comparing imageless navigation versus conventional for primary THA were accessed. In January 2022, the following databases were accessed: PubMed, Web of Science, Google Scholar and Embase. No time constraints were used for the search. The outcomes of interest were to compare cup inclination and anteversion, leg length discrepancy, surgical duration, Harris Hip Score and rate of dislocation of imageless navigation versus conventional THA.

RESULTS

Twenty-one studies (2706 procedures) were retrieved. Fifty-two percent of patients were women. There was between-group comparability at baseline in terms of age, body mass index (BMI), visual analogue scale, Harris Hip Score and leg length discrepancy (P > 0.1). Compared with conventional THA, the navigated group demonstrated slightly lower leg length discrepancy (P = 0.02) but longer duration of the surgical procedure (P < 0.0001). Cup anteversion (P = 0.6) and inclination (P = 0.5), Harris Hip Score (P = 0.1) and rate of dislocation (P = 0.98) were similar between the two interventions.

CONCLUSION

Imageless navigation may represent a viable option for THA.

Pragmatic approaches to reducing radiation dose in brain computed tomography scan using scan parameter modification

Background:

High radiation dose of patients has become a concern in the computed tomography (CT) examinations. The aim of this study is to guide the radiology technician in modifying or optimizing the underlying parameters of the CT scan to reduce the patient radiation dose and produce an acceptable image quality for diagnosis.

Methods:

The body mass measurement device phantom was repeatedly scanned by changing the scan parameters. To analyze the image quality, software-based and observer-based evaluations were employed. To study the effect of scan parameters such as slice thickness and reconstruction filter on image quality and radiation dose, the structural equation modeling was used.

Results:

By changing the reconstruction filter from standard to soft and slice thickness from 2.5 mm to 5 mm, low-contrast resolution did not change significantly. In addition, by increasing the slice thickness and changing the reconstruction filter, the spatial resolution at different radiation conditions did not significantly differ from the standard irradiation conditions (P > 0.05).

Conclusion:

In this study, it was shown that in the brain CT scan imaging, the radiation dose was reduced by 30%–50% by increasing the slice thickness or changing the reconstruction filter. It is necessary to adjust the CT scan protocols according to clinical requirements or the special conditions of some patients while maintaining acceptable image quality.

Articular Noise After THA Using Delta CoC Bearings Has Little Impact on Quality of Life

BACKGROUND

To report clinical outcomes and survival at a minimum of 10 years of a consecutive series of uncemented total hip arthroplasty (THA) with fourth-generation ceramic-on-ceramic (CoC) bearings and determine the incidence of articular noises, their risk factors, and impact on quality of life (QoL).

METHODS

From a series of 456 CoC THAs, there were 25 revisions, 38 deceased, and 36 lost to follow-up. The remaining 357 hips were assessed at 11.1 ± 0.7 years (range, 10-14) using the Forgotten Joint Score, Oxford Hip Score, and a questionnaire on articular noises. Kaplan-Meier survival was calculated, and multivariable analysis was performed to determine associations between articular noise and patient/surgical factors.

RESULTS

The 10-year survival was 96.3% for the cup, 96.5% for the stem, and 94.2% for all components. The Forgotten Joint Score was 79 ± 26 (range, 0-100), and Oxford Hip Score was 16 ± 7 (range, 12-60). The mean impact of articular noises on QoL was 1.8 ± 2.9 (range, 0-9): considered negligible in 60 hips (16%), moderate in 27 hips (7%), and severe in only 13 hips (4%). Multivariable analyses revealed that the incidence of articular noise decreased with age (odds ratio [OR], 0.94; P = .001), body mass index (OR, 0.85; P = .001), and in hips implanted with 32-mm (vs 36 mm) heads (OR, 0.18; P = .030).

CONCLUSION

Of 100 hips (28%) that reported some articular noises 10 years after CoC THA, the impact of articular noises on QoL was negligible for most patients. Although larger heads can improve mobility and reduce risks of dislocations, surgeons must be aware that increasing head size could also increase risks of articular noises, notably in young and active patients.

Arthroscopic evaluation and treatment of a squeaking hip. A case report

Background

Squeaking of ceramic-on-ceramic total hip arthroplasty is an unexpected complication which occurs in 1- 30% of patients. Revision surgery is required in 0.2% of the cases, when a ceramic fracture is suspected, or in case of severe malposition of the implants, subluxation, or impingement. Hip arthroscopy may be a useful diagnostic and therapeutic option in squeaking hips.

Case presentation

A patient presenting with a pain-free squeaking underwent hip arthroscopy to examine the sliding surfaces and the rim of the acetabulum, and to search for signs of impingement. Thorough lavage and debridement of hip synovitis and fibrous tissue was performed. The squeaking noise immediately disappeared after the surgery. The patient was allowed to fully weight bear as tolerated with 2 crutches for 2 weeks. Two years after the arthroscopy, the patient remained symptom-free.

Conclusions

The potential reasons for hip squeaking in our patient are discussed. Hip arthroscopy may prove useful as a diagnostic and therapeutic option for some patients presenting with a squeaking ceramic-on ceramic hip replacement.

Incidence of Ceramic Fracture in Contemporary Ceramic-on-Ceramic Total Hip Arthroplasty: A Meta-analysis of Proportions

BACKGROUND

We performed a proportion meta-analysis of currently available data to determine the prevalence of ceramic fracture for each generation.

METHODS

A total of 10,571 total hip arthroplasties from 45 studies were included. Proportion meta-analysis with a random-effects model was performed to estimate the prevalence of ceramic fracture. To determine whether the ceramic fractures have a fatigue nature and a risk or latent period for the development, postoperative time lapse, patient age, and body mass index were related with ceramic fracture by metaregression analysis.

RESULTS

As of postoperative 2.0 to 18.8 years, the rate of ceramic fracture was 0.5% (95% CI, 0.3%-0.8%) in the forte group and 0.2% (95% CI, 0.1%-0.4%) in the delta group (P = .059). The ceramic fracture rate for each component was 0.2% (95% CI, 0.1%-0.3%) for the forte head, 0.1% (95% CI, 0.0%-0.2%) for the delta head (P = .210), 0.2% (95% CI, 0.1%-0.3%) for the forte liner, and 0.2% (95% CI, 0.1%-0.4%) for the delta liner (P = .305). The rate of ceramic fracture per 1000 patient-years was 0.9 (95% CI, 0.5-0.13) in the forte group and 0.5 (95% CI, 0.2-0.8) in the delta group (P = .072). In metaregression analysis, no significant associations were found between prevalence of ceramic fracture and postoperative time lapse, patient age, or body mass index.

CONCLUSIONS

The rate of ceramic fracture was 0.9/1000 patient-year in the forte group and 0.5/1000 patient-year in the delta group. The results of this study provide baseline data for further studies validating ceramic bearings.

LEVEL OF EVIDENCE

Level I, meta-analysis.

Computerized navigation for total hip arthroplasty is associated with lower complications and ninety-day readmissions: a nationwide linked analysis

INTRODUCTION

The objective was to evaluate if the use of CA-THA was associated with lower complications in the first 90 days following THA compared with conventional THA.

METHODS

The Nationwide Readmission Database (NRD) was queried to identify patients who underwent THA between 2012 and 2014. The primary outcome was arthroplasty-related complications within the first 90 days following THA. Multivariate models predicting the risk of complications, readmission, and revision-related readmission within 90 days of discharge were created.

RESULTS

A total of 309,252 patients with a minimum 90-day follow-up following elective primary THA were identified. After controlling for age, sex, comorbidities, indication, income, and type of insurance, the use of CA during THA resulted in a 12% reduced odds of 90-day complications (OR 0.88, 95% CI 0.77-0.99, p = 0.04).

DISCUSSION

The use of CA-THA resulted in lower 90-day complication rates and readmission rates compared with traditional THA after controlling for confounding variables. There was no significant difference in the rates of revision surgery between the groups within the first 90 days.

The Accuracy of the Computed Tomography-Based Navigation System in Total Hip Arthroplasty Is Comparable With Crowe Type IV and Crowe Type I Dysplasia: A Case-Control Study

BACKGROUND

Clinical outcomes of total hip arthroplasty (THA) for Crowe type IV are poorer than for Crowe type I, because it is more difficult to accurately position the acetabular components. This study aimed to examine the accuracy of the computed tomography (CT)-based navigation system for acetabular component positioning in primary THA for Crowe type IV.

METHODS

From 2006 to 2018, 29 patients who underwent 34 primary THAs for Crowe type IV were enrolled in the "Type IV" group and 32 patients who underwent 34 THAs for Crowe type I were enrolled in the "Type I" group, formed by matching patients in the Type IV group on age, gender, body mass index, and surgical approach. We investigated (1) the accuracy of the cup size between that at preoperative planning and that actually implanted and (2) the mean deviation of the cup angle and 3-dimensional position of acetabular components between preoperative plan and postoperative records.

RESULTS

The accuracy of the cup size was 79.4% and 94.1% in the Type IV and Type I groups, respectively, without a statistically significant change detected (P = .075). The mean deviations of the cup angle and 3-dimensional position were comparable in both groups.

CONCLUSION

Using the CT-based navigation system, it was possible to accurately implant the acetabular component for Crowe type IV, and the accuracy was comparable to that for Crowe type I. The CT-based navigation system is a useful intraoperative tool to accurately implant the acetabular component, especially with severe pelvic deformities such as Crowe type IV.

Clinical efficacy of orthopilot navigation system versus conventional manual of total hip arthroplasty: A systematic review and meta-analysis

BACKGROUND

To compare the clinical efficacy between Orthopilot navigation system and conventional manual surgery in total hip arthroplasty (THA).

METHODS

Electronic databases were searched to identify randomized controlled trials (RCTs) investigating Orthopilot navigation system versus conventional manual in patients undergoing THA. Outcome measurements include anteversion angle, inclination angle, preoperative leg length discrepancy, postoperative leg length discrepancy and femoral offset. Statistical software Stata 12.0 was used for data-analysis.

RESULTS

A total of 5 studies were finally included in this meta-analysis. The results showed that the conventional manual group have a less anteversion angle than that in Orthopilot navigation system group (weighted mean difference (WMD) = 4.67, 95% confidence interval (CI) = 3.53, 5.82, P = .000). And pooled analysis showed that the inclination angle in Orthopilot navigation group was less than that in conventional manual group (WMD = -4.19, 95% CI = -8.00, -0.37, P = .031). There was no significant difference between the preoperative leg length discrepancy and postoperative leg length discrepancy (P > .05). Orthopilot navigation system compared with conventional manual procedure was associated with decreased of femoral offset by 2.76 (WMD = -2.76, 95%CI = -3.90, -1.62, P = .000).

CONCLUSION

Both Orthopilot navigation system and conventional THA result in significant improvements in patient function with similar overall complication rates and have their own edges in cup position.

Clinical efficacy of OrthoPilot navigation system versus conventional manual total hip arthroplasty: A systematic review and meta-analysis

Objective

This study was performed to compare the clinical efficacy between the OrthoPilot navigation system and conventional manual surgery in patients undergoing total hip arthroplasty.

Methods

The Embase, PubMed, CINAHL, and Cochrane databases were searched for clinical trials. The outcome measurements were the anteversion angle, inclination angle, and complications. Review Manager 5.3 statistical software was used for the data analysis.

Results

Significant differences were found in the femoral offset and overall complication rate between the conventional and navigation groups. Additionally, the conventional group had significantly less anteversion than the navigation group. However, the navigation group had significantly better inclination. The operation time was significantly shorter in the conventional than navigation group.

Conclusion

Both the OrthoPilot navigation system and conventional total hip arthroplasty result in significant improvements in patient function with similar overall complication rates and have their own advantages in achieving good cup position. The conventional procedure has a shorter operation time than does use of a navigation system.

Primary total hip arthroplasty with fourth-generation ceramic bearings: Clinical and survival results with a minimum follow-up of 5 years

OBJECTIVE

To evaluate the clinical results and survival of primary hip prosthesis with ceramic delta bearings (C-C) with a minimum follow-up of 5years.

MATERIAL AND METHOD

A total of 205 primary hip arthroplasties performed between 2008 and 2012 were studied. The clinical results, pre-surgical and at 5years of follow-up were evaluated using the Harris Hip Score (HHS), the Short Form-36 (SF-36), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the visual analogue scale (VAS). The position of the prosthetic components, periprosthetic osteolysis, loosening of the prosthetic components and ruptures of the ceramic components were studied radiologically. The adverse events related to bearings were recorded according to their diameter, paying special attention to prosthetic dislocations and the presence of noise. Survival with an endpoint of prosthetic revision for any cause was estimated using the Kaplan-Meier method.

RESULTS

Significant improvements were obtained in the HHS (88.7% of good/excellent results), SF36, WOMAC and EVA, P<.001. There were 19 adverse events related to the prosthesis (4 periprosthetic fractures, 4 dislocations, 2 superficial infections, 1 mobilization of the cup, 2 noises, 4 aseptic loosenings and 2 breaks of the prosthetic neck); 47.3% needed revision. The cumulative survival of the prostheses was 97.5% (95%CI: 96.4-98.5). No differences were found in survival, prosthetic adverse events, noise incidence or dislocations and clinical results among the different diameters used.

CONCLUSIONS

Primary hip prostheses with fourth-generation ceramic bearings showed good survival in the medium term, and good clinical results.

Application of tranexamic acid and diluted epinephrine in primary total hip arthroplasty

: Tranexamic acid (TXA) and diluted epinephrine (DEP) has been reported to be an efficient and well tolerated way for reducing blood loss in total hip arthroplasty (THA). This meta-analysis was designed to compare the effectiveness of combination application of TXA with DEP in primary THA. The following electronic databases were searched, including PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure and Google Search Engine, for published studies involving the TXA with DEP in primary THA. All randomized controlled trials (RCTs) were included. Statistical analysis was assessed using RevMan 5.3 software. Five independent RCTs were included, with a total sample size of 496 patients. The application of TXA with DEP can significantly reduce total blood loss (mean difference, 246.13; 95% CI, -369.95 to -122.32; P < 0.0001), hidden blood loss (mean difference, 299.98; 95% CI -433.61 to -166.35; P < 0.0001) and transfusion requirements (risk ratio, 0.50; 95% CI 0.28-0.90; P = 0.02) compared with the TXA alone. There were no significant differences in intraoperative blood loss (P = 0.46), drainage volume (P = 0.61), length of stay (P = 0.53) and the rate of DVT (P = 0.56) between the two groups. On the basis of current evidence, this meta-analysis showed that the application TXA with DEP is a well tolerated and efficacious treatment to reduce total blood loss, hidden blood loss and transfusion requirements in primary THA, without increasing the risk of DVT in primary THA.

Third-generation pure alumina and alumina matrix composites in total hip arthroplasty: What is the evidence?

Wear, corrosion and periprosthetic osteolysis are important causes of failure in joint arthroplasty, especially in young patients.

Ceramic bearings, developed 40 years ago, are an increasingly popular choice in hip arthroplasty. New manufacturing procedures have increased the strength and reliability of ceramic materials and reduced the risk of complications.

In recent decades, ceramics made of pure alumina have continuously improved, resulting in a surgical-grade material that fulfills clinical requirements.

Despite the track record of safety and long-term results, third-generation pure alumina ceramics are being replaced in clinical practice by alumina matrix composites, which are composed of alumina and zirconium.

In this review, the characteristics of both materials are discussed, and the long-term results with third-generation alumina-on-alumina bearings and the associated complications are compared with those of other available ceramics.

Cite this article: EFORT Open Rev 2018;3:7-14. DOI: 10.1302/2058-5241.3.170034