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Fontalis A, Zhao B, Putzeys P, Mancino F, Zhang S, Vanspauwen T, Glod F, Plastow R, Mazomenos E, Haddad FS. Is it feasible to develop a supervised learning algorithm incorporating spinopelvic mobility to predict impingement in patients undergoing total hip arthroplasty? Bone Jt Open 2024; 5:671-680. [PMID: 39139101 PMCID: PMC11322786 DOI: 10.1302/2633-1462.58.bjo-2024-0020.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
Aims Precise implant positioning, tailored to individual spinopelvic biomechanics and phenotype, is paramount for stability in total hip arthroplasty (THA). Despite a few studies on instability prediction, there is a notable gap in research utilizing artificial intelligence (AI). The objective of our pilot study was to evaluate the feasibility of developing an AI algorithm tailored to individual spinopelvic mechanics and patient phenotype for predicting impingement. Methods This international, multicentre prospective cohort study across two centres encompassed 157 adults undergoing primary robotic arm-assisted THA. Impingement during specific flexion and extension stances was identified using the virtual range of motion (ROM) tool of the robotic software. The primary AI model, the Light Gradient-Boosting Machine (LGBM), used tabular data to predict impingement presence, direction (flexion or extension), and type. A secondary model integrating tabular data with plain anteroposterior pelvis radiographs was evaluated to assess for any potential enhancement in prediction accuracy. Results We identified nine predictors from an analysis of baseline spinopelvic characteristics and surgical planning parameters. Using fivefold cross-validation, the LGBM achieved 70.2% impingement prediction accuracy. With impingement data, the LGBM estimated direction with 85% accuracy, while the support vector machine (SVM) determined impingement type with 72.9% accuracy. After integrating imaging data with a multilayer perceptron (tabular) and a convolutional neural network (radiograph), the LGBM's prediction was 68.1%. Both combined and LGBM-only had similar impingement direction prediction rates (around 84.5%). Conclusion This study is a pioneering effort in leveraging AI for impingement prediction in THA, utilizing a comprehensive, real-world clinical dataset. Our machine-learning algorithm demonstrated promising accuracy in predicting impingement, its type, and direction. While the addition of imaging data to our deep-learning algorithm did not boost accuracy, the potential for refined annotations, such as landmark markings, offers avenues for future enhancement. Prior to clinical integration, external validation and larger-scale testing of this algorithm are essential.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Baixiang Zhao
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | | | - Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Shuai Zhang
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | | | - Fabrice Glod
- Hôpitaux Robert Schuman, Luxembourg City, Luxembourg
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
| | - Evangelos Mazomenos
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
| | - Fares S. Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
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Scanlon CM, Christensen T, Bieganowski T, Buehring W, Meftah M, Hepinstall MS. "Stuck in the middle": the missing lumbosacral link in total hip arthroplasty. Hip Int 2024; 34:482-486. [PMID: 38469810 DOI: 10.1177/11207000231223706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Spinopelvic mobility drives functional acetabular position, influencing dislocation risk after total hip arthroplasty (THA). Patients have been described as "stuck sitting" or "stuck standing" based on pelvic tilt (PT). We hypothesised that some patients are "stuck in the middle," meaning their PT changes minimally from sitting to standing - increasing their risk of dislocation. METHODS We reviewed 195 patients with standing and sitting whole body radiographs prior to THA. Standing anterior pelvic plane tilt (APPT) and standing and sitting sacral slope (SS) were measured and used to calculate sitting APPT. Normal standing and sitting were defined as APPT >-10° and <-20°, respectively. Spinal stiffness was classified as <10° change in sacral slope between sitting and standing. Patients were categorised as: (A) able to fully sit and stand; (B) "stuck sitting" - able to fully sit; unable to fully stand; (C) "stuck standing" - able to fully stand; unable to fully sit; or (D) "stuck in the middle" - unable to sit or stand fully. RESULTS 84 patients could sit and stand normally (A), 22 patients were stuck sitting (B), 76 patients were stuck standing (C), and 13 patients were stuck in the middle (D). While 111 patients (56.9%) were considered stuck, only 58 patients (29.7%) met criteria for spinal stiffness. DISCUSSION We identified a subset of patients with stiff spines and abnormal PT in both sitting and standing, including 37.1% of patients who would be classified as "stuck sitting" based only on standing radiographs. Placing acetabular components in less than anatomic anteversion in these patients may increase posterior dislocation risk.
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Affiliation(s)
| | - Thomas Christensen
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Thomas Bieganowski
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Weston Buehring
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Morteza Meftah
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
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Shao H, Huang Y, Yang D, Deng W, Wu XD, Zhou Y. Variety of femoral anteversion and its measurement in cementless total hip arthroplasty: Does robotic technology improve accuracy? J Orthop Surg Res 2024; 19:47. [PMID: 38195511 PMCID: PMC10775668 DOI: 10.1186/s13018-024-04527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/01/2024] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND High-performance total hip arthroplasty (THA) depends on the accurate position of components. However, femoral anteversion is variable, and current studies only used traditional instruments to evaluate it, such as protractor and spirit level with limited cases. This study aimed to identify the variability in the measured femoral native anteversion and intraoperative stem anteversion under different measurement methods, including intraoperative robotic method. We hypothesized that robotic technology was more accurate than traditional instruments for femoral anteversion evaluation. METHODS This study included 117 hips of patients who underwent robotic-assisted THA between November 2019 and March 2021. Preoperative native femoral anteversion was measured using a robotic system. Intraoperative femoral stem anteversion was evaluated visually, and then measured with a goniometer and a robotic system, respectively. Variability in the measured femoral native anteversion and intraoperative femoral stem anteversion was calculated and compared. Intraclass correlation coefficient (ICC) and Pearson correlation analysis were used to assess the consistency and correlation of anteversion of different measurements and postoperative CT-measured stem anteversion, respectively. RESULTS The result of measurement for preoperative native femoral anteversion was more variable than the intraoperative robotic-measured stem anteversion. Intraoperative robotic-measured stem version showed the highest correlation with postoperative CT measurement of stem version (r = 0.806, P < 0.001), while intraoperative surgeon estimation had the lowest correlation coefficient (r = 0.281, P = 0.025). As for the consistency with postoperative CT measurement of femoral stem anteversion, the intraoperative robotic-measured femoral stem version also had the highest value (ICC = 0.892, P < 0.001). CONCLUSION Native femoral anteversion was variable preoperatively. Using cementless stems, anteversion was also highly variable. Robotic assessment for stem anteversion during surgery was more consistent with the final position than the preoperative assessment and conventional intraoperative estimation.
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Affiliation(s)
- Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing, 100035, China
| | - Yong Huang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing, 100035, China
| | - Dejin Yang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing, 100035, China
| | - Wang Deng
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing, 100035, China
| | - Xiang-Dong Wu
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing, 100035, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing, 100035, China.
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Ambrus R, Douša P, Almási J, Šteňo B. Current Concepts in Diagnosis and Management of Patients Undergoing Total Hip Replacement with Concurrent Disorders of Spinopelvic Anatomy: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1591. [PMID: 37763710 PMCID: PMC10535821 DOI: 10.3390/medicina59091591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/23/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023]
Abstract
Despite the high success rate of primary total hip replacement (THR), a significant early revision rate remains, which is largely attributed to instability and dislocations. Despite the implants being placed according to the safe zone philosophy of Lewinnek, occurrence of THR dislocation is not an uncommon complication. Large diagnostic and computational model studies have shown variability in patients' mobility based on the individual anatomic and functional relationship of the hip-pelvis-spine complex. The absolute and relative position of hip replacement components changes throughout motion of the patient's body. In the case of spinopelvic pathology such as spine stiffness, the system reaches abnormal positional states, as shown with computerized models. The clinical result of such pathologic hip positioning is edge loading, implant impingement, or even joint dislocation. To prevent such complications, surgeons must change the dogma of single correct implant positioning and take into account patients' individualized anatomy and function. It is essential to broaden the standard diagnostics and their anatomical interpretation, and correct the pre-operative surgical planning. The need for correct and personalized implant placement pushes forward the development and adaptation of novel technologies in THR, such as robotics. In this current concepts narrative review, we simplify the spinopelvic biomechanics and pathoanatomy, the relevant anatomical terminology, and the diagnosis and management algorithms most commonly used today.
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Affiliation(s)
- Richard Ambrus
- Department of Orthopaedics, Nemocnica Bory Penta Hospitals International, I. Kadlecika 2, Lamac, 841 03 Bratislava, Slovakia;
| | - Pavel Douša
- Department of Orthopaedics and Traumatology, Kralovske Vinohrady University Hospital, 3rd Faculty of Medicine Charles University, FNKV Srobarova 50, 100 34 Prague, Czech Republic;
- Department of Traumatology and Orthopaedics, Ostrava University Hospital, Faculty of Medicine University of Ostrava, FNO 17. Listopadu Street, Poruba, 708 52 Ostrava, Czech Republic
| | - Jozef Almási
- Department of Orthopaedics, Nemocnica Bory Penta Hospitals International, I. Kadlecika 2, Lamac, 841 03 Bratislava, Slovakia;
| | - Boris Šteňo
- II. University Department of Orthopaedic and Trauma Surgery, University Hospital Bratislava and Faculty of Medicine, Comenius University Bratislava, Antolska 11, Petrzalka, 851 01 Bratislava, Slovakia;
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Buchalter DB, Gall AM, Buckland AJ, Schwarzkopf R, Meftah M, Hepinstall MS. Creating Consensus in the Definition of Spinopelvic Mobility. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202306000-00005. [PMID: 37294841 PMCID: PMC10256344 DOI: 10.5435/jaaosglobal-d-22-00290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/29/2023] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The term "spinopelvic mobility" is most often applied to motion within the spinopelvic segment. It has also been used to describe changes in pelvic tilt between various functional positions, which is influenced by motion at the hip, knee, ankle and spinopelvic segment. In the interest of establishing a consistent language for spinopelvic mobility, we sought to clarify and simplify its definition to create consensus, improve communication, and increase consistency with research into the hip-spine relationship. METHODS A literature search was performed using the Medline (PubMed) library to identify all existing articles pertaining to spinopelvic mobility. We reported on the varying definitions of spinopelvic mobility including how different radiographic imaging techniques are used to define mobility. RESULTS The search term "spinopelvic mobility" returned a total of 72 articles. The frequency and context for the varying definitions of mobility were reported. 41 papers used standing and upright relaxed-seated radiographs without the use of extreme positioning, and 17 papers discussed the use of extreme positioning to define spinopelvic mobility. DISCUSSION Our review suggests that the definitions of spinopelvic mobility is not consistent in the majority of published literature. We suggest descriptions of spinopelvic mobility independently consider spinal motion, hip motion, and pelvic position, while recognizing and describing their interdependence.
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Affiliation(s)
- Daniel B. Buchalter
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Ashley M. Gall
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Aaron J. Buckland
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Ran Schwarzkopf
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Morteza Meftah
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Matthew S. Hepinstall
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
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Fontalis A, Putzeys P, Plastow R, Giebaly DE, Kayani B, Glod F, Haddad FS. Functional Component Positioning in Total Hip Arthroplasty and the Role of Robotic-Arm Assistance in Addressing Spinopelvic Pathology. Orthop Clin North Am 2023; 54:121-140. [PMID: 36894286 DOI: 10.1016/j.ocl.2022.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Hip, spine, and pelvis function as a unified kinetic chain. Any spinal pathology, results in compensatory changes in the other components to accommodate for the reduced spinopelvic motion. The complex relationship between spinopelvic mobility and component positioning in total hip arthroplasty presents a challenge in achieving functional implant positioning. Patients with spinal pathology, especially those with stiff spines and little change in sacral slope, are at high instability risk. In this challenging subgroup, robotic-arm assistance enables the execution of a patient specific plan, avoiding impingement and maximizing range of motion; especially utilizing virtual range of motion to dynamically assess impingement.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London NW1 2BU, UK; Division of Surgery and Interventional Science, University College London, Gower Street, London WC1E 6BT, UK.
| | - Pierre Putzeys
- Hôpitaux Robert Schuman, 9 Rue Edward Steichen, Luxembourg-City 2540, Luxembourg
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London NW1 2BU, UK
| | - Dia Eldean Giebaly
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London NW1 2BU, UK; Division of Surgery and Interventional Science, University College London, Gower Street, London WC1E 6BT, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London NW1 2BU, UK
| | - Fabrice Glod
- Hôpitaux Robert Schuman, 9 Rue Edward Steichen, Luxembourg-City 2540, Luxembourg
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, 235 Euston Road, London NW1 2BU, UK; Division of Surgery and Interventional Science, University College London, Gower Street, London WC1E 6BT, UK
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The Functional Mechanics of the Acetabular Component in Total Hip Arthroplasty. J Arthroplasty 2022; 37:2199-2207.e1. [PMID: 35643259 DOI: 10.1016/j.arth.2022.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/06/2022] [Accepted: 05/08/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty functional safe zones match postural hip changes to dynamic positioning of the acetabular component. We studied integrating the Anteinclination (AI) cup angle into the spinopelvic environment, defining normative values for all parameters and calculating adjustments to AI for each degree of altered standing pelvic position and postural mobility from these values. A sagittal geometric model was employed to determine these values using established spinopelvic parameter angles. METHODS Theoretical normative Pelvic Incidence (PI) specific values were calculated using a triangular construct employing a linear equation describing the functional relationship between the pelvic parameters at a mobility producing an isosceles solution for normative acetabular angles. Individual optimal AI cup values for altered Sacral Slope (SS)/pelvic tilt (sPT) and mobility (dSS) were calculated using specific ratios of angular change between parameters correcting from these normative values. RESULTS A PI:SS:sPT ratio of angular change of 3:2:1 at dSS = 25° mobility creates an isosceles condition solving for PI specific theoretical normative values for all construct parameters. Individualized tilt correction applies to each posture a +0.25° AI alteration for each +1° sPT increase from this architectural value. Mobility correction applies a +0.5° standing AI and -0.5° sitting AI alteration for each -1° dSS < 25°, the opposite for each +1° dSS > 25°. The Sacroacetabular angle/Pelvic acetabular angle (SAA/PAA) index describes the underlying spinopelvic environment the cup functions within. CONCLUSION This model quantitatively integrates an implanted acetabular component into the host spinopelvic environment. Theoretical normative and individual optimal cup orientations are passively determined by these conditions of standing pelvic position and mobility.
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Vaswani R, White AE, Feingold J, Ranawat AS. Hip-Spine Syndrome in the Nonarthritic Patient. Arthroscopy 2022; 38:2930-2938. [PMID: 35550420 DOI: 10.1016/j.arthro.2022.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 02/02/2023]
Abstract
Hip-spine syndrome refers to concurrent hip and spine pathology with overlapping symptoms. Most of the literature has studied it in relation to total hip arthroplasty literature and has been shown to increase dislocation risk. Lumbar spine and pelvic mobility have been studied less frequently in relation to nonarthritic pathologic hip states. Understanding the biomechanical relationship between the lumbar spine, pelvis, and hip can help elucidate how hip-spine syndrome affects the nonarthritic hip and how it impacts outcomes of hip arthroscopy. Changes in lumbar spine motion may be the reason certain predisposed patients develop symptomatic femoroacetabular impingement (FAI) or ischiofemoral impingement. Some athletes may be "hip users" with a low pelvic incidence, making them more reliant on hip motion due to less-intrinsic lumbopelvic motion. When these patients have FAI morphology, their increased reliance on hip motion makes them prone to experiencing femoroacetabular contact and concurrent symptoms. Other athletes may be "spine users," with larger pelvic incidence and more baseline lumbopelvic motion, making them less reliant on hip motion and therefore less prone to experiencing hip impingement even with hip FAI morphology. Hip-spine syndrome also appears to have an impact on patient selection, role of nonoperative treatment, and hip arthroscopy surgical outcomes. Identifying patients with concurrent pathology may allow surgeons to recommend targeted physical therapy or counsel patients better on their expectations after surgery.
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Affiliation(s)
- Ravi Vaswani
- Hospital for Special Surgery, New York, New York, U.S.A; Hospital for Special Surgery Sports Medicine Institute, New York, New York, U.S.A.
| | | | | | - Anil S Ranawat
- Hospital for Special Surgery, New York, New York, U.S.A; Hospital for Special Surgery Sports Medicine Institute, New York, New York, U.S.A
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Yun HH, Kim YB, Joo HJ, Koh YY. Does spinopelvic motion change after total hip arthroplasty? INTERNATIONAL ORTHOPAEDICS 2022; 46:2181-2187. [PMID: 35725952 DOI: 10.1007/s00264-022-05486-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/13/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Spinopelvic motion plays an important role in functional acetabular cup position after total hip arthroplasty (THA). Sacral slope (SS) has been a useful surrogate for spinopelvic motion. The present study aimed to investigate statistical characteristics of spinopelvic motion before and after THA using changes in SS in supine, standing, and sitting positions. METHODS A total of 76 patients (88 hips) were assessed. To classify spinopelvic mobility, defined as a change in SS from standing to sitting position (ΔSSstand/sit), 10° ≤ ΔSSstand/sit ≤ 30°, ΔSSstand/sit < 10°, and ΔSSstand/sit > 30° were considered normal, stiff, and hypermobile, respectively. RESULTS Over ± 7° changes in SS between before and one year after THA were observed in 39 (44.3%) hips in the sitting position, 19 (21.6%) hips in the supine position, seven (7.9%) in the standing position. Percentages of hips with stiff spinopelvic mobility (11.4% vs. 22.7%) and hypermobile spinopelvic mobility (23.9% vs. 12.5%) between before THA and one year after THA were significantly different (p = 0.034 and p = 0.016, McNemar's test). At one year after THA, 40.0% (4/10) of hips with stiff spinopelvic mobility and 57.1% (12/21) of hips with hypermobile spinopelvic mobility shifted to normal spinopelvic mobility. CONCLUSIONS Change in SS between before THA and one year after THA had a high inter-subject variability especially in the sitting position. In addition, there was a distinct shift to normal spinopelvic mobility postoperatively in hips with stiff and hypermobile spinopelvic mobility pre-operatively.
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Affiliation(s)
- Ho Hyun Yun
- Department of Orthopaedic Surgery, Veterans Healthcare Service Medical Center, Seoul, South Korea, 134791.
| | - Young Bae Kim
- Department of Orthopaedic Surgery, Veterans Healthcare Service Medical Center, Seoul, South Korea, 134791
| | - Hong Joon Joo
- Department of Orthopaedic Surgery, Veterans Healthcare Service Medical Center, Seoul, South Korea, 134791
| | - Yeong Yoon Koh
- Department of Orthopaedic Surgery, Veterans Healthcare Service Medical Center, Seoul, South Korea, 134791
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Zia AW, Liu R, Wu X. Structural design and mechanical performance of composite vascular grafts. Biodes Manuf 2022. [DOI: 10.1007/s42242-022-00201-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AbstractThis study reviews the state of the art in structural design and the corresponding mechanical behaviours of composite vascular grafts. We critically analyse surface and matrix designs composed of layered, embedded, and hybrid structures along the radial and longitudinal directions; materials and manufacturing techniques, such as tissue engineering and the use of textiles or their combinations; and the corresponding mechanical behaviours of composite vascular grafts in terms of their physical–mechanical properties, especially their stress–strain relationships and elastic recovery. The role of computational studies is discussed with respect to optimizing the geometrics designs and the corresponding mechanical behaviours to satisfy specialized applications, such as those for the aorta and its subparts. Natural and synthetic endothelial materials yield improvements in the mechanical and biological compliance of composite graft surfaces with host arteries. Moreover, the diameter, wall thickness, stiffness, compliance, tensile strength, elasticity, and burst strength of the graft matrix are determined depending on the application and the patient. For composite vascular grafts, hybrid architectures are recommended featuring multiple layers, dimensions, and materials to achieve the desired optimal flexibility and function for complying with user-specific requirements. Rapidly emerging artificial intelligence and big data techniques for diagnostics and the three-dimensional (3D) manufacturing of vascular grafts will likely yield highly compliant, subject-specific, long-lasting, and economical vascular grafts in the near-future.
Graphic abstract
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11
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van der Gronde BATD, Schlösser TPC, van Erp JHJ, Snijders TE, Castelein RM, Weinans H, de Gast A. Current Evidence for Spinopelvic Characteristics Influencing Total Hip Arthroplasty Dislocation Risk. JBJS Rev 2022; 10:01874474-202208000-00004. [PMID: 36000764 DOI: 10.2106/jbjs.rvw.22.00038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Decreased pelvic mobility and pelvic retroversion may result from spinal degeneration and lead to changes in the orientation of the acetabular implant after total hip arthroplasty (THA). While multiple patient and surgery-related factors contribute to THA dislocations, there is increasing evidence that sagittal spinopelvic dynamics are relevant for THA stability. The aim of this systematic review was to assess the relationship between previously described sagittal spinopelvic characteristics and implant dislocations after primary THA. METHODS A comprehensive literature search in the PubMed and Embase databases was conducted for studies reporting on spinopelvic morphology, alignment, pathology, or surgery and THA dislocations. Risk of bias was assessed using the MINORS criteria. Because of high heterogeneity in study methodology, a synthesis of best evidence was performed. Odds ratios (ORs), relative risks (RRs), and effect sizes (g) were calculated. RESULTS Fifteen studies (1,007,900 THAs) with quality scores of 15 to 23 out of 24 were included. Nine different spinopelvic alignment parameters (8 studies, g = 0.14 to 2.02), spinal pathology (2 studies, OR = 1.9 to 29.2), and previous spinal fusion surgery (8 studies, OR = 1.59 to 23.7, RR = 3.0) were found to be related to THA dislocation. Conflicting results were found for another sagittal pelvic morphology parameter, pelvic incidence. CONCLUSIONS Several sagittal spinopelvic patient characteristics were found to be related to THA dislocation, and the associated risks were greater than for other patient and surgery-related factors. Future research is needed to determine which of those characteristics and parameters should be taken into account in patients undergoing primary THA. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- B A T D van der Gronde
- Clinical Orthopedic Research Center midden Nederland, Department of Orthopedic Surgery, Diakonessenhuis Hospital, Zeist, the Netherlands
| | - T P C Schlösser
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J H J van Erp
- Clinical Orthopedic Research Center midden Nederland, Department of Orthopedic Surgery, Diakonessenhuis Hospital, Zeist, the Netherlands.,Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - T E Snijders
- Clinical Orthopedic Research Center midden Nederland, Department of Orthopedic Surgery, Diakonessenhuis Hospital, Zeist, the Netherlands
| | - R M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H Weinans
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Biomechanical Engineering, Technical University Delft, Delft, the Netherlands
| | - A de Gast
- Clinical Orthopedic Research Center midden Nederland, Department of Orthopedic Surgery, Diakonessenhuis Hospital, Zeist, the Netherlands
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GARCIA FLAVIOLUIS, PAJANOTI GUILHERMEPIANOWSKI, DEFINO HELTONLUIZAPARECIDO. SPINOPELVIC MOBILITY IN PATIENTS WITH HIP OSTEOARTHRITIS AND TOTAL HIP ARTHROPLASTY INDICATION. ACTA ORTOPÉDICA BRASILEIRA 2022; 30:e249351. [PMID: 36092173 PMCID: PMC9426008 DOI: 10.1590/1413-785220223004e249351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/11/2021] [Indexed: 11/22/2022]
Abstract
ABSTRACT Introduction: Reduction of spinopelvic mobility is associated with an increased dislocation of total hip arthroplasty (THA). Objective: To assess 1) spinopelvic mobility in patients with primary hip osteoarthritis and THA indication and 2) the influence of hip flexion contracture on spinopelvic mobility. Methods: Thirty adult patients with primary hip osteoarthritis and THA indication were evaluated using radiographic parameters (pelvic incidence, pelvic tilt, sacral slope, lumbar flexibility, and spinopelvic mobility). Results: Spinopelvic mobility ranged from 6.90 a 54.50° (mean 32.79 ± 11.42) and the group of patients with hip flexion contracture had higher mobility. Spinopelvic mobility was correlated with pelvic tilt as well as with lumbar flexibility. Conclusion: Around 13.4% of patients had spinopelvic mobility under 20° , indicating reduced spinopelvic mobility and risk of THA dislocation. Level of Evidence III, Retrospective Comparative Study.
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