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Vorimore C, Innmann M, Mavromatis S, Speirs A, Verhaegen JCF, Merle C, Grammatopoulos G. Impact of Offset and Leg Length on Functional Outcomes Post-Total Hip Arthroplasty: How Accurate Should Coronal Reconstruction Be? J Arthroplasty 2024; 39:S332-S339.e2. [PMID: 38897260 DOI: 10.1016/j.arth.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Accurate hip reconstruction is associated with improved biomechanical behavior following total hip arthroplasty (THA). However, whether this is associated with improved patient-reported outcomes (PROs) is unknown. HYPOTHESIS/PURPOSE This study aimed to: 1) describe the ability to reconstruct coronal geometry during THA without advanced technology; 2) assess whether restoration of global offset (GO) and leg length (LL) is associated with improved PROs; and 3) investigate whether increased femoral offset (FO) to compensate for reduced acetabular offset (AO) influences PROs. METHOD This was a prospective, multicenter, consecutive cohort study of 500 patients treated with primary THA without robotics or navigation. The Oxford Hip score (OHS) was obtained preoperatively and at 1-year follow-up. Supine anteroposterior pelvic radiographs were analyzed to determine AO, FO, GO, and LL relative to the native contralateral side. Contour plots for ΔOHS based on ΔLL and ΔGO were created, and ΔOHS was calculated within and outside various ranges (±2.5, ±5, or ±10 mm). RESULTS In the operated hip, mean FO increased by 3 ± 6 mm (range, -16 to 27), while AO decreased by 2 ± 4 mm (range, -17 to 10). The contour graph for ±2.5 mm zones showed the best outcomes (ΔOHS >25) with GO and LL centered on 0 ± 2.5 mm (P < .01). However, only 10% achieved such reconstruction. When GO and LL differences were within ±10 mm, ΔOHS was superior when both AO and FO were within ±5 mm (mean: 24 ± 10; range, -5 to 40) compared with when FO was above 5 mm to compensate for a reduction in AO (mean: 22 ± 11; range, -10 to 46; P = .040). CONCLUSIONS The PROs were associated with biomechanical reconstruction, and the best clinical improvement can be expected when GO and LL differences are both within 2.5 mm. Maintenance of AO is important, as compensation by increasing FO is associated with inferior OHS.
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Affiliation(s)
- Camille Vorimore
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Moritz Innmann
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Orthopaedic Surgery, Heidelberg University, Heidelberg, Germany
| | | | - Andrew Speirs
- Department of Mechanical and Aerospace Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Jeroen C F Verhaegen
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Orthopaedic Surgery, University Hospital Antwerp, Edegem, Belgium; Orthopaedic Centre Antwerp, AZ Monica, Antwerp, Belgium
| | - Christian Merle
- Department of Orthopaedic Surgery, Diakonie-Klinikum, Stuttgart, Germany
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Rivera RJ, Karasavvidis T, Pagan C, Haffner R, Ast MP, Vigdorchik JM, Debbi EM. Functional assessment in patients undergoing total hip arthroplasty. Bone Joint J 2024; 106-B:764-774. [PMID: 39084648 DOI: 10.1302/0301-620x.106b8.bjj-2024-0142.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Aims Conventional patient-reported surveys, used for patients undergoing total hip arthroplasty (THA), are limited by subjectivity and recall bias. Objective functional evaluation, such as gait analysis, to delineate a patient's functional capacity and customize surgical interventions, may address these shortcomings. This systematic review endeavours to investigate the application of objective functional assessments in appraising individuals undergoing THA. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied. Eligible studies of THA patients that conducted at least one type of objective functional assessment both pre- and postoperatively were identified through Embase, Medline/PubMed, and Cochrane Central database-searching from inception to 15 September 2023. The assessments included were subgrouped for analysis: gait analysis, motion analysis, wearables, and strength tests. Results A total of 130 studies using 15 distinct objective functional assessment methods (FAMs) were identified. The most frequently used method was instrumented gait/motion analysis, followed by the Timed-Up-and-Go test (TUG), 6 minute walk test, timed stair climbing test, and various strength tests. These assessments were characterized by their diagnostic precision and applicability to daily activities. Wearables were frequently used, offering cost-effectiveness and remote monitoring benefits. However, their accuracy and potential discomfort for patients must be considered. Conclusion The integration of objective functional assessments in THA presents promise as a progress-tracking modality for improving patient outcomes. Gait analysis and the TUG, along with advancing wearable sensor technology, have the potential to enhance patient care, surgical planning, and rehabilitation.
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Affiliation(s)
- Richard J Rivera
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Cale Pagan
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Rowan Haffner
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Michael P Ast
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Eytan M Debbi
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Fey B, Brenneis M, Stief F, van Drongelen S. Effect of Stem Design and Positioning on the Leg Axis after Total Hip Arthroplasty: A Secondary Analysis. J Clin Med 2024; 13:4453. [PMID: 39124720 PMCID: PMC11313081 DOI: 10.3390/jcm13154453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/10/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: Various parameters, like femoral offset and leg length, are associated with good patient outcomes after total hip arthroplasty. In this prospective study, the effects of stem design, its placement in the proximal femur and the resulting femoral offset on the total leg axis were investigated. Methods: The 27 patients included in this study received biplanar radiography (EOS®, EOS Imaging) with 3D reconstruction using sterEOS® both preoperatively and postoperatively. For all leg alignment parameters obtained from the 3D reconstruction and from measurements using mediCAD, the deltas between the postoperative and preoperative values were determined. Patients were divided into those who received a short-stem prosthesis and those who received a straight-stem prosthesis. Results: The change in femoral offset with the implantation of a short-stem prosthesis was significantly greater than that with the implantation of a straight-stem prosthesis (11.4 ± 5.9 vs. 4.6 ± 7.4 mm, p = 0.014). Compared with the straight-stem implantation, short-stem implantation caused a significantly greater increase in the varus orientation of the leg (-1.4 ± 0.9 vs. -0.4 ± 1.4°, p = 0.048). There was no significant difference in the positioning of the short-stem prosthesis compared to the straight-stem prosthesis in the proximal femur (3.6 ± 3.1 vs. 2.6 ± 1.9°, p = 0.317). Conclusions: These findings substantiate the impact of prosthesis design on offset and leg alignment. The implantation of short-stems is more variable and requires precise planning. Intraoperative non-physiological offset changes and varus deviation of the leg axis should be avoided. Trial registration: This study was retrospectively registered with the German Clinical Trials Register (DRKS) under the number DRKS00015053 on the 1 August 2018.
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Affiliation(s)
- Benjamin Fey
- Department of Trauma Surgery and Orthopedics, University Hospital Frankfurt, Goethe University Frankfurt, Marienburgstr. 2, 60528 Frankfurt, Germany; (B.F.); (M.B.); (F.S.)
| | - Marco Brenneis
- Department of Trauma Surgery and Orthopedics, University Hospital Frankfurt, Goethe University Frankfurt, Marienburgstr. 2, 60528 Frankfurt, Germany; (B.F.); (M.B.); (F.S.)
| | - Felix Stief
- Department of Trauma Surgery and Orthopedics, University Hospital Frankfurt, Goethe University Frankfurt, Marienburgstr. 2, 60528 Frankfurt, Germany; (B.F.); (M.B.); (F.S.)
| | - Stefan van Drongelen
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Trauma Surgery and Orthopedics, University Hospital Frankfurt, Goethe University Frankfurt, Marienburgstr. 2, 60528 Frankfurt, Germany
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Ryan NS, Kowalski E, Beaulé PE, Lamontagne M. The Effect of Surgical Approach and Hip Offset Reconstruction on Gait Biomechanics Following Total Hip Arthroplasty. J Arthroplasty 2024; 39:402-408.e1. [PMID: 37597822 DOI: 10.1016/j.arth.2023.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND This study aimed to examine how hip offset (HO) and surgical approach affect gait biomechanics following total hip arthroplasty (THA). METHODS There were 55 THA patients assigned to 3 groups based on surgical approach (ANT: anterior, LAT: lateral, or POS: posterior) and HO difference (large HO: >5 millimeters (mm), small HO; <5 mm, or normal; between +3 mm and -3 mm). Kinematics and kinetics were recorded using motion capture and force plate data. Group differences were assessed using statistical parametric mapping. RESULTS The ANT group demonstrated more normal sagittal plane kinematics and kinetics. No frontal plane kinematic differences were found, but the LAT group displayed more normal frontal plane kinetics. The LAT group displayed a slower walking speed than the ANT group, and the LAT and POS groups used a shorter stride/step length than the control group. The large HO group showed fewer differences in sagittal plane kinematics and kinetics than the small HO and normal groups. No frontal plane kinematic differences were observed, but the normal group demonstrated more significant differences than the large HO and small HO groups. No significant differences were found between any of the HO patient groups. CONCLUSION Anterior and lateral approaches led to more normal gait biomechanics in sagittal kinematics and frontal kinetics, respectively, but only the ANT group exhibited spatiotemporal gait parameters within normal ranges. Hip offset differences greater or less than 5 mm do not significantly change gait patterns. Surgical approach plays a greater role than HO reconstruction in producing more normal gait biomechanics following THA.
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Affiliation(s)
- Nicholas S Ryan
- Human Movement Biomechanics Laboratory, University of Ottawa, Ottawa, Ontario, Canada
| | - Erik Kowalski
- Human Movement Biomechanics Laboratory, University of Ottawa, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Human Movement Biomechanics Laboratory, University of Ottawa, Ottawa, Ontario, Canada; Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Mario Lamontagne
- Human Movement Biomechanics Laboratory, University of Ottawa, Ottawa, Ontario, Canada
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Karuna Pathirannehelage NR, Niroshana L, Sood M. Optimising Soft-Tissue Balancing in Hip Hemiarthroplasty Surgery Using a Simple Planning Protocol. Cureus 2023; 15:e50280. [PMID: 38196432 PMCID: PMC10776174 DOI: 10.7759/cureus.50280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2023] [Indexed: 01/11/2024] Open
Abstract
Introduction Intracapsular neck of the femur fractures are some of the most common fragility fractures with significant morbidity and mortality. Cemented hemiarthroplasty is the standard treatment in most cases. Restoring the horizontal offset and leg length is important to optimize the outcome of hip hemiarthroplasty. Preoperative templating based on a scaled radiograph is common prior to total hip arthroplasty surgery to achieve optimum offset and leg length. It is not routine to have scaled radiographs available prior to a hemiarthroplasty surgery. Our simple non-scaled radiograph templating protocol (NSRTP) was introduced to help establish the correct offset and leg length in the absence of scaled radiographs. Methods A retrospective, comparative, case-control study was carried out in an acute hospital setting. Scaled radiographs were not available for any patients in the study, as is usual for hemiarthroplasty patients in our hospital. One group had surgery without any templating. The other group had surgery using the NSRTP. The NSRTP determined optimal ipsilateral offset based on preoperative measurement of the contralateral hip offset and ipsilateral head diameter on unscaled radiographs together with intraoperative measurement of the diameter of the ipsilateral femoral head removed at surgery. To help achieve the correct length, the NSRTP also included assessment and restoration of the contralateral greater trochanter tip-to-head relationship. The neck cut was tailored to restore the correct relationship. Results Twenty-three patients underwent hemiarthroplasty surgery without any templating and 23 had surgery using the NSRTP. The implants used were C-STEM™ (DePuy Synthes, Raynham, Massachusetts, United States) and SPECTRON (Smith & Nephew plc, London, United Kingdom); stems were used together with monopolar heads. The stems were available in standard and high offset versions and with a variety of neck lengths, allowing the correct combination to be selected to restore offset. When the NSRTP was used, horizontal offset and leg length were restored to within 2 mm of the contralateral hip in 22 patients out of 23. There was a statistically significant improvement in restoration of offset and leg length when the NSRTP was used, compared to the control group. Conclusion Restoration of the offset and leg length is important to maximize the outcome of hip arthroplasty surgery. Preoperative templating is helpful to achieve offset and leg length in total hip replacement. In the absence of scaled radiographs, NSRTP enables restoration of offset and leg length to within 2 mm of normal in more than 96% of patients. This protocol requires knowledge of the offset of the hemiarthroplasty stems being used, which is easily available from the relevant manufacturer.
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Affiliation(s)
| | - Lamindu Niroshana
- Trauma and Orthopaedics, Bedfordshire Hospitals NHS Foundation Trust, Bedford, GBR
| | - Manoj Sood
- Trauma and Orthopaedics, Bedfordshire Hospitals NHS Foundation Trust, Bedford, GBR
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Sun L, Song W, Zhang Z, Xu Z, Sun M, Gao G, Jiang H, Ju C. Femoral offset restoration affects the early outcome of revision in patients with periprosthetic femoral fractures of Vancouver B2 - a single-center retrospective cohort study. BMC Musculoskelet Disord 2023; 24:567. [PMID: 37434207 DOI: 10.1186/s12891-023-06694-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/04/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Femoral offset (FO) restoration plays an important role in improving the prognosis and quality of life of patients undergoing hip replacement. However, it is not given enough attention in revisions among patients with periprosthetic femoral fractures (PPFFs); instead, more attention is given to reduction, fixation of fractures and stabilizing prostheses. The primary objective of this study was to evaluate the effect of FO restoration on the function of the hip joint in revisions of patients with PPFF of Vancouver B2. Moreover, we studied whether there is a difference in FO restoration between modular and nonmodular stems. METHODS A retrospective review of 20 patients with PPFF of Vancouver B2 revised with a tapered fluted modular titanium stem and 22 patients with PPFF of Vancouver B2 revised with a tapered fluted nonmodular titanium stem from 2016 to 2021 was conducted. Based on the difference between the FO of the affected side and that of the healthy side, 26 patients were allocated into Group A (difference ≤ 4 mm), and 16 patients were allocated into Group B (difference > 4 mm). The postoperative Harris Hip Score (HHS), range of motion of the hip joint, length of both lower limbs and dislocation were compared between Group A and Group B. The proportions of patients with FO restoration (difference ≤ 4 mm) and stem subsidence were compared between the modular and nonmodular groups. RESULTS The mean follow-up time was 34.3 ± 17.3 months, and all cases achieved fracture healing at the last visit. Patients in Group A had a higher HHS, larger range of abduction, fewer dislocations and less limb length discrepancy (LLD). Patients in the modular group had a higher proportion of FO restoration and less subsidence. CONCLUSION FO restoration improves postoperative hip joint function and reduces dislocation and LLD in revisions of patients with PPFF of Vancouver B2. Compared with nonmodular prostheses, modular prostheses tend to be easier for FO restoration under complex circumstances.
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Affiliation(s)
- Lei Sun
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Wenjing Song
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Zhongyuan Zhang
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Ziyao Xu
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Mengshuai Sun
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Guangling Gao
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Hongjiang Jiang
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China
| | - Changjun Ju
- Department of Orthopaedics, Wendeng Orthopaedic Hospital of Shandong Province, Weihai, 264400, China.
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McGoldrick NP, Antoniades S, El Meniawy S, Kreviazuk C, Beaulé PE, Grammatopoulos G. Supine versus lateral position for total hip replacement: accuracy of biomechanical reconstruction. Arch Orthop Trauma Surg 2022; 142:2945-2955. [PMID: 34557958 DOI: 10.1007/s00402-021-04179-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/09/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Restoration of normal hip anatomy and biomechanics is a key surgical goal for success in total hip arthroplasty. The aim of this study was to evaluate the influence, if any, that patient positioning in the supine and lateral decubitus positions has in achieving this goal. MATERIALS AND METHODS A single center multi-surgeon case-matched series from a tertiary level referral center of patients undergoing primary unilateral THA for osteoarthritis between April 2018 and December 2019 was retrospectively analyzed. Patients (n = 200) were divided into two matched groups: supine (anterior approach, n = 100) and lateral decubitus (direct lateral or posterior/SuperPATH™ approaches, n = 100). Post-operative anteroposterior pelvic radiographs were analyzed using a previously validated software (SurgiMap, Nemaris Inc., USA) for parameters of reconstruction of the hip in the coronal plane; leg length discrepancy, vertical and horizontal displacement of the center of rotation, femoral offset, and total offset. RESULTS Mean absolute leg length discrepancy in the supine group was 0.6 ± 3.3 mm (95% [CI] - 0.1 to 1.2 mm) versus 2.4 ± 3.8 mm (95% [CI] 1.6 to 3.1) in the lateral decubitus position (p < 0.001). The center of rotation was displaced medially by a mean of 3.2 ± 2.7 mm in the supine group versus 1.3 ± 4.0 mm in the lateral decubitus group (p < 0.001). For a surgical target of reconstructing both leg length and total offset within 5 mm of native anatomy, the supine group was more than twice as likely to achieve these goals with fewer outliers (OR 2.631, 95% [CI] 1.901-3.643) (76% v 30%, p < 0.001). CONCLUSION Total hip arthroplasty through the anterior approach in the supine position is more consistent and accurate for the restoration of leg length and total offset. Further study is required to assess how this translates with outcome. LEVEL OF EVIDENCE III-retrospective cohort study.
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Affiliation(s)
- Niall P McGoldrick
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Stephanie Antoniades
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Sherif El Meniawy
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Cheryl Kreviazuk
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada.
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López R, Pelayo de Tomás J, Morales Suárez Varela M, Rodrigo Pérez J. [Translated article] Comparison of leg length discrepancy correction after the use of a modular neck stem and its monoblock homologue in total primary hip arthroplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:T27-T35. [DOI: 10.1016/j.recot.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 01/18/2022] [Indexed: 11/29/2022] Open
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López R, Pelayo de Tomás J, Morales Suárez Varela M, Rodrigo Pérez J. Comparación de la corrección de la discrepancia de longitud de miembros tras el empleo de un vástago con cuello modular y su homólogo monobloque en la artroplastia total de cadera primaria. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:445-453. [DOI: 10.1016/j.recot.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/03/2022] [Accepted: 01/18/2022] [Indexed: 12/01/2022] Open
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Dincer R, Gulcu A, Tolga A, Başal Ö, Aslan A, Baykal YB. Effect of Vertical and Lateral Offset Restoration on Clinical Outcomes in Intracapsular and Extracapsular Hip Fractures Undergoing Hemiarthroplasty. Cureus 2022; 14:e22617. [PMID: 35371728 PMCID: PMC8958139 DOI: 10.7759/cureus.22617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2022] [Indexed: 11/13/2022] Open
Abstract
Objective We aimed to investigate whether there is a change in the postoperative lateral and vertical femoral offset (FO) in patients who underwent bipolar straight stem hemiarthroplasty (SSHA) and calcar stem hemiarthroplasty (CRHA) and whether this change makes a difference in the comparison of both groups. Material and methods This study included 109 patients who met these criteria. Patients are divided into two groups according to treatment methods. There were 58 patients (group 1) who underwent SSHA due to intracapsular (AO type 31-B neck and 31-C head fracture) femur fracture, and there were 51 patients (group 2) who underwent CRHA due to extracapsular (AO type 31-A intertrochanteric) femur fracture. We analyzed femoral vertical and lateral femoral offset, Wiberg angle, and head-neck angle difference in both groups. Results The median age was significantly higher in the CRHA group (p=0.042). The Harris hip score (HHS) was significantly higher in the SSHA group (p=0.023). The femoral offset difference was 5 mm in the SSHA group, while it was significantly lower (-6 mm) in the CRHA group (p<0.001). The Wiberg angle difference did not differ significantly between patient groups (p=0.214). The limb length difference was found to be similar in both surgical groups (p=0.483). Conclusions The study results show that there was no negative correlation between clinical and radiological outcomes in the SSHA group, whereas there was a negative correlation between clinical and radiological outcomes in the CRHA group. It is very difficult to control vertical and lateral offset reconstruction, especially in extracapsular hip fractures reconstructed by hemiarthroplasty. Deficiencies in lateral and vertical stabilization restoration may be associated with poor clinical outcomes in CRHA patients. Orthopedic surgeries should be performed carefully when restoring leg length and femoral offset, especially calcar replacement hemiarthroplasties.
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Castioni D, Galasso O, Iannò B, Mercurio M, Gasparini G. Posterior versus lateral surgical approach: functionality and quality of life after total hip arthroplasty in a matched cohort study. BMC Musculoskelet Disord 2021; 22:932. [PMID: 34749687 PMCID: PMC8576907 DOI: 10.1186/s12891-021-04679-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND One of the most controversial aspects for maximizing outcomes after total hip arthroplasty (THA) remains the surgical approach to the hip joint. The posterior (PA) and lateral approaches (LA) are the two most commonly performed approaches used worldwide, but sparse data are available for their comparison in terms of health-related quality-of-life (HRQoL). The aim of this study was to assess the role of the PA and LA in the HRQoL and hip functionality of patients who underwent primary and elective THA for osteoarthritis, after a minimum 2-year follow-up. METHODS One hundred twenty-eight patients (140 THAs: 68 with PA and 72 with LA) were evaluated in a matched cohort study. Data gathered included the body mass index, the American Society of Anesthesiologists score, surgery time, serum creatine phosphokinase (CpK) levels, estimated intraoperative blood loss and intra- or postoperative complications. Preoperatively and at the last follow-up, the activities of daily living, and the instrumental activities of daily living (IADL) scales, the Western Ontario and Mac Master University (WOMAC) Questionnaire, the Harris Hip Score (HHS) and the Visual Analogue Scale (VAS) were used to assess HRQoL and functionality. The Short Form-36 Health Survey (SF-36) Questionnaire was administered at the last follow-up. RESULTS Postoperatively, CpK was higher in the LA group compared to the PA (695 ± 648 vs. 447 ± 326 UI/L, p < 0.001). At a mean follow-up of 47 ± 22 months for the LA group and 42 ± 29 months for the PA group, IADL, VAS, HHS and WOMAC scores significantly improved for both groups (all p < 0.001), but PA reported better VAS, residual pain and WOMAC scores (p = 0.002, p = 0.004 and p = 0.018, respectively). The PA group demonstrated a significant higher mental SF-36 subscale values than the LA group (49 ± 13 vs. 42 ± 19, p = 0.001). The LA group showed a higher number of Trendelenburg signs (p = 0.029). On the contrary, the PA group showed a higher number of leg lengthening (p = 0.020); however, most of these cases was less than the clinically significant value of 10 mm (p = 0.738). CONCLUSIONS Patients who underwent THA performed with the PA reported greater improvement in HRQoL with lower residual pain, postoperative muscle damage and Trendelenburg signs than those who underwent the LA.
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Affiliation(s)
- Davide Castioni
- Department of Orthopaedic and Trauma Surgery, “Magna Græcia” University, “Mater Domini” University Hospital, V.le Europa, (loc. Germaneto), 88100 Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, “Magna Græcia” University, “Mater Domini” University Hospital, V.le Europa, (loc. Germaneto), 88100 Catanzaro, Italy
| | - Bruno Iannò
- Department of Surgery, Division of Orthopedics and Trauma Surgery, “G. Jazzolino” Hospital, Piazza Fleming, 89900 Vibo Valentia, Italy
| | - Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, “Magna Græcia” University, “Mater Domini” University Hospital, V.le Europa, (loc. Germaneto), 88100 Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, “Magna Græcia” University, “Mater Domini” University Hospital, V.le Europa, (loc. Germaneto), 88100 Catanzaro, Italy
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Mou P, Li H, Chen AJ, Ji Z, Dai XY, Zhou ZK. Cementless total hip arthroplasty for three different degrees of hip involved secondary to ankylosing spondylitis: an analysis of 195 hips. J Orthop Surg Res 2021; 16:608. [PMID: 34656166 PMCID: PMC8520615 DOI: 10.1186/s13018-021-02742-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/21/2021] [Indexed: 02/08/2023] Open
Abstract
Background Hip involved secondary to ankylosis spondylitis (AS) had a huge influence on hip function. Cementless total hip arthroplasty (THA) can improve hip function. However, no previous study compared the outcomes of THA for AS patients with three different degrees of hip involvement. Methods The 195 hips were retrospectively analyzed and divided into non-ankylosed group (group A, 94 hips), fibrous ankylosed group (group B, 49 hips), and bony ankylosed group (group C, 52 hips). postoperative range of motion (ROM), harris hip scores (HHS), the short-form 12 health survey (SF-12), length of stay (LOS), cost, radiological assessments, and complications were compared. Results The follow-up time was (79.4 ± 29.5) months for group A, (80.6 ± 28.9) months for group B, and (79.1 ± 28.9) months for group C (P = 0.966). Group A had the best postoperative hip ROM (P < 0.001), while group A and B can realize better HHS than group C (P < 0.001). The three groups had similar SF-12 postoperatively. For group A, LOS and cost for unilateral procedure were the least than that for group B and C (P = 0.003 and P = 0.001). Similar radiological assessments were achieved for three groups. 1 hip in group A encountered delay union of wound. 1 hip in group C encountered delay union of wound and dislocation and another patient encountered femoral fracture intraoperatively. 12 hips (12.8%) in group A, 6 hips (12.2%) in group B, and 6 hips (11.5%) in group C encountered asymptomatic heterotopic ossification (P = 0.977). Conclusion For AS patients with hip involvement, THA can improve hip ROM and function. THA for the non-ankylosed hip can realize the better hip function and postoperative ROM than ankylosed hip.
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Affiliation(s)
- Ping Mou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, #37 Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Hua Li
- Department of Rehabilitation Medicine, Jiang You Second People's Hospital, #10 Tuanshan Road, Jiang you, 621702, People's Republic of China
| | - An-Jing Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, #37 Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Zheng Ji
- West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Xin-Yi Dai
- West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zong-Ke Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, #37 Guoxue Road, Chengdu, 610041, People's Republic of China.
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13
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Vles G, Meynen A, De Mulder J, Ghijselings S. The External Obturator Footprint Is a Usable, Accurate, and Reliable Landmark for Stem Depth in Direct Anterior THA. Clin Orthop Relat Res 2021; 479:1842-1848. [PMID: 33944807 PMCID: PMC8277246 DOI: 10.1097/corr.0000000000001799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/09/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous CT and cadaver studies have suggested that the external obturator footprint might be used as a landmark for stem depth in direct anterior THA. Instructions on where to template this structure with small variability in height have been developed but have not been tested in daily clinical practice. QUESTIONS/PURPOSES In this study we sought to investigate the (1) usability, (2) accuracy, and (3) reliability of the external obturator footprint as a landmark for stem depth in direct anterior THA. METHODS The distance between the superior border of the external obturator tendon and the shoulder of the stem was measured intraoperatively in all patients (n = 135) who underwent primary THA via a direct anterior approach performed by the senior author between November 2019 and October 2020. The landmark was considered useful when two of thre`e evaluators agreed that the intersection of the vertical line comprised of the lateral wall of the trochanteric fossa and the oblique line formed by the intertrochanteric crest was clearly visible on the preoperative planning radiograph, and when the landmark was furthermore identified with certainty during surgery. Accuracy was defined as the degree of agreement (categorical for thresholds of 2 and 5 mm, the latter representing the threshold for developing unphysiological gait parameters) between the intraoperative distance and radiographic distance as measured on intraoperative fluoroscopy images or postoperative radiographs, which were calibrated based on femoral head sizes in a software program commonly used for templating. Intrarater reliability was defined as the degree of agreement (categorical for thresholds of 1 mm, which we considered an acceptable measurement error) between the ratings of one observer, who measured the radiographic distance on two different occasions separated by a washout period of at least 2 weeks. Interrater reliability was defined as the degree of agreement (categorical for thresholds of 1 mm, which we considered an acceptable measurement error) between the ratings of three observers with varying levels of experience (a fellowship-trained hip surgeon, a hip surgery fellow, and a medical student). RESULTS The landmark was considered useful in 77% (104 of 135) of patients who underwent direct anterior THA based on the observations that the trochanteric fossa was clearly visible on the planning radiograph in 117 patients and that the tendon was identified with certainty during surgery in 118 patients. There was good-to-excellent accuracy (intraclass correlation coefficient 0.75-087), and intrarater reliability (ICC 0.99) and interrater reliability (ICC 0.99) were both excellent. CONCLUSION This clinical study showed that the external obturator footprint is a useful, accurate, and reliable landmark for stem depth in direct anterior THA. CLINICAL RELEVANCE The external obturator landmark allows the surgeon to position the stem within a range of the templated depth that is beneath the threshold for the development of unphysiological gait parameters. Although strictly speaking it was found useful in 77% of patients in this study, we found that this percentage of usability can easily be improved to around 90% by providing the radiology lab technician with instructions to correct external rotation of the foot during the taking of the planning radiograph. Future studies could compare the established (in)equality in leg length in patients using the external obturator landmark with computer-assisted surgery.
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Affiliation(s)
- Georges Vles
- Division of Orthopaedic Surgery, Hip Unit, Gasthuisberg, University Hospitals Leuven, Leuven, Belgium
- Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Leuven, Belgium
| | - Alexander Meynen
- Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Leuven, Belgium
| | - Jef De Mulder
- Division of Orthopaedic Surgery, Hip Unit, Gasthuisberg, University Hospitals Leuven, Leuven, Belgium
| | - Stijn Ghijselings
- Division of Orthopaedic Surgery, Hip Unit, Gasthuisberg, University Hospitals Leuven, Leuven, Belgium
- Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Leuven, Belgium
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Kaszuba SV, Behrens KM, Anderson CB, Gordon AC. A Workflow Change in Anterior Approach Total Hip Arthroplasty Leads to Improved Accuracy of Biomechanical Reconstruction Without Increased Risk of Complications. Arthroplast Today 2021; 10:99-104. [PMID: 34337115 PMCID: PMC8318915 DOI: 10.1016/j.artd.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/26/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background During anterior approach total hip arthroplasty (THA), the femur may be an impediment for acetabular access, pushing reamers proximally and consequently altering the hip center. In an effort to address this, the senior author changed the surgical workflow from acetabulum first (AF) to femur first (FF). The objective of this study was to compare the precision of biomechanical hip reconstruction and clinical outcomes between the FF and AF techniques. Methods This is a retrospective, case-control study of 267 anterior THAs (132 AF and 135 FF). A normal, contralateral hip was used to determine the native biomechanical parameters. Using a calibrated software program, radiographic measurements were performed to calculate the hip center position, femoral offset, global offset, and leg length of the operative and native hips using 2-week postoperative anteroposterior pelvis radiographs. Demographics, operative information, hemoglobin change, and complication data were obtained. Functional outcomes were assessed with the Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement survey at 1 year postoperatively. Results The groups exhibited similar demographic characteristics. The FF group demonstrated significantly more accurate and more precise reconstruction of horizontal and vertical hip centers, femoral offset, and leg length. There was no significant difference in operative time, hemoglobin change, complication rate, or Hip Disability and Osteoarthritis Outcome Score, Joint Replacement scores between groups. Conclusions The FF technique allowed for more accurate and precise reconstruction of the hip center, leg length, and offset in THA than the AF workflow. Furthermore, the FF approach demonstrated no significant differences in complication rate or blood loss, nor in clinical outcomes. Level of Evidence Therapeutic Study Level III.
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Affiliation(s)
- Stephanie V. Kaszuba
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Department of Orthopedic Surgery, Illinois Bone & Joint Institute, Morton Grove, IL, USA
| | - Kyle M. Behrens
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
- Department of Orthopedic Surgery, Illinois Bone & Joint Institute, Morton Grove, IL, USA
| | - Chad B. Anderson
- Department of Orthopedic Surgery, Illinois Bone & Joint Institute, Morton Grove, IL, USA
- Department of Orthopedic Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA
- Department of Orthopedic Surgery, NorthShore Skokie Hospital, Skokie, IL, USA
| | - Alexander C. Gordon
- Department of Orthopedic Surgery, Illinois Bone & Joint Institute, Morton Grove, IL, USA
- Department of Orthopedic Surgery, Advocate Lutheran General Hospital, Park Ridge, IL, USA
- Department of Orthopedic Surgery, NorthShore Skokie Hospital, Skokie, IL, USA
- Corresponding author. Department of Orthopedic Surgery, Illinois Bone & Joint Institute, 9000 Waukegan Road, Suite 200, Morton Grove, IL 60053, USA. Tel.: +1 847-375-3000.
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15
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Carlson VR, Elliott IS, DeKeyser GJ, Pelt CE, Anderson LA, Gililland JM. Are We Being Fooled by Fluoroscopy? Distortion May Affect Limb-Length Measurements in Direct Anterior Total Hip Arthroplasty. J Arthroplasty 2021; 36:1799-1803. [PMID: 33303328 DOI: 10.1016/j.arth.2020.11.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/02/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Distortion is an intrinsic phenomenon associated with image-intensified fluoroscopy that is both poorly understood and infrequently appreciated by orthopedic surgeons. Little information exists regarding its potential influence on intraoperative parameters during orthopedic surgery, let alone during direct anterior (DA) total hip arthroplasty (THA). The purpose of this study was to quantify the amount of potential error caused by fluoroscopic distortion during DA THA. METHODS Intra-operative fluoroscopic pelvic images from 74 DA THAs were reviewed by two independent readers. All images were obtained using the same fluoroscopic C-arm unit with a radiopaque grid attached to the image intensifier. The vertical distortion from a straight central horizontal line at the peripheries of images were measured and summed to yield the combined vertical distortion similar to how a surgeon calculates a side to side comparison of limb lengths. Simple linear regression was used to evaluate associations between total distortion and patient demographics, operating theaters, and various operative parameters. RESULTS The average combined distortion was 10.0mm (range 2.0-20.0mm). There was a significant difference in the average distortion observed in different theaters (P < .001). There was no association between distortion and patient demographics or fluoroscopic time (all, P > .05). CONCLUSION Fluoroscopic distortion is unpredictable and can cause a substantial amount of error when comparing limb lengths during DA THA. This is a critical finding as this amount of inaccuracy could lead to unintended implant positioning and limb-length discrepancies if unaccounted for.
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Affiliation(s)
- Victor R Carlson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Iain S Elliott
- Department of Orthopaedics, Harborview Medical Center, University of Washington, Seattle, WA
| | | | | | - Lucas A Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
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16
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Esbjörnsson AC, Kiernan S, Mattsson L, Flivik G. Geometrical restoration during total hip arthroplasty is related to change in gait pattern - a study based on computed tomography and three-dimensional gait analysis. BMC Musculoskelet Disord 2021; 22:369. [PMID: 33879123 PMCID: PMC8058981 DOI: 10.1186/s12891-021-04226-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background The effect of change in hip anatomy on change in gait pattern is not well described in current literature. Therefore, our primary aim was to describe and quantify changes in hip geometry and gait pattern 1 year after total hip arthroplasty (THA) in individuals with hip osteoarthritis. Our secondary aim was to explore the effect of postoperative change in femoral neck anteversion (FNA) and femoral offset and acetabular offset (FO/AO) quota on postoperative change in hip rotation and hip adduction moment during gait, respectively, 1 year after THA”. Methods Sixty-five individuals with primary hip osteoarthritis, scheduled for THA, were analyzed in this prospective intervention study. Participants were evaluated pre- and 1 year postoperatively with computed tomography-scans, three-dimensional gait analysis, and patient-reported outcome measures. Multiple linear regressions were performed to evaluate the association between change in joint anatomy and change in gait pattern after THA. Results One year postoperatively, global offset was symmetrical between sides as a result of decreased acetabular offset and increased femoral offset on the operated side. Quality of overall gait pattern improved, and participants walked faster and with less trunk lean over the affected side. FNA and hip rotations during walking changed equally in external and internal directions after THA and change in hip rotation during walking was associated with change in FNA in the same direction. An increase in external hip adduction moments was, on the other hand, not associated with change in FO/AO quota but with a more upright walking position and increased walking speed. Conclusions The findings of this study suggest that geometrical restoration during THA impacts postoperative gait pattern and, in addition to known factors such as FO, height of hip rotation center, and leg length discrepancy, the FNA must also be taken into consideration. Trial registration Trial registration: Clinicaltrial.gov, NCT01512550, Registered 19 January 2012 - Retrospectively registered.
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Affiliation(s)
- A-C Esbjörnsson
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Skane University Hospital, 221 85, Lund, Sweden.
| | - S Kiernan
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Skane University Hospital, 221 85, Lund, Sweden
| | - L Mattsson
- Prophysics SOL, Jungmansvägen 3, 24335, Höör, Sweden
| | - G Flivik
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Skane University Hospital, 221 85, Lund, Sweden
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17
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Vles G, van Eemeren A, Taylan O, Scheys L, Ghijselings S. Anatomical Mapping of the External Obturator Footprint: A Study In Cadavers with Implications for Direct Anterior THA. Clin Orthop Relat Res 2021; 479:288-294. [PMID: 32956147 PMCID: PMC7899571 DOI: 10.1097/corr.0000000000001492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/19/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The external obturator footprint in the trochanteric fossa has been suggested as a potential landmark for stem depth in direct anterior THA. Its upper border can be visualized during surgical exposure of the femur. A recent study reported that the height of the tendon has little variability (6.4 ± 1.4 mm) as measured on CT scans and that the trochanteric fossa is consistently visible on conventional pelvic radiographs. However, it is unclear where exactly the footprint of this tendon should be templated during preoperative planning so that it can be useful intraoperatively. QUESTIONS/PURPOSES In this study, we sought: (1) to provide instructions on exactly where to template the external obturator footprint on a preoperative planning radiograph, and (2) to confirm the small variability in height of the external obturator footprint found on CT scans in a cadaver study. METHODS Two-dimensional (2-D) and three-dimensional (3-D) imaging was used to map the anatomy of the external obturator footprint. This dual approach was chosen because of their complementarity; conventional 2-D radiographs translate to clinical practice but 3-D navigation-based digitalization combined with CT allows for a better understanding of the cortical lines that comprise the outline of the trochanteric fossa. In 12 (four males, mean age 80 years, range 69 to 88) formalin-treated cadaveric lower extremities including the pelvis, the external obturator tendon was dissected, and the top and bottom end of its footprint marked with two small needles, and calibrated radiographs were taken. For another five (three males, mean age 75.7 years, range 61 to 91) fresh-frozen cadaveric lower extremities, including femoral reflective marker frames, CT scans were obtained and the exact location of the external obturator footprint was recorded using 3-D navigation-based digitalization. Qualitative analysis of both imaging modalities was used to develop instructions on where the external obturator footprint should be templated on a preoperative planning radiograph. Quantitative analysis of the dimensions of the external obturator footprint was performed. RESULTS The lowest point of the external obturator footprint was consistently found (± 1 mm) at the intersection of the vertical line comprised of the lateral wall of the trochanteric fossa and the oblique line formed by the intertrochanteric crest and therefore allows templating of this structure on the preoperative planning radiograph. The median (range) height of the footprint measured 6.4 mm and demonstrated small variability (4.7 to 7.6). CONCLUSIONS We suggest templating a 6.4-mm circle with its bottom on the intersection described above. CLINICAL RELEVANCE The distance between the templated shoulder of the stem and the top of the circle can be used intraoperatively for guidance. Discrepancy should lead to re-evaluation of stem depth and leg length. Future work will investigate the usability, validity, and reliability of the proposed methodology in daily clinical practice.
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Affiliation(s)
- Georges Vles
- G. Vles, A. van Eemeren, S. Ghijselings, Department of Orthopaedics - Hip Unit, Gasthuisberg, University Hospitals Leuven, Belgium
- O. Taylan, L. Scheys, Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Leuven, Belgium
| | - Anthony van Eemeren
- G. Vles, A. van Eemeren, S. Ghijselings, Department of Orthopaedics - Hip Unit, Gasthuisberg, University Hospitals Leuven, Belgium
- O. Taylan, L. Scheys, Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Leuven, Belgium
| | - Orcun Taylan
- G. Vles, A. van Eemeren, S. Ghijselings, Department of Orthopaedics - Hip Unit, Gasthuisberg, University Hospitals Leuven, Belgium
- O. Taylan, L. Scheys, Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Leuven, Belgium
| | - Lennart Scheys
- G. Vles, A. van Eemeren, S. Ghijselings, Department of Orthopaedics - Hip Unit, Gasthuisberg, University Hospitals Leuven, Belgium
- O. Taylan, L. Scheys, Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Leuven, Belgium
| | - Stijn Ghijselings
- G. Vles, A. van Eemeren, S. Ghijselings, Department of Orthopaedics - Hip Unit, Gasthuisberg, University Hospitals Leuven, Belgium
- O. Taylan, L. Scheys, Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Leuven, Belgium
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18
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O'Connor JD, Hill JC, Beverland DE, Dunne NJ, Lennon AB. Influence of preoperative femoral orientation on radiographic measures of femoral head height in total hip replacement. Clin Biomech (Bristol, Avon) 2021; 81:105247. [PMID: 33341521 DOI: 10.1016/j.clinbiomech.2020.105247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND In total hip arthroplasty the surgeon aims to restore the biomechanics of the joint. Femoral height has the greatest influence on restoring limb length and contributes equally to the restoration of femoral head centre. On X-ray, the level of femoral neck resection is most often referenced off the upper border of lesser trochanter. Less frequently, femoral head centre is referenced from the tip of the greater trochanter. The error in measurement of femoral height resulting from unknown femoral rotation is crucially important and can result in inappropriate surgical planning for implant selection and placement. It is unknown which reference produces lower error. METHODS A sample of femoral shapes was generated using a femoral statistical shape model. These were placed in a range of orientations in terms of external rotation and flexion, at intervals of 10°. Simulated X-rays were then produced and the distances from the tip of either greater or lesser trochanter to femoral head centre were measured. FINDINGS Although using greater trochanter as a reference demonstrated greater errors at the extremes, both techniques resulted in errors of 7-8 mm with 20° of both femoral external rotation and flexion. INTERPRETATION Moderate degrees of femoral external rotation combined with flexion can result in unsatisfactory errors when templating limb length. There should be greater focus and an agreed definition for femoral height. There is a clinical need for a method with a lower error in determining true femoral height and the level of neck resection.
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Affiliation(s)
- John D O'Connor
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, UK
| | - Janet C Hill
- Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
| | | | - Nicholas J Dunne
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland; Centre for Medical Engineering Research, School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland; School of Pharmacy, Queen's University Belfast, Belfast, UK; Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin 2, Ireland; Advanced Manufacturing Research Centre (I-Form), School of Mechanical and Manufacturing Engineering, Dublin City University, Glasnevin, Dublin 9, Ireland; Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland; Advanced Processing Technology Research Centre, Dublin City University, Dublin 9, Ireland; Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Alex B Lennon
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, UK.
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Kobsar D, Masood Z, Khan H, Khalil N, Kiwan MY, Ridd S, Tobis M. Wearable Inertial Sensors for Gait Analysis in Adults with Osteoarthritis-A Scoping Review. SENSORS 2020; 20:s20247143. [PMID: 33322187 PMCID: PMC7763184 DOI: 10.3390/s20247143] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 12/13/2022]
Abstract
Our objective was to conduct a scoping review which summarizes the growing body of literature using wearable inertial sensors for gait analysis in lower limb osteoarthritis. We searched six databases using predetermined search terms which highlighted the broad areas of inertial sensors, gait, and osteoarthritis. Two authors independently conducted title and abstract reviews, followed by two authors independently completing full-text screenings. Study quality was also assessed by two independent raters and data were extracted by one reviewer in areas such as study design, osteoarthritis sample, protocols, and inertial sensor outcomes. A total of 72 articles were included, which studied the gait of 2159 adults with osteoarthritis (OA) using inertial sensors. The most common location of OA studied was the knee (n = 46), followed by the hip (n = 22), and the ankle (n = 7). The back (n = 41) and the shank (n = 40) were the most common placements for inertial sensors. The three most prevalent biomechanical outcomes studied were: mean spatiotemporal parameters (n = 45), segment or joint angles (n = 33), and linear acceleration magnitudes (n = 22). Our findings demonstrate exceptional growth in this field in the last 5 years. Nevertheless, there remains a need for more longitudinal study designs, patient-specific models, free-living assessments, and a push for "Code Reuse" to maximize the unique capabilities of these devices and ultimately improve how we diagnose and treat this debilitating disease.
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Affiliation(s)
- Dylan Kobsar
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada; (Z.M.); (H.K.); (N.K.); (M.Y.K.); (M.T.)
- Correspondence:
| | - Zaryan Masood
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada; (Z.M.); (H.K.); (N.K.); (M.Y.K.); (M.T.)
| | - Heba Khan
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada; (Z.M.); (H.K.); (N.K.); (M.Y.K.); (M.T.)
| | - Noha Khalil
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada; (Z.M.); (H.K.); (N.K.); (M.Y.K.); (M.T.)
| | - Marium Yossri Kiwan
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada; (Z.M.); (H.K.); (N.K.); (M.Y.K.); (M.T.)
| | - Sarah Ridd
- Department of Psychology, Neuroscience, and Behaviour, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Matthew Tobis
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON L8S 4L8, Canada; (Z.M.); (H.K.); (N.K.); (M.Y.K.); (M.T.)
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20
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Ismailidis P, Nüesch C, Kaufmann M, Clauss M, Pagenstert G, Eckardt A, Ilchmann T, Mündermann A. Measuring gait kinematics in patients with severe hip osteoarthritis using wearable sensors. Gait Posture 2020; 81:49-55. [PMID: 32679463 DOI: 10.1016/j.gaitpost.2020.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The popularity of inertial sensors in gait analysis is steadily rising. To date, an application of a wearable inertial sensor system for assessing gait in hip osteoarthritis (OA) has not been reported. RESEARCH QUESTION Can the known kinematic differences between patients with hip OA and asymptomatic control subjects be measured using the inertial sensor system RehaGait®? METHODS The patients group consisted of 22 patients with unilateral hip OA scheduled for total hip replacement. Forty-five age matched healthy control subjects served as control group. All subjects walked for a distance of 20 m at their self-selected speed. Spatiotemporal parameters and sagittal kinematics at the hip, knee, and ankle including range of motion (ROM) were measured using the RehaGait® system. RESULTS Patients with hip OA walked at a slower walking speed (-0.18 m/s, P < 0.001) and with shorter stride length (-0.16 m, P < 0.001), smaller hip ROM during stance (-11.6°, P < 0.001) and swing (-11.3°, P < 0.001) and smaller knee ROM during terminal stance and swing (-9.0° and-11.5°, P < 0.001). Patients had a smaller hip ROM during stance and swing and smaller knee ROM during terminal stance and swing in the affected compared to the unaffected side (P < 0.001). SIGNIFICANCE The differences in spatiotemporal and kinematic gait parameters between patients with hip OA and age matched control subjects assessed using the inertial sensor system agree with those documented for camera-based systems. Hence, the RehaGait® system can measure gait kinematics characteristic for hip OA, and its use in daily clinical practice is feasible.
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Affiliation(s)
- Petros Ismailidis
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
| | - Corina Nüesch
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
| | - Mara Kaufmann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Martin Clauss
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland; Clarahof Clinic of Orthopaedic Surgery, Clarahofweg 19a, 4058 Basel, Switzerland
| | - Anke Eckardt
- ENDO-Team, Hirslanden Klinik, Birshof, Reinacherstrasse 28, 4142 Münchenstein, Switzerland
| | - Thomas Ilchmann
- ENDO-Team, Hirslanden Klinik, Birshof, Reinacherstrasse 28, 4142 Münchenstein, Switzerland
| | - Annegret Mündermann
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
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Wu K, Zhang X, Chen M, Shang X. Restoration of Proximal Femoral Anatomy during Total Hip Arthroplasty for High Developmental Dysplasia of the Hip: An Original Technique. Orthop Surg 2020; 12:343-350. [PMID: 32077256 PMCID: PMC7031569 DOI: 10.1111/os.12614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 12/07/2019] [Accepted: 12/20/2019] [Indexed: 11/29/2022] Open
Abstract
Objective To introduce a modified osteotomy method for proximal femur reconstruction (PFR) in total hip arthroplasty (THA) for high developmental dysplasia of the hip (DDH). Method A retrospective study was performed in a series of 24 patients (26 hips) with Crowe III/IV DDH who underwent THA and simultaneous PFR. We used an animated video to illustrate and help understand the procedure for this technique. Patients were reviewed clinically and radiographically with an average follow‐up of 31 months. The Harris hip score (HHS) was recorded preoperatively and at 3 and 12 months postoperatively. Results All patients achieved primary bone union. No revision was needed up to the latest follow‐up. One patient had a dislocation due to self‐fall and received manual reduction under general anesthesia. No patient had intraoperative femoral fractures, sciatic nerve injury, or infection. The mean HHS improved from 33.48 ± 9.06 preoperatively to 84.61 ± 4.78 immediately after surgery and 90.84 ± 4.96 at 12 months. Conclusion Proximal femur reconstruction is a simple and practical technique for femoral remolding during THA in patients with high DDH.
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Affiliation(s)
- Kerong Wu
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xianzuo Zhang
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Min Chen
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xifu Shang
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Influencing Factors for Joint Perception After Total Hip Arthroplasty: Asian Cohort Study. J Arthroplasty 2020; 35:1307-1314. [PMID: 31980209 DOI: 10.1016/j.arth.2019.12.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/14/2019] [Accepted: 12/20/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Perceiving replaced joints as natural is one of the best scenario after total hip arthroplasty (THA). We investigated the distribution of and influencing factors for patient's joint perception after THA in Asian cohort, which is not well known. METHODS We mailed a questionnaire to Asian patients who had undergone THA in our institution between 2012 and 2016, and this study included 318 Asian patients. The questionnaire assessed patient's joint perception, Oxford Hip Score (OHS), Short Form-12 Health Survey (SF-12) physical, mental, and role component summaries, and satisfaction score. Leg length discrepancy and global femoral offset before and after THA were measured using radiographs. The patients were divided into 2 groups with patient's joint perception: natural and artificial perception groups. OHS, SF-12, satisfaction, leg length discrepancy, and global femoral offset were compared between natural and artificial perception groups, and which factors significantly influenced joint perception were determined. RESULTS Of the 318 patients, 165 patients (51.8%) perceived their replaced joint as a natural joint. OHS, SF-12 physical and role component summaries, and satisfaction score in natural perception group were significantly higher than those in artificial perception group, without significant difference in SF-12 mental component summary. Multivariate analysis showed that less of usual pain, easier to get in or out of a car, and osteoarthritis in the contralateral hip were positively associated with natural joint perception after THA. CONCLUSION This study indicated to surgeons that pain relief and improvement in getting in or out of a car after THA could lead to even better patient's joint perception.
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