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Bido J, Meyers KN, Quevedo Gonzalez F, Zigan C, Wright TM, Rodriguez JA. Contribution of the Medial Iliofemoral Ligament to Hip Stability After Total Hip Arthroplasty Through the Direct Anterior Approach. J Arthroplasty 2024; 39:S266-S271. [PMID: 38537838 PMCID: PMC11330729 DOI: 10.1016/j.arth.2024.03.044] [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: 12/04/2023] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND Dislocation after total hip arthroplasty (THA) is a primary reason for THA revision. During THA through the direct anterior approach (DAA), the iliofemoral ligament, which provides the main resistance to external rotation (ER) of the hip, is commonly partially transected. We asked: (1) what is the contribution of the medial iliofemoral ligament to resisting ER after DAA THA? and (2) how much resistance to ER can be restored by repairing the ligament? METHODS A fellowship-trained surgeon performed DAA THA on 9 cadaveric specimens. The specimens were computed tomography scanned before and after implantation. Prior to testing, the ER range of motion of each specimen to impingement in neutral and 10° of extension was computationally predicted. Each specimen was tested on a 6-degrees-of-freedom robotic manipulator. The pelvis was placed in neutral and 10° of extension. The femur was externally rotated until it reached the specimen's impingement target. Total ER torque was recorded with the medial iliofemoral ligament intact, after transecting the ligament, and after repair. Torque at extremes of motion was calculated for each condition. To isolate the contribution of the native ligament, the torque for the transected state was subtracted from both the native and repaired conditions. RESULTS The medial iliofemoral ligament contributed an average of 68% (range, 34 to 87) of the total torque at the extreme of motion in neutral and 80% (58 to 97) in 10⁰ of extension. The repaired ligament contributed 17% (1 to 54) of the total torque at the extreme of motion in neutral and 14% (5 to 38) in 10⁰ of extension, restoring on average 18 to 25% of the native resistance against ER. CONCLUSIONS The medial iliofemoral ligament was an important contributor to the hip torque at the extreme of motion during ER. Repairing the ligament restored a fraction of its ability to generate torque to resist ER.
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Affiliation(s)
- Jennifer Bido
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
| | - Kathleen N Meyers
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | | | - Clarisse Zigan
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York
| | - Jose A Rodriguez
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
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Konishi T, Sato T, Hamai S, Kawahara S, Hara D, Nakashima Y. Robotic Arm-Assisted System Improved Accuracy of Cup Position and Orientation in Cementless Total Hip Arthroplasty for Dysplastic Hips: A Comparison Among Groups With Manual Placement, Computed Tomography-Based Navigation, and Robotic Surgery. Arthroplast Today 2024; 28:101461. [PMID: 39100425 PMCID: PMC11295473 DOI: 10.1016/j.artd.2024.101461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/05/2024] [Accepted: 06/09/2024] [Indexed: 08/06/2024] Open
Abstract
Background Accurate cup placement in total hip arthroplasty (THA) for patients with dysplasia is challenging due to the distinctive bone deformities. This study aimed to compare the accuracy of cup placement position and orientation across robotic arm-assisted systems (R-THA), computed tomography-based navigation (N-THA), and manual procedure (M-THA) in THA for osteoarthritis secondary to dysplasia. Methods A total of 167 patients (197 hips), including 88 R-THAs, 45 N-THAs, and 46 M-THAs, were analyzed. Propensity score matching was performed to align the patient backgrounds. Horizontal and vertical centers of rotation were measured for cup position, whereas radiographic inclination and anteversion were measured for cup orientation. The proportion of cases with cup placement within 3 mm and 5° from the target was compared. Results R-THA had a significantly higher percentage of cup placement within 3 mm of the target compared to N-THA (78% vs 49%; P = .0041) and M-THA (78% vs 53%; P = .013). Similarly, R-THA was significantly more successful in placing the cup within 5° of the target compared to N-THA (84% vs 58%; P = .0049) and M-THA (91% vs 20%; P < .0001). Moreover, N-THA was significantly better at placing the cup within 5° of the target compared to M-THA (62% vs 14%; P < .0001), whereas there was no significant difference in the percentage of cup placement within 3 mm of the target (51% vs 51%; P = 1.0). Conclusions Robotic arm-assisted system and computed tomography-based navigation improved accuracy in cup orientation compared to the manual procedure. Additionally, the robotic arm-assisted system further improved cup position accuracy.
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Affiliation(s)
- Toshiki Konishi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taishi Sato
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Hara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Iwakiri K, Ohta Y, Ueno S, Minoda Y, Kobayashi A, Nakamura H. A Novel Device for Intraoperative Measurement of Stem Anteversion Angle in Total Hip Arthroplasty. Arthroplast Today 2024; 28:101458. [PMID: 39100413 PMCID: PMC11295631 DOI: 10.1016/j.artd.2024.101458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/28/2024] [Accepted: 06/08/2024] [Indexed: 08/06/2024] Open
Abstract
Background Stem anteversion plays a crucial role in mitigating postoperative complications in total hip arthroplasty (THA). The application of the combined-anteversion theory in THA necessitates the intraoperative measurement of the stem anteversion angle (SAA). However, estimating SAA intraoperatively poses challenges for surgeons lacking a computer-assisted navigation system. In this study, we assessed the precision of intraoperative SAA measurements using a recently developed device, comparing them with 3-dimensional measurements obtained from postoperative computed tomography. Methods We examined 127 hips in 127 patients who underwent unilateral THA at our institution. Employing our newly constructed device, attachable to rasping broach handles, we measured the SAA intraoperatively. This process involved incorporating the correction angle derived from the preoperative epicondylar view. We then compared the postoperative SAA with the intraoperative measurements, both with and without the correction angle, to ascertain the device's utility. Results The device yielded an intraoperative SAA measurement of 17.93 ± 7.53°. In contrast, the true SAA measured on postoperative computed tomography was 26.40 ± 9.73°. The discrepancy between intraoperative and true SAA was 8.94 ± 5.44° (without the correction angle) and 4.93 ± 3.85° (with the correction angle). Accuracy within a discrepancy of <5° was achieved in 77 cases (60.6%), and <10° was achieved in 113 cases (89.0%). The accuracy remained consistent regardless of the stem-placement angle (varus/valgus, or flexion/extension) or the presence of ipsilateral knee osteoarthritis. Conclusions The SAA-measuring device, attachable to various rasping handles, proves useful for straightforward, cost-effective, and noninvasive intraoperative SAA measurement during THA.
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Affiliation(s)
- Kentaro Iwakiri
- Department of Orthopaedic Surgery, Shiraniwa Hospital Joint Arthroplasty Center, Nara, Japan
| | - Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shuhei Ueno
- Department of Orthopaedic Surgery, Shiraniwa Hospital Joint Arthroplasty Center, Nara, Japan
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Akio Kobayashi
- Department of Orthopaedic Surgery, Shiraniwa Hospital Joint Arthroplasty Center, Nara, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Marcovigi A, Grandi G, Bianchi L, Zambianchi F, Pavesi M, Catani F. Stem anteversion is not affected by proximal femur geometry in robotic-assisted total hip arthroplasty. ARTHROPLASTY 2024; 6:27. [PMID: 38824601 PMCID: PMC11144328 DOI: 10.1186/s42836-024-00248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/07/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND In the present study, the surgeon aimed to align the stem at 5° to 25° in anteversion. The robotic technology was used to measure stem anteversion with respect to proximal femur anteversion at different levels down the femur. METHODS A total of 102 consecutive patients underwent robotic-arm-assisted total hip arthroplasty (RTHA). 3D CT-based preoperative planning was performed to determine femoral neck version (FNV), posterior cortex anteversion (PCA), anterior cortex anteversion (ACA), and femoral metaphyseal axis anteversion (MAA) at 3 different levels: D (10 mm above lesser trochanter), E (the midpoint of the planned neck resection line) and F (head-neck junction). The robotic system was used to define and measure stem anteversion during surgery. RESULTS Mean FNV was 6.6° (SD: 8.8°) and the mean MAA was consistently significantly higher than FNV, growing progressively from proximal to distal. Mean SV was 16.4° (SD: 4.7°). There was no statistically significant difference (P = 0.16) between SV and MAA at the most distal measured level. In 96.1% cases, the stem was positioned inside the 5°-25° anteversion range. CONCLUSIONS Femoral anteversion progressively increased from neck to proximal metaphysis. Aligning the stem close to femoral anteversion 10 mm above the lesser trochanter often led to the desired component anteversion.
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Affiliation(s)
- Andrea Marcovigi
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Via del Pozzo 71, Modena, MO, 41125, Italy
| | - Gianluca Grandi
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Via del Pozzo 71, Modena, MO, 41125, Italy
| | - Luca Bianchi
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Via del Pozzo 71, Modena, MO, 41125, Italy
| | - Francesco Zambianchi
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Via del Pozzo 71, Modena, MO, 41125, Italy.
| | - Marco Pavesi
- Ab Medica S.p.A., Cerro Maggiore, MI, 20023, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Via del Pozzo 71, Modena, MO, 41125, Italy
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Ohyama Y, Minoda Y, Sugama R, Masuda S, Ohta Y, Nakamura H. A novel imageless accelerometer-based navigation system improves acetabular cup placement accuracy during total hip arthroplasty in the lateral decubitus position. Arch Orthop Trauma Surg 2024; 144:2865-2872. [PMID: 38753013 DOI: 10.1007/s00402-024-05376-5] [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: 01/22/2024] [Accepted: 05/07/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION The accuracy of acetabular cup placement using conventional portable imageless navigation systems in total hip arthroplasty (THA) in the lateral decubitus position remains challenging. Several novel portable imageless navigation systems have been developed recently to improve cup placement accuracy in THA. This study compared the accuracy of acetabular cup placement using a conventional accelerometer-based portable navigation (c-APN) system and a novel accelerometer-based portable navigation (n-APN) system during THA in the lateral decubitus position. MATERIALS AND METHODS This retrospective cohort study compared 45 THAs using the c-APN and 45 THAs using the n-APN system. The primary outcomes were the absolute errors between the intraoperative and postoperative values of acetabular cup radiographic inclination and anteversion angles and the percentage of cases with absolute errors within 5°. Intraoperative values were shown on navigation systems, and postoperative measurements were conducted using computed tomography images. RESULTS The median absolute errors of the cup inclination angles were significantly smaller in the n-APN group than in the c-APN group (3.9° [interquartile range 2.2°-6.0°] versus 2.2° [interquartile range 1.0°-3.3°]; P = 0.002). Additionally, the median absolute errors of the cup anteversion angles were significantly smaller in the n-APN group than in the c-APN group (4.4° [interquartile range 2.4°-6.5°] versus 1.9° [interquartile range 0.8°-2.7°]; P < 0.001). Significant differences were observed in the percentage of cases with absolute errors within 5° of inclination (c-APN group 67% versus n-APN group 84%; P = 0.049) and anteversion angles (c-APN group 62% versus n-APN group 91%; P = 0.001). CONCLUSIONS The n-APN system improved the accuracy of the cup placement compared to the c-APN system for THA in the lateral decubitus position.
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Affiliation(s)
- Yohei Ohyama
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka-city, 545-8585, Osaka, Japan
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka-city, 545-8585, Osaka, Japan.
| | - Ryo Sugama
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka-city, 545-8585, Osaka, Japan
| | - Sho Masuda
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka-city, 545-8585, Osaka, Japan
| | - Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka-city, 545-8585, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka-city, 545-8585, Osaka, Japan
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Kaneoka T, Imagama T, Okazaki T, Matsuki Y, Kawakami T, Yamazaki K, Sakai T. Evaluation of the reproducibility of preoperative three-dimensional computed tomography planning for posterolateral approach total hip arthroplasty. J Artif Organs 2024; 27:146-153. [PMID: 37081208 DOI: 10.1007/s10047-023-01396-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023]
Abstract
The anteversion of the stem is occasionally intentionally changed by the surgeon for patients with smaller femoral neck anteversion during total hip arthroplasty (THA). However, the reproducibility of preoperative planning with increasing anteversion has been rarely assessed. The present study investigated it using two types of stems. This retrospective study included patients who underwent primary posterolateral THA using taper-wedge (TS group; 73 hips) and anatomical (AS group; 70 hips) stems. Characteristics of sex and age were matched in the two groups by propensity score matching. In both groups, the relationship between the preoperative three-dimensional planning and postoperative stem position, and the relationship between postoperative stem position and femoral neck anteversion (FNA) were evaluated. In the TS group, there were no significant differences in average stem anteversion (SA) between preoperative planning and postoperative placement (36.1° ± 7.0° and 36.6° ± 11.1°, respectively: p = 0.651). The absolute error of SA was 8.1° ± 6.4°. In the AS group, the postoperative SA was significantly smaller than the preoperative planning SA (22.7° ± 11.6° and 30.0° ± 9.3°, respectively: p < 0.001). The absolute error of SA was 9.0° ± 5.8°. The postoperative SA was significantly larger than the FNA in the TS group (36.6° ± 11.1° and 26.3° ± 10.9°, respectively: p < 0.001). However, no significant differences between the two were observed in the AS group (23.7° ± 10.1° and 22.7° ± 11.6°, respectively: p = 0.253). The preoperative planning of intentional increasing anteversion did not show high reproducibility with taper-wedge and anatomical stems. The anatomical stem was placed according to the femoral medullary canal regardless of preoperative planning with increased SA.
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Affiliation(s)
- Takehiro Kaneoka
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, 755-8505, Japan
| | - Takashi Imagama
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, 755-8505, Japan
| | - Tomoya Okazaki
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, 755-8505, Japan
| | - Yuta Matsuki
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, 755-8505, Japan
| | - Takehiro Kawakami
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, 755-8505, Japan
| | - Kazuhiro Yamazaki
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, 755-8505, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, 755-8505, Japan.
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Habe Y, Hamada H, Uemura K, Takashima K, Ando W, Sugano N. Cup safe zone and optimal stem anteversion in total hip arthroplasty for patients with highly required range of motion. J Orthop Res 2024; 42:1283-1291. [PMID: 38084832 DOI: 10.1002/jor.25769] [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: 06/28/2023] [Revised: 11/29/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
To avoid dislocation after total hip arthroplasty, it is desirable to avoid implant impingement during activities of daily living. Numerous simulation studies have been performed at 30° of internal rotation (IR) with 90° of flexion. However, these studies may not reflect the impingement that occurs during activities such as floor sitting, which require a larger IR during flexion. The purpose of this study was to assess the impact of varying IR angles during flexion on the impingement-free safe zone and optimal stem anteversion. In this study, implant impingement simulation was evaluated in computer simulation. The prosthesis used a flat liner, and a 32- or 40-mm femoral head and stem. Three patterns of required IR angle (30° IR/40° IR/50° IR with 90° flexion) combined with 13 directions of the required range of motion were simulated. The optimal stem anteversion to maximize the safe zone was analyzed. Increasing the required IR at 90° flexion decreased the safe zone, particularly with small stem anteversion angles. With a 32-mm head, the desirable stem anteversion at 40° of cup inclination was 15°/25°/35° in required 30° IR/40° IR/50° IR with 90° flexion, respectively. The safe zone area of the 32-mm head was smaller than that of the 40-mm head. For patients who require a larger IR with 90° flexion, the stem and cup target anteversion should be adjusted according to the implant design, head diameter, and patient's required IR at flexion in their lifestyle.
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Affiliation(s)
- Yukihiro Habe
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Medical Division, KYOCERA Corporation, Fushimi-ku, Kyoto, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuma Takashima
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Liu C, Xu Z, Zeng JF, Song ZQ, Xie YY, Tang ZW, Wen J, Xiao S. Roles of combined femoral and acetabular anteversion in pathological changes of hip dysplasia and hip reconstructive surgery. World J Orthop 2024; 15:390-399. [PMID: 38835688 PMCID: PMC11145975 DOI: 10.5312/wjo.v15.i5.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/10/2024] [Accepted: 04/24/2024] [Indexed: 05/15/2024] Open
Abstract
Combined femoral and acetabular anteversion is the sum of femoral and acetabular anteversion, representing their morphological relationship in the axial plane. Along with the increasing understanding of hip dysplasia in recent years, numerous scholars have confirmed the role of combined femoral and acetabular anteversion in the pathological changes of hip dysplasia. At present, the reconstructive surgery for hip dysplasia includes total hip replacement and redirectional hip preservation surgery. As an important surgery index, combined femoral and acetabular anteversion have a crucial role in these surgeries. Herein, we discuss the role of combined femoral and acetabular anteversion in pathological changes of hip dysplasia, total hip replacement, and redirectional hip preservation surgery.
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Affiliation(s)
- Can Liu
- Department of Anatomy, Hunan Normal University School of Medicine, Changsha 410003, Hunan Province, China
| | - Zheng Xu
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Jian-Fa Zeng
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zhen-Qi Song
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Yu-Yin Xie
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zhong-Wen Tang
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Sheng Xiao
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
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Hidaka R, Matsuda K, Nakamura S, Nakamura M, Kawano H. Clinical effects of combined anteversion and offset on postoperative dislocation in total hip arthroplasty. ARTHROPLASTY 2024; 6:22. [PMID: 38704579 PMCID: PMC11070079 DOI: 10.1186/s42836-024-00245-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/29/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Implant impingement and soft tissue tension are factors involved in dislocation after total hip arthroplasty (THA). Combined anteversion (CA) has been used as an indicator for implant placement. However, optimal implant placement remains a challenge. Moreover, the effect of changes in offset on dislocation is still unclear. In this study, we aimed to clarify the effects of postoperative CA and pre- and postoperative changes in offset on dislocation. METHODS Included were patients who underwent primary cementless THA between 2013 and 2020. The mean values of CA and offset in the dislocation and non-dislocation groups were compared. The CA values within ± 10% of the recommended values were defined as good CA, and those outside the range were rated as poor CA. The dislocation rates were compared between the good and poor CA groups and between the groups with and without increased offset. RESULTS A total of 283 hips were included. The mean values of CA in the dislocation and non-dislocation groups were significantly different (P < 0.05). The dislocation rate was significantly lower in the good CA group (P < 0.05). The dislocation rates in the groups with and without increased total offset were 0.5% and 4.3%, respectively (P = 0.004). There were no dislocations in patients with good CA and increased offset. CONCLUSIONS The dislocation rate was significantly lower when implants were placed within ± 10% of the recommended CA value. Our results suggest that dislocation can be avoided by placing the implant in the good CA range and considering the increase in total offset on the operative side.
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Affiliation(s)
- Ryo Hidaka
- Department of Orthopedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
| | - Kenta Matsuda
- Department of Orthopedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan.
| | - Shigeru Nakamura
- Department of Orthopedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19, Shibakubo-Cho, Nishitokyo, Tokyo, 188-0014, Japan
| | - Masaki Nakamura
- Department of Orthopedic Surgery, Toranomon Hospital, 2-2-2, Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Hirotaka Kawano
- Department of Orthopedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
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Hayashi S, Kuroda Y, Nakano N, Matsumoto T, Kamenaga T, Tsubosaka M, Kuroda R. Accuracy of portable navigation during THA in patients with severe developmental dysplasia of hip. Arch Orthop Trauma Surg 2024; 144:2429-2435. [PMID: 38661997 DOI: 10.1007/s00402-024-05338-x] [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: 12/03/2023] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Correct cup placement in total hip arthroplasty (THA) for patients with developmental dysplasia of the hip (DDH) is considerably difficult. This study aimed to analyze the orientation accuracy of cup insertion during THA using a portable navigation system in patients with DDH. MATERIALS AND METHODS In this retrospective cohort study, we analyzed data from 64 patients who underwent THA using infrared stereo camera-matching portable navigation. Patients underwent THA via the anterolateral approach in the lateral decubitus position. Navigation records for intraoperative cup angles, postoperative cup angles measured on computed tomography (CT) images, and cup angle measurement differences were measured and compared between patients with non-DDH/mild DDH and severe DDH. Furthermore, the predictive factors for outliers of accurate acetabular cup placement were analyzed. RESULTS The average measurement absolute abduction differences (postoperative CT-navigation record) were 3.9 ± 3.5° (severe DDH) and 3.3 ± 2.6° (non-DDH/ mild DDH), and the anteversion differences were 4.7 ± 3.4° (severe DDH) and 2.3 ± 2.1° (non-DDH/ mild DDH). The anteversion difference was different between the two groups. Multivariate analysis showed that the navigation difference (absolute difference in anteversion between postoperative CT and navigation records of > 5°) was significantly associated with severe DDH (odds ratio [OR]: 3.3; p = 0.049, 95% confidence interval [CI]: 1.0-11.1) and posterior pelvic tilt (OR: 1.1; p = 0.042, 95% CI: 1.0-1.27). CONCLUSIONS In patients with severe DDH, it is important to pay close attention during THA using portable navigation. However, the average difference was < 5º even in patients with severe DDH, and the accuracy may be acceptable in a clinical setting when the cost is considered.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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11
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Gold PA, McCarthy TF, Borukhov I, Danoff J. How to Estimate Femoral Stem Anteversion During Direct Anterior Approach Total Hip Arthroplasty. Arthroplast Today 2024; 26:101326. [PMID: 38433872 PMCID: PMC10907387 DOI: 10.1016/j.artd.2024.101326] [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: 09/23/2023] [Revised: 11/25/2023] [Accepted: 01/27/2024] [Indexed: 03/05/2024] Open
Abstract
Background There are various traditional landmarks used to estimate the femoral component version, yet none are widely accepted by direct anterior surgeons. The purpose of this study was to compare bony landmarks easily accessible to direct anterior surgeons and to estimate which one provides the best estimate of femoral component anteversion. Methods A computed tomography database was used to identify 736 left entire-femur computed tomography scans. Seven visible anatomic landmarks were identified using a computer model in which a 45° virtual neck resection was made at 10 mm above the lesser trochanter. Thirteen axes, to reference the femoral stem position, were created between the 7 landmarks. Means and standard deviations (SDs) of angles between each axis and the transepicondylar axis (TEA) were compared for their precision. Results The traditional lesser trochanter predicted anteversion from the TEA was 34.1° (SD 9.7°). Predicted anteversion from the TEA was 3.3° (SD 8.1°) when aligned from the center of the canal to the middle of the medial calcar; 14.0° (SD 8.1°) from the center of the canal to the anterior 1/3 of the medial calcar; and 24.8° (SD 8.5°) from the center of the canal to the most anterior point on the medial calcar. Conclusions Compared to the lesser trochanter, 7 axes were more precise (lower SD) when predicting the version. Estimating the femoral component position, via simulated data, using 3 points along the medial calcar is a relatively precise and easily accessible tool for surgeons.
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Affiliation(s)
- Peter A. Gold
- Department of Orthopedics, Panorama Orthopedic & Spine Center, Golden, CO, USA
| | | | - Ilya Borukhov
- Department of Orthopedics, Stryker Orthopaedics, Mahwah, NJ, USA
| | - Jonathan Danoff
- Department of Orthopedics, Northwell Health, Great Neck, NY, USA
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12
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Imai N, Miyasaka D, Ibuchi S, Kimura K, Hirano Y, Horigome Y, Kawashima H. The Long-Term Efficacy of Computed Tomography-Navigated Total Hip Arthroplasty: An 18-Year Follow-Up Study. J Clin Med 2024; 13:1374. [PMID: 38592236 PMCID: PMC10932160 DOI: 10.3390/jcm13051374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
Backgroumd: There have been few reports on the long-term survival of computed tomography (CT)-navigated total hip arthroplasty (THA), which should lead to a lower incidence of dislocation and loosening. In this study, we examined survivorship, dislocation, and loosening incidence using plain radiographs over a minimum 15-year follow-up after CT-navigated THA. METHODS We retrospectively reviewed 145 consecutive CT-navigated THAs for >15 years. We surveyed the angles placed in both the acetabular and femoral components, survivorship, the occurrence of dislocation, the revision rate, and the fixation grade of the acetabular component. RESULTS The mean follow-up duration was 18.4 years. Overall, 73.8% of THAs were within the safe zone of Lewinnek. There were four dislocations (2.8%), with three occurring within 1 month after surgery and the other within 7 years after surgery. Revision THA was performed in one case (0.69%); consequently, the survival rate was 99.3%. The fixation grade was evaluated in 144 hips, and those were evaluated as having "no loosening". CONCLUSIONS CT-navigated THA was speculated to contribute to long-term survivorship, with a low rate of loosening, even after 18 years of follow-up. It was speculated that the acetabular component was placed at an acceptable insertion angle and a suitable position for stable initial fixation.
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Affiliation(s)
- Norio Imai
- Division of Comprehensive Musculoskeletal Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Dai Miyasaka
- Department of Orthopedic Surgery, Niigata Bandai Hospital, Niigata 950-0909, Japan
| | - Shinya Ibuchi
- Department of Orthopedic Surgery, Uonuma Kikan Hospital, Minami Uonuma 949-7302, Japan
| | - Keishi Kimura
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Yuki Hirano
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Yoji Horigome
- Division of Comprehensive Musculoskeletal Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
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13
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Palit A, Williams MA, Kiraci E, Seemala V, Gupta V, Pierrepont J, Plaskos C, King R. Evaluating computed bony range of motion (BROM) by registering in-vitro cadaver-based functional range of motion (FROM) to a hip motion simulation. Comput Biol Med 2024; 169:107799. [PMID: 38104517 DOI: 10.1016/j.compbiomed.2023.107799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/09/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND While modern hip replacement planning relies on hip motion simulation (HMS), it lacks the capability to include soft-tissues and ligaments restraints on computed bony range of motion (BROM), often leading to an overestimation of the in-vivo functional range of motion (FROM). Furthermore, there is a lack of literature on BROM assessment in relation to FROM. Therefore, the study aimed to assess computed BROM using in-vitro cadaver-derived FROM measurements, registered to a CT-based in-house HMS, and to further investigate the effect of functional and anatomical hip joint centres (FHJC and AHJC) on BROM. METHOD Seven limiting and three non-limiting circumducted passive FROM of four cadaver hips were measured using optical coordinate measuring machine with reference spheres (RSs) affixed to the pelvis and the femur, following CT-scan of the specimen. The RSs' centres were used to register the measured FROM in HMS, enabling its virtual recreation to compute corresponding BROM by detecting nearest bony impingement. FHJC, estimated from non-limiting FROM, was compared with AHJC to examine their positional differences and effect on BROM. RESULTS Differences in BROM and FROM were minimal in deep flexion (3.0° ± 4.1°) and maximum internal rotation (IR) at deep flexion (3.0° ± 2.9°), but substantially greater in extension (53.2° ± 9.5°). Bony impingement was observed during flexion, and IR at deep flexion for two hips. The average positional difference between FHJC and AHJC was 3.1 ± 1.2 mm, resulting in BROM differences of 1°-13° across four motions. CONCLUSIONS The study provided greater insight into the applicability and reliability of computed BROM in pre-surgical planning.
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Affiliation(s)
- Arnab Palit
- WMG, The University of Warwick, Coventry, UK.
| | | | | | | | - Vatsal Gupta
- Department of Trauma & Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Jim Pierrepont
- Corin Ltd, Corinium Centre, Cirencester, Gloucestershire, GL7 1YJ, UK
| | | | - Richard King
- Department of Trauma & Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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14
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Underwood NT, Madurawe C, Ashton LA. Intraoperative Assessment of Stability in Total Hip Arthroplasty: A Novel Method Utilizing Implant Collinearity. Arthroplast Today 2024; 25:101282. [PMID: 38317708 PMCID: PMC10839581 DOI: 10.1016/j.artd.2023.101282] [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: 09/04/2023] [Accepted: 11/04/2023] [Indexed: 02/07/2024] Open
Abstract
Background Hip dislocation remains a leading cause of revision following total hip arthroplasty, and intraoperative assessment of acetabular positioning can be difficult to perform. There are multiple clinical tests, as well as computer and robotic techniques, that aim to reduce dislocation rates after hip arthroplasty. These approaches aim to optimize the relationship between acetabular and femoral component positioning. It is hypothesized in this study that implant collinearity assessment intraoperatively can help determine appropriate acetabular component position. More specifically, implant collinearity, when achieved with a specific leg position, can reliably predict appropriate acetabular positioning. Methods A single-surgeon, single-centered study with 55 patients was undertaken between August 2017 and March 2020. Using preoperative imaging and computer simulation, data points were taken for 3 different acetabular configurations and comparing using 2 femoral positions. The angle differences from the collinear position (0 degrees) were compared between groups. Results A total of 55 patients' imaging was analyzed using 3 acetabular configurations and 2 femoral positions. The test leg position (30-degree flexion/30-degree internal rotation/10-degree adduction) was closer to collinearity than the control position (30-degree flexion/30-degree internal rotation/0-degree adduction) in all 3 acetabular configurations by a mean of 8 degrees (P < .001), 7 degrees (P < .001), and 4 degrees (P < .001), respectively. Conclusions The use of a 10-degree adducted position more reliably recreates implant collinearity when determining acetabular positioning during total hip arthroplasty. This intraoperative test adds another data point to assist the surgeon in achieving safe component positioning.
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Affiliation(s)
- Nathan T. Underwood
- Department of Orthopaedic Surgery, Orange Health Service, Orange, New South Wales, Australia
- Corin Australia Pty Ltd., Pymble, New South Wales, Australia
- Orthopaedic Department, Dudley Private Hospital, Orange, New South Wales, Australia
| | - Chameka Madurawe
- Department of Orthopaedic Surgery, Orange Health Service, Orange, New South Wales, Australia
- Corin Australia Pty Ltd., Pymble, New South Wales, Australia
- Orthopaedic Department, Dudley Private Hospital, Orange, New South Wales, Australia
| | - Lyal A. Ashton
- Department of Orthopaedic Surgery, Orange Health Service, Orange, New South Wales, Australia
- Corin Australia Pty Ltd., Pymble, New South Wales, Australia
- Orthopaedic Department, Dudley Private Hospital, Orange, New South Wales, Australia
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15
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Li Z, Yang Y, Guo S, Liu J, Zhou X, Ji H. Insufficient stem antetorsion and lower cup abduction is a combined risk factor for posterior hip dislocation in patients undergoing THA for femoral neck fractures: a retrospective analysis. BMC Musculoskelet Disord 2024; 25:103. [PMID: 38291445 PMCID: PMC10826068 DOI: 10.1186/s12891-024-07199-2] [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: 08/22/2023] [Accepted: 01/12/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND The role of acetabular and femoral component positions with respect to the risk of post-operative instability and dislocation remains debated. In this study, we aimed to identify potential risk factors for early dislocation following primary total hip arthroplasty (THA) for displaced intracapsular femoral neck fractures (FNF) using radiological measurements. METHODS We retrospectively analyzed data for patients who underwent cementless primary THA for FNF using a posterolateral approach between January 2018 and December 2021. Follow-up duration, age, sex, affected side, and mean time from THA to dislocation were recorded. Leg-length inequality, abductor lever arm, vertical and horizontal femoral offsets, vertical and horizontal hip centers of rotation, abduction, anteversion of the acetabulum and femoral prosthesis, and combined anteversion were measured. RESULTS The study sample included 17 men and 34 women, with 21 and 30 patients undergoing left- and right-hip operations, respectively. The mean patient age was 70.18 ± 7.64 years, and the mean follow-up duration was 27.73 ± 13.52 months. The mean time between THA and dislocation was 1.58 ± 0.79 months. Seven patients (13.73%) sustained posterior dislocation of the hip. The abduction angle (36.05 ± 6.82° vs. 45.68 ± 8.78°) (p = 0.008) and anteversion of the femoral prosthesis (8.26 ± 4.47° vs. 19.47 ± 9.01°) (p = 0.002) were significantly lower in the dislocation group than in the control group. There were no significant differences in other parameters. CONCLUSIONS Insufficient stem antetorsion combined with lower abduction angle of the acetabular component were associated with a high risk of dislocation, especially in patients with deep flexion or internal rotation of the flexed hip joint and knees, or in patients with a stiff spine or anterior pelvic tilt, impingement may then occur in the neck of the prosthesis and cup component, ultimately resulting in posterior dislocation. These findings could remind surgeons to avoid simultaneous occurrence of both in THA surgery. These results provide new insight into risk factors for hip dislocation in patients undergoing primary THA for FNF and may aid in reducing the risk of instability and dislocation. LEVEL OF EVIDENCE Prospective comparative study Level II.
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Affiliation(s)
- Zhuokai Li
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Yang Yang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical College, Zhejiang, China
| | - Shengyang Guo
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Ju Liu
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Xiaoxiao Zhou
- Department of Orthopedics, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
| | - Houlin Ji
- Jinji Lake Community Health Service Center of Suzhou Industrial Park, Suzhou, China.
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16
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Dimitriou D, Zindel C, Winkler E, Cornaz F, Mazel P, Zingg PO. Combined Anteversion Threshold to Avoid Anterior Dislocation in Primary Total Hip Arthroplasty Performed Through the Direct Anterior Approach. J Arthroplasty 2024; 39:145-150. [PMID: 37331442 DOI: 10.1016/j.arth.2023.06.026] [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: 04/29/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Component malposition in total hip arthroplasty (THA) can lead to dislocation, early implant failure, and revision surgery. As the surgical approach might affect the targeted combined anteversion (CA) of THA components, the present study aimed to evaluate the optimal CA threshold to avoid anterior dislocation in primary THA performed through a direct anterior approach (DAA). METHODS A total of 1,176 THAs in 1,147 consecutive patients (men: 593, women: 554) who had an average age of 63 years (range, 24 to 91) and a mean body mass index of 29 (range, 15 to 48) were identified. Medical records were reviewed for dislocation, whereas postoperative radiographs were assessed to measure the acetabular inclination and CA using a previously validated radiographic method. RESULTS An anterior dislocation occurred in 19 patients at an average of 40 days postoperatively. The average CA in patients who did and did not have a dislocation was 66 ± 8° and 45 ± 11°, respectively (P < .001). In 5 of 19 of the patients, a THA was performed for secondary osteoarthritis and 17 of 19 had a 28-mm femoral head. A CA ≥ 60° yielded a sensitivity of 93% and specificity of 90% for predicting an anterior dislocation in the present cohort. A CA ≥ 60° was associated with a significantly higher risk of anterior dislocation (odds ratio = 75.6; P < .001) compared to patients who had a CA<60 points. CONCLUSION The optimal CA to avoid anterior dislocations in THA performed through the DAA should be less than 60°. LEVEL OF EVIDENCE Cross-sectional study, Level III.
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Affiliation(s)
- Dimitris Dimitriou
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Christoph Zindel
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Elin Winkler
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Frédéric Cornaz
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Peter Mazel
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
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17
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Lin C, Chen W, Weng P, Huang Y, Liaw C. Liaw's Ellipse Anteversion Method for Distinguishing Acetabular Component Retroversion from Anteversion on Plain Radiographs. Orthop Surg 2024; 16:276-281. [PMID: 37986662 PMCID: PMC10782236 DOI: 10.1111/os.13902] [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: 04/14/2023] [Revised: 08/19/2023] [Accepted: 08/27/2023] [Indexed: 11/22/2023] Open
Abstract
Improper acetabulum component position is a significant risk factor for postoperative dislocation after total hip arthroplasty. Several radiographic two-dimensional methods exist for measuring acetabulum component anteversion, but they cannot distinguish between anteversion and retroversion. "Liaw's version," initially proposed as a simple mathematical standardized two-dimensional method, was modified to the computerized ellipse method, proving superior accuracy to traditional two-dimensional methods. In this article, we demonstrated its application in detecting and measuring retroverted acetabulum component. We obtained anteroposterior pelvis radiographs from a patient undergoing total hip arthroplasty on the day of surgery and 2 weeks postoperatively. The computerized ellipse method was used to measure the acetabulum component orientation. Upon comparison, the difference between θ assigned to be retroverted (9.52-8.56 = 0.96) is much smaller than the difference between θ assigned to be anteverted (23.81-18.86 = 4.95), leading us to determine retroversion. This was further confirmed by computed tomography at the 6-week follow-up. We propose that using the computerized ellipse method to measure Liaw's version can be a valuable tool in identifying acetabulum component retroversion on anteroposterior radiographs during routine postoperative follow-up and retrospective assessments of total hip arthroplasty patients.
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Affiliation(s)
- Chun‐Hao Lin
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
| | - Wei‐Cheng Chen
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
| | - Pei‐Wei Weng
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
- Department of Orthopaedics, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
- International PhD Program in Biomedical Engineering, College of Biomedical EngineeringTaipei Medical UniversityTaipeiTaiwan
- Research Center of Biomedical DevicesTaipei Medical UniversityTaipeiTaiwan
| | - Yu‐min Huang
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
- Department of Orthopaedics, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Chen‐Kun Liaw
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
- Department of Orthopaedics, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
- Research Center of Biomedical DeviceCollege of Biomedical Engineering, Graduate Institute of Biomedical Optomechatronics, Taipei Medical UniversityTaipeiTaiwan
- TMU Biodesign CenterTaipei Medical UniversityTaipeiTaiwan
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18
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Su S, Wang R, Chen Z, Zhou F, Zhang Y. Augmented reality-assisted versus conventional total hip arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:920. [PMID: 38042852 PMCID: PMC10693088 DOI: 10.1186/s13018-023-04421-0] [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: 09/12/2023] [Accepted: 11/28/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Extended reality (XR), including virtual reality, augmented reality (AR), and mixed reality, has been used to help achieve accurate acetabular cup placement in total hip arthroplasty (THA). This study aimed to compare the differences between XR-assisted and conventional THA. METHODS In this systematic review and meta-analysis, electronic databases including PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov were searched for studies from inception to September 10, 2023. The outcomes were accuracy of inclination and anteversion, duration of surgery, and intraoperative blood loss. Meta-analysis was performed using Review Manager 5.4 software. RESULTS A total of five studies with 396 patients were included in our study. The pooled results indicated AR-assisted THA had better accuracy of inclination and anteversion than conventional THA (SMD = - 0.51, 95% CI [- 0.96 to - 0.07], P = 0.02; SMD = - 0.96, 95% CI [- 1.19 to - 0.72], P < 0.00001), but duration of surgery and intraoperative blood loss were similar in the two groups. CONCLUSION This systematic review and meta-analysis found that AR-assisted THA had better accuracy of inclination and anteversion than conventional THA, but the duration of surgery and intraoperative blood loss were similar in the two groups. Based on the pooled results, we suggested that AR can provide more precise acetabular cup placement than conventional methods in THA.
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Affiliation(s)
- Shilong Su
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China
| | - Ruideng Wang
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China
| | - Zhengyang Chen
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China
| | - Fang Zhou
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China.
| | - Yunqing Zhang
- Department of Orthopedics, The First Hospital of Changsha, No.311 Yingpan Road, Changsha, 410005, Hunan Province, China.
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19
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Fujita M, Hayashi S, Kuroda Y, Nakano N, Maeda T, Matsushita T, Matsumoto T, Kuroda R. Accuracy comparison of cup positioning during total hip arthroplasty using Hip Align and AR-Hip in the supine position. Arch Orthop Trauma Surg 2023; 143:7229-7235. [PMID: 37479832 DOI: 10.1007/s00402-023-04975-y] [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: 12/26/2022] [Accepted: 06/26/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION The aim of this study is to compare the accuracy of acetabular cup positioning between the accelerometer-based navigation system and the augmented reality-based navigation system during THA in the supine position. MATERIALS AND METHODS This retrospective study included 66 patients (70 hips) who underwent THA using two types of portable navigation system, Hip Align or AR-Hip, in the spine position. The absolute difference between the intraoperative navigation record and postoperative measurement using computed tomography data was evaluated. Preoperative clinical factors that decreased the accuracy of cup positioning by ≥ 3° were analyzed via multiple logistic regression analyses. RESULTS The average absolute error of inclination was 2.8 ± 2.6° in Hip Align and 2.7 ± 1.8° in AR-Hip, and absolute anteversion error was 2.5 ± 2.0° in Hip Align and 2.6 ± 2.2° in AR-Hip, and there was no significantly different between the two navigation systems. There was a significant association between the absolute measurement error (≥ 3°) of cup inclination and patients' BMI in the Hip Align group [odds ratio (OR) 1.350; 95% confidence interval (CI) 1.035-1.760; p = 0.027], but not in the AR-Hip group. CONCLUSIONS The accuracy of the acetabular cup positioning between the Hip Align and AR-Hip showed no difference during THA in the spine position. The high BMI could have negative influence on the accuracy of cup positioning in THA using Hip Align, thus AR-Hip could be designable for obesity patients.
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Affiliation(s)
- Masahiro Fujita
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Shinya Hayashi
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan.
| | - Yuichi Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Naoki Nakano
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Toshihisa Maeda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Takehiko Matsushita
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan
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Incesoy MA, Yildiz F, Pulatkan MA, Yesiller OF, Toluk O, Erdem AC, Tuncay I. CT-based, robotic-arm assisted total hip arthroplasty (Mako) through anterior approach provides improved cup placement accuracy but no difference in clinical outcomes when compared to conventional technique. Technol Health Care 2023:THC231111. [PMID: 38217557 DOI: 10.3233/thc-231111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
BACKGROUND With the restoration of the natural hip biomechanics, a successful total hip arthroplasty (THA) and long-term survival is pursued. Although robotic THA (rTHA) has been developed to increase accuracy of implant positioning, leg lengths and offsets, discussions about its radiological and clinical advantages over conventional THA (cTHA) continues. OBJECTIVE The aim of this study was to compare clinical and radiological outcomes of robotic and conventional THA. METHODS This retrospective study compares functional and radiological outcomes of 82 rTHA with a matched group of 82 cTHA in terms of age, sex, body mass index and preoperative functional scores. The minimum follow up was 12 months for all patients. Functional outcomes were Harris Hip Score (HHS) and the Western Ontario and McMaster University Osteoarthritis index (WOMAC) evaluated pre- and postoperatively. Radiological evaluations included position of cup placement according to Lewinnek and Callanan safe zones, Canal Fill Ratio (CFR), Leg Length Discrepancy (LLD), Lateral offset (LO) and Femoral Component Alignment (FCA). Complications were also evaluated. RESULTS In the rTHA group, 91.5% (75 out of 82) of the acetabular cups were positioned within the safe zone whereas it was 63.4% (52 out of 82) for the cTHA group (p< 0.001). According to Callanan, they were 84.1% and 50%, respectively (p< 0.001). Between the groups, no statistically significant difference was found in CFR, LLD, HO, FCA, AI, AA, WOMAC, HHS and major complication rates. CONCLUSION rTHA is superior to cTHA in terms of accuracy and reproducibility of the cup placement, however no apparent clinical benefit was found in short term follow.
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Affiliation(s)
- Mustafa Alper Incesoy
- Department of Orthopedics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Fatih Yildiz
- Department of Orthopedics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Anil Pulatkan
- Department of Orthopedics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Omer Faruk Yesiller
- Department of Orthopedics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ozlem Toluk
- Department of Biostatistics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ahmet Can Erdem
- Department of Orthopedics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ibrahim Tuncay
- Department of Orthopedics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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21
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Ong CB, Buchan GBJ, Hecht Ii CJ, Kendoff DO, Homma Y, Kamath AF. Fluoroscopy-based robotic assistance for total hip arthroplasty improves acetabular cup placement accuracy for obese patients compared to the manual, fluoroscopic- assisted technique. Technol Health Care 2023:THC231127. [PMID: 37980587 DOI: 10.3233/thc-231127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND Patient obesity is a risk factor for poor acetabular cup positioning in total hip arthroplasty (THA). OBJECTIVE To assess the impact of using a novel, fluoroscopy-based robotic THA system on acetabular cup placement in obese versus non-obese patients. METHODS A review of 105 consecutive manual unassisted (mTHA) (47 Obese/58 Non-obese) and 102 robotic-assisted (RA-THA) (50 Obese/52 Non-obese) primary, direct anterior approach THA procedures was conducted. All cases were performed by a single surgeon, for a pre-operative diagnosis of osteoarthritis, avascular necrosis, or rheumatoid arthritis. Obesity was defined as a Body Mass Index (BMI) ⩾ 30 kg/m2. Outcomes included acetabular cup inclination and anteversion, and the proportion of cups within the Lewinnek safe-zone. RESULTS Obese patients in the mTHA cohort had larger cup inclination angles on average compared to non-obese patients (44.82∘± 6.51 vs. 41.39∘± 6.75; p= 0.009). Obese mTHA patients were less likely to have cup placement within the Lewinnek zone compared to non-obese mTHA patients (0.48 vs. 0.67; p= 0.027). Obesity had no effect on the accuracy of RA-THA. CONCLUSION Obesity affects the placement of the acetabular component in manual THA. The novel, fluoroscopy-based robotic THA system in this study demonstrated accurate cup placement regardless of obesity status.
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Affiliation(s)
- Christian B Ong
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Graham B J Buchan
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Christian J Hecht Ii
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel O Kendoff
- Chefarzt Zentrum für Orthopädie und Unfallchirurgie, HELIOS Kliniken Berlin-Buch, Berlin, Germany
| | - Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organs, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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22
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Lu X, Zhang Z, Wang W, Xu H, Zhang H. Accuracy and safety of a new robotic arm for both femoral and acetabular side in total hip arthroplasty: a cadaveric study. J Orthop Surg Res 2023; 18:830. [PMID: 37924147 PMCID: PMC10625291 DOI: 10.1186/s13018-023-04263-w] [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: 08/07/2023] [Accepted: 10/04/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND To investigate the accuracy and safety of a newly constructed robotic arm which can cover the whole process of THA, we performed a series of robot-assisted total hip replacement on the cadaver. METHODS Fifteen frozen cadaveric specimens (30 hips) were used for this study. In this investigation, united hip system and Longwell robotic-assisted system were used. The entire lower limb was CT scanned prior to surgery. The 3D model was produced based on CT data; the site of the prosthesis, including acetabular anteversion, inclination angle, and the position of femoral prosthesis, was planned. With the assistance of a robotic arm, the surgeon changed the parameters based on the preoperative plan and the actual condition during surgery, and completed the whole procedure. Following surgery, we measured the acetabular anteversion angle, acetabular inclination angle, femur anteversion angle, combined anteversion angle, stem angulation, and canal fill ratio. RESULTS The parameters proved that the acetabular anteversion angle was 16.85 ± 3.00°, the acetabular inclination angle was 40.38 ± 5.37°, femur anteversion angle was 15.90 ± 9.01°, combined anteversion angle was 32.75 ± 9.03°, stem angulation was 1.84 ± 0.99°, and leg length discrepancy was 2.47 ± 1.43 mm. The canal fill ratio (CFR) of femoral prosthesis of osteotomy line in sagittal section is 99.72 ± 1.54% and in coronal section is 62.94 ± 8.91%; below osteotomy line 2.5 cm in sagittal section is 100.00% and in coronal section is 81.48 ± 12.94%; below osteotomy line 7.5 cm in sagittal section is 59.51 ± 12.94% and in coronal section is 89.79 ± 11.13%; femoral shaft isthmus in sagittal section is 56.41 ± 13.80% and in coronal section is 84.95 ± 15.17%. CONCLUSION The accuracy and safety of this novel robotic arm are suitable for preparing both the acetabular and femoral sides, providing evidence for clinical trial.
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Affiliation(s)
- Xinzhe Lu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266100, Shandong, China
| | - Zian Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266100, Shandong, China
| | - Wenzhe Wang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266100, Shandong, China
| | - Hao Xu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266100, Shandong, China
| | - Haining Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266100, Shandong, China.
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23
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Kim K, Kwon S, Kwon J, Hwang J. A review of robotic-assisted total hip arthroplasty. Biomed Eng Lett 2023; 13:523-535. [PMID: 37872985 PMCID: PMC10590363 DOI: 10.1007/s13534-023-00312-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/02/2023] [Accepted: 08/11/2023] [Indexed: 10/25/2023] Open
Abstract
Total hip arthroplasty (THA) is a successful surgical method for hip replacement but still poses challenges and risks. Robotic-assisted THA (rTHA) using new generation robotic systems has emerged to improve surgical precision and outcomes. The purpose of this paper is to review the literature on rTHA, with a focus on its advantages, such as individualized preoperative planning, intraoperative assistance, and improved accuracy in implantation, especially in complex cases. Additionally, it aims to explore the disadvantages associated with the use of rTHA, including high costs, the learning curve, and prolonged operation time compared to manual THA (mTHA), which are critical drawbacks that require careful consideration and efforts for minimization. Some financial analyses suggest that rTHA may offer cost-effectiveness and reduced postoperative costs compared to mTHA. While technological advancements are expected to reduce technical complications, there are still debates surrounding long-term outcomes. Practical limitations, such as limited availability and accessibility, also warrant attention. Although the development of rTHA shows promise, it is still in its early stages, necessitating critical evaluation and further research to ensure optimal patient benefits.
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Affiliation(s)
- Kwangkyoun Kim
- Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Konyang University School of Medicine, Daejeon, South Korea
| | - Seungcheol Kwon
- Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Konyang University School of Medicine, Daejeon, South Korea
| | - Junhyuk Kwon
- Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Konyang University School of Medicine, Daejeon, South Korea
| | - Jihyo Hwang
- Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Konyang University School of Medicine, Daejeon, South Korea
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Alarcon Perico D, Warne CN, Lee SH, Roberts HJ, Sierra RJ. Combined Anteversion Technique for Total Hip Arthroplasty With Handheld Accelerometer-Based Navigation System. Arthroplast Today 2023; 23:101193. [PMID: 37745971 PMCID: PMC10514434 DOI: 10.1016/j.artd.2023.101193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/30/2023] [Accepted: 07/17/2023] [Indexed: 09/26/2023] Open
Abstract
Aiming for a combined cup and stem anteversion within a target range is one way to assess appropriate prosthetic component orientation and restoration of functional range of motion. We describe a surgical technique that allows the surgeon to assess the combined anteversion using a handheld accelerometer-based navigation system for total hip arthroplasty through a posterior approach. The femur is prepared first, at which time the femoral version is estimated by the surgeon. The acetabular component is then positioned using the navigation system to estimate anteversion, with the goal of providing a combined version of 37° ± 7°. The described technique allows surgeons to achieve the desired intraoperative combined anteversion. Level of evidence IV (technical note).
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Affiliation(s)
| | | | - Sheng-Hsun Lee
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Rafael J. Sierra
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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25
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Fujii J, Aoyama S, Tezuka T, Kobayashi N, Kawakami E, Inaba Y. Prediction of Change in Pelvic Tilt After Total Hip Arthroplasty Using Machine Learning. J Arthroplasty 2023; 38:2009-2016.e3. [PMID: 35788030 DOI: 10.1016/j.arth.2022.06.020] [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: 04/26/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND A postoperative change in pelvic flexion following total hip arthroplasty (THA) is considered to be one of the causes of dislocation. This study aimed to predict the change of pelvic flexion after THA integrating preoperative and postoperative information with artificial intelligence. METHODS This study involved 415 hips which underwent primary THA. Pelvic flexion angle (PFA) is defined as the angle created by the anterior pelvic plane and the horizontal/vertical planes in the supine/standing positions, respectively. Changes in PFA from preoperative supine position to standing position at 5 years after THA were recorded and which were defined as a 5-year change in PFA. Machine learning analysis was performed to predict 5-year change in PFA less than -20° using demographic, blood biochemical, and radiographic data as explanatory variables. Decision trees were constructed based on the important predictors for 5-year change in PFA that can be handled by humans in clinical practice. RESULTS Among several machine learning models, random forest showed the highest accuracy (area under the curve = 0.852). Lumbo-lordotic angle, femoral anteversion angle, body mass index, pelvic tilt, and sacral slope were most important random forest predictors. By integrating these preoperative predictors with those obtained 1 year after the surgery, we developed a clinically applicable decision tree model that can predict 5-year change in PFA with area under the curve = 0.914. CONCLUSION A machine learning model to predict 5-year change in PFA after THA has been developed by integrating preoperative and postoperative patient information, which may have capabilities for preoperative planning of THA.
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Affiliation(s)
- Junpei Fujii
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Shotaro Aoyama
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan; Medical Sciences Innovation Hub Program, RIKEN, Yokohama, Kanagawa, Japan; Advanced Data Science Project, RIKEN, Yokohama, Kanagawa, Japan
| | - Taro Tezuka
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Eiryo Kawakami
- Medical Sciences Innovation Hub Program, RIKEN, Yokohama, Kanagawa, Japan; Advanced Data Science Project, RIKEN, Yokohama, Kanagawa, Japan; Artificial Intelligence Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
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26
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Navacchia A, Pagkalos J, Davis ET. Defining the optimal position of the lipped liner in combination with cup orientation and stem version. Bone Joint Res 2023; 12:571-579. [PMID: 37727965 PMCID: PMC10509720 DOI: 10.1302/2046-3758.129.bjr-2022-0471.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Abstract
Aims The aim of this study was to identify the optimal lip position for total hip arthroplasties (THAs) using a lipped liner. There is a lack of consensus on the optimal position, with substantial variability in surgeon practice. Methods A model of a THA was developed using a 20° lipped liner. Kinematic analyses included a physiological range of motion (ROM) analysis and a provocative dislocation manoeuvre analysis. ROM prior to impingement was calculated and, in impingement scenarios, the travel distance prior to dislocation was assessed. The combinations analyzed included nine cup positions (inclination 30-40-50°, anteversion 5-15-25°), three stem positions (anteversion 0-15-30°), and five lip orientations (right hip 7 to 11 o'clock). Results The position of the lip changes the ROM prior to impingement, with certain combinations leading to impingement within the physiological ROM. Inferior lip positions (7 to 8 o'clock) performed best with cup inclinations of 30° and 40°. Superior lip positions performed best with cup inclination of 50°. When impingement occurs in the plane of the lip, the lip increases the travel distance prior to dislocation. Inferior lip positions led to the largest increase in jump distance in a posterior dislocation provocation manoeuvre. Conclusion The lip orientation that provides optimal physiological ROM depends on the orientation of the cup and stem. For a THA with stem anteversion 15°, cup inclination 40°, and cup anteversion 15°, the optimal lip position was posterior-inferior (8 o'clock). Maximizing jump distance prior to dislocation while preventing impingement in the opposite direction is possible with appropriate lip positioning.
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Affiliation(s)
| | - Joseph Pagkalos
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Edward T. Davis
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
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Dimitriou D, Zindel C, Winkler E, Cornaz F, Mazel P, Zingg PO. A novel method for evaluating combined component anteversion in total hip arthroplasty on cross-table lateral hip radiographs. Arch Orthop Trauma Surg 2023; 143:5977-5984. [PMID: 36899142 PMCID: PMC10449991 DOI: 10.1007/s00402-023-04825-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION Accurate measurement of combined component anteversion (CA) is important in evaluating the radiographic outcomes following total hip arthroplasty (THA). The aim of the present study was to evaluate the accuracy and reliability of a novel radiographic method in estimating CA in THA. MATERIALS AND METHODS The radiographs and computer tomography of patients who underwent a primary THA were retrospectively reviewed, to measure the radiographic CA (CAr), defined as the angle between a line connecting the center of the femoral head to the most anterior rim of the acetabular cup and a line connecting the center of the femoral head to the base of the femoral head to allow a comparison with the CA measured on the CT (CACT). Subsequently, a computational simulation was performed to evaluate the effect of cup anteversion, inclination, stem anteversion, and leg rotation on the CAr and develop a formula that would correct the CAr according to the acetabular cup inclination based on the best-fit equation. RESULTS In the retrospective analysis of 154 THA, the average CAr_cor, and CACT were 53 ± 11° and 54 ± 11° (p > 0.05), respectively. A strong correlation was found between CAr and CACT (r = 0.96, p < 0.001), with an average bias of - 0.5° between CAr_cor and CACT. In the computational simulation, the CAr was strongly affected by the cup anteversion, inclination, stem anteversion, and leg rotation. The formula to convert the CAr to CA_cor was: CA-cor = 1.3*Car - (17* In (Cup Inclination) - 31. CONCLUSION The combined anteversion measurement of THA components on the lateral hip radiograph is accurate and reliable, implying that it could be routinely used postoperatively but also in patients with persistent complaints following a THA. LEVEL OF EVIDENCE Cross-sectional study, Level III.
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Affiliation(s)
- Dimitris Dimitriou
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Christoph Zindel
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Elin Winkler
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Frédéric Cornaz
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Peter Mazel
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
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Sonoda K, Kubo Y, Komiyama K, Nakamura T, Hara T. Error of intraoperative measurement of stem anteversion is decreased by measuring in neutral hip position during total hip arthroplasty. J Orthop Sci 2023:S0949-2658(23)00217-8. [PMID: 37596167 DOI: 10.1016/j.jos.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/15/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Intraoperative stem anteversion, which is the angle between the lower leg axis and the trial-stem axis with hip flexion and adduction, is generally evaluated by the surgeon's visual estimation during total hip arthroplasty (THA). However, the conventional approach can be influenced by knee osteoarthritis or uncertain surgeon's observation point. Therefore, we developed a new method for measuring the stem anteversion angle in the neutral hip position using an original rod attached to the trial-stem perpendicular to the long axis and parallel to the stem neck. This study aimed to assess the accuracy of our method in comparison with the conventional method of measuring intraoperative stem anteversion angle. METHODS We measured the intraoperative stem anteversion angle in consecutive 106 hips of 106 patients who underwent cementless primary THA with a tapered wedge stem. Absolute error in the stem anteversion angle was expressed as the difference between intraoperative (common vs. neutral hip positions) and postoperative computed tomography measurements, i.e., true stem anteversion. Additionally, we investigated the factors affecting these errors. RESULTS The absolute error of measurement was significantly smaller in the neutral hip position than in the common position (3.0° ± 2.5° vs. 8.0° ± 3.9°; p < 0.0001). The factor associated with the error was advanced knee osteoarthritis in the common position, whereas it was not statistically significant in the neutral hip position. CONCLUSIONS This study suggests that the error in the intraoperative measurement of stem anteversion is decreased by measuring in the neutral hip position during THA.
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Affiliation(s)
- Kazuhiko Sonoda
- Department of Orthopaedic Surgery, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka 820-8505, Japan.
| | - Yusuke Kubo
- Department of Orthopaedic Surgery, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka 820-8505, Japan.
| | - Keisuke Komiyama
- Department of Orthopaedic Surgery, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka 820-8505, Japan.
| | - Tetsuro Nakamura
- Department of Orthopaedic Surgery, Fukuoka Mirai Hospital, 3-5-1 Higashi-Ku, Fukuoka 813-0017, Japan.
| | - Toshihiko Hara
- Department of Orthopaedic Surgery, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka 820-8505, Japan.
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Kurosaka K, Ogawa H, Hirasawa N, Saito M, Nakayama T, Tsukada S. Does Augmented Reality-based Portable Navigation Improve the Accuracy of Cup Placement in THA Compared With Accelerometer-based Portable Navigation? A Randomized Controlled Trial. Clin Orthop Relat Res 2023; 481:1515-1523. [PMID: 36862072 PMCID: PMC10344563 DOI: 10.1097/corr.0000000000002602] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/27/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Previous studies reported good outcomes of acetabular cup placement using portable navigation systems during THA. However, we are aware of no prospective studies comparing inexpensive portable navigation systems using augmented reality (AR) technology with accelerometer-based portable navigation systems in THA. QUESTIONS/PURPOSES (1) Is the placement accuracy of the acetabular cup using the AR-based portable navigation system superior to that of an accelerometer-based portable navigation system? (2) Do the frequencies of surgical complications differ between the two groups? METHODS We conducted a prospective, two-arm, parallel-group, randomized controlled trial involving patients scheduled for unilateral THA. Between August and December 2021, we treated 148 patients who had a diagnosis of osteoarthritis, idiopathic osteonecrosis, rheumatoid arthritis, or femoral neck fracture and were scheduled to undergo unilateral primary THA. Of these patients, 100% (148) were eligible, 90% (133) were approached for inclusion in the study, and 85% (126) were finally randomized into either the AR group (62 patients) or the accelerometer group (64 patients). An intention-to-treat analysis was performed, and there was no crossover between groups and no dropouts; all patients in both groups were included in the analysis. There were no differences in any key covariates, including age, sex, and BMI, between the two groups. All THAs were performed via the modified Watson-Jones approach with the patient in the lateral decubitus position. The primary outcome was the absolute difference between the cup placement angle displayed on the screen of the navigation system and that measured on postoperative radiographs. The secondary outcome was intraoperative or postoperative complications recorded during the study period for the two portable navigation systems. RESULTS There were no differences between the AR and accelerometer groups in terms of the mean absolute difference in radiographic inclination angle (3° ± 2° versus 3° ± 2° [95% CI -1.2° to 0.3°]; p = 0.22). The mean absolute difference in radiographic anteversion angle displayed on the navigation screen during surgery compared with that measured on postoperative radiographs was smaller in the AR group than that in the accelerometer group (2° ± 2° versus 5° ± 4° [95% CI -4.2° to -2.0°]; p < 0.001). There were few complications in either group. In the AR group, there was one patient each with a surgical site infection, intraoperative fracture, distal deep vein thrombosis, and intraoperative pin loosening; in the accelerometer group, there was one patient each with an intraoperative fracture and intraoperative loosening of pins. CONCLUSION Although the AR-based portable navigation system demonstrated slight improvements in radiographic anteversion of cup placement compared with the accelerometer-based portable navigation system in THA, whether those small differences will prove clinically important is unknown. Until or unless future studies demonstrate clinical advantages that patients can perceive that are associated with such small radiographic differences, because of the costs and the unquantified risks associated with novel devices, we recommend against the widespread use of these systems in clinical practice. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Kenji Kurosaka
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Mito, Japan
| | - Hiroyuki Ogawa
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Mito, Japan
| | - Naoyuki Hirasawa
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Mito, Japan
| | - Masayoshi Saito
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Mito, Japan
| | - Tsutomu Nakayama
- Department of Rehabilitation, Hokusuikai Kinen Hospital, Mito, Japan
| | - Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Mito, Japan
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Cho Y, Shin J, Kim S. Acetabular, Femoral, and Combined Anteversion in a Province in South Korea: Computed Tomography-Based Study. Clin Orthop Surg 2023; 15:567-573. [PMID: 37529189 PMCID: PMC10375808 DOI: 10.4055/cios22350] [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: 11/01/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 08/03/2023] Open
Abstract
Background The purpose of this study was to investigate the femoral, acetabular, and combined anteversion of the hip joint in South Koreans using computed tomography (CT). Methods We measured anteversion using CT venograms taken from 2016 to 2020. Of the total 1,073 patients, 952 patients were included in the study except for those with pelvic fractures, previous femoral fractures, childhood hip joint disease, osteoarthritis, or hip dysplasia (lateral center-edge angle, < 20), foreigners, and hip and knee replacement patients. Measurements were taken twice by two orthopedic surgeons. Results The femoral anteversion in women was 10.64° ± 10.26° (≤ 49 years), 15.75° ± 9.40° (50-59 years), 10.81° ± 9.14° (60-69 years), 12.38° ± 8.55° (70-79 years), and 11.23° ± 8.44° (≥ 80 years). The femoral anteversion in men was 12.02° ± 11.38° (≤ 49 years), 10.62° ± 9.11° (50-59 years), 6.09° ± 9.95° (60-69 years), 6.57° ± 9.51° (70-79 years), and 5.53° ± 9.29° (≥ 80 years). The acetabular anteversion in women was 17.65° ± 6.58° (≤ 49 years), 19.24° ± 6.42° (50-59 years), 20.30° ± 6.25° (60-69 years), 22.38° ± 7.36° (70-79 years), and 23.34° ± 6.98° (≥ 80 years). The acetabular anteversion in men was 15.21° ± 8.14° (≤ 49 years), 17.68° ± 6.00° (50-59 years), 17.54° ± 5.93° (60-69 years), 18.68° ± 6.62° (70-79 years), and 18.19° ± 6.94° (≥ 80 years). The combined anteversion in women was 28.29° ± 14.30° (≤ 49 years), 34.99° ± 10.62° (50-59 years), 31.11° ± 11.52° (60-69 years), 34.76° ± 10.86° (70-79 years), and 34.57° ± 11.45° (≥ 80 years). The combined anteversion in men was 27.23° ± 15.11° (≤ 49 years), 28.30° ± 11.23° (50-59 years), 23.63° ± 11.77° (60-69 years), 25.25° ± 12.02° (70-79 years), and 23.72° ± 11.88° (≥ 80 years). Conclusions Femoral anteversion tended to decrease with age in men and acetabular anteversion tended to increase in both men and women. Combined anteversion showed a tendency to increase slightly in women.
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Affiliation(s)
- Youngho Cho
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Jaeuk Shin
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Sangwoo Kim
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
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Nozaki A, Imai N, Funayama K, Horigome Y, Suzuki H, Minato I, Kobayashi K, Kawashima H. Accuracy of ZedView, the Software for Three-Dimensional Measurement and Preoperative Planning: A Basic Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1030. [PMID: 37374236 DOI: 10.3390/medicina59061030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: In the field of orthopedic surgery, novel techniques of three-dimensional shape modeling using two-dimensional tomographic images are used for bone-shape measurements, preoperative planning in joint-replacement surgery, and postoperative evaluation. ZedView® (three-dimensional measurement instrument and preoperative-planning software) had previously been developed. Our group is also using ZedView® for preoperative planning and postoperative evaluation for more accurate implant placement and osteotomy. This study aimed to evaluate the measurement error in this software in comparison to a three-dimensional measuring instrument (3DMI) using human bones. Materials and Methods: The study was conducted using three bones from cadavers: the pelvic bone, femur, and tibia. Three markers were attached to each bone. Study 1: The bones with markers were fixed on the 3DMI. For each bone, the coordinates of the center point of the markers were measured, and the distances and angles between these three points were calculated and defined as "true values." Study 2: The posterior surface of the femur was placed face down on the 3DMI, and the distances from the table to the center of each marker were measured and defined as "true values." In each study, the same bone was imaged using computed tomography, measured with this software, and the measurement error from the corresponding "true values" was calculated. Results: Study 1: The mean diameter of the same marker using the 3DMI was 23.951 ± 0.055 mm. Comparisons between measurements using the 3DMI and this software revealed that the mean error in length was <0.3 mm, and the error in angle was <0.25°. Study 2: In the bones adjusted to the retrocondylar plane with the 3DMI and this software, the average error in the distance from the planes to each marker was 0.43 (0.32-0.58) mm. Conclusion: This surgical planning software could measure the distance and angle between the centers of the markers with high accuracy; therefore, this is very useful for pre- and postoperative evaluation.
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Affiliation(s)
- Asami Nozaki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Norio Imai
- Division of Comprehensive Musculoskeletal Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Kazuhisa Funayama
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Yoji Horigome
- Division of Comprehensive Musculoskeletal Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Hayato Suzuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Izumi Minato
- Department of Orthopedic Surgery, Niigata Rinko Hospital, Niigata 950-0051, Japan
| | - Koichi Kobayashi
- School of Health Sciences, Faculty of Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
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Choi YS, Park JW, Kim TW, Kang KS, Lee YK, Koo KH, Chang CB. Effect of Total Hip Arthroplasty on Ipsilateral Lower Limb Alignment and Knee Joint Space Width: Minimum 5-Year Follow-up. J Korean Med Sci 2023; 38:e148. [PMID: 37218351 DOI: 10.3346/jkms.2023.38.e148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/12/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND This study aimed to 1) assess the effect of total hip arthroplasty (THA) on coronal limb alignment, namely, the hip-knee-ankle angle (HKA), 2) identify factors that determine changes in the HKA, and 3) determine whether alignment changes influence the knee joint space width. METHODS We retrospectively evaluated 266 limbs of patients who underwent THA. Three types of prostheses with neck shaft angles (NSAs) of 132°, 135°, and 138° were used. Several radiographic parameters were measured in the preoperative and final radiographs (at least 5 years after THA). A paired t-test was used to confirm the effect of THA on HKA change. Multiple regression analysis was performed to identify radiographic parameters related to HKA changes following THA and changes in knee joint space width. Subgroup analyses were performed to reveal the effect of NSA change on the HKA change, and the proportion of total knee arthroplasty usage and changes in radiographic parameters between maintained joint space and narrowed joint space groups were compared. RESULTS The preoperative mean HKA was 1.4° varus and increased to 2.7° varus after THA. This change was related to changes in the NSA, lateral distal femoral angle, and femoral bowing angle. In particular, in the group with a decrease in NSA of > 5°, the preoperative mean HKA was largely changed from 1.4° varus to 4.6° varus after THA. The prostheses with NSA of 132° and 135° also led to greater varus HKA changes than those with an NSA of 138°. Narrowing of the medial knee joint space was related to changes in the varus direction of the HKA, decrease in NSA, increase in femoral offset. CONCLUSION A large reduction in NSA can lead to considerable varus limb alignment after THA, which can have adverse effects on the medial compartment of the ipsilateral knee.
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Affiliation(s)
- Yun Seong Choi
- Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, Korea
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kee Soo Kang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Kay Joint Center, Cheil Orthopaedic Hospital, Seoul, Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
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Ning D, Xu F, Zhang Z, Yang X, Wei J. Application of transverse acetabular ligament in total hip arthroplasty: a systematic review. BMC Musculoskelet Disord 2023; 24:284. [PMID: 37055756 PMCID: PMC10099633 DOI: 10.1186/s12891-023-06410-0] [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] [Received: 09/09/2022] [Accepted: 04/07/2023] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION In total hip arthroplasty (THA), the correct position of the acetabular component directly determines the outcome of the surgery, or the success of the surgery. Therefore, how to accurately locate the position of the acetabular component has become a very critical step in THA. As an important anatomical structure of the hip joint, the transverse acetabular ligament (TAL) is helpful for acetabular component orientation in THA. The aim of this systematic review was to investigate application of TAL in THA. MATERIALS AND METHODS A systematic literature search of PUBMED, EMBASE, and Cochrane Library was performed (January and February 2023) using keywords "total hip arthroplasty," "total hip replacement," "total hip replacements," "total hip arthroplasties," "total hip prosthesis," and "transverse acetabular ligament" in all possible combinations. Reference lists of included articles were reviewed. Study design, surgical approach, patient demographics, TAL identification rate, appearance of the TAL, anteversion and inclination angle and rate of dislocations were recorded. RESULTS In total, 19 studies met the screening criteria. Study designs were prospective cohorts (42%), retrospective cohorts (32%), Case series (21%), and randomized controlled trial (5%). Twelve of the 19 (63.2%) studies investigated the application of TAL as an anatomical landmark for locating acetabular component position in THA. Analysis revealed that TAL is a reliable anatomical landmark for acetabular component orientation within the safe zone in THA. CONCLUSIONS TAL can reliably be used to align the acetabular component in the safe zone for anteversion and inclination in THA. However, TAL has individual variation influenced by some risk factors. More randomized controlled studies with larger numbers of patients are needed to investigate the precision and accuracy of TAL as an intraoperative landmark in THA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Dongfang Ning
- Department of Bone and Joint Surgery, Liuzhou Municipal Liutie Central Hospital, Liuzhou, Guangxi, 545007, China.
| | - Feng Xu
- Department of Bone and Joint Surgery, Liuzhou Municipal Liutie Central Hospital, Liuzhou, Guangxi, 545007, China
| | - Zhongxing Zhang
- Department of Bone and Joint Surgery, Liuzhou Municipal Liutie Central Hospital, Liuzhou, Guangxi, 545007, China
| | - Xiaolong Yang
- Department of Bone and Joint Surgery, Liuzhou Municipal Liutie Central Hospital, Liuzhou, Guangxi, 545007, China
| | - Jun Wei
- Department of Bone and Joint Surgery, Liuzhou Municipal Liutie Central Hospital, Liuzhou, Guangxi, 545007, China
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Park JW, Ko YS, Lee YK, Ha YC, Koo KH. Ten to 13-Year Results of Delta Ceramic-on-Ceramic Total Hip Arthroplasty in Patients Less Than 30 Years Old. J Bone Joint Surg Am 2023; 105:789-796. [PMID: 36947597 DOI: 10.2106/jbjs.22.01291] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND We previously reported mid-term results of total hip arthroplasty (THA) using Delta ceramic-on-ceramic (CoC) bearings in 72 patients (86 hips) who were <30 years old. Noise was noted in 8 (9.3%) of the hips, no osteolysis or loosening was detected, and no patient required reoperation. The purpose of this study was to assess clinical and radiographic outcomes, complications, and survivorship at >10 years after THA using Delta CoC bearings in patients who were <30 years old. METHODS Cementless THA with a Delta CoC bearing was performed between March 2008 and January 2012 in 91 hips of 76 patients who were <30 years old. Eighty-five hips in 71 patients (44 men and 27 women) with a mean age of 25.9 years (range, 16 to 29 years) at surgery were followed for a mean of 10.9 years (range, 10 to 13 years). RESULTS No ceramic bearings fractured. The incidence of squeaking increased to 5.9% (5 of 85), but the squeaking was not reproducible within individual patients. Periprosthetic osteolysis developed in 3 hips (3 patients): around the stem in 2 and around the metal shell in 1. The stem in 1 hip underwent revision because of a Vancouver type-B2 periprosthetic femoral fracture. One patient with systemic lupus erythematosus underwent irrigation and debridement for periprosthetic joint infection. Survivorship free of reoperation for any reason was 92.4% (95% confidence interval, 82.4% to 100%) at 13 years. CONCLUSIONS The long-term results and survivorship of Delta CoC THA in patients <30 years old were favorable. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Seung Ko
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
- Kay Joint Center, Cheil Orthopaedic Hospital, Seoul, South Korea
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Iwakiri K, Ohta Y, Minoda Y, Kobayashi A, Nakamura H. A comparison of accuracy and safety between stem-first and cup-first total hip arthroplasty: a prospective randomised controlled trial. Hip Int 2023; 33:231-240. [PMID: 34392737 DOI: 10.1177/11207000211039767] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND The combined anteversion theory to prevent impingement in total hip arthroplasty (THA) has been proposed. However, because stem-anteversion is influenced by the native femoral anteversion and the stem flexion/extension angle, it is often difficult to adjust stem anteversion during surgery. Therefore, the stem-first (combined anteversion) technique may be useful to adjust and achieve appropriate cup anteversion during surgery with respect to the implanted stem anteversion angle. However, the technique may adversely affect cup or stem angle accuracy and result in intra-operative bleeding, post-operative adverse events, and prolonged operative time. It is inconclusive whether either the stem-first or cup-first technique is safe or accurate. Therefore, this study assessed the accuracy and safety of stem-first THA compared to those of cup-first THA. MATERIALS AND METHODS This prospective randomised controlled trial analysed 114 patients who were randomly divided into 2 groups (stem-first group: n = 57, cup-first group (control group): n = 57). Primary outcomes included cup and stem angle, the discrepancies from the targeted angle and combined anteversion (evaluated via CT at 3 months postoperatively). Secondary outcomes included intraoperative blood loss, operative time, WOMAC, and adverse events. RESULTS There were no significant differences in age, gender, BMI or in the primary and secondary outcomes between the 2 groups. CONCLUSIONS Performing stem-first in THA did not adversely affect cup and stem angle accuracy, or result in intraoperative bleeding, prolongation of operative time, or postoperative adverse events. Thus, performing stem-first may be advantageous for achieving combined anteversion theory. TRIAL REGISTRATION University Hospital Medical Information Network (UMIN) registration number UMIN000025189.
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Affiliation(s)
- Kentaro Iwakiri
- Department of Orthopaedic Surgery, Shiraniwa Hospital Joint Arthroplasty Centre, Nara, Japan
| | - Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akio Kobayashi
- Department of Orthopaedic Surgery, Shiraniwa Hospital Joint Arthroplasty Centre, Nara, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Matsuki Y, Imagama T, Tokushige A, Yamazaki K, Sakai T. Accuracy of cup placement using computed tomography-based navigation system in total hip arthroplasty through the direct anterior approach. J Orthop Sci 2023; 28:370-375. [PMID: 34823976 DOI: 10.1016/j.jos.2021.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/23/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to elucidate the accuracy of cup placement with the computed tomography (CT)-based navigation system (CTN) in the direct anterior approach (DAA)-total hip arthroplasty (THA) in the supine position compared with the mechanical cup alignment guide (MG) or the fluoroscopy (FS). METHODS A total of 171 hips of 156 patients undergone primary THA were classified into the following three groups (the MG group: 63 hips, the FS group: 58 hips, the CTN group: 50 hips). Comparing the preoperative planning with postoperative CT measurement by three-dimensional templating software, the accuracy of cup placement was investigated in the three groups. RESULTS There were significant differences in the mean absolute error of radiographic inclination (RI) between the MG group (4.4° ± 3.2°) and the CTN group (2.8° ± 2.5°) (p = 0.01). The mean absolute error of radiographic anteversion (RA) also showed significant differences between the CTN group (2.8° ± 1.9°) and the MG group (5.8° ± 4.7°) (p = 0.0001) or the FS group (4.8° ± 4.1°) (p = 0.02). Regarding the cup center position, the mean absolute error of vertical position from preoperative planning was the smallest in the CTN group (1.8 ± 1.4 mm) compared with those in other groups (MG: 3.3 ± 3.2 mm, p = 0.007, FS: 3.2 ± 3.0 mm, p = 0.017). CONCLUSION The CTN guarantees accurate cup placement in the DAA-THA in the supine position compared with the MG and FS groups.
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Affiliation(s)
- Yuta Matsuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Takashi Imagama
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Atsunori Tokushige
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, 862-3 Ogori Shimogo, Yamaguchi City, Yamaguchi, 754-0002, Japan
| | - Kazuhiro Yamazaki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
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Mitsutake R, Tanino H, Ito H. The effect of range of motion simulated with a patient-specific three-dimensional simulation analysis on dislocation after total hip arthroplasty. Hip Int 2023; 33:313-322. [PMID: 34538126 DOI: 10.1177/11207000211044807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Dislocation continues to be a common complication following total hip arthroplasty (THA). Although previous studies of computed simulation analysis investigated the range of motion (ROM), it is unclear whether the ROM before impingement simulated using computed tomography-based 3-dimensional simulation analysis (simulated ROM) is related to dislocation after THA. It is also unclear what angles are required in computed simulation analyses for stable hips after THA. In this study, we compared the simulated ROM in patients with and without dislocation. METHODS 16 patients with posterior dislocation were compared with 48 matched patients without dislocation. Risk factors including preoperative bone morphology of the hip, implant position, change of femoral offset, change of leg length, anterior aspect of the greater trochanter (GTa) length, and anterior inferior iliac spine length were also compared. RESULTS The mean flexion angle, internal-rotation at 90° flexion (IR) angle, cup anteversion based on the anterior pelvic plane (APP), tilt-adjusted cup anteversion and GTa length were significantly different between patients with dislocation and patients without dislocation (p = 0.033, 0.002, 0.010, 0.047, 0.046). A receiver-operating characteristic curve analysis suggested cutoff points for flexion angle, IR angle, cup anteversion based on the APP, tilt-adjusted cup anteversion and GTa length, of 114.5°, 45.5°, 19.5°, 12.0° and 15.3 mm. CONCLUSIONS This study suggests that preoperative planning to achieve a larger simulated ROM, flexion angle and IR angle, may reduce the risk of posterior dislocation. This study also suggests that fine-tuning of cup anteversion and/or trimming of the overhanging GTa during preoperative planning may reduce the risk of posterior dislocation.
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Affiliation(s)
- Ryo Mitsutake
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiromasa Tanino
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiroshi Ito
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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Kobayashi D, Choe H, Kobayashi N, Watanabe S, Inaba Y. Effects of changes in whole-body alignment on ipsilateral knee pain after total hip arthroplasty. J Orthop Sci 2023; 28:398-402. [PMID: 34996698 DOI: 10.1016/j.jos.2021.12.006] [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] [Received: 05/15/2021] [Revised: 12/01/2021] [Accepted: 12/10/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Total hip arthroplasty decreases hip pain and often reduces knee pain in patients with hip osteoarthritis. Whole-body alignment may be associated with knee pain, but to our knowledge this relationship has not been previously investigated. The purpose of this study was to investigate the effect of changes in whole-body alignment on ipsilateral knee pain in patients after total hip arthroplasty. METHODS In total, 94 patients with unilateral hip osteoarthritis who underwent total hip arthroplasty were enrolled in this study. A visual analog scale (VAS) was used to investigate perioperative knee pain. An EOS 2D/3D X-ray system was used to quantify the whole-body alignment of the spine, pelvis, and lower extremities in the standing position. The relationship between perioperative changes in knee pain and whole-body alignment was investigated. RESULTS Among 61 patients who had preoperative ipsilateral knee pain, pain resolved in 30 (50%) and persisted in 31 (50%) after surgery. In these patients, average ipsilateral knee pain decreased significantly after surgery, from 41 mm to 14 mm on the VAS (P < 0.01). Preoperative knee pain was correlated with femorotibial rotation, and postoperative knee pain was correlated with K-L grade, preoperative knee pain visualized analog scale, and preoperative sagittal vertical axis. Multiple linear regression identified preoperative sagittal vertical axis as significantly associated with residual postoperative ipsilateral knee pain. CONCLUSIONS Ipsilateral knee pain decreased in half of patients after total hip arthroplasty. Patients with a considerable forward-bent posture may have residual ipsilateral knee pain after total hip arthroplasty.
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Affiliation(s)
- Daigo Kobayashi
- Yokohama City University, Department of Orthopaedic Surgery, Japan
| | - Hyonmin Choe
- Yokohama City University, Department of Orthopaedic Surgery, Japan.
| | - Naomi Kobayashi
- Yokohama City University Medical Center, Department of Orthopaedic Surgery, Japan
| | | | - Yutaka Inaba
- Yokohama City University, Department of Orthopaedic Surgery, Japan
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Su S, Wang R, Zhou R, Chen Z, Zhou F. The effectiveness of virtual reality, augmented reality, and mixed reality training in total hip arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:121. [PMID: 36803782 PMCID: PMC9940416 DOI: 10.1186/s13018-023-03604-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/10/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Extended reality (XR), including virtual reality (VR), augmented reality (AR), and mixed reality (MR), has been used in the training of total hip arthroplasty (THA). This study aims to examine the effectiveness of XR training in THA. METHODS In this systematic review and meta-analysis, we searched PubMed (MEDLINE), EMBASE (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and clinicaltrials.gov from inception to September 2022 for eligible studies. The Review Manager 5.4 software was applied to compare accuracy of inclination and anteversion, and surgical duration between XR training and conventional methods. RESULTS We identified 213 articles, of which 4 randomized clinical trials and 1 prospective controlled study including 106 participants met inclusion criteria. The pooled data indicated the XR training had better accuracy of inclination and shorter surgical duration than conventional methods (MD = -2.07, 95% CI [- 4.02 to -0.11], P = 0.04; SMD = -1.30, 95% CI [- 2.01 to -0.60], P = 0.0003), but the accuracy of anteversion was similar in the two groups. CONCLUSIONS This systematic review and meta-analysis found XR training had better accuracy of inclination and shorter surgical duration than conventional methods in THA, but the accuracy of anteversion was similar. Based on the pooled results, we suggested that XR training can better improve trainees' surgical skills than conventional methods in THA.
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Affiliation(s)
- Shilong Su
- grid.411642.40000 0004 0605 3760Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191 China
| | - Ruideng Wang
- grid.411642.40000 0004 0605 3760Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191 China
| | - Rubing Zhou
- grid.411642.40000 0004 0605 3760Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191 China
| | - Zhengyang Chen
- grid.411642.40000 0004 0605 3760Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191 China
| | - Fang Zhou
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191, China.
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Achieving Precise Cup Positioning in Direct Anterior Total Hip Arthroplasty: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020271. [PMID: 36837472 PMCID: PMC9959722 DOI: 10.3390/medicina59020271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 02/01/2023]
Abstract
Malpositioned implants in total hip arthroplasty are associated with impingement, increased wear, and dislocations, thus precise cup positioning is crucial. However, significant deviations between targeted and actually achieved cup positions have been found even in patients operated by experienced surgeons. When aiming for higher accuracy, various methods based on freehand positioning lead by anatomic landmarks, C-arm fluoroscopy, imageless navigation, or robotic-assisted-surgery have been described. There is a constant development of new products aiming to simplify and improve intraoperative guidance. Both the literature and expert opinions on this topic are often quite controversial. This article aims to give an overview of the different methods and systems with their specific advantages and potential pitfalls while also taking a look into the future of cup positioning in anterior hip replacements.
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The association of postoperative global femoral offset with total hip arthroplasty outcomes. Sci Rep 2023; 13:1621. [PMID: 36709404 PMCID: PMC9884219 DOI: 10.1038/s41598-023-28863-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 01/25/2023] [Indexed: 01/30/2023] Open
Abstract
Global femoral offset (GFO) and femoral offset (FO) reportedly affect outcomes following total hip arthroplasty (THA). However, FO assessed using plain radiography is affected by internal and external rotations of the hip joint. We investigated the relationship between leg length discrepancy and Harris hip score (HHS), and their influence on acetabular offset (AO), FO, GFO, anterior femoral offset, and outcomes after THA. We retrospectively evaluated 140 patients with hip osteoarthritis who underwent THA. A three-dimensional (3D) pelvis and femur model created from computed tomography (data using ZedHip software was used to investigate these parameters. The modified (m)HHS scores were significantly improved from 49.0 to 88.8 in total mHHS, 20.0-44.5 in pain, and 28.9-44.4 points in function. Significant correlations were found between the differences in AO, FO, GFO, and pain score in binominal, with maximum values of - 1.24, + 1.54, and + 0.90 mm/100 cm body height, respectively. The maximum value of GFO and mHHS in binominal was + 1.17 mm/100 cm body height (BH). The optimal range of difference of GFO was - 1.75 to 4.09 mm/100 cm BH. This is the first report using a 3D method for assessing FO. Preoperative planning using the system could improve postoperative function.
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Rebgetz P, McCarthy T, McLaren H, Wilson MJ, Whitehouse SL, Crawford RW. Achieving Target Cemented Femoral Stem Anteversion Using a 3-Dimensional Model. Arthroplast Today 2023; 19:101084. [PMID: 36688094 PMCID: PMC9852927 DOI: 10.1016/j.artd.2022.101084] [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: 10/23/2022] [Revised: 12/04/2022] [Accepted: 12/11/2022] [Indexed: 01/15/2023] Open
Abstract
Background Total hip arthroplasty aims to provide patients with a pain-free and stable hip joint through optimization of biomechanics such as femoral anteversion. There are studies evaluating the limits of cementless stem version, however, none assessing the range of version achieved by a cemented collarless stem. A computed tomography (CT)-based study was performed, utilizing a contemporary robotic planning platform to assess the amount of rotation afforded by a cemented collarless stem, whilst maintaining native biomechanics. Methods The study utilized 36 cadaveric hips. All had CT scans of the pelvis and hip joints. The CT scans were then loaded into a contemporary robotic planning platform. A stem that restored the patients native femoral offset was selected and positioned in the virtual femur. The stem was rotated while checking for cortical contact at the level of the neck cut. Cortical contact was regarded as the rotation limit, assessed in both anteversion and retroversion. Target range for stem anteversion was 10°-20°. Failure to achieve target version triggered a sequence of adjustments to simulate surgical decisions. Results Native femoral offset and target version range was obtained in 29 of 36 (80.5%) cases. Following an adjustment sequence, 4 further stems achieved target anteversion with a compromise in offset of 2.3 mm. Overall 33 of 36 (91.7%) stems achieved the target anteversion range of 10°-20°. Conclusions Target femoral stem anteversion can be achieved using a cemented, collarless stem in a CT-based 3-dimensional model in 80.5% of hips. With a small compromise in offset (mean 2.3 mm), this can be increased to 91.7%.
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Affiliation(s)
- Paul Rebgetz
- Orthopaedic Research Unit, School of Mechanical, Medical & Process Engineering, Faculty of Engineering, Queensland University of Technology, The Prince Charles Hospital, Chermside, Queensland, Australia
| | | | - Hamish McLaren
- Orthopaedic Research Unit, School of Mechanical, Medical & Process Engineering, Faculty of Engineering, Queensland University of Technology, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Matthew J. Wilson
- Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Sarah L. Whitehouse
- Orthopaedic Research Unit, School of Mechanical, Medical & Process Engineering, Faculty of Engineering, Queensland University of Technology, The Prince Charles Hospital, Chermside, Queensland, Australia,Exeter Hip Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Ross W. Crawford
- Orthopaedic Research Unit, School of Mechanical, Medical & Process Engineering, Faculty of Engineering, Queensland University of Technology, The Prince Charles Hospital, Chermside, Queensland, Australia,Corresponding author. Queensland University of Technology, Orthopaedic Research Unit, Level 5, CSB, The Prince Charles Hospital, Rode Rd, Brisbane, Queensland 4032, Australia. Tel.: +61 07 3139 4481.
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Zhang T, Jia Z, Han W, Wang J, Li J, Gong M, Jiang X. Effectiveness and Accuracy of a Patient-Specific Instrumentation System for Total Hip Arthroplasty. Orthop Surg 2023; 15:878-887. [PMID: 36636925 PMCID: PMC9977596 DOI: 10.1111/os.13665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Traditional total hip arthroplasty (THA) is often performed by visual inspection due to the lack of reliable reference, which results in inappropriate position of prosthesis and poor outcomes. This study attempts to introduce a novel patient-specific instrumentation (PSI) system and assess its effectiveness and accuracy compared with freehand operation and robot system through bone model experiments. METHODS Equally divide 30 sawbone models into the freehand group, PSI group, and robot group. Ten sets of prosthesis parameters were randomly generated as planning, and the three groups underwent simulated THA depending on these parameters. After the placement of the femoral prosthesis, the acetabular anteversion plan was adjusted in the PSI and robot groups so that the combined anteversion was maintained before and after adjustment. After the surgery, the actual prosthesis parameters of all bone models were measured and analyzed statistically. RESULTS No statistically significant difference was found in femoral anteversion error among the three groups (p = 0.951). The errors of acetabular cup anteversion, acetabular cup abduction, and combined anteversion in PSI group were 3.92° (2.94°, 4.62°), 5.65° (4.63°, 6.70°), and 3.93° (2.94°, 4.62°), respectively, which were significantly smaller than those in the freehand group [11.84° (9.92°, 13.87°), 13.54° (9.81°, 15.21°), 16.04° (8.18°, 19.25°), respectively, p < 0.05], but significantly larger than those in the robot group [1.34° (0.98°, 1.70°), 1.80° (1°, 2.02°), 1.34° (0.98°, 1.70°), respectively, p < 0.05]. CONCLUSION Compared with the traditional freehand operation, the patient-specific instrumentation system is feasible in total hip arthroplasty because it improves the accuracy of prosthesis placement. In addition, the rapid measurement of intraoperative femoral prosthesis parameters can help surgeons optimize preoperative planning.
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Affiliation(s)
- Teng Zhang
- Beijing Jishuitan HospitalTrauma OrthopedicsBeijingChina
| | - Zhao Jia
- Beijing Jishuitan Orthopaedic Robot Engineering Research Center Co., LTDBeijingChina
| | - Wei Han
- Beijing Jishuitan HospitalTrauma OrthopedicsBeijingChina
| | - Junqiang Wang
- Beijing Jishuitan HospitalTrauma OrthopedicsBeijingChina
| | - Jinqi Li
- Beijing Jishuitan Orthopaedic Robot Engineering Research Center Co., LTDBeijingChina
| | - Maoqi Gong
- Beijing Jishuitan HospitalTrauma OrthopedicsBeijingChina
| | - Xieyuan Jiang
- Beijing Jishuitan HospitalTrauma OrthopedicsBeijingChina
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Park JW, Kim HS, Kim KC, Lee YK, Ha YC, Koo KH. A 10- to 12-year follow-up study of delta ceramic-on-ceramic total hip arthroplasty. Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04758-x. [PMID: 36595032 DOI: 10.1007/s00402-022-04758-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND We previously reported five-to-seven-year results of total hip arthroplasty (THA) with the use of delta ceramic-on-ceramic (CoC) bearing. We conducted an extension study with a CT scan at a minimum of 10 years after surgery. METHODS From March 2009 to March 2011, 273 patients (310 hips) received cementless THA with delta CoC bearing, porous-coated cup and hydroxyapatite-coated stem. In this extended study, 252 patients (144 men and 108 women) (288 hips) with a mean age of 49.7 years (16-83) at surgery were followed for a mean of 10.4 years (10-12) with CT scans in 133 hips (46.2%, 133/288). Clinical and radiographic evaluations were made at each follow-up and Kaplan-Meier survival analysis was performed with revision and reoperation as endpoints. RESULTS There were no more ceramic fractures. Compared to mid-term results, the incidence of squeaking and RLLs increased to 3.1% (9/288) and 19.4% (56/288), respectively. The RLL progressed to focal osteolysis in 3 hips (5.4%, 3/56). No hip had detectable wear or prosthetic loosening. Two hips were reoperated due to periprosthetic joint infection and periprosthetic femoral fracture in each. The survivorship decreased to 98.3% (96.7-99.9%) at 12 years. CONCLUSION During the extended follow-up, no additional ceramic fracture occurred, and the incidence of squeak increased by 0.7%. The long-term survivorship of Delta CoC THA was encouraging. However, focal osteolysis occurred around the hydroxyapatite-coated stem in 1% (3/288). LEVEL OF EVIDENCE II (Prospective cohort study).
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Affiliation(s)
- Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-Ro, Bundang-gu, Seongnam, 463-707, South Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hong-Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, South Korea.,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ki-Choul Kim
- Department of Orthopaedic Surgery, Dankook University Hospital, Cheonan, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-Ro, Bundang-gu, Seongnam, 463-707, South Korea. .,Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-Ro, Bundang-gu, Seongnam, 463-707, South Korea.,Department of Orthopaedic Surgery, Kay Joint Center, Cheil Orthopaedic Hospital, Seoul, South Korea
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Baghdadi J, Alkhateeb S, Roth A, Jäger M, Alkhateeb S, Landgraeber S, Serong S, Haversath M, vonWasen A, Windhagen H, Flörkemeier T, Budde S, Kubilay J, Noll Y, Delank KS, Baghdadi J, Willburger R, Dücker M, Wilke A, Hütter F, Jäger M. Cup positioning and its effect on polyethylene wear of vitamin E- and non-vitamin E-supplemented liners in total hip arthroplasty: radiographic outcome at 5-year follow-up. Arch Orthop Trauma Surg 2023; 143:1679-1688. [PMID: 35397656 PMCID: PMC9957849 DOI: 10.1007/s00402-022-04424-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aseptic loosening remains a challenging problem after total hip arthroplasty. Accurate cup placement and supplementation of antioxidants in acetabular liners might reduce material failure rates. The aim of this study is to assess the effect of the cup position on the wear behaviour of UHMWPE-XE and UHMWPE-X liners in vivo using virtual radiographs. METHODS We conducted a prospective, randomized, controlled, multicenter trial. Clinical data of 372 probands were analyzed. Anteroposterior pelvic X-rays of 324 patients immediately postoperatively and after 1 and 5 years were evaluated by the RayMatch® analysis software regarding cup position and wear behaviour. RESULTS Mean cup anteversion was 20.3° (± 7.4) and inclination was 41.9° (± 7.0) postoperatively. 62.3% of all patients had an anteversion and inclination within the Lewinnek safe zone. Anterior and anterolateral approaches led to significantly higher cup anteversion compared to lateral approaches (27.3° ± 5.5; 20.9° ± 7.2; 17.5° ± 6.6; p < 0.001 and p = 0.001, respectively). Mean anteversion increased to 24.6° (± 8.0) after 1 year (p < 0.001). Only one revision occurred because of implant dislocation. Wear rates from UHMWPE-X and UHMWPE-XE did not differ significantly. Anteversion angles ≥ 25° correlated to increased polyethylene wear (23.7 µm/year ± 12.8 vs. 31.1 µm/year ± 22.8, p = 0.012) and this was amplified when inclination angles were ≥ 50° (23.6 µm/year ± 12.8 vs. 38.0 µm/year ± 22.7, p = 0.062). CONCLUSION Anterior approaches lead to the highest inaccuracy of cup placement, but cup positioning outside the Lewinnek safe zone does not necessarily cause higher dislocation rates. Moreover, mean anteversion increased by approximately four degrees within the first year after operation, which is expected to be functional due to a regularization of pelvic tilt after intervention. Mid-term wear rates of UHMWPE-X and UHMWPE-XE liners are comparable, but steep cup positions lead to significantly increased polyethylene wear. In summary, a re-evaluation of target zones for intraoperative cup positioning might be considered. In the long-term reduced oxidative embrittlement could lead to superior wear behaviour of vitamin E-blended liners.
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Affiliation(s)
- Josef Baghdadi
- Department of Orthopedics, Trauma, and Reconstructive Surgery, University Hospital Halle (Saale), Halle (Saale), Germany.
| | - Shareef Alkhateeb
- Department of Orthopedics, Trauma and Reconstructive Surgery, Marienhospital Mülheim an Der Ruhr, Chair of Orthopedics and Trauma Surgery, University of Duisburg–Essen, Essen, Germany
| | | | | | - Marcus Jäger
- Department of Orthopedics, Trauma and Reconstructive Surgery, Marienhospital Mülheim an Der Ruhr, Chair of Orthopedics and Trauma Surgery, University of Duisburg–Essen, Essen, Germany
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How does corrective fusion surgery for adult spinal deformities affect pelvic inclination in the supine position as the reference plane for THA? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:143-150. [PMID: 34825988 DOI: 10.1007/s00590-021-03166-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/15/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE To determine the changes in pelvic inclination in the supine and standing positions after spinal corrective surgery, and to identify the most predictive factor for changes in pelvic inclination with the supine position as the reference plane for total hip arthroplasty. METHODS We retrospectively analysed the data of 124 patients who underwent spinal corrective fusion surgery for adult spinal deformity between 2012 and 2016 at our institution. Spinal parameters were assessed preoperatively and postoperatively using whole spine radiographs in the standing position. The sacral slope (SS) was measured using spine and pelvis computed tomography. Differences between the preoperative and postoperative SS values in each position were calculated as Δsupine SSpre post and Δstanding SSpre post, respectively. We statistically analysed the correlations between Δsupine SS pre post and preoperative spinal parameters to determine the most useful predictor of Δ supine SSpre post. RESULTS The mean Δsupine SSpre post of 10.5°(-13°-50°) was significantly smaller than the mean Δstanding SSpre post of 13.2° (-19°-44°) (p = 0.02). Moreover, 21 patients (17%) had Δsupine SSpre post > 20°. The Δsupine SS pre post was correlated with preoperative LL (r = -0.34 p < 0.01), PT (r = 0.42 p < 0.01), and SVA (r = 0.37 p < 0.01). Preoperative supine SS (r = -0.54, p < 0.01) had the highest correlation with Δsupine SSpre post, whereas preoperative standing SS showed no correlation (r = -0.14 p = 0.12). CONCLUSION Preoperative supine SS is the most useful predictive factor for changes in supine pelvic inclination, and low preoperative values should be noted. This information should be considered for the management of patients with hip-spine syndrome.
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Kato M, Warashina H, Kataoka A, Ando T, Mitamura S. Localization of the ilioischial line on axial computed tomography images for preoperative planning of total hip arthroplasty. BMC Musculoskelet Disord 2022; 23:1032. [PMID: 36451146 PMCID: PMC9710038 DOI: 10.1186/s12891-022-06021-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 11/23/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND If the bony region indicating the ilioischial line is established on the preoperative axial computed tomography (CT) image, the distance between the simulated cup and the ilioischial line can be measured on this image so that the surgeon can use these data to define a more accurate preoperative two-dimensional (2D) template of total hip arthroplasty (THA). This study aimed to verify the hypothesis that on the CT axial image, the cortical bone area, indicated by the superimposition of a line (line α) with a perspective projection angle to the ilioischial line on radiography and tangent to the medial acetabular wall, is the cortical bone that represents the ilioischial line on radiography. METHODS Study 1: If the two measured distances (distance A' and distance B) are sufficiently equal, then the hypothesis can be supported. Distance A' was calculated by multiplying the distance A, between the ilioischial line and the medial margin of the metal cup after THA measured at the level of the hip joint center on the pelvic radiograph, by 0.91 to correct for radiographic magnification. Distance B was defined as the distance between the medial margin of the metal cup and line α on the axial CT image at the level of the hip joint center. These two distances were measured for all 51 hip joints included in the study. Study 2: The difference between distance A and distance A# (distance A on the 2D template) was compared between the group containing 59 primary THAs in which distance B' was measured (distance B in the simulation) and the control group containing 59 primary THAs. RESULTS Study 1: The average distance for A' was 4.5 ± 2 mm, and the average distance for B was 4.7 ± 2.1 mm. The difference between distances A and B was 0.2 ± 0.2 mm. Study 2: The mean difference between distance A and distance A# for the measurement and control groups was 1.8 ± 1.3 mm and 3.7 ± 2.4 mm, respectively (P < 0.001). CONCLUSIONS The ilioischial line is located in the bony region where line α intersects the medial acetabular wall with a maximum overlap on axial CT images.
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Affiliation(s)
- Michitaka Kato
- Nagoya Joint Replacement Orthopaedic Clinic, Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
| | - Hideki Warashina
- Nagoya Joint Replacement Orthopaedic Clinic, Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
| | - Akito Kataoka
- Nagoya Joint Replacement Orthopaedic Clinic, Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
| | - Takanori Ando
- Nagoya Joint Replacement Orthopaedic Clinic, Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
| | - Shingo Mitamura
- Nagoya Joint Replacement Orthopaedic Clinic, Iponbashi, Takadaji, Kita-Nagoya, Aichi 481-0011 Japan
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Tian Y, Liu Z, Liu S, Jing W, Li L, Ma W, Han Y. Efficacy of bed exercise in elderly patients after total hip arthroplasty: A retrospective study of 539 patients. Medicine (Baltimore) 2022; 101:e31779. [PMID: 36451424 PMCID: PMC9704895 DOI: 10.1097/md.0000000000031779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The purpose of this study was to observe the necessity of bed exercise therapy in the rehabilitation of elderly patients after hip replacement and to analyze whether bed exercise therapy has an impact on patients' psychological scores, hip function and postoperative complications. From January 2018 to January 2021, a total of 539 patients with end-stage femoral head necrosis or hip osteoarthritis were retrospectively analyzed. According to the method of postoperative rehabilitation exercise, patients were divided into 2 groups: Group A (routine gait) and Group B (bed exercise). There was no significant difference in general information between the 2 groups. There was no significant difference in baseline pain scores between patients in Group A and Group B (25.2 ± 9.6 vs 24.8 ± 10.4, P = .429). However, at 5 weeks post-operatively, the pain scores of patients in Group A were significantly higher than those in Group B (38.6 ± 7.7 vs 34.1 ± 8.1, P = .016). At 17 weeks post-operatively, the difference between Group A and Group B remained (40.9 ± 6.9 vs 37.5 ± 7.5, P = .041). Similar to the pain score, the hip function score compared between the 2 groups was significantly different at 5 weeks (39.7 ± 8.4 in Group A, 45.9 ± 9.2 in Group B, P < .001) and 17 weeks post-operatively (41.5 ± 7.6 in Group A, 47.2 ± 8.8 in Group B, P < .001). At 17 weeks post-operatively, between the 2 groups, only the range of motion (ROM) of abduction showed no significant difference. Patients in Group B exhibited a better ROM in any other movement posture. The results showed that compared with Group A, bed exercise rehabilitation training could reduce the incidence of deep venous thrombosis. This study demonstrates that bed exercise can improve the hip function and quality of life of elderly patients with total hip arthroplasty (THA) at an early postoperative stage. It can reduce the incidence of deep venous thrombosis of the lower limbs after surgery. For these patients, systematic bed exercise rehabilitation training is recommended in the early postoperative period.
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Affiliation(s)
- Yancha Tian
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Zeming Liu
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Sikai Liu
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Wenyu Jing
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Lin Li
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Wenhui Ma
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Yongtai Han
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
- *Correspondence: Yongtai Han, Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province, P.R. China (e-mail: )
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Harada S, Hamai S, Ikebe S, Hara D, Higaki H, Gondo H, Kawahara S, Shiomoto K, Harada T, Nakashima Y. Elucidation of target implant orientations with the safety range of hip rotation with adduction or abduction during squatting: Simulation based on in vivo replaced hip kinematics. Front Bioeng Biotechnol 2022; 10:1023721. [DOI: 10.3389/fbioe.2022.1023721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives: The study aimed to elucidate target cup orientation and stem anteversions to avoid impingement between the liner and stem neck even at hip rotation with adduction during the deeply flexed posture.Methods: A computer simulation analysis was performed on 32 total hip arthroplasty patients applying patient-specific orientation of the components and in vivo hip kinematics obtained from three-dimensional analysis of the squatting motion. The anterior/posterior liner-to-neck distance and impingement were evaluated based on a virtual change in internal/external rotation (0°–60°) and adduction/abduction (0°–20°) at actual maximum flexion/extension during squatting. Cutoff values of cup orientations, stem anteversion, and combined anteversion to avoid liner-to-neck impingements were determined.Results: The anterior liner-to-neck distance decreased as internal rotation or adduction increased, and the posterior liner-to-neck distance decreased as external rotation or adduction increased. Negative correlations were found between anterior/posterior liner-to-neck distances at maximum flexion/extension and internal/external rotation. Anterior/posterior liner-to-neck impingements were observed in 6/18 hips (18/56%) at 45° internal/external rotation with 20° adduction. The range of target cup anteversion, stem anteversion, and combined anteversion to avoid both anterior and posterior liner-to-neck impingements during squatting were 15°–18°, 19°–34°, and 41°–56°, respectively.Conclusion: Simulated hip rotations caused prosthetic impingement during squatting. Surgeons could gain valuable insights into target cup orientations and stem anteversion based on postoperative simulations during the deeply flexed posture.
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Ohyama Y, Sugama R, Kim Y, Ohta Y, Minoda Y, Nakamura H. A new accelerometer-based portable navigation system provides high accuracy of acetabular cup placement in total hip arthroplasty in both the lateral decubitus and supine positions. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04675-z. [PMID: 36322198 DOI: 10.1007/s00402-022-04675-z] [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: 08/29/2022] [Accepted: 10/23/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION No studies have compared the accuracy of acetabular cup placement in total hip arthroplasty (THA) in the supine and lateral decubitus positions using the same portable navigation system. Thus, this study aimed to compare the accuracy of acetabular cup placement using a new accelerometer-based portable navigation system combined with an infrared stereo camera and inertial measurement unit between the supine and lateral decubitus positions. MATERIALS AND METHODS This retrospective study compared 45 THAs performed in the supine position (supine group) and 44 THAs performed in the lateral decubitus position (lateral group) using the same portable navigation system. The primary outcome was the absolute errors of cup placement angles, defined as the absolute values of the differences between cup radiographic inclination and anteversion angles displayed on the navigation system and those measured on postoperative computed tomography images. RESULTS No significant difference in the median absolute error of the cup inclination angle (supine group 1.7° [interquartile range 0.8°-3.1°] vs. lateral group 2.1° [interquartile range 1.0°-3.7°]; p = 0.07) was found between the two groups. Similarly, no significant difference in the median absolute error of the anteversion angle (supine group 1.9° [interquartile range 0.8°-3.4°] vs. lateral group 2.1° [interquartile range 0.9°-3.1°]; p = 0.42) was found. CONCLUSION This new accelerometer-based portable navigation system may provide high accuracy of the cup placement in THA in the lateral decubitus and supine positions.
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Affiliation(s)
- Yohei Ohyama
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi Abeno-Ku, Osaka, Osaka, 45-8585, Japan.
| | - Ryo Sugama
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi Abeno-Ku, Osaka, Osaka, 45-8585, Japan
| | - Yuha Kim
- Department of Orthopaedic Surgery, Tsuji Surgical Rehabilitation Hospital, 3-24 Ikutama-Machi Tennoji-Ku, Osaka, Osaka, 543-0072, Japan
| | - Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi Abeno-Ku, Osaka, Osaka, 45-8585, Japan
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi Abeno-Ku, Osaka, Osaka, 45-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi Abeno-Ku, Osaka, Osaka, 45-8585, Japan
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