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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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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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Sun J, Zhang Y, Shen J, Zheng Q, Li T, Zhang B, Zhou Y, Zhang G. Comparison of Preoperative Computed Tomography and Intraoperative Estimation in Predicting the Version of a Single-Wedge Femoral Stem. Orthop Surg 2022; 14:2979-2986. [PMID: 36177805 PMCID: PMC9627059 DOI: 10.1111/os.13524] [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: 08/26/2021] [Revised: 08/27/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Early prediction of stem version aids in optimization of combined version during total hip arthroplasty (THA). This study aimed to analyze the discrepancy between stem version and native femoral version measured by different methods, and to explore which method can better predict the stem version. Methods We retrospectively reviewed 26 patients (39 hips) treated with robot‐assisted THA in our hospital between September 2019 and December 2019. A straight, single‐wedge, cementless stem (Accolade II) was used in all cases. Preoperative femoral version was measured at three levels on computerized tomography (CT) scan from the top to the middle level of femoral neck (Level 1 to Level 3). During THA, the version on cutting surface was measured prior to femoral broaching based on two reference lines: mid‐cortical line and T line (trochanteric fossa to the middle of medial cortex). After femoral broaching, stem version was measured based on the femoral neck trial using Mako system (Stryker). In the statistical analysis, the difference and absolute discrepancy between stem version and femoral version measured with various methods were examined using paired t‐test, and the relationship between stem version and various femoral versions were examined using correlation analysis. Results Mean femoral neck version (Level 1) was 9.5° ± 2.6° (range, −16.8°‐42.5°), while mean stem version measured by Mako system was 19.9° ± 2.0° (range, −8.0°‐49.0°). Femoral version measured with each method showed a moderate correlation with stem version (p < 0.05). There was a significant difference between stem version and femoral version except at Level 3, with a mean difference of 0.8° ± 13.6° (p = 0.729). With regard to the intraoperative estimation, stem version significantly increased compared to the value based on mid‐cortical line, with a mean difference of 8.4° ± 13.1° (p < 0.001). However, the mean value of stem version was a little smaller than that of femoral version measured by reference to T line, but without statistical significance (p = 0.156). No postoperative dislocations occurred during the study period. No revision was required for any component. Conclusions The middle level of femoral neck on CT scan and T line on cutting surface are better references to measure femoral version for predicting postoperative stem version. However, the relationship between stem version and predictive value was flexible. Therefore, further three‐dimensional studies of postoperative CT are needed to validate the press‐fit fixation and rotational freedom of the single‐wedge stem.
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Affiliation(s)
- Jingyang Sun
- Medical School of Chinese PLA, Beijing, China.,Orthopaedics Department, Peking University Shougang Hospital, Beijing, China
| | - Yanchao Zhang
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, The First Medical Center of PLA General Hospital, Beijing, China
| | - Junmin Shen
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, The First Medical Center of PLA General Hospital, Beijing, China
| | - Qingyuan Zheng
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, The First Medical Center of PLA General Hospital, Beijing, China
| | - Tiejian Li
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, The First Medical Center of PLA General Hospital, Beijing, China
| | - Bohan Zhang
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, The First Medical Center of PLA General Hospital, Beijing, China
| | - Yonggang Zhou
- Department of Orthopaedics, The First Medical Center of PLA General Hospital, Beijing, China.,Department of Orthopaedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Guoqiang Zhang
- Department of Orthopaedics, The First Medical Center of PLA General Hospital, Beijing, China.,Department of Orthopaedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
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Kim HS, Lee YK, Ha JH, Park SJ, Park JW, Koo KH. Distribution and outliers of anteversion of short-length cementless stem. INTERNATIONAL ORTHOPAEDICS 2021; 46:725-732. [PMID: 34799778 DOI: 10.1007/s00264-021-05265-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Inadequate stem version might lead to impingement and instability after cementless total hip arthroplasty (THA). We evaluated (1) the distribution of short-stem anteversion, (2) the proportion of stems with an anteversion less than 5° or larger than 25°, (3) combined cup and stem anteversion, and (4) dislocation rate. MATERIALS AND METHODS We evaluated the native femoral anteversion and stem anteversion in 340 patients (340 THAs): 144 men and 196 women. Their mean age was 56.2 (22-87) years and mean body mass index was 25.1 (15.2-40.7) kg/m2. The femoral neck anteversion was measured on pre-operative CT scan and the stem anteversion was obtained during the operation. The safe zone of the stem anteversion was defined as 5 to 25°. RESULTS The femoral neck anteversion ranged from -15 to 61° (mean, 15.0°; SD, ±10.6°). The stem anteversion ranged -7 to 50° (mean, 15.7°; SD, ±9.5°). It was optimal (5-25°) in 71.2% (242/340), insufficient (<5°) in 13.3% (45/340), and excessive (>25°) in 15.6% (53/340). The stem anteversion had a medium correlation with the femoral neck anteversion (correlation coefficient = 0.449). The combined anteversion was 42.0° (range, 35.2-52.3°; SD, ±2.8°). During two to four year follow-up, no hip dislocated. CONCLUSIONS Short-length stem had a great variability in the anteversion and considerable portion (28.9%, 98/340) of stems had an anteversion outside the safe zone. Surgeons should be aware of this variability of stem anteversion to compensate for abnormal stem anteversion, which might lead to impingement and instability after THA.
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Affiliation(s)
- Hong-Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, 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
| | - Joo-Hyung Ha
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, South Korea
| | - Se Jin Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, South Korea
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, 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, Seoul National University College of Medicine, Seoul, South Korea
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Castagnini F, Giardina F, Tassinari E, Biondi F, Bracci G, Traina F. Measuring stem anteversion after total hip arthroplasty: posterior condylar tangent versus transepicondylar axis. Skeletal Radiol 2021; 50:1775-1779. [PMID: 33532940 DOI: 10.1007/s00256-021-03725-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Stem anteversion in total hip arthroplasty (THA) has been measured using two different distal references, the posterior condyle (PC) or the transepicondylar axis (TEA). The reliability, the difference in value between these two techniques, and the possible confounding factors are scarcely known. Aims of this work were to assess (1) the intraclass correlation and the difference between the two measurement techniques and (2) the possible influence of condylar dysmorphisms on the anteversion value discrepancy. MATERIALS AND METHODS A consecutive series of post-THA CT scans were selected, excluding hip dysplasia, end-stage knee osteoarthritis, and replaced knees. Using a surgical planning software, stem anteversion was measured using the PC or the TEA reference. The intraclass reliability was assessed. The anteroposterior femoral condyle diameters were measured: the difference and the ratio were measured and correlated with the stem anteversion values. RESULTS 91 CT scans were included. Inter/intra-observer TEA measurements were more reliable than PC. The intraclass correlation between PC and TEA anteversion measurements was good, 0.954 (CI 95% 0.922-0965). The mean difference between PC and TEA anteversion was 5.27 ± 2.41°. The difference and the ratio between the two anteroposterior condyle diameters did not influence the anteversion difference (respectively, p 0.797 and p 0.901). CONCLUSIONS TEA and PC demonstrated to achieve a good correlation, not dependent from the condyle morphology. However, the difference between the two measurements (5°) can severely influence the combined anteversion (10-20%): due to clinical applicability and better inter/intra-observer agreement, TEA should be preferred for measuring stem anteversion.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Federico Giardina
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Enrico Tassinari
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Federico Biondi
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Giovanni Bracci
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
- University of Messina, Piazza Antonello, 98122, Messina, Italy
- DIBINEM, University of Bologna, 40123, Bologna, Italy
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Sun J, Zhang B, Geng L, Zheng Q, Li J, Cao W, Ni M, Zhang G. Measurement of operative femoral anteversion during cementless total hip arthroplasty and influencing factors for using neck-adjustable femoral stem. J Orthop Surg Res 2021; 16:353. [PMID: 34059087 PMCID: PMC8165773 DOI: 10.1186/s13018-021-02506-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/23/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Placement of femoral stem in excessive anteversion or retroversion can cause reduced range of motion, prosthetic impingement, and dislocation. The aim of this study was to assess the operative femoral anteversion in patients treated with total hip arthroplasty (THA) and analyze the need of adjusting stem anteversion. METHODS We retrospectively included 101 patients (126 hips) who underwent cementless THA with a manual goniometer to determine the femoral anteversion between October 2017 and December 2018. The operative femoral anteversion we measured was recorded during THA. We further divided those hips into three subgroups based on the range of operative femoral anteversion: group 1 (<10°), group 2 (10-30°), and group 3 (>30°) and compared the differences of their demographic data. Univariate and multivariate logistic regression were used to identify the influencing factors for the need of neck-adjustable femoral stem. The clinical and radiographic outcomes were also assessed. Perioperative complications were recorded. RESULTS After THA, the Harris hip scores improved from 52.87 ± 15.30 preoperatively to 90.04 ± 3.31 at the last follow-up (p < 0.001). No implant loosening, stem subsidence, and radiolucent lines were observed on radiographs. No severe complications occurred and no components needed revision at the latest follow-up. The mean operative femoral anteversion was 14.21° ± 11.80° (range, -9 to 60°). Patients with femoral anteversion more than 30° were about 10 years younger than others. Femoral anteversion >30° was more common in patients with developmental dysplasia of the hip (DDH). There were totally 14 hips treated with the neck-adjustable femoral stem. From the univariate analysis, we can observe that female sex, diagnosis of DDH (compared with osteonecrosis), and higher operative femoral anteversion and its value >30° (compared with <10°) are associated with higher rates of using the neck-adjustable femoral stem. However, all these factors were no longer considered as independent influencing factors when mixed with other factors. CONCLUSIONS This study highlighted the significance of operative femoral anteversion. Identification of abnormal femoral anteversion could assist in adjusting stem anteversion and reduce the risk of dislocation after THA.
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Affiliation(s)
- Jingyang Sun
- Medical School of Chinese PLA, Beijing, 100853, China.,Department of Orthopedics, the First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Bohan Zhang
- Medical School of Chinese PLA, Beijing, 100853, China.,Department of Orthopedics, the First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Lei Geng
- Department of Orthopedics, the First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Qingyuan Zheng
- Medical School of Chinese PLA, Beijing, 100853, China.,Department of Orthopedics, the First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Juncheng Li
- Medical School of Chinese PLA, Beijing, 100853, China.,Department of Orthopedics, the First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Wenzhe Cao
- Department of Orthopedics, the First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China
| | - Ming Ni
- Medical School of Chinese PLA, Beijing, 100853, China. .,Department of Orthopedics, the First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Guoqiang Zhang
- Medical School of Chinese PLA, Beijing, 100853, China. .,Department of Orthopedics, the First Medical Center, Chinese People's Liberation Army General Hospital, Fuxing Road, Haidian District, Beijing, 100853, China.
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Takada R, Jinno T, Miyatake K, Watanabe N, Koga H, Yoshii T, Okawa A. Difference in tapered wedge stem alignment between supine and lateral position in cementless total hip arthroplasty via modified Watson-Jones anterolateral approach. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:497-503. [PMID: 34021789 DOI: 10.1007/s00590-021-03001-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Whether different body positions during surgery affect postoperative stem alignment in total hip arthroplasty (THA) remains unclear. The purpose of this study was to clarify differences in tapered wedge stem alignment between supine and lateral positions in THA under the modified Watson-Jones anterolateral approach. METHODS We reviewed 242 consecutive, primary cementless THAs performed with ceramic-on-cross-linked polyethylene via the modified Watson-Jones approach in either supine or lateral positions between 2009 and 2015 (supine group: 113 cases; lateral group: 129 cases). No specific reasons to select supine or lateral positions for the surgery were given during the study period. Computed tomography was performed pre- and postoperatively to measure preoperative femoral anteversion and postoperative stem anteversion, respectively. Stem alignment in coronal and sagittal planes was also evaluated. RESULTS Mean difference in stem anteversion and femoral anteversion was 8.6 ± 9.4 in the supine position and 13.0 ± 11.4 in the lateral position (p = 0.0013). Although no significant difference was seen between groups for stem alignment in the coronal plane, flexed implantation was more likely in the supine group (46/113, 40.7%) than in the lateral group (20/129, 15.5%). A significant correlation was found between femoral anteversion and stem anteversion in both the supine and lateral groups (r = 0.68, p < 0.0001 and r = 0.52, p < 0.0001, respectively). CONCLUSION Although stem anteversion was more strongly correlated with femoral anteversion in the supine position than in the lateral position, neutral position in the sagittal plane was more likely to be found with the lateral position than with the supine position. Surgeons can achieve ideal stem positioning by considering these results in the modified Watson-Jones approach in both the supine and lateral positions.
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Affiliation(s)
- Ryohei Takada
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kazumasa Miyatake
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Naoto Watanabe
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hideyuki Koga
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Medical Hospital, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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3D Printed Guides and Preoperative Planning for Uncemented Stem Anteversion Reconstruction during Hip Arthroplasty: A Pilot Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6621882. [PMID: 33681357 PMCID: PMC7910057 DOI: 10.1155/2021/6621882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/16/2021] [Accepted: 01/30/2021] [Indexed: 11/24/2022]
Abstract
Objective To investigate if 3D printed guides and preoperative planning can accurately control femoral stem anteversion. Methods A prospective comparative study was carried out from 2018 to 2020, including 53 patients who underwent hip arthroplasty for femoral neck fracture. The target rotation center of the femoral head is determined by three-dimensional planning. In group A, planning was made by 2D templates. In group B, preoperative 3D planning and 3D printed osteotomy/positioning guides were performed. After the operation, 3D model registration was performed to calculate the accuracy of anteversion restoration. Results We screened 60 patients and randomized a total of 53 to 2 parallel study arms: 30 patients to the group A (traditional operation) and 23 patients to the group B (3D preoperative planning and 3D printed guide). There were no significant differences in demographic or perioperative data between study groups. The restoration accuracy of group A was 5.42° ± 3.65° and of group B was 2.32° ± 1.89°. The number and rate of abnormal cases was 15 (50%) and 2 (8.7%), respectively. Significant statistical differences were found in angle change, restoration accuracy, and number of abnormal cases. Conclusion Three-dimensional preoperative planning and 3D printed guides can improve the accuracy of the restoration of femoral anteversion during hip arthroplasty.
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Pongkunakorn A, Phetpangnga N, Kananai N. Accuracy of intraoperative estimation of femoral stem anteversion in cementless total hip arthroplasty by using a digital protractor and a spirit level. J Orthop Surg Res 2021; 16:27. [PMID: 33413529 PMCID: PMC7792124 DOI: 10.1186/s13018-020-02183-7] [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: 10/31/2020] [Accepted: 12/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background The femoral component anteversion during surgery is traditionally assessed by a visual assessment of the surgeon and has proven to be imprecise. We sought to determine the accuracy of a digital protractor and a spirit level to measure the stem anteversion during cementless THA. Methods A prospective study was conducted among 107 patients (114 hips) who underwent primary cementless THA via posterolateral approach. A pipe with a spirit level was attached to the tibial tubercle and intermalleolar midpoint. While the leg was held perpendicularly to the floor, stem anteversion was estimated by 3 methods: method A by visual assessment; method B by a digital protractor alone; and method C by a digital protractor combined with a spirit level. The angles were compared with the true anteversion measured by postoperative CT scan. Results The average anteversion by method C (22.8° ± 6.9°, range -2° to 40°) was significantly lower than method A (24.6° ± 5.2°, range 0° to 30°) (p=0.033), but not different from the true anteversion (22.1° ± 8.2°, range -5.4° to 43.1°) (p=0.445). There were no significant differences between method B (23.2° ± 8.2°, range -4° to 45°) and method A, C or the true anteversion. The mean deviation of the intraoperative estimation from the true anteversion was 0.8° ± 3.7° (range -7.1° to 8.0°) by method C; 1.2° ± 5.1° (range -8.8° to 14.3°) by method B; and 2.5° ± 7.4° (range -19.0° to 16.0°) by method A. Estimation error within 5° was found in 107 hips (93.9%) with method C; 86 hips (75.4%) with method B; and 59 hips (51.8%) with method A. Conclusion Accurate estimation of stem anteversion during cementless THA can be determined intraoperatively by the use of a digital protractor and a spirit level. Trial registration Thai Clinical Trials Registry (TCTR 20180326003). Registered on 20 March 2018. Retrospectively registered.
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Affiliation(s)
- Anuwat Pongkunakorn
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Educational Center, Lampang, Thailand.
| | - Nawakun Phetpangnga
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Educational Center, Lampang, Thailand
| | - Narawit Kananai
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Educational Center, Lampang, Thailand
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10
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Mitsutake R, Tanino H, Nishida Y, Higa M, Ito H. A simple angle-measuring instrument for measuring cemented stem anteversion during total hip arthroplasty. BMC Musculoskelet Disord 2020; 21:113. [PMID: 32075628 PMCID: PMC7031998 DOI: 10.1186/s12891-020-3142-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/17/2020] [Indexed: 11/30/2022] Open
Abstract
Background During total hip arthroplasty (THA), the accurate placement of the femoral components is an important determinant of the success of the procedure. This study assessed the accuracy of cemented stem placement using a new angle-measuring instrument. The primary objective was to investigate the accuracy of the intraoperative measurements of cemented stem anteversion obtained using the angle-measuring instrument. Our secondary objective was to evaluate the accuracy of stem positioning performed using the angle-measuring instrument. Methods We compared the intraoperative stem anteversion measurements obtained using the angle-measuring instrument with postoperative stem anteversion measurements obtained using computed tomography in 149 hips (measurement accuracy). We also compared the target angle and postoperative stem anteversion in 105 hips (implantation accuracy). Results The mean amount of intraoperative stem anteversion was 37.9° ± 10.1°, and the mean amount of postoperative stem anteversion was 37.0° ± 10.4°. The mean measurement accuracy was 0.9° ± 6.1°, and the absolute measurement accuracy was 4.9° ± 3.7°. The correlation coefficient for the relationship between the intraoperative and postoperative stem anteversion measurements was 0.824 (p = 0.000). The mean amount of target angle was 37.4° ± 7.6°, and the mean amount of postoperative stem anteversion was 35.9° ± 9.1°. The mean implantation accuracy was 1.4° ± 5.6°, and the mean absolute implantation accuracy was 4.3° ± 3.6°. The correlation coefficient for the relationship between the target angle and postoperative stem anteversion was 0.795 (p = 0.000). Conclusions The angle-measuring instrument measured intraoperative stem anteversion accurately, and cemented stem was implanted accurately during THA with the angle-measuring instrument.
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Affiliation(s)
- Ryo Mitsutake
- Department of Orthopaedic Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510, Japan.
| | - Hiromasa Tanino
- Department of Orthopaedic Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Yasuhiro Nishida
- Department of Orthopaedic Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Masaru Higa
- Department of Mechanical Engineering, University of Hyogo, 2167 Shosha, Himeji, 671-2280, Japan
| | - Hiroshi Ito
- Department of Orthopaedic Surgery, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
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Taniguchi N, Jinno T, Koga D, Ochiai S, Okawa A, Haro H. Comparative study of stem anteversion using a cementless tapered wedge stem in dysplastic hips between the posterolateral and anterolateral approaches. Orthop Traumatol Surg Res 2019; 105:1271-1276. [PMID: 31615749 DOI: 10.1016/j.otsr.2019.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 06/02/2019] [Accepted: 08/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND In total hip arthroplasty (THA), the concept of combined anteversion is accepted as one of best indicators of prosthetic joint stability. Technical parameters may influence the stem and cup anteversion. We therefore investigated if stem anteversion could be influenced by surgical approaches in cementless THA using a tapered wedge stem with stem-first technique. HYPOTHESIS We postulated that the type of approach, posterolateral (PLA) or anterolateral approach (ALA), would influence stem anteversion in dysplastic hip patients. We asked (1) whether stem anteversion was higher in the PLA group and (2) how postoperative stem anteversion was correlated to preoperative femoral anteversion in each group. PATIENTS AND METHODS We retrospectively compared two groups of hips that underwent THA using a tapered wedge stem with the posterolateral (PLA group; 154 hips) or anterolateral (ALA group; 81 hips) approaches. Computed tomography was utilized to measure femoral neck and stem anteversion. To investigate related factors that affect stem anteversion, a stepwise regression analysis was performed. RESULTS The stem anteversion in the PLA and ALA groups was 43.7°±9.8° and 34.0°±12.3°, respectively (p<0.01). The stepwise selection process resulted in a model involving femoral neck anteversion and surgical approach (p<0.01). The stem anteversion of the ALA group (r=0.75, p<0.01) was better correlated to femoral neck anteversion than that of the PLA group (r=0.52, p<0.01). DISCUSSION The stem implantation through the ALA is thought to be more restricted than that through the PLA due to the difference of difficulty in femoral exposure. Tapered wedge stems, which are relatively thin and flat, have a high degree of freedom in the femoral canal. Consequently, in cementless THA using a tapered wedge stem, the surgical approaches affected stem anteversion differently. Stem anteversion was more anatomically restored to femoral neck anteversion through the ALA than through the PLA. LEVEL OF EVIDENCE III, retrospective case-control study.
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Affiliation(s)
- Naofumi Taniguchi
- Department of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo-shi, 409-3898 Yamanashi, Japan; Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan; Second Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya-shi, 343-8555 Saitama, Japan.
| | - Daisuke Koga
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan
| | - Satoshi Ochiai
- Department of Orthopaedic Surgery, Kofu National Hospital, 11-35 Tenjin-cho, Kofu-shi, 409-8533 Yamanashi, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519 Tokyo, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo-shi, 409-3898 Yamanashi, Japan
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