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Coxe FR, Jordan LA, Wong ZP, Spaan JC, Ren R, Su EP. Functional Acetabular Component Positioning During Direct Anterior Approach Hip Arthroplasty Using a Novel Three-Dimensional Virtual Mesh Imaging System With Fluoroscopy. J Arthroplasty 2024; 39:S88-S96. [PMID: 38522804 DOI: 10.1016/j.arth.2024.03.042] [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] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Optimal position of total hip arthroplasty (THA) components is critical for joint mechanics and stability. Acetabular component positioning during supine surgery in direct anterior approach (DAA) THA may be different in the standing position postoperatively, which traditional fluoroscopy is unable to predict. A novel 3-dimensional (3D) image analysis technology (IAT) that uses artificial intelligence to measure the tilt and rotation of the pelvis has enabled prediction of component positioning from supine to standing. The purpose of this study was to compare intraoperative fluoroscopy, non-3D-IAT, and 3D-IAT with postoperative standing radiographs to assess the accuracy of component positioning. METHODS From 2022 to 2023, 30 consecutive patients (86.6% women, mean age 59 [range, 55 to 67]) undergoing primary DAA THA with the use of the 3D-IAT were identified. A separate cohort of 148 patients from 2020 to 2021 (85% women, mean age 65 [range, 55 to 69]) who underwent DAA THA with non-3D-IAT was used for comparison. Leg length discrepancy (LLD), cup anteversion, and inclination were manually measured on intraoperative fluoroscopic images and digitally measured using IAT. Follow-up evaluation occurred at 1 month with standing pelvis radiographs measured using Ein Bild Röntgen Analyze-Cup software. Measurements were compared via Wilcoxon signed rank tests where P ≤ .05 indicates significantly different measurements. RESULTS Median LLD, inclination, and anteversion measurements via non-3D-IAT and fluoroscopy were significantly different compared to postoperative standing radiographs (P < .001). The 3D-IAT more accurately predicted LLD, abduction, and anteversion, with values not significantly different from postoperative standing measurements (P = .23, P = .93, and P = .36, respectively). CONCLUSIONS The use of the 3D-IAT during DAA THA allowed for the more accurate prediction of acetabular component position in the standing position postoperatively.
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Affiliation(s)
- Francesca R Coxe
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - L Andrew Jordan
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Zachary P Wong
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Jonathan C Spaan
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Renee Ren
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Edwin P Su
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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Zhuang T, Young B, Hooper J, Amanatullah DF, Shapiro L, Kamal RN. Opioid Use After Robotic-Assisted Versus Conventional Total Hip Arthroplasty: A National Database Analysis. Orthopedics 2024; 47:289-294. [PMID: 38976847 DOI: 10.3928/01477447-20240702-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
BACKGROUND In this study, we tested the null hypothesis that robotic-assisted total hip arthroplasty (THA) vs conventional THA was not associated with (1) the amount of postoperative opioid use and (2) the incidence of new, persistent opioid use. MATERIALS AND METHODS We used a large, national administrative database to identify patients 50 years and older undergoing primary robotic or conventional THA. Patients with hip fractures or a history of malignancy, hip infection, or opioid use disorder were excluded. Patients who filled an opioid prescription within 1 year to 30 days preoperatively or who underwent a subsequent procedure within 1 year after THA were excluded. Outcomes included the morphine milligram equivalents (MMEs) filled within the THA perioperative period and the incidence of new, persistent opioid use. Multivariable logistic regression models were used to evaluate associations between robotic-assisted THA and new, persistent opioid use, adjusting for age, sex, insurance plan, region, location of surgery, and comorbidities. RESULTS In the postoperative period, robotic-assisted THA, compared with conventional THA, was associated with a lower mean total MMEs filled per patient (452.2 vs 517.1; P<.001) and a lower mean MMEs per patient per day (71.53 vs 74.64; P<.001). Patients undergoing robotic-assisted THA had decreased odds of developing new, persistent opioid use compared with patients undergoing conventional THA (adjusted odds ratio, 0.82 [95% CI, 0.74-0.90]). CONCLUSION Robotic-assisted THA is associated with lower postoperative opioid use and a decreased odds of developing new, persistent opioid use compared with conventional THA. For the purposes of reducing opioid use, our results support the adoption of robotic-assisted THA. [Orthopedics. 2024;47(5):289-294.].
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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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Xu Z, Chai S, Chen D, Wang W, Dai J, Zhang X, Qin J, Song K, Li X, Han J, Chang Q, Zhang M, Xue C, Lu J, Wu L, Yao Y, Li L, Jiang Q. The LANCET robotic system can improve surgical efficiency in total hip arthroplasty: A prospective randomized, multicenter, parallel-controlled clinical trial. J Orthop Translat 2024; 45:247-255. [PMID: 38601198 PMCID: PMC11004624 DOI: 10.1016/j.jot.2023.12.004] [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: 09/19/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 04/12/2024] Open
Abstract
Objective To evaluate the accuracy and safety of the LANCET robotic system, a robot arm assisted operation system for total hip arthroplasty via a multicenter clinical randomized controlled trial. Methods A total of 116 patients were randomized into two groups: LANCET robotic arm assisted THA group (N = 58) and the conventional THA group (N = 58). General information about the patients was collected preoperatively. Operational time and bleeding were recorded during the surgery. The position of the acetabular prosthesis was evaluated by radiographs one week after surgery and compared with preoperative planning. Harris score, hip mobility, prosthesis position and angle and complications were compared between the two groups at three months postoperatively. Results None of the 111 patients who ultimately completed the 3-month follow-up experienced adverse events such as hip dislocation and infection during follow-up. In the RAA group, 52 (92.9 %) patients were located in the Lewinnek safe zone and 49 (87.5 %) patients were located in the Callanan safe zone. In the control group were 47 (85.5 %) and 44 (80.0 %) patients, respectively. In the RAA group, 53 (94.6 %) patients had a postoperative acetabular inclination angle and 51 (91.1 %) patients had an acetabular version angle within a deviation of 5° from the preoperative plan. These numbers were significantly higher than those of the control group, which consisted of 42 (76.4 %) and 34 (61.8 %) patients respectively. There were no significant differences between the two groups of subjects in terms of general condition, intraoperative bleeding, hip mobility, and adverse complications. Conclusion The results of this prospective randomized, multicenter, parallel-controlled clinical study demonstrated that the LANCET robotic system leads conventional THA surgery in accuracy of acetabular cup placement and does not differ from conventional THA surgery in terms of postoperative hip functional recovery and complications. The translational potential of this article In the past, the success rate of total hip arthroplasty (THA) relied heavily on the surgeon's experience. As a result, junior doctors needed extensive training to become proficient in this technique. However, the introduction of surgical robots has significantly improved this situation. By utilizing robotic assistance, both junior and senior doctors can perform THA quickly and efficiently. This advancement is crucial for the widespread adoption of THA, as patients can now receive surgical treatment in local facilities instead of overwhelming larger hospitals and straining medical resources. Moreover, the development of surgical robots with fully independent intellectual property rights holds immense value in overcoming the limitations of high-end medical equipment. This aligns with the objectives outlined in the 14th Five Year Plan for National Science and Technology Strategy.
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Affiliation(s)
- Zhihong Xu
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Senlin Chai
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Dongyang Chen
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Weijun Wang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jin Dai
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xiaofeng Zhang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jianghui Qin
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Kai Song
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xinhua Li
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jing Han
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qing Chang
- Sports Medicine Center, Department of Orthopaedic Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Miaofeng Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Chenxi Xue
- Department of Orthopedic Surgery, The Second Hospital of Anhui Medical University, Hefei, China
| | - Jun Lu
- Sports Medicine Center, Department of Orthopaedic Surgery, Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Lidong Wu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, China
| | - Yunfeng Yao
- Department of Orthopedic Surgery, The Second Hospital of Anhui Medical University, Hefei, China
| | - Lan Li
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qing Jiang
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Factor S, Gurel R, Dan D, Benkovich G, Sagi A, Abialevich A, Benkovich V. Validating a Novel 2D to 3D Knee Reconstruction Method on Preoperative Total Knee Arthroplasty Patient Anatomies. J Clin Med 2024; 13:1255. [PMID: 38592666 PMCID: PMC10931545 DOI: 10.3390/jcm13051255] [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: 01/02/2024] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND As advanced technology continues to evolve, incorporating robotics into surgical procedures has become imperative for precision and accuracy in preoperative planning. Nevertheless, the integration of three-dimensional (3D) imaging into these processes presents both financial considerations and potential patient safety concerns. This study aims to assess the accuracy of a novel 2D-to-3D knee reconstruction solution, RSIP XPlan.ai™ (RSIP Vision, Jerusalem, Israel), on preoperative total knee arthroplasty (TKA) patient anatomies. METHODS Accuracy was calculated by measuring the Root Mean Square Error (RMSE) between X-ray-based 3D bone models generated by the algorithm and corresponding CT bone segmentations (distances of each mesh vertex to the closest vertex in the second mesh). The RMSE was computed globally for each bone, locally for eight clinically relevant bony landmark regions, and along simulated bone cut contours. In addition, the accuracies of three anatomical axes were assessed by comparing angular deviations to inter- and intra-observer baseline values. RESULTS The global RMSE was 0.93 ± 0.25 mm for the femur and 0.88 ± 0.14 mm for the tibia. Local RMSE values for bony landmark regions were 0.51 ± 0.33 mm for the five femoral landmarks and 0.47 ± 0.17 mm for the three tibial landmarks. The RMSE along simulated cut contours was 0.75 ± 0.35 mm for the distal femur cut and 0.63 ± 0.27 mm for the proximal tibial cut. Anatomical axial average angular deviations were 1.89° for the trans epicondylar axis (with an inter- and intra-observer baseline of 1.43°), 1.78° for the posterior condylar axis (with a baseline of 1.71°), and 2.82° (with a baseline of 2.56°) for the medial-lateral transverse axis. CONCLUSIONS The study findings demonstrate promising results regarding the accuracy of XPlan.ai™ in reconstructing 3D bone models from plain-film X-rays. The observed accuracy on real-world TKA patient anatomies in anatomically relevant regions, including bony landmarks, cut contours, and axes, suggests the potential utility of this method in various clinical scenarios. Further validation studies on larger cohorts are warranted to fully assess the reliability and generalizability of our results. Nonetheless, our findings lay the groundwork for potential advancements in future robotic arthroplasty technologies, with XPlan.ai™ offering a promising alternative to conventional CT scans in certain clinical contexts.
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Affiliation(s)
- Shai Factor
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Ron Gurel
- Division of Orthopedic Surgery, Tel Aviv Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Dor Dan
- Orthopedic Department, Meir Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 4428164, Israel
| | - Guy Benkovich
- Orthopedic Department, Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv 5262000, Israel
| | - Amit Sagi
- Orthopedic Department, Barzilai Medical Center, Ashkelon 78278, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8499000, Israel
- South West London Elective Orthopaedic Centre, Epsom KT18 7EG, UK
| | - Artsiom Abialevich
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8499000, Israel
- Department of Orthopedic Surgery, Soroka Medical Center, Beer Sheva 84101, Israel
- Israeli Joint Health Center, Tel Aviv 69710, Israel
| | - Vadim Benkovich
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8499000, Israel
- Department of Orthopedic Surgery, Soroka Medical Center, Beer Sheva 84101, Israel
- Israeli Joint Health Center, Tel Aviv 69710, Israel
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Giovanoulis V, Kenanidis E, Aïm F, Gamie Z, Marmor S, Potoupnis M, Lustig S, Tsiridis E. Collared versus collarless hydroxyapatite-coated stems for primary cementless total hip arthroplasty; a systematic review of comparative studies. Is there any difference in survival, functional, and radiographic outcomes? SICOT J 2024; 10:8. [PMID: 38358293 PMCID: PMC10868518 DOI: 10.1051/sicotj/2024003] [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: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION This systematic review aims to critically assess the literature comparative studies investigating collared and collarless Corail stem in primary total hip arthroplasty (THA) to find differences in revision rates, radiographic and clinical outcomes, and postoperative complications between these two types of the same stem. METHODS Eligible studies were found by searching PubMed, Science Direct/Scopus, and the Cochrane Database of Systematic Reviews from conception till May 2023. The PRISMA guidelines were followed. The investigation encompassed randomized controlled trials, case series, comparative, cohort, and observational studies that assessed at least one comparative outcome or complication between collared and collarless Corail stems. RESULTS Twelve comparative studies with 90,626 patients undergoing primary THA were included. There were 40,441 collared and 58,543 collarless stems. The follow-up ranged from 12 to 360 months. Our study demonstrated no significant difference in stem revision relative risk (RR = 0.68; 95% confidence interval (CI), 0.23, 2.02; p = 0.49), number of radiolucent lines (RR = 0.3; 95% CI, 0.06, 2.28; p = 0.29) and overall complication risk (RR = 0.62; 95% CI, 0.22, 1.76; p = 0.37) between collared and collarless stems. The collared stems demonstrated significantly lesser subsidence (mean difference: 1.01 mm; 95% CI, -1.77, -0.25; p = 0.009) and risk of periprosthetic fractures (RR = 0.52; 95% CI, 0.29, 0.92; p = 0.03). CONCLUSION The comparative studies between collared and collarless stem groups showed similar survival and overall complication rates and functional outcomes. The similar revision rates between groups make the impact of higher subsidence for collarless stems uncertain. The lower risk of periprosthetic fractures in the collared stems group must be clarified further but could be related to increased rotational stability.
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Affiliation(s)
- Vasileios Giovanoulis
- Orthopedic Surgery Department, Groupe Hospitalier Diaconnesses Croix Saint-Simon 125 Rue d’Avron 75020 Paris France
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon 103 Grande Rue de La Croix Rousse 69004 Lyon France
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
| | - Florence Aïm
- Orthopedic Surgery Department, Groupe Hospitalier Diaconnesses Croix Saint-Simon 125 Rue d’Avron 75020 Paris France
| | - Zakareya Gamie
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
| | - Simon Marmor
- Orthopedic Surgery Department, Groupe Hospitalier Diaconnesses Croix Saint-Simon 125 Rue d’Avron 75020 Paris France
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
| | - Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon 103 Grande Rue de La Croix Rousse 69004 Lyon France
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou Ring Road Efkarpia Thessaloniki 56403 Greece
- Center of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation(CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd PO Box 8318 GR 57001 Greece
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Giovanoulis V, Schmidt A, Vasiliadis AV, Koutserimpas C, Batailler C, Lustig S, Servien E. Prior medial meniscus arthroscopy is not associated with worst functional outcomes in patients undergoing primary total knee arthroplasty: A retrospective single-center study with a minimum follow-up of 5 years. SICOT J 2024; 10:5. [PMID: 38240731 PMCID: PMC10798227 DOI: 10.1051/sicotj/2024001] [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: 12/15/2023] [Accepted: 12/30/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION There have been controversial studies on the impact of prior knee arthroscopy (KA) on outcomes of total knee arthroplasty (TKA). The purpose of this comparative study is to investigate the impact of prior KA of medial meniscus on patients undergoing TKA by evaluating the International Knee Society Score (IKS), the complications, and revisions. METHODS This retrospective study reviewed 84 patients with TKA who had undergone prior KA of the medial meniscus and compared them to 84 cases, without a history of prior KA as a control group. Outcomes were assessed with the original IKS scores and complications. The mean follow-up was 8 years. RESULTS There was no significant difference between groups with respect to demographics, or pre-operative IKS. The mean pre and postoperative IKS was not different between groups. The all-cause reoperation, revision, and complication rates of the KA group were not significantly higher than those of the control group. CONCLUSION The present study seems to reveal that previous KA of the medial meniscus does not negatively affect a subsequent TKA. Nevertheless, larger studies may be necessary to confirm this observation.
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Affiliation(s)
- Vasileios Giovanoulis
- Orthopaedic Surgery and Sports Medicine Department, Croix-Rousse Hospital, University Hospital 69004 Lyon France
| | - Axel Schmidt
- Orthopaedic Surgery and Sports Medicine Department, Croix-Rousse Hospital, University Hospital 69004 Lyon France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
| | - Angelo V. Vasiliadis
- Orthopaedic Surgery and Sports Medicine Department, Croix-Rousse Hospital, University Hospital 69004 Lyon France
| | - Christos Koutserimpas
- Orthopaedic Surgery and Sports Medicine Department, Croix-Rousse Hospital, University Hospital 69004 Lyon France
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens 11527 Athens Greece
| | - Cécile Batailler
- Orthopaedic Surgery and Sports Medicine Department, Croix-Rousse Hospital, University Hospital 69004 Lyon France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
| | - Sébastien Lustig
- Orthopaedic Surgery and Sports Medicine Department, Croix-Rousse Hospital, University Hospital 69004 Lyon France
- Univ Lyon, Claude Bernard Lyon 1 University, IFSTTAR, LBMC UMR_T9406 69622 Lyon France
| | - Elvire Servien
- Orthopaedic Surgery and Sports Medicine Department, Croix-Rousse Hospital, University Hospital 69004 Lyon France
- LIBM – EA 7424, Interuniversity Laboratory of Biology of Mobility, Claude Bernard Lyon 1 University 69622 Lyon France
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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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Ramesh A, Di Laura A, Henckel J, Hart A. The variability of CT scan protocols for total hip arthroplasty: a call for harmonisation. EFORT Open Rev 2023; 8:809-817. [PMID: 37909704 PMCID: PMC10646515 DOI: 10.1530/eor-22-0141] [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: 11/03/2023] Open
Abstract
CT is the principal imaging modality used for the pre-operative 3D planning and assessment of total hip arthroplasty (THA). The image quality offered by CT has a radiation penalty to the patient. Higher than necessary radiation exposure is of particular concern when imaging young patients and women of childbearing age, due to the greater risk of radiation-induced cancer in this group. A harmonised low-dose CT protocol is needed, evidenced by the huge variability in the 17 protocols reviewed. The majority of the protocols were incomplete, leading to uncertainty among radiographers when performing the scans. Only three protocols (20%) were optimised for both 'field of view' and image acquisition parameters. 10 protocols (60%) were optimised for 'field of view' only. These protocols included imaging of the relevant landmarks in the bony pelvis in addition to the knees - the reference for femoral anteversion. CT parameters, including the scanner kilovoltage (kV), milliamperage-time product (mAs) and slice thickness, must be optimised with a 'field of view' that includes the relevant bony landmarks. The recommended kV and mAs values were very wide ranging from 100 to 150 and from 100 to 250, respectively. The large variability that exists amongst the CT protocols illustrates the need for a more consistent low-dose CT protocol for the planning of THA. This must provide an optimal balance between image quality and radiation dose to the patient. Current CT scanners do not allow for measurements of functional pelvic orientation and additional upright imaging modalities are needed to augment them.
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Affiliation(s)
- Angelika Ramesh
- Department of Mechanical Engineering, University College London, United Kingdom
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
| | - Anna Di Laura
- Department of Mechanical Engineering, University College London, United Kingdom
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
| | - Johann Henckel
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
| | - Alister Hart
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
- Institute of Orthopaedics and Musculoskeletal Science, University College London, United Kingdom
- Cleveland Clinic London, United Kingdom
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10
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Sirignano M, Nessler JM, Rhea EB, Ong KL, Watson H, Yakkanti MR, Malkani AL. "Incidence of Instability Following Primary Total Hip Arthroplasty Continues to Decline in the Medicare Population". J Arthroplasty 2023:S0883-5403(23)00391-1. [PMID: 37088227 DOI: 10.1016/j.arth.2023.04.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Instability has been the primary cause of failure following primary total hip arthroplasty (THA) leading to revision hip surgery. The purpose of this study was to determine if instability rates have further declined following advances in primary THA including dual mobility articulations, direct anterior approaches, advanced technologies, and improved knowledge of the hip-spine relationships. METHODS Using the 5% Medicare Part B claims data from 1999 to 2019, we identified 81,573 patients who underwent primary THA for osteoarthritis. Patients who experienced instability at 3 months, 6 months, 1 year, and 2 years were identified. Multivariate cox regression analyses evaluated the effect of patient and procedure characteristics on the risk for instability. RESULTS Instability at 1 year following primary THA declined from approximately 4% in 2000 to 2.3% in 2010 and 1.6% in 2018. The leading cause of revision surgery was infection (18.6%), followed by peri-prosthetic fracture (14%), mechanical loosening (11.5%), and instability (9.4%). High risk groups for instability continue to include increased age, higher Charlson index, obesity, lumbar spine pathology, and neurocognitive disorders. CONCLUSION Instability is no longer the leading etiology of failure following primary THA with a decline of approximately 40% over the past decade. Infection, periprosthetic fracture, mechanical loosening, and then instability are now the leading causes of failure. Multiple factors may play a role in the decline of instability including increased use of dual mobility articulations, direct anterior approaches, improved knowledge of the hip-spine relationships, and use of advanced technologies.
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Affiliation(s)
- Michael Sirignano
- University of Louisville, Dept. of Orthopaedic Surgery, 550 South Jackson Street, Louisville, KY 40202, USA
| | - Joseph M Nessler
- University of Louisville, Dept. of Orthopaedic Surgery, 550 South Jackson Street, Louisville, KY 40202, USA
| | - Evan B Rhea
- University of Louisville, Dept. of Orthopaedic Surgery, 550 South Jackson Street, Louisville, KY 40202, USA
| | - Kevin L Ong
- Exponent Inc., 3440 Market Street, Suite 600, Philadelphia, PA 19104, USA
| | - Heather Watson
- Exponent Inc., 15375 SE 30th Place, Suite 250, Bellevue, WA 98007, USA
| | | | - Arthur L Malkani
- University of Louisville, Dept. of Orthopedic Surgery, Adult Reconstruction Program, 550 South Jackson Street, Louisville, KY 40202, USA.
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Radaelli M, Buchalter DB, Mont MA, Schwarzkopf R, Hepinstall MS. A New Classification System for Cementless Femoral Stems in Total Hip Arthroplasty. J Arthroplasty 2023; 38:502-510. [PMID: 36122690 DOI: 10.1016/j.arth.2022.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/18/2022] [Accepted: 09/11/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The growing variety of total hip arthroplasty implants necessitates a standardized, simple, and brand-neutral language to precisely classify femoral components. Although previous classifications have been useful, they need updating to include stems that have current surface treatment technologies, modularity, collar features, and other geometric characteristics. METHODS To accomplish this, we propose a new classification system for stems based on 3 distinguishing stem features: (1) geometry, (2) location of modularity, and (3) length. RESULTS Our system allows for the easy classification of all currently used stem types. CONCLUSIONS One goal of this endeavor is to improve clinical record keeping to facilitate study comparisons as well as literature reviews.
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Affiliation(s)
- Marco Radaelli
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Daniel B Buchalter
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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12
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Foissey C, Batailler C, Coulomb R, Giebaly DE, Coulin B, Lustig S, Kouyoumdjian P. Image-based robotic-assisted total hip arthroplasty through direct anterior approach allows a better orientation of the acetabular cup and a better restitution of the centre of rotation than a conventional procedure. INTERNATIONAL ORTHOPAEDICS 2023; 47:691-699. [PMID: 36348089 DOI: 10.1007/s00264-022-05624-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE The aim was to investigate the contribution of robotics assisted total hip arthroplasty (THA) through direct anterior approach (DAA) in improving radiographic precision, functional results and complications. METHODS This retrospective study compared 100 primary conventional THA (cTHA) to 50 primary robotic THA (rTHA) through DAA. All cups were placed with the objective of having no anterior overhang while respecting the safe zones (SZ). Radiographic analysis included cup inclination and anteversion, vertical and horizontal changes of the rotation centre (ΔVCOR, ΔHCOR), acetabular and femoral offset. SZ were 30-50° of inclination and 10-30° of anteversion. Outliers were defined as medial displacement of the COR > 5 mm, vertical displacement of the COR > 3 mm superiorly. Harris hip score (HHS) and complications were compared at one year of follow-up. RESULTS The robotic cups were better oriented with 98% in the global SZ versus 68% in the cTHA group (p = 0.0002). The COR was on average better restored in the robotic group in both the horizontal and vertical planes (Δ HCOR = - 5.0 ± 5.0 vs - 3.4 ± 4.9, p = 0.03; Δ VCOR = 1.6 ± 3.3 vs 0.2 ± 2.7, p = 0.04). There were fewer outliers in the rTHA group concerning VCOR (28% versus 10%, p = 0.03). There was no significant difference in HHS and complication rate at one year. CONCLUSION The use of robotics for THA by DAA provided an advantage in controlling the orientation of the cup and the restoration of its rotation centre. Thanks to the 3D planning on CT scan, it allowed to respect the thresholds while avoiding the anterior overhangs.
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Affiliation(s)
- Constant Foissey
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Centre of Excellence, Lyon, France.
| | - Cécile Batailler
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Centre of Excellence, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Rémy Coulomb
- 2 Rue de L'École de Médecine, France - Laboratoire de Mécanique Et Génie Civile (LMGC), CNRS-UM1, Centre Hospitalo-Universitaire de Nîmes, Rue du Pr. Robert Debré, 30029 Nîmes, France - Université Montpellier 1, 860 Rue de St-Priest, 34090, Montpellier, France
| | - Dia Eldean Giebaly
- Department of Trauma and Orthopaedics Surgery, University College Hospital, London, UK
| | - Benoit Coulin
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Centre of Excellence, Lyon, France
| | - Sébastien Lustig
- Department of Orthopedic Surgery and Sport Medicine, Croix-Rousse Hospital, FIFA Medical Centre of Excellence, Lyon, France
- Université de Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622, Lyon, France
| | - Pascal Kouyoumdjian
- 2 Rue de L'École de Médecine, France - Laboratoire de Mécanique Et Génie Civile (LMGC), CNRS-UM1, Centre Hospitalo-Universitaire de Nîmes, Rue du Pr. Robert Debré, 30029 Nîmes, France - Université Montpellier 1, 860 Rue de St-Priest, 34090, Montpellier, France
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Does acetabular robotic-assisted total hip arthroplasty with femoral navigation improve clinical outcomes at 1-year post-operative? A case-matched propensity score study comparing 98 robotic-assisted versus 98 manual implantation hip arthroplasties. Orthop Traumatol Surg Res 2023; 109:103477. [PMID: 36375721 DOI: 10.1016/j.otsr.2022.103477] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/19/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Despite the optimization of implant positioning, the clinical benefit of the use of robotic assistance during THA remains uncertain. In this case-control study (robotic versus manual technique) we made a retrospective short-term comparison of: (1) the functional results, (2) the complications, (3) and the influence of radiological symmetrization of the hips on the functional result. HYPOTHESIS The use of a robotic arm improved the functional results of a THA. MATERIALS AND METHOD A retrospective case-control study was performed, including patients with unilateral hip osteoarthritis who underwent a robotic arm-assisted THA (THA-R). The controls (THA-C) were matched according to age, sex, body mass index and surgical approach. The Harris (HHS), Oxford (OHS) and Forgotten Joint (FJS) scores were collected preoperatively and 1 year postoperatively. At each review, complications were categorized into minor events, revision surgery with and without implant change. Radiographic analysis was performed on weight-bearing images of the pelvis 3 months postoperatively. The objective of the surgery was symmetrization of the THA in the contralateral healthy hip. For each measured parameter of the hip joint center of rotation (COR), global offset (GO) and articular leg length discrepancy (aLLD), the difference between the two sides corresponding to the delta symmetrization was compared. RESULTS Ninety-eight patients were included in the THA-R group and matched to 98 controls in the THA-C group. At 1 year postoperatively, the FJS and OHS scores were statistically higher in the THA-R group, respectively 82.1±22.3 [8.3; 100] and 40.8±8.8 [6; 48] vs. 71.2±27.8 [0; 100] and 38.1±9.7 [12; 48] in the THA-C group (p=0.004 and p=0.043). There was no difference in HHS (THA-R: 85.9±15.8 [31; 100] vs. THA-C: 85.8±13.3 [49-100] (p=0.962)). The implant revision rate at 1 year was significantly higher in the THA-C group (0% vs. 5.1% (p=0.025)). There was no difference in the reoperation without component exchange despite 3 dislocations (3.1%) in the THA-R group (5 (5.1%) vs. 9 (9.2%) (p=0.273)). The rate of abarticular pathologies (ilio-psoas irritation and greater trochanteric bursitis) was higher in the THA-C group (10 (10.8%) vs. 2 (2%) (p=0.016). Robotic acetabular assistance allowed a significantly better restitution of the horizontal position (THA-R: 1mm±4.8 [-11.7; 12.6] vs. THA-C: 4.1mm±7 [-29.6; 28] (p=0.0005)) and vertical COR (THA-R: 0.5mm±3.1 [-6; 8.3] vs. THA-C: 2mm±4.1 [-6; 14.6] (p=0.0068)). Navigated assistance of the femur did not significantly optimize the restitution of the Global Offset (THA-R: +2mm±6.4 [-16.4; 27.6] vs. THA-C: +0.5mm±7 .7 [-34; 30.2] (p=0.145)), or lower limb length (THA-R: +1.1mm±5 [-8.2; 13.5] vs. THA-C: +0.3mm±6 [-14.1; 22.5] (p=0.344). The FJS was statistically correlated with the restoration of the symmetry of the COR and the aLLD. A post-hoc power analysis confirmed sufficient potency (1-β=0.85). CONCLUSION Robotic acetabular assistance combined with femoral navigation improves clinical outcomes of THAs with fewer short-term complications. The precision of the positioning of the implants, optimized by the computer-assisted surgery system, is correlated with the missed joint score. LEVEL OF EVIDENCE III, retrospective case-control study.
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Hernigou P, Lustig S, Caton J. Artificial intelligence and robots like us (surgeons) for people like you (patients): toward a new human-robot-surgery shared experience. What is the moral and legal status of robots and surgeons in the operating room? INTERNATIONAL ORTHOPAEDICS 2023; 47:289-294. [PMID: 36637460 DOI: 10.1007/s00264-023-05690-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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15
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Influence of kinematics of the lumbopelvic complex in hip arthroplasty dislocation: from assessment to recommendations. Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04722-9. [PMID: 36717435 DOI: 10.1007/s00402-022-04722-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/29/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION In total hip arthroplasty (THA), misplacement of the implant can provide instability. Adequate orientation of the acetabular cup is a challenge due to variations in inter-individual anatomy and kinematics of the pelvis in everyday life. The aim of this study was to characterize the kinematic factors influencing the risk of dislocation in order to give recommendations for optimal placement of the cup. We hypothesized that the lack of pelvic adaptation would influence the risk of prosthetic instability and motivate adapted. MATERIALS AND METHODS Eighty patients with primary unilateral THA were included in a matched case-control study. Seventy-four patients were divided into two groups: group 1 (G1) consisting of patients with postoperative THA dislocation (37 patients) and group 2 (G2), without episodes of dislocation within two years postoperatively (37 patients). In both groups, spino-pelvic parameters and cup orientation were measured in standing and sitting positions with EOS® X-ray imaging and compared to each other between 12 and 24 months post-operatively. RESULTS No significant difference between the two groups was found for static parameters. In a sitting position, a lack of pelvic retroversion with a significant lower variation in sacral slope was observed in group 1 (8.0° ± 9.3 for G1 versus 14.7° ± 6.2 for G2, p < 0.01). Twenty-two (59%) patients with THA instability had sacral slope variations of less than 10° versus eight (21% of patients) with stable THA (p < 0.01). Cup orientation in the Lewinnek safe zone was not significantly different (59% vs 67%, p = 0.62), and the spino-pelvic parameters and cup orientation measured did not change between the standing and sitting positions. However, only 14 (37%) cups in G1 were in the functional safe zone versus 24 (67%) in G2 (p = 0.03). CONCLUSION Static parameters of the sagittal spinopelvic balance have a low predictive value for prosthetic instability. Dynamic analysis is essential. Kinematic parameters must be taken into account in determining the ideal position of the cup or stem. Stiffness with locked standing or sitting pelvis must be integrated in order to determine a personalized safe zone. LEVEL OF EVIDENCE Level III (matched case-control study).
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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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Bullock EKC, Brown MJ, Clark G, Plant JGA, Blakeney WG. Robotics in Total Hip Arthroplasty: Current Concepts. J Clin Med 2022; 11:6674. [PMID: 36431151 PMCID: PMC9695933 DOI: 10.3390/jcm11226674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/25/2022] [Accepted: 11/05/2022] [Indexed: 11/13/2022] Open
Abstract
This current concepts article reviews the literature pertaining to the use of robot-assisted systems in total hip arthroplasty (THA). The bulk of the literature is regarding the MAKO (currently the most used system worldwide) and the historic ROBODOC robotic systems. There is a paucity of literature available on other systems, with several still in pilot-phase development. Whilst the evidence shows improved radiological outcomes with robotic THA, functional outcomes are equivocal between conventional and robotic techniques. Acceptance of robotic THA worldwide is limited by its accessibility including cost, and by already exceptional results with the conventional technique. It is, however, a rapidly developing area of orthopaedic surgery. This article discusses the history of robotics in THA, current surgical techniques, functional and radiological outcomes, and ongoing avenues for development.
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Affiliation(s)
- Emily K. C. Bullock
- Department of Orthopaedic Surgery, Royal Perth Hospital, Wellington St., Perth, WA 6000, Australia
| | - Michael J. Brown
- Department of Orthopaedic Surgery, Royal Perth Hospital, Wellington St., Perth, WA 6000, Australia
| | - Gavin Clark
- Department of Orthopaedic Surgery, St John of God Subiaco Hospital, 12 Salvado Road, Subiaco, WA 6008, Australia
| | - James G. A. Plant
- Department of Orthopaedic Surgery, Royal Perth Hospital, Wellington St., Perth, WA 6000, Australia
- Department of Orthopaedic Surgery, St John of God Subiaco Hospital, 12 Salvado Road, Subiaco, WA 6008, Australia
| | - William G. Blakeney
- Department of Orthopaedic Surgery, Royal Perth Hospital, Wellington St., Perth, WA 6000, Australia
- Department of Orthopaedic Surgery, St John of God Subiaco Hospital, 12 Salvado Road, Subiaco, WA 6008, Australia
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Shaw JH, Rahman TM, Wesemann LD, Z Jiang C, G Lindsay-Rivera K, Davis JJ. Comparison of Postoperative Instability and Acetabular Cup Positioning in Robotic-Assisted Versus Traditional Total Hip Arthroplasty. J Arthroplasty 2022; 37:S881-S889. [PMID: 35143923 DOI: 10.1016/j.arth.2022.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/16/2022] [Accepted: 02/01/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Robotic-assisted total hip arthroplasty (R-THA) affords precision yet uncertain clinical benefits. This study compares dislocation rates and related revisions between R-THA and manual total hip arthroplasty (M-THA). Secondarily we evaluated cup position, patient-reported outcome measures (PROMs), and postoperative complications. METHODS A three-surgeon cohort study was conducted on 2247 consecutive patients (1724 M-THA and 523 R-THA) who received a primary THA between January 2014 and June 2020 at a single hospital. Demographics, PROMs, emergency department visits, readmissions, and 90-day complications were collected via the Michigan Arthroplasty Registry Collaborative Quality Initiative. Chart review yielded instability occurrence with an average follow-up of 4 years. Multivariate regression analysis was performed, and a sample of 368 radiographs, including all dislocations, were assessed. RESULTS There were significantly lower rates of dislocation in R-THA (0.6%) vs M-THA (2.5%; Multivariate odds ratio 3.74, P < .046). All cases of unstable R-THA were successfully treated conservatively, whereas 46% of unstable M-THA were revised for recurrent instability. Cup anteversion (25.6° ± 5.4° R-THA vs 20.6° ± 7.6° M-THA) was greater, and cup inclination (42.5° ± 5.3° R-THA vs 47.0° ± 6.7° M-THA) was lower in the R-THA group (P < .05). No significant differences were noted for demographics, PROMs, or other complications (P > .05). CONCLUSION R-THA resulted in less than one-fourth the dislocation rate compared to M-THA and no revision for instability. It was associated with no difference in PROMs or other early complications. The influence of R-THA on stability goes beyond simply cup positioning and deserves further study.
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Affiliation(s)
- Jonathan H Shaw
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI
| | - Tahsin M Rahman
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI
| | - Luke D Wesemann
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI
| | - Charles Z Jiang
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI
| | | | - Jason J Davis
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI
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D’Ambrosi R, Toni A, Czubak J, Guadilla J, Lieber L, Mariani I, Ursino N. Satisfactory clinical and radiologic outcomes with a new shorter and modular stem for end-stage hip osteoarthritis: an international prospective multicentre pilot study. SICOT J 2022; 8:9. [PMID: 35380533 PMCID: PMC8982177 DOI: 10.1051/sicotj/2022005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/14/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction: This multicenter prospective cohort study aimed to assess the safety and clinical and radiologic performance of the CLS® BreviusTM Stem with Kinectiv® Technology. Material and Methods: A total of 222 consecutive subjects, recruited in five different centers, qualifying for primary total hip arthroplasty (THA), were enrolled in the study. All the subjects received the CLS® BreviusTM Stem with Kinectiv® Technology. All the enrolled study subjects underwent pre-operative clinical and radiographic evaluation. Additionally, all subjects underwent post-operative clinical, functional and radiographic evaluations at 6 months and 1, 2, 3, and 5 years. These evaluations included implant survival, pain and functional performance (Harris Hip Score [HHS], University of California, Los Angeles [UCLA] Activity Score, Oxford Hip Score), subject quality-of-life (EQ-5D), radiographic parameters, complications, and concentration of metal ions (aluminum and titanium) in blood. Results: No revisions were performed during the follow-up period. Of the 222 patients, only 76 completed the 5-year follow-up. Only 7 and 5 patients had aluminum and titanium 5-year evaluations, respectively. All the clinical parameters showed an overall improvement in the overtime measured with ANOVA for repeated measures; furthermore, the clinical scores showed a statistically significant improvement at 5 years with respect to pre-operative value (p < 0.001). Aluminum and titanium showed no variation for repeated measures at different time points (p > 0.05). A total of six complications were reported, of which only two were hip-related. Conclusions: The function of the CLS® BreviusTM Stem with Kinectiv® Technology indicated that subject well-being significantly increased following THA regardless of age, gender, BMI, previous surgery, primary diagnosis, and lifestyle.
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Affiliation(s)
- Riccardo D’Ambrosi
- IRCCS Istituto Ortopedico Galeazzi 20161 Milano Italy
- Corresponding author:
| | - Aldo Toni
- IRCCS Istituto Ortopedico Rizzoli 40136 Bologna Italy
| | | | | | | | - Ilaria Mariani
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo” 34137 Trieste Italy
| | - Nicola Ursino
- IRCCS Istituto Ortopedico Galeazzi 20161 Milano Italy
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A Cost-Utility Analysis of Robotic Arm-Assisted Total Hip Arthroplasty: Using Robotic Data from the Private Sector and Manual Data from the National Health Service. Adv Orthop 2022; 2022:5962260. [PMID: 35265378 PMCID: PMC8898863 DOI: 10.1155/2022/5962260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/18/2022] [Accepted: 01/31/2022] [Indexed: 01/16/2023] Open
Abstract
Purpose The aim was to assess the cost-effectiveness of robotic arm-assisted total hip arthroplasty (rTHA) compared with manual total hip arthroplasty (mTHA) and to assess the influence of annual volume on the relative cost-effectiveness of rTHA. Methods A database of both rTHA (n = 48 performed in a private centre) and mTHA (n = 512 performed in the National Health Service) was used. Patient demographics, preoperative Oxford hip score, forgotten joint score, EuroQol 5-dimensional 3-level (EQ-5D), and postoperative EQ-5D were recorded. Two models for incremental cost-effectiveness ratios using cost per quality-adjusted life year (QALY) for rTHA were calculated based on a unit performing 100 rTHAs per year: 10-year follow-up and a lifetime time horizon (remaining life expectancy of a 69-year-old patient). Results When adjusting for confounding factors, rTHA was independently associated with a 0.091 (p=0.029) greater improvement in the EQ-5D compared to mTHA. This resulted in a 10-year time horizon cost per QALY for rTHA of £1,910 relative to mTHA, which increased to £2,349 per QALY when discounted (5%/year). When using the 10-year time horizon cost per QALY was approximately £3,000 for a centre undertaking 50 rTHAs per year and decreased to £1,000 for centre undertaking 200 rTHAs per year. Using a lifetime horizon, the incremental unadjusted cost per QALY gained was £980 and £1432 when discounted (5%/year) for rTHA compared with mTHA. Conclusions Despite the increased cost associated with rTHA, it was a cost-effective intervention relative to mTHA due to the associated greater health-related quality of health gain, according to the EQ-5D outcome measure.
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Hayashi S, Hashimoto S, Kuroda Y, Nakano N, Matsumoto T, Ishida K, Shibanuma N, Kuroda R. Robotic-arm assisted THA can achieve precise cup positioning in developmental dysplasia of the hip : a case control study. Bone Joint Res 2021; 10:629-638. [PMID: 34592109 PMCID: PMC8559969 DOI: 10.1302/2046-3758.1010.bjr-2021-0095.r1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIMS This study aimed to evaluate the accuracy of implant placement with robotic-arm assisted total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). METHODS The study analyzed a consecutive series of 69 patients who underwent robotic-arm assisted THA between September 2018 and December 2019. Of these, 30 patients had DDH and were classified according to the Crowe type. Acetabular component alignment and 3D positions were measured using pre- and postoperative CT data. The absolute differences of cup alignment and 3D position were compared between DDH and non-DDH patients. Moreover, these differences were analyzed in relation to the severity of DDH. The discrepancy of leg length and combined offset compared with contralateral hip were measured. RESULTS The mean values of absolute differences (postoperative CT-preoperative plan) were 1.7° (standard deviation (SD) 2.0) (inclination) and 2.5° (SD 2.1°) (anteversion) in DDH patients, and no significant differences were found between non-DDH and DDH patients. The mean absolute differences for 3D cup position were 1.1 mm (SD 1.0) (coronal plane) and 1.2 mm (SD 2.1) (axial plane) in DDH patients, and no significant differences were found between two groups. No significant difference was found either in cup alignment between postoperative CT and navigation record after cup screws or in the severity of DDH. Excellent restoration of leg length and combined offset were achieved in both groups. CONCLUSION We demonstrated that robotic-assisted THA may achieve precise cup positioning in DDH patients, and may be useful in those with severe DDH. Cite this article: Bone Joint Res 2021;10(10):629-638.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.,Kobe Kaisei Hospital, Kobe, Japan
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | | | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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22
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Solomon LB. CORR Insights®: The External Obturator Footprint Is a Usable, Accurate, and Reliable Landmark for Stem Depth in Direct Anterior THA. Clin Orthop Relat Res 2021; 479:1849-1851. [PMID: 34086010 PMCID: PMC8277279 DOI: 10.1097/corr.0000000000001851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/12/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Lucian Bogdan Solomon
- Professor, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, South Australia, Australia
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Fontalis A, Epinette JA, Thaler M, Zagra L, Khanduja V, Haddad FS. Advances and innovations in total hip arthroplasty. SICOT J 2021; 7:26. [PMID: 33843582 PMCID: PMC8040589 DOI: 10.1051/sicotj/2021025] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/20/2021] [Indexed: 12/12/2022] Open
Abstract
Total hip arthroplasty (THA) has been quoted as one of the most successful and cost-effective procedures in Orthopaedics. The last decade has seen an exponential rise in the number of THAs performed globally and a sharp increase in the percentage of young patients hoping to improve their quality of life and return to physically demanding activities. Hence, it is imperative to review the various applications of technology in total hip arthroplasty for improving outcomes. The development of state-of-the-art robotic technology has enabled more reproducible and accurate acetabular positioning, while long-term data are needed to assess its cost-effectiveness. This opinion piece aims to outline and present the advances and innovations in total hip arthroplasty, from virtual reality and three-dimensional printing to patient-specific instrumentation and dual mobility bearings. This illustrates and reflects the debate that will be at the centre of hip surgery for the next decade.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London NW1 2BU, UK
| | | | - Martin Thaler
- Department of Orthopaedics and Traumatology, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan 20161, Italy
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Box 37, Addenbrookes Hospital, Cambridge CB2 0QQ, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London NW1 2BU, UK
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24
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Batailler C, Caton J, Lustig S. Global perspective of Innovation in Hip and Knee Replacement in 2020. SICOT J 2020; 6:E1. [PMID: 33320807 PMCID: PMC7738158 DOI: 10.1051/sicotj/2020043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/12/2020] [Indexed: 01/11/2023] Open
Affiliation(s)
- Cécile Batailler
- FIFA Medical Center of Excellence, Orthopaedic Surgery and Sports Medicine Department, Croix Rousse Hospital, Civil Hospices of Lyon, 69004 Lyon, France - LBMC UMR T 9406, Laboratory of Chock Mechanics and Biomechanics, Claude Bernard Lyon 1 University, 69003 Lyon, France
| | - Jacques Caton
- Groupe Lépine, 175 rue Jacquard - CS 50307, 69727 Genay Cedex, France
| | - Sébastien Lustig
- FIFA Medical Center of Excellence, Orthopaedic Surgery and Sports Medicine Department, Croix Rousse Hospital, Civil Hospices of Lyon, 69004 Lyon, France - LBMC UMR T 9406, Laboratory of Chock Mechanics and Biomechanics, Claude Bernard Lyon 1 University, 69003 Lyon, France
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