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Anderson PM, Heinz T, Rak D, Arnholdt J, Holzapfel BM, Dorsch S, Weißenberger M, von Eisenhart-Rothe R, Jaenisch M, Ertl M, Wagner M, Windhagen H, Rudert M, Jakuscheit A. Accuracy of Positioning and Risk Factors for Malpositioning Custom-Made Femoral Stems in Total Hip Arthroplasty-A Retrospective Multicenter Analysis. J Pers Med 2023; 13:1285. [PMID: 37763052 PMCID: PMC10532930 DOI: 10.3390/jpm13091285] [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: 07/31/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/29/2023] Open
Abstract
Total hip arthroplasty (THA) is commonly performed using off-the-shelf implants. In the case of a severe mismatch between the anatomy of the proximal femur and the geometry of the stem, the use of custom-made stems might become necessary. The goal of this study was to investigate the precision of the implantation of custom-made stems of one manufacturer (CTX stem, AQ Implants) and to determine risk factors for malpositioning. All patients receiving a custom-made CTX stem between 2014 and 2020 at six high-volume academic centers were retrospectively recruited. The achieved position of the stem, as determined by stem version, stem coronal angle, and implantation depth on radiographs, was compared to the plan. The influence of radiographic and demographic parameters on the position was investigated. The results revealed a high variability of the achieved implant position in relation to the preoperative plan. While the stem coronal angle only differed slightly from the intended position, the stem version and the implantation depth showed a high frequency and amount of deviation. Right stems showed significantly higher positions than planned. Surgeons must be aware of this potential problem when implanting custom-made stems.
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Affiliation(s)
- Philip Mark Anderson
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
| | - Tizian Heinz
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
| | - Dominik Rak
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
| | - Jörg Arnholdt
- Department of Orthopedic Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Boris Michael Holzapfel
- Department of Orthopedic Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Silke Dorsch
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
| | - Manuel Weißenberger
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopaedics and Sports Orthopaedics, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany
| | - Max Jaenisch
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Max Ertl
- Department of Orthopaedic Surgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, Germany;
| | - Michael Wagner
- Department of Orthopaedics and Trauma Surgery, Klinikum Nürnberg Campus Süd, Paracelsus Medical University, Breslauer Straße 201, 90472 Nürnberg, Germany;
| | - Henning Windhagen
- Department of Orthopaedic Surgery, Annastift Hannover, Medical School Hannover, Borries Str. 1-6, 30625 Hannover, Germany;
| | - Maximilian Rudert
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
| | - Axel Jakuscheit
- Department of Orthopedics, König-Ludwig-Haus, University of Würzburg, Brettreichstraße 11, 97070 Wuerzburg, Germany
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Femoral Anteversion in Total Hip Arthroplasty: Retrospective Comparison of Short- and Straight-Stem Models Using CT Scans. J Clin Med 2023; 12:jcm12062391. [PMID: 36983391 PMCID: PMC10058265 DOI: 10.3390/jcm12062391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
Data on reconstruction of the femoral anteversion (FA) and the center of rotation after total hip arthroplasty (THA) are rare. We aimed to answer whether a short-stem fixation enables improved anatomical reconstruction of the FA compared to a straight-stem. Methods: One hundred and thirty patients who underwent short- (n = 89, group A, prospective) or straight-stem THA (n = 41, group B, retrospective) were included. CT scans of the hip, knee, and ankle were performed pre- and postoperatively in group A and in group B during the last follow-up. Femoral torsion was determined using three-dimensional models. Results: The mean preoperative FA was 22.4° ± 11.0°, and the mean postoperative FA was 23.4° ± 10.1°. The relative difference was −0.8° ± 8°, and the absolute difference was 6.4° ± 4.9°. Gender analysis revealed significant differences in preoperative FA between female (f) and male (m) patients (28.1° ± 11.2° (f) vs. 18.4° ± 8.3° (m); p > 0.001) as well as in postoperative FA (26.7° ± 23.5° (f) vs. 21.0° ± 9.7° (m); p < 0.007) in group A. Postoperative FA was higher in group A (mean 6.8°; 23.9° ± 10.1° (f) vs. 16.6° ± 8.6° (m); p < 0.001). Conclusions: The study’s findings suggest that short-stem THA leads to improved anatomical FA reconstruction; however, a substantial postoperative gender-related FA difference was detectable, which may warrant consideration by surgeons when determining the final stem anteversion. It should be noted that the impact of the postoperative gender-related FA difference on clinical outcomes is not entirely clear, and further research is warranted to elucidate this relationship.
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Constantinescu DS, Costello JP, Dalling AD, Wagner JD, Al-Hardan W, Carvajal JA. The efficacy of patient specific instrumentation (PSI) in total hip arthroplasty (THA): A systematic review and meta-analysis. J Orthop 2022; 34:404-413. [PMID: 36325516 PMCID: PMC9619218 DOI: 10.1016/j.jor.2022.10.001] [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: 08/03/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/15/2022] Open
Abstract
Background Patient-specific instrumentation (PSI) has been suggested to reduce improper component positioning, though the effectiveness of PSI in total hip arthroplasty (THA) remains inconclusive. The purpose of this study was to evaluate the radiographic parameters and clinical outcomes comparing PSI and standard instrumentation (SI). Methods This systematic review and meta-analysis was conducted in accordance with the 2020 PRISMA statement and was registered on PROSPERO. PubMed, Embase, Scopus, Google Scholar, and ClinicalTrials.gov were searched for relevant studies pertaining to the use of PSI in THA. Inclusion criteria included PSI used in THA, PSI was directly compared to SI, and publication in English. Exclusion criteria included non-primary THA, review articles, abstracts, book chapters, and animal models. Results 2,458 studies were initially identified, with 13 studies (677 THAs: 338 controls, 339 PSI) meeting all criteria. PSI was favored for the deviation from the preoperative plan for acetabular cup position for anteversion (p = 0.04) and inclination (p = 0.0002); risk of acetabular cup positioning outside the Lewinnek safe zone for anteversion (p = 0.005) and inclination (p < 0.0001); and postoperative Harris Hip Score (p = 0.0002). No significant differences were found for the deviation from the preoperative plan for femoral stem position for anteversion (p = 0.74) or varus/valgus (p = 0.15); intraoperative time (p = 0.55); or intraoperative blood loss (p = 0.62). Conclusion The use of PSI in THA is effective in improving acetabular component positioning and postoperative functional outcomes, without increasing intraoperative time or blood loss, compared to SI.
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Affiliation(s)
- David S. Constantinescu
- Department of Orthopedic Surgery, University of Miami Hospital, 1611 NW 12th Ave #303, Miami, FL, 33136, USA
| | - Joseph P. Costello
- University of Miami Leonard M. Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Anil D. Dalling
- University of Miami Leonard M. Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Jaxon D. Wagner
- University of Miami Leonard M. Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Waleed Al-Hardan
- Department of Orthopedic Surgery, University of Miami Hospital, 1611 NW 12th Ave #303, Miami, FL, 33136, USA
| | - Jaime A. Carvajal
- Department of Orthopedic Surgery, University of Miami Hospital, 1611 NW 12th Ave #303, Miami, FL, 33136, USA
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