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Hayashi S, Kuroda Y, Nakano N, Matsumoto T, Kamenaga T, Tsubosaka M, Kuroda R. Accuracy of portable navigation during THA in patients with severe developmental dysplasia of hip. Arch Orthop Trauma Surg 2024; 144:2429-2435. [PMID: 38661997 DOI: 10.1007/s00402-024-05338-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Correct cup placement in total hip arthroplasty (THA) for patients with developmental dysplasia of the hip (DDH) is considerably difficult. This study aimed to analyze the orientation accuracy of cup insertion during THA using a portable navigation system in patients with DDH. MATERIALS AND METHODS In this retrospective cohort study, we analyzed data from 64 patients who underwent THA using infrared stereo camera-matching portable navigation. Patients underwent THA via the anterolateral approach in the lateral decubitus position. Navigation records for intraoperative cup angles, postoperative cup angles measured on computed tomography (CT) images, and cup angle measurement differences were measured and compared between patients with non-DDH/mild DDH and severe DDH. Furthermore, the predictive factors for outliers of accurate acetabular cup placement were analyzed. RESULTS The average measurement absolute abduction differences (postoperative CT-navigation record) were 3.9 ± 3.5° (severe DDH) and 3.3 ± 2.6° (non-DDH/ mild DDH), and the anteversion differences were 4.7 ± 3.4° (severe DDH) and 2.3 ± 2.1° (non-DDH/ mild DDH). The anteversion difference was different between the two groups. Multivariate analysis showed that the navigation difference (absolute difference in anteversion between postoperative CT and navigation records of > 5°) was significantly associated with severe DDH (odds ratio [OR]: 3.3; p = 0.049, 95% confidence interval [CI]: 1.0-11.1) and posterior pelvic tilt (OR: 1.1; p = 0.042, 95% CI: 1.0-1.27). CONCLUSIONS In patients with severe DDH, it is important to pay close attention during THA using portable navigation. However, the average difference was < 5º even in patients with severe DDH, and the accuracy may be acceptable in a clinical setting when the cost is considered.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Lin CR, Chou H, Luo CA, Chang SH. A Novel Technique for Autograft Preparation Using Patient-Specific Instrumentation (PSI) Assistance in Total Hip Arthroplasty in Developmental Dysplasia of Hip (DDH). J Pers Med 2023; 13:1331. [PMID: 37763099 PMCID: PMC10532815 DOI: 10.3390/jpm13091331] [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: 07/19/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Due to the change in the structure of the proximal femur and acetabulum in patients with developmental dysplasia of the hip, total hip arthroplasty (THA) was difficult to perform for surgeons. To elevate the acetabular coverage rate, we developed a technique in the use of a patient-specific instrumentation (PSI) graft in patients with developmental dysplasia of hip (DDH) undergoing surgery. This study aims to evaluate the peri-operative outcomes of THA with PSI graft in patients with DDH. This study recruited 6 patients suffering from Crowe I DDH with secondary Grade IV osteoarthritis. All the patients underwent THA with PSI graft performed by a well-experienced surgeon. Perioperative outcomes included surgical procedures, blood loss during operation, the volume of blood transfusion, length of hospitalization, complications, and the mean difference in hemoglobin levels before and after surgery. All the outcomes analyzed were assessed by mean and standard deviation. The average duration of the surgical procedure was found to be 221.17 min, with an SD of 19.65 min. The mean blood loss during the operation was 733.33 mL, with an SD of 355.90 mL. The mean length of hospital stay was calculated to be 6 days, with an SD of 0.89 days. Furthermore, the mean difference between the pre- and postoperative hemoglobin levels was 2.15, with an SD of 0.99. A total of three patients received 2 units of leukocyte-poor red blood cells (LPR) as an accepted blood transfusion. There were no reported complications observed during the admission and one month after the operation. This study reported the peri-operative outcomes in the patients with DDH who underwent THA with PSI graft. We found that THA with PSI graft would provide a safe procedure without significant complications. We assumed that the PSI graft in THA may increase the coverage rate of the acetabulum, which may increase the graft union rates. Further cohort studies and randomized controlled trials were needed to confirm our findings.
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Affiliation(s)
- Chun-Ru Lin
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing Street, Guishan District, Taoyuan City 333423, Taiwan;
| | - Hsuan Chou
- School of Medicine, College of Medicine, Fu Jen Catholic University, No. 510, Zhongzheng Road, Xinzhuang District, New Taipei City 24205, Taiwan;
| | - Chu-An Luo
- Department of Precision Surgery Development, A Plus Biotechnology Co., Ltd., 6F, No. 23, Qiaohe Road, Zhonghe District, New Taipei City 23529, Taiwan;
| | - Shu-Hao Chang
- School of Medicine, College of Medicine, Fu Jen Catholic University, No. 510, Zhongzheng Road, Xinzhuang District, New Taipei City 24205, Taiwan;
- Department of Orthopedics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, No. 69, Guizi Road, Taishan District, New Taipei City 24352, Taiwan
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ÇATALTEPE A, İYETİN Y. The press-fit technique without screws and bone graft can be used as an alternative method in Crowe type II and III hip dysplasia. Turk J Med Sci 2023; 53:1448-1457. [PMID: 38813005 PMCID: PMC10763771 DOI: 10.55730/1300-0144.5712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/26/2023] [Accepted: 08/11/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim Developmental dysplasia of the hip (DDH) is the most common cause of secondary hip arthrosis. The primary purpose of this study was to assess the results of an oversized hemispherical cup via the press-fit technique used for Crowe type II and III DDH without screws and to determine if adequate medialization and initial stability of the acetabular component would allow us to avoid screw and graft use. Materials and methods Between February 2012 and May 2020, the current study analyzed 43 hips with Crowe type II and III DDH treated with a porous-coated cup by placing the press-fit technique or screw. The acetabular cup was fixed with the press-fit technique without additional screws in 27 hips and with screws in 16 hips. The inclusion criterion in this study was a minimum 2-year-period after the surgery. Results The mean duration of follow-up was 6.83 ± 2.67 years in the press-fit group and 6.21 ± 2.01 years in the screw group. The mean age of the patients was 47.96 ± 12.37 years in the press-fit group and 50.5 ± 12.37 years in the screw group. Measurements revealed that the hip center of rotation (HCR) was located more medially and superiorly postoperatively than preoperatively in both groups. The mean cup coverage in the screw group was 85.58% ± 7.51% (75.3%-97.2%), while it was less than 90.41% ± 6.15% (76.3%-98.2%) in the press-fit group (p = 0.038). No component was revised because of loosening, and all of the implants were radiologically stable within the observation period. No statistically significant differences were observed regarding the postoperative limp-length discrepancy between the groups (p = 0.496). Conclusion Press-fit implantation of a porous-coated acetabular component without screws can also be used as an alternative method for THA in Crowe type II and III DDH. The initial stability was obtained using the press-fit technique with a small cup positioned more medially and superiorly, which may allow the surgeon to avoid screw and graft use.
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Affiliation(s)
- Aziz ÇATALTEPE
- Department of Orthopedic Surgery and Traumatology, Medipol University, İstanbul,
Turkiye
| | - Yusuf İYETİN
- Department of Orthopedic Surgery and Traumatology, Pendik Hospital, İstanbul,
Turkiye
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Okutani Y, Kataoka M, Harada H, Kunishita T, Ryoki H, Arai R. A high body mass index tilts the pelvis caudally in the lateral decubitus position for total hip arthroplasty. Hip Int 2022; 33:371-376. [PMID: 35311359 DOI: 10.1177/11207000221084627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Accurate cup placement is essential for obtaining excellent outcomes in total hip arthroplasty (THA). We evaluated the pelvic lateral tilt of the patient (which affects the incline of the acetabular cup in THA) and investigated the factors affecting it. METHODS We reviewed the medical records of THA procedures performed at our hospital between October 2015 and January 2021 for which an anteroposterior pelvic radiograph was always taken preoperatively once the patient was placed in the lateral decubitus position. These radiographs were used to measure the lateral pelvic tilt in each case. We analysed whether patient factors (sex, body mass index [BMI], range of motion of abduction or adduction in both hips, surgical history of both hips, and lumbar Cobb angle) influenced the tilt. RESULTS We reviewed 363 cases (341 primary, 22 revision). The mean pelvic lateral tilt was 4.1°, and the operated hip was located on the caudal side compared to the unoperated hip. Statistical analyses revealed that the patient BMI and surgical history of the operated and unoperated hips significantly influenced tilt. CONCLUSIONS The pelvis in the lateral decubitus position leaned 4.1° to the caudal side, most commonly due to a high BMI. Surgeons should consider this when performing acetabular cup implantation in THA.
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Affiliation(s)
- Yuki Okutani
- Department of Orthopaedic Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Masanao Kataoka
- Department of Orthopaedic Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Hideto Harada
- Department of Orthopaedic Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | | | - Hayato Ryoki
- Department of Orthopaedic Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Ryuzo Arai
- Department of Orthopaedic Surgery, Kyoto Katsura Hospital, Kyoto, Japan
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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: 9] [Impact Index Per Article: 3.0] [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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Wang C, Yu D, Xu C, Li M, Zhong D, Wang L, Liu H, Li Y. Simulated operation combined with patient-specific instrumentation technology is superior to conventional technology for supramalleolar osteotomy: a retrospective comparative study. Am J Transl Res 2021; 13:6087-6097. [PMID: 34306347 PMCID: PMC8290754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/31/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Over the past seven years, our team has designed a simulated operation combined with patient-specific instrumentation (SO-PSI) assisted supramalleolar osteotomy (SMOT) method and applied it in the clinic. This study aimed to evaluate the differences between SO-PSI technology and conventional operation (CO) technology for SMOT in preoperative planning, intraoperative application, and postoperative curative effect. METHODS We retrospectively analyzed SMOT data collected from our hospital between October 2014 and December 2018. Patients (n = 28) were enrolled and divided into CO (n = 17) and SO-PSI (n = 11) groups; mean follow-up time was 33.4 (range, 13 to 59) months. We statistically analyzed and compared perioperative data, accuracy of preoperative planning, intraoperative application, difference between pre- and post-operative radiologic ankle angles, changes in American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analogue scale (VAS) score, range of ankle motion, and Takakura stage after surgery. RESULTS All ankle alignments and positions were recovered for both groups. Compared with the CO group, the SO-PSI group had a shorter mean operating time and postoperative hospital stay, a decreased number of fluoroscopy examinations, lower albumin reduction, longer preoperative planning time and preoperative hospital stay, and increased hospitalization expenses. In the SO-PSI group, comparison of ankle angles at preoperative planning and postoperatively revealed good correlation, while this was not the case in the CO group. Mean tibial ankle center discrepancy for the SO-PSI group was 1.86 ± 1.06 mm. On follow-up, all radiologic parameters for the two groups improved significantly; however, the improvement of the tibial anterior surface angle and tibiotalar tilt angle for the SO-PSI group were more obvious than those for the CO group. AOFAS score, VAS score, ankle range of motion, and Takakura stage improved after surgery in both groups; however, the improvements in the SO-PSI group were greater than those in the CO group overall. CONCLUSIONS SO-PSI technology can facilitate accurate and rapid preoperative planning for SMOT. In general, compared with conventional technology, SO-PSI has advantages for preoperative planning, intraoperative application, and postoperative curative effect.
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Affiliation(s)
- Chenggong Wang
- Department of Orthopedics, Xiangya Hospital Central South UniversityNo. 87 Xiangya Road, Changsha 410008, Hunan, China
- Department of Foot and Ankle Surgery, Xiangya Hospital Central South UniversityNo. 87 Xiangya Road, Changsha 410008, Hunan, China
| | - Dengjie Yu
- Department of Orthopedics, Xiangya Hospital Central South UniversityNo. 87 Xiangya Road, Changsha 410008, Hunan, China
| | - Can Xu
- Department of Orthopedics, Xiangya Hospital Central South UniversityNo. 87 Xiangya Road, Changsha 410008, Hunan, China
- Department of Foot and Ankle Surgery, Xiangya Hospital Central South UniversityNo. 87 Xiangya Road, Changsha 410008, Hunan, China
| | - Mingqing Li
- Department of Orthopedics, Xiangya Hospital Central South UniversityNo. 87 Xiangya Road, Changsha 410008, Hunan, China
- Department of Foot and Ankle Surgery, Xiangya Hospital Central South UniversityNo. 87 Xiangya Road, Changsha 410008, Hunan, China
| | - Da Zhong
- Department of Orthopedics, Xiangya Hospital Central South UniversityNo. 87 Xiangya Road, Changsha 410008, Hunan, China
| | - Long Wang
- Department of Orthopedics, Xiangya Hospital Central South UniversityNo. 87 Xiangya Road, Changsha 410008, Hunan, China
| | - Hua Liu
- Department of Orthopedics, Xiangya Hospital Central South UniversityNo. 87 Xiangya Road, Changsha 410008, Hunan, China
- Department of Foot and Ankle Surgery, Xiangya Hospital Central South UniversityNo. 87 Xiangya Road, Changsha 410008, Hunan, China
| | - Yusheng Li
- Department of Orthopedics, Xiangya Hospital Central South UniversityNo. 87 Xiangya Road, Changsha 410008, Hunan, China
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Efficacy Evaluation of 3D Navigational Template for Salter Osteotomy of DDH in Children. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8832617. [PMID: 34124261 PMCID: PMC8166498 DOI: 10.1155/2021/8832617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 05/17/2021] [Indexed: 02/07/2023]
Abstract
Background The aim of this study is to retrospectively evaluate the efficacy of 3D navigational template for Salter osteotomy of DDH in children. Methods Thirty-two consecutive patients with DDH who underwent Salter osteotomy were evaluated between July 2014 and August 2017, and they were divided into the conventional group (n = 16) and navigation template group (n = 16) according to different surgical methods. The corrective acetabular degrees, radiation exposure, and operation time were compared between the two groups. Results No nerve palsy or redislocation was reported in the navigation template group. Compared with the conventional group, the navigation template group had the advantages of more accurate acetabular degrees, less radiation exposure, and shorter operation time (P < 0.05). Meanwhile, the navigation template group achieved a better surgical outcome than the conventional group (McKay, P = 0.0293; Severin, P = 0.0949). Conclusions The 3D navigational template for Salter osteotomy of DDH is simple and effective, which could be an alternative approach to improve the Salter osteotomy accuracy and optimize the efficacy.
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Papachristou GC, Pappa E, Chytas D, Masouros PT, Nikolaou VS. Total Hip Replacement in Developmental Hip Dysplasia: A Narrative Review. Cureus 2021; 13:e14763. [PMID: 34094728 PMCID: PMC8168999 DOI: 10.7759/cureus.14763] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The reconstruction of the hip joint in patients suffering from developmental hip dysplasia (DDH) is a demanding procedure and presents many challenges to the reconstructive surgeon. Higher rates of mechanical complications are present in this group of patients. The results of cemented and uncemented implants used in DDH patients are very promising, according to recent outcomes. However, the surgeon has to be aware of several complications, in order to establish an uneventful surgical management of DDH. The specific article investigates the technical challenges and clinical results of total hip arthroplasty in patients with DDH.
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Affiliation(s)
- George C Papachristou
- 2nd Department of Orthopaedics, School of Medicine. National and Kapodistrian University of Athens, Athens, GRC
| | - Eleni Pappa
- 5th Department of Orthopaedics, "KAT" General Hospital of Athens, Athens, GRC
| | - Dimitrios Chytas
- Department of Orthopaedics, European University of Cyprus, Nicosia, CYP
| | | | - Vasileios S Nikolaou
- 2nd Department of Orthopaedics, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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Acetabular Bone Defect in Total Hip Arthroplasty for Crowe II or III Developmental Dysplasia of the Hip: A Finite Element Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4809013. [PMID: 32908892 PMCID: PMC7468597 DOI: 10.1155/2020/4809013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/08/2020] [Indexed: 11/17/2022]
Abstract
Background The purpose of this study was to establish the finite element analysis (FEA) model of acetabular bone defect in Crowe type II or III developmental dysplasia of the hip (DDH), which could evaluate the stability of the acetabular cup with different types of bone defects, different diameters of femoral ceramic heads, and the use of screws and analyze the stress distribution of screws. Methods The FEA model was based on the CT scan of a female patient without any acetabular bone defect. The model of acetabular bone defect in total hip arthroplasty for Crowe II or III DDH was made by the increasing superolateral bone defect area of the acetabular cup. Point A was located in the most medial part of the acetabular bone defect. A 52 mm PINNACLE cup with POROCOAT Porous coating was implanted, and two screws (the lengths were 25 mm and 40 mm) were implanted to fix the acetabular cup. The stability of the acetabular cup and the von Mises stress of point A and screws were analyzed by a single-legged stance loading applied in 1948 N (normal working). The different diameters of the femoral ceramic head (28 mm, 32 mm, and 36 mm) were also analyzed. Results The von Mises stress of point A was gradually increased with the increasing uncoverage values. When the uncoverage values exceeded 24.5%, the von Mises stress of point A without screws increased significantly, leading to instability of the cup. Screws could effectively reduce the von Mises stress of point A with uncoverage values of more than 24.5%. However, the peak von Mises stress in the screws with the uncoverage values that exceeded 24.5% was considerably increased. The diameter of the femoral ceramic head had no significant effect on the von Mises stress and the stability of the acetabular cup. Conclusions We recommend that uncoverage values of less than 24.5% with or without screw is safe for patients with Crowe II or III DDH.
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Xing QQ, Zhong D, Pan YX, An SB, Wang CG, Su SL, Wang L, Hu YH. A Comparative Study of Patients' Subjective Feelings Toward Total Hip Arthroplasty with Patient-Specific Instruments and Traditional Total Hip Arthroplasty. Orthop Surg 2020; 12:269-276. [PMID: 32077264 PMCID: PMC7031611 DOI: 10.1111/os.12626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/25/2019] [Accepted: 01/03/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To determine whether differences exist in patients' subjective feelings, daily life, and surgical satisfaction between those who underwent surgery for developmental dysplasia of the hip (DDH) using patient-specific instruments (PSIs) and those who underwent traditional surgical total hip arthroplasty (THA). METHODS We selected 30 adult patients with various types of DDH who underwent surgery during 2016-2017 at our hospital. The patients were divided into PSI surgery group and the traditional surgery group. All patients underwent follow-up, and we collected data on the Harris Hip Score, Oxford University Hip Score (OHS), Forgotten Joint Score (FJS-12), Visual Analogue Scale (VAS) score, patient satisfaction score, intraoperative surgical time, amount of bleeding and postoperative complications incidence for both groups. We then performed statistical analyses on the data. RESULTS The Harris Hip Score, OHS, VAS score, patient satisfaction score, and mean bleeding volume did not differ statistically significantly (t-tests, P > 0.05). No statistically significant differences were found between surgical groups in the incidence of complication and sub-trochanteric osteotomy, or in the surgical side (chi-square tests, P > 0.05). For the experimental group, the FJS-12 score was 80.0 ± 12.0, and for the control group the score was 68.5 ± 16.1. The operative time of the experimental group was 138.4 ± 32.2 min, while that of the control group was 88.9 ± 26.8 min. The values of these data differed significantly (t-tests, P < 0.05). CONCLUSIONS The novel PSI designed by our group has certain advantages for the short-term subjective feelings of patients after THA, but it may cause prolonged operative times.
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Affiliation(s)
- Qi-Qi Xing
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Da Zhong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yi-Xiao Pan
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Sen-Bo An
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Cheng-Gong Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Shi-Long Su
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Long Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yi-He Hu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
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Wang C, Ouyang Y, Liu H, Xu C, Xiao H, Hu Y, Li Y, Zhong D. Surgery simulation teaching based on real reconstruction aid versus traditional surgical live teaching in the acquisition of an adult total hip arthroplasty surgical technique for developmental dysplasia of the hip: a randomized comparative study. BMC MEDICAL EDUCATION 2020; 20:228. [PMID: 32690056 PMCID: PMC7370451 DOI: 10.1186/s12909-020-02135-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND A simulation and model (SM) teaching aid using 3D printing was developed to improve a training course for total hip arthroplasty of adult developmental dysplasia of the hip (adult DDH-THA). We named this new method Surgery Simulation Teaching based on a Real Reconstruction Aid (RRA-SST). A prospective randomized comparison was performed with the traditional surgical live teaching method to evaluate the training effectiveness of RRA-SST for adult DDH-THA. METHODS Twenty-six trainees, who were already practicing but were not experienced, participated in the study. We randomly divided the trainees into two groups: Group A (n = 13) received RRA-SST and group B (n = 13) received traditional surgical live teaching. A surgery simulation test and a questionnaire were used for evaluation. Next, each group received training with the other teaching method, and then the test and questionnaire were used again for evaluation. RESULTS After the first test, the RRA-SST method was shown to produce better results than the traditional surgical live teaching method. After the second test, the results showed the training effect in both groups reached the same level, which was level as Group A RRA-SST results. Analysis of the questionnaire results showed that the training effect of RRA-SST was higher than that of traditional surgical live teaching, from multiple perspectives. CONCLUSIONS The use of RRA-SST improved participant performance according to simulation assessment. RRA-SST can be helpful for trainees who are already practicing but not experienced when developing proficiency in adult DDH-THA surgical techniques.
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Affiliation(s)
- Chenggong Wang
- Office of teaching affairs, Xiangya Hospital, Central South University, Changsha, Hunan China
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Yang Ouyang
- Office of teaching affairs, Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Hua Liu
- Office of teaching affairs, Xiangya Hospital, Central South University, Changsha, Hunan China
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Can Xu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Han Xiao
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Yihe Hu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Yusheng Li
- Office of teaching affairs, Xiangya Hospital, Central South University, Changsha, Hunan China
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Da Zhong
- Office of teaching affairs, Xiangya Hospital, Central South University, Changsha, Hunan China
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan China
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12
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Wang M, Li D, Shang X, Wang J. A review of computer-assisted orthopaedic surgery systems. Int J Med Robot 2020; 16:1-28. [PMID: 32362063 DOI: 10.1002/rcs.2118] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/07/2020] [Accepted: 04/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Computer-assisted orthopaedic surgery systems have great potential, but no review has focused on computer-assisted surgery systems for the spine, hip, and knee. METHODS A systematic search was performed in Web of Science and PubMed. We searched the literature on computer-assisted orthopaedic surgery systems from 2008 to the present and focused on three aspects of systems: training, planning, and intraoperative navigation. RESULTS AND DISCUSSION In this review study, we reviewed 34 surgical training systems, 31 surgical planning systems, and 41 surgical navigation systems. The functions and characteristics of the surgical systems were compared and analysed, and the current concerns about and the impact of the surgical systems on doctors and surgery were clarified. CONCLUSION Computer-assisted orthopaedic surgery systems are still in the development stage. Future surgical training systems should include synthetic models with patient anatomy. Surgical planning systems with automatic planning should be developed, and surgical navigation systems with multimodal fusion, robotic assistance and imaging should be developed.
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Affiliation(s)
- Monan Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Donghui Li
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Xiping Shang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Jian Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
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13
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Wang C, Xu C, Li M, Li H, Xiao H, Zhong D, Liu H. Patient-specific instrument-assisted minimally invasive internal fixation of calcaneal fracture for rapid and accurate execution of a preoperative plan: A retrospective study. BMC Musculoskelet Disord 2020; 21:407. [PMID: 32593302 PMCID: PMC7321547 DOI: 10.1186/s12891-020-03439-3] [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: 02/05/2020] [Accepted: 06/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Traditional methods for minimally invasive internal fixation (MIIF) of calcaneal fractures require extensive intraoperative fluoroscopy, and fracture recovery is usually not ideal. We developed a new surgical procedure using digital surgical simulation and constructed a patient-specific instrument (PSI) for calcaneal fracture that we used during the operation. This study investigated whether PSI-assisted MIIF of calcaneal fracture enables rapid and accurate execution of the preoperative plan. Methods We retrospectively analyzed patients with Sanders type III or IV fresh calcaneal fractures who had undergone PSI-assisted MIIF at our hospital from January 2016 to December 2018. We analyzed perioperative data including intraoperative fluoroscopy time, concurrence of internal fixation actual usage (IFAU) with the preoperative plan, surgery time, and complications. We also compared pre- and postoperative actual measurements from X-ray radiographs and computed tomography images including Böhler, Gissane, and calcaneus valgus angles; subtalar joint width; and calcaneal volume overlap ratio with the preoperative design. All patients had been followed up and their American Orthopedic Foot and Ankle Score (AOFAS) score was available. Results Mean intraoperative fluoroscopy time was 3.95 ± 1.78 h; IFAU in 16 patients (16 ft) was the same as the preoperative plan; mean surgery time was 28.16 ± 10.70 min; and none of the patients developed complications. Böhler, Gissane, and calcaneus valgus angles and subtalar joint width did not differ between pre- and postoperative plans; however, the actual preoperative values of each of these parameters differed significantly from those measured postoperatively. The calcaneal volume overlap ratio with the preoperative design was 91.2% ± 2.3%. AOFAS scores increased with time, with significant differences in the score at each time point. Conclusions The newly developed PSI-assisted calcaneal fracture MIIF method can rapidly and accurately execute the preoperative plan.
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Affiliation(s)
- Chenggong Wang
- Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.,Department of foot and ankle surgery, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Can Xu
- Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.,Department of foot and ankle surgery, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Mingqing Li
- Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.,Department of foot and ankle surgery, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Hui Li
- Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.,Department of foot and ankle surgery, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Han Xiao
- Department of Sports Medicine, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Da Zhong
- Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Hua Liu
- Department of Orthopedics, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China. .,Department of foot and ankle surgery, Xiangya Hospital Central South University, No.87 Xiangya Road, Changsha, 410008, Hunan, China.
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14
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Xiao H, Wang C, Zhong D, Lei P, Hu Y, Su S. Effect of patient-specific instrument on lowering threshold for junior physicians to perform total hip arthroplasty on developmental dysplasia of the hip patients. INTERNATIONAL ORTHOPAEDICS 2020; 44:1281-1286. [PMID: 32405884 DOI: 10.1007/s00264-020-04599-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/27/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE To create a patient-specific instrument (PSI) in lowering the surgical experience requirement for junior physicians to perform total hip arthroplasty (THA) on developmental dysplasia of the hip (DDH) patients. METHODS Combined with rapid prototyping technology, we created a PSI and established DDH hip model in vitro. We enrolled 48 junior physicians and randomly assigned them into two groups. After creation of the PSI, they performed simulated THA surgery on a full-scale hip model with or without PSI on DDH models. The planned prothesis orientation, post-operative prothesis orientation, and surgery time were recorded. RESULTS The final cup inclination was 42.0 ± 0.8° in PSI group and 37.8 ± 2.0° in control group, while final cup anteversion was 16.0 ± 0.7° in PSI group and 24.7 ± 3.5° in control group. The △inclination in PSI group was smaller than that in control group (4.2 ± 0.5° vs 9.5 ± 1.4°, P < 0.01), so does △inclination (2.9 ± 0.4° in PSI group vs 15.2 ± 2.5° in control group, P < 0.01). The outlier percent was 8.3% in PSI group and 70.8% in control group (P < 0.01). At the same time, the PSI group did not prolong the operation time (P = 0.551). CONCLUSION The PSI can greatly increase the accuracy of placing the cup orientation and lower the threshold for junior physicians to perform THA on DDH patients. It could be a training tool for them to increase their THA surgical skills.
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Affiliation(s)
- Han Xiao
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Digital Orthopaedic Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chenggong Wang
- Digital Orthopaedic Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Da Zhong
- Digital Orthopaedic Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China. .,Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Pengfei Lei
- Digital Orthopaedic Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yihe Hu
- Digital Orthopaedic Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shilong Su
- Digital Orthopaedic Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
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15
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Yan L, Wang P, Zhou H. 3D Printing Navigation Template Used in Total Hip Arthroplasty for Developmental Dysplasia of the Hip. Indian J Orthop 2020; 54:856-862. [PMID: 33133409 PMCID: PMC7572928 DOI: 10.1007/s43465-020-00093-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/18/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of our study was to explore the feasibility of 3D printing navigation template used in total hip arthroplasty (THA) for adult developmental dysplasia of the hip (DDH). MATERIALS AND METHODS 25 patients who received THA for DDH from February 2014 to May 2018 were randomized into the control or intervention group. Of these patients, 12 received THAs assisted with 3D printing navigation templates, 13 THAs underwent THAs without navigation templates. The mean follow-up was 1.6 (range, 1.2-3.8) years. Clinical scores and radiographic results were evaluated for two groups. RESULTS Operating time, intra- and postoperative hemorrhage and Harris Hip Score (HHS) at 6 months postoperatively in the 3D printing group were better than those for patients in the conventional hip replacement group, while infection and implant loosening were 0 in the two groups. There were no significant differences in anteversion angle, abduction angle and the distance from rotation center to the ischial tuberosity line in 3D printing group as compared to the normal side. The abduction angle and the distance from rotation center to the ischial tuberosity line were significantly different between the two sides in the traditional group. CONCLUSION Application of the 3D printing template for THA with DDH can facilitate the surgical procedure and create an ideal artificial acetabulum placement.
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Affiliation(s)
- Liang Yan
- grid.263761.70000 0001 0198 0694Department of Orthopedics, The Second Affiliate Hospital of Soochow University, Soochow, 215000 Jiangsu China ,Department of Orthopedics, Nantong Rich Hospital, Nantong, 226300 Jiangsu China
| | - Peng Wang
- Department of Orthopedics, Nantong Rich Hospital, Nantong, 226300 Jiangsu China
| | - Haibin Zhou
- grid.263761.70000 0001 0198 0694Department of Orthopedics, The Second Affiliate Hospital of Soochow University, Soochow, 215000 Jiangsu China
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16
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Lei PF, Su SL, Kong LY, Wang CG, Zhong D, Hu YH. Mixed Reality Combined with Three-Dimensional Printing Technology in Total Hip Arthroplasty: An Updated Review with a Preliminary Case Presentation. Orthop Surg 2020; 11:914-920. [PMID: 31663276 PMCID: PMC6819179 DOI: 10.1111/os.12537] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/18/2019] [Accepted: 08/20/2019] [Indexed: 12/19/2022] Open
Abstract
Three-dimensional (3D) printing technology, virtual reality, and augmented reality technology have been used to help surgeons to complete complex total hip arthroplasty, while their respective shortcomings limit their further application. With the development of technology, mixed reality (MR) technology has been applied to improve the success rate of complicated hip arthroplasty because of its unique advantages. We presented a case of a 59-year-old man with an intertrochanteric fracture in the left femur, who had received a prior left hip fusion. After admission to our hospital, a left total hip arthroplasty was performed on the patient using a combination of MR technology and 3D printing technology. Before surgery, 3D reconstruction of a certain bony landmark exposed in the surgical area was first performed. Then a veneer part was designed according to the bony landmark and connected to a reference registration landmark outside the body through a connecting rod. After that, the series of parts were made into a holistic reference registration instrument using 3D printing technology, and the patient's data for bone and surrounding tissue, along with digital 3D information of the reference registration instrument, were imported into the head-mounted display (HMD). During the operation, the disinfected reference registration instrument was installed on the selected bony landmark, and then the automatic real-time registration was realized by HMD through recognizing the registration landmark on the reference registration instrument, whereby the patient's virtual bone and other anatomical structures were quickly and accurately superimposed on the real body of the patient. To the best of our knowledge, this is the first report to use MR combined with 3D printing technology in total hip arthroplasty.
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Affiliation(s)
- Peng-Fei Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Shi-Long Su
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Ling-Yu Kong
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Cheng-Gong Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Da Zhong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yi-He Hu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
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