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Vorimore C, Innmann M, Mavromatis S, Speirs A, Verhaegen JCF, Merle C, Grammatopoulos G. Impact of Offset and Leg Length on Functional Outcomes Post-Total Hip Arthroplasty: How Accurate Should Coronal Reconstruction Be? J Arthroplasty 2024; 39:S332-S339.e2. [PMID: 38897260 DOI: 10.1016/j.arth.2024.06.017] [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: 12/11/2023] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Accurate hip reconstruction is associated with improved biomechanical behavior following total hip arthroplasty (THA). However, whether this is associated with improved patient-reported outcomes (PROs) is unknown. HYPOTHESIS/PURPOSE This study aimed to: 1) describe the ability to reconstruct coronal geometry during THA without advanced technology; 2) assess whether restoration of global offset (GO) and leg length (LL) is associated with improved PROs; and 3) investigate whether increased femoral offset (FO) to compensate for reduced acetabular offset (AO) influences PROs. METHOD This was a prospective, multicenter, consecutive cohort study of 500 patients treated with primary THA without robotics or navigation. The Oxford Hip score (OHS) was obtained preoperatively and at 1-year follow-up. Supine anteroposterior pelvic radiographs were analyzed to determine AO, FO, GO, and LL relative to the native contralateral side. Contour plots for ΔOHS based on ΔLL and ΔGO were created, and ΔOHS was calculated within and outside various ranges (±2.5, ±5, or ±10 mm). RESULTS In the operated hip, mean FO increased by 3 ± 6 mm (range, -16 to 27), while AO decreased by 2 ± 4 mm (range, -17 to 10). The contour graph for ±2.5 mm zones showed the best outcomes (ΔOHS >25) with GO and LL centered on 0 ± 2.5 mm (P < .01). However, only 10% achieved such reconstruction. When GO and LL differences were within ±10 mm, ΔOHS was superior when both AO and FO were within ±5 mm (mean: 24 ± 10; range, -5 to 40) compared with when FO was above 5 mm to compensate for a reduction in AO (mean: 22 ± 11; range, -10 to 46; P = .040). CONCLUSIONS The PROs were associated with biomechanical reconstruction, and the best clinical improvement can be expected when GO and LL differences are both within 2.5 mm. Maintenance of AO is important, as compensation by increasing FO is associated with inferior OHS.
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Affiliation(s)
- Camille Vorimore
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Moritz Innmann
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Orthopaedic Surgery, Heidelberg University, Heidelberg, Germany
| | | | - Andrew Speirs
- Department of Mechanical and Aerospace Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Jeroen C F Verhaegen
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Orthopaedic Surgery, University Hospital Antwerp, Edegem, Belgium; Orthopaedic Centre Antwerp, AZ Monica, Antwerp, Belgium
| | - Christian Merle
- Department of Orthopaedic Surgery, Diakonie-Klinikum, Stuttgart, Germany
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Aubert T, Gerard P, Galanzino G, Marmor S. In silico analysis of the patient-specific acetabular cup anteversion safe zone. Orthop Traumatol Surg Res 2024:103940. [PMID: 39043498 DOI: 10.1016/j.otsr.2024.103940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Various computer-assisted surgical systems claim to improve the accuracy of cup placement in total hip arthroplasties after assessing spinopelvic mobility to prevent prosthetic impingement. However, no study has yet analyzed the extent of the patient-specific cup anteversion safe zones. HYPOTHESIS We hypothesized that most patients have a safe zone >10 °, except those with abnormal spinopelvic mobility, who have a much narrower safe zone. MATERIALS AND METHODS We simulated the risks of prosthetic impingement using the planned cup anteversion. The consecutive cohort included 341 patients who underwent total hip arthroplasty. Our primary endpoint was the patient-specific impingement-free zone for cup anteversion, which was then divided into four subgroups: 0 °, 1 ° to 5 °, 6 ° to 10 °, and >10 °. This data was then secondarily analyzed for abnormal spinopelvic mobility (the difference in the spinopelvic tilt [ΔSPT] from a standing to a flexed seated position >20 °). RESULTS The mean anteversion safe zone was 22.8 ° with 82.4% (281/341) of patients with a zone strictly >10 °. The mean safe zone was 8.9 ° (+/- 9 °) in patients with an ΔSPT ≥20 ° (18.2%), with 37.1% of these patients having a zone of 0 °, 16.13% a zone between 1 ° and 5 °, 8.06% a zone between 6 ° and 10 ° and 38.71% a zone >10 °. The mean safe zone was 25.9 ° (+/- 9 °) in patients with an ΔSPT <20 ° (81.8%), and the proportion of cases in each zone was 2.51%, 1.08%, 4.3%, and 92.11%, respectively (p < 0.001). CONCLUSION The safe zone for anteversion appears to be fairly wide in most patients. However, identifying patients at risk of abnormal spinopelvic mobility seems necessary to identify the two-thirds of patients with a narrow safe zone. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Thomas Aubert
- Orthopedic Department, Croix St Simon Hospital 125 rue d'Avron, 75020 Paris, France.
| | - Philippe Gerard
- Orthopedic Department, Croix St Simon Hospital 125 rue d'Avron, 75020 Paris, France
| | - Giacomo Galanzino
- Orthopedic Department, Croix St Simon Hospital 125 rue d'Avron, 75020 Paris, France
| | - Simon Marmor
- Orthopedic Department, Croix St Simon Hospital 125 rue d'Avron, 75020 Paris, France
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Naito Y, Hasegawa M, Tone S, Wakabayashi H, Sudo A. Accuracy of cup placement and pelvic motion in total hip arthroplasty in the lateral decubitus position using a new computed tomography-based navigation system with augmented reality technology. Arch Orthop Trauma Surg 2024; 144:2381-2389. [PMID: 38554208 DOI: 10.1007/s00402-024-05284-8] [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: 11/20/2023] [Accepted: 03/10/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION This study aimed to investigate the accuracy of cup position and assess the changes in pelvic tilt during primary total hip arthroplasty (THA) in the lateral decubitus position using a new computed tomography (CT)-based navigation system with augmented reality (AR) technology. MATERIALS AND METHODS There were 37 cementless THAs performed using a CT-based navigation system with AR technology in the lateral decubitus position and 63 cementless THAs performed using manual implant techniques in the lateral decubitus position in this retrospective study. Postoperative cup radiographic inclination and anteversion were measured using postoperative CT, and the proportion of hips within Lewinnek's safe zone was analyzed and compared between the two groups. The mean absolute values of navigation error were assessed. Intraoperative pelvic tilt angles were also recorded using navigation system. RESULTS The percentage of cups inside Lewinnek's safe zone was 100% in the navigation group and 35% in the control group (p < 0.001). The mean absolute values of navigation error in inclination and anteversion were 2.9° ± 2.1° and 3.3° ± 2.4°, respectively. The mean abduction angle of the pelvis was 5.1° ± 4.8° after placing the patients in the lateral decubitus position and 4.1° ± 6.0° after cup placement. The mean posterior tilt angle was 6.8° ± 5.1° after placing the patients in the lateral decubitus position and 9.3° ± 5.9° after cup placement. The mean internal rotation angle was 14.8° ± 7.4° after cup placement. There were no correlations between the navigation error in inclination or anteversion and the absolute values of changes of the pelvic tilt angle at any phase. CONCLUSIONS Although progressive pelvic motion occurred in THA in the lateral decubitus position, especially during cup placement, the CT-based navigation system with AR technology improved cup placement accuracy.
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Affiliation(s)
- Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
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Sarpong NO, Rodriguez S, Kuyl EV, Lyman S, Della Valle AG, Vigdorchik JM, Rodriguez JA. Dislocation Following Anterior and Posterior Total Hip Arthroplasty in the Setting of Spinal Deformity and Stiffness: Evolving Trends Using a High-Risk Protocol at a Single Tertiary Center. J Arthroplasty 2024; 39:1019-1024.e1. [PMID: 37918487 DOI: 10.1016/j.arth.2023.10.041] [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: 07/23/2023] [Revised: 10/16/2023] [Accepted: 10/21/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Patients who have spinal stiffness and deformity are at the highest risk for dislocation after total hip arthroplasty (THA). Previous reports of this cohort are limited to antero-lateral and postero-lateral (PL) approaches. We investigated the dislocation rate after direct anterior (DA) and PL approach THA with a contemporary high-risk protocol to optimize stability. METHODS We investigated patients undergoing THA who had preoperative biplanar imaging from January-December 2019. Patients were identified using radiographic criteria of spinal-stiffness (<10-degree change in sacral slope from standing to seated) and deformity (flatback deformity with >10-degree difference in pelvic incidence and lumbar lordosis). There were 367 patients identified (181 DA, 186 PL). The primary outcome was dislocation rate at 2-years postoperatively. Risk-factors for dislocation were evaluated using logistic regressions (significance level of 0.05). RESULTS There were 6 (1.6%) dislocations in the entire cohort, with low dislocation rates for both DA (0.6%) and PL-THA (2.7%). We observed increased utilization of dual mobility with larger outer head bearings (>38 mm) with PL-THA (34.4 versus 5.0%, P < .01) and conversely increased utilization of 32-mm femoral-heads with DA-THA (39.4 versus 7.0%, P < .001). Surgical approach (PL) was not a significant risk-factor for dislocation (odds ratio: 5.03, P = .15). Patients who had a history of lumbar-fusion had 8-times higher odds for dislocation (OR: 8.20, P = .020). CONCLUSIONS To the best of our knowledge, this is the largest series to date evaluating DA and PL-THA in the hip-spine 2B-group. Our results demonstrate lower dislocation rate than expected with either surgical approach using a high-risk protocol.
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Affiliation(s)
- Nana O Sarpong
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Samuel Rodriguez
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Emile-Victor Kuyl
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Stephen Lyman
- Department of Biostatistics, Hospital for Special Surgery, New York, New York
| | | | | | - Jose A Rodriguez
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
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Tamaki Y, Goto T, Wada K, Omichi Y, Hamada D, Sairyo K. Robotic arm-assisted total hip arthroplasty via a minimally invasive anterolateral approach in the supine position improves the precision of cup placement in patients with developmental dysplasia of the hip. J Orthop Sci 2024; 29:559-565. [PMID: 36801090 DOI: 10.1016/j.jos.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/02/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND This study evaluated the accuracy of the cup alignment angles and spatial cup positioning on computed tomography (CT) images in patients with osteoarthritis secondary to developmental dysplasia of the hip (DDH) who underwent total hip arthroplasty (THA) using a minimally invasive technique via an anterolateral approach in the supine position according to whether a robotic arm-assisted system or a CT-based navigation system was used. METHODS We reviewed 60 robotic arm-assisted (RA)-THA cases and 174 navigation-assisted (NA)-THA cases. After propensity score matching, there were 52 hips in each group. Postoperative cup alignment angles and position were assessed by superimposition of a three-dimensional cup template onto the actual implanted cup using postoperative CT images with pelvic coordinates matching the preoperative planning. RESULTS The mean absolute error of the inclination angle and the anteversion angle between the preoperative planning and the postoperative measurement was significantly smaller in the RA-THA group (inclination, 1.1° ± 0.9; anteversion, 1.3° ± 1.0) than in the NA-THA group (inclination, 2.2° ± 1.5; anteversion, 3.3° ± 2.5). For acetabular cup positioning, the mean discrepancy between the preoperative planning and the postoperative measurement was 1.3 ± 1.3 mm on the transverse axis, 2.0 ± 2.0 mm on the longitudinal axis, and 1.3 ± 1.7 mm on the sagittal axis in the RA-THA group and 1.6 ± 1.4 mm, 2.6 ± 2.3 mm, and 1.8 ± 1.3 mm, respectively, in the NA-THA group. High precision of cup positioning was observed in both groups with no statistically significant difference. CONCLUSION Robotic arm-assisted THA using a minimally invasive technique via an anterolateral approach in the supine position allows accurate cup placement in patients with DDH.
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Affiliation(s)
- Yasuaki Tamaki
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan
| | - Tomohiro Goto
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan.
| | - Keizo Wada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan
| | - Yasuyuki Omichi
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan
| | - Daisuke Hamada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima City, Tokushima 770-8503, Japan
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Kurmis AP, Lourens EC. Quantifying anterior pelvic roll during total hip arthroplasty in the lateral decubitus position. J Orthop Surg Res 2023; 18:863. [PMID: 37957756 PMCID: PMC10644623 DOI: 10.1186/s13018-023-04350-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/29/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Unintended pelvic positional change is an acknowledged intra-operative problem for hip arthroplasty, seen commonly with procedures performed in the lateral position. If unrecognised, such changes can dramatically alter final acetabular component anteversion potentially resulting in suboptimal construct performance. It has previously been suggested that pelvic roll of just 13° may be enough to place an otherwise perfectly orientated cup outside of conventional ± 10° safe zones. Using the real-time tracking capacity of a commercially available optical navigation system, we aimed to accurately quantify pelvic roll occurring during total hip arthroplasties (THAs) performed in the decubitus position. METHODS Prospectively collected data for 107 consecutive, unilateral, THAs were interrogated to determine the magnitude of pelvic movement around a central longitudinal axis (i.e. AP roll). Correlation statistics with patient age and body mass index (BMI) were also calculated. RESULTS A mean pelvic roll of 9.5° was observed, being anterior in 96% of cases. Of these, 18.3% of hips had a magnitude of roll greater than 13°. There were no statistically significant independent correlations observed between age (p = 0.87) or BMI (p = 0.59) and mean roll. CONCLUSIONS Errors in achieving acetabular target version may result in numerous post-operative concerns including instability/dislocation, bearing wear, squeaking, range-of-movement limitation and increased revision rate. In a general cohort, our findings suggest a mean anterior pelvic roll during THA of nearly 10°. Without purposeful correction, this may cause substantial deviation from intended target positions. Future work is indicated to map changing pelvic roll during THA which is likely to follow a nonlinear trajectory. Level of evidence: IV. .
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Affiliation(s)
- Andrew P Kurmis
- Discipline of Medical Specialties, University of Adelaide, Adelaide, SA, Australia.
- Department of Orthopaedic Surgery, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA, 5112, Australia.
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
| | - Ernest C Lourens
- Department of Orthopaedic Surgery, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA, 5112, Australia
- Department of Orthopaedic Surgery, Mount Gambier Hospital, Mount Gambier, SA, Australia
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Antoniades S, McGoldrick NP, Meermans G, Beaulé PE, Grammatopoulos G. Contemporary, non-navigation, cup orientation techniques improve accuracy and eliminate differences seen between the anterior and posterior approach in THA. Hip Int 2023; 33:977-984. [PMID: 36852719 DOI: 10.1177/11207000231156543] [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] [Indexed: 03/01/2023]
Abstract
BACKGROUND This study aimed to: (1) Determine the ability to achieve the surgeons' desired cup orientation, without navigation, using contemporary measures with the anterior- (AA) and posterior- approaches (PA); and (2) assess whether surgical approach is associated with cup orientation accuracy, as previously reported, when contemporary measures are used. METHODS A prospective, 2-centre, multi-surgeon study of 400 THAs (200 AA; 200 PA) was performed. Intraoperative radiographs were obtained with the AA. A digital inclinometer and 3-point pelvic support were used with the PA. With the PA, intraoperative cup inclination at impaction was recorded. Radiographic inclination/anteversion (RI/RA) was measured from intraoperative radiographs (AA-only) and from postoperative radiographs for all cases. Optimum inclination/anteversion was defined as 40°/20° (±10°). The difference between intra- and postoperative orientations allowed for determination of the difference in pelvic position at impaction. RESULTS Optimum RI and RA were achieved in 91.3% (n = 365) and 92% (n = 368) of cases respectively. Optimum cup orientation was detected in 84% of cases (n = 336). There was equivalent ability to achieve cup orientation between approaches (AA: 82.5% vs. PA: 85.5%; p = 0.41). The use of an inclinometer in the PA was associated with a smaller variability of inclination at implantation (10° vs. 14°) and counteracted the greater difference in pelvic position (4.4° vs. 2.1°) seen with the PA. CONCLUSIONS Over 80% of cases can have optimum orientation without navigation, using simple, cheap contemporary measures. Such measures eliminate differences between approaches, related to patient position. Narrower implantation angles will further reduce variability in cup orientation achieved.
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Affiliation(s)
| | - Niall P McGoldrick
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Geert Meermans
- Department of Orthopaedics, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
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Ma M, Song P, Zhang S, Kong X, Chai W. Does robot-assisted surgery reduce leg length discrepancy in total hip replacement? Robot-assisted posterior approach versus direct anterior approach and manual posterior approach: a propensity score-matching study. J Orthop Surg Res 2023; 18:445. [PMID: 37344859 PMCID: PMC10286345 DOI: 10.1186/s13018-023-03864-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/18/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Advocates of robot-assisted technique argue that robots could improve leg length restoration in total hip replacement. However, there were few studies to compare the robot-assisted posterior approach (RPA) with conventional posterior approach (PA) THA and direct anterior approach (DAA) THA in LLD. This study aimed to determine whether robot-assisted techniques could significantly reduce LLD compared to manual DAA and manual PA. METHODS We retrospectively reviewed the cohort of consecutive ONFH patients who underwent THA robot-assisted posterior, manual posterior, and manual DAA from January 2018 to December 2020 in one institution. One experienced surgeon performed all procedures. We calculated the propensity score to match similar patients in different groups by multivariate logistic regression analysis for each patient. We included confounders consisting of age at the time of surgery, sex, body mass index (BMI), and preoperative LLD. Postoperative LLD and Harris hip scores (HHS) at two years after surgery of different cohorts were compared. RESULT We analyzed 267 ONFH patients treated with RPA, DAA, or PA (73 RPA patients, 99 DAA patients, and 95 PA patients). After propensity score matching, we generated cohorts of 40 patients in DAA and RPA groups. And we found no significant difference in postoperative LLD between RPA and DAA cohorts (4.10 ± 3.50 mm vs 4.60 ± 4.14 mm, p = 0.577) in this study. The HHS at 2 years postoperatively were 87.04 ± 7.06 vs 85.33 ± 8.34 p = 0.202. After propensity score matching, we generated cohorts of 58 patients in manual PA and RPA groups. And there were significant differences in postoperative LLD between the RPA and PA cohorts. (3.98 ± 3.27 mm vs 5.38 ± 3.68 mm, p = 0.031). The HHS at 2 years postoperatively were 89.38 ± 6.81 vs 85.33 ± 8.81 p = 0.019. After propensity score matching, we generated cohorts of 75 patients in manual DAA and PA groups. And there were significant differences in postoperative LLD between the DAA and PA cohorts. (4.03 ± 3.93 mm vs 5.39 ± 3.83 mm, p = 0.031) The HHS at 2 years postoperatively were 89.71 ± 6.18 vs 86.91 ± 7.20 p = 0.012. CONCLUSION This study found no significant difference in postoperative LLD between RPA and DAA, but we found a significant difference between RPA and manual PA, DAA and manual PA in ONFH patients. We found a significant advantage in leg length restoration in primary total hip arthroplasty with robot-assisted surgery.
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Affiliation(s)
- Mingyang Ma
- Chinese PLA Medical School, Beijing, China
- Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Fuxing Road No. 28, Haidian, Beijing, China
- National Clinical Research Center for Orthopedics Sports Medicine and Rehabilitation, Beijing, China
| | - Ping Song
- Chinese PLA Medical School, Beijing, China
- Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Fuxing Road No. 28, Haidian, Beijing, China
- National Clinical Research Center for Orthopedics Sports Medicine and Rehabilitation, Beijing, China
| | - Shuai Zhang
- Chinese PLA Medical School, Beijing, China
- Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Fuxing Road No. 28, Haidian, Beijing, China
- National Clinical Research Center for Orthopedics Sports Medicine and Rehabilitation, Beijing, China
| | - Xiangpeng Kong
- Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Fuxing Road No. 28, Haidian, Beijing, China
- National Clinical Research Center for Orthopedics Sports Medicine and Rehabilitation, Beijing, China
| | - Wei Chai
- Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Fuxing Road No. 28, Haidian, Beijing, China
- National Clinical Research Center for Orthopedics Sports Medicine and Rehabilitation, Beijing, China
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Papalia GF, Zampogna B, Albo E, Torre G, Villari E, Papalia R, Denaro V. The role of patient surgical positioning on hip arthroplasty component placement and clinical outcomes: a systematic re-view and meta-analysis. Orthop Rev (Pavia) 2023; 15:74116. [PMID: 37064045 PMCID: PMC10097590 DOI: 10.52965/001c.74116] [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: 04/18/2023] Open
Abstract
Total Hip Arthroplasty (THA) may be performed through various approaches; however, depending on the surgical position of the patient, the superiority of lateral or supine position is still debated. The aim of this systematic review and meta-analysis was to compare the supine versus lateral position in THA in terms of intraoperative and postoperative outcomes and component placement. The systematic literature search was performed by the use of Cochrane Central, Pub-Med-Medline, and Google Scholar in order to select studies that evaluated clinical outcomes and the outliers of cup alignment for inclination and anteversion between supine and lateral position for hip arthroplasty. Finally, 9 articles were included in this review. The meta-analysis showed no significant differences between the two groups for clinical outcomes, unless for blood loss and VAS (respectively p = 0.05 and p = 0.004 in favour of lateral decubitus). Regarding the number of outliers, the supine decubitus showed significant differences only for the cup anteversion (p = 0.01). However, more prospective studies with a longer follow-up that analyze both clinical and radiological parameters are needed to assess the superiority of supine or lateral patient position for total hip arthroplasty.
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Affiliation(s)
- Giuseppe Francesco Papalia
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Biagio Zampogna
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Erika Albo
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Guglielmo Torre
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Eleonora Villari
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery Campus Bio-Medico University of Rome
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Koster M, Luzier AD, Temmerman OPP, Vos SJ(CJ, Benner JL. How do dislocation rates differ between different approaches to total hip arthroplasty? A systematic review and meta-analysis. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2023. [DOI: 10.1177/22104917221147688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Different surgical approaches for total hip arthroplasty (THA) exist, without predisposition when it comes to dislocation risk. The direct anterior approach (DAA) is thought to have reduced risk since soft tissue trauma is minimalized. Therefore, we assessed the dislocation risk for different surgical approaches, and the relative dislocation risk of DAA compared to other approaches. Methods: Six electronic databases were systematically searched for prospective studies reporting dislocation following THA. Proportion meta-analyses were performed to assess the dislocation rate for subgroups of the surgical approach. Meta-analysis for binary outcomes was performed to determine the relative risk of dislocation for the DAA compared to other approaches. Results: Eleven studies with 2025 patients were included (mean age 64.6 years, 44% male, mean follow-up 10.5 months), of which four studies were also used in the risk ratio meta-analysis. Overall dislocation rate was 0.79% (95% CI 0.37–1.69). Subgroup analyses showed that most dislocations occurred in the posterior approaches group (1.38%), however non-significant. Furthermore, the DAA emerged with a non-significant lower risk of dislocation (RR 0.37, 95% CI 0.05–2.46) compared to other surgical approaches. Conclusion: Current literature shows non-significant predisposition for a surgical approach to THA regarding dislocation risk. To what extent patient characteristics influence the risk of dislocation could not be determined. Future research should focus on this, as well as on the influence of a surgeon's experience with a specific approach.
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Affiliation(s)
- Marc Koster
- Department of Orthopedic Surgery, CORAL Centre for Orthopedic Research Alkmaar, Northwest Clinics, Alkmaar, The Netherlands
| | - Anton D Luzier
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Olivier PP Temmerman
- Department of Orthopedic Surgery, CORAL Centre for Orthopedic Research Alkmaar, Northwest Clinics, Alkmaar, The Netherlands
| | - Stan J (CJ) Vos
- Department of Orthopedic Surgery, CORAL Centre for Orthopedic Research Alkmaar, Northwest Clinics, Alkmaar, The Netherlands
| | - Joyce L Benner
- Department of Orthopedic Surgery, CORAL Centre for Orthopedic Research Alkmaar, Northwest Clinics, Alkmaar, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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11
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Cho E, Hisatome T, Oda S, Fujimaki H, Nakanishi K. Accuracy of acetabular cup placement during anterolateral supine total hip arthroplasty using intraoperative fluoroscopy: a retrospective study. J Orthop Surg Res 2022; 17:523. [PMID: 36471354 PMCID: PMC9720972 DOI: 10.1186/s13018-022-03422-9] [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: 10/23/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In our institution, total hip arthroplasty (THA) is performed using the anterolateral supine (ALS) approach with intraoperative fluoroscopy. This study aimed to investigate and review the accuracy of acetabular cup placement in ALS-THA using intraoperative fluoroscopy. METHODS A total of 142 patients with 154 joints (mean age 64.3 years, 30 males and 112 females) underwent ALS-THA with intraoperative fluoroscopy at the same institution. The target angle of the cup position was set at 40° for radiographic inclination (RI) and 5°-25° for radiographic anteversion (RA) based on the functional pelvic plane according to the pelvic motion during individual postural changes. The cup position angle was measured using postoperative computed tomography, and the error in the target angle was investigated. RESULTS The target angle of RI was 40°, and the postoperative RI was 39.3° ± 4.3°. The target angle of the RA was 17° ± 2.6°, and the postoperative RA was 20.6° ± 3.7°. The absolute values of the error from the target angle were 3.6° ± 2.5° for RI and 4.2° ± 3.3° for RA. For RI and RA, 67.5% (104/154 joints) were within ± 5° of the target and 96.1% (148/154 joints) were within ± 10°. CONCLUSIONS The accuracy of cup positioning in ALS-THA using intraoperative fluoroscopy was good and appeared comparable to that of various navigation systems.
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Affiliation(s)
- Eiji Cho
- grid.495549.00000 0004 1764 8786Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Takashi Hisatome
- grid.412178.90000 0004 0620 9665Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Shuhei Oda
- grid.412178.90000 0004 0620 9665Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Hirohisa Fujimaki
- grid.412178.90000 0004 0620 9665Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan
| | - Kazuyoshi Nakanishi
- grid.495549.00000 0004 1764 8786Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
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12
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McGoldrick NP, Antoniades S, El Meniawy S, Kreviazuk C, Beaulé PE, Grammatopoulos G. Supine versus lateral position for total hip replacement: accuracy of biomechanical reconstruction. Arch Orthop Trauma Surg 2022; 142:2945-2955. [PMID: 34557958 DOI: 10.1007/s00402-021-04179-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/09/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Restoration of normal hip anatomy and biomechanics is a key surgical goal for success in total hip arthroplasty. The aim of this study was to evaluate the influence, if any, that patient positioning in the supine and lateral decubitus positions has in achieving this goal. MATERIALS AND METHODS A single center multi-surgeon case-matched series from a tertiary level referral center of patients undergoing primary unilateral THA for osteoarthritis between April 2018 and December 2019 was retrospectively analyzed. Patients (n = 200) were divided into two matched groups: supine (anterior approach, n = 100) and lateral decubitus (direct lateral or posterior/SuperPATH™ approaches, n = 100). Post-operative anteroposterior pelvic radiographs were analyzed using a previously validated software (SurgiMap, Nemaris Inc., USA) for parameters of reconstruction of the hip in the coronal plane; leg length discrepancy, vertical and horizontal displacement of the center of rotation, femoral offset, and total offset. RESULTS Mean absolute leg length discrepancy in the supine group was 0.6 ± 3.3 mm (95% [CI] - 0.1 to 1.2 mm) versus 2.4 ± 3.8 mm (95% [CI] 1.6 to 3.1) in the lateral decubitus position (p < 0.001). The center of rotation was displaced medially by a mean of 3.2 ± 2.7 mm in the supine group versus 1.3 ± 4.0 mm in the lateral decubitus group (p < 0.001). For a surgical target of reconstructing both leg length and total offset within 5 mm of native anatomy, the supine group was more than twice as likely to achieve these goals with fewer outliers (OR 2.631, 95% [CI] 1.901-3.643) (76% v 30%, p < 0.001). CONCLUSION Total hip arthroplasty through the anterior approach in the supine position is more consistent and accurate for the restoration of leg length and total offset. Further study is required to assess how this translates with outcome. LEVEL OF EVIDENCE III-retrospective cohort study.
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Affiliation(s)
- Niall P McGoldrick
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Stephanie Antoniades
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Sherif El Meniawy
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Cheryl Kreviazuk
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada.
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13
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Innmann MM, Verhaegen J, Merle C, Beaulé PE, Meermans G, Grammatopoulos G. Cup orientation following posterior approach THA - the effect of different visual aids and pelvic supports. BMC Musculoskelet Disord 2022; 23:881. [PMID: 36138377 PMCID: PMC9502576 DOI: 10.1186/s12891-022-05820-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction This study aims to compare cup inclination achieved (1) Using two orientation guides, whilst using the same 3-point pelvic positioner and (2) Using two types of pelvic positioners, whilst measuring intra-operative cup inclination with an inclinometer. Materials and methods This is a prospective, diagnostic cohort study of a consecutive series of 150 THAs performed through a posterior approach. Two types of 3-point pelvic positioners were used (Stulberg and modified Capello Hip Positioners) and the cup was positioned freehand using one of two orientation guides (mechanical guide or digital inclinometer). Intra-operative inclination was recorded, radiographic cup inclination and anteversion were measured from radiographs. The differences in inclination due to pelvic position (ΔPelvicPosition) and orientation definitions (ΔDefinition) were calculated. Target radiographic inclination and anteversion was 40/20° ± 10°. Results There was no difference in radiographic cup inclination/ (p = 0.63) using a mechanical guide or digital inclinometer. However, differences were seen in ΔPelvicPosition between the positioners ((Stulberg: 0° ± 5 vs. Capello: 3° ± 6); p = 0.011). Intra-operative inclination at implantation was different between positioners and this led to equivalent cases within inclination/anteversion targets (Stulberg:84%, Capello:80%; p = 0.48). Conclusions With the pelvis securely positioned with 3-point supports, optimum cup orientation can be achieved with both alignment guides and inclinometer. Non-optimal cup inclinations were seen when intra-operative inclinations were above 40° and below 32°, or the ΔPelvicPosition was excessive (> 15°; n = 2). We would thus recommend that the intra-operative cup inclination should be centered strictly between 30° and 35° relative to the floor. Small differences exist between different type of pelvic positioners that surgeons need to be aware off and account for.
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Affiliation(s)
- Moritz M Innmann
- Division of Orthopaedic Surgery, The Ottawa Hospital, Critical Care Wing, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada. .,Department of Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Jeroen Verhaegen
- Division of Orthopaedic Surgery, The Ottawa Hospital, Critical Care Wing, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,Department of Orthopaedics and Traumatology, University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Orthopedic Center Antwerp, Kielsevest 14, 2018, Antwerp, Belgium
| | - Christian Merle
- Department of Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Critical Care Wing, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Geert Meermans
- Department of Orthopaedics, Bravis Hospital, Boerhaavelaan 25, 4708 AE, Roosendaal, The Netherlands
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, Critical Care Wing, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
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14
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Moreta J, Gayoso Ó, Donaire-Hoyas D, Roces-García J, Gómez-Vallejo J, Moya-Gómez E, Raya-Roldán D, Albert-Ullibarri A, Marqués-López F, Albareda J. Orthopedic Surgeons' Accuracy When Orienting an Acetabular Cup. A Comparison with Untrained Individuals. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:973. [PMID: 35888692 PMCID: PMC9317603 DOI: 10.3390/medicina58070973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 06/29/2022] [Accepted: 07/18/2022] [Indexed: 12/04/2022]
Abstract
Background and Objectives: Previous studies demonstrated a huge variability among surgeons when it comes to reproducing the position of an acetabular cup in total hip arthroplasty. Our main objective is to determine if orthopedic surgeons can replicate a given orientation on a pelvic model better than untrained individuals. Our secondary objective is to determine if experience has any influence on their ability for this task. Materials and Methods: A group of specialist orthopedic hip surgeons and a group of volunteers with no medical training were asked to reproduce three given (randomly generated) acetabular cup orientations (inclination and anteversion) on a pelvic model. Error was measured by means of a hip navigation system and comparisons between groups were made using the appropriate statistical methods. Results: The study included 107 individuals, 36 orthopedic surgeons and 71 untrained volunteers. The mean error among surgeons was slightly greater as regards both inclination (7.84 ± 5.53 vs. 6.70 ± 4.03) and anteversion (5.85 ± 4.52 vs. 5.48 ± 3.44), although statistical significance was not reached (p = 0.226 and p = 0.639, respectively). Similarly, although surgeons with more than 100 procedures a year obtained better results than those with less surgical experience (8.01 vs. 7.67 degrees of error in inclination and 5.83 vs. 5.87 in anteversion), this difference was not statistically significant, either (p = 0.852 and p = 0.981). Conclusions: No differences were found in the average error made by orthopedic surgeons and untrained individuals. Furthermore, the surgeons' cup orientation accuracy was not seen to improve significantly with experience.
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Affiliation(s)
- Jesús Moreta
- Department of Orthopedic Surgery and Traumatology, Hospital Galdakao-Usansolo, 48960 Galdakao, Spain
| | - Óscar Gayoso
- Department of Orthopedic Surgery and Traumatology, Hospital San Rafael, 15006 A Coruña, Spain;
| | - Daniel Donaire-Hoyas
- Department of Orthopedic Surgery and Traumatology, Hospital de Poniente, 04700 El Ejido, Spain; (D.D.-H.); (D.R.-R.); (A.A.-U.)
| | - Jorge Roces-García
- Department of Construction and Manufacturing Engineering, Polytechnic School of Engineering of Gijón, University of Oviedo, 33204 Gijón, Spain;
| | - Jesús Gómez-Vallejo
- Department of Orthopedic Surgery and Traumatology, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain; (J.G.-V.); (J.A.)
| | - Esther Moya-Gómez
- Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Cruz y San Pablo, 08025 Barcelona, Spain;
| | - David Raya-Roldán
- Department of Orthopedic Surgery and Traumatology, Hospital de Poniente, 04700 El Ejido, Spain; (D.D.-H.); (D.R.-R.); (A.A.-U.)
| | - Alberto Albert-Ullibarri
- Department of Orthopedic Surgery and Traumatology, Hospital de Poniente, 04700 El Ejido, Spain; (D.D.-H.); (D.R.-R.); (A.A.-U.)
| | - Fernando Marqués-López
- Department of Orthopedic Surgery and Traumatology, Parc de Salut Mar, 08003 Barcelona, Spain;
| | - Jorge Albareda
- Department of Orthopedic Surgery and Traumatology, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain; (J.G.-V.); (J.A.)
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15
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Stability in Direct Lateral vs Direct Anterior Total Hip Arthroplasty in the Context of Lumbar Spinal Fusion. J Am Acad Orthop Surg 2022; 30:e628-e639. [PMID: 35139054 DOI: 10.5435/jaaos-d-21-00499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/23/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Lumbar spinal fusion (LSF) may increase the risk of dislocation in patients who have undergone total hip arthroplasty (THA), especially when the LSF was done before the THA. Most publications evaluated patients who had undergone THA using a posterior approach to the hip, yet there are little data on the influence of other surgical approaches. The goal of this study was to evaluate the risk of THA dislocation with anterior supine-based surgical approaches to the hip in patients who have undergone surgical management of concurrent hip and spine pathology. METHODS Patients older than 18 years who underwent an LSF and THA using a supine approach-either direct anterior (DA) or direct lateral (DL)-between 2000 and 2018 were identified. Only standard bearings (28-32-36-40 mm) were used. The dislocation rate was determined in this cohort. A subsequent analysis was conducted, stratifying patients based on the order in which they received the LSF or THA. RESULTS A total of 582 surgical hip-spine patients were retrospectively identified and included in the cohort. Of total, 332 patients (57.0%) received an LSF before the THA; 250 (43.0%) had the fusion after a primary hip replacement. There were 143 patients (24.6%) in the DA group and 439 (75.4%) in the DL group. Overall, there were five dislocations (0.9%) in the entire cohort. CONCLUSIONS In patients with simultaneous degenerative hip and lumbar spine pathology, anterior supine-based approaches demonstrate a low (<1%) risk of instability. Given the small number of total dislocation events (n = 5), additional analysis is warranted to assess the effect of different anterior approaches (DA versus DL) or timing of lumbar spinal surgery (before or after THA). LEVEL OF EVIDENCE Level III.
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16
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Dion CA, Schmidt-Braekling T, Falsetto A, Kreviazuk C, Beaulé PE, Grammatopoulos G. Does Surgical Approach Influence the Natural History of the Unstable Total Hip Arthroplasty? J Arthroplasty 2022; 37:787-794. [PMID: 34923093 DOI: 10.1016/j.arth.2021.12.012] [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: 08/03/2021] [Revised: 11/19/2021] [Accepted: 12/10/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dislocation following total hip arthroplasty (THA) is a significant complication that occurs in 0.3%-10% of cases with 13%-42% of patients requiring revision surgery. The literature has primarily focused on the dislocation risk associated with different surgical approaches. However, little is known about the natural history of the dislocated hip and whether surgical approach of the index THA is associated with further instability and revision surgery. METHODS This is a retrospective, single-center, multi-surgeon consecutive case series of all patients who experienced THA dislocation from 2002 to 2020. Patients were excluded if the initial dislocation was secondary to infection or fracture. The natural history of the cohort as per approach was determined. Outcome measurements of interest were the number of dislocations; the treatment surrounding each dislocation; the necessity and type of revision; and the complications encountered. RESULTS Of the 75 patients, 58 (77%) dislocated within 6 months following primary THA. The anterior group had greater odds of dislocation within 2 weeks post-THA compared to the lateral and posterior groups (P = .04). The mean number of dislocations per patient was significantly lower in the anterior (1.5 ± 0.7) compared to the lateral (2.4 ± 1.2) and posterior (2.1 ± 1.0) groups (P = .02). Revision surgery was needed in 30% (6/20) of patients in the anterior, 69% (25/36) of the posterior, and 68% (13/19) of the lateral groups (P = .01). CONCLUSION This study illustrates that while primary THA dislocations happen earlier with the anterior approach, they are typically less complicated and have a lower risk of recurrent instability and revision surgery.
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Affiliation(s)
- Charles-Antoine Dion
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Tom Schmidt-Braekling
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amedeo Falsetto
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Cheryl Kreviazuk
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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17
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Windsor EN, Sharma AK, Premkumar A, Gkiatas I, Sculco PK, Vigdorchik JM. The Use of Technology to Achieve the Functional Acetabular Safe Zone in Total Hip Arthroplasty. JBJS Rev 2022; 10:01874474-202202000-00001. [PMID: 35113821 DOI: 10.2106/jbjs.rvw.21.00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Functional acetabular safe zones based on patient-specific factors during total hip arthroplasty are theorized to result in more optimal component stability than the use of traditional safe zones based on static targets. » Preoperative planning that takes into account functional pelvic positions and spinopelvic mobility is increasingly recommended. » Computer navigation and robotics can be utilized to help accurately achieve the targeted cup position within the functional safe zone. » Each technology platform (imageless and image-based computer navigation and robotics) utilizes a specific referencing method for the pelvis, which influences anteversion and inclination values. » The purpose of this article is to summarize how these different systems reconcile differences in pelvic referencing to ensure that the surgeon achieves the targeted functional cup position.
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Affiliation(s)
- Eric N Windsor
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Abhinav K Sharma
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Ajay Premkumar
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Ioannis Gkiatas
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
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18
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Scott CEH, Clement ND, Davis ET, Haddad FS. Modern total hip arthroplasty: peak of perfection or room for improvement? Bone Joint J 2022; 104-B:189-192. [PMID: 35094584 DOI: 10.1302/0301-620x.104b2.bjj-2022-0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Chloe E H Scott
- Royal Infirmary of Edinburgh, Edinburgh, UK.,The Bone & Joint Journal , London, UK.,Bone & Joint Research , London, UK.,University of Edinburgh, Edinburgh, UK
| | | | | | - Fares S Haddad
- The Bone & Joint Journal , London, UK.,University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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19
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Nishihara S, Hayashida K. Comparison between freehand technique and computed tomography-based navigation in acetabular cup placement through direct anterior approach for total hip arthroplasty. Arch Orthop Trauma Surg 2022; 142:323-329. [PMID: 33929597 DOI: 10.1007/s00402-021-03920-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 04/19/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION In total hip arthroplasty (THA), improper cup orientation can result in dislocation, early excessive polyethylene wear, and pain following THA. The supine position during THA provides a more reproducible functional pelvic position than the lateral decubitus position and may allow freehand cup placement as reliable as that obtained by computer navigation. The purpose of this study was to investigate the accuracy of freehand cup placement through a supine direct anterior approach (DAA) compared with computed tomography (CT)-based navigation. MATERIALS AND METHODS The same surgeon performed primary cementless THA through the DAA in 144 supine patients. Seventy-two patients underwent freehand cup placement with standard mechanical guidance-oriented radiographic target cup positioning, and 72 underwent placement with CT-based navigation guidance. Using three-dimensional templating software, the study group calculated cup inclination and anteversion on postoperative CT scans. RESULTS The navigation method resulted in a significantly smaller deviation of inclination from the target (p < 0.05); the difference in anteversion was not significant. In addition, the navigation method resulted in significantly fewer cups placed ± 10° outside the target position (0% for inclination, 0% for anteversion) than did the freehand procedure (26% for inclination, 25% for anteversion) (p < 0.0001). CONCLUSIONS Freehand cup placement is less reliable even in the supine position. Use of a CT-based navigation system can significantly improve cup positioning in THA through the DAA by reducing the incidence of outliers.
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Affiliation(s)
- Shunsaku Nishihara
- Department of Orthopaedic Surgery, Daini Osaka Police Hospital, 2-6-40 Karasugatsuji, Tennouji-ku, Osaka, 543-8922, Japan.
| | - Kenji Hayashida
- Department of Orthopaedic Surgery, Daini Osaka Police Hospital, 2-6-40 Karasugatsuji, Tennouji-ku, Osaka, 543-8922, Japan
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20
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Xiao Y, Li Z, Feng E, Lin F, Zhang Y, Weng Y, Chen J. Direct anterior approach for total hip arthroplasty with patients in the lateral decubitus versus supine positions: A prospective, double-blinded, randomized clinical trial. J Orthop Surg (Hong Kong) 2022; 30:23094990221074758. [PMID: 35302412 DOI: 10.1177/23094990221074758] [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] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The direct anterior approach (DAA) for total hip arthroplasty (THA) can be performed with patients in either in the lateral decubitus or supine position. Prompted by the lack of studies addressing differences between the two positions, this investigation aimed to examine clinical and radiographic outcomes and compare the lateral decubitus versus the supine position for THA using the DAA. METHODS Between January 1 and October 1, 2020, 90 patients who underwent primary unilateral THA using the DAA were recruited, with 54 (60%) undergoing THA in the supine position (SP group) and 36 (40%) in the lateral decubitus position (LP group). Technical information, clinical and radiographic outcomes, and patient-reported outcomes, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short-Form-12 (SF-12) were evaluated. All data were subjected to several statistical tests. RESULTS There were no preoperative differences in baseline characteristics between the LP and SP groups, which were also similar in terms of operative duration, length of hospital stay, and blood loss. Radiographic assessment confirmed satisfactory positioning of the prosthesis in both groups. There were no significant differences in terms of CK-MB and hemoglobin levels, Harris Hip Score, WOMAC, UCLA, visual analog scale score, and SF-12. The incidence of complications in the LP group was lower than in the SP group. CONCLUSION Total hip arthroplasty performed via DAA in the LP and SP groups yielded excellent clinical outcomes, although the incidence of complications in the former was lower than in the latter.
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Affiliation(s)
- Yao Xiao
- Department of Arthrosis Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
- 47858Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zhanglai Li
- Department of Arthrosis Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Eryou Feng
- Department of Arthrosis Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
- 47858Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Feitai Lin
- Department of Arthrosis Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Yiyuan Zhang
- Department of Arthrosis Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Yan Weng
- Department of Arthrosis Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Jinhua Chen
- 117890Fujian Medical University Union Hospital, Fuzhou, China
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21
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Suraci AB, Bhullar RS, Dobransky JS, Beaulé PE. Hueter Anterior Approach for Metal-on-Metal Hip Resurfacing Arthroplasty: 555 Cases at a Minimum Five-Year Follow-Up. J Arthroplasty 2021; 36:3200-3208. [PMID: 33992480 DOI: 10.1016/j.arth.2021.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/06/2021] [Accepted: 04/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Purpose of this study was to determine implant survivorship and resultant outcomes, including modes of failure, for metal-on-metal hip resurfacing through the Hueter anterior approach (HAA). METHODS Retrospective review of cases from 2006 to 2015, resulted in 555 metal-on-metal hip resurfacing via HAA, mean age 49.4 ± 6.9 years and mean BMI 28.1 ± 5.3. Kaplan-Meier curves were used to assess implant survivorship. Evaluation of technique was based on radiographic assessment of component position at 6 weeks. Patient-reported outcome measures were assessed using 12-Item Short Form Survey 12, University of California Los Angeles activity, Western Ontario and McMaster Universities Osteoarthritis Index, and hip disability osteoarthritis outcome scores. RESULTS At a mean follow-up of 9.18 years, survivorship was 95.0% at 5 years (95% CI: 93.2-96.8 years) and 92.5% at 10 years (95% CI: 90.0-95.0 years); men at 96.1% (95% CI: 94.3-97.9) and 93.8% (95% CI: 91.1-96.5), and women at 88.8% (95% CI: 81.9-95.7) and 85.6% (95% CI: 77.6-93.6), 5 and 10 years, respectively (P = .033). There were 37 revisions to total hips (7%) at a mean time of 3.3 years (SD 2.7). Indications for revision were aseptic loosening of acetabular (n = 12) and femoral component (n = 7) and pseudotumor (n = 6). Radiographic parameters were respectable and consistent, median acetabular inclination angle 41.2° and femoral stem shaft angle 137.7°. Patient-reported outcome measure scores significantly improved and remained stable at 2 and 5 years postoperatively. CONCLUSION Although choice of surgical approach should always be based on surgeon's technical expertise, this study has shown that HAA is safe and effective for hip resurfacing. Mindful attention to long-term metal ion exposure must still be considered.
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Affiliation(s)
- Alison B Suraci
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON
| | | | | | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON; Scientist, The Ottawa Hospital Research Institute, Ottawa, ON
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van Duren BH, Royeca JM, Cunningham CM, Lamb JN, Brew CJ, Pandit H. Can the use of an inclinometer improve acetabular cup inclination in total hip arthroplasty? A review of the literature. Hip Int 2021; 31:609-617. [PMID: 32750263 PMCID: PMC8488637 DOI: 10.1177/1120700020946716] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The angle of acetabular (cup) radiographic inclination is an important measurement in total hip arthroplasty (THA) procedures. Abnormal radiographic inclination is associated with dislocation, edge loading and higher failure rates. Consistently achieving a satisfactory radiographic inclination remains a challenge. Inclinometers have been increasingly used over the last decade. This paper reviews the literature to determine whether using an inclinometer improves the accuracy of acetabular cup inclination in THA. METHODS A systematic literature search was performed. The following search terms were used: ('hip' OR 'hip replacement' OR 'hip arthroplasty' OR 'primary hip replacement' OR 'THR' OR 'THA' OR 'Acetabular cup Inclination') AND ('Inclinometer'). Titles and abstracts were screened for relevance. Both radiographic and operative inclination comparisons were included. RESULTS 7 studies met the inclusion criteria. 2 were randomised control trials with level I evidence, and the remaining studies were cohort studies with level III/IV evidence. 5 were clinical and 2 experimental. In total there were 16 cohorts: 7 using an inclinometer, 6 freehand, and 3 using MAG techniques. All studies comparing radiographic inclination and 1 of 2 studies comparing operative inclination showed an improvement in the attainment of the optimal inclination. Similarly, the use of an inclinometer showed a reduction in the number of outliers when compared to MAG and freehand techniques. DISCUSSION This review demonstrates that using an inclinometer improved the surgeon's ability to achieve their intended inclination (both operative and radiographic) and reduced the incidence of positioning outside the safe-zone. However, only 2 of the studies were randomised control trials and these resulted in opposing conclusions. Therefore, further studies looking at the use of inclinometers would prove useful in understanding their true benefit.
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Affiliation(s)
- Bernard H van Duren
- Leeds Orthopaedic and Trauma Sciences, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK,Bernard H van Duren, Leeds Institute of Rheumatic and Musculoskeletal Medicine, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.
| | | | | | - Jonathan N Lamb
- Leeds Orthopaedic and Trauma Sciences, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Hemant Pandit
- Leeds Orthopaedic and Trauma Sciences, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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23
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Goyal T, Choudhury AK, Paul S, Gupta T, Das L. Acetabular and Femoral Component Positioning Using Direct Anterior Approach Versus Posterior Approach in Total Hip Arthroplasty. Indian J Orthop 2021; 55:1215-1224. [PMID: 34824723 PMCID: PMC8586307 DOI: 10.1007/s43465-020-00343-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/30/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Direct anterior approach (DAA) has recently become popular in total hip arthroplasty (THA). However, irrespective of the surgical approach used, component malposition is an important factor affecting function and complications after THA. This study aims to compare component positioning on the femoral and acetabular side between DAA and posterior approach (PA) to the hip joint. We hypothesized that the two approaches are similar in terms of component positioning. METHODS We prospectively studied 50 patients, matched according to age, sex, and body mass index, undergoing THA, divided non-randomly into 2 groups. Group 1 comprised 25 patients (35 hips) undergoing THA using DAA and group 2 comprised 25 patients (25 hips) undergoing THA using PA. Ten patients from group 1 had simultaneous bilateral THA. Radiological parameters studied were acetabular inclination (AI), coronal femoral stem alignment (CFA), leg length difference (LLD), acetabular cup version (AV), and femoral stem version (FV). RESULTS There was no significant difference in AI, CFA, LLD, AV, and FV between the two groups. Excellent to good inter and intra-observer reliability expressed in terms of intraclass correlation coefficient (ICC) was noted for all the radiographic measurements. CONCLUSION Both DAA and PA for THA achieve comparable radiological component positioning. DAA may not provide any advantage over PA in terms of positioning of the prosthesis. LEVEL OF EVIDENCE Level II, non-randomized comparative study.
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Affiliation(s)
- Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, 151001 Punjab India
| | | | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Tushar Gupta
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Lakshmana Das
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
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Asai H, Takegami Y, Seki T, Ishiguro N. Pelvic Tilt Reduces the Accuracy of Acetabular Component Placement When Using a Portable Navigation System: An In Vitro Study. Arthroplast Today 2021; 7:177-181. [PMID: 33553546 PMCID: PMC7856392 DOI: 10.1016/j.artd.2020.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/15/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background A portable navigation system (PNS) was recently introduced. The PNS enables surgeons to place the acetabular component accurately. While the margin of the error for the cup abduction and anteversion was larger than the values obtained from a computed tomography-based navigation system. We hypothesized that the accuracy of the PNS might be affected by pelvic tilt. Material and Methods A bone substitute model of the pelvis was used in this in vitro study. We set the acetabular component using PNS. We set the acetabular component angle after changing the sagittal, coronal, and axial pelvic tilt. We calculated the difference between the angle displayed on the PNS display and the actual angle of the acetabular component. The difference in inclination angle was defined as ΔRI, and the difference in the anteversion angle was defined as ΔRA. We evaluated the trends in this ΔRI and ΔRA due to the pelvic tilt. Results In this in vitro study, the placement of the acetabular component was accurate in the neutral position; ΔRI was 0.5 ± 0.7° and ΔRA was 1.0 ± 0.7°. Sagittal pelvic tilt and axial pelvic tilt increased both the ΔRA and ΔRI (P = .017). Coronal tilt increased ΔRI but did not change ΔRA. Conclusions While the PNS may enable surgeons to place accurate component placement in the neutral position, its accuracy decreased by pelvic tilt. The surgeons should use a solid pelvic lateral positioner for reducing discrepancies in pelvic tilt when using the PNS in the lateral decubitus position.
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Affiliation(s)
- Hiroshi Asai
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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25
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Viamont-Guerra MR, Saffarini M, Laude F. Surgical Technique and Case Series of Total Hip Arthroplasty with the Hueter Anterior Approach for Crowe Type-IV Dysplasia. J Bone Joint Surg Am 2020; 102:99-106. [PMID: 32530875 DOI: 10.2106/jbjs.20.00081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) is being increasingly performed via the Hueter anterior approach (HAA), which has proven benefits with nondysplastic hips; however, little has been published on its outcomes with dysplastic hips, where it can provide better acetabular exposure. We describe our technique for THA via the HAA in hips with Crowe type-IV developmental dysplasia and report the mid-term outcomes of cases that were performed over 5 consecutive years. METHODS We retrospectively evaluated a continuous series of 8 hips (6 patients) with Crowe type-IV dysplasia; the patient ages ranged from 44 ± 20 years (range, 17 to 65 years) at the index THA. All of the patients received uncemented implants via the HAA on a traction table to restore the hip center of rotation to the true acetabulum. Femoral head autografts (FHAs) were used to increase acetabular coverage in 6 hips, and subtrochanteric shortening osteotomies (SSOs) were performed in 5 hips. Patients were assessed clinically and radiographically at a minimum follow-up of 2 years. RESULTS There were no revisions, deaths, dislocations, or infections. Two hips (25%) had intraoperative complications, and 1 hip (13%) had a postoperative complication that required reoperation without implant removal. All of the hips were assessed clinically and radiographically at 4 ± 1 years (range, 2 to 6 years). The modified Harris hip score (mHHS) improved from 33 ± 7 to 90 ± 7, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) improved from 53 ± 14 to 89 ± 6; the postoperative leg-length discrepancy was 3.2 mm (range, -10 to 20 mm). None of the hips had osteolysis or radiolucent lines of >2 mm. CONCLUSIONS THA via the HAA on a traction table for hips with Crowe type-IV dysplasia yielded satisfactory mid-term outcomes. Both FHA and SSO can be adequately performed via the HAA to help restore the hip center of rotation to the true acetabulum. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Maria-Roxana Viamont-Guerra
- Ramsay Générale de Santé, Clinique du Sport Paris V, Paris, France.,Hip Surgery Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Frederic Laude
- Ramsay Générale de Santé, Clinique du Sport Paris V, Paris, France
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Vanbiervliet J, Dobransky J, Poitras S, Beaulé PE. Safety of Single-Stage Bilateral Versus Unilateral Anterior Total Hip Arthroplasty: A Propensity-Matched Cohort Study. J Bone Joint Surg Am 2020; 102:107-113. [PMID: 32554997 DOI: 10.2106/jbjs.20.00105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Limited data exist on patient safety after single-stage bilateral and unilateral total hip arthroplasty (THA) through the anterior approach (AA). Therefore, the aim of this study was to compare length of stay (LOS), operative time, 90-day adverse events, 90-day readmission rate, and 1-year revision rate after single-stage bilateral and unilateral THA in matched patients. METHODS This was a retrospective matched cohort study of prospectively collected data from 2008 to 2018 of a single-surgeon practice. We used the built-in propensity score matching formula in SPSS software and matched bilateral and unilateral patient groups on the relevant covariates of age, sex, and body mass index. This resulted in 60 patients undergoing bilateral THA and 60 patients undergoing unilateral THA. RESULTS The average LOS was 4.7 days (interquartile range [IQR], 3 to 5 days; range, 2 to 21 days) after bilateral THA and 3.0 days (IQR, 2 to 4 days; range, 1 to 13 days) after unilateral THA (p < 0.001). The mean operative time was 140 minutes for bilateral THA and 69 minutes for unilateral THA (p < 0.001). The adverse event rate was 6.7% after bilateral THA and 5.0% after unilateral THA (p = 0.660). The 90-day readmission rate was 3.3% after bilateral THA and 5.0% after unilateral THA (p = 0.321), which also accounted for all of the revisions within the first year. CONCLUSIONS When considering single-stage versus staged bilateral AA total hip replacement, patients can expect the same clinical outcome. Because the operative time is longer with bilateral THA, the main advantages are that the patient avoids a second anesthesia session and has an overall shorter recovery time. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jens Vanbiervliet
- Division of Orthopaedic Surgery, University of Ottawa Faculty of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
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27
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Hasegawa M, Naito Y, Tone S, Wakabayashi H, Sudo A. Accuracy of acetabular cup insertion in an anterolateral supine approach using an accelerometer-based portable navigation system. J Artif Organs 2020; 24:82-89. [PMID: 32880017 DOI: 10.1007/s10047-020-01206-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/24/2020] [Indexed: 01/07/2023]
Abstract
The purpose of this study was to determine the accuracy of acetabular cup insertion during total hip arthroplasty (THA) in a supine position using an accelerometer-based portable navigation system. A single-surgeon study was conducted in which 62 prospective patients with navigation and 42 retrospective patients without navigation as historical controls were compared. The patients underwent THA via an anterolateral supine approach. The absolute values of errors of radiographic inclination and anteversion were calculated. The navigation error was also calculated. The factors that affected the absolute values of errors of cup alignment were determined. The mean absolute error of the postoperative CT measurement from the target angle for radiographic inclination was 3.8° in the navigation group and 6.6° in the control group (P < 0.001). The mean absolute error for anteversion was 3.3° in the navigation group and 5.9° in the control group (P < 0.001). The mean absolute values of navigation error were 3.7° ± 2.8° in inclination and 3.0° ± 2.6° in anteversion. Changes in the pelvic tilt angle among preoperative, intraoperative, and postoperative were the significant risk factors for the absolute values of navigation error of anteversion relative to the anterior pelvic plane. Other factors affecting the absolute values of errors in the navigation group were not found for radiographic inclination and anteversion. The portable navigation system significantly improved the accuracy of cup inclination and anteversion. Changes in the pelvic tilt were the risk factors for the error of anteversion relative to the anterior pelvic plane.
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Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
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Kawahara S, Hara T, Sato T, Kitade K, Shimoto T, Nakamura T, Mawatari T, Higaki H, Nakashima Y. Digitalized analyses of intraoperative acetabular component position using image-matching technique in total hip arthroplasty. Bone Joint Res 2020; 9:360-367. [PMID: 32728432 PMCID: PMC7376306 DOI: 10.1302/2046-3758.97.bjr-2019-0260.r2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aims Appropriate acetabular component placement has been proposed for prevention of postoperative dislocation in total hip arthroplasty (THA). Manual placements often cause outliers in spite of attempts to insert the component within the intended safe zone; therefore, some surgeons routinely evaluate intraoperative pelvic radiographs to exclude excessive acetabular component malposition. However, their evaluation is often ambiguous in case of the tilted or rotated pelvic position. The purpose of this study was to develop the computational analysis to digitalize the acetabular component orientation regardless of the pelvic tilt or rotation. Methods Intraoperative pelvic radiographs of 50 patients who underwent THA were collected retrospectively. The 3D pelvic bone model and the acetabular component were image-matched to the intraoperative pelvic radiograph. The radiological anteversion (RA) and radiological inclination (RI) of the acetabular component were calculated and those measurement errors from the postoperative CT data were compared relative to those of the 2D measurements. In addition, the intra- and interobserver differences of the image-matching analysis were evaluated. Results Mean measurement errors of the image-matching analyses were significantly small (2.5° (SD 1.4°) and 0.1° (SD 0.9°) in the RA and RI, respectively) relative to those of the 2D measurements. Intra- and interobserver differences were similarly small from the clinical perspective. Conclusion We have developed a computational analysis of acetabular component orientation using an image-matching technique with small measurement errors compared to visual evaluations regardless of the pelvic tilt or rotation.Cite this article: Bone Joint Res 2020;9(7):360-367.
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Affiliation(s)
- Shinya Kawahara
- Department of Orthopaedic Surgery, Aso-Iizuka Hospital, Iizuka, Japan
| | - Toshihiko Hara
- Department of Orthopaedic Surgery, Aso-Iizuka Hospital, Iizuka, Japan
| | - Taishi Sato
- Department of Orthopaedic Surgery, Aso-Iizuka Hospital, Iizuka, Japan
| | - Kazuki Kitade
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Shimoto
- Faculty of Information Engineering, Fukuoka Institute of Technology, Fukuoka, Japan
| | - Tetsuro Nakamura
- Department of Orthopaedic Surgery, Japan Community Health Care Organization Kyushu Hospital, Kitakyushu, Japan
| | - Taro Mawatari
- Department of Orthopaedic Surgery, Hamanomachi Hospital, Fukuoka, Japan
| | - Hidehiko Higaki
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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29
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Viamont-Guerra MR, Chen AF, Stirling P, Nover L, Guimarães RP, Laude F. The Direct Anterior Approach for Total Hip Arthroplasty for Severe Dysplasia (Crowe III and IV) Provides Satisfactory Medium to Long-Term Outcomes. J Arthroplasty 2020; 35:1642-1650. [PMID: 32046871 DOI: 10.1016/j.arth.2020.01.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/20/2019] [Accepted: 01/10/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The direct anterior approach (DAA) is increasingly used for total hip arthroplasty (THA). Although the DAA can reduce pain, recovery time, and dislocations in nondysplastic hips, few studies report its results in patients with severe dysplasia. We aimed to evaluate outcomes of primary THA through the DAA with cup placement at the true acetabulum in hips with severe dysplasia. METHODS We retrospectively evaluated 23 consecutive patients (29 hips) who underwent THA by DAA for osteoarthritis secondary to Crowe III-IV dysplasia. Surgical procedures were performed on a traction table, and the acetabular cup was placed in the true acetabulum. Patients were assessed clinically (complications, modified Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, Oxford Hip Score) and radiographically (radiolucencies, subsidence, leg length discrepancies, cup inclination, and cup coverage) at a minimum of 2 years. RESULTS One patient (2 hips) died with original implants (at 13 and 14 years), 3 patients (3 hips) were revised due to wear-induced loosening (at 14, 16, and 18 years), and there were no dislocations or infections. The remaining 19 patients (24 hips) were assessed at 8.4 ± 4.7 years (range 2-20); 2 patients (2 hips) had complications that required reoperation without implant removal. The modified Harris Hip Score improved from 32 ± 9 to 94 ± 7, Western Ontario and McMaster Universities Osteoarthritis Index from 46 ± 18 to 90 ± 7, and Oxford Hip Score was 56 ± 4. Patients were very satisfied (90%) or satisfied (10%). Limb length discrepancy was 2.5 ± 9.0 mm. CONCLUSION THA through the DAA with cup placement at the true acetabulum provides satisfactory mid to long-term clinical and radiographic outcomes compared to other approaches for hips with severe dysplasia. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Maria-Roxana Viamont-Guerra
- Département d'Orthopédie, Ramsay Santé, Clinique du Sport Paris V, Paris, France; Departamento de Ortopedia e Traumatologia, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Antonia F Chen
- Department of Orthopaedics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Luca Nover
- Medical Technology, ReSurg SA, Nyon, Switzerland
| | | | - Frederic Laude
- Département d'Orthopédie, Ramsay Santé, Clinique du Sport Paris V, Paris, France
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30
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Gofton WT, Ibrahim MM, Kreviazuk CJ, Kim PR, Feibel RJ, Beaulé PE. Ten-Year Experience With the Anterior Approach to Total Hip Arthroplasty at a Tertiary Care Center. J Arthroplasty 2020; 35:1281-1289.e1. [PMID: 31955983 DOI: 10.1016/j.arth.2019.12.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/03/2019] [Accepted: 12/12/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The anterior approach (AA) to total hip arthroplasty (THA) has advantages for patients and healthcare providers. However, some studies have reported high rates of adverse events when introducing AA-THA. This was not consistent with our center's experience, where 4 senior surgeons safely introduced AA-THA into practice. The purpose of this study is to define the adverse event rates associated with the introduction of AA-THA by a group of experienced surgeons at a single tertiary care center and define experiential factors that may modify adverse event rates. METHODS Retrospective review of prospectively collected data for an observational cohort of all patients undergoing a THA between 2006 and 2017 was conducted. Four senior surgeons at a single institution operated on 1087 primary elective hips using AA-THA. RESULTS Between 2006 and 2016, AA-THA rose from 1.5% to 53.2% of annual THA. Adverse events included intraoperative events, early postoperative periprosthetic fractures, dislocation, implant failure, early infection, and wound complications. We observed an overall 90-day adverse event rate of 6.4% (of 1087 hips). The adverse event rate was 41.6% (of 12 hips) in the first 12 months of the study period and 3.6% (of 166 hips) in the final 12 months of the study period reviewed. Sixty hips (5.5%) required a reoperation with or without revision of components, 1 (8.3%) in the first 12 months of the study period and 1 (0.6%) in the final 12 months of the study period. Infection and wound complications were the most common causes of reoperation at 1.8% for all cases (20 hips). Higher rates of adverse events are associated with early procedures (n ≤ 15) for all surgeons but showed no statistically significant impact on 5-year survival rate. CONCLUSION Our experience demonstrates that AA-THA can be introduced into practice with an acceptable adverse event rate when compared with other approaches to THA. As expected the incidence of adverse events is higher in the early part of the learning curve. Surgeon mentoring in the first 20 cases should be considered to minimize risk of adverse events. LEVEL OF EVIDENCE Therapeutic Level III.
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Affiliation(s)
- Wade T Gofton
- Division of Orthopaedic Surgery, The Ottawa Hospital General Campus, Ottawa, ON, Canada
| | - Mazen M Ibrahim
- Division of Orthopaedic Surgery, The Ottawa Hospital General Campus, Ottawa, ON, Canada; Department of Orthopaedic Surgery, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Cheryl J Kreviazuk
- Division of Orthopaedic Surgery, The Ottawa Hospital General Campus, Ottawa, ON, Canada
| | - Paul R Kim
- Division of Orthopaedic Surgery, The Ottawa Hospital General Campus, Ottawa, ON, Canada
| | - Robert J Feibel
- Division of Orthopaedic Surgery, The Ottawa Hospital General Campus, Ottawa, ON, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital General Campus, Ottawa, ON, Canada
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31
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Tetsunaga T, Yamada K, Tetsunaga T, Sanki T, Kawamura Y, Ozaki T. An accelerometer-based navigation system provides acetabular cup orientation accuracy comparable to that of computed tomography-based navigation during total hip arthroplasty in the supine position. J Orthop Surg Res 2020; 15:147. [PMID: 32295628 PMCID: PMC7161129 DOI: 10.1186/s13018-020-01673-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/03/2020] [Indexed: 11/21/2022] Open
Abstract
Background Inadequate acetabular component orientation is associated with postoperative impingement, dislocation, and accelerated polyethylene wear. Computed tomography (CT)-based navigation systems provide accuracy for total hip arthroplasty (THA) but are not available in all facilities. Accelerometer-based navigation systems are inexpensive, but their accuracy remains undetermined. This study compares the accuracy of cup orientation in THA using CT-based and accelerometer-based navigation systems. Methods This retrospective study included 35 consecutive patients (11 males, 24 females; mean age, 65 years) who underwent primary cementless THA via an anterolateral approach in the supine position. Both CT-based and accelerometer-based navigation systems were used simultaneously. The accuracy of cup orientation was compared between the two systems using postoperative CT. Results The accuracy of cup inclination was 2.7° ± 2.0° in the CT-based group and 3.3° ± 2.4° in the accelerometer-based group. The accuracy of cup anteversion was 2.8° ± 2.6° in the CT-based group and 3.4° ± 2.2° in the accelerometer-based group. No significant difference was observed in cup inclination (p = 0.29) or cup anteversion (p = 0.34) between CT-based and accelerometer-based navigation. Conclusions The accuracy of cup positioning did not differ significantly between CT-based and accelerometer-based navigation systems.
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Affiliation(s)
- Tomonori Tetsunaga
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
| | - Kazuki Yamada
- Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Tomoko Tetsunaga
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Tomoaki Sanki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yoshi Kawamura
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
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Zhao JX, Su XY, Zhao Z, Xiao RX, Zhang LC, Tang PF. Radiographic assessment of the cup orientation after total hip arthroplasty: a literature review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:130. [PMID: 32175423 DOI: 10.21037/atm.2019.12.150] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Optimal acetabular cup orientation is of substantial importance to good long-term function and low complication rates after total hip arthroplasty (THA). The radiographic anteversion (RA) and inclination (RI) angles of the cup are typically studied due to the practicability, simplicity, and ease of interpretation of their measurements. A great number of methods have been developed to date, most of which have been performed on pelvic or hip anteroposterior radiographs. However, there are primarily two influencing factors for these methods: X-ray offset and pelvic rotation. In addition, there are three types of pelvic rotations about the transverse, longitudinal, and anteroposterior axes of the body. Their effects on the RA and RI angles of the cup are interactively correlated with the position and true orientation of the cup. To date, various fitted or analytical models have been established to disclose the correlations between the X-ray offset and pelvic rotation and the RA and RI angles of the cup. Most of these models do not incorporate all the potential influencing parameters. Advanced methods for performing X-ray offset and pelvic rotation corrections are mainly performed on a single pelvic AP radiograph, two synchronized radiographs, or a two-dimensional/three-dimensional (2D-3D) registration system. Some measurement systems, originally developed for evaluating implant migration or wear, could also be used for correcting the X-ray offset and pelvic rotation simultaneously, but some drawbacks still exist with these systems. Above all, the 2D-3D registration technique might be an alternative and powerful tool for accurately measuring cup orientation. In addition to the current methods used for postoperative assessment, navigation systems and augmented reality are also used for the preoperative planning and intraoperative guidance of cup placement. With the continuing development of artificial intelligence and machine learning, these techniques could be incorporated into robot-assisted orthopaedic surgery in the future.
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Affiliation(s)
- Jing-Xin Zhao
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Xiu-Yun Su
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,Intelligent and Digital Surgery Innovation Center, Southern University of Science and Technology Hospital, Shenzhen, Guangdong 518055, China
| | - Zhe Zhao
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Ruo-Xiu Xiao
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Li-Cheng Zhang
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Pei-Fu Tang
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
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Takada R, Jinno T, Miyatake K, Hirao M, Yoshii T, Okawa A. Portable imageless navigation system and surgeon's estimate for accurate evaluation of acetabular cup orientation during total hip arthroplasty in supine position. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:707-712. [PMID: 31925538 DOI: 10.1007/s00590-020-02625-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/08/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND This prospective study aimed to clarify whether this novel device can evaluate the cup orientation during total hip arthroplasty (THA) more closely to that measured in postoperative computed tomography (CT) compared to the surgeon's estimate using a manual goniometer. METHODS We prospectively performed 30 cementless THAs via the anterolateral approach in supine position between October 2018 and July 2019, wherein cup orientation was evaluated by both a portable imageless navigation system (HipAlign) and a manual goniometer during surgeries. Primary outcome was the absolute estimate error [the absolute value of the difference between cup angles measured by postoperative CT and those measured by HipAlign (group H) or surgeon's estimate using the manual goniometer (group S) during surgery]. The number of outliers of the absolute estimate error (> 10°) in each group was also estimated. RESULTS The absolute estimate error of cup inclination in groups H and S was 3.3° ± 2.7° and 3.0° ± 2.5°, respectively (p = 0.51), whereas that of cup anteversion was 3.8° ± 3.4° and 6.0° ± 3.7°, respectively (p = 0.0008). The number of outliers of the estimate error in groups H and S was one case (3.3%) and six cases (20.0%), respectively (p = 0.04). In all six outlier cases, surgeons underestimated cup anteversion during surgeries. CONCLUSIONS This portable imageless navigation system was a useful method, especially for avoiding incorrect cup anteversion. Underestimation of cup anteversion during THA in the supine position with the conventional alignment assisting device should be given attention.
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Affiliation(s)
- Ryohei Takada
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Tetsuya Jinno
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kazumasa Miyatake
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Masanobu Hirao
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Atsushi Okawa
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Supine versus lateral position for accurate positioning of acetabular cup in total hip arthroplasty using the modified Watson-Jones approach: A randomized single-blind controlled trial. Orthop Traumatol Surg Res 2019; 105:915-922. [PMID: 31204181 DOI: 10.1016/j.otsr.2019.05.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The orientation of the acetabular cup is a critical factor for prevention of various postoperative complications in total hip arthroplasty (THA). Although most patients are treated in either supine or lateral position during surgery, it is still unclear which position is superior to achieve more accurate cup positioning. Our study was conducted in order to answer the following questions: (1) does the supine position provide a higher accuracy of cup positioning than the lateral position in THA using modified Watson-Jones approach? (2) is there any difference in the distribution of cup position between the two positions? Hypothesis Our hypothesis was that the supine position would provide a higher accuracy of cup positioning than the lateral position in THA using modified Watson-Jones approach. PATIENTS AND METHODS A single-center prospective randomized study (registration number: UMIN000021627) was conducted between May 2016 and December 2017. We recruited a total of 60 participants undergoing unilateral primary cementless THA using modified Watson-Jones anterolateral approach based on the result of the sample size calculation. They were randomly assigned to either supine position (n=29) or lateral position (n=31). The cup alignment was targeted using a goniometer during surgery. The radiographic cup inclination was targeted to 40° and the radiographic cup anteversion was targeted considering the femoral stem anteversion during surgery. Postoperative cup alignment was measured by plain radiography and computed tomography. We defined the difference between postoperative and target cup angle as target error and our primary outcome was the absolute value of the target angle. As secondary outcome, the distribution of the target error was evaluated. The target errors of each inclination and anteversion were divided into 3 groups; neutral (-3°≤the target error≤3°), positive error (3°<the target error), and negative error (the target error<-3°). RESULTS The assessment of primary outcome for all recruited patients showed that supine group was significantly more accurate than lateral group in terms of radiographic inclination (2.4° vs. 4.5°, respectively, mean difference 2.1°; 95% confidence interval, 0.7 to 3.5; p<0.01). There was no significant difference in terms of radiographic cup anteversion (5.6° vs. 5.2°, mean difference 0.4°; 95% confidence interval, -1.8 to 2.6; p=0.69). The rate of positive error of anteversion in supine and lateral group was larger than that of negative value of anteversion (51.7% vs. 10.3% and 48.4% vs. 12.9%, respectively). Any acute complication (dislocation, fracture, and infection) was not found in both groups during postoperative 3 months. DISCUSSION In this randomized-controlled trial, higher accuracy of acetabular cup inclination was provided by supine position than by lateral position in THA. On the other hand, there was no significant difference between both groups in terms of cup anteversion. In both groups, most cups were placed with larger anteversion than we targeted. Modified Watson-Jones approach in both positions should be performed considering these results. STUDY REGISTRATION NUMBER UMIN000021627. Level of evidence II, randomised controlled study (population-limited).
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Haddad FS. Are we the victims of our own success? Bone Joint J 2019; 101-B:753-754. [PMID: 31256670 DOI: 10.1302/0301-620x.101b7.bjj-2019-0628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Fares S Haddad
- The Bone & Joint Journal, Professor of Orthopaedic Surgery, University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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