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Karasavvidis T, Pagan CA, Sharma AK, Jerabek SA, Mayman DJ, Vigdorchik JM. Decreased Instability in High-Risk (Hip-Spine 2B) Patients After Modifications of Surgical Planning and Technique. J Arthroplasty 2024; 39:S138-S144. [PMID: 38642849 DOI: 10.1016/j.arth.2024.04.043] [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: 12/04/2023] [Revised: 04/08/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Patients undergoing primary total hip arthroplasty (THA) who have spinal deformity and a stiff spine are the highest-risk group for instability. Despite the increasing use of dual-mobility cups and large femoral heads, dislocation remains a major complication after THA. Preoperative planning becomes a critical aspect of ensuring precise component positioning within a safe zone. The purpose of this study was to investigate dislocation rates over a 9-year period. METHODS A retrospective review of 4,731 THAs performed by 3 orthopaedic surgeons between January 2014 and March 2023 was performed. Spinopelvic measurements were conducted to determine the hip-spine classification group for each patient. Only patients classified as 2B (pelvic incidence-lumbar lordosis > 10° and Δsacral slope < 10°) were eligible. Both absolute and relative dislocation frequencies were then analyzed using time-series analysis techniques and Fisher's exact tests. RESULTS A total of 281 hip-spine 2B patients undergoing primary THA were eligible for analysis (57% women; mean age, range: 66 years, 23 to 87; mean body mass index, range: 28, 16 to 45). The overall dislocation rate was 4.3%. Use of femoral head sizes ≥ 40 mm increased from 4% in 2014 to 2019 to 37% in 2020 to 2023 (P < .001), while the use of dual-mobility cups decreased from 100% in 2014 to 2019 to 37% in 2020 to 2023 (P < .001). Acetabular component planning was changed from the supine plane to the standing plane in February 2020. Those changes in surgical practice were notably correlated with a significant decrease in dislocation rates from 6.8% in 2014 to 2019 to 1.5% in 2020 to 2023 (P = .03). CONCLUSIONS Our study demonstrates that the introduction of advanced preoperative THA planning to the standing plane, coupled with precise intraoperative technology for implant placement, can significantly reduce the risk of instability in high-risk THA patients. Notably, we observed a significant decrease in dislocation rates, which aligned with the shift in surgical practice. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Cale A Pagan
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Abhinav K Sharma
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York; Department of Orthopaedic Surgery, University of California, Irvine, Orange, California
| | - Seth A Jerabek
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - David J Mayman
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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Handford C, Campbell R, Lorimer M, Molnar R, Harris IA. Risk of early revision in total hip arthroplasty: the relative contribution of the surgeon versus the hospital. ANZ J Surg 2024; 94:1507-1510. [PMID: 38727033 DOI: 10.1111/ans.19031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 03/20/2024] [Accepted: 05/01/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Early revision for total hip arthroplasty is a serious adverse outcome. There are multiple contributing risk factors for early revision. Risk factors can exist at the level of the surgeon and the level of the institution. The primary research question of this study was to determine the relative contribution of surgeon-level and hospital-level variance to rates of early revision (overall and for infection) after primary total hip arthroplasty. METHODS This is a registry-based study from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). Data for the most commonly used stem (Exeter V40) were used to reduce prosthesis variation from the analysis. A mixed effects Cox Model (also known as a frailty model) with crossed random effects for surgeon and hospital was used. Outcomes were early revision (within 2 years) for all causes and for infection. This model allowed for the risk of early revision to be explained by the variability at the surgeon level or hospital level. RESULTS There were 32 031 procedures performed by 735 surgeons across 250 hospitals between 1 January 2015 and 31 December 2019. Surgeon variability significantly contributed to overall variation in revision for any cause and revision for infection (P < 0.0001). There was no significant contribution of hospital-level variation to overall revision or for infection. CONCLUSIONS Surgeon-level factors play a more important role than institution-level factors in early revision after primary total hip arthroplasty. If surgeons are identified as having a higher risk of revision, there is potential for surgeon-level practice change to reduce the risk of early revision.
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Affiliation(s)
- Cameron Handford
- Department orthopaedic and Trauma surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Department of Orthopaedic and Trauma Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Ryan Campbell
- Department orthopaedic and Trauma surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Department of Orthopaedic and Trauma Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Michelle Lorimer
- Department of Orthopaedic and Trauma Surgery, St George Hospital, Sydney, New South Wales, Australia
- National Joint Replacement Registry, Australian Orthopaedic Association, Sydney, New South Wales, Australia
| | - Robert Molnar
- Department of Orthopaedic and Trauma Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - Ian A Harris
- Department of Orthopaedic and Trauma Surgery, St George Hospital, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Southern Western Sydney Clinical School, UNSW Sydney, Liverpool, New South Wales, Australia
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Graefe SB, Kirchner GJ, Pahapill NK, Nam HH, Dunleavy ML, Haines N. Adverse events associated with robotic-assistance in total hip arthroplasty: an analysis based on the FDA MAUDE database. Hip Int 2024:11207000241263315. [PMID: 39099264 DOI: 10.1177/11207000241263315] [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: 08/06/2024]
Abstract
BACKGROUND The Food and Drug Administration (FDA) maintains the Manufacturer and User Facility Device Experience (MAUDE) database for reporting adverse events associated with medical devices, including emerging technologies, such as robotic-assisted total hip arthroplasty (THA). Aim of this study was to evaluate the variation of adverse events associated with robotics in THA. METHODS Medical device reports (MDRs) within the MAUDE database were identified between 2017 and 2021. For MDR identification the product class "orthopaedic stereotaxic equipment" and terms associated with THA were used. Individual adverse events were identified and organised by type and consequences, such as patient injury, surgical delay, or conversion to the manual technique. RESULTS 521 MDRs constituting 546 discrete events were found. The most common reported complication was intraoperative hardware failure (304/546, 55.7%), among which the most common failure was a broken impaction handle/platform (110, 20.1%). Inaccurate cup placement was the second most common reported complication (63, 11.5%). Abandoning the robot occurred in 13.0% (71/521) of reports. A surgical delay was noted in 28% (146/521) of reports, with an average delay of 17.9 (range 1-60) minutes. CONCLUSIONS Identifying complications that may occur with robotics in THA is an important first step in preventing adverse events and surgical delays. Database analysis provide an overview of the range of complications.
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Affiliation(s)
- S Bradley Graefe
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Gregory J Kirchner
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Natalie K Pahapill
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Hannah H Nam
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Mark L Dunleavy
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Nikkole Haines
- Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
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Stauss R, Becker NT, Savov P, Ettinger M, Seeber GH. Analysis of Postoperative Complication and Revision Rates and Mid- to Long-Term Implant Survival in Primary Short-Stem Total Hip Arthroplasty. J Clin Med 2024; 13:3779. [PMID: 38999347 PMCID: PMC11242722 DOI: 10.3390/jcm13133779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/18/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: Short-stem prostheses were introduced as an alternative to conventional straight-stem prostheses. Despite their benefits, including minimally invasive approaches, soft-tissue- and bone-sparing implantation, and physiological load transfer to the metaphysis, data on postoperative complication and revision rates as well as on implant survival are scarce. Methods: A retrospective analysis of 1327 patients who underwent primary total hip arthroplasty (THA) using the Metha® short stem between 2006 and 2023 was conducted. Complication and revision rates were analysed for the intraoperative, direct postoperative, and follow-up episodes. Implant survival was analysed with the endpoint of all-cause stem revision. Results: Intraoperative complications were observed in 3.77% of the cases and included 44 hairline cracks and 6 fractures. In 15 cases (30.0%), conversion to a straight-stem or revision implant was necessary. The direct postoperative complication rate was 2.44%, and 11 revision procedures were performed during inpatient stay (0.84%). Mean follow-up was 7 years (range 1-17). During follow-up, femoral component revision was performed in 60 cases. Aseptic loosening and stem subsidence accounted for a combined percentage of 80% of all indications. Implant survival rate was 95.66% after 5 years, 95.58% after 10 years, and 95.50% after 15 years. Conclusions: Our study provides a comprehensive analysis of postoperative complication and revision rates in a large sample undergoing primary short-stem THA. Postoperative complication rates were favourable, and the long-term implant survival rates were comparable to conventional straight-stem prostheses. Therefore, short-stem THA may be considered an alternative for younger patients.
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Affiliation(s)
- Ricarda Stauss
- Division of Orthopaedics at Campus Pius-Hospital, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, 26121 Oldenburg, Germany
| | - Nils T. Becker
- Division of Orthopaedics at Campus Pius-Hospital, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, 26121 Oldenburg, Germany
| | - Peter Savov
- Division of Orthopaedics at Campus Pius-Hospital, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, 26121 Oldenburg, Germany
| | - Max Ettinger
- Division of Orthopaedics at Campus Pius-Hospital, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, 26121 Oldenburg, Germany
| | - Gesine H. Seeber
- Division of Orthopaedics at Campus Pius-Hospital, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, 26121 Oldenburg, Germany
- Department of Orthopedics, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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Romanelli F, Hong IS, Khan JA, Porter A, Jankowski JM, Liporace FA, Yoon RS. Intraoperative Fluoroscopy Versus Navigation to Determine Cup Anteversion in Direct Anterior Total Hip Replacement: A Technical Trick for Obtaining "True" Anteversion. Arthroplast Today 2024; 27:101426. [PMID: 38952777 PMCID: PMC11215948 DOI: 10.1016/j.artd.2024.101426] [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: 03/23/2024] [Accepted: 05/01/2024] [Indexed: 07/03/2024] Open
Abstract
During acetabular cup positioning, intraoperative measurements of cup anteversion were taken using both fluoroscopy and navigation system. With the C-arm introduced at 40°, an anteroposterior view of the pelvis is taken. The C-arm is then centered over the hip, showing an anteverted cup with an approximate inclination of 40°. The axial C-arm is tilted away until the cup opening is visualized as a straight line, indicating that the beam of the fluoroscopy is aligned with the cup's anteversion. The tilt angle on the C-arm and anteversion reading on the navigation workstation were recorded. The high degree of agreement between fluoroscopic and navigation measurement of acetabular cup anteversion supports the use of fluoroscopy in settings with limited access to navigation systems in direct anterior total hip arthroplasty.
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Affiliation(s)
- Filippo Romanelli
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Livingston/Jersey City, NJ, USA
| | - Ian S. Hong
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Livingston/Jersey City, NJ, USA
| | - Jibran A. Khan
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Livingston/Jersey City, NJ, USA
| | - Andrew Porter
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Livingston/Jersey City, NJ, USA
| | - Jaclyn M. Jankowski
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Livingston/Jersey City, NJ, USA
| | - Frank A. Liporace
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Livingston/Jersey City, NJ, USA
| | - Richard S. Yoon
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center – RWJBarnabas Health, Livingston/Jersey City, NJ, USA
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McIntosh EI, Sarpong NO, Steele JR, Davis E, Muir JM, Canoles HG, Vigdorchik JM. The Hip-spine Assessment of a Novel Surgical Planning Software Provides Acetabular Component Targets That Are Reliable and in Agreement With Current Clinical Recommendations. Arthroplast Today 2024; 25:101288. [PMID: 38292149 PMCID: PMC10825230 DOI: 10.1016/j.artd.2023.101288] [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: 07/31/2023] [Revised: 10/11/2023] [Accepted: 11/04/2023] [Indexed: 02/01/2024] Open
Abstract
Background Spinopelvic immobility has been reported to increase dislocation risk following total hip arthroplasty. Surgically placing acetabular components in a functional orientation has been shown to mitigate risk. The aim of this study was to evaluate the validity and reliability of novel surgical planning software to generate clinically recommended cup targets. Methods Hip-spine assessments were performed retrospectively on 40 patients. Five reviewers, including 3 arthroplasty-trained surgical fellows and 2 clinical research scientists performed the assessments. Hip-spine assessments consisted of measuring anterior pelvic plane tilt, sacral slope, pelvic incidence, and lumbar lordosis on standing anteroposterior pelvis and lateral standing and seated hip-spine images. Generated cup targets and a control group (40°/20° relative to the anterior pelvic plane) were compared to clinically recommended cup targets. Agreement was defined as a cup position within the recommended range or within 3° of a specific target (eg, 40° inclination) when no range was provided. Intraclass correlation coefficients were used to assess interrater and intrarater reliability, and McNemar's chi-square test was used to measure success relative to the control group. Results The intraclass correlation coefficient was 0.88 for delta sacral slope and 0.92 for pelvic incidence-lumbar lordosis mismatch. For patients with spinopelvic risk factors, the generated targets matched the clinical recommendations in 81% of patients compared to only 16% in the control group. Conclusions Excellent interrater and intrarater reliability was achieved using the novel surgical planning software. The resultant target values agreed with clinical recommendations to a greater extent than the control group.
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Affiliation(s)
- Emily I. McIntosh
- Department of Clinical Research, Intellijoint Surgical Inc, Kitchener, ON, Canada
| | - Nana O. Sarpong
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - John R. Steele
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Elizabeth Davis
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Jeffrey M. Muir
- Department of Clinical Research, Intellijoint Surgical Inc, Kitchener, ON, Canada
| | - Haley G. Canoles
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan M. Vigdorchik
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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Villa JM, Pannu TS, Ozery M, Jin Y, Piuzzi NS, Patel PD, Higuera CA. Does Time to Aseptic Failure After Primary Total Hip Arthroplasty Affect Clinical and Patient-Reported Outcomes? J Arthroplasty 2024; 39:180-186. [PMID: 37531980 DOI: 10.1016/j.arth.2023.07.019] [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: 05/15/2023] [Revised: 07/12/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Evidence on the effects of time-to-failure from primary total hip arthroplasty (THA) to aseptic first-revision on clinical results and patient-reported outcome measures (PROMs) is scarce. Therefore, we sought to compare demographics, operative times, lengths of stay, discharge dispositions, 90-day readmissions, re-revision rates, mortalities, and PROMs between early and late aseptic THA revisions. METHODS This study is a retrospective review of a prospectively collected institutional database of all elective hip procedures. In total, 572 patients who underwent aseptic revision after primary THA from August 2015 to December 2018 were analyzed. Patients were stratified into either early revision (<3-years; n = 176) or late revision (≥3-years; n = 396) cohorts. RESULTS Significantly more patients were revised earlier for bone-related (ie, periprosthetic fractures) (22.7% versus 8.3%) or other various complications (19.9% versus 5.8%), whereas more late revisions were performed to treat implant-related failures (6.8% versus 37.1%), respectively. Operative time was significantly shorter in early versus late revisions (133 versus 157 minutes). A significantly higher delta-change/improvement from baseline/preoperative to 1-year postoperative was found for hip disability and osteoarthritis outcome score physical function (HOOS-PS), veterans-RAND-12 physical and mental components (VR-12-PCS and MCS, respectively) of early revisions. However, HOOS-PS and HOOS-Pain at 1-year of follow-up were significantly worse in early revisions. CONCLUSION With exception of operative time, time-to-failure had no significant influence on clinical results. Despite greater improvements on PROMs from preoperative to postoperative, patients undergoing early revisions after primary THA perceive significantly higher levels of pain and worse physical functionality at 1-year of follow-up.
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Affiliation(s)
- Jesus M Villa
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Tejbir S Pannu
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Matan Ozery
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Yuxuan Jin
- Department of Orthopaedic Surgery, Cleveland Clinic Main Campus, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Main Campus, Cleveland, Ohio
| | - Preetesh D Patel
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Carlos A Higuera
- Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
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Shaikh HJF, Hasan SS, Woo JJ, Lavoie-Gagne O, Long WJ, Ramkumar PN. Exposure to Extended Reality and Artificial Intelligence-Based Manifestations: A Primer on the Future of Hip and Knee Arthroplasty. J Arthroplasty 2023; 38:2096-2104. [PMID: 37196732 DOI: 10.1016/j.arth.2023.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Software-infused services, from robot-assisted and wearable technologies to artificial intelligence (AI)-laden analytics, continue to augment clinical orthopaedics - namely hip and knee arthroplasty. Extended reality (XR) tools, which encompass augmented reality, virtual reality, and mixed reality technology, represent a new frontier for expanding surgical horizons to maximize technical education, expertise, and execution. The purpose of this review is to critically detail and evaluate the recent developments surrounding XR in the field of hip and knee arthroplasty and to address potential future applications as they relate to AI. METHODS In this narrative review surrounding XR, we discuss (1) definitions, (2) techniques, (3) studies, (4) current applications, and (5) future directions. We highlight XR subsets (augmented reality, virtual reality, and mixed reality) as they relate to AI in the increasingly digitized ecosystem within hip and knee arthroplasty. RESULTS A narrative review of the XR orthopaedic ecosystem with respect to XR developments is summarized with specific emphasis on hip and knee arthroplasty. The XR as a tool for education, preoperative planning, and surgical execution is discussed with future applications dependent upon AI to potentially obviate the need for robotic assistance and preoperative advanced imaging without sacrificing accuracy. CONCLUSION In a field where exposure is critical to clinical success, XR represents a novel stand-alone software-infused service that optimizes technical education, execution, and expertise but necessitates integration with AI and previously validated software solutions to offer opportunities that improve surgical precision with or without the use of robotics and computed tomography-based imaging.
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Affiliation(s)
| | - Sayyida S Hasan
- Donald and Barbara Zucker School of Medicine at Hofstra, Uniondale, New York
| | | | | | | | - Prem N Ramkumar
- Hospital for Special Surgery, New York, New York; Long Beach Orthopaedic Institute, Long Beach, California
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Frandsen JJ, Rainey JP, Kahn TL, Blackburn BE, Pelt CE, Anderson LA, Gililland JM. A Novel Method to Calculate Functional Pelvic Tilt Using a Standing Anteroposterior Pelvis Radiograph. Arthroplast Today 2023; 21:101145. [PMID: 37274836 PMCID: PMC10238463 DOI: 10.1016/j.artd.2023.101145] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/16/2023] [Accepted: 04/04/2023] [Indexed: 06/07/2023] Open
Abstract
Background Functional patient-specific acetabular component positioning is important in total hip arthroplasty. We preoperatively evaluate the pelvic tilt (PT) on standing anteroposterior (AP) pelvis radiographs using a novel measurement and then recreate this intraoperatively using imaging. The purpose of this study was to determine if there is a linear correlation between this novel measurement and the actual PT. Methods A retrospective study of 200 patients was performed, measuring PT on standing lateral radiographs as the angle between the anterior superior iliac spines and the pubic symphysis. On the AP pelvis radiographs, the trans-teardrop (TT) line was drawn between the teardrops. The vertical distance between the TT line and the top of the pubic symphysis (TTPS) was then measured. A ratio was made between the lengths of both lines to account for the overall size of the pelvis (TTPS/TT). Linear regression analysis was then performed between PT and TTPS/TT. Results There was a strong linear correlation between the TTPS/TT ratio on AP pelvis radiographs and PT on lateral radiographs (r = 0.785, r2 = 0.616, P < .001). On subanalysis of the female cohort, the correlation became even stronger (r = 0.864, r2 = 0.747, P < .001). Using regression analysis, a linear equation was created (PT = 97.32 [TTPS/TT] - 5.51), to calculate the PT using the TTPS/TT ratio. Conclusions There is a strong linear correlation between the TTPS/TT ratio and PT. Using this information, a surgeon can reliably use the distance between the TT line and the superior pubic symphysis on an AP radiograph to recreate the patient's functional PT intraoperatively, allowing for a more accurate patient-specific placement of the acetabular component.
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Affiliation(s)
| | - Joshua P. Rainey
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | | | | | | | - Lucas A. Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
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Ackerman SJ, Vigdorchik JM, Siljander BR, Gililland JM, Sculco PK, Polly DW. Projected Savings Associated with Lowering the Risk of Total Hip Arthroplasty Revision Due to Dislocation in Patients with Spinopelvic Pathology. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:321-330. [PMID: 37143936 PMCID: PMC10153402 DOI: 10.2147/ceor.s410453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/15/2023] [Indexed: 05/06/2023] Open
Abstract
Purpose In the United States (US), total hip arthroplasty (THA) is the most common hospital inpatient operation among Medicare beneficiaries and is ranked fourth when considering all payers. Spinopelvic pathology (SPP) is associated with an increased risk of THA revision (rTHA) due to dislocation. Several strategies have been proposed to mitigate the risk of instability in this population, including use of dual-mobility implants, anterior-based surgical approaches, and technology-assistance (digital 2D/3D pre-surgical planning, computer navigation, and robotic assistance). For primary THA (pTHA) patients with SPP who subsequently undergo rTHA due to dislocation, we aimed to estimate (1) target population size; (2) economic burden; and (3) 10-year projected savings to the US payer of lowering the risk of rTHA due to dislocation among pTHA patients with SPP. Methods A budget impact analysis from the US payer perspective was undertaken using published literature; American Academy of Orthopaedic Surgeons American Joint Replacement Registry 2021 Annual Report; Centers for Medicare & Medicaid Services MEDPAR 2019; and National (Nationwide) Inpatient Sample (NIS) 2019. Expenditures were inflation-adjusted to 2021 US dollars using the Medical Care component of the Consumer Price Index. Sensitivity analyses were performed. Results The target population size in 2021 was estimated at 5040 (range, 4830-6309) for Medicare (fee-for-service plus Medicare Advantage) and 8003 (range, 7669-10,018) for all-payer. Annual rTHA episode-of-care (through 90 days) expenditures for Medicare and all-payer were $185 million and $314 million, respectively. Using a 4.14% compound annual growth rate from NIS, the estimated number of applicable rTHA procedures that will be performed from 2022-2031 was 63,419 Medicare and 100,697 all-payer. With each 10% reduction in relative risk of rTHA due to dislocation, Medicare and all-payer could save $233 million and $395 million, respectively, over a 10-year period. Conclusion Among pTHA patients with spinopelvic pathology, a modest reduction in the risk of rTHA due to dislocation could achieve substantial cumulative savings to payers while improving healthcare quality.
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Affiliation(s)
- Stacey J Ackerman
- Department of Biomedical Engineering, Johns Hopkins University, San Diego, CA, USA
- Correspondence: Stacey J Ackerman, Email
| | | | - Breana R Siljander
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Jeremy M Gililland
- Department of Orthopedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Peter K Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - David W Polly
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
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Xu J, Veltman ES, Chai Y, Walter WL. Accuracy of acetabular component alignment with surgical guidance systems during hip arthroplasty. SICOT J 2023; 9:12. [PMID: 37144949 PMCID: PMC10161875 DOI: 10.1051/sicotj/2023010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/12/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Navigation in total hip arthroplasty has been shown to improve acetabular positioning and can decrease the incidence of mal-positioned acetabular components. This study aimed to assess two surgical guidance systems by comparing intra-operative measurements of acetabular component inclination and anteversion with a post-operative CT scan. METHODS We prospectively collected intra-operative navigation data from 102 hips receiving conventional THA or hip resurfacing arthroplasty through either a direct anterior or posterior approach. Two guidance systems were used simultaneously: an inertial navigation system (INS) and an optical navigation system (ONS). Acetabular component anteversion and inclination were measured on a post-operative CT. RESULTS The average age of the patients was 64 years (range: 24-92) and the average BMI was 27 kg/m2 (range 19-38). 52% had hip surgery through an anterior approach. 98% of the INS measurements and 88% of the ONS measurements were within 10° of the CT measurements. The mean (and standard deviation) of the absolute difference between the postoperative CT and the intra-operative measurements for inclination and anteversion were 3.0° (2.8) and 4.5° (3.2) respectively for the ONS, along with 2.1° (2.3) and 2.4° (2.1) respectively for the INS. There was a significantly lower mean absolute difference to CT for the INS when compared to ONS in both anteversions (p < 0.001) and inclination (p = 0.02). CONCLUSIONS We found that both inertial and optical navigation systems allowed for adequate acetabular positioning as measured on postoperative CT, and thus provide reliable intraoperative feedback for optimal acetabular component placement. LEVEL OF EVIDENCE Therapeutic Level II.
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Affiliation(s)
- Joshua Xu
- University of Sydney, Sydney, New South Wales, Australia - Department of Orthopaedic and Trauma Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia - Tom Reeve Academic Clinic, Ground Floor Kolling Building, 10 Westbourne Street, St Leonards, NSW 2065, Australia
| | - Ewout S Veltman
- Department of Orthopaedic and Trauma Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
| | - Yuan Chai
- University of Sydney, Sydney, New South Wales, Australia
| | - William L Walter
- University of Sydney, Sydney, New South Wales, Australia - Department of Orthopaedic and Trauma Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
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12
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Canoles HG, Vigdorchik JM. Occupational Hazards to the Joint Replacement Surgeon: How Can Technology Help Prevent Injury? J Arthroplasty 2022; 37:1478-1481. [PMID: 35074449 DOI: 10.1016/j.arth.2022.01.030] [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: 12/01/2021] [Revised: 01/08/2022] [Accepted: 01/12/2022] [Indexed: 02/02/2023] Open
Abstract
Occupational hazards pose varying threats to the joint replacement surgeon. Musculoskeletal pain due to the repetitive nature of performing joint arthroplasty is felt daily by most surgeons. The purpose of this paper is to offer a basic introduction and demonstrate the many ways technology utilized during total joint arthroplasty can help mitigate common occupational hazards for the arthroplasty surgeon. This paper guides readers through the evolution and drivers behind technology in joint arthroplasty, describes several technologies currently available, and discusses how certain aspects of this technology may work to improve surgeon and patient outcomes. We review how advanced technologies in arthroplasty may reduce physical and mental demand, improve reproducibility, and decrease complications. The decision to utilize advanced technology in joint arthroplasty is ultimately made on an individual level after careful consideration of available literature.
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Affiliation(s)
- Haley G Canoles
- Department of Orthopedic Surgery, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY
| | - Jonathan M Vigdorchik
- Department of Orthopedic Surgery, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY
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13
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Roof MA, Kreinces JB, Schwarzkopf R, Rozell JC, Aggarwal VK. Are there avoidable causes of early revision total knee arthroplasty? Knee Surg Relat Res 2022; 34:29. [PMID: 35717341 PMCID: PMC9206343 DOI: 10.1186/s43019-022-00157-z] [Citation(s) in RCA: 2] [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] [Received: 12/20/2021] [Accepted: 05/20/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Surgeons can improve their practice by understanding potentially avoidable reasons for early revision total knee arthroplasty (rTKA). The purpose of this study is to describe potentially avoidable indications for rTKA within 5 years of the index procedure. Methods This retrospective observational analysis utilized the rTKA database at a large, academic orthopedic specialty hospital to identify 167 consecutive rTKA from 2014 to 2019 performed within 5 years after primary TKA (pTKA). Two fellowship-trained arthroplasty surgeons reviewed the cases to classify them as potentially avoidable or unavoidable. Unavoidable indications for rTKA included infection/wound complication, arthrofibrosis, instability due to underlying collagen disease or significant weight loss, and any traumatic event leading to pTKA failure. Potentially avoidable indications included atraumatic instability, intraoperative fracture, metal allergy, and atraumatic patellar instability or maltracking. Aseptic loosening was considered avoidable if it occurred in the presence of component malpositioning or poor cementation technique. Results There were 112 (67.1%) unavoidable cases and 55 avoidable cases (32.9%). Of the unavoidable cases, there were 68 rTKA for infection or wound complications (60.7%), 23 for arthrofibrosis (20.5%), 6 for instability (5.4%), 6 for postoperative fracture (5.4%), 6 for aseptic loosening (5.4%), and 3 for extensor mechanism pathology following trauma (2.6%). Of the potentially avoidable rTKA, 24 were for aseptic loosening (43.7%), 23 for atraumatic instability (41.8%), 6 for atraumatic extensor mechanism pathology (10.9%), 1 for nickel allergy (1.8%), and 1 for intraoperative fracture (1.8%). Conclusion These findings indicate that over 30% of early rTKA are potentially avoidable. Interventions should focus on addressing potentially avoidable causes such as short-term aseptic loosening and instability to reduce the need for costly and resource-intensive rTKA. Level of evidence III, retrospective observational analysis
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Affiliation(s)
- Mackenzie A Roof
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, 462 First Ave (BHC), CD Bldg Room 4-85, New York, NY, USA
| | - Jason B Kreinces
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, 462 First Ave (BHC), CD Bldg Room 4-85, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, 462 First Ave (BHC), CD Bldg Room 4-85, New York, NY, USA
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, 462 First Ave (BHC), CD Bldg Room 4-85, New York, NY, USA
| | - Vinay K Aggarwal
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, 462 First Ave (BHC), CD Bldg Room 4-85, New York, NY, USA.
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14
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Walter WL, Baker NA, Marsden-Jones D, Sadeghpour A. Novel Measure of Acetabular Cup Inclination and Anteversion During Total Hip Arthroplasty. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2022; 15:1-14. [PMID: 35115849 PMCID: PMC8806051 DOI: 10.2147/mder.s339669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/20/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE The purposes of the present research were to assess the accuracy and usability of the inertial navigation system (INS). MATERIALS AND METHODS The accuracy of the device navigation subsystem was assessed using benchtop testing. The usability was assessed through simulated use with surgeons. These results were compared to recent cadaveric results for the same system. RESULTS The navigation subsystem had an overall mean absolute error of 1.21° and a maximum absolute error across all devices of 4.79°. The device was found to be usable and to add an estimated 7 minutes to surgery time. CONCLUSION The INS uses a novel approach to provide the surgeon with accurate and fast acetabular cup inclination and anteversion angles during THA.
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Affiliation(s)
- William L Walter
- Orthopaedics and Traumatic Surgery, University of Sydney, Sydney, New South Wales, Australia
| | - Neri A Baker
- Innovation Department, Navbit, Sydney, New South Wales, Australia
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15
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Agarwal S, Eckhard L, Walter WL, Peng A, Hatton A, Donnelly B, de Steiger R. The Use of Computer Navigation in Total Hip Arthroplasty Is Associated with a Reduced Rate of Revision for Dislocation: A Study of 6,912 Navigated THA Procedures from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg Am 2021; 103:1900-1905. [PMID: 34143758 DOI: 10.2106/jbjs.20.00950] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The use of computer navigation has been shown to produce more accurate cup positioning when compared with non-navigated total hip arthroplasty (THA), but so far there is only limited evidence to show its effect on clinical outcomes. The present study analyzed data from the Australian Orthopaedic Association National Joint Replacement Registry to assess the impact of computer navigation on the rates of all-cause revision and revision for dislocation following THA. METHODS Data for all non-navigated and navigated primary THAs performed for osteoarthritis in Australia from January 1, 2009, to December 31, 2019, were examined to assess the rate of revision. We analyzed the effects of navigation on rate, reason, and type of revision. Hazard ratios (HRs) from Cox proportional hazard models, adjusted for age, sex, and head size, were utilized. Because of known prosthesis-specific differences in outcomes, we performed a further analysis of the 5 acetabular and femoral component combinations most commonly used with navigation. RESULTS Computer navigation was utilized in 6,912 primary THAs for osteoarthritis, with the use of navigation increasing from 1.9% in 2009 to 4.4% of all primary THAs performed in 2019. There was no difference in the rate of all-cause revision between navigated and non-navigated THAs looking at the entire group. There was a lower rate of revision for dislocation in the navigation THA cohort. The cumulative percent revision for dislocation at 10 years was 0.4% (95% confidence interval [CI], 0.2% to 0.6%) for navigated compared with 0.8% (95% CI, 0.8% to 0.9%) for non-navigated THAs (HR adjusted for age, sex, and head size, 0.46; 95% CI, 0.29 to 0.74; p = 0.002). In the 5 component combinations most commonly used with navigation, the rate of all-cause revision was significantly lower when these components were navigated compared with non-navigated. The cumulative percent revision at 10 years for these 5 prostheses combined was 2.4% (95% CI, 1.6% to 3.4%) for navigated compared with 4.2% (95% CI, 4.0% to 4.5%) for non-navigated THAs (HR, 0.64; 95% CI, 0.48 to 0.86; p = 0.003). CONCLUSIONS This study showed that the use of computer navigation was associated with a reduced rate of revision for dislocation following THA. Furthermore, in the component combinations most commonly used with navigation there was also a reduction in the rate of all-cause revision. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sujit Agarwal
- Australian Institute of Musculo-Skeletal Research, Sydney, New South Wales, Australia.,Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, England
| | - Lukas Eckhard
- Australian Institute of Musculo-Skeletal Research, Sydney, New South Wales, Australia.,Department of Orthopaedics and Traumatology, University Medical Center of the Johannes-Gutenberg University Mainz, Mainz, Germany
| | - William L Walter
- Institute of Bone and Joint Research, the Kolling Institute, The University of Sydney, and Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Andrea Peng
- South Australian Health and Medical Research Institute, South Adelaide, South Australia, Australia
| | - Alesha Hatton
- South Australian Health and Medical Research Institute, South Adelaide, South Australia, Australia
| | - Bill Donnelly
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Richard de Steiger
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia.,Department of Surgery, Epworth Healthcare, University of Melbourne, Richmond, Victoria, Australia
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16
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Davis ET, Pagkalos J, Kopjar B. Using an asymmetric crosslinked polyethylene liner in primary total hip arthroplasty is associated with a lower risk of revision surgery : an analysis of the National Joint Registry. Bone Joint J 2021; 103-B:1479-1487. [PMID: 34465151 PMCID: PMC9948452 DOI: 10.1302/0301-620x.103b9.bjj-2021-0365.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS The aim of our study was to investigate the effect of asymmetric crosslinked polyethylene liner use on the risk of revision of cementless and hybrid total hip arthroplasties (THAs). METHODS We undertook a registry study combining the National Joint Registry dataset with polyethylene manufacturing characteristics as supplied by the manufacturers. The primary endpoint was revision for any reason. We performed further analyses on other reasons including instability, aseptic loosening, wear, and liner dissociation. The primary analytic approach was Cox proportional hazard regression. RESULTS A total of 213,146 THAs were included in the analysis. Overall, 2,997 revisions were recorded, 1,569 in THAs with a flat liner and 1,428 in THAs using an asymmetric liner. Flat liner THAs had a higher risk of revision for any reason than asymmetric liner THAs when implanted through a Hardinge/anterolateral approach (hazard ratio (HR) 1.169, 95% confidence interval (CI) 1.022 to 1.337) and through a posterior approach (HR 1.122, 95% CI 1.108 to 1.346). There was no increased risk of revision for aseptic loosening when asymmetric liners were used for any surgical approach. A separate analysis of the three most frequently used crosslinked polyethylene liners was in agreement with this finding. When analyzing THAs with flat liners only, THAs implanted through a Hardinge/anterolateral approach were associated with a reduced risk of revision for instability compared to posterior approach THAs (HR 0.561 (95% CI 0.446 to 0.706)). When analyzing THAs with an asymmetric liner, there was no significant difference in the risk of revision for instability between the two approaches (HR 0.838 (95% CI 0.633 to 1.110)). CONCLUSION For THAs implanted through the posterior approach, the use of asymmetric liners reduces the risk of revision for instability and revision for any reason. In THAs implanted through a Hardinge/anterolateral approach, the use of an asymmetric liner was associated with a reduced risk of revision. The effect on revision for instability was less pronounced than in the posterior approach. Cite this article: Bone Joint J 2021;103-B(9):1479-1487.
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Affiliation(s)
- Edward T. Davis
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK,Correspondence should be sent to Edward T. Davis. E-mail:
| | - Joseph Pagkalos
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Branko Kopjar
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK,School of Public Health, University of Washington Department of Health Services, Seattle, Washington, USA
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17
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Davis ET, McKinney KD, Kamali A, Kuljaca S, Pagkalos J. Reduced Risk of Revision with Computer-Guided Versus Non-Computer-Guided THA: An Analysis of Manufacturer-Specific Data from the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man. JB JS Open Access 2021; 6:JBJSOA-D-21-00006. [PMID: 34337286 PMCID: PMC8318654 DOI: 10.2106/jbjs.oa.21.00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Computer-assisted total hip arthroplasty (THA) is known to improve implantation precision, but clinical data demonstrating an improvement in survivorship and patient-reported outcome measures (PROMs) are lacking. Our aim was to compare the risk of revision, PROMs, and patient satisfaction between cohorts who underwent THA with and without the use of computer guidance. Methods We used the data set and linked PROM data of the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man. Our sample included THAs performed for osteoarthritis using cementless acetabular components from a single manufacturer (cementless and hybrid THAs). An additional analysis was performed limiting the sample size to cementless-only THAs. The primary end point was revision (any component) for any reason. Kaplan-Meier survivorship analysis and an adjusted Cox proportional-hazards model were used. Results There were 41,683 non-computer-guided and 871 (2%) computer-guided cases included in our analysis of the cementless and hybrid group. There were 943 revisions in the non-computer-guided group and 7 in the computer-guided group. The cumulative revision rate at 10 years was 3.88% (95% confidence interval [CI]: 3.59% to 4.18%) for the non-computer-guided group and 1.06% (95% CI: 0.45% to 2.76%) for the computer-guided group. The Cox proportional-hazards model yielded a hazard ratio of 0.45 (95% CI: 0.21 to 0.96; p = 0.038). In the analysis of the cementless-only group, the cumulative revision rate at 10 years was 3.99% (95% CI: 3.62% to 4.38%) and 1.20% (95% CI: 0.52% to 3.12%) for the 2 groups, respectively. The Cox proportional-hazards model yielded a hazard ratio of 0.47 (95% CI: 0.22 to 1.01; p = 0.053). There was no significant difference in the 6-month Oxford Hip Score, the EuroQol-5 Dimension (EQ-5D) and EQ-VAS (Visual Analogue Scale) scores, and patient-reported success rates. Patient satisfaction (single-item satisfaction outcome measure) was higher in the computer-guided group, but this finding was limited by a reduced number of responses. Conclusions In our analysis, the use of computer-guided surgery was associated with a lower rate of revision at mean follow-up of 5.6 years. This finding was upheld when the sample was restricted to cementless-only THAs. Causality cannot be inferred in view of the observational nature of the study, and additional studies are recommended to validate these findings. Level of Evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Edward T Davis
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | | | | | | | - Joseph Pagkalos
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
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18
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The Effect of a Degenerative Spine and Adverse Pelvic Mobility on Prosthetic Impingement in Patients Undergoing Total Hip Arthroplasty. J Arthroplasty 2021; 36:2523-2529. [PMID: 33692000 DOI: 10.1016/j.arth.2021.02.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite the placement of acetabular components in the traditional "safe-zone", dislocations and all parts of the instability spectrum, including impingement, continue to be an issue. Recent research has established the importance of a degenerative spine and adverse pelvic mobility on functional acetabular orientation. The purpose of this study is to quantify the clinical consequences of a degenerative spine and adverse pelvic mobility on prosthetic impingement in patients undergoing total hip arthroplasty. METHODS Between January 2018 and December 2019, a series of 1592 patients undergoing total hip arthroplasty had functional lateral radiographs and a computed tomography scan taken. Two spinal parameters and 2 pelvic mobility parameters were investigated for their association with impingement. Each patient was evaluated for anterior and posterior impingement, at all orientations within a traditional supine safe zone and a patient-specific functional safe zone. RESULTS Patients with limited lumbar flexion (stiff spine), higher pelvic incidence-lumbar lordosis mismatch (sagittal imbalance), and more anterior pelvic mobility from stand to flexed-seated, exhibit increased anterior impingement. Patients with larger posterior pelvic mobility from supine-to-stand exhibited increased posterior impingement. Impingement was reduced 3-fold when the target cup orientation was tailored to a patient's functional safe zone rather than a generic target. Six percent of patients showed unavoidable impingement even with an optimized functional cup orientation. CONCLUSION Our results support growing evidence that patients with a degenerative spine and adverse pelvic mobility are likely to have unfavorable functional cup orientations, resulting in prosthetic impingement. Preoperative functional radiographic screening is recommended to assess the likelihood of a patient experiencing impingement due to their unique spinopelvic mobility.
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19
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Motomura G, Hamai S, Ikemura S, Fujii M, Kawahara S, Yoshino S, Nakashima Y. Contemporary indications for first-time revision surgery after primary cementless total hip arthroplasty with emphasis on early failures. J Orthop Surg Res 2021; 16:140. [PMID: 33596927 PMCID: PMC7887811 DOI: 10.1186/s13018-021-02298-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To clarify contemporary indications for first-time revision surgery after primary cementless total hip arthroplasty (THA) for addressing potential issues with cementless THA. METHODS Data for 101 consecutive hips in 94 patients who underwent primary cementless THA at our institution and subsequently underwent first-time revision surgery were retrospectively reviewed. Baseline characteristics, indications for first-time revision surgery, and time from the primary THA to first-time revision surgery were evaluated. RESULTS The overall mean time to first-time revision surgery was 10.3 years (range, 0-33 years). The indications for first-time revision surgery were polyethylene wear and osteolysis in 33 hips, aseptic loosening in 25 hips, infection in 17 hips, periprosthetic fracture in 13 hips, instability in 8 hips, and component failure (liner dissociation or stem fracture) in 5 hips. Thirty-seven hips (37%) had undergone first-time revision surgery within 5 years of primary THA, of which the most common indications were infection and periprosthetic fracture. CONCLUSION The current results suggested that reducing the number of early failures seems to be essential form improving THA outcomes.
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Affiliation(s)
- Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shinya Kawahara
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Soichiro Yoshino
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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20
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Hughes R, Hallstrom B, Schemanske C, Howard PW, Wilton T. Returning to operating following COVID-19 shutdown: what can human factors tell us? Bone Joint J 2020; 102-B:1277-1278. [PMID: 32993342 DOI: 10.1302/0301-620x.102b10.bjj-2020-1450.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Richard Hughes
- Michigan Arthroplasty Registry Collaborative Quality Initiative, Michigan, USA
| | - Brian Hallstrom
- Michigan Arthroplasty Registry Collaborative Quality Initiative, Michigan, USA
| | | | | | - Tim Wilton
- National Joint Registry of England, Wales, UK
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21
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Bostrom MPG, Haddad FS. The Hip Society Supplement 2019. Bone Joint J 2019; 101-B:1. [PMID: 31146566 DOI: 10.1302/0301-620x.101b6.bjj-2019-0549] [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)
- M P G Bostrom
- Hospital for Special Surgery, New York City, New York, USA
| | - Fares S Haddad
- The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH
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