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Guezou-Philippe A, Dardenne G, Letissier H, Yvinou A, Burdin V, Stindel E, Lefèvre C. Anterior pelvic plane estimation for total hip arthroplasty using a joint ultrasound and statistical shape model based approach. Med Biol Eng Comput 2023; 61:195-204. [PMID: 36342596 DOI: 10.1007/s11517-022-02681-2] [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: 09/14/2021] [Accepted: 09/21/2022] [Indexed: 11/09/2022]
Abstract
Orienting properly the prosthetic cup in total hip arthroplasty is key to ensure the postoperative stability. Several navigation solutions have been developed to assist surgeons in orienting the cup regarding the anterior pelvic plane (APP), defined by both anterior superior iliac spines (ASIS) and the pubic symphysis. However acquiring the APP when the patient is ready for surgery, i.e., mainly in lateral decubitus, is difficult due to the contralateral ASIS being against the operating table. We propose a method to determine the APP from both (1) alternative anatomical landmarks which are easy to acquire with a navigated ultrasound probe and (2) a Statistical Shape Model (SSM) of the pelvis. After creating a pelvic SSM from 40 data, a SSM-based morphometric analysis has been carried out to identify the best anatomical landmarks allowing the easy determination of the APP. The proposed method has then been assessed with both in silico and in vivo experiments on respectively forty synthetic data, and five healthy volunteers. The in silico experiment shows the feasibility to determine the APP with an average error of 4.7∘ by only acquiring the iliac crest, the anterior superior iliac spine, the anterior inferior iliac spine, and the pubic symphysis. The average in vivo error using the ultrasound modality was 7.3∘ with an estimated impact on both the cup anteversion and inclination of 4.0∘ and 1.7∘ respectively. The proposed method shows promising results that could allow the determination of the APP in lateral decubitus with a clinically acceptable impact on the computation of the cup orientation.
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Affiliation(s)
- Aziliz Guezou-Philippe
- Latim INSERM UMR 1101, Brest, France. .,CHU, Brest, France. .,University of Western Brittany, Brest, France.
| | | | - Hoel Letissier
- Latim INSERM UMR 1101, Brest, France.,CHU, Brest, France.,University of Western Brittany, Brest, France
| | - Agathe Yvinou
- Latim INSERM UMR 1101, Brest, France.,CHU, Brest, France.,University of Western Brittany, Brest, France
| | - Valérie Burdin
- Latim INSERM UMR 1101, Brest, France.,IMT Atlantique, Brest, France
| | - Eric Stindel
- Latim INSERM UMR 1101, Brest, France.,CHU, Brest, France.,University of Western Brittany, Brest, France
| | - Christian Lefèvre
- Latim INSERM UMR 1101, Brest, France.,CHU, Brest, France.,University of Western Brittany, Brest, France
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Kiefer H, Löchel J, Sambo K, Leder B, Wassilew GI. Anterior pelvic plane registration accuracy and cup position measurement using ultrasound- and pointer-based navigation in primary total hip arthroplasty. Technol Health Care 2021; 28:315-323. [PMID: 31658073 DOI: 10.3233/thc-191888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Incorrect cup positioning in primary total hip arthroplasty is known as a risk factor for early implant failure. The use of navigation systems leads to more accurate cup positioning. OBJECTIVE The aim of this study was to compare the registration accuracy of the anterior pelvic plane and the measurement accuracy of the definite cup position for a pointer computer-assisted orthopaedic navigation system (P-CAOS) and an ultrasound-based navigation tool (US-CAOS) in an intra-individual study design. METHODS Anterior pelvic plane registration was performed in 44 patients receiving a primary total hip arthroplasty with P-CAOS and US-CAOS. The cup implantation was performed using US-CAOS. Intraoperatively, the cup position was assessed using P-CAOS and US-CAOS. The postoperative cup position was determined via CT scan. Inclination and anteversion errors were calculated using intraoperative values and CT data. All operations were performed by a single, high-volume surgeon using a minimally invasive anterolateral approach. RESULTS The mean inclination error was 0.9∘ in the US-CAOS group and -1.1∘ in the P-CAOS group. This was not statistically significant. The mean anteversion error was significantly reduced (p< 0.001) in the US-CAOS group (1.4∘) compared to the P-CAOS group (-8.0∘). Significantly more cups (23 of 44; 52%) in the P-CAOS group were outliers regarding to the defined anteversion error range of 15∘± 10∘. Outliers in the US-CAOS group amounted to two (of 44; 5%) (p< 0.001). The number of outliers regarding the inclination error range of 40∘± 10∘, did not differ significantly between the P-CAOS (2; 5%) and US-CAOS (1; 2%) group. CONCLUSION We were able to show a systematic anterior pelvic plane registration error in this intraindividual study design. US-CAOS based APP landmark registration showed to be significantly more precise compared to P-CAOS registration. The anteversion error of the cup using US-CAOS showed to be significantly reduced compared to the P-CAOS method.
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Affiliation(s)
- Hartmuth Kiefer
- Department of Orthopaedic and Trauma Surgery, Lukas-Hospital Bünde, Germany.,Department of Orthopaedic and Trauma Surgery, Lukas-Hospital Bünde, Germany
| | - Jannis Löchel
- Center for Musculoskeletal Surgery, Orthopaedic Department, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Orthopaedic and Trauma Surgery, Lukas-Hospital Bünde, Germany
| | - Keosun Sambo
- Department of Orthopaedic and Trauma Surgery, Lukas-Hospital Bünde, Germany
| | - Björn Leder
- Department of Orthopaedic and Trauma Surgery, Lukas-Hospital Bünde, Germany
| | - Georgi I Wassilew
- Department for Orthopaedic Surgery, University of Greifswald, Greifswald, Germany
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Kievit AJ, Dobbe JGG, Mallee WH, Blankevoort L, Streekstra GJ, Schafroth MU. Accuracy of cup placement in total hip arthroplasty by means of a mechanical positioning device: a comprehensive cadaveric 3d analysis of 16 specimens. Hip Int 2021; 31:58-65. [PMID: 31506002 PMCID: PMC7797610 DOI: 10.1177/1120700019874822] [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 We tested whether a mechanical device (such as Hipsecure) to pinpoint the anterior pelvic plane (APP) as a guide can improve acetabular cup placement. To assess accuracy we asked: (1) is the APP an effective guide to position acetabular cup placement within acceptable ° of divergence from the optimal 40° inclination and 15° anteversion; (2) could a mechanical device increase the number of acetabular cup placements within Lewinnek's safe zone (i.e. inclination 30° to 50°; anteversion 5° to 25°)? METHODS 16 cadaveric specimens were used to assess the 3D surgical success of using a mechanical device APP to guide acetabular cup placement along the APP. We used the Hipsecure mechanical device to implant acetabular cups at 40° inclination and 15° anteversion. Subequently, all cadaveric specimens with implants were scanned with a CT and 3D models were created of the pelvis and acetabular cups to assess the outcome in terms of Lewinnek's safe zones. RESULTS The mean inclination of the 16 implants was 40.6° (95% CI, 37.7-43.4) and the mean anteversion angle was 13.4° (95% CI, 10.7-16.1). All 16 cup placements were within Lewinnek's safe zone for inclination (between 30° and 50°) and all but 2 were within Lewinnek's safe zone for anteversion (between 5° and 25°). CONCLUSION In cadaveric specimens, the use of a mechanical device and the APP as a guide for acetabular cup placement resulted in good positioning with respect to both of Lewinnek's safe zones.
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Affiliation(s)
- Arthur J Kievit
- Orthopaedic Research Centre Amsterdam, Department of Orthopaedics of the Amsterdam University Medical Centre, University of Amsterdam, The Netherlands,Arthur J Kievit, Orthopaedic Research Centre Amsterdam, Department of Orthopaedics of the Amsterdam University Medical Centre, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands.
| | - Johannes G G Dobbe
- Department of Biomedical Engineering and Physics of the Amsterdam University Medical Centre, University of Amsterdam, The Netherlands
| | - Wouter H Mallee
- Orthopaedic Research Centre Amsterdam, Department of Orthopaedics of the Amsterdam University Medical Centre, University of Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Orthopaedic Research Centre Amsterdam, Department of Orthopaedics of the Amsterdam University Medical Centre, University of Amsterdam, The Netherlands
| | - Geert J Streekstra
- Department of Biomedical Engineering and Physics of the Amsterdam University Medical Centre, University of Amsterdam, The Netherlands
| | - Matthias U Schafroth
- Orthopaedic Research Centre Amsterdam, Department of Orthopaedics of the Amsterdam University Medical Centre, University of Amsterdam, The Netherlands
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Mihalič R, Zdovc J, Mohar J, Trebše R. Electromagnetic navigation system for acetabular component placement in total hip arthroplasty is more precise and accurate than the freehand technique: a randomized, controlled trial with 84 patients. Acta Orthop 2020; 91:675-681. [PMID: 32608315 PMCID: PMC8023939 DOI: 10.1080/17453674.2020.1783073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The accuracy of conventional navigation systems depends on precise registration of bony landmarks. We investigated the clinical use of electromagnetic navigation (EMN), with a unique device for precise determination of the anterior pelvic plane. Patients and methods - We randomly allocated patients scheduled for total hip arthroplasty into 2 groups of 42 patients each. In the study group, cups were placed at the predetermined target angles (inclination: 42.5°; anteversion: 15°) with the support of EMN. In the control group, cups were placed freehand aiming at the same target angles. Postoperatively the true position of the cup was determined using computed tomography scan of the pelvis. Precision (root mean squared error, RMSE) bias (mean bias error, ME), accuracy, and duration of surgery were compared between the methods. Results - Cup anteversion was more accurate and precise in the navigated group. The ME in the navigated and freehand group was -1.7° (95% CI -2.4 to 1.1) and -4.5° (CI -6.5 to 2.5), respectively. The RMSE in the navigated and freehand group was 2.8° (CI 2.3-3.2) and 8.0° (CI 6.3-9.5), respectively. The inclination was also more precise in the navigated group, with the RMSE in the navigated and freehand group at 4.6° (CI 3.4-5.9) and 6.5° (CI 5.4-7.5), respectively. The accuracy of the inclination and the duration of surgeries were similar between the groups. Interpretation - Cup placement with the help of EMN is more precise than the freehand technique and it does not affect the duration of surgery.
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Affiliation(s)
- Rene Mihalič
- Valdoltra Orthopaedic Hospital, Ankaran,Correspondence:
| | - Jurij Zdovc
- University of Ljubljana, Faculty of Pharmacy, Ljubljana
| | | | - Rihard Trebše
- Valdoltra Orthopaedic Hospital, Ankaran,University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia
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Guezou-Philippe A, Dardenne G, Salhi A, Burdin V, Lefevre C, Stindel E. Statistical Shape Modeling to Determine the Anterior Pelvic Plane for Total Hip Arthroplasty. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:1364-1367. [PMID: 33018242 DOI: 10.1109/embc44109.2020.9176588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The anterior pelvic plane (APP) defined by both iliac spines and the pubic symphysis, is essential in total hip arthroplasty (THA) for the orientation of the prosthetic cup. However, the APP is nowadays still difficult to determine in computer assisted orthopedic surgery (CAOS). We propose to use a statistical shape model (SSM) of the pelvis to estimate the APP from ipsilateral anatomical landmarks, more easily accessible during surgery in computer assisted THA with the patient in lateral decubitus position. A SSM of the pelvis has been built from 40 male pelvises. Various ipsilateral anatomical landmarks have been extracted from these data and used to deform the SSM. Fitting the SSM to several combinations of these landmarks, we were able to reconstruct the pelvis with an accuracy between 2.8mm and 4.4mm, and estimate the APP inclination with an angular error between 1.3° and 2.8°, depending on the landmarks fitted. Results are promising and show that the APP could be acquired during the intervention from ipsilateral landmarks only.
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Abstract
Navigation in primary total hip arthroplasty has a history of over 20 years. During this process, imageless computer navigation can be particularly helpful in optimally restoring the hip’s biomechanics. This involves the accurate placement of the acetabular component with the determination of the anteversion and abduction, whereby the navigated femur-first technique also allows for a calculation of the combined anteversion. Additional critical parameters such as the reconstruction of the rotation centre, as well as the femoral and acetabular offset, can also be optimally adjusted. Last but not least, an intra-operative evaluation and equalisation of the leg length is possible. Nonetheless, the disadvantages of this surgical technique in terms of the high costs in the acquisition and preservation of the necessary devices, as well as the longer operation time, must be taken into account. However, economic aspects are not the only thing preventing widespread use of the navigation technique. Determining the plane of reference (APP) for the optimal orientation of the implants is based on palpation of the bony landmarks – and this is influenced by the thickness of the soft tissue layer. Furthermore, the experience of the surgeon constitutes a variable that influences the accuracy of navigation. In summary, hip navigation certainly offers an interesting technique for the optimisation of total hip arthroplasty with reconstruction of proper biomechanics. At the same time, there is currently a lack of high-quality randomised controlled long-term trials that evaluate the clinical advantage for the patients, together with cost utility and survival rates.
Cite this article: Renner L, Janz V, Perka C, Wassilew GI. What do we get from navigation in primary THA? EFORT Open Rev 2016;1:205-210. 10.1302/2058-5241.1.000034.
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Affiliation(s)
- Lisa Renner
- Centre for Musculoskeletal Surgery, Charité Universitätsmedizin, Berlin, Germany
| | - Viktor Janz
- Centre for Musculoskeletal Surgery, Charité Universitätsmedizin, Berlin, Germany
| | - Carsten Perka
- Centre for Musculoskeletal Surgery, Charité Universitätsmedizin, Berlin, Germany
| | - Georgi I Wassilew
- Centre for Musculoskeletal Surgery, Charité Universitätsmedizin, Berlin, Germany
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Reply to the Letter to the Editor: Editor's Spotlight/Take 5: No Benefit after THA Performed with Computer-assisted Cup Placement: 10-year Results of a Randomized Controlled Study. Clin Orthop Relat Res 2017; 475:567-569. [PMID: 27864788 PMCID: PMC5213955 DOI: 10.1007/s11999-016-5164-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/07/2016] [Indexed: 01/31/2023]
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Analysis of acetabular orientation and femoral anteversion using images of three-dimensional reconstructed bone models. Int J Comput Assist Radiol Surg 2017; 12:855-864. [PMID: 28063078 DOI: 10.1007/s11548-016-1514-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Radiographic measurements using two-dimensional (2D) plain radiographs or planes from computed tomography (CT) scans have several drawbacks, while measurements using images of three-dimensional (3D) reconstructed bone models can provide more consistent anthropometric information. We compared the consistency of results using measurements based on images of 3D reconstructed bone models (3D measurements) with those using planes from CT scans (measurements using 2D slice images). METHODS Ninety-six of 561 patients who had undergone deep vein thrombosis-CT between January 2013 and November 2014 were randomly selected. We evaluated measurements using 2D slice images and 3D measurements. The images used for 3D reconstruction of bone models were obtained and measured using [Formula: see text] and [Formula: see text] (Materialize, Leuven, Belgium). RESULTS The mean acetabular inclination, acetabular anteversion and femoral anteversion values on 2D slice images were 42.01[Formula: see text], 18.64[Formula: see text] and 14.44[Formula: see text], respectively, while those using images of 3D reconstructed bone models were 52.80[Formula: see text], 14.98[Formula: see text] and 17.26[Formula: see text]. Intra-rater reliabilities for acetabular inclination, acetabular anteversion, and femoral anteversion on 2D slice images were 0.55, 0.81, and 0.85, respectively, while those for 3D measurements were 0.98, 0.99, and 0.98. Inter-rater reliabilities for acetabular inclination, acetabular anteversion and femoral anteversion on 2D slice images were 0.48, 0.86, and 0.84, respectively, while those for 3D measurements were 0.97, 0.99, and 0.97. CONCLUSION The differences between the two measurements are explained by the use of different tools. However, more consistent measurements were possible using the images of 3D reconstructed bone models. Therefore, 3D measurement can be a good alternative to measurement using 2D slice images.
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State of the Art of Ultrasound-Based Registration in Computer Assisted Orthopedic Interventions. COMPUTATIONAL RADIOLOGY FOR ORTHOPAEDIC INTERVENTIONS 2016. [DOI: 10.1007/978-3-319-23482-3_14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Jeffers JRT. The role of biomechanics and engineering in total hip replacement. Why surgeons need technical help. Proc Inst Mech Eng H 2013; 226:947-54. [PMID: 23636958 DOI: 10.1177/0954411912445735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Implanting the acetabular cup of hard-on-hard bearings, like metal-on-metal or ceramic-on-ceramic, requires considerable surgeon skill to avoid the complications associated with edge loading. Successful cup positioning instruments have been designed in the past by pioneering surgeons, like Peter Ring and Michael Freeman, and these are re-visited in this article. An advantage of these instruments is that they could position the acetabular cup without defining a reference pelvic plane. Computer-assisted cup orientation is able to reduce outliers in cup orientation, but the technology has not been widely adopted. There may be an opportunity to improve the uptake of computer-assisted surgery by incorporating some of the concepts from historically successful manual instruments.
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Statistical model based shape prediction from a combination of direct observations and various surrogates: Application to orthopaedic research. Med Image Anal 2012; 16:1156-66. [DOI: 10.1016/j.media.2012.04.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 04/18/2012] [Accepted: 04/19/2012] [Indexed: 11/20/2022]
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Hohmann E, Bryant A, Tetsworth K. Anterior pelvic soft tissue thickness influences acetabular cup positioning with imageless navigation. J Arthroplasty 2012; 27:945-52. [PMID: 22036932 DOI: 10.1016/j.arth.2011.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 09/16/2011] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to investigate acetabular component position after total hip arthroplasty correlating both version and inclination to anterior pelvic soft tissue thickness. Thirty patients with a mean age of 66.5 ± 14 (28-87) years and an average body mass index of 30.04 ± 4.6 were included. The same surgeon operated on all 30 patients, using an anterolateral approach in a supine position and an imageless navigation system. Postoperative assessment of cup inclination, cup anteversion, and soft tissue thickness was measured by an independent research associate using computed tomographic scans. Pearson's moment correlations did not reveal any significant relationships between body mass index, soft tissue thickness, final intraoperative, or postoperative cup position. Anterior soft tissue thickness had no significant effect on the accuracy of acetabular cup positioning.
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Affiliation(s)
- Erik Hohmann
- Musculoskeletal Research Unit, CQ University, Rockhampton QLD 4700, Australia
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Wassilew GI, Perka C, Janz V, König C, Asbach P, Hasart O. Use of an ultrasound-based navigation system for an accurate acetabular positioning in total hip arthroplasty: a prospective, randomized, controlled study. J Arthroplasty 2012; 27:687-94. [PMID: 22000576 DOI: 10.1016/j.arth.2011.06.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Revised: 05/11/2011] [Accepted: 06/22/2011] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to compare an ultrasound-based navigation system with an imageless navigation system with surface registration in the postoperative acetabular cup position. A prospective randomized controlled study of 2 groups of 40 patients each was performed. In the first group, cup positioning was assisted by an ultrasound-based navigation system, and in the second group, the cup was assisted by imageless navigation system with surface registration. There was significantly more outliers in the imageless navigation group. In addition, there was statistical significance in the anteversion angles and in the anteversion error between the imageless navigation and ultrasound-based navigation groups. Ultrasound-based navigation improves cup positioning in total hip arthroplasty better than an imageless navigation system by reducing the outliers, achieving a higher accuracy of anteversion.
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Affiliation(s)
- Georgi I Wassilew
- Charité-Universitätsmedizin Berlin, Center for Musculoskeletal Surgery Berlin, Orthopaedic Department, Germany
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Ultrasound-based computer navigation of the acetabular component: a feasibility study. Arch Orthop Trauma Surg 2012; 132:517-25. [PMID: 22042088 DOI: 10.1007/s00402-011-1412-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Indexed: 10/16/2022]
Abstract
INTRODUCTION This feasibility study investigated the accuracy of anterior pelvic reference plane (APP) registration and acetabular cup orientation in two cadavers with different BMIs. METHOD Five observers each registered the APP five times in the 2 cadavers (BMIs: 32 kg/m(2) and 25 kg/m(2)) using an ultrasound-based navigation system. By comparison against the CT-derived reference landmarks, the errors in determining the individual landmarks defining the APP, as well as the resulting errors in the orientation of the APP and the acetabular cup orientation were determined. RESULTS Across all measurements obtained with the ultrasound navigation system, the errors in rotation and version in determining the APP were 0.5° ± 1.0° and -0.4° ± 2.0°, respectively. The cup abduction and anteversion errors determined from all measurements of the five investigators for both cadavers together were -0.1° ± 1.0° and -0.4° ± 2.7°, respectively. The data further demonstrated a high reproducibility of the measurements for the resulting cup adduction and anteversion angle. CONCLUSION Our preliminary results confirm that ultrasound navigation is a highly accurate tool that allows a reproducible registration of the APP and thereby enables accurate and precise intraoperative determination of the acetabular cup orientation also in patients with increased BMI.
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Schumann S, Nolte LP, Zheng G. Determination of pelvic orientation from sparse ultrasound data for THA operated in the lateral position. Int J Med Robot 2011; 8:107-13. [DOI: 10.1002/rcs.443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2011] [Indexed: 11/07/2022]
Affiliation(s)
- Steffen Schumann
- Institute for Surgical Technology and Biomechanics; University of Bern; Stauffacherstrasse 78 CH-3014 Bern Switzerland
| | - Lutz-P. Nolte
- Institute for Surgical Technology and Biomechanics; University of Bern; Stauffacherstrasse 78 CH-3014 Bern Switzerland
| | - Guoyan Zheng
- Institute for Surgical Technology and Biomechanics; University of Bern; Stauffacherstrasse 78 CH-3014 Bern Switzerland
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Schumann S, Nolte LP, Zheng G. Compensation of sound speed deviations in 3-D B-mode ultrasound for intraoperative determination of the anterior pelvic plane. ACTA ACUST UNITED AC 2011; 16:88-97. [PMID: 21984516 DOI: 10.1109/titb.2011.2170844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An accurate determination of the pelvic orientation is inevitable for the correct cup prosthesis placement of navigated total hip arthroplasties. Conventionally, this step is accomplished by percutaneous palpation of anatomic landmarks. Sterility issues and an increased landmark localization error for obese patients lead to the application of B-mode ultrasound imaging in the field of computer-assisted orthopedic surgery. Many approaches have been proposed in the literature to replace the percutaneous digitization by 3-D B-mode ultrasound imaging. However, the correct depth localization of the pelvic landmarks could be significantly affected by the acoustic properties of the penetrated tissues. Imprecise depth estimation could lead to a miscalculation of the pelvic orientation and subsequently to a misalignment of the acetabular cup implant. But so far, no solution has been presented, which compensates for acoustic property differences for correct depth estimation. In this paper, we present a novel approach to determine pelvic orientation from ultrasound images by applying a hierarchical registration scheme based on patch statistical shape models to compensate for differences in speed of sound. The method was validated based on plastic bones and a cadaveric specimen.
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Affiliation(s)
- Steffen Schumann
- Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland.
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Lin F, Lim D, Wixson RL, Milos S, Hendrix RW, Makhsous M. Limitations of imageless computer-assisted navigation for total hip arthroplasty. J Arthroplasty 2011; 26:596-605. [PMID: 20817389 DOI: 10.1016/j.arth.2010.05.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 05/25/2010] [Indexed: 02/01/2023] Open
Abstract
We prospectively evaluated acetabular cup placement in total hip arthroplasty with an imageless computer navigation system or using conventional manual technique. The achieved cup orientation in the manual group had substantially larger variances and greater placement error than the navigation cases. The use of navigation was abandoned in 3 cases because of excessive pelvic tilt and unreliable registration of the pelvis. Computer navigation system helped improve the accuracy of the acetabular cup placement for total hip arthroplasty in this study. The variation between the intraoperative navigation readings and the computed tomographic values suggests that relying on palpation of bony landmarks through drapes and tissue is a limitation of this method. Further, the variation in pelvic tilt has an effect on cup placement that requires further studies.
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Affiliation(s)
- Fang Lin
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois 60611, USA
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Sendtner E, Schuster T, Wörner M, Kalteis T, Grifka J, Renkawitz T. Accuracy of acetabular cup placement in computer-assisted, minimally-invasive THR in a lateral decubitus position. INTERNATIONAL ORTHOPAEDICS 2010; 35:809-15. [PMID: 20495801 DOI: 10.1007/s00264-010-1042-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 04/27/2010] [Accepted: 04/27/2010] [Indexed: 11/29/2022]
Abstract
In a prospective and randomised clinical study, we implanted acetabular cups either by means of an image-free computer-navigation system (navigated group, n = 32) or by free-hand technique (freehand group n = 32, two drop-outs). Total hip replacement was conducted in the lateral position and through a minimally invasive anterior approach (MicroHip). The position of the component was determined postoperatively on CT scans of the pelvis using CT-planning software. We found an average inclination of 42.3° (range 32.7-50.6°; SD ± 3.8°) and an average anteversion of 24.5° (range 12.0-33.3°; SD ± 6.0°) in the computer-assisted study group and an average inclination of 37.9° (range 25.6-50.2°; SD ± 6.3°) and an average anteversion of 23.8° (range 5.6-46.9°; SD ± 10.1°) in the freehand group. The higher precision of computer navigation was indicated by the lower standard deviations. For both measurements we found a significant heterogeneity of variances (p < 0.05, Levene's test). The mean difference between the cup inclination/anteversion values displayed by computer navigation and the true cup position (CT control) was 0.37° (SD 3.26) and -5.61° (SD 6.48), respectively. We found a bias (underestimation) with regard to anteversion determined by the imageless computer navigation system. A bias for inclination was not found. Registration of the landmarks of the anterior pelvic plane in lateral position with undraped percutaneous methods leads to an error in cup anteversion, but not to an error in cup inclination. The bias we found is consistent with a correct registration of the anterosuperior iliac spine (ASIS) and with a registration of the symphysis 1 cm above the bone, corresponding to the less compressible overlying soft tissue in this region. There was no significant correlation between the bias and the thickness of soft tissue above the pubic tubercles. We suggest use of a percutaneous registration of ASIS and an invasive registration above the pubic tubercles when computer-assisted navigation is performed in minimally invasive THR in a lateral position.
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Affiliation(s)
- Ernst Sendtner
- Orthopedic Department, Asklepios Klinik Bad Abbach, Bad Abbach, Germany.
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Schumann S, Puls M, Ecker T, Schwaegli T, Stifter J, Siebenrock KA, Zheng G. Determination of Pelvic Orientation from Ultrasound Images Using Patch-SSMs and a Hierarchical Speed of Sound Compensation Strategy. INFORMATION PROCESSING IN COMPUTER-ASSISTED INTERVENTIONS 2010. [DOI: 10.1007/978-3-642-13711-2_15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hasart O, Poepplau BM, Asbach P, Perka C, Wassilew GI. Ultrasound-based navigation and 3D CT compared in acetabular cup position. Orthopedics 2009; 32:6-10. [PMID: 19835299 DOI: 10.3928/01477447-20090915-50] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Intraoperative landmarks are used in image-free navigation systems. The ultrasound-based navigation systems try to overcome the problems of positional deviation associated with soft tissue. Our study analyzed the accuracy of ultrasound-based navigation of cup positioning compared with postoperative 3-dimensional (3D) computed tomography scans of cup positioning. Twenty-five ultrasound-navigated total hip arthroplasties (THAs) were analyzed. The difference between the intraoperative cup orientation (navigation) and the postoperative cup position (CT) was evaluated. The average difference between intraoperative navigation and postoperative CT measurements was 2.8 degrees (SD+/-1.8 degrees ) for abduction and 2.2 degrees (SD+/-1.6 degrees ) for anteversion. Therefore, we recommend ultrasound-based navigation as an exact tool for cup positioning in THA.
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Affiliation(s)
- Olaf Hasart
- Charité Orthopaedic Department, Center for Musculoskeletal Surgery, Charité Universitätsmedizin, 10117 Berlin, Germany
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Ohashi H, Matsuura M, Okamoto Y, Okajima Y. Intra- and intersurgeon variability in image-free navigation system for THA. Clin Orthop Relat Res 2009; 467:2305-9. [PMID: 19381745 PMCID: PMC2866939 DOI: 10.1007/s11999-009-0833-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 03/30/2009] [Indexed: 01/31/2023]
Abstract
In image-free navigation systems, cup orientation is determined in the pelvic coordinate by registration of bony landmarks. While the value of navigation relates primarily to the reliability and accuracy of cup placement, the reliability of registration plays a role in cup placement. We therefore examined intra- and intersurgeon variability in registration and the distance between registration points in each bony landmark. Thirty-seven THAs were performed in the lateral position and 15 THAs in the supine position. The cup was fixed using a navigation system. The registration was repeated two more times by operator and assistant, and the intra- and intersurgeon variability of cup abduction angle and anteversion was analyzed by ICC (intraclass correlation coefficients). In 25 hips, the distance between intrasurgeon registration points and between intersurgeon registration points in each landmark were calculated. The ICC in the lateral position ranged between 0.59 and 0.81, and between 0.85 and 0.95 in the supine position. The ICCs of cup abduction angle for the intra- and intersurgeon variability were 0.92 and 0.95 for the supine position and 0.65 and 0.59 for the lateral position. Those of anteversion were 0.93, 0.85, and 0.81, 0.72, respectively. The variability in locating the ASIS in the lateral position was greater than that in the supine position. The variability of registration points depended on bony landmarks and patient position but the range of variability we found would not likely result in a large variability in cup placement.
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Affiliation(s)
- Hirotsugu Ohashi
- Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, 2-10-39 Shibata, Kita-ku, Osaka, 530-0012, Japan.
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Pelvic balance in sagittal and Lewinnek reference planes in the standing, supine and sitting positions. Orthop Traumatol Surg Res 2009; 95:70-6. [PMID: 19251240 DOI: 10.1016/j.otsr.2008.01.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Accepted: 01/09/2008] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Sagittal pelvic balance is a recognized factor influencing targeted acetabular-component anteversion during total hip arthroplasty implantation. However, no studies in the literature have systematically reported pelvic parameters data in the standing, sitting and supine positions. HYPOTHESIS Variations in acetabular cup orientation can be traced to eventual pelvic balance changes in one of these three usual positions. MATERIALS AND METHODS In these three positions (supine, standing and sitting), pelvic anatomical parameters and reference planes were radiologically defined from a group of 67 patients (average age: 70.2+/-3.2 years). The complete X-rays individual sets were digitized and measurements were obtained by a single operator using a Spineview software (previously, strictly validated for these kind of measurements). Positioning according to the Lewinnek pelvic coordinate system, which is considered as a possible source of errors when vertically standing or horizontally lying, was also investigated. RESULTS The average pelvic incidence of 59.6 degrees did not vary in the sitting, supine or standing positions, with no statistically significant difference between sexes. The Legaye equation--pelvic incidence is equals to pelvic version plus sacral slope--was verified. Pelvic version increased by an average 22 degrees from the sitting to the supine or standing positions. Sacral slope varied in a reverse order. Pelvic-femoral angle (PFA) decreased by 20 degrees from the standing to the supine position. The Lewinnek plane was located 4 degrees posterior to the vertical plane. Whatever the position adopted, pelvi-Lewinnek angle appeared constant, averaging 12 degrees. DISCUSSION The average pelvic incidence in this series was high, most probably associated with advancing patient age and/or pathology. The concept of functional anteversion appeared critical when taking into account pelvic version variations (according to the position, sitting, supine or standing) positions. The Lewinnek plane, commonly accepted as the reference plane for hip navigation, was individualised to each patient and should not be mistaken with the vertical plane; positioning of the femur in relation to the Lewinnek plane was also specific to each patient. Cumulative approximation on these two parameters at surgery resulted in a combined imprecision of 26 degrees when standing and 36 degrees when lying down. We have thus defined crucial parameters to be integrated in computer-assisted hip surgery softwares: positional variations of the pelvic version (functional anteversion), positioning of the Lewinnek plane, and PFA value (both specifically patient's dependant). If integration of these parameters into new sofwares versions appears possible, this would represent a reliable compromise between maximum prosthetic stability, maximum joint amplitudes and elimination of possible prosthetic conflict.
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