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Vorimore C, Innmann M, Mavromatis S, Speirs A, Verhaegen JCF, Merle C, Grammatopoulos G. Impact of Offset and Leg Length on Functional Outcomes Post-Total Hip Arthroplasty: How Accurate Should Coronal Reconstruction Be? J Arthroplasty 2024; 39:S332-S339.e2. [PMID: 38897260 DOI: 10.1016/j.arth.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Accurate hip reconstruction is associated with improved biomechanical behavior following total hip arthroplasty (THA). However, whether this is associated with improved patient-reported outcomes (PROs) is unknown. HYPOTHESIS/PURPOSE This study aimed to: 1) describe the ability to reconstruct coronal geometry during THA without advanced technology; 2) assess whether restoration of global offset (GO) and leg length (LL) is associated with improved PROs; and 3) investigate whether increased femoral offset (FO) to compensate for reduced acetabular offset (AO) influences PROs. METHOD This was a prospective, multicenter, consecutive cohort study of 500 patients treated with primary THA without robotics or navigation. The Oxford Hip score (OHS) was obtained preoperatively and at 1-year follow-up. Supine anteroposterior pelvic radiographs were analyzed to determine AO, FO, GO, and LL relative to the native contralateral side. Contour plots for ΔOHS based on ΔLL and ΔGO were created, and ΔOHS was calculated within and outside various ranges (±2.5, ±5, or ±10 mm). RESULTS In the operated hip, mean FO increased by 3 ± 6 mm (range, -16 to 27), while AO decreased by 2 ± 4 mm (range, -17 to 10). The contour graph for ±2.5 mm zones showed the best outcomes (ΔOHS >25) with GO and LL centered on 0 ± 2.5 mm (P < .01). However, only 10% achieved such reconstruction. When GO and LL differences were within ±10 mm, ΔOHS was superior when both AO and FO were within ±5 mm (mean: 24 ± 10; range, -5 to 40) compared with when FO was above 5 mm to compensate for a reduction in AO (mean: 22 ± 11; range, -10 to 46; P = .040). CONCLUSIONS The PROs were associated with biomechanical reconstruction, and the best clinical improvement can be expected when GO and LL differences are both within 2.5 mm. Maintenance of AO is important, as compensation by increasing FO is associated with inferior OHS.
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Affiliation(s)
- Camille Vorimore
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Moritz Innmann
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Orthopaedic Surgery, Heidelberg University, Heidelberg, Germany
| | | | - Andrew Speirs
- Department of Mechanical and Aerospace Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Jeroen C F Verhaegen
- Department of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Orthopaedic Surgery, University Hospital Antwerp, Edegem, Belgium; Orthopaedic Centre Antwerp, AZ Monica, Antwerp, Belgium
| | - Christian Merle
- Department of Orthopaedic Surgery, Diakonie-Klinikum, Stuttgart, Germany
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Fontalis A, Yasen AT, Kayani B, Luo TD, Mancino F, Magan A, Plastow R, Haddad FS. Two-Dimensional Versus Three-Dimensional Preoperative Planning in Total Hip Arthroplasty. J Arthroplasty 2024; 39:S80-S87. [PMID: 38810812 DOI: 10.1016/j.arth.2024.05.054] [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: 05/16/2024] [Accepted: 05/19/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Preoperative planning in total hip arthroplasty (THA) involves utilizing radiographs or advanced imaging modalities, including computerized tomography scans, for precise prediction of implant sizing and positioning. This study aimed to compare 3-dimensional (3D) versus 2-dimensional (2D) preoperative planning in primary THA with respect to key surgical metrics, including restoration of the horizontal and vertical center of rotation (COR), combined offset, and leg length. METHODS This study included 60 patients undergoing primary THA for symptomatic hip osteoarthritis (OA), randomly allocated to either robotic arm-assisted or conventional THA. Digital 2D templating and 3D planning using the robotic software were performed for all patients. All measurements to evaluate the accuracy of templating methods were conducted on the preoperative computerized tomography scanogram, using the contralateral hip as a reference. Sensitivity analyses explored differences between 2D and 3D planning in patients who had superolateral or medial OA patterns. RESULTS Compared to 2D templating, 3D templating was associated with less medialization of the horizontal COR (-1.2 versus -0.2 mm, P = .002) and more accurate restoration of the vertical COR (1.63 versus 0.3 mm, P < .001) with respect to the contralateral side. Furthermore, 3D templating was superior for planned restoration of leg length (+0.23 versus -0.74 mm, P = .019). Sensitivity analyses demonstrated that in patients who had medial OA, 3D planning resulted in less medialization of horizontal COR and less offset reduction. Conversely, in patients who had superolateral OA, there was less lateralization of horizontal COR and less offset increase using 3D planning. Additionally, 3D planning showed superior reproducibility for stem, acetabular cup sizes, and neck angle, while 2D planning often led to smaller stem and cup sizes. CONCLUSIONS Our findings indicated higher accuracy in the planned restoration of native joint mechanics using 3D planning. Additionally, this study highlights distinct variances between the 2 planning methods across different OA pattern subtypes, offering valuable insights for clinicians employing 2D planning.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK
| | - Adam T Yasen
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tianyi David Luo
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK; Orthopaedics Northeast, Fort Wayne, Indiana
| | - Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ahmed Magan
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
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Al Ani Z, Sharif K, Verghese SC, Singh S, Killampalli VV. An Intraoperative Technique to Assess Tissue Tension and Leg Length When Aligning the Hip Centre of Rotation With the Acetabulum in Hip Arthroplasties. Cureus 2024; 16:e65860. [PMID: 39219948 PMCID: PMC11364204 DOI: 10.7759/cureus.65860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Hip arthroplasties are cost-effective procedures; however, instability and leg length discrepancy are common complications that can lead to higher revision rates and patient dissatisfaction. Preoperative planning aids surgeons in choosing the right offset and neck length before surgery. Nonetheless, intraoperative measures are still necessary due to the differences dictated by the surgical procedure. Several hip trials might be needed to reach the optimum choice of implants. We have introduced a technique that utilizes the trunnion as a reference point to the hip centre of rotation, matching it with the acetabulum centre of rotation after applying the necessary soft tissue tension. This serves as a proximal reference point. Using the trunnion, as opposed to the trial head, allows for a better assessment of tissue tension within the acetabular void, avoiding constraints imposed by the applied trial head. Additionally, determining the acetabulum's centre of rotation is challenging if obscured by the trial head. Matching the two tibial tuberosities indicates the correct leg length, serving as the distal reference point. Both reference points should be considered together to select the right neck length and offset for optimal tissue tension. This technique has been tested on hip arthroplasty patients over five years. All hip surgeons who used this technique agree that it gives a better representation of the tissue tension, easing the challenges when preparing the acetabulum as well as reducing the need for multiple trials.
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Affiliation(s)
- Zaid Al Ani
- Trauma and Orthopaedics, Peterborough City Hospital, Peterborough, GBR
| | - Khalid Sharif
- Trauma & Orthopaedics, Diana, Princess of Wales Hospital, Grimsby, GBR
| | - Sumant C Verghese
- Trauma & Orthopaedics, Hinchingbrooke & Peterborough City Hospital, North-West Anglia NHS Foundation Trust, Huntingdon, GBR
| | - Sarvpreet Singh
- Lower Limb Arthroplasties, Peterborough City Hospital, Peterborough, GBR
| | - Vijay V Killampalli
- Trauma and Orthopaedics, North-West Anglia NHS Foundation Trust, Huntingdon, GBR
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Fontalis A, Kayani B, Plastow R, Giebaly DE, Tahmassebi J, Haddad IC, Chambers A, Mancino F, Konan S, Haddad FS. A prospective randomized controlled trial comparing CT-based planning with conventional total hip arthroplasty versus robotic arm-assisted total hip arthroplasty. Bone Joint J 2024; 106-B:324-335. [PMID: 38555946 DOI: 10.1302/0301-620x.106b4.bjj-2023-1045.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Aims Achieving accurate implant positioning and restoring native hip biomechanics are key surgeon-controlled technical objectives in total hip arthroplasty (THA). The primary objective of this study was to compare the reproducibility of the planned preoperative centre of hip rotation (COR) in patients undergoing robotic arm-assisted THA versus conventional THA. Methods This prospective randomized controlled trial (RCT) included 60 patients with symptomatic hip osteoarthritis undergoing conventional THA (CO THA) versus robotic arm-assisted THA (RO THA). Patients in both arms underwent pre- and postoperative CT scans, and a patient-specific plan was created using the robotic software. The COR, combined offset, acetabular orientation, and leg length discrepancy were measured on the pre- and postoperative CT scanogram at six weeks following surgery. Results There were no significant differences for any of the baseline characteristics including spinopelvic mobility. The absolute error for achieving the planned horizontal COR was median 1.4 mm (interquartile range (IQR) 0.87 to 3.42) in RO THA versus 4.3 mm (IQR 3 to 6.8; p < 0.001); vertical COR mean 0.91 mm (SD 0.73) in RO THA versus 2.3 mm (SD 1.3; p < 0.001); and combined offset median 2 mm (IQR 0.97 to 5.45) in RO THA versus 3.9 mm (IQR 2 to 7.9; p = 0.019). Improved accuracy was observed with RO THA in achieving the desired acetabular component positioning (root mean square error for anteversion and inclination was 2.6 and 1.3 vs 8.9 and 5.3, repectively) and leg length (mean 0.6 mm vs 1.4 mm; p < 0.001). Patient-reported outcome measures were comparable between the two groups at baseline and one year. Participants in the RO THA group needed fewer physiotherapy sessions postoperatively (median six (IQR 4.5 to 8) vs eight (IQR 6 to 11; p = 0.005). Conclusion This RCT suggested that robotic-arm assistance in THA was associated with improved accuracy in restoring the native COR, better preservation of the combined offset, leg length correction, and superior accuracy in achieving the desired acetabular component positioning. Further evaluation through long-term and registry data is necessary to assess whether these findings translate into improved implant survival and functional outcomes.
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Affiliation(s)
- Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dia E Giebaly
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Jenni Tahmassebi
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Isabella C Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alastair Chambers
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sujith Konan
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
- The Bone & Joint Journal , London, UK
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Rodríguez-González FA, Bartrina-Tarrio A, Gómez-Muñoz E, Garríguez-Pérez D, Echevarría-Marin M, Llanos S, Francés-Borrego A. [Translated article] Clinical results of total hip arthroplasty assisted by robotic arm in Spain: Preliminary study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T108-T120. [PMID: 37992860 DOI: 10.1016/j.recot.2023.11.009] [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: 10/12/2022] [Accepted: 05/22/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVES Clinical, radiological and functional results of the first Spanish series of patients undergoing total hip arthroplasty assisted by Mako® (Stryker) robotic arm at the Hospital Clínico San Carlos (HCSC) in Madrid. MATERIAL AND METHODS Prospective and descriptive study analyzing the first 25 patients who underwent robotic-assisted THA at the HCSC, with a minimum follow-up of 4 months. Demographics, imaging studies (Mako® processing, Rx and CT), clinical parameters, functionality (modified Harris) and associated complications were evaluated. RESULTS Average age was 67.2 years (min 47, max 88), being 56% male population sample. 88% involves primary coxarthrosis, 4% post-traumatic coxarthrosis, 4% secondary avascular necrosis and 4% secondary femoroacetabular impingement. Average surgery time was 116.9min (min 92, max 150). The average time of the first five surgeries was 122.6min, and, regarding the last five interventions, it was 108.2min. Found medical intraoperative complications were four intraoperative markers loss. Average admission time was 4.4days (min 3, max 7), with an average postoperative haemoglobin decrease of 3.08±1.08g/dl, requiring a transfusion in 12% of the cases. Three medical complications have been registered in the meantime of the admission, with a relevant case of a confusional syndrome and a fall, which resulted in a non-displaced AG1 periprosthetic fracture. The analysis of the positioning of registered implants with Mako® system shows 40.55±1.53 acetabular inclination degrees and 12.2±3.6 acetabular anteversion degrees. The postoperative image study carried out on patients, are consistent with Mako® results, as it shows an acetabular inclination of 41.2±1.7 in Rx, as well as acetabular anteversion of 16±4.6 in CT. Hip length variance ranges depending on preoperative values of 3.91mm (SD: 3.9; min -12, max 3) to 1.29mm (SD: 1.96) after surgery registered with Mako®, with an increase of an average hip length of 5.64mm (SD: 3.35). Rx simple study results show a postoperative difference between both hips of 0.5±3.08mm, which is consistent with Mako® results. Native femoral offset was stable after surgery with a showing difference both pre and post operative of the intervened hip of 0.1mm (SD: 3.7), registered with Mako®. Preoperatory modified Harris punctuation was 41.6±13.3, improving to postoperative values of 74.6±9.7 after four months since the surgery. No complications were registered in immediate postoperative (4 months). CONCLUSIONS Total hip arthroplasty robot-assisted achieves an adequate precision and repeatability of the implant positioning and the postoperative hip dysmetry without showing an increase of associated complications to the technique applied. Surgery time, complications and functional results in a short-time period are similar to conventional techniques applied to great series previously published.
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Affiliation(s)
| | | | - E Gómez-Muñoz
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | | | - S Llanos
- Hospital Universitario Clínico San Carlos, Madrid, Spain
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Rodríguez-González FA, Bartrina-Tarrio A, Gómez-Muñoz E, Garríguez-Pérez D, Echevarría-Marin M, Llanos S, Francés-Borrego A. Clinical results of total hip arthroplasty assisted by robotic arm in Spain: Preliminary study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:108-120. [PMID: 37245634 DOI: 10.1016/j.recot.2023.05.009] [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: 10/12/2022] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 05/30/2023] Open
Abstract
OBJECTIVES Clinical, radiological and functional results of the first Spanish series of patients undergoing total hip arthroplasty assisted by Mako® (Stryker) robotic arm at the Hospital Clínico San Carlos (HCSC) in Madrid. MATERIAL AND METHODS Prospective and descriptive study analyzing the first 25 patients who underwent robotic-assisted THA at the HCSC, with a minimum follow-up of 4months. Demographics, imaging studies (Mako® processing, Rx and CT), clinical parameters, functionality (modified Harris) and associated complications were evaluated. RESULTS Average age was 67.2years (min 47, max 88), being 56% male population sample. 88% involves primary coxarthrosis, 4% post-traumatic coxarthrosis, 4% secondary avascular necrosis and 4% secondary femoroacetabular impingement. Average surgery time was 116.9min (min 92, max 150). The average time of the first five surgeries was 122.6min, and, regarding the last five interventions, it was 108.2min. Found medical intraoperative complications were four intraoperative markers loss. Average admission time was 4.4days (min 3, max 7), with an average postoperative hemoglobin decrease of 3.08±1.08g/dL, requiring a transfusion in 12% of the cases. Three medical complications have been registered in the meantime of the admission, with a relevant case of a confusional syndrome and a fall, which resulted in a non-displaced AG1 periprosthetic fracture. The analysis of the positioning of registered implants with Mako® system shows 40.55±1.53 acetabular inclination degrees and 12.2±3.6 acetabular anteversion degrees. The postoperative image study carried out on patients, are consistent with Mako® s results, as it shows an acetabular inclination of 41.2±1.7 in Rx, as well as acetabular anteversion of 16±4.6 in CT. Hip length variance ranges depending on preoperative values of 3.91mm (SD: 3.9; min -12, max 3) to 1.29mm (SD: 1.96) after surgery registered with Mako®, with an increase of an average hip length of 5.64mm (SD: 3.35). Rx simple study results show a postoperative difference between both hips of 0.5±3.08mm, which is consistent with Mako® results. Native femoral offset was stable after surgery with a showing difference both pre and post operative of the intervened hip of 0.1mm (SD: 3.7), registered with Mako®. Preoperatory modified Harris punctuation was 41.6±13.3, improving to postoperative values of 74.6±9.7 after four months since the surgery. No complications were registered in immediate postoperative (4month). CONCLUSIONS Total hip arthroplasty robot-assisted achieves an adequate precision and repeatability of the implant positioning and the postoperative hip dysmetry without showing an increase of associated complications to the technique applied. Surgery time, complications and functional results in a short-time period are similar to conventional techniques applied to great series previously published.
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Affiliation(s)
| | | | - E Gómez-Muñoz
- Hospital Universitario Clínico San Carlos, Madrid, España
| | | | | | - S Llanos
- Hospital Universitario Clínico San Carlos, Madrid, España
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Stadler C, Feldler S, Stevoska S, Schopper C, Gotterbarm T, Luger M. Gender differences in cementless short stem total hip arthroplasty: significantly higher femoral lengthening in female patients. Sci Rep 2024; 14:1154. [PMID: 38212361 PMCID: PMC10784556 DOI: 10.1038/s41598-024-51621-7] [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: 05/17/2023] [Accepted: 01/08/2024] [Indexed: 01/13/2024] Open
Abstract
Modern cementless short stems in total hip arthroplasty (THA) enable a precise reconstruction of the native pre-arthritic hip geometry. While gender differences have been reported for older generation straight hip stems, there are hardly reports regarding modern cementless short hip stems. Therefore, we aimed to evaluate the influence of gender differences in hip anatomy in cementless short stem THA. A total of 207 patients (109 females, 98 males) with unilateral THA and absence of contralateral joint space narrowing (Kellgren-Lawrence grade ≤ 2) were included. Acetabular height and offset as well as femoral height and offset were measured on pre- and 3-months-postoperative anteroposterior X-rays of the pelvis and compared to the contralateral hip. Additionally, implant position was evaluated on the postoperative radiograph. In male patients, the loss of acetabular offset was significantly greater than in females (p = 0.012), leading to a compensatory increase in femoral offset (p = 0.041). Femoral height discrepancy was significantly higher in females (p < 0.001), accounting for an increased global hip height discrepancy (p < 0.001). The mean acetabular anteversion was significantly greater in female patients (p < 0.001). Female patients are at higher risk of femoral lengthening in THA with a cementless short stem potentially caused by a further proximally conducted femoral neck osteotomy and show significantly higher cup anteversion angles. Therefore, surgeons should take special care to the level of neck resection and implant positioning in female patients.
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Affiliation(s)
- Christian Stadler
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria.
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria.
| | - Sandra Feldler
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Stella Stevoska
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Clemens Schopper
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Matthias Luger
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
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Sun Z, Li N, Yang Z, Zhang W, Liu J. Anatomical cup implantation assisted with dynamic 3D planning improves functional outcomes in primary total hip arthroplasty: A retrospective study. J Back Musculoskelet Rehabil 2024; 37:295-304. [PMID: 37980641 DOI: 10.3233/bmr-230004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND Anatomical cup implantation is a promising approach in primary total hip arthroplasty (THA) and improves functional outcomes. OBJECTIVE We aimed to evaluate the cup position and functional outcomes in primary THA with preoperative dynamic 3D planning. METHODS We retrospectively reviewed 54 hips in 48 patients who underwent primary THA with anatomical cup implantation (mean follow-up time: 52 months). Cup positions were evaluated based on patient-specific morphology, the acetabular fossa and the combined anteversion test. Functional outcomes were assessed after THA. The paired-sample t-test was performed for surgical and contralateral native hips among 42 patients who underwent unilateral THA. RESULTS Two hips suffered intraoperative trochanteric fracture, but no hip dislocations occurred. No patients reported groin or thigh pain, and all patients were capable of deep squatting and one-leg standing. The mean Harris hip score, WOMAC score, and physical SF-36 score were 94.46 ± 6.16, 10.41 ± 3.62, and 95.19 ± 8.74, respectively. Except for acetabular offset, THA restored biomechanics to those of contralateral native hip, including cup anteversion, abduction, femoral offset and acetabular height (P> 0.05). CONCLUSION This study provided evidence for the application of anatomical cup implantation assisted with dynamic 3D planning in primary THA, which restored morphology and improved functional outcomes.
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Affiliation(s)
- Zhenhui Sun
- Department of Orthopaedics, Tianjin Hospital of Tianjin University, Tianjin, China
| | - Nan Li
- Department of Orthopaedics, Tianjin Hospital of Tianjin University, Tianjin, China
| | - Zhi Yang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Wenhui Zhang
- Department of Orthopaedics, People's Hospital of Gansu Province, Lanzhou, Gansu, China
| | - Jie Liu
- Department of Orthopaedics, People's Hospital of Gansu Province, Lanzhou, Gansu, China
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Nieschk C, Abelmann-Brockmann J, Lisitano L, Fenwick A, Röttinger H, Ecker M, Mayr E, Röttinger T. Clinical effects of different center of rotation reconstructions in total hip arthroplasty after femoral neck fractures: a cohort study including a follow-up analysis on patient's mobility and daily living ability. J Orthop Traumatol 2023; 24:58. [PMID: 37946089 PMCID: PMC10635998 DOI: 10.1186/s10195-023-00738-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The aim of this study is a clinical evaluation of the center of rotation (COR) placement towards a patient's recovery with respect to daily living ability and mobility. In past experiments based on three-dimensional (3D) models, medialization of the COR in total hip arthroplasty (THA) showed a negative influence on muscle strength of the abductors and reaction force of the hip joint. This contradicts paradigms, where reduced hip loading forces are claimed to increase functional outcomes. METHODS The plain X-rays of 110 patients who underwent THA after a femoral neck fracture between January 2019 and January 2021 were retrospectively evaluated. A Barthel Index on discharge was obtained in 69 cases. 47 patients were available for a follow-up interview concerning the Barthel Index, Parker mobility score (PMS), and pain levels (NRS) 6 and 12 months after surgery. RESULTS Medialization of the COR had a significantly negative effect on the need for care (Barthel Index) at patient discharge (Spearman correlation 0.357, p = 0.013). The effect on the PMS is still existent at 6 and 12 months (Spearman correlation 0.471, p = 0.009 at 6 months; 0.472, p = 0.008 at 12 months). Mann-Whitney U tests showed that the groups with medialized COR performed significantly worse than the lateralized groups. This was seen for the Barthel Index at discharge and at 6 months after surgery and for the PMS at 6 and 12 months. The accurately reconstructed CORs showed no significant differences from the lateralized rotation centers in need of care and mobility. The superior COR placement group showed significantly reduced mobility at 12 months in contrast to the inferior COR placement group (p = 0.008), and the group of accurately reconstructed rotation centers showed significantly less pain than the inferior COR placement group (p = 0.007 after 6 months, p = 0.026 after 12 months). Especially the combination of both (superomedialization) leads to reduced mobility (Spearman correlation 0.67, p = < 0.001). CONCLUSIONS COR superior displacement, COR medialization, and the combination of both (superomedialization, Spearman p = < 0.001) lead to reduced mobility while inferior displacement showed increased pain. According to our results, we recommend an exact vertical COR restoration, while horizontal medial displacement needs to be avoided. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Christopher Nieschk
- Universitätsklinikum Augsburg, Klinik für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - Johanna Abelmann-Brockmann
- Universitätsklinikum Augsburg, Klinik für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - Leonard Lisitano
- Universitätsklinikum Augsburg, Klinik für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - Annabel Fenwick
- Universitätsklinikum Augsburg, Klinik für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - Heinz Röttinger
- München Klinik Neuperlach, Oskar-Maria-Graf-Ring 51, 81737, München, Deutschland
- Faculty of Medical University of Pleven, Pleven, Bulgaria
| | - Michael Ecker
- Universitätsklinikum Augsburg, Klinik für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - Edgar Mayr
- Universitätsklinikum Augsburg, Klinik für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - Timon Röttinger
- Universitätsklinikum Augsburg, Klinik für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Stenglinstraße 2, 86156, Augsburg, Deutschland.
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10
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Erivan R, Bourzat N, Mulliez A, Mougues C, Descamps S, Boisgard S, Villatte G. Single-use versus reusable ancillaries for dual mobility cup in total hip replacement. A prospective randomized short-term safety and feasibility comparison. Orthop Traumatol Surg Res 2023; 109:103658. [PMID: 37451339 DOI: 10.1016/j.otsr.2023.103658] [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: 02/09/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Single-use (SU) ancillaries for cup preparation in total hip arthroplasty (THR) aim to reduce the costs of hip replacement surgery. These devices have been recently introduced, but their safety and feasibility have not been studied. Therefore, we performed a prospective randomized study aiming to assess the impact in our department of using these SU ancillaries versus standard reusable ancillaries for dual mobility THR regarding 1) the cost, 2) operative time, 3) quality of primary fixation. HYPOTHESIS We hypothesized that the use of SU ancillaries for acetabular preparation would reduce maintenance costs, and so optimise the operating procedure, reduce the overall cost of surgery, save time, while maintaining the same quality of prosthesis fitting. METHOD We conducted a randomised, controlled, open-label, two-arm, single-centre, prospective therapeutic trial with a medico-economic objective. Inclusions were made prospectively from patients hospitalised and surgically managed in our department for arthrosis over 18 years old treated with dual mobility THR. RESULTS In the current study, 18/20 (90%) of the cases required the use of one SU reamer when using SU ancillaries. Only two cases (10%) required a second SU reamer (without SU failure regarding the acetabular implant) because there was too much subchondral bone left and not enough cancellous bone allowing correct cup fitting. We also found that the test implant supplied in the SU kit had a less secure press-fit than the reusable metal test implants. There was one of primary press-fit failure in the SU group requiring a different cup with additional screws. The estimated cost to the supplier per procedure was 20,105 euros using single-use reamers versus 26,666 euros using conventional ancillary kits, a saving of 6561 euros (p<0.001). For the healthcare institution, the median price per intervention on the differentiating points was 2648 euros versus 2580 euros, with no significant difference (p=0.297). The results show an average societal cost of 52,199 euros using single-use and 53,572 euros using reusable ancillary equipment, with a significant difference between the two groups (p<0.003). The average cost of Healthcare Risk Waste (HCRW) disposal in the SU group was 5.2 euros per intervention against 5.1 euros in the RU group, without significant difference (p=0.910). We found a similar result for the cost of disposal of non-HCRW waste per procedure: 0.37 euros in the SU group versus 0.34 in the RU group, without significant difference (p=0.345). CONCLUSION SU ancillaries significantly reduce the table set up time and have the potential to facilitate time and cost savings but further research is needed in this direction. Our study shows that the daily workload, operating times, and the number of boxes of instruments to be sterilised are decreased. The associated environmental gain is significant. Nevertheless, the economic promise of these SU ancillaries is only partially supported in this trial owing to the small number of patients. Further work will be needed to obtain a more powerful medico-economic assessment of this promising ancillary product. LEVEL OF EVIDENCE II; prospective randomized study.
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Affiliation(s)
- Roger Erivan
- Université de Clermont Auvergne, CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France.
| | | | - Aurélien Mulliez
- Délégation à la recherche clinique et aux innovations (DRCI), CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Chalin Mougues
- Délégation à la recherche clinique et aux innovations (DRCI), CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Stéphane Descamps
- Université de Clermont Auvergne, CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- Université de Clermont Auvergne, CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
| | - Guillaume Villatte
- Université de Clermont Auvergne, CHU de Clermont-Ferrand, CNRS, SIGMA Clermont, ICCF, 63000 Clermont-Ferrand, France
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11
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Kobayashi K, Tsurumoto N, Tsuda S, Shiraishi K, Chiba K, Osaki M. The Anterior Position of the Hip Center of Rotation Is Related to Anterior Cup Protrusion Length and Symptomatic Iliopsoas Impingement in Primary Total Hip Arthroplasty. J Arthroplasty 2023; 38:2366-2372. [PMID: 37271227 DOI: 10.1016/j.arth.2023.05.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Iliopsoas impingement (IPI) is an important complication after total hip arthroplasty (THA), and anterior cup protrusion is believed to be its main cause; however, the relationship between the hip center of rotation (COR) and symptomatic IPI or cup protrusion remains poorly understood. Therefore, the present study investigated these relationships. METHODS The medical records of 138 patients who underwent unilateral primary THA were retrospectively reviewed. There were 8 patients (5.8%) who had symptomatic IPI. The COR and cup protrusion length measured with 2 methods were assessed on computed tomography. Risk factors for symptomatic IPI and the relationship between the COR and protrusion length were evaluated. RESULTS Logistic regression analyses showed that anteroposterior position of the COR, sagittal cup protrusion length (SCPL) at the COR, and both axial and SCPLs at the most anterior margin of the cup were related to symptomatic IPI. Multivariable regression analyses showed that acetabular offset was related to axial protrusion length at the COR, and anteroposterior position of the COR was related to both axial and sagittal protrusion lengths at the most anterior margin of the cup. CONCLUSION Anterior position of the cup was related to symptomatic IPI and both axial and sagittal protrusion lengths at the most anterior margin of the cup. Anterior reaming and cup protrusion should be avoided as much as possible to prevent symptomatic IPI.
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Affiliation(s)
- Kyosuke Kobayashi
- Department of Orthopaedic Surgery, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Naoji Tsurumoto
- Department of Orthopaedic Surgery, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Soichiro Tsuda
- Department of Orthopaedic Surgery, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Kazuteru Shiraishi
- Department of Orthopaedic Surgery, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Ko Chiba
- Department of Orthopaedic Surgery, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Makoto Osaki
- Department of Orthopaedic Surgery, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
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12
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Viglietta E, Previ L, Giuliani V, Rescigno G, Gugliotta Y, Redler A, Iorio R. "Single-use peripheral" vs "conventional" reaming in total hip arthroplasty: how to respect native centre of rotation and acetabular offset? A CT study. INTERNATIONAL ORTHOPAEDICS 2023; 47:2737-2742. [PMID: 37541983 PMCID: PMC10602958 DOI: 10.1007/s00264-023-05899-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 08/06/2023]
Abstract
PURPOSE The respect of native hip offset represents a mainstay for satisfying results in total hip arthroplasty (THA). Historically, a great interest has been focused on restoration of femoral offset, while only in recent years, acetabular offset (AO) has been considered. The purpose of the current study was to compare the "single-use peripheral" reaming technique with the "conventional" one for the maintenance of the native COR of the hip and AO in patients undergoing to primary THA. METHODS Eighty patients affected from primary hip osteoarthritis were prospectively enrolled in the study and were divided in two groups (Group A "single-use peripheral" and Group B "conventional" reaming technique). Pre- and post-operatively, AO, acetabular floor distance (AFd) and acetabular version (AV) were assessed through a CT scan. A comparison between groups for the radiological parameters, surgical time and complications was performed. RESULTS The demographic data were similar in both groups. The complications rate and the AV did not differ statistically between groups. Group A presented a statistically significant shorter surgical time and lower variation between pre- and post-operative AO and AFd. Statistical significance was defined as p < 0.05. CONCLUSIONS The "single-use peripheral" reaming technique demonstrated to be more reliable in reproducing the native COR and AO of patients undergoing to primary THA than the "conventional" one. The operative time was significantly reduced, and it may lead to a reduction in the infection risk even though it was not observed in the current study. Further research could be useful to validate such findings and to assess clinical impact and long-term survival of the implant.
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Affiliation(s)
- Edoardo Viglietta
- Orthopaedic Unit, S. Andrea Hospital, University of Rome, "La Sapienza" Via Di Grottarossa 1035, Rome, Italy.
| | - Leonardo Previ
- Orthopaedic Unit, S. Andrea Hospital, University of Rome, "La Sapienza" Via Di Grottarossa 1035, Rome, Italy
| | - Veronica Giuliani
- Orthopaedic Unit, S. Andrea Hospital, University of Rome, "La Sapienza" Via Di Grottarossa 1035, Rome, Italy
| | - Giulia Rescigno
- Orthopaedic Unit, S. Andrea Hospital, University of Rome, "La Sapienza" Via Di Grottarossa 1035, Rome, Italy
| | - Yuri Gugliotta
- Orthopaedic Unit, S. Andrea Hospital, University of Rome, "La Sapienza" Via Di Grottarossa 1035, Rome, Italy
| | - Andrea Redler
- Orthopaedic Unit, S. Andrea Hospital, University of Rome, "La Sapienza" Via Di Grottarossa 1035, Rome, Italy
| | - Raffaele Iorio
- Orthopaedic Unit, S. Andrea Hospital, University of Rome, "La Sapienza" Via Di Grottarossa 1035, Rome, Italy
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13
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Descamps J, Teissier V, Graff W, Mouton A, Bouché PA, Marmor S. Managing early complications in total hip arthroplasty: the safety of immediate revision. J Orthop Traumatol 2023; 24:38. [PMID: 37525070 PMCID: PMC10390444 DOI: 10.1186/s10195-023-00719-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE Immediate revision refers to a reoperation that involves resetting, draping, and exchanging the implant, after wound closure in total hip arthroplasty. The purpose of this study is to investigate the impact of immediate revision after total hip arthroplasty on subsequent infection and complication rates. METHODS A total of 14,076 primary total hip arthroplasties performed between 2010 and 2020 were identified in our institutional database, of which 42 underwent immediate revision. Infection rates were determined 2 years after the index arthroplasty. The cause and type of revision, duration of primary and revision surgeries, National Nosocomial Infections Surveillance score, implant type, changes in implants, complications, and preoperative and intraoperative antibiotic prophylaxis were all determined. RESULTS No infections were observed within 2 years after the index arthroplasty. Leg length discrepancy (88%, n = 37) and dislocation (7.1%, n = 3) were the main causes of immediate revision. In most cases of discrepancy, the limb was clinically and radiologically longer before the immediate revision. The mean operative time was 48 ± 14 min for the primary procedure and 23.6 ± 9 min for the revision. The time between the first incision and last skin closure ranged from 1 to 3 h. None of the patients were extubated between the two procedures. Two patients had a National Nosocomial Infections Surveillance score of 2, 13 had a score of 1, and 27 had a score of 0. CONCLUSION Immediate revision is safe for correcting clinical and radiological abnormalities, and may not be associated with increased complication or infection rates. STUDY DESIGN Retrospective cohort study; level of evidence, 3.
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Affiliation(s)
- Jules Descamps
- Bone-and-Joint Infections Referral Center, Groupe Hospitalier Diaconnesses Croix Saint-Simon, 125 Rue d'Avron, 75020, Paris, France.
- Orthopedic Surgery Departement, Groupe Hospitalier Diaconnesses Croix Saint-Simon, 125 Rue d'Avron, 75020, Paris, France.
| | - Victoria Teissier
- Bone-and-Joint Infections Referral Center, Groupe Hospitalier Diaconnesses Croix Saint-Simon, 125 Rue d'Avron, 75020, Paris, France
- Orthopedic Surgery Departement, Groupe Hospitalier Diaconnesses Croix Saint-Simon, 125 Rue d'Avron, 75020, Paris, France
| | - Wilfrid Graff
- Bone-and-Joint Infections Referral Center, Groupe Hospitalier Diaconnesses Croix Saint-Simon, 125 Rue d'Avron, 75020, Paris, France
- Orthopedic Surgery Departement, Groupe Hospitalier Diaconnesses Croix Saint-Simon, 125 Rue d'Avron, 75020, Paris, France
| | - Antoine Mouton
- Bone-and-Joint Infections Referral Center, Groupe Hospitalier Diaconnesses Croix Saint-Simon, 125 Rue d'Avron, 75020, Paris, France
- Orthopedic Surgery Departement, Groupe Hospitalier Diaconnesses Croix Saint-Simon, 125 Rue d'Avron, 75020, Paris, France
| | - Pierre-Alban Bouché
- Bone-and-Joint Infections Referral Center, Groupe Hospitalier Diaconnesses Croix Saint-Simon, 125 Rue d'Avron, 75020, Paris, France
- Orthopedic Surgery Departement, Groupe Hospitalier Diaconnesses Croix Saint-Simon, 125 Rue d'Avron, 75020, Paris, France
| | - Simon Marmor
- Bone-and-Joint Infections Referral Center, Groupe Hospitalier Diaconnesses Croix Saint-Simon, 125 Rue d'Avron, 75020, Paris, France
- Orthopedic Surgery Departement, Groupe Hospitalier Diaconnesses Croix Saint-Simon, 125 Rue d'Avron, 75020, Paris, France
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14
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Andrzejewski K, Domżalski M, Komorowski P, Poszepczyński J, Rokita B, Elgalal M. Optimization of Revision Hip Arthroplasty Workflow by Means of Detailed Pre-Surgical Planning Using Computed Tomography Data, Open-Source Software and Three-Dimensional-Printed Models. Diagnostics (Basel) 2023; 13:2516. [PMID: 37568878 PMCID: PMC10417331 DOI: 10.3390/diagnostics13152516] [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: 06/13/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND In revision hip arthroplasty (RHA), establishing the center of rotation (COR) can be technically challenging due to the acetabular bone destruction that is usually present, particularly in severe cases such as Paprosky type II and III defects. The aim of this study was to demonstrate the use of open-source medical image reconstruction software and low-cost 3D anatomical models in pre-surgical planning of RHA. METHODS A total of 10 patients, underwent RHA and were included in the study. Computed tomography (CT) scans were performed for all cases, before surgery and approximately 1 week after the procedure. The reconstruction of CT data, 3D virtual planning of the COR and positioning of acetabular cups, including their inclination and anteversion angles, was carried out using the free open source software platform 3D Slicer. In addition, anatomical models of the pelvis were built on a desktop 3D printer from polylactic acid (PLA). Preoperative and postoperative reconstructed imaging data were compared for each patient, and the position of the acetabular cups as well as the COR were evaluated for each case. RESULTS Analysis of the pre- and post-op center of rotation position data indicated statistically insignificant differences for the location of the COR on the X-axis (1.5 mm, t = 0.5741, p = 0.5868) with a fairly strong correlation of the results (r = -0.672, p = 0.0982), whilst for the location of the COR in the Y and Z-axes, there was statistical dependence (Y axis, 4.7 mm, t = 3.168 and p = 0.0194; Z axis, 1.9 mm, t = 1.887 and p = 0.1081). A strong correlation for both axes was also observed (Y and Z) (Y-axis, r = 0.9438 and p = 0.0014; Z-axis, r = 0.8829 and p = 0.0084). Analysis of inclination angle values showed a statistically insignificant difference between mean values (3.9 degrees, t = 1.111, p = 0.3092) and a moderate correlation was found between mean values (r = -0.4042, p = 0.3685). Analysis of the anteversion angle showed a statistically insignificant difference between mean values (1.9 degrees, t = 0.8671, p = 0.4192), while a moderate correlation between mean values was found (r = -0.4782, p = 0.2777). CONCLUSIONS Three-dimensional reconstruction software, together with low-cost anatomical models, are very effective tools for pre-surgical planning, which have great potential use in orthopedic surgery, particularly RHA. In up and in- and up and out-type defects, it is essential to establish a new COR and to identify three support points within the revision acetabulum in order to correctly position acetabular cups.
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Affiliation(s)
- Krzysztof Andrzejewski
- Department of Orthopaedics and Trauma, Veteran’s Memorial Hospital, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland; (K.A.); (M.D.); (J.P.)
| | - Marcin Domżalski
- Department of Orthopaedics and Trauma, Veteran’s Memorial Hospital, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland; (K.A.); (M.D.); (J.P.)
| | - Piotr Komorowski
- Division of Biophysics, Institute of Materials Science, Lodz University of Technology, Stefanowskiego 1/15, 90-924 Lodz, Poland;
| | - Jan Poszepczyński
- Department of Orthopaedics and Trauma, Veteran’s Memorial Hospital, Medical University of Lodz, Zeromskiego 113, 90-549 Lodz, Poland; (K.A.); (M.D.); (J.P.)
| | - Bożena Rokita
- Institute of Applied Radiation Chemistry, Faculty of Chemistry, Lodz University of Technology, Wroblewskiego 15, 93-590 Lodz, Poland;
| | - Marcin Elgalal
- Second Department of Radiology and Diagnostic Imaging, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland
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15
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Weishorn J, Heid S, Bruckner T, Merle C, Renkawitz T, Innmann MM. How is hip anatomy reconstruction and inlay wear associated up to 10 years after primary THA using ceramic on highly crosslinked polyethylene bearings? BMC Musculoskelet Disord 2023; 24:400. [PMID: 37202754 DOI: 10.1186/s12891-023-06501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/09/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Conventional polyethylene (PE) wear has been reported to be associated with femoral offset reconstruction and cup orientation after THA. Thus, the present study aimed (1) to determine the polyethylene wear rate of 32 mm ceramic heads with highly cross-linked polyethylene (HXLPE) inlays up to 10 years postoperatively and (2) to identify patient and surgery-related factors affecting the wear rate. METHODS A prospective cohort study was performed, investigating 101 patients with 101 cementless THAs and ceramic (32 mm) on HXLPE bearings after 6-24 months, 2-5 years and 5-10 years postoperatively. The linear wear rate was determined using a validated software (PolyWare®, Rev 8, Draftware Inc, North Webster, IN, USA) by two reviewers, blinded to each other. A linear regression model was used to identify patient and surgery-related factors on HXLPE -wear. RESULTS After an initial bedding-in phase of 1 year after surgery, the mean linear wear rate was 0.059 ± 0.031 mm/y at ten years (mean 7.7 years; SD 0.6 years, range 6-10), being below the osteolysis relevant threshold of 0.1 mm/year. The regression analysis demonstrated that age at surgery, BMI, cup inclination or anteversion and the UCLA score were not associated with the linear HXLPE-wear rate. Only increased femoral offset showed a significant correlation with an increased HXLPE-wear rate (correlation coefficient of 0.303; p = 0.003) with a moderate clinical effect size (Cohen's f²=0.11). CONCLUSION In contrast to conventional PE inlays, hip arthroplasty surgeons may be less concerned about osteolysis-related wear of the HXLPE if the femoral offset is slightly increased. This allows focusing on joint anatomy reconstruction, hip stability and leg length.
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Affiliation(s)
- Johannes Weishorn
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Samira Heid
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Christian Merle
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
- Department of Orthopaedic Surgery, Diakonie Klinikum Stuttgart, Stuttgart, Germany
| | - Tobias Renkawitz
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Moritz M Innmann
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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16
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Shimizu T, Takahashi D, Ishizu H, Yokota S, Hasebe Y, Uetsuki K, Iwasaki N. Anatomical and Simulation Studies Based on Three-Dimensional-Computed Tomography Image Reconstruction of Femoral Offset. Diagnostics (Basel) 2023; 13:diagnostics13081434. [PMID: 37189535 DOI: 10.3390/diagnostics13081434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/12/2023] [Accepted: 03/28/2023] [Indexed: 05/17/2023] Open
Abstract
Although the hip joint morphology varies by race, few studies have investigated the associations between two-dimensional (2D) and three-dimensional (3D) morphologies. This study aimed to use computed tomography simulation data and radiographic (2D) data to clarify the 3D length of offset, 3D changes in the hip center of rotation, and femoral offset as well as investigate the anatomical parameters associated with the 3D length and changes. Sixty-six Japanese patients with a normal femoral head shape on the contralateral side were selected. In addition to radiographic femoral, acetabular, and global offsets, 3D femoral and cup offsets were investigated using commercial software. Our findings revealed that the mean 3D femoral and cup offsets were 40.0 mm and 45.5 mm, respectively; both were distributed around the mean values. The difference between the 3D femoral and cup offsets (i.e., 5 mm) was associated with the 2D acetabular offset. The 3D femoral offset was associated with the body length. In conclusion, these findings can be applied to the design of better ethnic-specific stem designs and can help physicians achieve more accurate preoperative diagnoses.
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Affiliation(s)
- Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Daisuke Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Hotaka Ishizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Shunichi Yokota
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
| | - Yoshihiro Hasebe
- R&D Center, Teijin Nakashima Medical Co., Ltd., Okayama 701-1221, Japan
| | - Keita Uetsuki
- R&D Center, Teijin Nakashima Medical Co., Ltd., Okayama 701-1221, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan
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17
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Krull P, Steinbrück A, Grimberg AW, Melsheimer O, Morlock MM, Perka C. [Standard and special liner in primary hip arthroplasty : Current study and survey results from the German Arthroplasty Registry (EPRD)]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:222-232. [PMID: 36635446 DOI: 10.1007/s00132-022-04333-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Instability constitutes the main reason for revision hip arthroplasties. Modified polyethylene liners are designed to improve the stability of a hip replacement. In July 2022 The Bone & Joint Journal published a study with data of the German Arthroplasty Registry (EPRD). The study investigated mechanical failure of standard and modified liner designs in primary, cementless total hip arthroplasty. Following the study, the EPRD conducted a survey of German clinics to research the utilization of lipped liners in primary total hip replacement. METHODS The liner study included 151,096 primary, elective, cementless total hip arthroplasties. Data from November 2012 to November 2020 were obtained from the EPRD. Standard polyethylene liners were compared with lipped, angulated, offset and angulated/offset inlays. Cumulative incidences for endpoint revision due to mechanical complication were calculated with a competing risk analysis. The influence of other variables was investigated with a multivariate Cox regression. In the following online survey, 237 out of 789 hospitals completed a form. RESULTS AND CONCLUSION In our analysis, only offset liners were, compared to standard liners, associated with a reduced risk of mechanical failure in a short to medium follow up. However, the resultant joint reaction force is increased with offset liners due to the lateralization of the hip center of rotation. Thus, the long-term performance of offset liners needs to be observed. Our survey indicated that lipped liners were implanted more often if the posterior approach was used. Moreover, lipped liners were mostly positioned with the elevated rim in the biomechanically less optimal posterior-superior quadrant. To improve stability it is suggested to position the elevated rim in the posterior-inferior quadrant.
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Affiliation(s)
- Paula Krull
- Endoprothesenregister Deutschland (EPRD gGmbH), Str. des 17. Juni 106-108, 10623, Berlin, Deutschland. .,Centrum für Muskuloskeletale Chirurgie (CMSC), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Arnd Steinbrück
- Endoprothesenregister Deutschland (EPRD gGmbH), Str. des 17. Juni 106-108, 10623, Berlin, Deutschland.,Orthopädisch Chirurgisches Kompetenzzentrum Augsburg (OCKA), Vinzenz-von-Paul-Platz 1, 86152, Augsburg, Deutschland
| | - Alexander W Grimberg
- Endoprothesenregister Deutschland (EPRD gGmbH), Str. des 17. Juni 106-108, 10623, Berlin, Deutschland
| | - Oliver Melsheimer
- Endoprothesenregister Deutschland (EPRD gGmbH), Str. des 17. Juni 106-108, 10623, Berlin, Deutschland
| | - Michael M Morlock
- Technische Universität Hamburg (TUHH), Am Schwarzenberg-Campus 1, 21073, Hamburg, Deutschland
| | - Carsten Perka
- Centrum für Muskuloskeletale Chirurgie (CMSC), Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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18
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Raj JJ, Thompson M, Whitehouse SL, Jaiprakash A, Varughese I, Crawford RW. Downsizing and minimising medialisation of the acetabular component: Novel technique to preserve bone in THA. Proc Inst Mech Eng H 2023; 237:368-374. [PMID: 36734414 DOI: 10.1177/09544119231152351] [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] [Indexed: 02/04/2023]
Abstract
Standard practice for acetabular component placement in total hip arthroplasty (THA) is to medialise the acetabular component. Bone preservation techniques during primary THA are beneficial for possible future revisions. The goal of this study is to examine the effect of downsizing and minimising medialisation of the acetabular component on bone resection volume. The volume of bone resected during acetabular preparation for different sizes of components was calculated and the volume of bone preserved by downsizing the cup was determined. Minimising medialisation of the acetabular component by 1-3 mm from the true floor was calculated. Absolute values and percentage of bone volume preserved when acetabular components are downsized or less medialised is presented. Downsizing the acetabular component by one size (2 mm) preserves between 2.6 cm3 (size 40 vs 42) and 8.4 cm3 (size 72 vs 74) of bone volume and consistently reduces resected bone volume by at least 35% (range 35.2%-37.5%). Similarly, reducing medialisation of a 56 mm acetabular cup (as an example of a commonly implanted component) by 3 mm reduces bone loss by 5.9 cm3- 44% less bone volume resection. Downsizing and minimising medialisation of the cup in THA substantially preserves bone which may benefit future revision surgeries. Surgeons could consider implanting the smallest acceptable acetabular shell to preserve bone without compromising on head size.
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Affiliation(s)
- Jeffrey J Raj
- Queensland University of Technology, Brisbane, QLD, Australia
- Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia
| | | | | | | | - Ibin Varughese
- Queensland University of Technology, Brisbane, QLD, Australia
| | - Ross W Crawford
- Queensland University of Technology, Brisbane, QLD, Australia
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19
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Does acetabular robotic-assisted total hip arthroplasty with femoral navigation improve clinical outcomes at 1-year post-operative? A case-matched propensity score study comparing 98 robotic-assisted versus 98 manual implantation hip arthroplasties. Orthop Traumatol Surg Res 2023; 109:103477. [PMID: 36375721 DOI: 10.1016/j.otsr.2022.103477] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/19/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Despite the optimization of implant positioning, the clinical benefit of the use of robotic assistance during THA remains uncertain. In this case-control study (robotic versus manual technique) we made a retrospective short-term comparison of: (1) the functional results, (2) the complications, (3) and the influence of radiological symmetrization of the hips on the functional result. HYPOTHESIS The use of a robotic arm improved the functional results of a THA. MATERIALS AND METHOD A retrospective case-control study was performed, including patients with unilateral hip osteoarthritis who underwent a robotic arm-assisted THA (THA-R). The controls (THA-C) were matched according to age, sex, body mass index and surgical approach. The Harris (HHS), Oxford (OHS) and Forgotten Joint (FJS) scores were collected preoperatively and 1 year postoperatively. At each review, complications were categorized into minor events, revision surgery with and without implant change. Radiographic analysis was performed on weight-bearing images of the pelvis 3 months postoperatively. The objective of the surgery was symmetrization of the THA in the contralateral healthy hip. For each measured parameter of the hip joint center of rotation (COR), global offset (GO) and articular leg length discrepancy (aLLD), the difference between the two sides corresponding to the delta symmetrization was compared. RESULTS Ninety-eight patients were included in the THA-R group and matched to 98 controls in the THA-C group. At 1 year postoperatively, the FJS and OHS scores were statistically higher in the THA-R group, respectively 82.1±22.3 [8.3; 100] and 40.8±8.8 [6; 48] vs. 71.2±27.8 [0; 100] and 38.1±9.7 [12; 48] in the THA-C group (p=0.004 and p=0.043). There was no difference in HHS (THA-R: 85.9±15.8 [31; 100] vs. THA-C: 85.8±13.3 [49-100] (p=0.962)). The implant revision rate at 1 year was significantly higher in the THA-C group (0% vs. 5.1% (p=0.025)). There was no difference in the reoperation without component exchange despite 3 dislocations (3.1%) in the THA-R group (5 (5.1%) vs. 9 (9.2%) (p=0.273)). The rate of abarticular pathologies (ilio-psoas irritation and greater trochanteric bursitis) was higher in the THA-C group (10 (10.8%) vs. 2 (2%) (p=0.016). Robotic acetabular assistance allowed a significantly better restitution of the horizontal position (THA-R: 1mm±4.8 [-11.7; 12.6] vs. THA-C: 4.1mm±7 [-29.6; 28] (p=0.0005)) and vertical COR (THA-R: 0.5mm±3.1 [-6; 8.3] vs. THA-C: 2mm±4.1 [-6; 14.6] (p=0.0068)). Navigated assistance of the femur did not significantly optimize the restitution of the Global Offset (THA-R: +2mm±6.4 [-16.4; 27.6] vs. THA-C: +0.5mm±7 .7 [-34; 30.2] (p=0.145)), or lower limb length (THA-R: +1.1mm±5 [-8.2; 13.5] vs. THA-C: +0.3mm±6 [-14.1; 22.5] (p=0.344). The FJS was statistically correlated with the restoration of the symmetry of the COR and the aLLD. A post-hoc power analysis confirmed sufficient potency (1-β=0.85). CONCLUSION Robotic acetabular assistance combined with femoral navigation improves clinical outcomes of THAs with fewer short-term complications. The precision of the positioning of the implants, optimized by the computer-assisted surgery system, is correlated with the missed joint score. LEVEL OF EVIDENCE III, retrospective case-control study.
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20
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Morgan S, Barriga J, Dadia S, Merose O, Sternheim A, Snir N. Three dimensional printing as an aid for pre-operative planning in complex cases of total joint arthroplasty: A case series. J Orthop 2022; 34:142-146. [PMID: 36072761 PMCID: PMC9441292 DOI: 10.1016/j.jor.2022.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Digital templating is an essential aspect of pre-operative planning for total joint arthroplasty procedures. For complex cases of joint reconstruction, the standard templating software is insufficient to achieve the desired accuracy. 3D printing significantly aids the pre-operative planning in complicated cases of joint reconstruction and offers immense potential towards improving outcomes in these cases. The purpose of the present study is to present the various ways in which 3D printing has aided our department in facilitating complex cases of lower extremity reconstruction. Methods Data was retrospectively retrieved for all patients that underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA) with the aid of 3D printing technology at our institution between January 2016-February 2021. Patient pain was determined before and after surgery using the visual analogue scale (VAS). Patient reported outcome measures (PROMs) were additionally analyzed using the hip disability and osteoarthritis outcome score (HOOS) and knee injury and osteoarthritis outcome score (KOOS). Results The final study population consisted of 39 patients that underwent TKA or THA procedures with the use of 3D printing. Twenty-four (61.5%) of the surgeries in the study were THA procedures, whereas 15 (38.5%) were TKA procedures. The average VAS for patients reduced from 8.4% before surgery to 5.4% after surgery (p < 0.001). The mean KOOS of patients that underwent TKA was 17.33 ± 9.33 (43%) and the mean HOOS of patients that underwent THA was 13.79 ± 6.6 (42%). Conclusions The following series demonstrates the ability by which 3D printing facilitates complex cases of hip and knee reconstruction. 3D printing offers an improvement in understanding of patient specific anatomy, enhancing patient outcomes. Departments should consider the use of 3D printing technology as an adjunct when performing complex cases of lower extremity reconstruction.
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Affiliation(s)
- Samuel Morgan
- Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Juan Barriga
- Department of Orthopaedics, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Israel
| | - Solomon Dadia
- Sackler Faculty of Medicine, Tel Aviv University, Israel
- National Unit of Orthopaedic Oncology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Israel
| | - Omri Merose
- Sackler Faculty of Medicine, Tel Aviv University, Israel
- National Unit of Orthopaedic Oncology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Israel
| | - Amir Sternheim
- Sackler Faculty of Medicine, Tel Aviv University, Israel
- National Unit of Orthopaedic Oncology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Israel
| | - Nimrod Snir
- Sackler Faculty of Medicine, Tel Aviv University, Israel
- Division of Adult Joint Reconstruction, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Israel
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21
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McGoldrick NP, Antoniades S, El Meniawy S, Kreviazuk C, Beaulé PE, Grammatopoulos G. Supine versus lateral position for total hip replacement: accuracy of biomechanical reconstruction. Arch Orthop Trauma Surg 2022; 142:2945-2955. [PMID: 34557958 DOI: 10.1007/s00402-021-04179-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/09/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Restoration of normal hip anatomy and biomechanics is a key surgical goal for success in total hip arthroplasty. The aim of this study was to evaluate the influence, if any, that patient positioning in the supine and lateral decubitus positions has in achieving this goal. MATERIALS AND METHODS A single center multi-surgeon case-matched series from a tertiary level referral center of patients undergoing primary unilateral THA for osteoarthritis between April 2018 and December 2019 was retrospectively analyzed. Patients (n = 200) were divided into two matched groups: supine (anterior approach, n = 100) and lateral decubitus (direct lateral or posterior/SuperPATH™ approaches, n = 100). Post-operative anteroposterior pelvic radiographs were analyzed using a previously validated software (SurgiMap, Nemaris Inc., USA) for parameters of reconstruction of the hip in the coronal plane; leg length discrepancy, vertical and horizontal displacement of the center of rotation, femoral offset, and total offset. RESULTS Mean absolute leg length discrepancy in the supine group was 0.6 ± 3.3 mm (95% [CI] - 0.1 to 1.2 mm) versus 2.4 ± 3.8 mm (95% [CI] 1.6 to 3.1) in the lateral decubitus position (p < 0.001). The center of rotation was displaced medially by a mean of 3.2 ± 2.7 mm in the supine group versus 1.3 ± 4.0 mm in the lateral decubitus group (p < 0.001). For a surgical target of reconstructing both leg length and total offset within 5 mm of native anatomy, the supine group was more than twice as likely to achieve these goals with fewer outliers (OR 2.631, 95% [CI] 1.901-3.643) (76% v 30%, p < 0.001). CONCLUSION Total hip arthroplasty through the anterior approach in the supine position is more consistent and accurate for the restoration of leg length and total offset. Further study is required to assess how this translates with outcome. LEVEL OF EVIDENCE III-retrospective cohort study.
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Affiliation(s)
- Niall P McGoldrick
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Stephanie Antoniades
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Sherif El Meniawy
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Cheryl Kreviazuk
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW 1638, Ottawa, ON, K1H 8L6, Canada.
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22
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Ivanova S, Vuillemin N, Hapa O, Siebenrock KA, Keel MJB, Tosounidis TH, Bastian JD. Revision of a Failed Primary Total Hip Arthroplasty following Excessive Reaming with a Medial Cup Protrusion. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091254. [PMID: 36143931 PMCID: PMC9503264 DOI: 10.3390/medicina58091254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Atraumatic intrapelvic protrusion of the acetabular component following excessive reaming of the acetabulum with a far medial positioning of the cup is a rare, but serious complication of a total hip arthroplasty (THA). This study analyzes the factors contributing to this uncommon complication and presents the outcome after the revision surgery using the Ganz reinforcement ring combined with a bone graft and plating of the posterior column and/or screws for the anterior column. Materials and Methods: A retrospective case series study with seven patients (four males, mean age 76 ± 10 years (60−86)) that underwent a revision THA within 24 ± 17 days (5−60) after an atraumatic periprosthetic acetabular fracture with a medial cup protrusion was performed. All fractures were reconstructed with a Ganz reinforcement ring and bone graft with a mean follow-up of 1.7 ± 1.7 years (0.5−5). Radiographs were evaluated for the following: (i) cup positioning immediately after the primary THA and the revision surgery, (ii) cup migration in the follow-up, and (iii) fracture healing. Results: The position of the acetabular component as assessed on the postoperative radiographs after the index surgery and before the complete medial cup protrusion showed a cup placement beyond the ilioischial line indicative of a fracture of the medial wall. The revision surgery with the reconstruction of the medial wall with a Ganz reinforcement ring combined with a bone graft restored in the presented cases the center of rotation in the horizontal direction with a statistical significance (p < 0.05). During the follow-up, there was no aseptic loosening with the relevant cup migration or significant change in the position of the acetabular cup at the final follow-up (p > 0.05) after the revision. All seven fractures and bone grafts realized a bone union until the latest follow-up. Conclusions: Following excessive reaming, the acetabular component was placed too far medially and resulted in an intrapelvic cup protrusion. An unstable cup following a fracture of the medial wall was evident on the immediate postoperative radiographs. In the case of the medial wall perforation with an intrapelvic cup protrusion after the primary THA, the reconstruction with a Ganz reinforcement ring was a successful treatment option resulting in the fracture healing and a stable cup positioning. Surgeons should be aware of that rare and probably underreported complication and restore the anatomic center of rotation by treating the defect intraoperatively.
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Affiliation(s)
- Silviya Ivanova
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Nicolas Vuillemin
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Onur Hapa
- Department of Orthopaedics and Traumatology, Faculty of Medicine Dokuz Eylül University, Izmir 35330, Turkey
| | - Klaus A. Siebenrock
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Marius J. B. Keel
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Theodoros H. Tosounidis
- Department of Orthopaedic Surgery, Medical School, University of Crete, University Hospital, 71003 Heraklion, Crete, Greece
| | - Johannes D. Bastian
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Correspondence:
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23
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Zhang S, Liu Y, Yang M, Ma M, Cao Z, Kong X, Chai W. Robotic-assisted versus manual total hip arthroplasty in obese patients: a retrospective case-control study. J Orthop Surg Res 2022; 17:368. [PMID: 35907875 PMCID: PMC9338672 DOI: 10.1186/s13018-022-03263-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/25/2022] [Indexed: 11/12/2022] Open
Abstract
Aims The objective of this study was to evaluate the accuracy of acetabular cup positioning in the obese patients when using robotic-assisted technology during total hip arthroplasty (THA). Methods Data were retrospectively collected from patients who underwent primary (THA) with a body mass index (BMI) ≥ 28 kg/m2 and ≥ 1 year of follow-up between January 2018 and December 2019. Their demographics, diagnosis, acetabular cup positioning, American Society of Anesthesiologists (ASA) score, Harris Hip Score (HHS), and Forgotten Joint Score (FJS) at the final follow-up were recorded for analysis. Results There were no statistically significant differences between the two groups in height, weight, BMI, ASA score, or preoperative Harris Hip Score (HHS). Also, there was no difference in inclination angle between the two groups (R-THA: 41.29° ± 3.04°; manual THA (M-THA): 40.47° ± 5.46°; P = 0.312). However, the mean anteversion angle was greater in the R-THA group (20.71° ± 1.98° vs. 19.08° ± 4.04°; P < 0.001). Compared to M-THA, R-THA more frequently achieved an acetabular cup angle within 5° of the target (anteversion, 98.1% vs. 78.1% P = 0.001; inclination, 88.5% vs. 53.1%, P < 0.001). The R-THA group was more advantageous in restoring the hip center of rotation (COR) and leg length difference (LLD). There was no statistical difference in postoperative HHS (P = 0.404) or FJS (P = 0.497) between the two groups. Conclusions Compared to manual technique, robotic-assisted technique provided more precise acetabular cup positioning and better leg length restoration for obese patients. The robotic-assisted technique was more advantageous in recovering the center of rotation position and achieved a higher proportion of the acetabular cup placed in the target safety zone. Further studies are needed to confirm the clinical outcomes of surgeries in obese patients using robotic-assisted technology.
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Affiliation(s)
- Shuai Zhang
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing, China.,Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Yubo Liu
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, China
| | - Minzhi Yang
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, China
| | - Mingyang Ma
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing, China.,Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Zheng Cao
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, China
| | - Xiangpeng Kong
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China. .,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
| | - Wei Chai
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China. .,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
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24
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Sioen W, Lattré T, Parmentier S, Claeys K. Total hip arthroplasty with a superior approach and in situ preparation of the femoral stem: technique and feasibility in a prospective series of 80 cases. Acta Orthop Belg 2022; 88:35-42. [PMID: 35512152 DOI: 10.52628/88.1.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report on the feasibility of a technique for total hip replacement with in situ preparation of the femoral stem through a superior approach and with the use of standard instruments. From December 2017 to august 2018, 100 patients were recruited for total hip replacement. 80 patients underwent THA through a superior approach with femoral broaching before femoral neck cut. We evaluated feasibility, complications and early functional outcome. There were no major complications. Postoperative leg length discrepancy was on average +0.6mm and offset -0.5mm. The mean acetabular cup inclination was 42.0° and the mean anteversion was 14.5°. The mean WOMAC score was 46 before, 76 at 1 month and 86 at 3 months after surgery. Functional scores (OARSI) were significantly improved at 3 months. Superior in situ total hip replacement is a reliable and reproducible technique with an excellent clinical outcome. It is an iteration to the posterior approach, hence the learning curve is steep and if needed, conversion to a standard posterior approach is possible.
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25
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de Waard S, Verboom T, Bech NH, Sierevelt IN, Kerkhoffs GM, Haverkamp D. Femoroacetabular offset restoration in total hip arthroplasty; Digital templating a short stem vs a conventional stem. World J Orthop 2022; 13:139-149. [PMID: 35317405 PMCID: PMC8891660 DOI: 10.5312/wjo.v13.i2.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/02/2021] [Accepted: 01/08/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Failure in restoring individual anatomy could be a reason for persistent functional limitations post total hip arthroplasty. Femoroacetabular offset (FAO) plays an important role in anatomic restoration, as loss of offset ≥ 5 mm is associated with altered gait and decreased functional outcome. Preoperative assessment by use of digital templating has shown to be a reliable method for sizing the components in total hip arthroplasty, and can show if anatomic restoration is achieved. In recent years, short stems are growing in popularity as it could allow better restoration due to more variety in placement.
AIM To assess whether restoration of the FAO differs between a short or a conventional stem by use of digital templating. Additionally, association of the preoperative offset and caput-colllum-diaphyseal angle (CCD-angle) within restoration of both stems was investigated, and the reliability of measurements was assessed.
METHODS A total of 100 standardized hip radiographs were used for digital templating. Restoration of FAO was classified into “restored” or “not restored”, when a < 5 mm or ≥ 5 mm difference from baseline value presented, respectively. Differences between the two stems concerning proportions of correct restoration of the FAO were analyzed by use of McNemar tests. To assess association between CCD-angle and preoperative FAO with absolute FAO restoration, multi-level analysis was performed by use of a linear mixed model to account for paired measurements. Through determination of the optimal point under the curve in operating curve-analysis, bootstrapping of thousand sets was performed to determine the optimal cutoff point of the preoperative FAO for restoration within the limits of 5 mm. Three observers participated for inter-observer reliability, with two observers measuring the radiographs twice for intra-observer reliability.
RESULTS The mean preoperative FAO was 79.7 mm (range 62.5-113 mm), with a mean CCD-angle of 128.6° (range 114.5°-145°). The conventional stem could only restore the FAO in 72 of the cases, whereas the short stem restored the FAO in all cases. CCD-angle was not a predictor, but the preoperative FAO was. A cut-off point of 81.25 mm (95% confidence interval of 80.75-84.75 mm) in preoperative FAO was found where the conventional stem was unable to restore the FAO. Reliability of measurements was excellent, with an intra-observer reliability of 0.99 and inter-observer reliability in baseline measurements higher than 0.9 between the three observers.
CONCLUSION In preoperative planning of FAO restoration in total hip arthroplasty, digital templating shows that short stems with a curve following the medial calcar are potentially better at restoring the FAO compared to conventional stems if the preoperative offset is ≥ 80.0 mm.
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Affiliation(s)
- Sheryl de Waard
- Orthopedic Surgery, Xpert Orthopedie Amsterdam, Amsterdam 1101 EA, Netherlands
| | - Tom Verboom
- Orthopedic Surgery, Xpert Orthopedie Amsterdam, Amsterdam 1101 EA, Netherlands
| | - Niels Hendrik Bech
- Orthopedic Surgery, Xpert Orthopedie Amsterdam, Amsterdam 1101 EA, Netherlands
| | - Inger N Sierevelt
- Orthopedic Surgery, Xpert Orthopedie Amsterdam, Amsterdam 1101 EA, Netherlands
| | - Gino M Kerkhoffs
- Orthopaedic Surgery, Academic Medical Centre, Amsterdam 1105 AZ, Netherlands
| | - Daniël Haverkamp
- Orthopedic Surgery, Xpert Orthopedie Amsterdam, Amsterdam 1101 EA, Netherlands
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26
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Affiliation(s)
- Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College London Hospital, London, UK.,Department of Orthopaedic Surgery, The Princess Grace Hospital, London, UK
| | - Dia Giebaly
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Fares S Haddad
- The Bone & Joint Journal , London, UK.,University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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27
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De Pieri E, Atzori F, Ferguson SJ, Dendorfer S, Leunig M, Aepli M. Contact force path in total hip arthroplasty: effect of cup medialisation in a whole-body simulation. Hip Int 2021; 31:624-631. [PMID: 32343622 DOI: 10.1177/1120700020917321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cup medialisation down to the true acetabular floor in total hip arthroplasty with a compensatory femoral offset increase seems to be mechanically advantageous for the abductor muscles due to the relocation of the lever arms (body weight lever arm decreased, abductor lever arm increased). However, limited information is currently available about the effects of this reconstruction type at the head cup interface, compared to an anatomical reconstruction that maintains the natural lever arms. Through a whole-body simulation analysis, we compared medialised versus anatomical reconstruction in THA to analyse the effects on: (1) contact force magnitude at the head cup interface; (2) contact force path in the cup; and (3) abductor activity. METHODS Musculoskeletal simulations were performed to calculate the above-mentioned parameters using inverse dynamics analysis. The differences between the virtually implanted THAs were calculated to compare the medialised versus anatomical reconstruction. RESULTS Cup medialisation with compensatory femoral offset increase led to: (1) a reduction in contact force magnitude at the head cup interface up to 6.6%; (2) a similar contact force path in the cup in terms of sliding distance and aspect ratio; and (3) a reduction in abductor activity up to 17.2% (gluteus medius). CONCLUSIONS In our opinion, these potential biomechanical gains do not generally justify a fully medialised reconstruction, especially in younger patients that are more likely to undergo revision surgery in their lifetime. Cup medialisation should be performed until sufficient press fit and bony coverage of a properly sized and oriented cup can be achieved.
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Affiliation(s)
- Enrico De Pieri
- Institute for Biomechanics, ETH Zurich, Zurich, ZH, Switzerland
| | - Federica Atzori
- Institute for Biomechanics, ETH Zurich, Zurich, ZH, Switzerland
| | | | | | - Michael Leunig
- Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Martin Aepli
- Department of Orthopaedic Surgery, Schulthess Clinic, Zurich, Switzerland
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Zuo J, Xu M, Zhao X, Shen X, Gao Z, Xiao J. Effects of the depth of the acetabular component during simulated acetabulum reaming in total hip arthroplasty. Sci Rep 2021; 11:9836. [PMID: 33972628 PMCID: PMC8110577 DOI: 10.1038/s41598-021-89292-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/21/2021] [Indexed: 12/05/2022] Open
Abstract
We aimed to evaluate whether there are differences in the rotation center, cup coverage, and biomechanical effects between conventional and anatomical technique. Computed tomography scans of 26 normal hips were used to simulate implantation of acetabular component. The hip rotation center and acetabular component coverage rate were calculated. Moreover, a finite element model of the hip joint was generated to simulate and evaluate the acetabular cup insertion. Micromotion and the peak stress distribution were used to quantify the biomechanical properties. The medial and superior shifts of the rotation center were 5.2 ± 1.8 mm and 1.6 ± 0.7 mm for the conventional reaming technique and 1.1 ± 1.5 mm and 0.8 ± 0.5 mm for anatomical technique, respectively. The acetabular component coverage rates for conventional reaming technique and anatomical technique were 86.8 ± 4% and 70.0 ± 7%, respectively. The micromotion of the cup with conventional reaming technique was greater than that with anatomical technique. The peak stress concentration was highest in the superior portion with conventional reaming technique, whereas with anatomical technique, there was no stress concentration. Paradoxically although the acetabular component coverage rate is larger with conventional reaming technique, anatomical technique provides less micromotion and stress concentration for initial cup stability. Thus, anatomical technique may be more suitable for acetabulum reaming during primary total hip arthroplasty.
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Affiliation(s)
- Jianlin Zuo
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Avenue, Changchun, Jilin, China
| | - Meng Xu
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Road, Changchun, Jilin, China
| | - Xin Zhao
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Road, Changchun, Jilin, China
| | - Xianyue Shen
- Department of Orthopedics, The Second Hospital of Jilin University, 218 Ziqiang Road, Changchun, Jilin, China
| | - Zhongli Gao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Avenue, Changchun, Jilin, China
| | - Jianlin Xiao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 Xiantai Avenue, Changchun, Jilin, China.
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Kayani B, Konan S, Huq SS, Ibrahim MS, Ayuob A, Haddad FS. The learning curve of robotic-arm assisted acetabular cup positioning during total hip arthroplasty. Hip Int 2021; 31:311-319. [PMID: 31838874 DOI: 10.1177/1120700019889334] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Robotic-arm assisted surgery aims to reduce manual errors and improve the accuracy of implant positioning and orientation during total hip arthroplasty (THA). The objective of this study was to assess the surgical team's learning curve for robotic-arm assisted acetabular cup positioning during THA. METHODS This prospective cohort study included 100 patients with symptomatic hip osteoarthritis undergoing primary total THA performed by a single surgeon. This included 50 patients receiving conventional manual THA and 50 patients undergoing robotic-arm assisted acetabular cup positioning during THA. Independent observers recorded surrogate markers of the learning curve including operative times, confidence levels amongst the surgical team using the state-trait anxiety inventory (STAI) questionnaire, accuracy in restoring native hip biomechanics, acetabular cup positioning, leg-length discrepancy, and complications within 90 days of surgery. RESULTS Cumulative summation (CUSUM) analysis revealed robotic-arm assisted acetabular cup positioning during THA was associated with a learning curve of 12 cases for achieving operative times (p < 0.001) and surgical team confidence levels (p < 0.001) comparable to conventional manual THA. There was no learning curve of robotic-arm assisted THA for accuracy of achieving the planned horizontal (p = 0.83) and vertical (p = 0.71) centres of rotation, combined offset (p = 0.67), cup inclination (p = 0.68), cup anteversion (p = 0.72), and correction of leg-length discrepancy (p = 0.61). There was no difference in postoperative complications between the two treatment groups. CONCLUSIONS Integration of robotic-arm assisted acetabular cup positioning during THA was associated with a learning curve of 12 cases for operative times and surgical team confidence levels but there was no learning curve effect for accuracy in restoring native hip biomechanics or achieving planned acetabular cup positioning and orientation.
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Affiliation(s)
- Babar Kayani
- University College Hospital, London, UK.,Princess Grace Hospital, London, UK
| | - Sujith Konan
- University College Hospital, London, UK.,Princess Grace Hospital, London, UK
| | - Sumon S Huq
- University College Hospital, London, UK.,Princess Grace Hospital, London, UK
| | - Mazin S Ibrahim
- University College Hospital, London, UK.,Princess Grace Hospital, London, UK
| | - Atif Ayuob
- University College Hospital, London, UK.,Princess Grace Hospital, London, UK
| | - Fares S Haddad
- University College Hospital, London, UK.,Princess Grace Hospital, London, UK
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Jin SY, Jin JY, Cheon JH, Yoon TR, Park KS. Survival Analysis of Total Hip Arthroplasty for High Hip Dislocation Secondary to Developmental Dysplasia or Septic Arthritis of the Hip. J Arthroplasty 2021; 36:1671-1677. [PMID: 33248922 DOI: 10.1016/j.arth.2020.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/25/2020] [Accepted: 11/03/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This retrospective study was conducted to know clinical and radiographic outcomes, complication rate, and survival of THA in patients with high hip dislocation secondary to developmental dysplasia(DDH) or septic arthritis of the hip(SSH). METHODS Between March 2005 and September 2014, there were consecutive series of 53 THAs in patients with a highly dislocated hip secondary to DDH or SSH. Of these, 48 hips (DDH 24 and SSH 24) were reviewed at a mean follow-up of 7.9 years(range, 5.0-14.3 years). The mean age at the time of THA was 39.1 years(range, 18.0-59.0 years). RESULTS Intraoperative blood loss, total drainage and blood transfusion amounts, and mean time to greater trochanter union were significantly lower in the DDH group than in the SSH group (P = .001, P = .039 and P = .014, and P = .015, respectively). No significant difference in Kaplan-Meier survivorship was observed between groups (log-rank, P = .343). The survival rates with an endpoint of cup aseptic loosening in cases with a cemented cup at 7.9 and 10 years (68.1% and 60.5%, respectively) were significantly lower than those in cementless cup cases (100%) at the same checkpoints (P = .019).. CONCLUSION We found similar clinical outcomes between the DDH and SSH groups. However, due to poor bone quality and a lack of containment, cementless acetabular cups could not be performed in more than 50% of patients. Our experience shows that revision cementless fixation cup was possible due to reconstitution of the acetabulum in cases with failed cemented fixation.
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Affiliation(s)
- Sheng-Yu Jin
- Department of Orthopedic Surgery, Center for Joint Disease Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea
| | - Jing-Yao Jin
- Department of Orthopedic Surgery, Center for Joint Disease Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea
| | - Jae-Hyeok Cheon
- Department of Orthopedic Surgery, Center for Joint Disease Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea
| | - Taek-Rim Yoon
- Department of Orthopedic Surgery, Center for Joint Disease Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea
| | - Kyung-Soon Park
- Department of Orthopedic Surgery, Center for Joint Disease Chonnam National University Hwasun Hospital, Jeonnam, Republic of Korea
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Merle C, Innmann MM, Westhauser F, Sadoghi P, Renkawitz T. [What are the benefits of patient-specific reconstruction in total hip replacement?]. DER ORTHOPADE 2021; 50:287-295. [PMID: 33751196 DOI: 10.1007/s00132-021-04087-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The success of primary total hip replacement (THR) is predominately determined by the primary stability of the implant and the restoration of the patient-specific joint biomechanics. The three-dimensional (patho-) anatomy, size, geometry, and shape of the acetabulum and proximal femur is highly variable in patients with advanced hip osteoarthritis. Accurate preoperative planning is an essential prerequisite for all replacement procedures. CURRENT SITUATION Current data demonstrates clinical advantages for patient-specific reconstruction of functional joint geometry via surrogate parameters (offset and leg length). Frequently cited "target zones" for the positioning and orientation of the cup are increasingly in the focus of scientific discussion, as individually adjusted target zones for implant positioning allow for a potential reduction of impingement risk. Patients with spinal fusions or pathologic spinopelvic alignment require that particular attention be paid to patient-specific preoperative preparation, the surgical technique, and implant selection in order to reduce the risk of postoperative instability.
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Affiliation(s)
- Christian Merle
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - Moritz M Innmann
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Fabian Westhauser
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Patrick Sadoghi
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Graz, Österreich
| | - Tobias Renkawitz
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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32
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Meermans G. CORR Insights®: Anatomical Mapping of the External Obturator Footprint: A Study In Cadavers with Implications for Direct Anterior THA. Clin Orthop Relat Res 2021; 479:295-297. [PMID: 33475297 PMCID: PMC7899531 DOI: 10.1097/corr.0000000000001531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/21/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Geert Meermans
- G. Meermans, Department of Orthopaedics, Bravis Hospital: Bravis ziekenhuis, Roosendaal, Brabant, the Netherlands
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Vles G, van Eemeren A, Taylan O, Scheys L, Ghijselings S. Anatomical Mapping of the External Obturator Footprint: A Study In Cadavers with Implications for Direct Anterior THA. Clin Orthop Relat Res 2021; 479:288-294. [PMID: 32956147 PMCID: PMC7899571 DOI: 10.1097/corr.0000000000001492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/19/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The external obturator footprint in the trochanteric fossa has been suggested as a potential landmark for stem depth in direct anterior THA. Its upper border can be visualized during surgical exposure of the femur. A recent study reported that the height of the tendon has little variability (6.4 ± 1.4 mm) as measured on CT scans and that the trochanteric fossa is consistently visible on conventional pelvic radiographs. However, it is unclear where exactly the footprint of this tendon should be templated during preoperative planning so that it can be useful intraoperatively. QUESTIONS/PURPOSES In this study, we sought: (1) to provide instructions on exactly where to template the external obturator footprint on a preoperative planning radiograph, and (2) to confirm the small variability in height of the external obturator footprint found on CT scans in a cadaver study. METHODS Two-dimensional (2-D) and three-dimensional (3-D) imaging was used to map the anatomy of the external obturator footprint. This dual approach was chosen because of their complementarity; conventional 2-D radiographs translate to clinical practice but 3-D navigation-based digitalization combined with CT allows for a better understanding of the cortical lines that comprise the outline of the trochanteric fossa. In 12 (four males, mean age 80 years, range 69 to 88) formalin-treated cadaveric lower extremities including the pelvis, the external obturator tendon was dissected, and the top and bottom end of its footprint marked with two small needles, and calibrated radiographs were taken. For another five (three males, mean age 75.7 years, range 61 to 91) fresh-frozen cadaveric lower extremities, including femoral reflective marker frames, CT scans were obtained and the exact location of the external obturator footprint was recorded using 3-D navigation-based digitalization. Qualitative analysis of both imaging modalities was used to develop instructions on where the external obturator footprint should be templated on a preoperative planning radiograph. Quantitative analysis of the dimensions of the external obturator footprint was performed. RESULTS The lowest point of the external obturator footprint was consistently found (± 1 mm) at the intersection of the vertical line comprised of the lateral wall of the trochanteric fossa and the oblique line formed by the intertrochanteric crest and therefore allows templating of this structure on the preoperative planning radiograph. The median (range) height of the footprint measured 6.4 mm and demonstrated small variability (4.7 to 7.6). CONCLUSIONS We suggest templating a 6.4-mm circle with its bottom on the intersection described above. CLINICAL RELEVANCE The distance between the templated shoulder of the stem and the top of the circle can be used intraoperatively for guidance. Discrepancy should lead to re-evaluation of stem depth and leg length. Future work will investigate the usability, validity, and reliability of the proposed methodology in daily clinical practice.
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Affiliation(s)
- Georges Vles
- G. Vles, A. van Eemeren, S. Ghijselings, Department of Orthopaedics - Hip Unit, Gasthuisberg, University Hospitals Leuven, Belgium
- O. Taylan, L. Scheys, Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Leuven, Belgium
| | - Anthony van Eemeren
- G. Vles, A. van Eemeren, S. Ghijselings, Department of Orthopaedics - Hip Unit, Gasthuisberg, University Hospitals Leuven, Belgium
- O. Taylan, L. Scheys, Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Leuven, Belgium
| | - Orcun Taylan
- G. Vles, A. van Eemeren, S. Ghijselings, Department of Orthopaedics - Hip Unit, Gasthuisberg, University Hospitals Leuven, Belgium
- O. Taylan, L. Scheys, Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Leuven, Belgium
| | - Lennart Scheys
- G. Vles, A. van Eemeren, S. Ghijselings, Department of Orthopaedics - Hip Unit, Gasthuisberg, University Hospitals Leuven, Belgium
- O. Taylan, L. Scheys, Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Leuven, Belgium
| | - Stijn Ghijselings
- G. Vles, A. van Eemeren, S. Ghijselings, Department of Orthopaedics - Hip Unit, Gasthuisberg, University Hospitals Leuven, Belgium
- O. Taylan, L. Scheys, Institute of Orthopaedic Research and Training, Gasthuisberg, University Hospitals Leuven/Catholic University of Leuven, Leuven, Belgium
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O'Connor JD, Hill JC, Beverland DE, Dunne NJ, Lennon AB. Influence of preoperative femoral orientation on radiographic measures of femoral head height in total hip replacement. Clin Biomech (Bristol, Avon) 2021; 81:105247. [PMID: 33341521 DOI: 10.1016/j.clinbiomech.2020.105247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND In total hip arthroplasty the surgeon aims to restore the biomechanics of the joint. Femoral height has the greatest influence on restoring limb length and contributes equally to the restoration of femoral head centre. On X-ray, the level of femoral neck resection is most often referenced off the upper border of lesser trochanter. Less frequently, femoral head centre is referenced from the tip of the greater trochanter. The error in measurement of femoral height resulting from unknown femoral rotation is crucially important and can result in inappropriate surgical planning for implant selection and placement. It is unknown which reference produces lower error. METHODS A sample of femoral shapes was generated using a femoral statistical shape model. These were placed in a range of orientations in terms of external rotation and flexion, at intervals of 10°. Simulated X-rays were then produced and the distances from the tip of either greater or lesser trochanter to femoral head centre were measured. FINDINGS Although using greater trochanter as a reference demonstrated greater errors at the extremes, both techniques resulted in errors of 7-8 mm with 20° of both femoral external rotation and flexion. INTERPRETATION Moderate degrees of femoral external rotation combined with flexion can result in unsatisfactory errors when templating limb length. There should be greater focus and an agreed definition for femoral height. There is a clinical need for a method with a lower error in determining true femoral height and the level of neck resection.
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Affiliation(s)
- John D O'Connor
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, UK
| | - Janet C Hill
- Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
| | | | - Nicholas J Dunne
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland; Centre for Medical Engineering Research, School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland; School of Pharmacy, Queen's University Belfast, Belfast, UK; Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin 2, Ireland; Advanced Manufacturing Research Centre (I-Form), School of Mechanical and Manufacturing Engineering, Dublin City University, Glasnevin, Dublin 9, Ireland; Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, Dublin, Ireland; Advanced Processing Technology Research Centre, Dublin City University, Dublin 9, Ireland; Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
| | - Alex B Lennon
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, UK.
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Clement ND, Gaston P, Bell A, Simpson P, Macpherson G, Hamilton DF, Patton JT. Robotic arm-assisted versus manual total hip arthroplasty. Bone Joint Res 2021; 10:22-30. [PMID: 33380216 PMCID: PMC7845457 DOI: 10.1302/2046-3758.101.bjr-2020-0161.r1] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIMS The primary aim of this study was to compare the hip-specific functional outcome of robotic assisted total hip arthroplasty (rTHA) with manual total hip arthroplasty (mTHA) in patients with osteoarthritis (OA). Secondary aims were to compare general health improvement, patient satisfaction, and radiological component position and restoration of leg length between rTHA and mTHA. METHODS A total of 40 patients undergoing rTHA were propensity score matched to 80 patients undergoing mTHA for OA. Patients were matched for age, sex, and preoperative function. The Oxford Hip Score (OHS), Forgotten Joint Score (FJS), and EuroQol five-dimension questionnaire (EQ-5D) were collected pre- and postoperatively (mean 10 months (SD 2.2) in rTHA group and 12 months (SD 0.3) in mTHA group). In addition, patient satisfaction was collected postoperatively. Component accuracy was assessed using Lewinnek and Callanan safe zones, and restoration of leg length were assessed radiologically. RESULTS There were no significant differences in the preoperative demographics (p ≥ 0.781) or function (p ≥ 0.383) between the groups. The postoperative OHS (difference 2.5, 95% confidence interval (CI) 0.1 to 4.8; p = 0.038) and FJS (difference 21.1, 95% CI 10.7 to 31.5; p < 0.001) were significantly greater in the rTHA group when compared with the mTHA group. However, only the FJS was clinically significantly greater. There was no difference in the postoperative EQ-5D (difference 0.017, 95% CI -0.042 to 0.077; p = 0.562) between the two groups. No patients were dissatisfied in the rTHA group whereas six were dissatisfied in the mTHA group, but this was not significant (p = 0.176). rTHA was associated with an overall greater rate of component positioning in a safe zone (p ≤ 0.003) and restoration of leg length (p < 0.001). CONCLUSION Patients undergoing rTHA had a greater hip-specific functional outcome when compared to mTHA, which may be related to improved component positioning and restoration of leg length. However, there was no difference in their postoperative generic health or rate of satisfaction. Cite this article: Bone Joint Res 2021;10(1):22-30.
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Affiliation(s)
- Nicholas D. Clement
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Paul Gaston
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
- Spire Murrayfield Hospital, Edinburgh, UK
| | | | - Philip Simpson
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
- Spire Murrayfield Hospital, Edinburgh, UK
| | - Gavin Macpherson
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
- Spire Murrayfield Hospital, Edinburgh, UK
| | - David F. Hamilton
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
- Spire Murrayfield Hospital, Edinburgh, UK
- Department of Orthopaedics, School of Clinical Sciences, Edinburgh, UK
- School of Health and Social Care, Edinburgh Napier University, Ediburgh, UK
| | - James T. Patton
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
- Spire Murrayfield Hospital, Edinburgh, UK
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Abstract
As our understanding of hip function and disease improves, it is evident that the acetabular fossa has received little attention, despite it comprising over half of the acetabulum’s surface area and showing the first signs of degeneration. The fossa’s function is expected to be more than augmenting static stability with the ligamentum teres and being a templating landmark in arthroplasty. Indeed, the fossa, which is almost mature at 16 weeks of intrauterine development, plays a key role in hip development, enabling its nutrition through vascularization and synovial fluid, as well as the influx of chondrogenic stem/progenitor cells that build articular cartilage. The pulvinar, a fibrofatty tissue in the fossa, has the same developmental origin as the synovium and articular cartilage and is a biologically active area. Its unique anatomy allows for homogeneous distribution of the axial loads into the joint. It is composed of intra-articular adipose tissue (IAAT), which has adipocytes, fibroblasts, leucocytes, and abundant mast cells, which participate in the inflammatory cascade after an insult to the joint. Hence, the fossa and pulvinar should be considered in decision-making and surgical outcomes in hip preservation surgery, not only for their size, shape, and extent, but also for their biological capacity as a source of cytokines, immune cells, and chondrogenic stem cells. Cite this article: Bone Joint Res 2020;9(12):857–869.
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Affiliation(s)
- Pablo A Slullitel
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Daniel Coutu
- Regenerative Medicine Program, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Martin A Buttaro
- 'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Paul Edgar Beaule
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Canada
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Morosato F, Cristofolini L, Castagnini F, Traina F. Effect of cup medialization on primary stability of press-fit acetabular cups. Clin Biomech (Bristol, Avon) 2020; 80:105172. [PMID: 32927407 DOI: 10.1016/j.clinbiomech.2020.105172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Appropriate restoration of the native centre of rotation is of paramount importance in total hip arthroplasty. Reconstruction of the centre of rotation depends on reaming technique: conventional approaches require more cup medialization than anatomical preparations. To date, the influence of cup medialization on socket stability in cementless implants is still unknown. METHODS Ten cadaveric hemipelvises were sequentially reamed using anatomical technique (only subchondral bone removal with restoration of the native centre of rotation) and conventional preparation (reaming to the lamina and medializing the cup). A biomechanical test was performed on the reconstructions. Implant motions were measured with digital image correlation while a cyclic load of increasing magnitude was applied. FINDINGS No significant difference was measured between the two implantation techniques in terms of permanent cup migrations. The only significant difference was found for the cup inducible rotations, where the conventional technique was associated with larger rotations. INTERPRETATION Conventional reaming and cup medialization do not improve initial cup stability. Beyond the recently questioned concerns about medialization and hip biomechanics, this is another issue to bear in mind when reaming the acetabulum.
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Affiliation(s)
- Federico Morosato
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Luca Cristofolini
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum - Università di Bologna, Bologna, Italy.
| | | | - Francesco Traina
- Chirurgia Protesica, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, Università di Bologna, Italy
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Kouyoumdjian P, Mansour J, Assi C, Caton J, Lustig S, Coulomb R. Current concepts in robotic total hip arthroplasty. SICOT J 2020; 6:45. [PMID: 33258445 PMCID: PMC7705325 DOI: 10.1051/sicotj/2020041] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/16/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Total hip replacement provides mostly fair functional and clinical results. Many factors play an essential role in hip stability and long-term outcomes. Surgical positioning remains fundamental for obtaining accurate implant fit and prevent hip dislocation or impingement. Different categories of robotic assistance have been established throughout the previous years and all of the technologies target accuracy and reliability to reduce complications, and enhance clinical outcomes. MATERIALS AND METHODS An overview is proposed over the principles of robotic assistance in hip arthroplasty surgery. Accuracy, reliability, management of the bone stock, clinical outcomes, constraints and limits of this technology are reported, based on recent literature. RESULTS Potential advantages regarding pre-operative planning accuracy, cup positioning, maintenance of the center of rotation, preservation of an adequate bone stock nay clinical short- and mid-term outcomes are balanced with some reported disadvantages and limits like hip anatomical specificity, cost-effectiveness, engineering dependence. DISCUSSION The use of robotic-assisted THA presents clear and evident benefits related to accurate implant positioning and maintenance of a minimal bone while allowing. For some authors, an early improvement in functional results and patient's recovery. This technology demonstrated a shorter surgical time and a short learning curve required to optimize its use and this technology presents promising outcomes and results and potential use in routine clinical application but its limitation of use is still present especially the cost of the robot, the need for the presence of an engineer during the surgery, its availability of use in all hospitals as well as the difficulty presented in dysplastic or dysmorphic hip joints.
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Affiliation(s)
- Pascal Kouyoumdjian
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Centre Hospitalo-universitaire de Nîmes Rue du Pr. Robert Debré 30029 Nîmes France
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Université Montpellier 1 2 Rue de l’École de Médecine 34090 Montpellier France
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Laboratoire de Mécanique et Génie Civile (LMGC), CNRS-UM1 860 Rue de St-Priest 34090 Montpellier France
| | - Jad Mansour
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Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital Beirut Lebanon
| | - Chahine Assi
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Department of Orthopedic Surgery, Lebanese American University-Rizk Hospital Beirut Lebanon
| | | | - Sebastien Lustig
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Centre Albert-Trillat, CHU Lyon Croix-Rousse, Hospices Civils de Lyon 69004 Lyon France
| | - Remy Coulomb
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Centre Hospitalo-universitaire de Nîmes Rue du Pr. Robert Debré 30029 Nîmes France
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Université Montpellier 1 2 Rue de l’École de Médecine 34090 Montpellier France
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Deeper Central Reaming May Enhance Initial Acetabular Shell Fixation. Arthroplast Today 2020; 6:343-349. [PMID: 32548228 PMCID: PMC7286971 DOI: 10.1016/j.artd.2020.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/16/2020] [Accepted: 03/22/2020] [Indexed: 12/02/2022] Open
Abstract
Background The initial stability of press-fit acetabular components is partially determined by the reaming technique. Nonhemispherical (NHS) acetabular shells, which have a larger radius at the rim than the dome, often require larger reaming preparations than the same-sized hemispherical (HS) shells. Furthermore, deeper central reaming may provide a more stable press fit. Using a reproducible, in vitro protocol, we compared initial shell stability under different reaming techniques with HS and NHS acetabular components. Methods Cavities for 54-mm NHS and 56-mm HS acetabular components were premachined in 20-pcf Sawbones blocks. Acetabular cavities included diameters of 54, 55, “54+,” and “55+”. “+” indicates a cavity with a 2-mm smaller diameter that is 2-mm deeper. A 4750N statically applied force seated shells to a height that was comparable with shell height after an orthopaedic surgeon’s manual impaction. Force required to dislodge shells was assessed via a straight torque-out with a linear load. Results Increased preparation depth (+) was associated with deeper shell seating in all groups. Deeper central reaming increased required lever-out force for all groups. Overall, HS and NHS implants prepared with 55 + preparation had the highest lever-out forces, although this was not significantly higher than those with 54+. Conclusions In 20-pcf Sawbones, representing dense bone, overreaming depth by 1-mm improved initial seating measurements. In both HS and NHS acetabular shells, seating depth and required lever-out force were higher in the “+” category. It is unclear, however, whether a decreased diameter ream increased seating stability (55+ vs 54+). Clinically, this deeper central reaming technique may help initial acetabular stability.
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Benson JR, Govindarajan M, Muir JM, Lamb IR, Sculco PK. Surgical Approach and Reaming Depth Influence the Direction and Magnitude of Acetabular Center of Rotation Changes During Total Hip Arthroplasty. Arthroplast Today 2020; 6:414-421. [PMID: 32577487 PMCID: PMC7305266 DOI: 10.1016/j.artd.2020.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/23/2020] [Accepted: 04/02/2020] [Indexed: 12/01/2022] Open
Abstract
Background Changes in acetabular or hip center of rotation (HCOR) commonly occur during acetabular component preparation during total hip arthroplasty (THA). HCOR displacement in mediolateral or superoinferior directions is known to influence offset and leg length, but the incidence and range of HCOR change in the anteroposterior direction is less understood as the sagittal plane cannot be measured on standard anteroposterior radiographs. This study assessed the 3-dimensional displacement of HCOR after cup implantation and evaluated for potential factors associated with increased acetabular component translations. Methods A total of 894 THAs were performed using a posterior, lateral, or direct anterior approach. Only intraoperative data from the navigation device were included in the analysis. All THAs performed between September 2015 and October 2017 were included. Paired t-tests were used to compare native HCOR and new HCOR values. Results The mean HCOR displacement in 3 directions was 4.97mm medially (P < .001), 0.83mm superiorly (P < .001), and 0.64mm posteriorly (P < .001). Subgroup analysis revealed greater posterior HCOR displacement with the anterior approach than the lateral/posterior approach (2.32mm vs 0.44mm; P < .001). Increasing medial HCOR displacement also resulted in increased superior and posterior HCOR displacement across surgical cases (P < .001). Conclusions HCOR displacement is commonly observed in medial, superior, and posterior directions. HCOR changes are influenced by surgical approach, potentially secondary to patient positioning, with greater posterior HCOR displacement observed in anterior cases. Surgeons should be aware of these factors, particularly in cases with deficient or reduced posterior column bone stock.
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Affiliation(s)
- Jessica R Benson
- Department of Clinical Research, Intellijoint Surgical, Inc., Kitchener, Ontario, Canada
| | - Meinusha Govindarajan
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jeffrey M Muir
- Department of Clinical Research, Intellijoint Surgical, Inc., Kitchener, Ontario, Canada
| | - Iain R Lamb
- Department of Clinical Research, Intellijoint Surgical, Inc., Kitchener, Ontario, Canada
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Yao M, Wang Y, Wei C, Han Y, Li H. Greater increase in femoral offset with use of collum femoris-preserving stem than Tri-Lock stem in primary total hip arthroplasty. J Int Med Res 2020; 48:300060520925999. [PMID: 32459103 PMCID: PMC7273761 DOI: 10.1177/0300060520925999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE This study was performed to compare the clinical outcomes and performance of the collum femoris-preserving (CFP) stem (Waldemar Link GmbH & Co., Hamburg, Germany) and the Tri-Lock stem (DePuy Orthopaedics, Warsaw, IN, USA) in terms of femoral offset (FO) and leg length reconstruction. METHODS Clinical and radiographic data of patients who underwent total hip arthroplasty with either a CFP stem or Tri-Lock stem from January 2016 to March 2017 were compared (65 and 57 patients, respectively). The Harris hip score and Western Ontario and McMaster Universities Osteoarthritis Index were recorded. The FO, femoral vertical offset, and neck-shaft angle were measured at the last follow-up. The occurrence of dislocation and periprosthetic fracture during the follow-up period was recorded. RESULTS The CFP stem induced significantly more FO than did the Tri-Lock stem on the operated side than contralateral side (3.63 ± 4.28 vs. 0.83 ± 5.46 mm). Significantly fewer patients had a >5-mm decrease in FO on the unaffected side in the CFP stem group (n = 1) than Tri-Lock stem group (n = 10). CONCLUSION Both stems similarly improved hip function and reconstructed the leg length, but the CFP stem was superior to the Tri-Lock stem in reconstructing FO.
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Affiliation(s)
- Mengxuan Yao
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Yuchuan Wang
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Congcong Wei
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Yongtai Han
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Huijie Li
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
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Kobayashi H, Cech A, Kase M, Pagenstart G, Carrillon Y, O'Loughlin PF, Bothorel H, Aït-Si-Selmi T, Bonnin MP. Pre-operative templating in THA. Part II: a CT-based strategy to correct architectural hip deformities. Arch Orthop Trauma Surg 2020; 140:551-562. [PMID: 31974697 DOI: 10.1007/s00402-020-03341-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Pre-operative templating for total hip arthroplasty (THA) remains inaccurate due to improper magnification and alignment. We aimed to describe an improved templating strategy using computed tomography (CT) to predict component sizes and offsets with greater accuracy. MATERIALS AND METHODS We analysed 184 CT images acquired for pre-operative templating of primary THA. We aimed to restore native (pre-arthritic) femoral offset and limb length, by raising the head center to the level of the templated cup center cranio-caudally, but maintaining the pathologic (pre-operative) head center medio-laterally (except in medialized hips). Acetabular offset (AO) and femoral offset (FO) were measured on pre-operative CT scans, during acetate templating, and on post-operative true antero-posterior radiographs. RESULTS The post-operative offsets were within ± 5 mm from templated estimates in 174 hips (91%) for AO, in 116 hips (61%) for FO, in 111 hips (58%) for GO, and in 134 hips (70%) for neck cut level. The post-operative hip architecture reproduced the templated hip architecture within ±5 mm in 77 hips (40%). The agreement between planned and post-operative parameters was moderate for stem size (0.57), cup size (0.62), AO (0.50), but fair for FO (0.45). The AO decreased in most arthritic types, notably in lateralized hips (6.6 mm), but remained unchanged in medialized hips. The FO increased in most arthritic types (1.8-3.1 mm) but remained unchanged in medialized and lateralized hips. CONCLUSIONS We described a strategy for pre-operative templating in THA. Despite the accuracy of CT, the authors found significant variations between planned and post-operative reconstructions, which suggest that pre-operative templating should only be used as an approximate guide.
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Affiliation(s)
- Hideo Kobayashi
- Department of Orthopaedic Surgery, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Alexandre Cech
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Masanori Kase
- Department of Orthopaedic Surgery, Nissan Tamagawa Hospital, Setagayaku, Tokyo, Japan
| | - Geert Pagenstart
- Department of Clinical Research, University of Basel, Basel, Switzerland.,Clarahof Clinic of Orthopaedic Surgery, Merian-Iselin-Hospital Swiss Olympic Medical Center, Basel, Switzerland.,Knee Institute Basel, Basel, Switzerland
| | - Yannick Carrillon
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Padhraig F O'Loughlin
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.,Cork University Hospital, South Infirmary, Victoria University Hospital, Mater Private Cork, Cork, Ireland
| | - Hugo Bothorel
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Tarik Aït-Si-Selmi
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.,Artro Institute, Lyon, France
| | - Michel P Bonnin
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.,Artro Institute, Lyon, France
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Pre-operative planning in THA. Part III: do implant size prediction and offset restoration influence functional outcomes after THA? Arch Orthop Trauma Surg 2020; 140:563-573. [PMID: 31974695 DOI: 10.1007/s00402-020-03342-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Few studies evaluated clinical benefits of pre-operative templating in total hip arthroplasty (THA). We investigated whether mismatch between planned and real implant sizes and medio-lateral offsets compromises THA outcomes. MATERIALS AND METHODS We reviewed records of 184 primary THAs with pre-operative CT scans used for templating. Acetabular offset (AO), femoral offset (FO) and global offset (GO) were measured on pre-operative CT scans, during acetate templating, and post-operative antero-posterior radiographs. Multivariable analyses were performed to determine if Forgotten Joint Score (FJS) and Oxford Hip Score (OHS) at > 2 years were associated with differences between post-operative and planned parameters. RESULTS The FJS and OHS were not influenced by mismatch of component sizes nor of FO and GO. The FJS was better when the post-operative AO was greater than planned (p = 0.050). The FJS differed among arthritic types (p = 0.015). Multivariable analyses confirmed that older patients had better OHS (beta - 0.16; p = 0.033) and FJS (beta 0.74; p = 0.002), medialized hips had worse FJS (beta - 20.1; p = 0.041) and hips with greater AO than planned had better FJS (beta 1.71; p = 0.024) CONCLUSIONS: Implanting a component of different size than planned did not compromise THA outcomes, but medialized hips had worse scores, and conservative acetabular reaming improved scores.
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Wirries N, Ezechieli M, Floerkemeier T, Windhagen H, Skutek M. Proceeding from direct lateral to anterolateral approach in total hip arthroplasty: A closer look on radiological and clinical aspects. J Orthop 2020; 21:10-13. [PMID: 32071526 DOI: 10.1016/j.jor.2020.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/25/2020] [Indexed: 01/21/2023] Open
Abstract
Introduction Since less invasive approaches for total hip arthroplasty (THA) are promoted, our aim was to compare direct lateral (DLA) and anterolateral approach (ALA) under otherwise identical conditions. Methods Pre - and postoperative x-rays from 200 propensity matched patients (DLA vs. ALA) were evaluated for anatomical reconstruction. Results Overall, the cup position was within the safe zone in both group while the mean center of rotation (COR) was placed more medial and cranial in both groups compared to preoperative anatomy (p > 0.05). The mean leg elongation was comparable between both approaches (p > 0.05). Postoperatively the WOMAC improved about 90%. Conclusion This study confirmed that the ALA can be safely used for THA in minimal invasive setting.
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Affiliation(s)
- Nils Wirries
- Diakovere Annastift Hannover, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Marco Ezechieli
- St. Josefs-Krankenhaus Salzkotten, Dr.-Krismann-Str. 12, 33154, Salzkotten, Germany
| | - Thilo Floerkemeier
- Diakovere Annastift Hannover, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Henning Windhagen
- Diakovere Annastift Hannover, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Michael Skutek
- Diakovere Annastift Hannover, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
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Savov P, Budde S, Tsamassiotis S, Windhagen H, Klintschar M, Ettinger M. Three-dimensional templating in hip arthroplasty: the basis for template-directed instrumentation? Arch Orthop Trauma Surg 2020; 140:827-833. [PMID: 32157370 PMCID: PMC7244460 DOI: 10.1007/s00402-020-03394-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Computed tomography-based three-dimensional models may allow the accurate determination of the center of rotation, lateral and anterior femoral offsets, and the required implant size in total hip arthroplasty. In this cadaver study, the accuracy of anatomical reconstruction was evaluated using a three-dimensional planning tool. MATERIALS AND METHODS A total of eight hip arthroplasties were performed on four bilateral specimens. Based on a computed tomography scan, the position and size of the prosthesis were templated with respect to the anatomical conditions. RESULTS On average, all parameters were reconstructed to an accuracy of 4.5 mm and lie within the limits recommended in the literature. All prostheses were implanted with the templated size. CONCLUSIONS The exact anatomy of the patient and the required size and position of the prosthesis were precisely analyzed using a templating software. Based on the present findings, the development of template-directed instrumentation is conceivable using this method. However, further technical features (e.g., navigation or robot-assisted surgery) are required for improved precision for implant positioning.
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Affiliation(s)
- P. Savov
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
| | - S. Budde
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
| | - S. Tsamassiotis
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
| | - H. Windhagen
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
| | - M. Klintschar
- grid.10423.340000 0000 9529 9877Institute for Forensic Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hanover, Germany
| | - M. Ettinger
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
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Kase M, O'Loughlin PF, Aït-Si-Selmi T, Pagenstert G, Langlois J, Bothorel H, Bonnin MP. Pre-operative templating in THA. Part I: a classification of architectural hip deformities. Arch Orthop Trauma Surg 2020; 140:129-137. [PMID: 31696320 DOI: 10.1007/s00402-019-03298-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION While numerous classifications of hip arthritis have been proposed, none considered the magnitude and direction of femoral head translation relative to the native acetabulum. A more precise classification of architectural hip deformities is necessary to improve preoperative templating and anticipate surgical challenges of total hip arthroplasty (THA). The purpose of the present study was to introduce a classification system to distinguish different types of architectural hip deformities, based on femoral head translation patterns, and to evaluate its repeatability using plain radiographs (qualitative) and Computed Tomography (CT) measurements (quantitative). MATERIALS AND METHODS We studied pre-operative frontal and lateral hip radiographs and CT scans of 191 hips (184 patients) that received primary THA. The distance between the femoral head center (FC) and the acetabular center (AC) was measured, as well as femoral offset, acetabular offset, head center height, acetabular floor distance and femoral neck angle. The hips were classified qualitatively using frontal plain radiographs, and then quantitatively using CT scans (with an arbitrary threshold of 3 mm as Centered, Medialized, Lateralized, Proximalized or Proximo-lateralized. The agreement between qualitative and quantitative classification methods was compared for applying the same classification. RESULTS Qualitative classification identified 120 centered (63%), 8 medialized (4%), 49 lateralized (26%), 3 proximalized (2%), and 11 proximo-lateralized (6%) hips, while quantitative classification identified 116 centered (61%), 8 medialized (4%), 51 lateralized (27%), 5 proximalized (3%), and 11 proximo-lateralized (6%) hips. The agreement between the two methods was excellent (0.94; CI 0.90-0.98). Medialization reached 9.7 mm, while lateralization reached 10.9 mm, and proximalization reached 8.5 mm. Proximalized and proximo-lateralized hips had more valgus necks, while medialized hips had more varus necks (p = 0.003). CONCLUSIONS The classification system enabled repeatable distinction of 5 types of architectural hip deformities. The excellent agreement between quantitative and qualitative methods suggests that plain radiographs are sufficient to classify architectural hip deformities.
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Affiliation(s)
- Masanori Kase
- Department of Orthopaedic Surgery, Nissan Tamagawa Hospital, Setagaya-ku, Tokyo, Japan
| | - Padhraig F O'Loughlin
- Department of Orthopaedic Surgery, Mater Hospital Cork, Cork, Ireland
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Tarik Aït-Si-Selmi
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
- Artro Institute, Lyon, France
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Clarahof Clinic of Orthopaedic Surgery, Merian-Iselin-Hospital Swiss Olympic Medical Center, Basel, Switzerland
- Knee Institute Basel, Basel, Switzerland
| | - Jean Langlois
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Hugo Bothorel
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Michel P Bonnin
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
- Artro Institute, Lyon, France
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Cheng R, Zhang H, Kernkamp WA, Zheng J, Dai K, Yao Y, Wang L, Tsai TY. Relations between the Crowe classification and the 3D femoral head displacement in patients with developmental dysplasia of the hip. BMC Musculoskelet Disord 2019; 20:530. [PMID: 31711458 PMCID: PMC6849202 DOI: 10.1186/s12891-019-2838-z] [Citation(s) in RCA: 5] [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: 06/25/2019] [Accepted: 09/20/2019] [Indexed: 11/19/2022] Open
Abstract
Background The purpose of this study was to investigate the relationship between the three dimensional (3D) femoral head displacement in patients with developmental dysplasia of the hip (DDH) and Crowe classification. Methods Retrospectively, CT scans of 60 DDH patients and 55 healthy demography-matched healthy control subjects were analyzed. Using the anterior pelvic plane a pelvic anatomic coordinate system was established. The center coordinates of the femoral heads of both the DDH patients and control subjects were quantified relative to the pelvic coordinate system and were mapped proportionally to a representative normal pelvis for comparison. Results In the anteroposterior (AP) direction, the center of the femoral head was significantly more anterior in the DDH patients (type I, II, and III, respectively45.0 ± 5.5, 42.9 ± 7.1, and 43.9 ± 4.6 mm) when compared to the controls (50.0 ± 5.2 mm) (p < 0.001 for all). In the medial-lateral (ML) direction, the center of the femoral head was significantly more lateral in the DDH patients (type I, II, and III =103.5 ± 8.6, 101.5 ± 6.6, 102.1 ± 11.2 mm) when compared to the controls (87.5 ± 5.1 mm) (p < 0.001 for all). In the superior-inferior (SI) direction, the center of the femoral head was significantly more proximal in the DDH patients (type I, II, and III =62.4 ± 7.3, 50.0 ± 6.3, and 43.2 ± 6.6 mm) when compared to the controls (66.0 ± 6.2 mm) (p < 0.001 for all). Conclusions The severity of DDH using the Crowe classification was related to the degree of the femoral head displacement in the SI direction, but not in the ML or AP directions. By assessing the 3D femoral head displacement in DDH patients, individualized component positioning might benefit surgical outcome.
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Affiliation(s)
- Rongshan Cheng
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Henghui Zhang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Willem Alexander Kernkamp
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Jingmao Zheng
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China.,Guangxi Clinical Research Center for Digital Medicine and 3D Printing, Guigang City People's Hospital, Guangxi, 537100, China
| | - Kerong Dai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China.,Engineering Research Center of Clinical Translational Digital Medicine, Ministry of Education of P.R. China, Shanghai, 200030, China
| | - Yifei Yao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China.,Engineering Research Center of Clinical Translational Digital Medicine, Ministry of Education of P.R. China, Shanghai, 200030, China
| | - Liao Wang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China.
| | - Tsung-Yuan Tsai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China. .,Engineering Research Center of Clinical Translational Digital Medicine, Ministry of Education of P.R. China, Shanghai, 200030, China.
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Abstract
Robotic total hip arthroplasty (THA) improves accuracy in achieving the planned acetabular cup positioning compared to conventional manual THA. Robotic THA improves precision and reduces outliers in restoring the planned centre of hip rotation compared to conventional manual THA. Improved accuracy in restoring hip biomechanics and acetabular cup positioning in robotic THA have not translated to any differences in early functional outcomes, correction of leg-length discrepancy, or postoperative complications compared to conventional manual THA. Limitations of robotic THA include substantive installation costs, additional radiation exposure, steep learning curves for gaining surgical proficiency, and compatibility of the robotic technology with a limited number of implant designs. Further higher quality studies are required to compare differences in conventional versus robotic THA in relation to long-term functional outcomes, implant survivorship, time to revision surgery, and cost-effectiveness.
Cite this article: EFORT Open Rev 2019;4:618-625. DOI: 10.1302/2058-5241.4.180088
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Affiliation(s)
| | | | - Atif Ayuob
- University College London Hospital, London, UK
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49
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Al-Amiry B, Pantelakis G, Mahmood S, Kadum B, Brismar TB, Sayed-Noor AS. Does body mass index affect restoration of femoral offset, leg length and cup positioning after total hip arthroplasty? A prospective cohort study. BMC Musculoskelet Disord 2019; 20:422. [PMID: 31510993 PMCID: PMC6739956 DOI: 10.1186/s12891-019-2790-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 08/27/2019] [Indexed: 01/12/2023] Open
Abstract
Background In obese patients, total hip arthroplasty (THA) can be technically demanding with increased perioperative risks. The aim of this prospective cohort study is to evaluate the effect of body mass index (BMI) on radiological restoration of femoral offset (FO) and leg length as well as acetabular cup positioning. Methods In this prospective study, patients with unilateral primary osteoarthritis (OA) treated with THA between September 2010 and December 2013 were considered for inclusion. The perioperative plain radiographs were standardised and used to measure the preoperative degree of hip osteoarthritis, postoperative FO, leg length discrepancy (LLD), acetabular component inclination and anteversion. Results We included 213 patients (74.5% of those considered for inclusion) with a mean BMI of 27.7 (SD 4.5) in the final analysis. The postoperative FO was improper in 55% and the LLD in 15%, while the cup inclination and anteversion were improper in 13 and 23% of patients respectively. A multivariable logistic regression model identified BMI as the only factor that affected LLD. Increased BMI increased the risk of LLD (OR 1.14, 95% CI 1.04 to 1.25). No other factors included in the model affected any of the primary or secondary outcomes. Conclusion Increased BMI showed a negative effect on restoration of post-THA leg length but not on restoration of FO or positioning of the acetabular cup. Age, gender, OA duration or radiological severity and surgeon’s experience showed no relation to post-THA restoration of FO, leg length or cup positioning.
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Affiliation(s)
- Bariq Al-Amiry
- Department of Surgical and Perioperative Sciences, Umeå University, 901 85, Umeå, Sweden
| | - Georgios Pantelakis
- Department of Surgical and Perioperative Sciences, Umeå University, 901 85, Umeå, Sweden
| | - Sarwar Mahmood
- Department of Surgical and Perioperative Sciences, Umeå University, 901 85, Umeå, Sweden
| | - Bakir Kadum
- Institutionen för klinisk och experimentell medicin, Linköping University, 58183, Linköping, Sweden
| | - Torkel B Brismar
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, 171 77, Stockholm, Sweden
| | - Arkan S Sayed-Noor
- Department of Surgical and Perioperative Sciences, Umeå University, 901 85, Umeå, Sweden.
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Cao L, Wang Y, Zou S, Cheng H. A novel positioner for accurately sitting the acetabular component: a retrospective comparative study. J Orthop Surg Res 2019; 14:279. [PMID: 31462276 PMCID: PMC6714239 DOI: 10.1186/s13018-019-1331-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/19/2019] [Indexed: 02/02/2023] Open
Abstract
Introduction In this study, we described a positioner which allows a combination of preoperative plan and intraoperative insertion of the cup to improve the reconstruction of the rotation center of the hip. Materials and methods A retrospective study was conducted on 32 consecutive patients (group A) using this positioner and 40 consecutive patients (group B) using conventional method; radiological parameters and clinical measurements before operation and at last follow-up were collected and evaluated. Results Group A had a reconstructed center of rotation (COR) that was 0.19 mm closer to the anatomic COR in height (P < 0.005), compared with group B with 3.45 mm vertical dislocation. There were no statistically significant differences in the horizontal displacement between the two groups. The accuracy of cup inclination was 42.14 ± 3.57 in the group A and 38.73 ± 7.65 in the group B (P = 0.015). The accuracy of cup anteversion was 14.82 ± 1.44 in the group A and 13.08 ± 5.95 in the group B (P = 0.082). All cups in the group A were radiologically stable, while one cup in the group B was radiologically unstable and was successfully treated with second-stage revision. Both of the groups obtained a higher mean postoperative Harris Hip Score. Conclusions Utilizing this positioner helps to restore the COR position more precisely and provides satisfactory radiological and clinical outcomes in the short term, and more studies are required before its widespread adoption for complicated cases.
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Affiliation(s)
- Liangliang Cao
- Department of Joint Surgery, Zhengzhou Orthopaedic Hospital, 58 Longhai Middle Road, Zhengzhou City, Henan Province, China
| | - Yuehui Wang
- Department of Joint Surgery, Zhengzhou Orthopaedic Hospital, 58 Longhai Middle Road, Zhengzhou City, Henan Province, China.
| | - Shiping Zou
- Department of Joint Surgery, Zhengzhou Orthopaedic Hospital, 58 Longhai Middle Road, Zhengzhou City, Henan Province, China
| | - Hui Cheng
- Department of Joint Surgery, Zhengzhou Orthopaedic Hospital, 58 Longhai Middle Road, Zhengzhou City, Henan Province, China
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