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Kouyoumdjian P, Mansour J, Haignère V, Demattei C, Maury E, George D, Coulomb R. Hip-Spine Relationship between Sagittal Balance of the Lumbo-Pelvi-Femoral Complex and Hip Extension Capacity: An EOS Evaluation in a Healthy Caucasian Population. Global Spine J 2024; 14:265-271. [PMID: 35604878 PMCID: PMC10676160 DOI: 10.1177/21925682221103831] [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] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN A prospective study of healthy volunteers. OBJECTIVES The influence of the sagittal alignment of the spine and its influence on the extension reserve have been reported in the literature. However, specific analysis of the intrinsic coxofemoral and extrinsic pelvic component in subjects without any spinal or hip pathologies remains poorly reported. The aim of this study was to categorize the hip extension capacity, or extension reserve (ER), in relation to spinal sagittal alignment whilst standing, in a young healthy population. We hypothesized that the global extension reserve (GER) of the hip joint was influenced by the sagittal spinopelvic alignment. METHODS We evaluated the ER of 120 healthy Caucasian volunteers (56 females (46.7%), 74 males (53.3%); mean age 25.6 years), using low dose radiographs from an EOS® X-ray imaging system in 2 functional positions; neutral standing position and in a forward lunge position. The GER is defined as the sum of the intrinsic (hip) extension reserve (IER) and the extrinsic (pelvic) extension reserve (EER). Cases were grouped into 4 sagittal alignment subtypes according to the Roussouly classification, and analyzed. RESULTS Global extension reserve values were not significantly different between the 4 Roussouly subtypes (P = .094), nor between patients with a sacral slope (SS) <35° (types 1/2) and ≥ 35° (type 3/4) (P = .837). Statistically significant differences were seen between IER in each subtype (P = .015), and EER (P = .006). No difference in ER was seen between subtypes regarding pelvic incidence (PI). CONCLUSION An inverse relationship was found between IER and EER among Roussouly subtypes. The range of motion of the pelvis and the hip joint was higher in patients with a greater sacral slope.
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Affiliation(s)
- Pascal Kouyoumdjian
- Centre Hospitalo-universitaire de Nîmes, Montpellier, France
- Laboratoire de Mécanique et Génie Civile (LMGC), Montpellier, France
| | - Jad Mansour
- Laboratoire de Mécanique et Génie Civile (LMGC), Montpellier, France
| | | | - Christophe Demattei
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, CHU Nimes, Univ Montpellier, Nimes, France
| | - Etienne Maury
- Centre Hospitalier Universitaire de Montpellier. Hôpital Lapeyronie
| | - David George
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Remy Coulomb
- Centre Hospitalo-universitaire de Nîmes, Montpellier, France
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van Erp JHJ, Snijders TE, Weinans H, Castelein RM, Schlösser TPC, de Gast A. The role of the femoral component orientation on dislocations in THA: a systematic review. Arch Orthop Trauma Surg 2022; 142:1253-1264. [PMID: 34101017 PMCID: PMC9110501 DOI: 10.1007/s00402-021-03982-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Dislocation remains a major complication in total hip arthroplasty (THA), in which femoral component orientation is considered a key parameter. New imaging modalities and definitions on femoral component orientation have been introduced, describing orientation in different planes. This study aims to systematically review the relevance of the different orientation parameters on implant stability. METHODS A systematic review was performed according to the PRISMA guidelines to identify articles in the PubMed and EMBASE databases that study the relation between any femoral component orientation parameters and implant stability in primary THA. RESULTS After screening for inclusion and exclusion criteria and quality assessment, nine articles were included. Definitions to describe the femoral component orientation and methodologies to assess its relevance for implant stability differed greatly, with lack of consensus. Seven retrospective case-control studies reported on the relevance of the transversal plane orientation: Low femoral- or low combined femoral and acetabular anteversion was statistical significantly related with more posterior dislocations, and high femoral- or combined femoral and acetabular anteversion with anterior dislocations in two studies. There were insufficient data on sagittal and coronal component orientation in relation to implant stability. CONCLUSION Because of incomparable definitions, limited quality and heterogeneity in methodology of the included studies, there is only weak evidence that the degree of transverse component version is related with implant stability in primary THA. Recommendations about the optimal orientation of the femoral component in all three anatomical planes cannot be provided. Future studies should uniformly define the three-dimensional orientation of the femoral component and systematically describe implant stability.
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Affiliation(s)
- Joost H. J. van Erp
- Department of Orthopedics, Diakonessenhuis, Utrecht, Zeist, The Netherlands
- Clinical Orthopedic Research Center m-N, Zeist, The Netherlands
- Department of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| | - Thom E. Snijders
- Department of Orthopedics, Diakonessenhuis, Utrecht, Zeist, The Netherlands
- Clinical Orthopedic Research Center m-N, Zeist, The Netherlands
| | - Harrie Weinans
- Department of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | | | | | - Arthur de Gast
- Department of Orthopedics, Diakonessenhuis, Utrecht, Zeist, The Netherlands
- Clinical Orthopedic Research Center m-N, Zeist, The Netherlands
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Auberger G, Pansard E, Bouche PA, Marmorat JL, Judet T, Lonjon G. Pelvic position, lying on a traction table, during THA by direct anterior approach. Comparison with the standing position and influence on the acetabular cup anteversion. Orthop Traumatol Surg Res 2021; 107:103077. [PMID: 34563732 DOI: 10.1016/j.otsr.2021.103077] [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: 03/01/2017] [Revised: 04/28/2021] [Accepted: 06/07/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The placement of prostheses for a total hip arthroplasty (THA) is essential to limit complications and optimize functional results. In a recent study of more than 100 THA placed through a direct anterior approach using a traction table, we found that the mean anteversion of the cup was greater (30°) than recommended (20°). To explain this phenomenon, we considered that the anterior pelvic plane (APP), defined by the plane passing through the anterior-superior iliac spines and the pubic symphysis, which serves as a landmark for the placement and calculation of the anteversion of the cup, was not horizontal when the patient was lying on the traction table. This concept has not been evaluated so we conducted a prospective study to: 1) measure the position of the pelvis on a traction table; 2) compare to the standing position, 3) assess its impact on the anteversion of the cup. HYPOTHESIS The standing pelvic version is identical to the supine pelvic version on the traction table. MATERIAL AND METHODS A prospective 3-month monocentric study was conducted. All patients operated on for a THA by a direct anterior approach, on a traction table, were included. The position of the pelvis was assessed by measuring the tilt of the APP on lateral pelvic X-rays, while on the traction table and while standing. The impact of the position of the pelvis on the positioning of the cup, as well as the anteversion, were measured using the EOS imaging system. The anatomic anteversion of the cup was measured in relation to the APP. RESULTS Fifty-eight patients were included (32 women, 26 men) with an average age of 67 years. The tilt of the supine APP was 6°±8.3 [range of -10.5 to 31.0] (indicating a retroverted pelvis on the traction table). The difference between the tilt of the standing and lying APP (within 90°) was not significant (standing was on average 4.5° [range of -11.0 to 27.0] versus lying on the table, was on average 6° [range of -10.5 to 31.0] (p=0.75). A strong correlation was observed between the tilt of the supine APP and the anatomic anteversion of the cup (p<0.001). Thus, the more retroverted the pelvis was on the traction table, the lower the anatomic anteversion of the acetabular cup. CONCLUSION The supine pelvis on the traction table is not always horizontal and its position on the traction table is similar to its standing position, within 90 degrees. The analysis of the positioning of the preoperative pelvis appears to be essential in the planning of a THA through direct anterior approach using a traction table. LEVEL OF EVIDENCE IV; Prospective Cohort Study.
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Affiliation(s)
- Guillaume Auberger
- Department of orthopaedic and trauma surgery, Croix Saint Simon Hospital, GH Diaconnesses Croix Saint Simon, Paris, France.
| | - Erwan Pansard
- Department of orthopaedic and trauma surgery, Ambroise Paré Hospital, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France; Domont Clinic, RAMSAY Group, 85, route de Domont, 95460 Ezanville, France
| | - Pierre-Alban Bouche
- Department of orthopaedic and trauma surgery, Ambroise Paré Hospital, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France; Department of orthopaedic surgery, Raymond-Poincaré Hospital, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - Jean-Luc Marmorat
- Department of orthopaedic surgery, Raymond-Poincaré Hospital, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - Thierry Judet
- Department of orthopaedic surgery, Raymond-Poincaré Hospital, 104, boulevard Raymond-Poincaré, 92380 Garches, France
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Brenneis M, Braun S, van Drongelen S, Fey B, Tarhan T, Stief F, Meurer A. Accuracy of Preoperative Templating in Total Hip Arthroplasty With Special Focus on Stem Morphology: A Randomized Comparison Between Common Digital and Three-Dimensional Planning Using Biplanar Radiographs. J Arthroplasty 2021; 36:1149-1155. [PMID: 33160804 DOI: 10.1016/j.arth.2020.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/20/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Accurate preoperative planning is a key component of successful total hip arthroplasty (THA). The purpose of the present study was to compare the accuracy and reliability of three-dimensional (hipEOS) and common digital two-dimensional (TraumaCad) templating with special focus on stem morphology. METHODS 51 patients undergoing THA were randomized to two groups. Preoperative planning was performed on 23 patients with hipEOS (3D) and on 28 patients with TraumaCad (2D) planning software. Planning results were compared with the implanted component size. Inter- and intraobserver reliability as well as planning accuracy of both planning methods with special focus on straight and short stem design were recorded. RESULTS Intraobserver reliability of both planning methods was good for component planning (ICC2,1: 0.835-0.967). Interobserver ICC2,1 for stem and cup planning were higher for 3D templating (3D ICC2,1: 0.906-0.918 vs. 2D ICC2,1: 0.835-0.843). Total stem and cup size predictions were within 2 sizes for 3D and within 3 sizes for 2D planning. Comparing short stem planning accuracy of both planning methods, absolute difference between implanted and planned component size was significantly lower in 3D planning (P = .029). There was no significant difference in straight stem (P = .935) and cup (P = .954) planning accuracy. CONCLUSION Our findings suggest that 3D templating with hipEOS software has a good overall reliability and may have a better planning accuracy of short stem prostheses than digital templating with TraumaCad software. Assuming that the number of implanted short stem prostheses will further increase in coming years, a more precise planning with 3D technique can contribute to improve surgery outcome.
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Affiliation(s)
- Marco Brenneis
- Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt/Main, Germany
| | - Sebastian Braun
- Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt/Main, Germany
| | - Stefan van Drongelen
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt/Main, Germany
| | - Benjamin Fey
- Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt/Main, Germany
| | - Timur Tarhan
- Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt/Main, Germany
| | - Felix Stief
- Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt/Main, Germany
| | - Andrea Meurer
- Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt/Main, Germany
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Burapachaisri A, Elbuluk A, Abotsi E, Pierrepont J, Jerabek SA, Buckland AJ, Vigdorchik JM. Lewinnek Safe Zone References are Frequently Misquoted. Arthroplast Today 2020; 6:945-953. [PMID: 33299915 PMCID: PMC7701843 DOI: 10.1016/j.artd.2020.09.011] [Citation(s) in RCA: 3] [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: 08/13/2020] [Revised: 09/13/2020] [Accepted: 09/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Optimal acetabular component orientation in total hip arthroplasty (THA) is a necessity in achieving a stable implant. Although there has been considerable debate in the literature concerning the safe zone, to date, there has not been any review to determine if these references are consistent with the definition applied by Lewinnek et al. in 1978. Therefore, this article aims to examine the available literature in the PubMed database to determine how often a correct reference to the safe zone as defined by Lewinnek was applied to discussions regarding THA. METHODS A search for literature in the PubMed database was performed for articles from 1978 to 2019. Search criteria included terms 'Lewinnek,' 'safe zone,' and 'total hip arthroplasty.' Exclusions included abstract-only articles, non-English articles, articles unrelated to THA, and those lacking full content. RESULTS A review of literature yielded 147 articles for inclusion. Overall, only 11% (17) cited the Lewinnek article correctly. Forty-five percent (66) of articles referenced measurements in the supine position, 18% (26) referenced other positions, and 37% (55) did not specify. Nineteen percent (28) reported measurements of the acetabular cup orthogonal to the anterior pelvic plane, while 73% (108) did not, and 7% (11) did not specify. Twenty-three percent (34) measured from computed tomography scans instead of other methods. CONCLUSIONS In the discussion of the safe zone regarding THA, only 11% of articles listed are consistent with the definition established by Lewinnek. This warrants further investigation into a consistent application of the term and its implications for THA implant stability and dislocation rates.
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Affiliation(s)
- Aonnicha Burapachaisri
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Ameer Elbuluk
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Edem Abotsi
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Jim Pierrepont
- Chief Innovation Officer, Corin Group, New South Wales, Australia
| | - Seth A. Jerabek
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Aaron J. Buckland
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Jonathan M. Vigdorchik
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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Ha YC, Yoo JI, Ahn JM, Lee YK, Kang Y, Koo KH. Trans-lateral decubitus radiograph of the hip: A new view to measure the anteversion of the femoral stem. Asian J Surg 2020; 44:99-104. [PMID: 32312488 DOI: 10.1016/j.asjsur.2020.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/13/2020] [Accepted: 03/25/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Malposition of the femoral stem is a risk factor for dislocation after total hip arthroplasty (THA). Currently, two radiological methods are available for the measurement of stem anteversion. However, one method is not applicable in patients with a stiff hip, and the other one cannot differentiate the anteversion and retroversion of the stem. Therefore, we developed a method to measure the stem anteversion and assessed its reliability as well as validity. METHODS Trans-lateral decubitus view of the proximal femur was taken with the patient in lateral decubitus position, the hip in extension and the knee in 90° flexion. Hip anteroposterior (AP) view, trans-lateral decubitus view and CT scan of the hip were taken in 36 patients, who underwent THA. Their mean age was 59.8 (27-84) years and the mean body mass index was 25.2 (18.8-30.9) kg/m2. The stem neck-femoral shaft angle was measured on hip AP view and the trans-lateral decubitus view. Then, the stem anteversion was calculated using the Ogata-Goldsand formula. We assessed the intra- and inter-observer reliabilities and evaluated the validity by comparing with the measurements on CT scan. RESULTS The intra- and inter-observer reliabilities were 0.934 and 0.935, respectively. The calculated stem anteversion (23.72°±8.17°) correlated well with the stem anteversion on CT scan (23.91°±10.25°), especially when the radiological anteversion was <30° (correlation coefficient = 0.729, p = 0.001). CONCLUSION We developed a reliable and valid method to measure stem anteversion using hip AP view and trans-lateral decubitus view of the femur. This method can replace conventional radiological methods.
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Affiliation(s)
- Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, South Korea.
| | - Joongl-Mo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Bundang, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Bundang, South Korea
| | - Yusuhn Kang
- Department of Radiology, Seoul National University Bundang Hospital, Bundang, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Bundang, South Korea
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Darrith B, Bell JA, Culvern C, Della Valle CJ. Can the use of an inclinometer improve the positioning of the acetabular component in total hip arthroplasty? Bone Joint J 2018; 100-B:862-866. [PMID: 29954211 DOI: 10.1302/0301-620x.100b7.bjj-2017-1607.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Accurate placement of the acetabular component is essential in total hip arthroplasty (THA). The purpose of this study was to determine if the ability to achieve inclination of the acetabular component within the 'safe-zone' of 30° to 50° could be improved with the use of an inclinometer. Patients and Methods We reviewed 167 primary THAs performed by a single surgeon over a period of 14 months. Procedures were performed at two institutions: an inpatient hospital, where an inclinometer was used (inclinometer group); and an ambulatory centre, where an inclinometer was not used as it could not be adequately sterilized (control group). We excluded 47 patients with a body mass index (BMI) of > 40 kg/m2, age of > 68 years, or a surgical indication other than osteoarthritis whose treatment could not be undertaken in the ambulatory centre. There were thus 120 patients in the study, 68 in the inclinometer group and 52 in the control group. The inclination angles of the acetabular component were measured from de-identified plain radiographs by two blinded investigators who were not involved in the surgery. The effect of the use of the inclinometer on the inclination angle was determined using multivariate regression analysis. Results The mean inclination angle for the THAs in the inclinometer group was 42.9° (95% confidence interval (CI) 41.7° to 44.0°; range 29.0° to 63.8°) and 46.5° (95% CI 45.2° to 47.7°; range 32.8° to 63.2°) in the control group (p < 0.001). Regression analysis identified a 9.1% difference in inclination due to the use of an inclinometer (p < 0.001), and THAs performed without the inclinometer were three times more likely to result in inclination angles of > 50° (odds ratio (OR) 2.8, p = 0.036). The correlation coefficient for the interobserver reliability of the measurement of the two investigators was 0.95 (95% CI 0.93 to 0.97). Conclusion The use of a simple inclinometer resulted in a significant reduction in the number of outliers compared with a freehand technique. Cite this article: Bone Joint J 2018;100-B:862-6.
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Affiliation(s)
- B Darrith
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - J A Bell
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - C Culvern
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Ililnois, USA
| | - C J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Mainard D, Barbier O, Knafo Y, Belleville R, Mainard-Simard L, Gross JB. Accuracy and reproducibility of preoperative three-dimensional planning for total hip arthroplasty using biplanar low-dose radiographs : A pilot study. Orthop Traumatol Surg Res 2017; 103:531-536. [PMID: 28323248 DOI: 10.1016/j.otsr.2017.03.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/23/2017] [Accepted: 03/09/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND In total hip arthroplasty (THA), the acetabular cup and femoral stem must be correctly sized and positioned to avoid intraoperative and postoperative complications, achieve good functional outcomes and ensure long-term survival. Current two-dimensional (2D) techniques do not provide sufficient accuracy, while low-dose biplanar X-rays (EOS) had not been assessed in this indication. Therefore, we performed a case-control study to : (1) evaluate the prediction of stem and cup size for a new 3D planning technique (stereoradiographic imaging plus 3D modeling) in comparison to 2D templating on film radiographs and (2) evaluate the accuracy and reproducibility of this 3D technique for preoperative THA planning. HYPOTHESIS Accuracy and reproducibility are better with the 3D vs. 2D method. PATIENTS AND METHODS Stem and cup sizes were retrospectively determined by two senior surgeons, twice, for a total of 31 unilateral primary THA patients in this pilot study, using 3D preplanning software on low-dose biplanar X-rays and with 2D templating on conventional anteroposterior (AP) film radiographs. Patients with a modular neck or dual-mobility prosthesis were excluded. All patients but one had primary osteoarthritis; one following trauma did not have a cup implanted. The retrospectively planned sizes were compared to the sizes selected during surgery, and intraclass coefficients (ICC) calculated. RESULTS 3D planning predicted stem size more accurately than 2D templating: stem sizes were planned within one size in 26/31 (84%) of cases in 3D versus 21/31 (68%) in 2D (P=0.04). 3D and 2D planning accuracies were not significantly different for cup size: cup sizes were planned within one size in 28/30 (92%) of cases in 3D versus 26/30 (87%) in 2D (P=0.30). ICC for stem size were 0.88 vs. 0.91 for 3D and 2D, respectively. Inter-operator ICCs for cup size were 0.84 vs. 0.71, respectively. Repetitions of the 3D planning were within one size (except one stem), with the majority predicting the same size. DISCUSSION Increased accuracy in 3D may be due to the use of actual size (non-magnified) images, and judging fit on AP and lateral images simultaneously. Results for other implant components may differ from those presented. Size selection may improve further with planning experience, based on a feedback loop between planning and surgical execution. LEVEL OF EVIDENCE Level III. Retrospective case-control study.
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Affiliation(s)
- D Mainard
- Department of Orthopedics and Trauma Surgery, hôpital Central, CHU de Nancy, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France.
| | - O Barbier
- Department of Orthopedics and Trauma Surgery, hôpital Central, CHU de Nancy, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France
| | - Y Knafo
- Department of Orthopedics and Trauma Surgery, hôpital Central, CHU de Nancy, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France
| | - R Belleville
- Department of Orthopedics and Trauma Surgery, hôpital Central, CHU de Nancy, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France
| | - L Mainard-Simard
- Department of Orthopedics and Trauma Surgery, hôpital Central, CHU de Nancy, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France
| | - J-B Gross
- Department of Orthopedics and Trauma Surgery, hôpital Central, CHU de Nancy, 29, avenue de Lattre-de-Tassigny, 54000 Nancy, France
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Thelen T, Thelen P, Demezon H, Aunoble S, Le Huec JC. Normative 3D acetabular orientation measurements by the low-dose EOS imaging system in 102 asymptomatic subjects in standing position: Analyses by side, gender, pelvic incidence and reproducibility. Orthop Traumatol Surg Res 2017; 103:209-215. [PMID: 28025151 DOI: 10.1016/j.otsr.2016.11.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 11/08/2016] [Accepted: 11/21/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Three-dimensional (3D) acetabular orientation is a fundamental topic in orthopedic surgery. Computed tomography (CT) allows 3D measurement of native acetabular orientation, but with a substantial radiation dose. The EOS imaging system was developed to perform this kind of evaluation, but has not been validated in this indication with specific attention to the acetabulum. We therefore performed a prospective study using EOS to assess: (1) the reproducibility of the 3D acetabulum orientation measures; (2) normative asymptomatic acetabular morphology in standing position, according to side and gender; and (3) the relationship between acetabular anteversion and pelvic incidence. HYPOTHESIS The low-dose EOS imaging system is a reproducible method for measuring 3D acetabular orientation in standing position. PATIENTS AND METHODS In a previous prospective study of spine sagittal balance, 165 asymptomatic volunteers were examined on whole-body EOS biplanar X-ray; 102 had appropriate images for pelvic and acetabular analysis, with an equal sex-ratio (53 female, 49 male). These EOS images were reviewed using sterEOS 3D software, allowing automatic measurement of acetabular parameters (anteversion and inclination) and pelvic parameters (pelvic incidence, pelvic tilt and sacral slope) in an anatomical (anterior pelvic plane: APP) and a functional reference plane (patient vertical plane: PVP). RESULTS Both intra- and inter-observer analysis showed good agreement (ICC>0.90); Bland-Altman plot distributions were good. Acetabular anatomical anteversion and inclination relative to APP (AAAPP and AIAPP, respectively) were significantly greater in women than in men, with no effect of side (right AAA: women 21.3°±3.4° vs. men 16.1°±3.3° (P<0001); right AIAPP: women 55.3°±3.7° vs. men 52.5°±3.0° (P<0001); left AAAPP: women 20.9°±3.5° vs. men 15.6°±4.0° (P<0001); left AIAPP: women 54.6°±3.5° vs. men 52.7°±2.8° (P=0003)). The same differences between men and women were observed when measurements were related to PVP. Pelvic incidence subgroup (<44°; 44-62°; >62°) correlated significantly with functional acetabular orientation in standing position: PVP functional anteversion decreased by 5° relative to APP anteversion with incidence <44°, was equal to APP with incidence 44-62°, and or was greater by 4° relative to APP with incidence >62°. DISCUSSION The use of a 3D sterEOS software prototype version for 3D reconstruction of the native acetabulum from standard EOS X-ray was shown to be a reliable and reproducible method. This innovative method enabled the reference values of 3D acetabular orientation in standing position to be measured for the first time. The results reinforced the concept of hip-spine relationships, and involved very low radiation dose. LEVEL OF EVIDENCE IV prospective study without control group.
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Affiliation(s)
- T Thelen
- Orthopedic and Spine Surgery Unit 2, Bordeaux University Hospital, Place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - P Thelen
- RIM Maussins-Nollet, 114, Rue Nollet, 75017 Paris, France
| | - H Demezon
- Orthopedic and Spine Surgery Unit 2, Bordeaux University Hospital, Place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - S Aunoble
- Orthopedic and Spine Surgery Unit 2, Bordeaux University Hospital, Place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - J-C Le Huec
- Orthopedic and Spine Surgery Unit 2, Bordeaux University Hospital, Place Amélie-Raba-Léon, 33000 Bordeaux, France.
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Li W, Ye Z, Wang W, Wang K, Li L, Zhao D. Clinical effect of hyperbaric oxygen therapy in the treatment of femoral head necrosis. DER ORTHOPADE 2016; 46:440-446. [DOI: 10.1007/s00132-016-3360-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Blum A, Gondim-Teixeira P, Gabiache E, Roche O, Sirveaux F, Olivier P, Coudane H, Raymond A, Louis M, Grandhaye M, Meyer JB, Mainard D, Molé D. Developments in imaging methods used in hip arthroplasty: A diagnostic algorithm. Diagn Interv Imaging 2016; 97:735-47. [PMID: 27452630 DOI: 10.1016/j.diii.2016.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/01/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Several imaging modalities can be used to diagnose complications of hip prosthesis placement. Despite progress in these imaging techniques, there are, as yet, no guidelines as to their respective indications. METHODS We formed a panel of experts in fields related to prosthesis imaging (radiology, nuclear medicine, orthopedic surgery) and conducted a review of the literature to determine the value of each modality for diagnosing complications following hip replacement. RESULTS Few recent studies have investigated the benefits related to the use of the latest technical developments, and studies comparing different methods are extremely rare. CONCLUSIONS We have developed a diagnostic tree based on the characteristics of each imaging technique and recommend its use. Computed topography was found to be the most versatile and cost-effective imaging solution and therefore a key tool for diagnosing the complications of hip replacement surgery.
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Affiliation(s)
- A Blum
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - P Gondim-Teixeira
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - E Gabiache
- Service de médecine nucléaire, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France.
| | - O Roche
- Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| | - F Sirveaux
- Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France.
| | - P Olivier
- Service de médecine nucléaire, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France.
| | - H Coudane
- Chirurgie traumatologique et arthroscopique de l'appareil locomoteur (ATOL), CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | | | - A Raymond
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - M Louis
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - M Grandhaye
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - J-B Meyer
- Service d'imagerie Guilloz, CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - D Mainard
- Chirurgie orthopédique et traumatologique (COT), CHU de Nancy, avenue de Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - D Molé
- Centre chirurgical Émile-Gallé, 49, rue Hermite, 54000 Nancy, France.
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