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Ghotra SS, Cottier Y, Bruguier C, Dominguez A, Monnin P, Sá Dos Reis C. A pilot study to identify suitable MRI protocols for preoperative planning of total hip arthroplasty. Eur J Radiol 2024; 178:111620. [PMID: 39029238 DOI: 10.1016/j.ejrad.2024.111620] [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: 10/03/2023] [Revised: 06/15/2024] [Accepted: 07/11/2024] [Indexed: 07/21/2024]
Abstract
PURPOSE The purpose of this study is to identify suitable MRI sequences and evaluate the feasibility and performance of MRI for total hip arthroplasty (THA) preoperative planning. METHOD A multicentric pilot study was conducted to evaluate DP TSE and T1 GRE 3D sequences. High-resolution pelvis, hip, knee and ankle images were acquired. Protocols were optimised to enhance image quality (IQ) and reduce acquisition time to fit clinical practice. The final protocol was validated with 19 healthy volunteers with variable BMIs at 1.5 and 3 Tesla. Visual assessment was performed by five radiographers and radiologists using the ViewDEX software. Visual Grading Analysis (VGA), Intraclass Correlation Coefficient (ICC), Prevalence-adjusted and bias-adjusted kappa (PABAK) and Visual Grading Characteristics (VGC) were performed to analyse data. RESULTS VGA scores indicated that the optimised 3D DP TSE and 3D T1 GRE sequences at 3 T, as well as 3D DP TSE sequence at 1.5 T offer adequate IQ and allow a correct visualisation of the anatomy. Overall ICC analysis was moderate to good reliability at 0.749 (95 % CI 0.69-0.79) and increased from good to excellent at 0.846 (95 % CI 0.72-0.91) for DP at 3 T. PABAK shows fair agreement at 0.25 (95 % CI 0.227-0.273). VGC analysis showed that 3D DP TSE sequences performed statistically better than 3D T1 GRE at 1.5 and 3 T (p-value ≤ 0.05). Furthermore, 3 T sequences showed a statistically better performance compared to 1.5 T (p-value ≤ 0.05). CONCLUSIONS According to the results, 3D DP and T1 MRI sequences can be considered for preoperative planning for THA. Further research is required to emphasize the clinical validation of the results.
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Affiliation(s)
- Switinder Singh Ghotra
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne 1011, Switzerland; Department of Radiology, Hospital of Yverdon-les-Bains (eHnv), 1400 Yverdon-les-Bains, Switzerland.
| | - Yann Cottier
- Centre d'Imagerie Diagnostique de Lausanne, Lausanne 1011, Switzerland
| | - Christine Bruguier
- Department of Diagnostic & Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne 1011, Switzerland; University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne 1011, Switzerland.
| | - Alejandro Dominguez
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne 1011, Switzerland; University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne 1011, Switzerland.
| | - Pascal Monnin
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne 1011, Switzerland.
| | - Cláudia Sá Dos Reis
- School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne 1011, Switzerland.
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Heliere G, David G, Cypel S, Steiger V, Ducellier F, Rony L. Does two dimensional templating allow for the use of reduced-size ancillaries in total hip arthroplasty? INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06276-4. [PMID: 39172270 DOI: 10.1007/s00264-024-06276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 08/09/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE Rising costs in healthcare for total hip arthroplasty (THA) mean that new solutions must be considered, such as the use of single-use ancillaries (SUA). The goal of this study was to assess the accuracy of 2D templating in primary THA for the use of reduced-size SUA. Our hypothesis was that the accuracy of 2D templating in primary THA would be higher than 95%, give or take two sizes. METHOD This single-centre prospective study included all primary THAs performed over two years. Templating was carried out using 2D templating on anteroposterior pelvic X-rays. The template sizes were compared to the implant sizes. The primary endpoint was the rate of coincidence between digitally templated estimates and the actual implant sizes. The secondary endpoint was the difference of accuracy based on patient parameters. RESULTS We analysed 512 cases of THA. Accuracy within two sizes was 96.9% for acetabular implants and 98.5% for femoral implants. Accuracy was below the 95% threshold only in patients under 55 and over 85 years old. A BMI above 30.0 kg/m2 significantly reduced accuracy but did not fall below the 95% threshold. The operated hip, the type of implant, and the operative indication did not significantly influence templating accuracy. CONCLUSION Using reduced-size SUA with five rasps and five reamers depending on template sizes means that THA can be performed in more than 95% of cases allowing the use of compact single use ancillaries.
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Affiliation(s)
- Gregoire Heliere
- Department of Orthopaedic Surgery, CHU d'Angers, 4, rue Larrey, Angers Cedex 9, 49933, France.
| | - Guillaume David
- Department of Orthopaedic Surgery, CHU d'Angers, 4, rue Larrey, Angers Cedex 9, 49933, France
| | - Sarah Cypel
- Department of Orthopaedic Surgery, CHU d'Angers, 4, rue Larrey, Angers Cedex 9, 49933, France
| | - Vincent Steiger
- Department of Orthopaedic Surgery, CHU d'Angers, 4, rue Larrey, Angers Cedex 9, 49933, France
| | - Florian Ducellier
- Department of Orthopaedic Surgery, CHU d'Angers, 4, rue Larrey, Angers Cedex 9, 49933, France
| | - Louis Rony
- Department of Orthopaedic Surgery, CHU d'Angers, 4, rue Larrey, Angers Cedex 9, 49933, France
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Zampogna B, Parisi FR, Zampoli A, Prezioso A, Vorini F, Laudisio A, Papalia M, Papapietro N, Falez F, Papalia R. Accuracy of two-dimensional digital planning in uncemented primary hip arthroplasty: monocentric analysis of eight hundred implants. INTERNATIONAL ORTHOPAEDICS 2024; 48:1979-1985. [PMID: 38622366 DOI: 10.1007/s00264-024-06172-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE In the last decades, there has been a refinement in total hip arthroplasty, which allowed surgeons to achieve the highest performance and better patient outcomes. Preoperative planning in primary hip arthroplasty is an essential step that guides the surgeon in restoring the anatomy and biomechanics of the joint. This study aims to evaluate the accuracy of the 2D digital planning, considering cup sizing, stem sizing, and limb length discrepancy. Additionally, we conducted a multivariable analysis of demographic data and comorbidities to find factors influencing preoperative planning. METHODS This retrospective study analyzed the planning accuracy in 800 consecutive uncemented primary total hip arthroplasty. We compared the preoperatively planned total hip arthroplasty with postoperative results regarding the planned component size, the implanted size, and the lower limb length restoration. Therefore, we investigated factors influencing planning accuracy: overweight and obesity, sex, age, past medical history, comorbidities, and implant design. All the surgeries were performed in the posterolateral approach by one expert surgeon who did the preoperative planning. The preoperative planning was determined to be (a) exact if the planned and the implanted components were the same size and (b) accurate if exact ± one size. The restoration of postoperative limb length discrepancy was classified into three groups: ± 3 mm, ± 5 mm, and ± 10 mm. This assessment was performed through a digital method 2D based on a standard hip X-ray. RESULTS This court of 800 implants showed that planning was exact in 60% of the cups and 44% of the stems and was accurate in 94% of the cups and 80% of the stems. The postoperative limb length discrepancy was ± 3 mm in 91% and ± 5 mm in 97%. CONCLUSIONS This study showed preoperative 2D digital planning great precision and reliability, and we demonstrated that it was accurate in 94% of the cups and 80% of the stems. Therefore, the preoperative limb length discrepancy analysis was essential to guarantee the recovery of the operated limb's correct length.
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Affiliation(s)
- Biagio Zampogna
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- BIOMORF Department, Biomedical, Dental and Morphological and Functional Images, University of Messina. A.O.U. Policlinico "G.Martino", Messina, Italy
| | - Francesco Rosario Parisi
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Andrea Zampoli
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Anna Prezioso
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Ferruccio Vorini
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Alice Laudisio
- Department of Medicine, Research Unit of Geriatrics, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Roma, Italy.
- Fondazione Policlinico Universitario Campus Bio-Medico, Operative Research Unit of Geriatrics, Via Alvaro del Portillo, 200, 00128, Roma, Italy.
| | - Matteo Papalia
- Orthopaedic and Traumatology Department, Nuova Itor Clinic, Rome, Italy
| | - Nicola Papapietro
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesco Falez
- Department of Orthopaedics and Traumatology, ASL Roma 1, S. Filippo Neri Hospital, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Bouché PA, Corsia S, Auberger G, Descamps J, Anract P, Hamadouche M. Validation of mediCAD® software for fully digital preoperative planning of total hip arthroplasty: a retrospective study. Orthop Traumatol Surg Res 2024:103941. [PMID: 39043497 DOI: 10.1016/j.otsr.2024.103941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 03/11/2024] [Accepted: 04/09/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION The planning step that precedes a total hip arthroplasty (THA) procedure is crucial. Digital planning software programs are being increasingly used, although few studies have reported on the reliability of such tools. Furthermore, no studies have been conducted on the mediCAD® software, despite it being widely used in France. This led us to conduct a retrospective study to: (1) assess the accuracy of this planning software, (2) determine the intra- and inter-rater reliability, (3) determine how obesity affects the accuracy of planning. HYPOTHESIS THA planning is accurate and reliable when using the mediCAD® software. PATIENTS AND METHODS This was a single center, retrospective study. One hundred one consecutive cases performed by a single experienced surgeon were planned retrospectively by two blinded surgeons on two separate occasions. The acetabular cup was cemented in 90 hips (89%), cementless in 11 hips (11%). A dual mobility cup was used in 21 hips (21%). The femoral stem was cemented in 60 hips (59%). The endpoint was the number of exact plans, defined as the same size as the actual implants. An acceptable match was defined as a difference of one size. The match was unacceptable if the planned and implanted size differed by more than 2 for the acetabular cup or by more than 1 size for the femoral stem. The intra-rater and inter-rater reliability were calculated using the intraclass correlation coefficient (ICC) with 95% confidence intervals (CI). RESULTS Exact agreement was found by the first rater for 15 planned acetabular cups (15%) and for 45 planned femoral stems (45%) relative to the implants used. The second rater reached exact agreement for 20 planned acetabular cups (20%) and 50 planned femoral stems (50%). The intra-rater reliability for the acetabular cup was average (ICC = 0.57; 95%CI [0.43-0.69]) and poor (ICC = 0.38 95%CI [0.20-054]) for the 1st and 2nd rater, respectively. The intra-rater reliability for the femoral stem was poor for the 1st rater (ICC = 0.47 95%CI [0.30-0.61]) and the 2nd rater (ICC = 0.45 95%CI [0.29-0.60]). The interobserver reliability was low for the planned acetabular cup (ICC = 0.39 95%CI [0.21-0.54]) and the planned femoral stem (ICC = 0.42 95%CI [0.24-0.57]). Overall, when combining the two raters, exact prediction of the acetabular cup was achieved in 31 hips (19%) in non-obese patients and in 7 hips (21%) in obese patients (p = 0.62). DISCUSSION This study found acceptable reliability of the mediCAD® software. Experience level, radiograph magnification affected the planning outcome in this study, but obesity did not. We currently do not have the ability to incorporate a reliable radiological scale for two-dimensional templating. Some surgeons prefer using a CT scan, but this costs more than conventional radiographs and exposes the patient to more radiation. This study shows that the mediCAD® software can provide satisfactory output for the preoperative planning of THA. LEVEL OF EVIDENCE III; retrospective, diagnostic, comparative study.
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Affiliation(s)
- Pierre-Alban Bouché
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Lariboisière, 2 rue Ambroise Paré 75010 Paris, France.
| | - Simon Corsia
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques 75014 Paris, France
| | - Guillaume Auberger
- Service de Chirurgie Orthopédique et Traumatologique, Groupe Hospitalier Diaconesses Croix St-Simon, 125 rue d'Avron, 75020 Paris, France
| | - Jules Descamps
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Lariboisière, 2 rue Ambroise Paré 75010 Paris, France
| | - Philippe Anract
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques 75014 Paris, France
| | - Moussa Hamadouche
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques 75014 Paris, France
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Van Ravestyn A, Frantz T, Vandemeulebroucke J, Jansen B, Duerinck J, Scheerlinck T. Determination of rotation center and diameter of femoral heads using off-the-shelf augmented reality hardware for navigation. Sci Rep 2024; 14:15458. [PMID: 38965266 PMCID: PMC11224340 DOI: 10.1038/s41598-024-64957-x] [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: 03/24/2024] [Accepted: 06/14/2024] [Indexed: 07/06/2024] Open
Abstract
In total hip arthroplasty (THA), determining the center of rotation (COR) and diameter of the hip joint (acetabulum and femoral head) is essential to restore patient biomechanics. This study investigates on-the-fly determination of hip COR and size, using off-the-shelf augmented reality (AR) hardware. An AR head-mounted device (HMD) was configured with inside-out infrared tracking enabling the determination of surface coordinates using a handheld stylus. Two investigators examined 10 prosthetic femoral heads and cups, and 10 human femurs. The HMD calculated the diameter and COR through sphere fitting. Results were compared to data obtained from either verified prosthetic geometry or post-hoc CT analysis. Repeated single-observer measurements showed a mean diameter error of 0.63 mm ± 0.48 mm for the prosthetic heads and 0.54 mm ± 0.39 mm for the cups. Inter-observer comparison yielded mean diameter errors of 0.28 mm ± 0.71 mm and 1.82 mm ± 1.42 mm for the heads and cups, respectively. Cadaver testing found a mean COR error of 3.09 mm ± 1.18 mm and a diameter error of 1.10 mm ± 0.90 mm. Intra- and inter-observer reliability averaged below 2 mm. AR-based surface mapping using HMD proved accurate and reliable in determining the diameter of THA components with promise in identifying COR and diameter of osteoarthritic femoral heads.
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Affiliation(s)
- Antoine Van Ravestyn
- Department of Orthopedic Surgery and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
- Vrije Universiteit Brussel (VUB), Research Group BEFY-ORTHO, Laarbeeklaan 103, 1090, Brussels, Belgium.
| | - Taylor Frantz
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium
- IMEC, Kapeldreef 75, 3001, Leuven, Belgium
| | - Jef Vandemeulebroucke
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium
- IMEC, Kapeldreef 75, 3001, Leuven, Belgium
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Bart Jansen
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Pleinlaan 2, 1050, Brussels, Belgium
- IMEC, Kapeldreef 75, 3001, Leuven, Belgium
| | - Johnny Duerinck
- Department of Neurosurgery, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Thierry Scheerlinck
- Department of Orthopedic Surgery and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
- Vrije Universiteit Brussel (VUB), Research Group BEFY-ORTHO, Laarbeeklaan 103, 1090, Brussels, Belgium
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Berhouet J, Samargandi R. Emerging Innovations in Preoperative Planning and Motion Analysis in Orthopedic Surgery. Diagnostics (Basel) 2024; 14:1321. [PMID: 39001212 PMCID: PMC11240316 DOI: 10.3390/diagnostics14131321] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/15/2024] [Accepted: 06/20/2024] [Indexed: 07/16/2024] Open
Abstract
In recent years, preoperative planning has undergone significant advancements, with a dual focus: improving the accuracy of implant placement and enhancing the prediction of functional outcomes. These breakthroughs have been made possible through the development of advanced processing methods for 3D preoperative images. These methods not only offer novel visualization techniques but can also be seamlessly integrated into computer-aided design models. Additionally, the refinement of motion capture systems has played a pivotal role in this progress. These "markerless" systems are more straightforward to implement and facilitate easier data analysis. Simultaneously, the emergence of machine learning algorithms, utilizing artificial intelligence, has enabled the amalgamation of anatomical and functional data, leading to highly personalized preoperative plans for patients. The shift in preoperative planning from 2D towards 3D, from static to dynamic, is closely linked to technological advances, which will be described in this instructional review. Finally, the concept of 4D planning, encompassing periarticular soft tissues, will be introduced as a forward-looking development in the field of orthopedic surgery.
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Affiliation(s)
- Julien Berhouet
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Régional Universitaire (CHRU) de Tours, 1C Avenue de la République, 37170 Chambray-les-Tours, France
- Equipe Reconnaissance de Forme et Analyse de l'Image, Laboratoire d'Informatique Fondamentale et Appliquée de Tours EA6300, Ecole d'Ingénieurs Polytechnique Universitaire de Tours, Université de Tours, 64 Avenue Portalis, 37200 Tours, France
| | - Ramy Samargandi
- Service de Chirurgie Orthopédique et Traumatologique, Centre Hospitalier Régional Universitaire (CHRU) de Tours, 1C Avenue de la République, 37170 Chambray-les-Tours, France
- Department of Orthopedic Surgery, Faculty of Medicine, University of Jeddah, Jeddah 23218, Saudi Arabia
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Schweizer C, Niggemeyer O, Jens JH, Junker M. Coxa valga and antetorta configuration leads to underestimation of the femoral component size: a matched case-control study of patients undergoing cementless total hip arthroplasty. Arch Orthop Trauma Surg 2024; 144:2859-2864. [PMID: 38743114 DOI: 10.1007/s00402-024-05373-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Total hip arthroplasty (THA) is the gold standard procedure for patients with end-stage osteoarthritis after failed conservative therapy. Digital templating is commonly employed in preoperative preparation for THA and contributes positively to its outcome. However, the impact of coxa valga and antetorta (CVA) configurations on stem size prediction accuracy remains not reported. Previous studies demonstrated that the size of the lesser trochanter (LT) can be used to determine femoral anteversion on pelvis radiographs. This study investigates the accuracy of preoperative digital templating in predicting stem size in patients with CVA undergoing cementless THA. METHODS Preoperative radiographs of 620 patients undergoing cementless THA were retrospectively investigated. Radiographs were standardized with patients standing and the leg internally rotated by 15°. A CVA group was established including patients with a CCD angle greater than 140° and a lesser trochanter (LT) size of at least 10 mm for men and 8 mm for women. For the control group, radiographs with a CCD angle ranging from 125-135° and LT size 3-10 mm for men and 3-8 mm for women were selected. Preoperative templating was performed using mediCAD. To reduce confounding factors, case-control matching was carried out for BMI and body height. RESULTS After case-control matching, a total of thirty-one matches were analyzed. Stem size was underestimated in 74% (23/31) in the CVA and 13% (4/31) in the control group (p < 0.001). Moreover, patients with CVA were more likely to be underestimated by two sizes compared to controls (p < 0.004). In contrast, the exact stem size was predicted more frequently in the control group (p < 0.001). CONCLUSION Stem size in patients with a CVA configuration are at high risk of being underestimated when using digital templating. These findings can be valuable for guiding in intraoperative decisions and lowering the risk of complications associated with an undersized femoral component.
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Affiliation(s)
- Conradin Schweizer
- Department of Orthopaedic Surgery, Tabea Hospital, Kösterbergstraße 32, 22587, Hamburg, Germany
| | - Oliver Niggemeyer
- Department of Orthopaedic Surgery, Tabea Hospital, Kösterbergstraße 32, 22587, Hamburg, Germany
- Department of Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan-Hauke Jens
- Department of Orthopaedic Surgery, Tabea Hospital, Kösterbergstraße 32, 22587, Hamburg, Germany
| | - Marius Junker
- Department of Orthopaedic Surgery, Tabea Hospital, Kösterbergstraße 32, 22587, Hamburg, Germany.
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Surroca M, Miguela S, Bartra-Ylla A, Nuñez JH, Angles-Crespo F. Surgeon's Experience and Accuracy of Preoperative Digital Templating in Primary Total Hip Arthroplasty. Hip Pelvis 2024; 36:129-134. [PMID: 38825822 PMCID: PMC11162868 DOI: 10.5371/hp.2024.36.2.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 06/04/2024] Open
Abstract
Purpose Preoperative planning has become essential in performance of total hip arthroplasty (THA). However, data regarding the effect of the planner's experience on the accuracy of digital preoperative planning is limited. The objective of this study was to assess the accuracy of digital templating in THA based on the surgeon's experience. Materials and Methods A retrospective study was conducted. An analysis of 98 anteroposterior pelvic radiographs, which were individually templated by four surgeons (two hip surgeons and two orthopaedic residents) using TraumaCad® digital planning, was performed. A comparison of preoperatively planned sizes with implanted sizes was performed to evaluate the accuracy of predicting component size. The results of preoperative planning performed by hip surgeons and orthopaedic residents were compared for testing of the planner's experience. Results Femoral stem was precisely predicted in 32.4% of cases, acetabular component in 40.3%, and femoral offset in 76.7%. Prediction of cup size showed greater accuracy than femoral size among all observers. No differences in any variable were observed among the four groups (acetabular cup P=0.07, femoral stem P=0.82, femoral offset P=0.06). All measurements showed good reliability (intraclass correlation coefficient [ICC] acetabular cup: 0.76, ICC femoral stem: 0.79). Conclusion The results of this study might suggest that even though a surgeon's experience supports improved precision during the planning stage, it should not be restricted only to surgeons with a high level of experience. We consider preoperative planning an essential part of the surgery, which should be included in training for orthopaedics residents.
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Affiliation(s)
- Maria Surroca
- Hip Unit, Department of Orthopedic Surgery, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
- Department of Surgery, Universitat de Barcelona, Barcelona, Spain
| | - Silvia Miguela
- Hip Unit, Department of Orthopedic Surgery, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
- Department of Surgery, Universitat de Barcelona, Barcelona, Spain
| | - Agustí Bartra-Ylla
- Hip Unit, Department of Orthopedic Surgery, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
- Department of Surgery, Universitat de Barcelona, Barcelona, Spain
| | - Jorge H. Nuñez
- Hip Unit, Department of Orthopedic Surgery, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
- Department of Surgery, Universitat de Barcelona, Barcelona, Spain
| | - Francesc Angles-Crespo
- Hip Unit, Department of Orthopedic Surgery, Fundació Assistencial Mútua Terrassa, Terrassa, Spain
- Department of Surgery, Universitat de Barcelona, Barcelona, Spain
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Teja T, Shrivastava S, Choudhary A, Rathod V, Balusani P. Optimizing Acetabular Positioning: A Comprehensive Review of Contemporary Strategies in Total Hip Arthroplasty. Cureus 2024; 16:e59114. [PMID: 38803755 PMCID: PMC11128723 DOI: 10.7759/cureus.59114] [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] [Received: 04/11/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Total hip arthroplasty (THA) is a widely practiced surgical intervention to alleviate pain and reinstate functionality in individuals afflicted with hip joint pathology. The positioning of the acetabulum assumes paramount significance in determining the efficacy of THA, exerting profound influences on biomechanical dynamics, stability, and the durability of outcomes over time. This comprehensive review meticulously evaluates contemporary methodologies for optimizing acetabular positioning in THA, encompassing advanced technologies such as computer-assisted navigation systems, patient-specific instrumentation, robotic-assisted surgical approaches, image-based planning techniques, and intraoperative fluoroscopy. Crucially, key discoveries underscore the pivotal role of precise acetabular alignment in mitigating complications such as dislocation, component wear, and impingement. Moreover, the implications for clinical practice accentuate the imperative of continuous education and training to ensure effective deployment of sophisticated methodologies. Recommendations for furthering research and enhancing practice development underscore the necessity of scrutinizing long-term prognoses, assessing cost-effectiveness, and embracing technological innovations perpetually refining THA outcomes. Collaborative endeavors among researchers, practitioners, and industry stakeholders emerge as indispensable drivers of advancement in this domain, fostering an environment conducive to elevating the standard of care for individuals undergoing THA.
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Affiliation(s)
- Tarun Teja
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sandeep Shrivastava
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhishek Choudhary
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vinit Rathod
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prashanth Balusani
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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10
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Cha Y, Chung JY, Kim JW, Yoo JI, Lee W, Kim JT. Digital Templating of Hip Arthroplasty Using Microsoft PowerPoint: A Pilot Study with Technical Details. Bioengineering (Basel) 2024; 11:327. [PMID: 38671749 PMCID: PMC11048024 DOI: 10.3390/bioengineering11040327] [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: 02/23/2024] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/28/2024] Open
Abstract
Templating is essential in hip arthroplasty preparation, facilitating implant size prediction and surgical rehearsal. It ensures the selection of suitable implants according to patient anatomy and disease, aiming to minimize post-operative complications. Various templating methods exist, including traditional acetate templating on both analog and digital images, alongside digital templating on digital images, which is categorized into 2D and 3D approaches. Despite the popularity of acetate templating on digital images, challenges such as the requirement for physical templates and result preservation persist. To address these limitations, digital templating with software like OrthoSize and Orthoview has been suggested, although not universally accessible. This technical note advocates for Microsoft PowerPoint as an effective alternative for 2D digital templating, highlighting its user-friendly features for image manipulation without needing specialized software. The described method involves scanning acetate templates, adjusting the images in PowerPoint 365 for size, position, and calibration on patient radiographs, and demonstrating reliability through preliminary assessments, with intraclass correlation coefficient (ICC) values indicating a high level of agreement for cup and stem size (ICC = 0.860, 0.841, respectively) but moderate for neck length (ICC = 0.592). We have introduced a method for performing 2D digital templating in the clinical field without the need for specialized software dedicated to digital templating. We believe this method significantly improves the accessibility to 2D digital templating, which was previously limited by the need for digital templating software. Additionally, it enables surgeons to easily establish arthroplasty plans and share them, overcoming the limitations of acetate templates.
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Affiliation(s)
- Yonghan Cha
- Department of Orthopaedic Surgery, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon 35233, Republic of Korea
| | - Jun Young Chung
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Suwon 16499, Republic of Korea
| | - Jin-Woo Kim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Republic of Korea
| | - Jun-Il Yoo
- Department of Orthopedic Surgery, Inha University Hospital, Inha University College of Medicine, Incheon 22332, Republic of Korea
| | - Woohyun Lee
- Hallym University College of Medicine, Chuncheon 24252, Republic of Korea
| | - Jung-Taek Kim
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center, Suwon 16499, Republic of Korea
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11
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Rouzrokh P, Khosravi B, Mickley JP, Erickson BJ, Taunton MJ, Wyles CC. THA-Net: A Deep Learning Solution for Next-Generation Templating and Patient-specific Surgical Execution. J Arthroplasty 2024; 39:727-733.e4. [PMID: 37619804 DOI: 10.1016/j.arth.2023.08.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND This study introduces THA-Net, a deep learning inpainting algorithm for simulating postoperative total hip arthroplasty (THA) radiographs from a single preoperative pelvis radiograph input, while being able to generate predictions either unconditionally (algorithm chooses implants) or conditionally (surgeon chooses implants). METHODS The THA-Net is a deep learning algorithm which receives an input preoperative radiograph and subsequently replaces the target hip joint with THA implants to generate a synthetic yet realistic postoperative radiograph. We trained THA-Net on 356,305 pairs of radiographs from 14,357 patients from a single institution's total joint registry and evaluated the validity (quality of surgical execution) and realism (ability to differentiate real and synthetic radiographs) of its outputs against both human-based and software-based criteria. RESULTS The surgical validity of synthetic postoperative radiographs was significantly higher than their real counterparts (mean difference: 0.8 to 1.1 points on 10-point Likert scale, P < .001), but they were not able to be differentiated in terms of realism in blinded expert review. Synthetic images showed excellent validity and realism when analyzed with already validated deep learning models. CONCLUSION We developed a THA next-generation templating tool that can generate synthetic radiographs graded higher on ultimate surgical execution than real radiographs from training data. Further refinement of this tool may potentiate patient-specific surgical planning and enable technologies such as robotics, navigation, and augmented reality (an online demo of THA-Net is available at: https://demo.osail.ai/tha_net).
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Affiliation(s)
| | | | - John P Mickley
- Department of Orthopedic Surgery, Mayo Clinic, Minnesota
| | | | | | - Cody C Wyles
- Department of Orthopedic Surgery, Mayo Clinic, Minnesota
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12
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Meisterhans M, Dimitriou D, Fasser MR, Hoch A, Jud L, Zingg PO. Influence of offset on osseointegration in cementless total hip arthroplasty: A finite element study. J Orthop Res 2024. [PMID: 38376065 DOI: 10.1002/jor.25808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/21/2024]
Abstract
Early aseptic loosening is caused by deficient osteointegration of the femoral stem due to increased micromotions and represents a common mode of failure in uncemented total hip arthroplasty (THA). This study hypothesized that a higher femoral offset, a smaller stem size and obesity increase femoral micromotion, potentially resulting in early aseptic loosening. A finite element analysis was conducted based on computed tomography segmented model of four patients who received a THA with a triple-tapered straight stem (Size 1, 3, 6). The influence of femoral stem offset (short neck, standard, lateral), head length (S to XXL), femoral anteversion and obesity during daily activities of fast walking and stair climbing was analyzed. The micromotions for the femoral stem zones were compared to a threshold representing a value above which only partial osseointegration is expected. The minimum femoral offset configuration compared to the maximum offset configuration (short neck stem, S head vs. lateral stem, XXL head) leads to a relative mean micromotion increase of 24% for the upper stem zone. Increasing the body weight (body mass index 30-35 kg/m2 ) increases the micromotion by 20% for all stem zones. The obese population recorded threshold-exceeding micromotions for stem sizes 1 and 3 for all offset configurations during stair climbing. Higher femoral offset, a smaller stem size, and higher loading due to obesity lead to an increase in micromotion between the prosthesis and proximal femur and represent a risk configuration for impaired osseointegration of a triple-tapered straight stem, especially when these three factors are present simultaneously.
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Affiliation(s)
- Michel Meisterhans
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Dimitris Dimitriou
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marie-Rosa Fasser
- Institute of Biomechanics, Balgrist Campus, ETH Zurich, Zurich, Switzerland
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Jud
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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13
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Vasiljeva K, Lunn D, Chapman G, Redmond A, Wang L, Thompson J, Williams S, Wilcox R, Jones A. Dynamic Acetabular Cup Orientation during Gait: A Study of Fast- and Slow-Walking Total Hip Replacement Patients. Bioengineering (Basel) 2024; 11:151. [PMID: 38391637 PMCID: PMC10885924 DOI: 10.3390/bioengineering11020151] [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: 12/04/2023] [Revised: 01/17/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
The dynamic orientation of total hip replacement acetabular cups during walking may vary substantially from their assumed position at surgical implantation and may vary between individuals. The scale of this effect is of interest for both pre-clinical device testing and for pre-operative surgical planning. This work aimed to evaluate (1) patient variation in dynamic cup orientation; (2) whether walking speed was a candidate proxy measure for the dynamic cup orientation; and (3) the relationships between dynamic cup orientation angles and planar pelvic angles. Pelvic movement data for patients with fast (20 patients) and slow (19 patients) self-selected walking speeds were used to calculate acetabular cup inclination and version angles through gait. For aim 1, the range and extremes of acetabular cup orientation angles were analysed for all patients. A large patient-to-patient variation was found in the ranges of both inclination angle (1° to 11°) and version angle (4° to 18°). The version angle was typically retroverted in comparison to the implantation position (greatest deviation 27°). This orientation is substantially different to the static, 0° version, simplifying assumptions in pre-clinical 'edge loading' testing. For aim 2, the cup orientation angles were compared between the fast- and slow-walking groups using statistical parametric mapping. The only significant differences observed were for cup version angle, during ~12% of the gait cycle before toe-off (p < 0.05). Therefore, self-selected walking speed, in isolation, is not a sufficient proxy measure for dynamic acetabular orientation. For aim 3, correlations were recorded between the acetabular cup orientation angles and the planar pelvic angles. The cup inclination angle during gait was strongly correlated (Spearman's coefficient -1) with pelvic obliquity alone, indicating that simple planar assessment could be used to anticipate inclination angle range. The cup version angle was correlated with both pelvic rotation and tilt (Spearman's coefficient 0.8-1), indicating that cup version cannot be predicted directly from any single pelvic movement. This complexity, along with the interaction between inclination angle and range of version angle, supports the use of computational tools to aid clinical understanding.
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Affiliation(s)
- Ksenija Vasiljeva
- Leeds Institute of Medical and Biological Engineering, University of Leeds, Leeds LS2 9JT, UK
| | - David Lunn
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds LS7 4SA, UK
| | - Graham Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Anthony Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds LS7 4SA, UK
| | - Lin Wang
- Leeds Institute of Medical and Biological Engineering, University of Leeds, Leeds LS2 9JT, UK
- DePuy Synthes Joint Reconstruction, Leeds LS11 8DT, UK
| | - Jonathan Thompson
- Leeds Institute of Medical and Biological Engineering, University of Leeds, Leeds LS2 9JT, UK
- DePuy Synthes Joint Reconstruction, Leeds LS11 8DT, UK
| | - Sophie Williams
- Leeds Institute of Medical and Biological Engineering, University of Leeds, Leeds LS2 9JT, UK
| | - Ruth Wilcox
- Leeds Institute of Medical and Biological Engineering, University of Leeds, Leeds LS2 9JT, UK
| | - Alison Jones
- Leeds Institute of Medical and Biological Engineering, University of Leeds, Leeds LS2 9JT, UK
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14
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Kouyoumdjian P. How the hip-spine relationship influences total hip arthroplasty. Orthop Traumatol Surg Res 2024; 110:103773. [PMID: 38000509 DOI: 10.1016/j.otsr.2023.103773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 06/30/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Motion in the spine, pelvis and hips which make up the spinopelvic femoral complex (SPFC) implies mechanical relationships that help maintain trunk balance and optimize hip functionThe aim of this study was to understand the physiology of the SPFC and evaluate the dysfunctions of the SPFC and their implications for total hip arthroplasty considering the hip-spine relationship. METHODS A review of relevant and comprehensive studies on this subject is reported in order to highlight a pathophysiology that integrates the description of the evaluations of the spine-pelvic and hip parameters and recommendations for the kinematic planning of the THA procedure. The primary objective was to determine which type of hip-spine relationship has the highest risk for THA complications and to become proficient in selecting the priority surgical intervention when both the hip and spine are affected. Finally, this review attempted to assist hip surgeons with surgical technique, tools, implant selection, and goals of planning a THA that requires personalized kinematic alignment. Determine the influence of THA on these kinematics and the effect of stiffness of the lumbopelvic complex on the risk of THA failure. RESULTS When a person sits, the pelvis goes into retroversion and the acetabulum opens forward. This frees the femoral head and neck to allow hip flexion. The opposite - pelvic anteversion - occurs when a person stands. When pelvic mobility is limited, the hip must increase its range of motion to accommodate these posture changes. Disturbances in spinal and pelvic kinematics lead to abnormal hip function, which may contribute to complications following total hip arthroplasty (THA). CONCLUSION A precise evaluation of the parameters governing the SPFC must be taken into account in order to best optimize the placement and choice of THA implants. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Pascal Kouyoumdjian
- CHU de Nîmes, Faculté de Médecine Montpellier-Nîmes, Université Montpellier, Hôpital Carémeau, 4, place du Professeur-Robert-Debré, 30900 Nîmes, France.
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15
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Khatri C, Metcalfe A, Wall P, Underwood M, Haddad FS, Davis ET. Robotic trials in arthroplasty surgery. Bone Joint J 2024; 106-B:114-120. [PMID: 38295854 DOI: 10.1302/0301-620x.106b2.bjj-2023-0711.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: 02/08/2024]
Abstract
Total hip and knee arthroplasty (THA, TKA) are largely successful procedures; however, both have variable outcomes, resulting in some patients being dissatisfied with the outcome. Surgeons are turning to technologies such as robotic-assisted surgery in an attempt to improve outcomes. Robust studies are needed to find out if these innovations are really benefitting patients. The Robotic Arthroplasty Clinical and Cost Effectiveness Randomised Controlled Trials (RACER) trials are multicentre, patient-blinded randomized controlled trials. The patients have primary osteoarthritis of the hip or knee. The operation is Mako-assisted THA or TKA and the control groups have operations using conventional instruments. The primary clinical outcome is the Forgotten Joint Score at 12 months, and there is a built-in analysis of cost-effectiveness. Secondary outcomes include early pain, the alignment of the components, and medium- to long-term outcomes. This annotation outlines the need to assess these technologies and discusses the design and challenges when conducting such trials, including surgical workflows, isolating the effect of the operation, blinding, and assessing the learning curve. Finally, the future of robotic surgery is discussed, including the need to contemporaneously introduce and evaluate such technologies.
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Affiliation(s)
- Chetan Khatri
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Warwick Orthopaedics Specialist Training Programme, University Hospitals Coventry & Warwickshire, Coventry, UK
| | - Andrew Metcalfe
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Warwick Orthopaedics Specialist Training Programme, University Hospitals Coventry & Warwickshire, Coventry, UK
| | - Peter Wall
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Martin Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Warwick Orthopaedics Specialist Training Programme, University Hospitals Coventry & Warwickshire, Coventry, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospitals, London, UK
- The Bone & Joint Journal , London, UK
| | - Edward T Davis
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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16
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Buchan GBJ, Hecht CJ, Rodriguez-Elizalde S, Kabata T, Kamath AF. Automated digital templating of component sizing is accurate in robotic total hip arthroplasty when compared to predicate software. Med Eng Phys 2024; 124:104105. [PMID: 38418018 DOI: 10.1016/j.medengphy.2024.104105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/17/2023] [Accepted: 01/09/2024] [Indexed: 03/01/2024]
Abstract
Accurate pre-operative templating of prosthesis components is an essential factor in successful total hip arthroplasty (THA), including robotically-assisted THA (RA-THA) techniques. We sought to validate the accuracy of a novel, robotic-optimized THA planning software compared to a predicate THA planner for component sizing. We analyzed a series of 199 patients who received manual THA (mTHA) and fluoroscopy-based RA-THA at a single institution. All cases were templated using a predicate pre-operative templating software. For RA-THA cases, the novel robotic-optimized pre-operative planner software was also used for templating. The differences between templated and implanted acetabular cup, femoral head, and stem component sizes were compared based on matching within 1, 2, and ≥3 sizes. Differences in templated and implanted femoral stem implant geometry were also compared. The robot-optimized pre-operative RA-THA plans demonstrated equivalent accuracy to that of predicate pre-operative plans for both RA-THA and mTHA cases. Templated acetabular cups (90.4 vs. 86.8 vs. 82.8; p = 0.421), femoral stems (76.0 vs. 65.1 vs. 67.7; p = 0.096), and femoral heads (91.3 vs. 96.2 vs. 88.2; p = 0.302) were within +/-1 size of implanted components. No significant differences were detected in the proportion of matching templated and implanted stem geometry across the study cohorts.
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Affiliation(s)
- Graham B J Buchan
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Christian J Hecht
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | | | - Tamon Kabata
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Japan
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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17
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Anantha-Krishnan A, Myers CA, Fitzpatrick CK, Clary CW. Instantaneous Generation of Subject-Specific Finite Element Models of the Hip Capsule. Bioengineering (Basel) 2023; 11:37. [PMID: 38247914 PMCID: PMC10813259 DOI: 10.3390/bioengineering11010037] [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: 12/07/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
Subject-specific hip capsule models could offer insights into impingement and dislocation risk when coupled with computer-aided surgery, but model calibration is time-consuming using traditional techniques. This study developed a framework for instantaneously generating subject-specific finite element (FE) capsule representations from regression models trained with a probabilistic approach. A validated FE model of the implanted hip capsule was evaluated probabilistically to generate a training dataset relating capsule geometry and material properties to hip laxity. Multivariate regression models were trained using 90% of trials to predict capsule properties based on hip laxity and attachment site information. The regression models were validated using the remaining 10% of the training set by comparing differences in hip laxity between the original trials and the regression-derived capsules. Root mean square errors (RMSEs) in laxity predictions ranged from 1.8° to 2.3°, depending on the type of laxity used in the training set. The RMSE, when predicting the laxity measured from five cadaveric specimens with total hip arthroplasty, was 4.5°. Model generation time was reduced from days to milliseconds. The results demonstrated the potential of regression-based training to instantaneously generate subject-specific FE models and have implications for integrating subject-specific capsule models into surgical planning software.
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Affiliation(s)
- Ahilan Anantha-Krishnan
- Center of Orthopaedic Biomechanics, University of Denver, Denver, CO 80208, USA; (A.A.-K.); (C.A.M.)
| | - Casey A. Myers
- Center of Orthopaedic Biomechanics, University of Denver, Denver, CO 80208, USA; (A.A.-K.); (C.A.M.)
| | - Clare K. Fitzpatrick
- Mechanical and Biomedical Engineering, Boise State University, Boise, ID 83725, USA;
| | - Chadd W. Clary
- Center of Orthopaedic Biomechanics, University of Denver, Denver, CO 80208, USA; (A.A.-K.); (C.A.M.)
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18
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Wasim AS, Tahir M, Ridha A, Sinha A, Hussain S. A Standardised Protocol for Pre-operative Pelvic Radiographs for Templating in Total Hip Arthroplasty. Cureus 2023; 15:e50687. [PMID: 38229784 PMCID: PMC10791152 DOI: 10.7759/cureus.50687] [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: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
PURPOSE Digital templating using pre-operative radiographs enables pre-operative planning for total hip arthroplasty (THA). This allows surgeons to reproduce hip biomechanics effectively, reducing the risk of post-operative complications. Pelvic radiographs demonstrating the head, neck, trochanters, and proximal one-third of the femoral shaft allow calculation of key measurements including femoral offset and limb length discrepancy (LLD). Currently, no standardised guideline exists for obtaining pre-operative radiographs for templating in THA. Materials and methods: A single-blinded retrospective cohort study assessing the quality of pre- and post-operative radiographs of 195 patients who underwent elective THA for osteoarthritis over a two-year period was performed. Quality was rated as good, fair or poor, respectively, depending upon whether ≥2, 1 or none of the following were met: Pubic symphysis (PS) and coccyx in a straight line with 1-3 cm between the superior edge of the PS and tip of coccyx, trochanters distinguishable, obturator rings symmetric. Post-operative images were assessed to determine whether the distal end of the implanted prosthesis was visible. Results: The sample consisted of 195 patients. Pre-operatively 115 (59%) radiographs were classified as good, 71 (36.4%) fair and 9 (4.6%) poor. Post-operatively 46 (23.6%) were classified as good, 114 (58.4%) as fair and 30 (15.4%) as poor. In the post-operative radiographs, 25.6% did not include the distal tip of the prosthesis. Conclusion: This study highlights significant scope to improve the quality of pre-operative radiographs, allowing accurate templating to optimise outcomes for THA. A protocol is recommended whereby the pelvic radiograph is centred on the PS at the lesser trochanter level, ensuring adequate exposure of the proximal femur, acetabulum and iliac crests.
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Affiliation(s)
- Abdus S Wasim
- Orthopaedics and Trauma, Sandwell and West Birmingham NHS Trust, Birmingham, GBR
| | - Muaaz Tahir
- Trauma and Orthopaedics, Royal Orthopaedic Hospital, Birmingham, GBR
| | - Ali Ridha
- Orthopaedics and Trauma, Sandwell and West Birmingham NHS Trust, Birmingham, GBR
| | - Amil Sinha
- Orthopaedics and Trauma, Sandwell and West Birmingham NHS Trust, Birmingham, GBR
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19
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Aubert T, Galanzino G, Gerard P, Le Strat V, Rigoulot G, Lhotellier L. Accuracy of Preoperative 3D vs 2D Digital Templating for Cementless Total Hip Arthroplasty Using a Direct Anterior Approach. Arthroplast Today 2023; 24:101260. [PMID: 38023640 PMCID: PMC10652126 DOI: 10.1016/j.artd.2023.101260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/26/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background An important aspect of preoperative planning for total hip arthroplasty is templating. Although two-dimensional (2D) templating remains the gold standard, computerized tomography (CT)-based three-dimensional (3D) templating is a novel preoperative planning technique. This study aims to compare the accuracy of a 2D and 3D plan using an anterior approach for the placement of the same uncemented prosthesis. Methods Two consecutive cohorts of 100 patients each were retrospectively analyzed. We analyzed the accuracy of the size of the implant (stem, cup, head), the length of head, and offset. As a secondary criterion, we analyzed the rates of stems with more than 3° of varus, fracture, and/or subsidence at 3 months postoperatively. Results Within the exact size, the accuracy of the stem and cup size with the 2D plan was 69% and 56%, respectively. With the 3D plan accuracy being 88% (P = .0046) and 96% (P < .0001), respectively. Regarding size and length of the implant head, accuracy was 86% and 82% with the 2D plan and 100% (P < .0001) and 94% (P = .016), respectively, with the 3D plan. The offset of the implants increased beyond 3 mm in 23% of patients in the 2D group and in 5% of patients in the 3D group (P = .0003). The rate of varus stems was 10% in the 2D group and 2% in the 3D group (P = .03). Two fractures and one case of subsidence occurred in the 2D group. None were identified in the 3D cohort. Conclusions A CT-based 3D plan is more accurate for implant size selection, allows better prosthetic offset, and reduces the rate of varus stems.
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Affiliation(s)
- Thomas Aubert
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Giacomo Galanzino
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Philippe Gerard
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Vincent Le Strat
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Guillaume Rigoulot
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Luc Lhotellier
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
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20
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Panez-Toro I, Heymann D, Gouin F, Amiaud J, Heymann MF, Córdova LA. Roles of inflammatory cell infiltrate in periprosthetic osteolysis. Front Immunol 2023; 14:1310262. [PMID: 38106424 PMCID: PMC10722268 DOI: 10.3389/fimmu.2023.1310262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/13/2023] [Indexed: 12/19/2023] Open
Abstract
Classically, particle-induced periprosthetic osteolysis at the implant-bone interface has explained the aseptic loosening of joint replacement. This response is preceded by triggering both the innate and acquired immune response with subsequent activation of osteoclasts, the bone-resorbing cells. Although particle-induced periprosthetic osteolysis has been considered a foreign body chronic inflammation mediated by myelomonocytic-derived cells, current reports describe wide heterogeneous inflammatory cells infiltrating the periprosthetic tissues. This review aims to discuss the role of those non-myelomonocytic cells in periprosthetic tissues exposed to wear particles by showing original data. Specifically, we discuss the role of T cells (CD3+, CD4+, and CD8+) and B cells (CD20+) coexisting with CD68+/TRAP- multinucleated giant cells associated with both polyethylene and metallic particles infiltrating retrieved periprosthetic membranes. This review contributes valuable insight to support the complex cell and molecular mechanisms behind the aseptic loosening theories of orthopedic implants.
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Affiliation(s)
- Isidora Panez-Toro
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Chile, Independencia, Santiago, Chile
- Nantes Université, Centre National de Recherche Scientifique (CNRS), UMR6286, US2B, Nantes, France
- Institut de Cancérologie de l’Ouest, Tumor Heterogeneity and Precision Medicine Laboratory, Saint-Herblain, France
| | - Dominique Heymann
- Nantes Université, Centre National de Recherche Scientifique (CNRS), UMR6286, US2B, Nantes, France
- Institut de Cancérologie de l’Ouest, Tumor Heterogeneity and Precision Medicine Laboratory, Saint-Herblain, France
- Nantes Université, Laboratory of Histology and Embryology, Medical School, Nantes, France
- The University of Sheffield, Dept of Oncology and Metabolism, Sheffield, United Kingdom
| | - François Gouin
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Jérôme Amiaud
- Nantes Université, Laboratory of Histology and Embryology, Medical School, Nantes, France
| | - Marie-Françoise Heymann
- Nantes Université, Centre National de Recherche Scientifique (CNRS), UMR6286, US2B, Nantes, France
- Institut de Cancérologie de l’Ouest, Tumor Heterogeneity and Precision Medicine Laboratory, Saint-Herblain, France
| | - Luis A. Córdova
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Chile, Independencia, Santiago, Chile
- IMPACT, Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Santiago, Chile
- Oral and Maxillofacial Surgery, Clínica MEDS, Santiago, Chile
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21
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Zhai H, Huang J, Li L, Tao H, Wang J, Li K, Shao M, Cheng X, Wang J, Wu X, Wu C, Zhang X, Wang H, Xiong Y. Deep learning-based workflow for hip joint morphometric parameter measurement from CT images. Phys Med Biol 2023; 68:225003. [PMID: 37852280 DOI: 10.1088/1361-6560/ad04aa] [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: 05/07/2023] [Accepted: 10/18/2023] [Indexed: 10/20/2023]
Abstract
Objective.Precise hip joint morphometry measurement from CT images is crucial for successful preoperative arthroplasty planning and biomechanical simulations. Although deep learning approaches have been applied to clinical bone surgery planning, there is still a lack of relevant research on quantifying hip joint morphometric parameters from CT images.Approach.This paper proposes a deep learning workflow for CT-based hip morphometry measurement. For the first step, a coarse-to-fine deep learning model is designed for accurate reconstruction of the hip geometry (3D bone models and key landmark points). Based on the geometric models, a robust measurement method is developed to calculate a full set of morphometric parameters, including the acetabular anteversion and inclination, the femoral neck shaft angle and the inclination, etc. Our methods were validated on two datasets with different imaging protocol parameters and further compared with the conventional 2D x-ray-based measurement method.Main results. The proposed method yields high bone segmentation accuracies (Dice coefficients of 98.18% and 97.85%, respectively) and low landmark prediction errors (1.55 mm and 1.65 mm) on both datasets. The automated measurements agree well with the radiologists' manual measurements (Pearson correlation coefficients between 0.47 and 0.99 and intraclass correlation coefficients between 0.46 and 0.98). This method provides more accurate measurements than the conventional 2D x-ray-based measurement method, reducing the error of acetabular cup size from over 2 mm to less than 1 mm. Moreover, our morphometry measurement method is robust against the error of the previous bone segmentation step. As we tested different deep learning methods for the prerequisite bone segmentation, our method produced consistent final measurement results, with only a 0.37 mm maximum inter-method difference in the cup size.Significance. This study proposes a deep learning approach with improved robustness and accuracy for pelvis arthroplasty planning.
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Affiliation(s)
- Haoyu Zhai
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian 116024, People's Republic of China
| | - Jin Huang
- Department of Orthopaedics, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Lei Li
- Department of Vascular Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116024, People's Republic of China
| | - Hairong Tao
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, People's Republic of China
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai 200011, People's Republic of China
- Shanghai Jiao Tong University Shcool of Medicine, Shanghai 200011, People's Republic of China
| | - Jinwu Wang
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai 200011, People's Republic of China
- Shanghai Jiaotong University School of Medicine Department of Orthopaedics & Bone and Joint Research Center, Shanghai 200011, People's Republic of China
| | - Kang Li
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Moyu Shao
- Jiangsu Yunqianbai Digital Technology Co., LTD, Xuzhou 221000, People's Republic of China
| | - Xiaomin Cheng
- Jiangsu Yunqianbai Digital Technology Co., LTD, Xuzhou 221000, People's Republic of China
| | - Jing Wang
- Xi'an JiaoTong University. School of Chemical Engineering and Technology, Xi'an 710049, People's Republic of China
| | - Xiang Wu
- School of Medical Information & Engineering, Xuzhou Medical University, Xuzhou 221000, People's Republic of China
| | - Chuan Wu
- School of Medical Information & Engineering, Xuzhou Medical University, Xuzhou 221000, People's Republic of China
| | - Xiao Zhang
- School of Medical Information & Engineering, Xuzhou Medical University, Xuzhou 221000, People's Republic of China
| | - Hongkai Wang
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian 116024, People's Republic of China
- Liaoning Key Laboratory of Integrated Circuit and Biomedical Electronic System, Dalian 116024, People's Republic of China
| | - Yan Xiong
- Department of Orthopaedics, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
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22
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Ben-Ari E, Shichman I, Sissman E, Oakley C, Hepinstall M, Schwarzkopf R. Calibration of magnification in two-dimensional low-dose full-body imaging for preoperative planning of total hip arthroplasty. Arch Orthop Trauma Surg 2023; 143:6875-6881. [PMID: 37340223 DOI: 10.1007/s00402-023-04926-7] [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: 01/11/2023] [Accepted: 05/21/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION Preoperative planning of total hip arthroplasty (THA) using two-dimensional low-dose (2DLD) full-body imaging has gained popularity in recent years. The low-dose imaging system is said to produce a calibrated image with constant 1:1 magnification. However, the planning software used in conjunction with those images may introduce variations in the degree of magnification in 2DLD imaging, and this has not yet been investigated. The purpose of the present study was to quantify any variation in 2DLD image to assess the need for image calibration when using conventional planning software. METHODS Postoperative 2DLD images from 137 patients were retrospectively evaluated. Only patients who underwent THA for primary osteoarthritis were included in the study cohort. The femoral head diameter was measured by two independent observers using both Orthoview™ and TraumaCad™ planning software programs. Actual sizes of the femoral head implants were extracted from surgical reports to calculate image magnification. Magnification measurement reliability was calculated with the intra-class correlation coefficient (ICC) index. RESULTS Image magnification varied among cases (mean 133%, range 129-135%). There was no statistical difference in mean image magnification among the various implant sizes (p = 0.8). Mean observer and inter-observer reliability was rated excellent. CONCLUSION THA planning with 2DLD imaging is subject to variation in magnification as analyzed with conventional planning software in this series. This finding is of paramount importance for surgeons using 2DLD imaging in preparation for THA since errors in magnification could affect the accuracy of preoperative planning and ultimately the clinical outcome.
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Affiliation(s)
- Erel Ben-Ari
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA.
- Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel.
| | - Ittai Shichman
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA
- Department of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ethan Sissman
- Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel
| | - Christian Oakley
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA
| | - Matthew Hepinstall
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstructive Surgery, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA
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Ramesh A, Di Laura A, Henckel J, Hart A. The variability of CT scan protocols for total hip arthroplasty: a call for harmonisation. EFORT Open Rev 2023; 8:809-817. [PMID: 37909704 PMCID: PMC10646515 DOI: 10.1530/eor-22-0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
CT is the principal imaging modality used for the pre-operative 3D planning and assessment of total hip arthroplasty (THA). The image quality offered by CT has a radiation penalty to the patient. Higher than necessary radiation exposure is of particular concern when imaging young patients and women of childbearing age, due to the greater risk of radiation-induced cancer in this group. A harmonised low-dose CT protocol is needed, evidenced by the huge variability in the 17 protocols reviewed. The majority of the protocols were incomplete, leading to uncertainty among radiographers when performing the scans. Only three protocols (20%) were optimised for both 'field of view' and image acquisition parameters. 10 protocols (60%) were optimised for 'field of view' only. These protocols included imaging of the relevant landmarks in the bony pelvis in addition to the knees - the reference for femoral anteversion. CT parameters, including the scanner kilovoltage (kV), milliamperage-time product (mAs) and slice thickness, must be optimised with a 'field of view' that includes the relevant bony landmarks. The recommended kV and mAs values were very wide ranging from 100 to 150 and from 100 to 250, respectively. The large variability that exists amongst the CT protocols illustrates the need for a more consistent low-dose CT protocol for the planning of THA. This must provide an optimal balance between image quality and radiation dose to the patient. Current CT scanners do not allow for measurements of functional pelvic orientation and additional upright imaging modalities are needed to augment them.
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Affiliation(s)
- Angelika Ramesh
- Department of Mechanical Engineering, University College London, United Kingdom
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
| | - Anna Di Laura
- Department of Mechanical Engineering, University College London, United Kingdom
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
| | - Johann Henckel
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
| | - Alister Hart
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
- Institute of Orthopaedics and Musculoskeletal Science, University College London, United Kingdom
- Cleveland Clinic London, United Kingdom
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24
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Perez-Abdala JI, Huespe I, Vildoza S, Novillo M, Llano L, Carabelli G, Taype D, Sancineto C, Barla J. The internal rotation traction radiograph does not improve the reliability in the AO classification system for pertrochanteric fractures. An inter- and intra-observer reliability assessment. Injury 2023; 54 Suppl 6:110779. [PMID: 38143126 DOI: 10.1016/j.injury.2023.05.010] [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: 02/27/2023] [Revised: 04/24/2023] [Accepted: 05/01/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION The most universal method for classifying pertrochanteric fractures is the AO/OTA classification. These fractures are classified into different categories according to the features found in the anteroposterior radiograph of the hip. Anteroposterior radiograph of the hip with internal rotation traction can improve the characterization of the fracture. Inter- and intra-observer reliability in any classification is essential to achieve a homogeneous agreement for decision making. Our objective is assessing the overall reliability and by level of experience of the new AO/OTA classification of pertrochanteric fractures. MATERIALS AND METHODS A hospital registry was used to collect patients with pertrochanteric hip fracture who had anteroposterior radiograph of the hip with and without internal rotation traction. We selected six evaluators stratified by levels of expertise in orthopedic trauma, leaving three groups: advanced, intermediate and beginner. Radiographs were sent through electronic forms and inter- and intra-observer reliability was calculated using the kappa (K) statistic. RESULTS 115 (one hundred fifteen) patients were included, each with their corresponding anteroposterior radiograph of the hip with and without internal rotation traction. Overall inter- and intra-observer reliability was moderate on both anteroposterior radiographs of the hip with and without internal rotation traction. Regarding the different levels of experience, the advanced level group reached a substantial inter- and intra-observer reliability in both anteroposterior radiographs with and without traction, while the rest of the groups with lower level of experience obtained a lesser reliability. CONCLUSION Our study found that the internal rotation traction x-ray did not improve the reliability of the new AO/OTA classification for pertrochanteric fractures, as assessed by inter- and intra-observer agreement, in either the overall group or in groups divided by experience level.
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Affiliation(s)
- Juan Ignacio Perez-Abdala
- Department of Orthopedic Surgery "Prof. Dr. Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, CABA, Argentina.
| | - Ivan Huespe
- Department of Orthopedic Surgery "Prof. Dr. Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, CABA, Argentina
| | - Santiago Vildoza
- Department of Orthopedic Surgery "Prof. Dr. Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, CABA, Argentina
| | - Matías Novillo
- Department of Orthopedic Surgery "Prof. Dr. Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, CABA, Argentina
| | - Lionel Llano
- Department of Orthopedic Surgery "Prof. Dr. Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, CABA, Argentina
| | - Guido Carabelli
- Department of Orthopedic Surgery "Prof. Dr. Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, CABA, Argentina
| | - Danilo Taype
- Department of Orthopedic Surgery "Prof. Dr. Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, CABA, Argentina
| | - Carlos Sancineto
- Department of Orthopedic Surgery "Prof. Dr. Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, CABA, Argentina
| | - Jorge Barla
- Department of Orthopedic Surgery "Prof. Dr. Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, CABA, Argentina
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25
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Mulford KL, Johnson QJ, Mujahed T, Khosravi B, Rouzrokh P, Mickley JP, Taunton MJ, Wyles CC. A Deep Learning Tool for Automated Landmark Annotation on Hip and Pelvis Radiographs. J Arthroplasty 2023; 38:2024-2031.e1. [PMID: 37236288 DOI: 10.1016/j.arth.2023.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Automatic methods for labeling and segmenting pelvis structures can improve the efficiency of clinical and research workflows and reduce the variability introduced with manual labeling. The purpose of this study was to develop a single deep learning model to annotate certain anatomical structures and landmarks on antero-posterior (AP) pelvis radiographs. METHODS A total of 1,100 AP pelvis radiographs were manually annotated by 3 reviewers. These images included a mix of preoperative and postoperative images as well as a mix of AP pelvis and hip images. A convolutional neural network was trained to segment 22 different structures (7 points, 6 lines, and 9 shapes). Dice score, which measures overlap between model output and ground truth, was calculated for the shapes and lines structures. Euclidean distance error was calculated for point structures. RESULTS Dice score averaged across all images in the test set was 0.88 and 0.80 for the shape and line structures, respectively. For the 7-point structures, average distance between real and automated annotations ranged from 1.9 mm to 5.6 mm, with all averages falling below 3.1 mm except for the structure labeling the center of the sacrococcygeal junction, where performance was low for both human and machine-produced labels. Blinded qualitative evaluation of human and machine produced segmentations did not reveal any drastic decrease in performance of the automatic method. CONCLUSION We present a deep learning model for automated annotation of pelvis radiographs that flexibly handles a variety of views, contrasts, and operative statuses for 22 structures and landmarks.
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Affiliation(s)
- Kellen L Mulford
- Department of Orthopedic Surgery, Orthopedic Surgery Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Quinn J Johnson
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Tala Mujahed
- Mayo Clinic Alix School of Medicine, Scottsdale, Arizona
| | - Bardia Khosravi
- Department of Orthopedic Surgery, Orthopedic Surgery Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota; Mayo Clinic Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Pouria Rouzrokh
- Department of Orthopedic Surgery, Orthopedic Surgery Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota; Mayo Clinic Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota
| | - John P Mickley
- Department of Orthopedic Surgery, Orthopedic Surgery Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Michael J Taunton
- Department of Orthopedic Surgery, Orthopedic Surgery Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota; Mayo Clinic Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cody C Wyles
- Department of Orthopedic Surgery, Orthopedic Surgery Artificial Intelligence Laboratory, Mayo Clinic, Rochester, Minnesota; Mayo Clinic Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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26
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Alagha MA, Logishetty K, O’Hanlon C, Liddle AD, Cobb J. Three-Dimensional Preoperative Planning Software for Hip Resurfacing Arthroplasty. Bioengineering (Basel) 2023; 10:939. [PMID: 37627824 PMCID: PMC10451941 DOI: 10.3390/bioengineering10080939] [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: 05/29/2023] [Revised: 07/10/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023] Open
Abstract
Three-dimensional planning of hip arthroplasty is associated with better visualisation of anatomical landmarks and enhanced mapping for preoperative implant sizing, which can lead to a decrease in surgical time and complications. Despite the advantages of hip resurfacing arthroplasty (HRA), it is considered a technically challenging procedure and associated with inaccurate implant placement. This study aimed to examine the validity, reliability, and usability of preoperative 3D Hip Planner software for HRA. Fifty random cases of various hip osteoarthritis severity were planned twice by two junior trainees using the 3D Hip Planner within a one-month interval. Outcome measures included femoral/cup implant size, stem-shaft angle, and cup inclination angle, and were assessed by comparing outcomes from 2D and 3D planning. An adapted unified theory of acceptance and use of technology (UTAUT) survey was used for software usability. Bland-Altman plots between 3D and 2D planning for stem-shaft and inclination angles showed mean differences of 0.7 and -0.6, respectively (r = 0.93, p < 0.001). Stem-shaft and inclination angles showed inter-rater reliability biases of around -2° and 3°, respectively. Chi-square and Pearson's correlation for femoral implant size showed a significant association between the two assessors (r = 0.91, p < 0.001). The 3D test-retest coefficient of repeatability for stem-shaft and inclination angles were around ±2° and ±3°, respectively, with a strong significant association for femoral implant size (r = 0.98, p < 0.001). Survey analyses showed that 70-90% agreed that 3D planning improved expectancy in four domains. 3D hip planner appears to be valid and reliable in preoperative HRA and shows significant potential in optimising the quality and accuracy of surgical planning.
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Affiliation(s)
- M. Abdulhadi Alagha
- MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London W12 0BZ, UK
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27
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Gautreaux M, Kautz S, Martin Z, Morgan E, Barton RS, Dubose M, McBride H, Solitro GF. Acetabular Wall Weakening in Total Hip Arthroplasty: A Pilot Study. PATHOPHYSIOLOGY 2023; 30:83-91. [PMID: 37092522 PMCID: PMC10123709 DOI: 10.3390/pathophysiology30020008] [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: 11/30/2022] [Revised: 02/08/2023] [Accepted: 03/08/2023] [Indexed: 04/25/2023] Open
Abstract
Total hip arthroplasty is a widely performed operation allowing disabled patients to improve their quality of life to a degree greater than any other elective procedure. Planning for a THA requires adequate patient assessment and preoperative characterizations of acetabular bone loss via radiographs and specific classification schemes. Some surgeons may be inclined to ream at a larger diameter thinking it would lead to a more stable press-fit, but this could be detrimental to the acetabular wall, leading to intraoperative fracture. In the attempt to reduce the incidence of intraoperative fractures, the current study aims to identify how increased reaming diameter degrades and weakens the acetabular rim strength. We hypothesized that there is proportionality between the reaming diameter and the reduction in acetabular strength. To test this hypothesis, this study used bone surrogates, templated from CT scans, and reamed at different diameters. The obtained bone surrogate models were then tested using an Intron 8874 mechanical testing machine (Instron, Norwood, MA) equipped with a custom-made fixture. Analysis of variance (ANOVA) was used to identify differences among reamed diameters while linear regression was used to identify the relationship between reamed diameters and acetabular strength. We found a moderate correlation between increasing reaming diameter that induced thinning of the acetabular wall and radial load damage. For the simplified acetabular model used in this study, it supported our hypothesis and is a promising first attempt in providing quantitative data for acetabular weakening induced by reaming.
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Affiliation(s)
- Madeline Gautreaux
- Department of Orthopedic Surgery, LSU Health Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - Steven Kautz
- Department of Orthopedic Surgery, LSU Health Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - Zashiana Martin
- Department of Orthopedic Surgery, LSU Health Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - Edward Morgan
- Department of Orthopedic Surgery, LSU Health Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - R Shane Barton
- Department of Orthopedic Surgery, LSU Health Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - Matthew Dubose
- Department of Orthopedic Surgery, LSU Health Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - Hayden McBride
- Department of Orthopedic Surgery, LSU Health Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA
| | - Giovanni F Solitro
- Department of Orthopedic Surgery, LSU Health Shreveport, 1501 Kings Hwy, Shreveport, LA 71103, USA
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28
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Luca DiGiovanni P, Gasparutto X, Armand S, Hannouche D. The modern state of femoral, acetabular, and global offsets in total hip arthroplasty: a narrative review. EFORT Open Rev 2023; 8:117-126. [PMID: 36916758 PMCID: PMC10026057 DOI: 10.1530/eor-22-0039] [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: 03/16/2023] Open
Abstract
Offsets in the frontal plane are important for hip function. Research on total hip arthroplasty (THA) surgery agrees that increasing femoral offset up to 5 mm could improve functional outcome measures. The literature indicates that global offset is a key parameter that physicians should restore within 5 mm during surgery and avoid decreasing. Substantiated findings on acetabular offset are lacking despite its recognized importance, and the medialization approach must be assessed in light of its shortcomings. Future research, possibly through improved measurement, unified definitions, patient-specific surgical planning, and technology-enhanced surgical control, with specific focus on acetabular offset, is needed to better understand its impact on THA outcomes.
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Affiliation(s)
- Peter Luca DiGiovanni
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Division of Orthopaedic Surgery and Musculoskeletal Trauma Care, Surgery Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Xavier Gasparutto
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Division of Orthopaedic Surgery and Musculoskeletal Trauma Care, Surgery Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Division of Orthopaedic Surgery and Musculoskeletal Trauma Care, Surgery Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Didier Hannouche
- Division of Orthopaedic Surgery and Musculoskeletal Trauma Care, Surgery Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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29
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Fischer MCM, Tokunaga K, Okamoto M, Habor J, Radermacher K. Implications of the uncertainty of postoperative functional parameters for the preoperative planning of total hip arthroplasty. J Orthop Res 2022; 40:2656-2662. [PMID: 35266575 DOI: 10.1002/jor.25291] [Citation(s) in RCA: 2] [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: 06/28/2021] [Revised: 12/23/2021] [Accepted: 01/30/2022] [Indexed: 02/04/2023]
Abstract
The functional parameters pelvic tilt (PT) and hip joint force (HJF) are required to calculate patient-specific target zones based on the range of motion (ROM) and implant loading for preoperative planning of total hip arthroplasty (THA). Both functional parameters may change after THA. The preoperative prediction of the postoperative PT and HJF is associated with a specific amount of uncertainty. The prediction uncertainty has to be considered in the preoperative planning process to avoid a suboptimal implantation. So far, very little attention has been paid to the necessary reduction of patient-specific target zones by the prediction uncertainties of postoperative functional parameters. Prediction models for the postoperative PT in standing position and for the HJF during one-leg stance as a surrogate for the peak force phase during level walking were used to quantify the reduction of the ROM- and load-based target zones of 196 Japanese THA patients. The prediction uncertainty was about 14° for the postoperative standing PT and ranged from 17% body weight to 37% body weight for the components of the HJF. On average, the prosthetic ROM-based target zone had to be significantly reduced by 43% and the load-based target zone by 39%. This led to a median reduction of the combined prosthetic ROM- and load-based target zone of 96%. The study sharpens the awareness for the substantial reduction of ROM- and load-based target zones by prediction uncertainties of the postoperative PT and HJF and highlights the importance of further research to improve prediction models for both functional parameters.
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Affiliation(s)
- Maximilian C M Fischer
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Kunihiko Tokunaga
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City, Japan
| | - Masashi Okamoto
- Department of Radiology, Kameda Daiichi Hospital, Niigata City, Japan
| | - Juliana Habor
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Klaus Radermacher
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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30
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Chen X, Wang Y, Ma R, Peng H, Zhu S, Li S, Li S, Dong X, Qiu G, Qian W. Validation of CT-Based Three-Dimensional Preoperative Planning in Comparison with Acetate Templating for Primary Total Hip Arthroplasty. Orthop Surg 2022; 14:1152-1160. [PMID: 35524643 PMCID: PMC9163964 DOI: 10.1111/os.13298] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/07/2022] [Accepted: 04/09/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study aims to compare the accuracy of CT-based preoperative planning with that of acetate templating in predicting implant size, neck length, and neck cut length, and to evaluate the reproducibility of the two methods. METHODS This prospective study was conducted between August 2020 and March 2021. Patients who underwent elective primary total hip arthroplasty by a single surgeon were assessed for eligibility. The included patients underwent both acetate templating and CT-based planning by two observers after the operation. Each observer conducted both acetate templating and CT-based planning twice for each case. The outcome measures included the following: (1) the accuracy of surgical planning in predicting implant size, calcar length, and neck length, which was defined as the difference between the planned size and length and the actual size and length; (2) reproducibility of the two planning techniques, which were assessed by inter-observer and intra-observer reliability analysis; (3) the influence of potential confounding factors on planning accuracy, which was evaluated using generalized estimating equations. RESULTS A total of 57 cases were included in the study. CT-based planning was more accurate than acetate templating for predicting cup size (93% vs 79%, p < 0.001) and stem size (93% vs 75%, p < 0.001). When assessed by mean absolute difference, the comparison between acetate templating and CT-based planning was 4.28 mm vs 3.74 mm (p = 0.122) in predicting neck length and 3.05 mm vs 2.93 mm (p = 0.731) in predicting neck cut length. In the inter-observer reliability analysis, an intraclass correlation coefficient (ICC) of 0.790 was achieved for predicting cup size, and an ICC of 0.966 was achieved for predicting stem size using CT-based planning. In terms of intra-observer reliability, Observer 1 achieved an ICC of 0.803 for predicting cup size and 0.965 for predicting stem size in CT-based planning. Observer 2 achieved ICC values of 0.727 and 0.959 for predicting cup and stem sizes, respectively. The average planning time was 6.48 ± 1.55 min for CT-based planning and 6.12 ± 1.40 min for acetate templating (p = 0.015). CONCLUSION The CT-based planning system is more accurate than acetate templating for predicting implant size and has good reproducibility in total hip arthroplasty.
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Affiliation(s)
- Xi Chen
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical ScienceBeijingChina
| | - Yiou Wang
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical ScienceBeijingChina
| | - Ruichen Ma
- School of MedicineTsinghua UniversityBeijingChina
| | - Huiming Peng
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical ScienceBeijingChina
| | - Shibai Zhu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical ScienceBeijingChina
| | - Shanni Li
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical ScienceBeijingChina
| | - Songlin Li
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical ScienceBeijingChina
| | - Xiying Dong
- School of MedicineTsinghua UniversityBeijingChina
| | - Guixing Qiu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical ScienceBeijingChina
| | - Wenwei Qian
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical CollegeChinese Academy of Medical ScienceBeijingChina
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Mirghaderi SP, Sharifpour S, Moharrami A, Ahmadi N, Makuku R, Salimi M, Mortazavi SMJ. Determining the accuracy of preoperative total hip replacement 2D templating using the mediCAD® software. J Orthop Surg Res 2022; 17:222. [PMID: 35399090 PMCID: PMC8996579 DOI: 10.1186/s13018-022-03086-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/21/2022] [Indexed: 02/06/2023] Open
Abstract
Background Templating is a preoperative planning procedure that improves the efficiency of the surgical process and reduces postoperative complications of total hip arthroplasty (THA) by improving the precision of prediction of prosthetic implant size. This study aimed to evaluate the accuracy of the preoperative cup and stem size digital 2D templating of THA with mediCAD® software and find the factors that influence the accuracy, such as indication for surgery, patients’ demographics, implant brand, and the assessors’ grade of education.
Methods We retrospectively retrieved 420 patient template images of all patients who underwent THA between March 2018 and March 2021. Templating of all included images was processed using mediCAD® software a day before surgery by a newcomer physician to hip arthroplasty course (PGY-2 orthopedic resident or hip surgery fellow). Preoperative templating cup and stem sizes were compared with the actual inserted implant sizes. Result After excluding ineligible patients, this study included 391 patients, 193 (49.4%) males and 198 (50.6%) females with a mean age of 43.3 ± 14.9. The average cup sizes predicted before and after surgery were 52.12 ± 14.28 and 52.21 ± 15.05 respectively, and the mean delta cup size (before and after surgery) was 2.79 ± 2.94. The delta stem size before and after surgery has a mean value of 1.53 ± 1.49. The acetabular cup components, measured within ± 0, ± 1, and ± 2 sizes, were 28.9%, 63.9%, 83.1% accurate, respectively. The femoral stem design component measured within ± 0, ± 1, and ± 2 sizes were 27.2%, 61.0%, 78.6% accurate, respectively. Wagner Cone® stem brand, DDH patients, and females showed significantly higher accuracy of stem size templating. Revision THA has the lowest accuracy in terms of cup size templating. The compression of accuracy rate between resident and fellow revealed no significant differences. Also, no significant difference was detected between the accuracy of templating performed in the first months with the second months of the arthroplasty course period. Conclusion Our study showed that under mentioned condition, templating using mediCAD® has acceptable accuracy in predicting the sizes of femoral and acetabular components in THA patients. Digital software like mediCAD® remains favorable because of the short learning curve, user-friendly features, and low-cost maintenance, leading to level-up patient care and THA efficacy. Further studies are necessary for clarifying the role of the assessor’s experience and expertise in THA preoperative templating. Level of evidence Level III (retrospective observational study).
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Reinbacher P, Smolle MA, Friesenbichler J, Draschl A, Leithner A, Maurer-Ertl W. Pre-operative templating in THA using a short stem system: precision and accuracy of 2D versus 3D planning method. J Orthop Traumatol 2022; 23:16. [PMID: 35318558 PMCID: PMC8941012 DOI: 10.1186/s10195-022-00634-x] [Citation(s) in RCA: 1] [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: 05/16/2021] [Accepted: 02/26/2022] [Indexed: 12/19/2022] Open
Abstract
Background Total hip arthroplasty (THA) is the most successful orthopaedic surgery of the past century. The current study aimed to compare the accuracy of digital planning using 2D versus 3D templating. Materials and methods Ninety-five THAs in 90 patients were included in the current study. Pre- and post-operative X-rays (in two planes) and low-dose rotation computed tomography scans from hip to foot were performed. Paired t-test and regression analyses were conducted to compare 2D and 3D templating accuracy of the definitive implant. Results Cup size planned both with 2D (p < 0.0001) and 3D (p = 0.012) templating was significantly different from the definitively used cup size. The difference between the 2D-planned and implanted stem size (p < 0.0001) was statistically significant. In contrast, there were no significant differences in the 3D-planned and implanted stem size (p = 0.181). Three-dimensional templating showed significantly higher accuracy than 2D templating in terms of cup size (1.1 ± 1.4 versus 1.7 ± 1.8; p = 0.007) and stem size (0.3 ± 0.6 versus 0.7 ± 0.7; p < 0.0001). With increasing body mass index (BMI), 2D templating of the stem became more inaccurate (p = 0.041). Remarkably, 3D templating remained accurate for all components (stem, p = 0.533; cup, p = 0.479) despite increasing BMI. Conclusion Despite extended planning time and increased exposure to radiation, 3D-based planning showed higher accuracy than 2D templating, especially in obese patients. On the basis of our results, we believe that 3D-based pre-operative planning in THA is justifiable and beneficial in patients with increased BMI. Level of Evidence III.
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Affiliation(s)
- Patrick Reinbacher
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Joerg Friesenbichler
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Alexander Draschl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Werner Maurer-Ertl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
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Accuracy of digital templating of uncemented total hip arthroplasty at a certified arthroplasty center: a retrospective comparative study. Arch Orthop Trauma Surg 2022; 142:2471-2480. [PMID: 33725193 PMCID: PMC9474525 DOI: 10.1007/s00402-021-03836-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/15/2021] [Indexed: 12/04/2022]
Abstract
INTRODUCTION To investigate the accuracy of preoperative digital templating for total hip arthroplasty (THA) at a certified arthroplasty center (EndoCert EPZmax). MATERIALS AND METHODS In a retrospective study design, we analysed 620 uncemented primary THAs for templating accuracy by comparing the preoperatively planned THA component size and the implanted size as documented by the surgeon. Templating was determined to be a) exact if the planned and the implanted component were the same size and b) accurate if they were exact ± one size. Moreover, we investigated factors that potentially influence templating accuracy: overweight and obesity (WHO criteria), sex, implant design, surgeon experience, preoperative diagnosis. Digital templating was done with MediCAD software. The Mann-Whitney U test and the Kruskal-Wallis test were used for statistical analysis. RESULTS Templating was exact in 52% of stems and 51% of cups and was accurate in 90% of the stems and 85% of the cups. Regarding the factors potentially influencing templating accuracy, the type of cup implant had a significant influence (p = 0.016). Moreover, greater accuracy of stem templating was achieved in female patients (p = 0.004). No such effect was determined for the other factors investigated. CONCLUSIONS We conclude that preoperative 2D templating is accurate in 90% of the stems and 85% of the cups. Greater accuracy may be achieved in female patients. In addition to gender, the type of implant used may influence planning accuracy as well. Surgeon experience, BMI and preoperative diagnosis did not influence templating accuracy. LEVEL OF EVIDENCE Level III (retrospective comparative study with prospective cohort).
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Smith JBV, Bishi H, Wang C, Asopa V, Field RE, Sochart DH. The accuracy and reliability of preoperative digital 2D templating in prosthesis size prediction in uncemented versus cemented total hip arthroplasty: a systematic review and meta-analysis. EFORT Open Rev 2021; 6:1020-1039. [PMID: 34909222 PMCID: PMC8631246 DOI: 10.1302/2058-5241.6.210048] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The purpose of this study was to compare the accuracy and the inter- and intra-observer reliability of preoperative digital 2D templating in prosthesis size prediction for the planning of cemented or uncemented THA. This study was registered in the NIHR PROSPERO database (ID: CRD42020216649) and conducted according to the PRISMA guidelines. A search of electronic databases in March 2021 found 29 papers overall. The quality of evidence was assessed using the IHE Quality Appraisal of Case Series Studies Checklist and the CASP Randomised Controlled Trials Checklist. A meta-analysis was conducted, and the accuracy was presented as proportions and the inter- and intra-observer reliability were measured using intraclass correlation coefficients (ICC). Accuracy within one prosthesis size (±1) for cemented stems was 0.89 (95% confidence interval (CI) 0.83–0.95), cemented cups 0.78 (95% CI 0.67–0.89), uncemented stems 0.74 (95% CI 0.66–0.82) and uncemented cups 0.73 (95% CI 0.67–0.79) (test of group differences: p = 0.010). Inter-observer reliability (ICC) for uncemented cups was 0.88 (95% CI 0.85–0.91), uncemented stems 0.86 (95% CI 0.81–0.91), cemented stems 0.69 (95% CI 0.54–0.84) and cemented cups 0.68 (95% CI 0.55–0.81) (test of group differences: p = 0.004). Due to lack of data, intra-observer reliability (ICC) could only be calculated for uncemented prostheses, which for the stems was 0.90 (95% CI 0.88–0.92) and for the cups was 0.87 (95% CI 0.83–0.90) (test of group differences: p = 0.124). The accuracy of preoperative digital templating is greater for cemented prostheses, but the inter-observer reliability is greater for uncemented prostheses. The intra-observer reliability showed a high level of agreement for uncemented prostheses.
Cite this article: EFORT Open Rev 2021;6:1020-1039. DOI: 10.1302/2058-5241.6.210048
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Affiliation(s)
- Joshua B V Smith
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
| | - Habeeb Bishi
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
| | - Chao Wang
- Kingston University and St George's University of London, Tooting, London, UK
| | - Vipin Asopa
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
| | - Richard E Field
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
| | - David H Sochart
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
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Tolk JJ, Eastwood DM, Hashemi-Nejad A. Leg length discrepancy in patients with Perthes' disease : a note of caution for the arthroplasty surgeon. Bone Joint J 2021; 103-B:1736-1741. [PMID: 34719271 DOI: 10.1302/0301-620x.103b11.bjj-2020-2583.r2] [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: 11/05/2022]
Abstract
AIMS Perthes' disease (PD) often results in femoral head deformity and leg length discrepancy (LLD). Our objective was to analyze femoral morphology in PD patients at skeletal maturity to assess where the LLD originates, and evaluate the effect of contralateral epiphysiodesis for length equalization on proximal and subtrochanteric femoral lengths. METHODS All patients treated for PD in our institution between January 2013 and June 2020 were reviewed retrospectively. Patients with unilateral PD, LLD of ≥ 5 mm, and long-leg standing radiographs at skeletal maturity were included. Total leg length, femoral and tibial length, articulotrochanteric distance (ATD), and subtrochanteric femoral length were compared between PD side and the unaffected side. Furthermore, we compared leg length measurements between patients who did and who did not have a contralateral epiphysiodesis. RESULTS Overall, 79 patients were included, of whom 21 underwent contralateral epiphysiodesis for leg length correction. In the complete cohort, the mean LLD was 1.8 cm (95% confidence interval (CI) 1.5 to 2.0), mean ATD difference was 1.8 cm (95% CI -2.1 to -1.9), and mean subtrochanteric difference was -0.2 cm (95% CI -0.4 to 0.1). In the epiphysiodesis group, the mean LLD before epiphysiodesis was 2.7 cm (95% CI 1.3 to 3.4) and 1.3 cm (95% CI -0.5 to 3.8) at skeletal maturity. In the nonepiphysiodesis group the mean LLD was 2.0 cm (95% CI 0.5 to 5.1; p = 0.016). The subtrochanteric region on the PD side was significantly longer at skeletal maturity in the epiphysiodesis group compared to the nonepiphysiodesis group (-1.0 cm (95% CI -2.4 to 0.6) vs 0.1 cm (95% CI -1.0 to 2.1); p < 0.001). CONCLUSION This study demonstrates that LLD after PD originates from the proximal segment only. In patients who had contralateral epiphysiodesis to balance leg length, this is achieved by creating a difference in subtrochanteric length. Arthroplasty surgeons need to be aware that shortening of the proximal femur segment in PD patients may be misleading, as the ipsilateral subtrochanteric length in these patients can be longer. Therefore, we strongly advise long-leg standing films for THA planning in PD patients in order to avoid inadvertently lengthening the limb. Cite this article: Bone Joint J 2021;103-B(11):1736-1741.
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Affiliation(s)
- Jaap J Tolk
- Catterall Unit, Royal National Orthopaedic Hospital NHS Trust, London, UK.,Orthopaedics and Sports Medicine, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Deborah M Eastwood
- Catterall Unit, Royal National Orthopaedic Hospital NHS Trust, London, UK.,Orthopaedic Surgery, Great Ormond Street Hospital, London, UK.,University College London, London, UK
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Pujol O, Soza D, Lara Y, Castellanos S, Hernández A, Barro V. Restoring hip biomechanics during the learning curve of a novice surgeon: Direct anterior approach vs posterior approach. J Orthop 2021; 26:72-78. [PMID: 34349397 DOI: 10.1016/j.jor.2021.07.014] [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: 05/14/2021] [Accepted: 07/11/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction It remains controversial whether the direct anterior approach (DAA) or the posterior approach (PA) allows better restoration of hip biomechanics after total hip arthroplasty (THA). Besides, it is not certain which approach is best for a novice surgeon to avoid implant malposition, neither during the learning curve nor once the curve plateau has been reached. Methods We performed a retrospective cohort study of THAs operated on between 2014 and 2019 by a single novice surgeon (DAA, n = 187; PA, n = 184). The surgeon used both approaches, and thus went through parallel learning curves. Results While the DAA presented a greater number of acetabular cup implantations within Lewinnek's "safe zone" for inclination (84.5% vs. 79.3%; p = 0.003), the PA returned superior results for anteversion (77.7% vs. 68.4%; p = 0.000). The PA showed a tendency to verticalize acetabular cups, while the DAA tended to antevert them. The DAA resulted in fewer patients with leg length discrepancy (3.2% vs. 8.2%, p = 0.041). No differences were found in stem coronal alignment or femoral offset. Conclusion Both approaches are safe and reliable for restoring hip biomechanics through THA surgery during the learning curve of a novice hip surgeon. Similar radiological outcomes are also seen once the surgeon has reached the learning curve plateau.
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Affiliation(s)
- Oriol Pujol
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Barcelona, Spain
| | - Diego Soza
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Barcelona, Spain
| | - Yuri Lara
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Barcelona, Spain
| | - Sara Castellanos
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Barcelona, Spain
| | - Alejandro Hernández
- Hip Surgery Unit, Orthopedic Surgery Department, Josep Trueta University Hospital, Girona, Spain
| | - Víctor Barro
- Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona Departament de Cirurgia, Barcelona, Spain
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Scheerlinck T, De Winter E, Sas A, Kolk S, Van Gompel G, Vandemeulebroucke J. Hip implants can restore anatomical and medialized rotation centres in most cases : a 3D templating study comparing four implantation strategies. Bone Jt Open 2021; 2:476-485. [PMID: 34236237 PMCID: PMC8325978 DOI: 10.1302/2633-1462.27.bjo-2021-0065.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Aims Hip arthroplasty does not always restore normal anatomy. This is due to inaccurate surgery or lack of stem sizes. We evaluated the aptitude of four total hip arthroplasty systems to restore an anatomical and medialized hip rotation centre. Methods Using 3D templating software in 49 CT scans of non-deformed femora, we virtually implanted: 1) small uncemented calcar-guided stems with two offset options (Optimys, Mathys), 2) uncemented straight stems with two offset options (Summit, DePuy Synthes), 3) cemented undersized stems (Exeter philosophy) with three offset options (CPT, ZimmerBiomet), and 4) cemented line-to-line stems (Kerboul philosophy) with proportional offsets (Centris, Mathys). We measured the distance between the templated and the anatomical and 5 mm medialized hip rotation centre. Results Both rotation centres could be restored within 5 mm in 94% and 92% of cases, respectively. The cemented undersized stem performed best, combining freedom of stem positioning and a large offset range. The uncemented straight stem performed well because of its large and well-chosen offset range, and despite the need for cortical bone contact limiting stem positioning. The cemented line-to-line stem performed less well due to a small range of sizes and offsets. The uncemented calcar-guided stem performed worst, despite 24 sizes and a large and well-chosen offset range. This was attributed to the calcar curvature restricting the stem insertion depth along the femoral axis. Conclusion In the majority of non-deformed femora, leg length, offset, and anteversion can be restored accurately with non-modular stems during 3D templating. Failure to restore hip biomechanics is mostly due to surgical inaccuracy. Small calcar guided stems offer no advantage to restore hip biomechanics compared to more traditional designs. Cite this article: Bone Jt Open 2021;2(7):476–485.
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Affiliation(s)
- Thierry Scheerlinck
- Department of Orthopaedic Surgery and Traumatology, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Medische Beeldvorming en Fysische Wetenschappen (BEFY), Vrije Universiteit Brussel, Brussels, Belgium
| | - Elien De Winter
- Department of Orthopaedic Surgery and Traumatology, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Medische Beeldvorming en Fysische Wetenschappen (BEFY), Vrije Universiteit Brussel, Brussels, Belgium
| | - Amelie Sas
- Department of Mechanical Engineering, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Gert Van Gompel
- Medische Beeldvorming en Fysische Wetenschappen (BEFY), Vrije Universiteit Brussel, Brussels, Belgium.,Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jef Vandemeulebroucke
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussel, Belgium.,iMinds, Department of Medical IT, Gent, Belgium
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Fischer MCM, Damm P, Habor J, Radermacher K. Effect of the underlying cadaver data and patient-specific adaptation of the femur and pelvis on the prediction of the hip joint force estimated using static models. J Biomech 2021; 139:110526. [PMID: 34092401 DOI: 10.1016/j.jbiomech.2021.110526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 05/05/2021] [Accepted: 05/09/2021] [Indexed: 10/21/2022]
Abstract
The prediction of the hip joint force (HJF) is a fundamental factor for the prevention of edge loading in total hip arthroplasty. Naturally, the loading of the liner of the acetabular component depends on the HJF acting on the artificial joint. In contrast to dynamic musculoskeletal models, static models for HJF prediction do not require motion analysis of the patient. However, patient-specific adaptability and validity of static models have to be scrutinized. In this study, a modular framework for HJF prediction using static models is introduced to compare the results of different cadaver templates that are the basis of most static and dynamic models, and different scaling laws for the patient-specific adaptation with in vivo HJF of ten patients for one-leg stance and level walking. The results revealed the significant effect of the underlying cadaver template used for the prediction of the HJF (p < 0.01). A higher degree of patient-specific scaling of the cadaver template often did not significantly reduce the prediction error. Three static models with the lowest prediction errors were compared to results of dynamic models from literature. The prediction error of the peak HJF of the static models (median absolute errors below 15% body weight in magnitude and below 5° in direction) was similar in magnitude and even smaller in direction compared to dynamic models. The necessary reduction of a load-based target zone for the prevention of edge loading due to the uncertainty of the HJF prediction has to be considered in the preoperative planning. The framework for HJF prediction is openly accessible at https://github.com/RWTHmediTEC/HipJointForceModel.
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Affiliation(s)
- Maximilian C M Fischer
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Germany
| | - Philipp Damm
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, Germany
| | - Juliana Habor
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Germany
| | - Klaus Radermacher
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Germany.
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Floerkemeier T. Patientenspezifische Planung in der Hüftendoprothetik. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Templating for Total Hip Arthroplasty in the Modern Age. J Am Acad Orthop Surg 2021; 29:e208-e216. [PMID: 33543909 DOI: 10.5435/jaaos-d-20-00693] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/19/2020] [Indexed: 02/01/2023] Open
Abstract
Preoperative templating provides several benefits to the patient, surgeon, and hospital. Appropriate implant selection and sizing optimizes surgical workflow and leads to efficient care-delivery systems. Accurate templating establishes intraoperative targets for component position and reduces complications such as leg length inequality, impingement, wear, dislocation, and fracture, all of which lead to decreased patient satisfaction. Recent technological advances in preoperative imaging include a better understanding of patient-specific pelvic motion allowing the surgeon to preoperatively address the risk of lumbar pathology with adjustments in component placement and bearing choice. The introduction of two-dimensional to three-dimensional (3D) radiographs, biplanar low-dose radiographs, and computed tomography scans with 3D reconstructions have all allowed for a more comprehensive preoperative planning in 3D. This article will review the fundamentals of templating before total hip arthroplasty with an emphasis on how to incorporate and implement patient-specific pelvic motion and 3D templating into practice.
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Moralidou M, Di Laura A, Henckel J, Hothi H, Hart AJ. Three-dimensional pre-operative planning of primary hip arthroplasty: a systematic literature review. EFORT Open Rev 2020; 5:845-855. [PMID: 33425373 PMCID: PMC7784139 DOI: 10.1302/2058-5241.5.200046] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Three-dimensional (3D) pre-operative planning in total hip arthroplasty (THA) is being recognized as a useful tool in planning elective surgery, and as crucial to define the optimal component size, position and orientation. The aim of this study was to systematically review the existing literature for the use of 3D pre-operative planning in primary THA.A systematic literature search was performed using keywords, through PubMed, Scopus and Google Scholar, to retrieve all publications documenting the use of 3D planning in primary THA. We focussed on (1) the accuracy of implant sizing, restoration of hip biomechanics and component orientation; (2) the benefits and barriers of this tool; and (3) current gaps in literature and clinical practice.Clinical studies have highlighted the accuracy of 3D pre-operative planning in predicting the optimal component size and orientation in primary THAs. Component size planning accuracy ranged between 34-100% and 41-100% for the stem and cup respectively. The absolute, average difference between planned and achieved values of leg length, offset, centre of rotation, stem version, cup version, inclination and abduction were 1 mm, 1 mm, 2 mm, 4°, 7°, 0.5° and 4° respectively.Benefits include 3D representation of the human anatomy for precise sizing and surgical execution. Barriers include increased radiation dose, learning curve and cost. Long-term evidence investigating this technology is limited.Emphasis should be placed on understanding the health economics of an optimized implant inventory as well as long-term clinical outcomes. Cite this article: EFORT Open Rev 2020;5:845-855. DOI: 10.1302/2058-5241.5.200046.
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Affiliation(s)
- Maria Moralidou
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Anna Di Laura
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Johann Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Harry Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
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Huang J, Zhu Y, Ma W, Zhang Z, Shi W, Lin J. A Novel Method for Accurate Preoperative Templating for Total Hip Arthroplasty Using a Biplanar Digital Radiographic (EOS) System. JB JS Open Access 2020; 5:JBJSOA-D-20-00078. [PMID: 33283127 PMCID: PMC7592990 DOI: 10.2106/jbjs.oa.20.00078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Accurate preoperative planning for total hip arthroplasty (THA) relies on conventional anteroposterior radiographs. The difficulty of determining the magnification factor of radiographs is a major limitation. Despite the use of markers for calibration, identifying the plane of the hip joint is a major challenge. The aim of this study was to evaluate the accuracy of a novel method for image calibration and preoperative planning in THA involving the use of a biplanar radiographic (EOS imaging) system and a self-designed coin device. Methods: Biplanar radiographs (with the self-designed coin device) and a conventional anteroposterior radiograph (with a coin) were made for 26 patients after primary THA. The agreement between the actual and calculated diameters for each method was assessed using the concordance correlation coefficient (CCC) and Bland-Altman plots. In addition, 15 patients undergoing primary THA were prospectively enrolled to evaluate the EOS imaging-based method (EOS method), with biplanar radiographs made with use of the coin device. The accuracy of the preoperative predicted size of the implants was evaluated. Results: Both the EOS and conventional anteroposterior radiograph-based methods were reliable in repeated measurements of the diameter of the artificial femoral head in the reproducibility study, with the average CCCs for both methods >0.990. The agreement between the actual and EOS-based calculated diameters of the artificial femoral head was excellent, with a CCC of >0.990, while the agreement was poor between the actual and anteroposterior radiograph-based calculated diameters, with a CCC of <0.75. The EOS method exhibited a lower absolute difference (0.09 ± 0.07 mm) between the actual and calculated diameters compared with conventional anteroposterior radiography (1.26 ± 0.86 mm) (p < 0.001). EOS-based preoperative plans also exhibited excellent performance on the accuracy of the planning of the cups and stems; only 1 patient (6.7%) had a final implanted cup that differed by 1 size from the predicted size. Two patients (13.3%) had final implanted stems that differed by 1 size from the predicted size, and for 1 patient (6.7%), the stem size was off by ≥2 sizes. Conclusions: We describe a novel and easy-to-use method for the accurate calibration of radiographs and preoperative planning for THA. The EOS method evaluated in this study is an alternative method for preoperative planning in clinical practice.
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Affiliation(s)
- Jun Huang
- Departments of Orthopaedic Surgery (J.H., Z.Z., W.S., and J.L.), Clinical Pharmacology (Y.Z.), and Quality Management (W.M.), the First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Ye Zhu
- Departments of Orthopaedic Surgery (J.H., Z.Z., W.S., and J.L.), Clinical Pharmacology (Y.Z.), and Quality Management (W.M.), the First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Wenxia Ma
- Departments of Orthopaedic Surgery (J.H., Z.Z., W.S., and J.L.), Clinical Pharmacology (Y.Z.), and Quality Management (W.M.), the First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Zhigang Zhang
- Departments of Orthopaedic Surgery (J.H., Z.Z., W.S., and J.L.), Clinical Pharmacology (Y.Z.), and Quality Management (W.M.), the First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Weidong Shi
- Departments of Orthopaedic Surgery (J.H., Z.Z., W.S., and J.L.), Clinical Pharmacology (Y.Z.), and Quality Management (W.M.), the First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Jun Lin
- Departments of Orthopaedic Surgery (J.H., Z.Z., W.S., and J.L.), Clinical Pharmacology (Y.Z.), and Quality Management (W.M.), the First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
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Zannoni S, Albano D, Jannone ML, Messina C, Sconfienza LM. Correlation between muscle mass and quality around the hip and of psoas muscles at L3 level using unenhanced CT scans. Skeletal Radiol 2020; 49:1649-1655. [PMID: 32476068 DOI: 10.1007/s00256-020-03475-z] [Citation(s) in RCA: 8] [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: 03/24/2020] [Revised: 05/11/2020] [Accepted: 05/17/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE CT segmentation of psoas muscles at L3 level is used to measure sarcopenia status, but it is not feasible when L3 is not included in the examination. We tested the correlation of psoas muscle mass and quality estimation at L3 with that of hip muscles, which could be opportunistically used in patients undergoing hip surgery. MATERIALS AND METHODS Unenhanced abdominal CT performed in 50 patients (29 males, mean/median age 69/72 years) were reviewed. Regions of interest were drawn to assess cross-sectional area (CSA) and attenuation of psoas muscles at L3. These values were correlated with CSA and attenuation of iliopsoas, rectus femoris, sartorius, and tensor fascia latae at the level of the hip, separately on each side. After applying Bonferroni correction for multiple comparisons, statistical significance was set as P < .002. RESULTS Attenuation of each psoas at L3 and ipsilateral hip muscles was significantly correlated (P ≤ .001, r = .491-.754). A significant correlation was observed between CSA of right psoas and ipsilateral muscles (P ≤ .00, r = .432-.525). We observed a significant correlation between CSA of left psoas and ipsilateral rectus femoris, iliopsoas, tensor fascia latae at the apex of the femoral head, and sartorius at the level of the lesser trochanter (P ≤ .001, r = .431-.502). Average time to measure CSA and attenuation of psoas muscles at L3 was 41 s, that of hip muscles was 2 min 12 s. CONCLUSION Measurements of mass and quality of hip muscles are feasible and correlate to those of psoas muscles at L3, being potentially used in future works on the association of sarcopenia and outcomes after hip surgery.
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Affiliation(s)
- Stefania Zannoni
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
- Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Via del Vespro 127, 90127, Palermo, Italy.
| | - Maria Laura Jannone
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy
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Marappa-Ganeshan R, Sim F, Sidhom S, Chakrabarty G, Pandit HG, van Duren BH. How Accurate is the Use of Contralateral Implant Size as a Template in Bilateral Hemiarthroplasty? Indian J Orthop 2020; 54:863-867. [PMID: 33123318 PMCID: PMC7573054 DOI: 10.1007/s43465-020-00203-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 07/14/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Accurately predicting implant size for hemiarthroplasties offers an important contribution to theatre efficiency and patients' intraoperative care. However, pre-operative sizing using templating of implants in hip fracture patients requiring a hemiarthroplasty is often difficult due to non-standard radiographs, absence of a calibration marker, poor marker placement, variable patient position, and in many institutions a lack of templating facilities. In patients who have previously undergone a hemiarthroplasty on the contralateral side, surgeons can use the contralateral implant size for pre-operative planning purposes. However, the accuracy of doing this has not previously been reported. The aim of this study was to investigate the reliability of using an in situ contralateral implant as a predictor of implant size on the contralateral side. METHODS A retrospective review of our local neck of femur fracture (NOF) database was undertaken to identify patients who had bilateral hip hemiarthroplasty. Operative records were reviewed to establish the size of prostheses used at operation. Correlation, agreement, and reliability analysis were performed using the least squares, Bland-Altman plot, and intra-class correlation coefficient (ICC) methods, respectively. RESULTS Operative records were identified for 45 patients who had bilateral hemiarthroplasties. There was a difference in implant size used in 58% of cases. Of these 77% required a larger implant on the right. Implant sizes were within 1 mm of the contralateral side in 78% and within 2 mm in 91% of patients. However, in 9% of patients, there was a discrepancy greater than 2 mm with some cases having up to 6 mm discrepancy. Correlation coefficient was 0.83 and the ICC 0.90. CONCLUSIONS The findings in this study indicated that using the size of a contralateral implant can be used as a reliable indicator of head size in cases of bilateral hemiarthroplasty. However, the surgeon should remain cautious as there is a one in ten chance of there being a 3 mm or more difference in implant size.
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Affiliation(s)
| | - Francis Sim
- Calderdale and Huddersfield Hospitals Trust, Huddersfield, England UK
| | - Sameh Sidhom
- Calderdale and Huddersfield Hospitals Trust, Huddersfield, England UK
| | - Gautam Chakrabarty
- Calderdale and Huddersfield Hospitals Trust, Huddersfield, England UK ,University of Huddersfield, Huddersfield, England UK
| | - Hemant G. Pandit
- Leeds Orthopaedic Trauma Sciences, Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, England UK
| | - Bernard H. van Duren
- Leeds Orthopaedic Trauma Sciences, Leeds Institute of Rheumatology and Musculoskeletal Medicine, University of Leeds, Leeds, England UK
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Hardie JA, Brennan PA. Are you surgically current? Lessons from aviation for returning to non-urgent surgery following COVID-19. Br J Oral Maxillofac Surg 2020; 58:843-847. [PMID: 32576468 PMCID: PMC7303632 DOI: 10.1016/j.bjoms.2020.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/08/2020] [Indexed: 12/27/2022]
Abstract
The COVID-19 crisis has caused many issues across healthcare. In surgery, many operations have been cancelled with some surgeons losing their regular operating lists. During this time, technical expertise and decision making can deteriorate. In aviation after a prolonged period of absence from flying, this deficit in keeping skills and thinking up to date is known as being “out of currency” or “not current”. Although aviation and healthcare cannot be compared, numerous human factors concepts are applicable to both. In this article, we explore the likely impact of potentially prolonged absences in operating on surgical skills and psyche, and introduce the concept of a Surgical Skills Currency Barometer. We also discuss a “task-o-meter” thought experiment, and suggest practices which could be adopted to help protect surgeon workload from exceeding surgical capability when returning to operating following a period of prolonged absence.
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Affiliation(s)
- J A Hardie
- Trauma & Orthopaedic Department, Frimley Park Hospital, Camberley GU16 7UJ, UK.
| | - P A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
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