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Aubert T, Gerard P, Galanzino G, Marmor S. In silico analysis of the patient-specific acetabular cup anteversion safe zone. Orthop Traumatol Surg Res 2024:103940. [PMID: 39043498 DOI: 10.1016/j.otsr.2024.103940] [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: 07/07/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Various computer-assisted surgical systems claim to improve the accuracy of cup placement in total hip arthroplasties after assessing spinopelvic mobility to prevent prosthetic impingement. However, no study has yet analyzed the extent of the patient-specific cup anteversion safe zones. HYPOTHESIS We hypothesized that most patients have a safe zone >10 °, except those with abnormal spinopelvic mobility, who have a much narrower safe zone. MATERIALS AND METHODS We simulated the risks of prosthetic impingement using the planned cup anteversion. The consecutive cohort included 341 patients who underwent total hip arthroplasty. Our primary endpoint was the patient-specific impingement-free zone for cup anteversion, which was then divided into four subgroups: 0 °, 1 ° to 5 °, 6 ° to 10 °, and >10 °. This data was then secondarily analyzed for abnormal spinopelvic mobility (the difference in the spinopelvic tilt [ΔSPT] from a standing to a flexed seated position >20 °). RESULTS The mean anteversion safe zone was 22.8 ° with 82.4% (281/341) of patients with a zone strictly >10 °. The mean safe zone was 8.9 ° (+/- 9 °) in patients with an ΔSPT ≥20 ° (18.2%), with 37.1% of these patients having a zone of 0 °, 16.13% a zone between 1 ° and 5 °, 8.06% a zone between 6 ° and 10 ° and 38.71% a zone >10 °. The mean safe zone was 25.9 ° (+/- 9 °) in patients with an ΔSPT <20 ° (81.8%), and the proportion of cases in each zone was 2.51%, 1.08%, 4.3%, and 92.11%, respectively (p < 0.001). CONCLUSION The safe zone for anteversion appears to be fairly wide in most patients. However, identifying patients at risk of abnormal spinopelvic mobility seems necessary to identify the two-thirds of patients with a narrow safe zone. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Thomas Aubert
- Orthopedic Department, Croix St Simon Hospital 125 rue d'Avron, 75020 Paris, France.
| | - Philippe Gerard
- Orthopedic Department, Croix St Simon Hospital 125 rue d'Avron, 75020 Paris, France
| | - Giacomo Galanzino
- Orthopedic Department, Croix St Simon Hospital 125 rue d'Avron, 75020 Paris, France
| | - Simon Marmor
- Orthopedic Department, Croix St Simon Hospital 125 rue d'Avron, 75020 Paris, France
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Ivanišević A, Boban Z, Jurić J, Vukojević K. Smart Drill for a Streamlined Estimation of the Drilling Angle and Channel Length in Orthopedic Surgical Procedures. Bioengineering (Basel) 2024; 11:630. [PMID: 38927866 PMCID: PMC11200387 DOI: 10.3390/bioengineering11060630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/12/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
The estimation of distances and angles is a routine part of an orthopedic surgical procedure. However, despite their prevalence, these steps are most often performed manually, heavily relying on the surgeon's skill and experience. To address these issues, this study presents a sensor-equipped drill system which enables automatic estimation of the drilling angle and channel length. The angular accuracy and precision of the system were tested over a range of inclination angles and proved to be superior to the manual approach, with mean absolute errors ranging from 1.9 to 4.5 degrees for the manual approach, and from 0.6 to 1.3 degrees with the guided approach. When sensors were used for simultaneous estimation of both the inclination and anteversion angles, the obtained mean absolute errors were 0.35 ± 0.25 and 2 ± 1.33 degrees for the inclination and anteversion angles, respectively. Regarding channel length estimation, using measurements obtained with a Vernier caliper as a reference, the mean absolute error was 0.33 mm and the standard deviation of errors was 0.41 mm. The obtained results indicate a high potential of smart drill systems for improvement of accuracy and precision in orthopedic surgical procedures, enabling better patient clinical outcomes.
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Affiliation(s)
- Arsen Ivanišević
- Department of Surgery, Division of Orthopaedics and Traumatology, University Hospital of Split, 21000 Split, Croatia;
| | - Zvonimir Boban
- Department of Medical Physics and Biophysics, University of Split School of Medicine, 21000 Split, Croatia
| | - Josip Jurić
- Independent Researcher, 21000 Split, Croatia;
| | - Katarina Vukojević
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, 21000 Split, Croatia;
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Zhang S, Ma M, Kong X, Zhou Y, Chen J, Chai W. Robotic-assisted total hip arthroplasty in patients with developmental dysplasia of the hip. INTERNATIONAL ORTHOPAEDICS 2024; 48:1189-1199. [PMID: 38358516 DOI: 10.1007/s00264-024-06115-6] [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: 10/13/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Abstract
PURPOSES Due to the morphological diversity of deformities, technical difficulties, improperly designed components, and so on, THA remains a challenging task in dysplastic hips, especially in highly dislocated hips. The purpose of this study was to comprehensively evaluate the clinical outcomes of robot-assisted THA in patients with DDH through a large cohort study, including the precision of acetabular cup positioning, indicators of inflammatory response, indicators of muscle damage, and complications. METHODS We retrospectively analyzed patients with DDH who underwent THA in our prospectively constructed joint registry between August 2018 and August 2022. Finally, 147 manual THAs and 147 robotic-assisted THAs were included in the final analysis. Patient demographics, indicators of inflammation, indicators of muscle damage, operative time, Harris hip scores (HHS), and forgotten joint score (FJS) were recorded for analysis. The precision of the positioning of the acetabular component was assessed with plain radiographs. RESULTS In the Crowe II/III groups, the reconstructed center of rotation (COR) in the robotic-assisted group was closer to the anatomical COR with less variation than the manual group (absolute horizontal distances of COR 3.5 ± 2.8 vs. 5.4 ± 4.9 mm, p < 0.05; absolute vertical distances of COR 6.4 ± 4.1 vs. 11.7 ± 8.2 mm, p = 0.001). For all Crowe subtypes, the robotic-assisted THA significantly increased the proportion of acetabular cups located in the safety zone within 5° (all p < 0.05). Interleukin-6 and creatine kinase levels were slightly lower and significantly different in the robotic-assisted group at three days postoperatively (all p < 0.05). CONCLUSIONS Compared to the manual technique, the robot-assisted technique improved the precision and reproducibility of acetabular component positioning, particularly in DDH patients with Crowe types II/III. The robotic-assisted technique did not increase operative time, bleeding, complications, or revision rates, and had a slighter early inflammatory response and muscle damage.
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Affiliation(s)
- Shuai Zhang
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China
- Department of Orthopedics, the 969th Hospital of the PLA joint Logisitcs Support Force, No. 51 Aimin street, Xincheng District, Huhehaote, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Mingyang Ma
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
| | - Xiangpeng Kong
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Yonggang Zhou
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
| | - Jiying Chen
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
| | - Wei Chai
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
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Zheng H, Feng E, Xiao Y, Liu X, Lai T, Xu Z, Chen J, Xie S, Lin F, Zhang Y. Is AI 3D-printed PSI an accurate option for patients with developmental dysplasia of the hip undergoing THA? BMC Musculoskelet Disord 2024; 25:308. [PMID: 38649919 PMCID: PMC11034034 DOI: 10.1186/s12891-024-07449-3] [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: 11/18/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND In traditional surgical procedures, significant discrepancies are often observed between the pre-planned templated implant sizes and the actual sizes used, particularly in patients with congenital hip dysplasia. These discrepancies arise not only in preoperative planning but also in the precision of implant placement, especially concerning the acetabular component. Our study aims to enhance the accuracy of implant placement during Total Hip Arthroplasty (THA) by integrating AI-enhanced preoperative planning with Patient-Specific Instrumentation (PSI). We also seek to assess the accuracy and clinical outcomes of the AI-PSI (AIPSI) group in comparison to a manual control group. METHODS This study included 60 patients diagnosed with congenital hip dysplasia, randomly assigned to either the AIPSI or manual group, with 30 patients in each. No significant demographic differences between were noted the two groups. A direct anterior surgical approach was employed. Postoperative assessments included X-rays and CT scans to measure parameters such as the acetabular cup anteversion angle, acetabular cup inclination angle, femoral stem anteversion angle, femoral offset, and leg length discrepancy. Functional scores were recorded at 3 days, 1 week, 4 weeks, and 12 weeks post-surgery. Data analysis was conducted using SPSS version 22.0, with the significance level was set at α = 0.05. RESULTS AND CONCLUSION The AIPSI group demonstrated greater prosthesis placement accuracy. With the aid of PSI, AI-planned THA surgery provides surgeons with enhanced precision in prosthesis positioning. This approach potentially offers greater insights and guidelines for managing more complex anatomical variations or cases.
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Affiliation(s)
- Han Zheng
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
- The Second School of Medicine, Fujian University of Traditional Chinese, Fujian, China
| | - Eryou Feng
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China.
- Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma(2020Y2014), Fuzhou, China.
| | - Yao Xiao
- Fuzhou Changle Hospital of Traditional Chinese Medicine, Fuzhou, China
| | - Xingyu Liu
- Longwood Valley Medical Technology Co Ltd, Beijing, China
| | - Tianyu Lai
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Zhibiao Xu
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Jingqiao Chen
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Shiwei Xie
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Feitai Lin
- Department of Arthrosis Surgery, Fuzhou Second Hospital, Fuzhou, China
| | - Yiling Zhang
- Longwood Valley Medical Technology Co Ltd, Beijing, China.
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Cruz J, Gonçalves SB, Neves MC, Silva HP, Silva MT. Intraoperative Angle Measurement of Anatomical Structures: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2024; 24:1613. [PMID: 38475148 PMCID: PMC10934548 DOI: 10.3390/s24051613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024]
Abstract
Ensuring precise angle measurement during surgical correction of orientation-related deformities is crucial for optimal postoperative outcomes, yet there is a lack of an ideal commercial solution. Current measurement sensors and instrumentation have limitations that make their use context-specific, demanding a methodical evaluation of the field. A systematic review was carried out in March 2023. Studies reporting technologies and validation methods for intraoperative angular measurement of anatomical structures were analyzed. A total of 32 studies were included, 17 focused on image-based technologies (6 fluoroscopy, 4 camera-based tracking, and 7 CT-based), while 15 explored non-image-based technologies (6 manual instruments and 9 inertial sensor-based instruments). Image-based technologies offer better accuracy and 3D capabilities but pose challenges like additional equipment, increased radiation exposure, time, and cost. Non-image-based technologies are cost-effective but may be influenced by the surgeon's perception and require careful calibration. Nevertheless, the choice of the proper technology should take into consideration the influence of the expected error in the surgery, surgery type, and radiation dose limit. This comprehensive review serves as a valuable guide for surgeons seeking precise angle measurements intraoperatively. It not only explores the performance and application of existing technologies but also aids in the future development of innovative solutions.
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Affiliation(s)
- João Cruz
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal; (J.C.); (S.B.G.)
| | - Sérgio B. Gonçalves
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal; (J.C.); (S.B.G.)
| | | | - Hugo Plácido Silva
- IT—Instituto de Telecomunicações, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal;
| | - Miguel Tavares Silva
- IDMEC, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais 1, 1049-001 Lisboa, Portugal; (J.C.); (S.B.G.)
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Marcinko M, Sadhwani S, Dahl R, Ali M. The Practicality of the Robotic Total Hip Arthroplasty for the Treatment of Complex Bilateral Adult Hip Dysplasia. Technology Makes It Easy. Arthroplast Today 2023; 24:101249. [PMID: 38023648 PMCID: PMC10679762 DOI: 10.1016/j.artd.2023.101249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 12/01/2023] Open
Abstract
Adult hip dysplasia provides many challenges for joint surgeons. Due to the abnormal bone morphology and altered biomechanics of the hip, surgeons must ensure accurate implant positioning to avoid postoperative complications. We present a 56-year-old female with a history of bilateral Legg-Calve-Perthes disease and subsequent dysplasia who underwent bilateral total hip arthroplasty using robotic navigation. We highlight the utility of robotic navigation in adult hip dysplasia to improve implant positioning and ensure optimal patient outcomes.
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Affiliation(s)
- Michael Marcinko
- Department of Orthopaedic Surgery, UPMC Community Osteopathic, Harrisburg, PA, USA
| | - Shaan Sadhwani
- Department of Orthopaedic Surgery, UPMC Community Osteopathic, Harrisburg, PA, USA
| | - Raymond Dahl
- Department of Orthopaedic Surgery, UPMC Community Osteopathic, Harrisburg, PA, USA
| | - Muzaffar Ali
- North Shore University Hospital, Northwell Health, Manhasset, NT, USA
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Antoniades S, McGoldrick NP, Meermans G, Beaulé PE, Grammatopoulos G. Contemporary, non-navigation, cup orientation techniques improve accuracy and eliminate differences seen between the anterior and posterior approach in THA. Hip Int 2023; 33:977-984. [PMID: 36852719 DOI: 10.1177/11207000231156543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND This study aimed to: (1) Determine the ability to achieve the surgeons' desired cup orientation, without navigation, using contemporary measures with the anterior- (AA) and posterior- approaches (PA); and (2) assess whether surgical approach is associated with cup orientation accuracy, as previously reported, when contemporary measures are used. METHODS A prospective, 2-centre, multi-surgeon study of 400 THAs (200 AA; 200 PA) was performed. Intraoperative radiographs were obtained with the AA. A digital inclinometer and 3-point pelvic support were used with the PA. With the PA, intraoperative cup inclination at impaction was recorded. Radiographic inclination/anteversion (RI/RA) was measured from intraoperative radiographs (AA-only) and from postoperative radiographs for all cases. Optimum inclination/anteversion was defined as 40°/20° (±10°). The difference between intra- and postoperative orientations allowed for determination of the difference in pelvic position at impaction. RESULTS Optimum RI and RA were achieved in 91.3% (n = 365) and 92% (n = 368) of cases respectively. Optimum cup orientation was detected in 84% of cases (n = 336). There was equivalent ability to achieve cup orientation between approaches (AA: 82.5% vs. PA: 85.5%; p = 0.41). The use of an inclinometer in the PA was associated with a smaller variability of inclination at implantation (10° vs. 14°) and counteracted the greater difference in pelvic position (4.4° vs. 2.1°) seen with the PA. CONCLUSIONS Over 80% of cases can have optimum orientation without navigation, using simple, cheap contemporary measures. Such measures eliminate differences between approaches, related to patient position. Narrower implantation angles will further reduce variability in cup orientation achieved.
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Affiliation(s)
| | - Niall P McGoldrick
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Geert Meermans
- Department of Orthopaedics, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, ON, Canada
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Verhaegen JCF, Ojaghi R, Kim P, Schwarz AJ, Bingham J, Grammatopoulos G. Selective THA-approach use amongst junior surgeons improves safety of introducing the anterior approach: a prospective, multi-surgeon, comparative, study. Arch Orthop Trauma Surg 2023; 143:6829-6836. [PMID: 37119326 DOI: 10.1007/s00402-023-04895-x] [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: 01/03/2023] [Accepted: 04/16/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND Learning curves associated with independent practice and anterior approach total hip arthroplasty (AA-THA) has been associated with inferior outcome. This study compared outcome of junior, fellowship-trained, surgeons who perform THA through both anterior and posterior (PA) approach, with senior surgeons who perform either AA or PA, to determine whether: 1. Fellowship training and selective practice allows for safe introduction of AA into practice; and 2. Whether selective approach-use influences outcome. METHODS This is a prospective, consecutive study comparing the first 800 THAs of two junior, dual-approach, surgeons (AA/PA: 455/345), with 400 THAs cases of two senior, single-approach, surgeons (AA/PA: 200/200), between 2018 and 2020. Most patients were female (54.4%), mean age was 65 years-old (range 19-96) and mean BMI was 29 kg/m2 (range 16-66). Outcome included radiologic measurements (inclination/anteversion and leg-length), complication- and revision rates, and patient-reported outcomes including Oxford Hip Score (OHS). RESULTS At 3.1 years (range 2.0-6.8) follow-up, there were 43 complications (3.6%), including 27 re-operations (2.3%); with no difference between junior and senior surgeons for AA-THA (Junior: 8/455 vs. Senior: 3/200; p = 0.355) or PA-THA (Junior: 11/345 vs. Senior: 5/200; p = 0.400). Amongst juniors, there was no difference in complications (AA:8/455 vs. PA:11/345; p = 0.140) and in ΔOHS (AA:20.5 ± 7.7 vs. PA:20.5 ± 8.0; p = 0.581) between approaches. CONCLUSION Contemporary training and selective approach-use minimizes the learning curve, allowing junior staff to have equivalent outcome to established, senior surgeons in both AA and PA. We would advocate for selective approach use amongst junior arthroplasty surgeons when introducing the AA into independent practice.
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Affiliation(s)
- Jeroen C F Verhaegen
- Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Critical Care Wing, Suite CCW 1638, Ottawa, ON, K1H 8L6, Canada
- University Hospital Antwerp, Edegem, Belgium
- Orthopaedic Centre Antwerp, Antwerp, Belgium
| | - Reza Ojaghi
- Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Critical Care Wing, Suite CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Paul Kim
- Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Critical Care Wing, Suite CCW 1638, Ottawa, ON, K1H 8L6, Canada
| | - Adam J Schwarz
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Josh Bingham
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Critical Care Wing, Suite CCW 1638, Ottawa, ON, K1H 8L6, Canada.
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Ambrus R, Douša P, Almási J, Šteňo B. Current Concepts in Diagnosis and Management of Patients Undergoing Total Hip Replacement with Concurrent Disorders of Spinopelvic Anatomy: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1591. [PMID: 37763710 PMCID: PMC10535821 DOI: 10.3390/medicina59091591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/23/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023]
Abstract
Despite the high success rate of primary total hip replacement (THR), a significant early revision rate remains, which is largely attributed to instability and dislocations. Despite the implants being placed according to the safe zone philosophy of Lewinnek, occurrence of THR dislocation is not an uncommon complication. Large diagnostic and computational model studies have shown variability in patients' mobility based on the individual anatomic and functional relationship of the hip-pelvis-spine complex. The absolute and relative position of hip replacement components changes throughout motion of the patient's body. In the case of spinopelvic pathology such as spine stiffness, the system reaches abnormal positional states, as shown with computerized models. The clinical result of such pathologic hip positioning is edge loading, implant impingement, or even joint dislocation. To prevent such complications, surgeons must change the dogma of single correct implant positioning and take into account patients' individualized anatomy and function. It is essential to broaden the standard diagnostics and their anatomical interpretation, and correct the pre-operative surgical planning. The need for correct and personalized implant placement pushes forward the development and adaptation of novel technologies in THR, such as robotics. In this current concepts narrative review, we simplify the spinopelvic biomechanics and pathoanatomy, the relevant anatomical terminology, and the diagnosis and management algorithms most commonly used today.
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Affiliation(s)
- Richard Ambrus
- Department of Orthopaedics, Nemocnica Bory Penta Hospitals International, I. Kadlecika 2, Lamac, 841 03 Bratislava, Slovakia;
| | - Pavel Douša
- Department of Orthopaedics and Traumatology, Kralovske Vinohrady University Hospital, 3rd Faculty of Medicine Charles University, FNKV Srobarova 50, 100 34 Prague, Czech Republic;
- Department of Traumatology and Orthopaedics, Ostrava University Hospital, Faculty of Medicine University of Ostrava, FNO 17. Listopadu Street, Poruba, 708 52 Ostrava, Czech Republic
| | - Jozef Almási
- Department of Orthopaedics, Nemocnica Bory Penta Hospitals International, I. Kadlecika 2, Lamac, 841 03 Bratislava, Slovakia;
| | - Boris Šteňo
- II. University Department of Orthopaedic and Trauma Surgery, University Hospital Bratislava and Faculty of Medicine, Comenius University Bratislava, Antolska 11, Petrzalka, 851 01 Bratislava, Slovakia;
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Kara GK, Turan K, Eroglu ON, Ozturk C, Ertürer E. Is the Acetabular Cup Orientation Different in Robot-Assisted and Conventional Total Hip Arthroplasty With Right-Handed Surgeons Using an Anterolateral Approach? Cureus 2023; 15:e42335. [PMID: 37614261 PMCID: PMC10443961 DOI: 10.7759/cureus.42335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 08/25/2023] Open
Abstract
Introduction Total hip arthroplasty (THA) is one of the most successful orthopaedic procedures. Survival rates from 90% at 10 years to 93% at 20 years have been reported in different studies. Differences in implant and patient characteristics can undoubtedly explain some of this variability observed in prosthesis durability, but the effect of surgical technique and implant orientation cannot be ignored. Therefore, many intraoperative methods (anatomic landmarks, intraoperative x-ray, fluoroscopy, navigation, and robotic surgery) have been attempted to avoid acetabular component malpositioning. Although postoperative computed tomography (CT) is accepted as the gold standard for the measurement of acetabular anteversion, it remains controversial in respect of costs and radiation exposure. The aim of this study was to examine how acetabular component orientation was affected in robotic and conventional THA operations performed by two surgeons with right-hand dominance. Material and methods The study included 113 primary THA operations performed on 113 patients between 2017 and 2022 in two groups: (i) robotic THA (Mako, Stryker Corporation, Kalamazoo, Michigan, United States) (55 patients) and (ii) conventional THA (58 patients). The patients comprised 51 males and 62 females. THA was performed on 54 right-side hips and 59 left-side hips. The operations were performed by two orthopaedic surgeons, each with 20 years of arthroplasty experience, on all the patients in the lateral decubitus position with an anterolateral approach. In all the cases, the orientation of the acetabular component was 40° inclination and 20° anteversion. Difficult THA procedures (patients with developmental dysplasia of the hip (DDH), a history of hip surgery, revision THA, defect or deformity of the acetabulum, a history of scoliosis or lumbar posterior surgery, or those requiring proximal femoral osteotomy) were excluded from the study. Using the Liaw and Lewinnek methods, the acetabular component anteversion was measured on the radiographs taken in the optimal position postoperatively and the acetabular cup inclination angles were measured on the pelvis radiographs. The groups were compared using the Kolmogorov-Smirnov, Pearson Chi-square and Mann-Whitney U statistical tests. The limits were accepted as 40±5° for inclination and 20±5° for anteversion. Results No statistically significant difference was determined between the groups in respect of age, gender, or operated side. No statistically significant difference was determined between the optimal acetabular cup inclination angles of the robotic and conventional THA groups (p = 0.79). No statistically significant difference was determined between the optimal acetabular cup anteversion angles of the left and right conventional THA groups. Statistically significantly better results were determined in the robotic group in respect of acetabular cup anteversion (p<0,001). Conclusion The optimal orientation of the acetabular component is a key factor for successful THA. Otherwise, revision surgery is inevitable for reasons such as instability, impingement, or increased wear. The results of this study demonstrated that robotic surgery was superior to the conventional method in the placement of the acetabular component in the desired orientation.
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Affiliation(s)
| | - Kayhan Turan
- Orthopedics and Traumatology, Atlas University, İstanbul, TUR
| | | | - Cagatay Ozturk
- Orthopedics and Traumatology, Istinye University, Istanbul, TUR
| | - Erden Ertürer
- Orthopedics and Traumatology, Istinye University, İstanbul, TUR
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Brush PL, Santana A, Toci GR, Slotkin E, Solomon M, Jones T, Saxena A. Surgeon Estimations of Acetabular Cup Orientation Using Intraoperative Fluoroscopic Imagining Are Unreliable. Arthroplast Today 2023; 20:101109. [PMID: 36938353 PMCID: PMC10018435 DOI: 10.1016/j.artd.2023.101109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/12/2022] [Accepted: 01/22/2023] [Indexed: 03/21/2023] Open
Abstract
Background Accurate acetabular cup orientation is associated with decreased revision rates and improved outcomes of primary total hip arthroplasty. This study assesses surgeon's ability to estimate both the acetabular component inclination and anteversion angles via intraoperative fluoroscopy (IF) images. Methods We surveyed orthopedic surgeons to estimate acetabular component inclination and anteversion based on 20 IF images of total hip arthroplasty through a direct anterior approach. Postoperative computed-tomography scans were used to calculate the true inclination and anteversion component angles. The absolute difference between the true and estimated values was calculated to determine the mean and standard deviation of the survey results. Interrater reliability was determined through interclass correlation coefficients. Results A majority of surgeons preferred the direct anterior approach (83.3%) and utilized IF during surgery (70%). Surgeons surveyed were on average 5.9° away from the true value of inclination (standard deviation = 4.7) and 8.8° away from the true value of anteversion (standard deviation = 6.0). Respondents were within 5° of both inclination and anteversion in 19.7% of cases, and within 10° in 57.3% of cases. All surgeons were determined to have poor reliability in estimating anteversion (interclass correlation coefficient < 0.5). Only 2 surgeons were determined to have moderate reliability when estimating inclination. Conclusions Surgeons, when solely relying on IF for the estimation of anteversion and inclination, are unreliable. Utilization of other techniques in conjunction with IF would improve observer reliability.
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Affiliation(s)
- Parker L. Brush
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
- Corresponding author. Rothman Orthopaedic Institute, 925 Chestnut Street, Philadelphia, PA, USA. Tel.: +1 316 993 3876.
| | - Adrian Santana
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Gregory R. Toci
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Eric Slotkin
- Orthopaedic Associates of Reading, Tower Health, Reading Hopsital, West Reading, PA, USA
| | - Michael Solomon
- Sydney Orthopaedic Specialists, Prince of Wales Private Hospital, Randwick, Australia
| | | | - Arjun Saxena
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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12
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Is outcome of total hip arthroplasty for hip fracture inferior to that of arthritis in a contemporary arthroplasty practice? J Arthroplasty 2023:S0883-5403(23)00201-2. [PMID: 36889530 DOI: 10.1016/j.arth.2023.02.069] [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: 11/30/2022] [Revised: 02/22/2023] [Accepted: 02/25/2023] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION Outcome of total hip arthroplasty (THA) for femoral neck fractures (FNF) has been associated with higher complication rates. However, THA for FNF is not always performed by arthroplasty-surgeons. This study aimed to compare THA outcomes for FNF to osteoarthritis (OA). In doing so, we described contemporary THA failure modes for FNF performed by arthroplasty surgeons. METHODS This was a retrospective, multi-surgeon study from an academic center. Of FNF treated between 2010 and 2020, 177 received THA by an arthroplasty-surgeon [mean age 67 years (range, 42 to 97), sex: 64.4% women]. These were matched (1:2) for age and sex with 354 THAs performed for hip OA, by the same surgeons. No dual-mobilities were used. Outcomes included radiologic measurements (inclination/anteversion and leg-length), mortality, complications, reoperation rates and patient-reported outcomes including Oxford Hip Score (OHS). RESULTS Post-operative mean leg-length difference was 0 millimeters (mm) (range, -10 to -10 mm), with a mean cup inclination and anteversion of 41 and 26° respectively. There was no difference in radiological measurements between FNF and OA patients (p=0.3). At 5 years follow-up, mortality rate was significantly higher in the FNF-THA compared to the OA-THA group (15.3 vs. 1.1%; p<0.001). There was no difference in complications (7.3 vs. 4.2%; p=0.098) or reoperation rates (5.1 vs. 2.9%; p=0.142) between groups. Dislocation rate was 1.7%. OHS at final follow-up was similar [43.7 points (range, 10 to 48) vs. 43.6 points (range, 10 to 48); p=0.030]. CONCLUSION Total hip arthroplasty for the treatment of FNF is a reliable option and is associated with satisfactory outcomes. Instability was not a common reason of failure, despite not using dual-mobility articulations in this at-risk population. This is likely due to THAs being performed by the arthroplasty staff. When patients live beyond 2-years, similar clinical and radiographic outcomes with low rates of revision can be expected, comparable to elective THA for OA.
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13
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Howgate D, Oliver M, Stebbins J, Roberts PG, Kendrick B, Rees J, Taylor S. Validating the accuracy of a novel virtual reality platform for determining implant orientation in simulated primary total hip replacement. Digit Health 2022; 8:20552076221141215. [PMCID: PMC9742742 DOI: 10.1177/20552076221141215] [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: 08/05/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Accurate acetabular cup and femoral stem component orientation are critical for optimising patient outcomes, reducing complications and increasing component longevity following total hip replacement (THR). This study aimed to determine the accuracy of a novel virtual reality (VR) platform in assessing component orientation in a simulated THR model. Methods The VR platform (HTC Vive Pro® system hardware) was compared against the validated Vicon® optical motion capture (MoCap) system. An acetabular cup and femoral stem were manually implanted across a range of orientations into pelvic and femur sawbones, respectively. Simultaneous readings of the acetabular cup operative anteversion (OA) and inclination (OI) and femoral stem alignment (FSA) and neck anteversion (FNA) were obtained from the VR and MoCap systems. Statistical analysis was performed using Pearson product-moment correlation coefficient (PPMCC) (Pearson’s r) and linear regression (R2). Results A total of 55 readings were obtained for the acetabular cup and 68 for the femoral stem model. The mean average differences in OA, OI, FSA and FNA between the systems were 3.44°, −0.01°, 0.01° and −0.04°, respectively. Strong positive correlations were demonstrated between both systems in OA, OI, FSA and FNA, with Pearson’s r = 0.92, 0.94, 0.99 and 0.99, and adjusted R2 = 0.82, 0.9, 0.98 and 0.98, respectively. Conclusion The novel VR platform is highly accurate and reliable in determining both acetabular cup and femoral stem component orientations in simulated THR models. This adaptable and cost-effective digital tracking platform may be modified for use in a range of simulated surgical training and educational purposes, particularly in orthopaedic surgery.
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Affiliation(s)
- Daniel Howgate
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford, UK,NIHR Oxford Biomedical Research Centre, The Joint Research Office, Oxford, UK,Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK, London, UK,Dinwoodie Charitable Company and Royal College of Surgeons of England Research Fellow, London, UK,Daniel Howgate, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), The Botnar Research Centre, University of Oxford, Old Road, Headington, Oxford, OX3 7LD, UK.
| | - Michael Oliver
- The MRC Weatherall Institute of Molecular Medicine, Oxford, UK
| | - Julie Stebbins
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford, UK,NIHR Oxford Biomedical Research Centre, The Joint Research Office, Oxford, UK,Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK, London, UK
| | - Patrick Garfjeld Roberts
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford, UK,NIHR Oxford Biomedical Research Centre, The Joint Research Office, Oxford, UK,Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK, London, UK
| | - Ben Kendrick
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford, UK,Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK, London, UK
| | - Jonathan Rees
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford, UK,NIHR Oxford Biomedical Research Centre, The Joint Research Office, Oxford, UK,Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK, London, UK
| | - Stephen Taylor
- The MRC Weatherall Institute of Molecular Medicine, Oxford, UK
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14
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Thomas C, Gupta V, Parsons H, Metcalfe A, Foguet P, King R. Does functional planning, 3D templating and patient-specific instrumentation improve accuracy in total hip replacement?- a randomized controlled trial. ARTHROPLASTY (LONDON, ENGLAND) 2022; 4:43. [PMID: 36183111 PMCID: PMC9526907 DOI: 10.1186/s42836-022-00143-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/01/2022] [Indexed: 11/05/2022]
Abstract
AIMS Debate continues as to the optimal orientation of the acetabular component in total hip arthroplasty (THA) and how to reliably achieve this. The primary objective of this study was to compare functional CT-based planning and patient-specific instruments with conventional THA using 2D templating. METHODS A pragmatic single-center, patient-assessor blinded, randomized control trial of patients undergoing THA was performed. 54 patients (aged 18-70) were recruited to either Corin Optimized Positioning System (OPS) or conventional THA. All patients received a cementless acetabular component. All patients underwent pre- and postoperative CT scans, and four functional X-rays. Patients in the OPS group had a 3D surgical plan and bespoke guides made. Patients in the conventional group had a surgical plan based on 2D templating X-rays. The primary outcome measure was the mean error in acetabular anteversion as determined by postoperative CT scan. RESULTS There was no statistically significant difference in the mean error in angle of acetabular anteversion when comparing OPS and conventional THA. In the OPS group, the achieved acetabular anteversion was within 10° of the planned anteversion in 96% of cases, compared with only 76% in the conventional group. The clinical outcomes were comparable between the groups. CONCLUSION Large errors in acetabular orientation appear to be reduced when CT-based planning and patient-specific instruments are used compared to the standard technique but no significant differences were seen in the mean error.
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Affiliation(s)
- Christopher Thomas
- grid.15628.380000 0004 0393 1193University Hospitals Coventry & Warwickshire NHS Trust, Coventry, England ,grid.414081.80000 0004 0400 1166Present address: Dorset County Hospital, Williams Avenue, Dorchester, DT1 2JY UK
| | - Vatsal Gupta
- grid.15628.380000 0004 0393 1193University Hospitals Coventry & Warwickshire NHS Trust, Coventry, England
| | - Helen Parsons
- grid.7372.10000 0000 8809 1613University of Warwick, Coventry, England
| | - Andrew Metcalfe
- grid.15628.380000 0004 0393 1193University Hospitals Coventry & Warwickshire NHS Trust, Coventry, England ,grid.7372.10000 0000 8809 1613University of Warwick, Coventry, England
| | - Pedro Foguet
- grid.15628.380000 0004 0393 1193University Hospitals Coventry & Warwickshire NHS Trust, Coventry, England
| | - Richard King
- grid.15628.380000 0004 0393 1193University Hospitals Coventry & Warwickshire NHS Trust, Coventry, England
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15
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Innmann MM, Verhaegen J, Merle C, Beaulé PE, Meermans G, Grammatopoulos G. Cup orientation following posterior approach THA - the effect of different visual aids and pelvic supports. BMC Musculoskelet Disord 2022; 23:881. [PMID: 36138377 PMCID: PMC9502576 DOI: 10.1186/s12891-022-05820-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction This study aims to compare cup inclination achieved (1) Using two orientation guides, whilst using the same 3-point pelvic positioner and (2) Using two types of pelvic positioners, whilst measuring intra-operative cup inclination with an inclinometer. Materials and methods This is a prospective, diagnostic cohort study of a consecutive series of 150 THAs performed through a posterior approach. Two types of 3-point pelvic positioners were used (Stulberg and modified Capello Hip Positioners) and the cup was positioned freehand using one of two orientation guides (mechanical guide or digital inclinometer). Intra-operative inclination was recorded, radiographic cup inclination and anteversion were measured from radiographs. The differences in inclination due to pelvic position (ΔPelvicPosition) and orientation definitions (ΔDefinition) were calculated. Target radiographic inclination and anteversion was 40/20° ± 10°. Results There was no difference in radiographic cup inclination/ (p = 0.63) using a mechanical guide or digital inclinometer. However, differences were seen in ΔPelvicPosition between the positioners ((Stulberg: 0° ± 5 vs. Capello: 3° ± 6); p = 0.011). Intra-operative inclination at implantation was different between positioners and this led to equivalent cases within inclination/anteversion targets (Stulberg:84%, Capello:80%; p = 0.48). Conclusions With the pelvis securely positioned with 3-point supports, optimum cup orientation can be achieved with both alignment guides and inclinometer. Non-optimal cup inclinations were seen when intra-operative inclinations were above 40° and below 32°, or the ΔPelvicPosition was excessive (> 15°; n = 2). We would thus recommend that the intra-operative cup inclination should be centered strictly between 30° and 35° relative to the floor. Small differences exist between different type of pelvic positioners that surgeons need to be aware off and account for.
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Affiliation(s)
- Moritz M Innmann
- Division of Orthopaedic Surgery, The Ottawa Hospital, Critical Care Wing, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada. .,Department of Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Jeroen Verhaegen
- Division of Orthopaedic Surgery, The Ottawa Hospital, Critical Care Wing, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,Department of Orthopaedics and Traumatology, University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Orthopedic Center Antwerp, Kielsevest 14, 2018, Antwerp, Belgium
| | - Christian Merle
- Department of Orthopaedics and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Critical Care Wing, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Geert Meermans
- Department of Orthopaedics, Bravis Hospital, Boerhaavelaan 25, 4708 AE, Roosendaal, The Netherlands
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital, Critical Care Wing, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
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16
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Moreta J, Gayoso Ó, Donaire-Hoyas D, Roces-García J, Gómez-Vallejo J, Moya-Gómez E, Raya-Roldán D, Albert-Ullibarri A, Marqués-López F, Albareda J. Orthopedic Surgeons’ Accuracy When Orienting an Acetabular Cup. A Comparison with Untrained Individuals. Medicina (B Aires) 2022; 58:medicina58070973. [PMID: 35888692 PMCID: PMC9317603 DOI: 10.3390/medicina58070973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 06/29/2022] [Accepted: 07/18/2022] [Indexed: 12/04/2022] Open
Abstract
Background and Objectives: Previous studies demonstrated a huge variability among surgeons when it comes to reproducing the position of an acetabular cup in total hip arthroplasty. Our main objective is to determine if orthopedic surgeons can replicate a given orientation on a pelvic model better than untrained individuals. Our secondary objective is to determine if experience has any influence on their ability for this task. Materials and Methods: A group of specialist orthopedic hip surgeons and a group of volunteers with no medical training were asked to reproduce three given (randomly generated) acetabular cup orientations (inclination and anteversion) on a pelvic model. Error was measured by means of a hip navigation system and comparisons between groups were made using the appropriate statistical methods. Results: The study included 107 individuals, 36 orthopedic surgeons and 71 untrained volunteers. The mean error among surgeons was slightly greater as regards both inclination (7.84 ± 5.53 vs. 6.70 ± 4.03) and anteversion (5.85 ± 4.52 vs. 5.48 ± 3.44), although statistical significance was not reached (p = 0.226 and p = 0.639, respectively). Similarly, although surgeons with more than 100 procedures a year obtained better results than those with less surgical experience (8.01 vs. 7.67 degrees of error in inclination and 5.83 vs. 5.87 in anteversion), this difference was not statistically significant, either (p = 0.852 and p = 0.981). Conclusions: No differences were found in the average error made by orthopedic surgeons and untrained individuals. Furthermore, the surgeons’ cup orientation accuracy was not seen to improve significantly with experience.
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Affiliation(s)
- Jesús Moreta
- Department of Orthopedic Surgery and Traumatology, Hospital Galdakao-Usansolo, 48960 Galdakao, Spain
- Correspondence:
| | - Óscar Gayoso
- Department of Orthopedic Surgery and Traumatology, Hospital San Rafael, 15006 A Coruña, Spain;
| | - Daniel Donaire-Hoyas
- Department of Orthopedic Surgery and Traumatology, Hospital de Poniente, 04700 El Ejido, Spain; (D.D.-H.); (D.R.-R.); (A.A.-U.)
| | - Jorge Roces-García
- Department of Construction and Manufacturing Engineering, Polytechnic School of Engineering of Gijón, University of Oviedo, 33204 Gijón, Spain;
| | - Jesús Gómez-Vallejo
- Department of Orthopedic Surgery and Traumatology, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain; (J.G.-V.); (J.A.)
| | - Esther Moya-Gómez
- Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Cruz y San Pablo, 08025 Barcelona, Spain;
| | - David Raya-Roldán
- Department of Orthopedic Surgery and Traumatology, Hospital de Poniente, 04700 El Ejido, Spain; (D.D.-H.); (D.R.-R.); (A.A.-U.)
| | - Alberto Albert-Ullibarri
- Department of Orthopedic Surgery and Traumatology, Hospital de Poniente, 04700 El Ejido, Spain; (D.D.-H.); (D.R.-R.); (A.A.-U.)
| | - Fernando Marqués-López
- Department of Orthopedic Surgery and Traumatology, Parc de Salut Mar, 08003 Barcelona, Spain;
| | - Jorge Albareda
- Department of Orthopedic Surgery and Traumatology, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain; (J.G.-V.); (J.A.)
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17
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Killen CJ, Murphy MP, Ralles SJ, Khayatzadeh S, Brown NM, Patwardhan AG, Havey RM, Wu K. Characterising acetabular component orientation with pelvic motion during total hip arthroplasty. Hip Int 2021; 31:743-750. [PMID: 32375525 DOI: 10.1177/1120700020925013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Suboptimal acetabular component position can result in impingement, dislocation, and accelerated wear. Intraoperative pelvic motion has led to surgeon error and acetabular cup malposition. This study characterises the relationship between pelvic rotation and postoperative acetabular cup orientation. METHODS A device was constructed to allow cadaveric pelvis rotation along three axes about an acetabular cup in fixed orientation. The acetabular cup was fixed in space at 40° of radiographic inclination and 15° of anteversion relative to the anterior pelvic plane to represent consistent surgeon intraoperative placement. Active marker clusters were fixed to surgical equipment while the cadaveric pelvis was cemented with passive reflective markers, both identified with the Optotrak Certus motion capture system. The reamed cadaveric pelvis was rotated along three axes from -45° to 45° of roll, -30° to 30° of tilt, and -35° to 35° of pitch. The change in component inclination and anteversion was recorded at each 5° interval. Using computed tomography 3D reconstruction, the experimental setup was duplicated computationally to assess against a greater range of pelvis and implant sizes. RESULTS Radiographic anteversion and inclination showed a non-linear relationship dependent on pelvic roll, tilt, and pitch. Radiographic anteversion changed -0.59°, 0.76° and 0.01° while radiographic inclination changed 0.23°, 0.18° and 1.00° for every 1° of pelvic roll, tilt and pitch, respectively. Computationally, anteversion changed -0.61°, 0.75° and 0.00° while inclination changed 0.22°, 0.19° and 1.00° for every 1° of pelvic roll, tilt and pitch, respectively. These results were independent of cup and pelvis size. CONCLUSIONS Intraoperative pelvic motion can significantly affect final cup position, and this should be accounted for when placing acetabular components during total hip arthroplasty. Based on this study, intraoperative adjustment of the acetabular component position based on pelvis motion may be implemented to improve postoperative component position.
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Affiliation(s)
- Cameron J Killen
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Michael P Murphy
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Steven J Ralles
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Saeed Khayatzadeh
- Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. V.A. Hospital, Hines, IL, USA
| | - Nicholas M Brown
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Avinash G Patwardhan
- Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. V.A. Hospital, Hines, IL, USA
| | - Robert M Havey
- Musculoskeletal Biomechanics Laboratory, Edward Hines Jr. V.A. Hospital, Hines, IL, USA
| | - Karen Wu
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
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18
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Zhou Y, Shao H, Huang Y, Deng W, Yang D, Bian T. Does robotic assisted technology improve the accuracy of acetabular component positioning in patients with DDH? J Orthop Surg (Hong Kong) 2021; 29:23094990211025325. [PMID: 34308688 DOI: 10.1177/23094990211025325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Accurate positioning of the acetabular component is key in performing total hip arthroplasty (THA). However, reconstruction of the acetabulum in the setting of developmental dysplasia of the hip (DDH) is a challenge. Robotic assisted THA has the potential to improve the accuracy of implantation of the acetabular cup in cases with DDH. The purpose of this study was to assess whether robotic technology improves the accuracy of acetabular component positioning in patients with DDH. MATERIAL AND METHODS We included 59 THAs using robotic assisted technology from June 2019 to January 2020 as the study group. These were compared to conventional THAs without robotic technology after control for age, gender, body mass index (BMI), Crowe type and operation date. Radiographic measurements were taken by 2 blinded orthopaedic residents. The percentage of hips within the Lewinnek and Collanan safe zones were calculated, along with acetabular rotation centers for the "target zone." Surgical time and perioperative bleeding were also compared between both groups. RESULTS One patient suffered dislocation in conventional group while no dislocation occurred in robotic group. The acetabular components of the robotic assisted group had more cases located within the Lewinnek (p = 0.013) and Collanan (p = 0.008) safe zones than conventional group (94.9% vs 79.7% and 74.6% vs 50.8%). There were 7 cases in conventional group and 4 cases in robotic group that had more lateral or more superior rotational centers of THA, but did not reach statistical significance (p = 0.342). No statistical difference was detected between groups with regards to blood loss (p = 0.098) and surgical time (p = 0.602). CONCLUSION Robot assisted technology can assist surgeons with implanting acetabular cups more in Lewinnek and Callanan safe zone than conventional techniques without additional blood loss and surgical time. LEVEL OF EVIDENCE Therapeutic Level Ⅲ.
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Affiliation(s)
- Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yong Huang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Wang Deng
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Dejin Yang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Tao Bian
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
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19
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van Duren BH, Royeca JM, Cunningham CM, Lamb JN, Brew CJ, Pandit H. Can the use of an inclinometer improve acetabular cup inclination in total hip arthroplasty? A review of the literature. Hip Int 2021; 31:609-617. [PMID: 32750263 PMCID: PMC8488637 DOI: 10.1177/1120700020946716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The angle of acetabular (cup) radiographic inclination is an important measurement in total hip arthroplasty (THA) procedures. Abnormal radiographic inclination is associated with dislocation, edge loading and higher failure rates. Consistently achieving a satisfactory radiographic inclination remains a challenge. Inclinometers have been increasingly used over the last decade. This paper reviews the literature to determine whether using an inclinometer improves the accuracy of acetabular cup inclination in THA. METHODS A systematic literature search was performed. The following search terms were used: ('hip' OR 'hip replacement' OR 'hip arthroplasty' OR 'primary hip replacement' OR 'THR' OR 'THA' OR 'Acetabular cup Inclination') AND ('Inclinometer'). Titles and abstracts were screened for relevance. Both radiographic and operative inclination comparisons were included. RESULTS 7 studies met the inclusion criteria. 2 were randomised control trials with level I evidence, and the remaining studies were cohort studies with level III/IV evidence. 5 were clinical and 2 experimental. In total there were 16 cohorts: 7 using an inclinometer, 6 freehand, and 3 using MAG techniques. All studies comparing radiographic inclination and 1 of 2 studies comparing operative inclination showed an improvement in the attainment of the optimal inclination. Similarly, the use of an inclinometer showed a reduction in the number of outliers when compared to MAG and freehand techniques. DISCUSSION This review demonstrates that using an inclinometer improved the surgeon's ability to achieve their intended inclination (both operative and radiographic) and reduced the incidence of positioning outside the safe-zone. However, only 2 of the studies were randomised control trials and these resulted in opposing conclusions. Therefore, further studies looking at the use of inclinometers would prove useful in understanding their true benefit.
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Affiliation(s)
- Bernard H van Duren
- Leeds Orthopaedic and Trauma Sciences, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK,Bernard H van Duren, Leeds Institute of Rheumatic and Musculoskeletal Medicine, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.
| | | | | | - Jonathan N Lamb
- Leeds Orthopaedic and Trauma Sciences, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - Hemant Pandit
- Leeds Orthopaedic and Trauma Sciences, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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20
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Murphy MP, Killen CJ, Ralles SJ, Brown NM, Song AJ, Wu K. The area method for measuring acetabular cup anteversion: An accurate and autonomous solution. J Clin Orthop Trauma 2021; 18:61-65. [PMID: 33996450 PMCID: PMC8099551 DOI: 10.1016/j.jcot.2021.04.002] [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: 10/25/2020] [Accepted: 04/03/2021] [Indexed: 11/18/2022] Open
Abstract
Several radiological methods of measuring anteversion of the acetabular component after total hip arthroplasty have been described, all time-consuming and with varying reproducibility. This study aimed to compare the recently proposed Area method to true cup anteversion as determined by an accelerometer. This study further applied this method programmatically to autonomously determine radiographic cup orientation using two computer programs, then compared these results to hand and accelerometer measurements. 160 anteroposterior pelvis radiographs were taken of a standard Sawbones® pelvis fitted with a total hip arthroplasty system. The acetabular cup was re-oriented between each radiograph, with anteversion ranging from 0° to 90°. An accelerometer was mounted to the cup to measure true cup anteversion. Radiographic anteversion was independently measured via three methods: by hand, linear image processing, and machine learning. Measurements were compared to triaxial accelerometer recordings. Coefficient of determination (R2) was found to be 0.997, 0.991, and 0.989 for hand measurements, the machine learning, and linear image processing, respectively. The machine learning program and hand measurements overestimated anteversion by 0.70° and 0.02° respectively. The program using linear techniques underestimated anteversion by 5.02°. Average runtime was 0.03 and 0.59 s for the machine learning and linear image processing program, respectively. The machine learning program averaged within 1° of cup orientation given a true cup anteversion less than 51°, and within 2° given an anteversion less than 85°. The Area method showed great accuracy and reliability with hand measurements compared to true anteversion. The results of this study support the use of machine learning for accurate, timely, autonomous assessment of cup orientation.
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Affiliation(s)
- Michael P. Murphy
- Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 2160 S. First Avenue,Maguire Suite 1700, Maywood, IL 60153, USA
- Corresponding author.
| | - Cameron J. Killen
- Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 2160 S. First Avenue,Maguire Suite 1700, Maywood, IL 60153, USA
| | - Steven J. Ralles
- Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 2160 S. First Avenue,Maguire Suite 1700, Maywood, IL 60153, USA
| | - Nicholas M. Brown
- Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 2160 S. First Avenue,Maguire Suite 1700, Maywood, IL 60153, USA
| | - Albert J. Song
- Loyola University Medical Center, Department of Radiology, 2160 S. First Avenue,Maguire Suite 1700, Maywood, IL 60153, USA
| | - Karen Wu
- Loyola University Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 2160 S. First Avenue,Maguire Suite 1700, Maywood, IL 60153, USA
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21
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van Duren BH, Al Ashqar M, Lamb JN, Pandit HG, Brew C. A novel mechanical inclinometer device to measure acetabular cup inclination in total hip arthroplasty. J Med Eng Technol 2020; 44:481-488. [PMID: 33118407 DOI: 10.1080/03091902.2020.1825846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
It is well recognised that acetabular cup orientation influences patient function and implant survival post-THR. Reliable intra-operative determination of cup orientation remains a challenge. We describe the design and testing of a novel mechanical inclinometer to measure intra-operative acetabular cup inclination. The aim was to design a generic inclinometer to measure acetabular inclination to within + 5° without requiring modification to existing instrumentation while remaining easy to handle, robust/reusable, and sterilizable. The device was drafted using CAD software, prototyped using a 3D printer and constructed using stainless steel. Two experiments were undertaken to test accuracy: (1) the absolute accuracy was tested; (2) placement of an acetabular component using the device was compared to a freehand technique using a sawbone pelvis. 18 surgeons were asked to place an uncemented acetabular cup in a saw bone pelvis to a target of 40°. The average root-mean-square error was 1.1° (SD: 0.9°). Comparison showed that with the freehand component placement 50% of the surgeons were outside the specified range (35°-45°) where all participants achieved placement within range when using the inclinometer. This work demonstrates that the design and initial testing of a mechanical inclinometer which is suitable for use in determining the acetabular cup inclination in THR.
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Affiliation(s)
- B H van Duren
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | | | - J N Lamb
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - H G Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - C Brew
- Bradford Royal Infirmary, Bradford, UK
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22
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Agarwal A, Pawar I, Singh S, Randev D, Sati HC. Validation of use of transverse acetabular ligament and mechanical angle guide device to orient the acetabular cup. J Clin Orthop Trauma 2020; 11:S766-S771. [PMID: 32999553 PMCID: PMC7503160 DOI: 10.1016/j.jcot.2020.07.034] [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: 04/24/2020] [Revised: 07/05/2020] [Accepted: 07/30/2020] [Indexed: 10/23/2022] Open
Abstract
AIM To verify if transverse acetabular ligament (TAL) can be used as an anatomical landmark to reliably orient the cup in primary total hip arthroplasty and compare it to acetabular cups placed with the help of mechanical angle guide (MAG) device. MATERIALS AND METHODS Thirty Five patients with primary total hip arthroplasty, all performed by the same surgeon were included in the study. All patients had undergone surgery by anterolateral approach and all were cementless total hip arthroplasty. TAL was used as a reference guide for positioning of the cup in one group while MAG device was used in the other. Post operatively CT was done to confirm the version and inclination of the acetabular cup and the femoral stem version. SPSS was used for statistical analysis. RESULTS 18 males and 17 females were included. The most common etiological cause for THR was secondary osteoarthritis due to AVN (40%). At 18 months follow up, there was just 1 case of dislocation in group in which angle guide device was used. The mean anteversion of the acetabular cup on CT findings was 23.82° by using TAL while 18.35° with help of MAG device (P < 0.05). All were within Leweniks safe zone. CONCLUSIONS The TAL and MAG device both can be effectively used to align the acetabulum component. TAL is patient specific intraoperative landmark which is not affected by patient positioning while angle guide device can give false positive assessment of cup version.
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Affiliation(s)
- Archit Agarwal
- ESIC PGIMSR and Model Hospital, Delhi, India,Corresponding author.
| | - Inder Pawar
- ESIC PGIMSR and Model Hospital, Delhi, India
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23
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Cotter BD, Innmann MM, Dobransky JS, Merle C, Beaulé PE, Grammatopoulos G. Does Functional Cup Orientation Change at Minimum of 10 Years After Primary Total Hip Arthroplasty? J Arthroplasty 2020; 35:2507-2512. [PMID: 32444235 DOI: 10.1016/j.arth.2020.04.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cup orientation has been shown to influence the postoperative risk of impingement and dislocation following total hip arthroplasty (THA) and may change over time due to changes in pelvic tilt that occur with aging. The purpose of this study is to determine if there is a significant change in acetabular cup inclination and anteversion over a 10-year period following THA. METHODS A retrospective, multisurgeon, single-center cohort study was conducted of 46 patients that underwent THA between 1995 and 2002. A total of 46 patients were included, with a median age at surgery of 56 years, and a median time between initial postoperative radiograph and the most recent one being 13.5 years (minimum 10 years). Cup orientation was measured from postoperative and follow-up supine anterior-posterior pelvic radiographs. Using a validated software, inclination and anteversion were calculated at each interval and the change in cup anteversion and inclination angle was determined. Furthermore, the difference in the sacro-femoral-pubic angle was measured, reflecting the difference in pelvic tilt between intervals. RESULTS No significant difference was detected between measurements taken from initial postoperative radiograph and measurements a minimum of 10 years later (P > .45), with the median (interquartile range) change in anteversion, inclination, and sacro-femoral-pubic being 0° (-1° to 3°), 1° (-3° to 2°), and 0° (-2° to 3°), respectively. CONCLUSION Our study found no significant change in functional cup orientation a minimum of 10 years after THA. No shifts in functional cup orientation as a result of altering spinopelvic alignment seemed to be present over a 10-year period.
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Affiliation(s)
- Brendan D Cotter
- Division of Orthopaedic Surgery, The Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | - Moritz M Innmann
- Department of Orthopaedic and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Johanna S Dobransky
- Division of Orthopaedic Surgery, The Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | - Christian Merle
- Department of Orthopaedic and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | - George Grammatopoulos
- Division of Orthopaedic Surgery, The Ottawa Hospital General Campus, Ottawa, Ontario, Canada
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Widmer KH. The Impingement-free, Prosthesis-specific, and Anatomy-adjusted Combined Target Zone for Component Positioning in THA Depends on Design and Implantation Parameters of both Components. Clin Orthop Relat Res 2020; 478:1904-1918. [PMID: 32732575 PMCID: PMC7371099 DOI: 10.1097/corr.0000000000001233] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/04/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lewinnek's recommendation for orienting the cup in THA is criticized because it involves a static assessment of the safe zone and because it does not consider stem geometry. A revised concept of the safe zone should consider those factors, but to our knowledge, this has not been assessed. QUESTIONS/PURPOSES (1) To determine the shape, size, and location of target zones for combined cup and stem orientation for a straight stem/hemispheric cup THA to maximize the impingement-free ROM and (2) To determine whether and how these implant positions change as stem anteversion, neck-shaft angle, prosthetic head size and target range of movements are varied. METHODS A three-dimensional computer-assisted design model, in which design geometry was expressed in terms of parameters, of a straight stem/hemispheric cup hip prosthesis was designed, its design parameters modified systematically, and each prosthesis model was implanted virtually at predefined component orientations. Functional component orientation referencing to body planes was used: cups were abducted from 20° to 70°, and anteverted from -10° to 40°. Stems were rotated from -10° to 40° anteversion, neck-shaft angles varied from 115° to 143°, and head sizes varied from 28 to 40 mm. Hip movements up to the point of prosthetic impingement were tested, including simple flexion/extension, internal/external rotation, ab/adduction, combinations of these, and activities of daily living that were known to trigger dislocation. For each combination of parameters, the impingement-free combined target zone was determined. Maximizing the size of the combined target zone was the optimization criterion. RESULTS The combined target zones for impingement-free cup orientation had polygonal boundaries. Their size and position in the diagram changed with stem anteversion, neck-shaft angle, head size, and target ROM. The largest target zones were at neck-shaft angles from 125° to 127°, at stem anteversions from 10° to 20°, and at radiographic cup anteversions between 17° and 25°. Cup anteversion and stem anteversion were inverse-linearly correlated supporting the combined-anteversion concept. The range of impingement-free cup inclinations depended on head size, stem anteversion, and neck-shaft angle. For a 127°-neck-shaft angle, the lowest cup inclinations that fell within the target zone were 42° for the 28-mm and 35° for the 40-mm head. Cup anteversion and combined version depended on neck-shaft angle. For head size 32-mm cup, anteversion was 6° for a 115° neck-shaft angle and 25° for a 135°-neck-shaft angle, and combined version was 15° and 34° respectively. CONCLUSIONS The shape, size, and location of the combined target zones were dependent on design and implantation parameters of both components. Changing the prosthesis design or changing implantation parameters also changed the combined target zone. A maximized combined target zone was found. It is mandatory to consider both components to determine the accurate impingement-free prosthetic ROM in THA. CLINICAL RELEVANCE This study accurately defines the hypothetical impingement-free, design-specific component orientation in THA. Transforming it into clinical precision may be the case for navigation and/or robotics, but this is speculative, and as of now, unproven.
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Affiliation(s)
- Karl-Heinz Widmer
- K.-H. Widmer, Medical Faculty University of Basel, Basel, Switzerland
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25
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Xiao H, Wang C, Zhong D, Lei P, Hu Y, Su S. Effect of patient-specific instrument on lowering threshold for junior physicians to perform total hip arthroplasty on developmental dysplasia of the hip patients. INTERNATIONAL ORTHOPAEDICS 2020; 44:1281-1286. [PMID: 32405884 DOI: 10.1007/s00264-020-04599-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/27/2020] [Indexed: 01/11/2023]
Abstract
PURPOSE To create a patient-specific instrument (PSI) in lowering the surgical experience requirement for junior physicians to perform total hip arthroplasty (THA) on developmental dysplasia of the hip (DDH) patients. METHODS Combined with rapid prototyping technology, we created a PSI and established DDH hip model in vitro. We enrolled 48 junior physicians and randomly assigned them into two groups. After creation of the PSI, they performed simulated THA surgery on a full-scale hip model with or without PSI on DDH models. The planned prothesis orientation, post-operative prothesis orientation, and surgery time were recorded. RESULTS The final cup inclination was 42.0 ± 0.8° in PSI group and 37.8 ± 2.0° in control group, while final cup anteversion was 16.0 ± 0.7° in PSI group and 24.7 ± 3.5° in control group. The △inclination in PSI group was smaller than that in control group (4.2 ± 0.5° vs 9.5 ± 1.4°, P < 0.01), so does △inclination (2.9 ± 0.4° in PSI group vs 15.2 ± 2.5° in control group, P < 0.01). The outlier percent was 8.3% in PSI group and 70.8% in control group (P < 0.01). At the same time, the PSI group did not prolong the operation time (P = 0.551). CONCLUSION The PSI can greatly increase the accuracy of placing the cup orientation and lower the threshold for junior physicians to perform THA on DDH patients. It could be a training tool for them to increase their THA surgical skills.
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Affiliation(s)
- Han Xiao
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Digital Orthopaedic Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chenggong Wang
- Digital Orthopaedic Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Da Zhong
- Digital Orthopaedic Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China. .,Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Pengfei Lei
- Digital Orthopaedic Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yihe Hu
- Digital Orthopaedic Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shilong Su
- Digital Orthopaedic Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
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26
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Zhao JX, Su XY, Zhao Z, Xiao RX, Sun GF, Zhang LC, Tang PF. The synergetic effect of pelvic rotation and X-ray offset on radiographic angles of the acetabular cup. Med Biol Eng Comput 2019; 57:2359-2371. [PMID: 31502181 DOI: 10.1007/s11517-019-02041-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/24/2019] [Indexed: 01/08/2023]
Abstract
The objective of this study is to investigate the synergetic effect of the pelvic rotation and X-ray offset on the radiographic anteversion/inclination (RA/RI) angles of the acetabular cup using a mathematical model. A cone model for establishing the spatial relationship between a three-dimensional (3D) circle and its two-dimensional (2D) elliptical projection is utilized to quantify the relationship between the 3D RA/RI angles of the cup and their 2D counterparts with different types of pelvic rotations in pelvic/hip anteroposterior radiographs. The results reveal that the effect of inlet/outlet views on the 2D RA angle is similar to that of iliac/obturator views. The permissible ranges of pelvic rotation for the 2D RA angle with an acceptable bias are the 3D space formed by the limits of triple axial rotations. For a specified acceptable bias of the 2D RA angle, these ranges are almost equal between pelvic and hip radiographs. The combined inlet/obturator or outlet/iliac views can maintain the 2D RA angle of a pelvic radiograph within the same range of acceptable bias as that of a hip radiograph. For a 2D RA angle with an acceptable bias, the permissible range of pelvic rotation needs to be evaluated with equal attention in both radiographs. Graphical abstract The traditional methods for calculating the radiographic angles of the acetabular cup are based on the ellipse projection of the opening circle of the cup on radiographs. However, with varying locations of the X-ray source and pelvis rotations about different axes, the outline of this ellipse projection will change, and accordingly, the traditional method and calculating results will be inaccurate. In this study, a cone model for three-dimensional circle-to-two-dimensional ellipse projection is utilized to incorporate the effect of X-ray offset and quantify the relationships of the radiographic angles of the cup with the true orientation of the cup and pelvic rotations in either pelvic or hip anteroposterior radiographic situation.
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Affiliation(s)
- Jing-Xin Zhao
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiu-Yun Su
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhe Zhao
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Ruo-Xiu Xiao
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Guo-Fei Sun
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Li-Cheng Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Pei-Fu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China.
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Rivière C, Harman C, Parsons T, Villet L, Cobb J, Maillot C. Kinematic alignment versus conventional techniques for total hip arthroplasty: A retrospective case control study. Orthop Traumatol Surg Res 2019; 105:895-905. [PMID: 30930093 DOI: 10.1016/j.otsr.2019.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 11/20/2018] [Accepted: 02/11/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Residual complications of conventionally implanted hip components have only been partially reduced by improved implant design and higher surgical precision, and their occurrence is poorly predicted by the radiographic standing/supine cup orientation. This has raised awareness that conventional techniques may not aim for the correct component orientation target, and the lumbo-pelvic kinematics, which influences the functional acetabular orientation, may be of interest to further improve THA clinical outcomes. This has led to the development of the Lumbo-Pelvic kinematic alignment (KA) technique for THA that aims to anatomically position and kinematically align hip implants (acetabular and femoral, total and resurfacing components), in order to optimise prosthetic hip biomechanics and hopefully improve prosthetic function, patient satisfaction, and components' lifespan. Therefore, we conducted a case control investigation to assess the early-term safety and efficacy of this new technique by answering the following questions: does the KA technique for THA: (1) better restore the native hip anatomy, (2) generate a different radiographic supine cup position, and (3) improve clinical outcomes in comparison to the conventional mechanical alignment technique? HYPOTHESES Using KA technique allows there is no statistically significant difference between the pre to postoperative differential for acetabular medial and vertical offsets, femoral offset, and leg length. METHODS We led a case control retrospective study with prospectively collected clinical data. Forty-one consecutive unselected KA-THAs performed with manual instrumentation were paired with 41 mechanically aligned THAs. The 1-year clinical outcomes and radiographical measurements were compared. RESULTS Compared to the mechanical alignment technique, the KA technique resulted in a more anatomical restoration of the prosthetic hip centre of rotation with a lower delta pre- to post-operative horizontal acetabular offset (1.47mm for KA versus -5.1mm for MA, p=0.001), and with 74% of KA versus 50% of MA cups (p=0.044) being within 15% of native anatomy for the horizontal acetabular offset. In addition, the KA technique resulted in a higher cup anteversion (22°±7° vs 15°±8°, p<0.001) but similar cup inclination (41°±6° vs. 42°±7°, p=0.25), a similar proportion of cups within the Lewinnek zone (65% vs. 70%, p=0.8), similar excellent functional outcomes (delta Oxford score pre- to follow-up of 24.3 and 23.5 points for KA and MA groups, respectively, p=0.88), similar patient satisfaction scores of 95.4/100 and 89.5/100 for KA and MA groups, respectively, and the same absence of aseptic complications. CONCLUSION The KA technique for THA has been demonstrated to be safe, efficacious, and not inferior to the conventional MA technique at early-term. As the concept of the KA technique for THA is only at an early stage, its influence on mid to long-term clinical outcomes remains to be determined and further refinements of the concept are yet to be made. LEVEL OF EVIDENCE III; case-control retrospective study.
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Affiliation(s)
- Charles Rivière
- South West London Elective Orthopaedic Centre, MSK Lab - Imperial College London, Dorking Road, KT18 7EG Epsom, United Kingdom.
| | - Ciara Harman
- SWLEOC Research centre, Dorking Road, KT18 7EG Epsom, United Kingdom
| | - Thomas Parsons
- SWLEOC Research centre, Dorking Road, KT18 7EG Epsom, United Kingdom
| | - Loic Villet
- Clinique du Sport, Centre de l'arthrose, 4, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Justin Cobb
- Laboratory Block, MSK Lab - Imperial College London, Charing Cross Campus, St Dunstan's Road, W6 8RP Hammersmith, London United Kingdom
| | - Cedric Maillot
- South West London Elective Orthopaedic Centre, MSK Lab - Imperial College London, Dorking Road, KT18 7EG Epsom, United Kingdom
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Can an Augmented Reality Headset Improve Accuracy of Acetabular Cup Orientation in Simulated THA? A Randomized Trial. Clin Orthop Relat Res 2019; 477:1190-1199. [PMID: 30507832 PMCID: PMC6494316 DOI: 10.1097/corr.0000000000000542] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Accurate implant orientation reduces wear and increases stability in arthroplasty but is a technically demanding skill. Augmented reality (AR) headsets overlay digital information on top of the real world. We have developed an enhanced AR headset capable of tracking bony anatomy in relation to an implant, but it has not yet been assessed for its suitability as a training tool for implant orientation. QUESTIONS/PURPOSES (1) In the setting of simulated THA performed by novices, does an AR headset improve the accuracy of acetabular component positioning compared with hands-on training by an expert surgeon? (2) What are trainees' perceptions of the AR headset in terms of realism of the task, acceptability of the technology, and its potential role for surgical training? METHODS Twenty-four study participants (medical students in their final year of school, who were applying to surgery residency programs, and who had no prior arthroplasty experience) participated in a randomized simulation trial using an AR headset and a simulated THA. Participants were randomized to two groups completing four once-weekly sessions of baseline assessment, training, and reassessment. One group trained using AR (with live holographic orientation feedback) and the other received one-on-one training from a hip arthroplasty surgeon. Demographics and baseline performance in orienting an acetabular implant to six patient-specific values on the phantom pelvis were collected before training and were comparable. The orientation error in degrees between the planned and achieved orientations was measured and was not different between groups with the numbers available (surgeon group mean error ± SD 16° ± 7° versus AR 14° ± 7°; p = 0.22). Participants trained by AR also completed a validated posttraining questionnaire evaluating their experiences. RESULTS During the four training sessions, participants using AR-guidance had smaller mean (± SD) errors in orientation than those receiving guidance from the surgeon: 1° ± 1° versus AR 6° ± 4°, p < 0.001. In the fourth session's assessment, participants in both groups had improved (surgeon group mean improvement 6°, 95% CI, 4-8°; p < 0.001 versus AR group 9°, 95% CI 7-10°; p < 0.001). There was no difference between participants in the surgeon-trained and AR-trained group: mean difference 1.2°, 95% CI, -1.8 to 4.2°; p = 0.281. In posttraining evaluation, 11 of 12 participants would use the AR platform as a training tool for developing visuospatial skills and 10 of 12 for procedure-specific rehearsals. Most participants (11 of 12) stated that a combination of an expert trainer for learning and AR for unsupervised training would be preferred. CONCLUSIONS A novel head-mounted AR platform tracked an implant in relation to bony anatomy to a clinically relevant level of accuracy during simulated THA. Learners were equally accurate, whether trained by AR or a surgeon. The platform enabled the use of real instruments and gave live feedback; AR was thus considered a feasible and valuable training tool as an adjunct to expert guidance in the operating room. Although there were no differences in accuracy between the groups trained using AR and those trained by an expert surgeon, we believe the tool may be useful in education because it demonstrates that some motor skills for arthroplasty may be learned in an unsupervised setting. Future studies will evaluate AR-training for arthroplasty skills other than cup orientation and its transfer validity to real surgery. LEVEL OF EVIDENCE Level I, therapeutic study.
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Rutherford M, O'Connor JD, Gill HS, Hill J, Beverland D, Lennon AB, Dunne NJ. Operative and radiographic acetabular component orientation in total hip replacement: Influence of pelvic orientation and surgical positioning technique. Med Eng Phys 2019; 64:7-14. [DOI: 10.1016/j.medengphy.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/12/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022]
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30
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Wang C, Xiao H, Yang W, Wang L, Hu Y, Liu H, Zhong D. Accuracy and practicability of a patient-specific guide using acetabular superolateral rim during THA in Crowe II/III DDH patients: a retrospective study. J Orthop Surg Res 2019; 14:19. [PMID: 30642333 PMCID: PMC6332857 DOI: 10.1186/s13018-018-1029-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/04/2018] [Indexed: 01/27/2023] Open
Abstract
Background It is challenging to create an ideal artificial acetabulum during total hip arthroplasty (THA) in adult DDH. Our team developed a new patient-specific instrument (PSI) that uses the superolateral rim of the acetabulum as a positioning mark to assist in the production of an artificial acetabulum in adult Crowe II/III DDH patients. The purpose of this retrospective study is to verify whether this new PSI can be used to implement the preoperative plan accurately and quickly to create an ideal artificial acetabulum during THA in adult Crowe II/III DDH patients. Methods We selected suitable adult Crowe II/III DDH patients from the registration system for artificial joint surgery at our hospital during April 2016 to March 2018 who underwent THA assisted by a PSI using the superolateral rim of the acetabulum as a positioning mark. We retrospectively analyzed data, including preoperative and postoperative anteversion, inclination, postoperative bilateral rotator center discrepancy (BRCD), surgery time, and the incidence of neurovascular injury. All patients underwent follow-up, and their Harris hip score (HHS) and X-ray data were recorded. Then, we performed statistical analyses on the data described above. Results A total of 20 hip surgeries from 17 patients were included in our study. All patients underwent a successful operation assisted by the PSI. The mean anteversion of the cup in our preoperative plan was 15.1° (range, 10.0° to 20.0°), while the mean postoperative anteversion of the cup was 15.3° (range, 7.0° to 28.6°). The mean inclination of the cup in our preoperative plan was 44.7° (range, 40.0° to 50.0°), while the mean postoperative inclination of the cup was 45.6° (range, 35.0° to 57.6°). Paired-samples t test revealed no significant differences in anteversion and inclination between pre- and postoperation times (P > 0.05). The mean BRCD was 3.38 ± 3.0 mm (range, 0.5 to 11.0 mm). The average operation time was 105.1 ± 15.4 min, and no patients had neurovascular injury complications. All patients’ acetabular components appeared clinically and radiologically stable after surgery. The mean HHS values were significantly improved at 12 weeks (P < 0.05) and 24 weeks (P < 0.05) postoperatively compared to the preoperative mean scores. Conclusions The new PSI is accurate and practical to create an ideal artificial acetabulum during THA in adult Crowe II/III DDH patients. Electronic supplementary material The online version of this article (10.1186/s13018-018-1029-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chenggong Wang
- Department of Orthopedics, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Han Xiao
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Weiwei Yang
- Geisel School of Medicine, Dartmouth College, Hanover, USA
| | - Long Wang
- Department of Orthopedics, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Yihe Hu
- Department of Orthopedics, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Hua Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Da Zhong
- Department of Orthopedics, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, Hunan, China.
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Snijders TE, Willemsen K, van Gaalen SM, Castelein RM, Weinans H, de Gast A. Lack of consensus on optimal acetabular cup orientation because of variation in assessment methods in total hip arthroplasty: a systematic review. Hip Int 2019; 29:41-50. [PMID: 29772949 DOI: 10.1177/1120700018759306] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION: Dislocation is 1 of the main reasons for revision of total hip arthroplasty but dislocation rates have not changed in the past decades, compromising patients' well-being. Acetabular cup orientation plays a key role in implant stability and has been widely studied. This article investigates whether there is a consensus on optimal cup orientation, which is necessary when using a navigation system. METHODS: A systematic search of the literature in the PubMed, Embase and Cochrane databases was performed (March 2017) to identify articles that investigated the direct relationship between cup orientation and dislocation, including a thorough evaluation of postoperative cup orientation assessment methods. RESULTS: 28 relevant articles evaluating a direct relation between dislocation and cup orientation could not come to a consensus. The key reason is a lack of uniformity in the assessment of cup orientation. Cup orientation is assessed with different imaging modalities, different methodologies, different definitions for inclination and anteversion, several reference planes and distinct patient positions. CONCLUSIONS: All available studies lack uniformity in cup orientation assessment; therefore it is impossible to reach consensus on optimal cup orientation. Using navigation systems for placement of the cup is inevitably flawed when using different definitions in the preoperative planning, peroperative placement and postoperative evaluation. Further methodological development is required to assess cup orientation. Consequently, the postoperative assessment should be uniform, thus differentiating between anterior and posterior dislocation, use the same definitions for inclination and anteversion with the same reference plane and with the patient in the same position.
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Affiliation(s)
- Thom E Snijders
- 1 Clinical Orthopedic Research Centre - mN, Zeist, Utrecht, The Netherlands
| | - Koen Willemsen
- 1 Clinical Orthopedic Research Centre - mN, Zeist, Utrecht, The Netherlands
| | | | - Rene M Castelein
- 2 Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, The Netherlands.,3 Department of Rheumatology, University Medical Center Utrecht, Utrecht, The Netherlands.,4 Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Harrie Weinans
- 2 Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, The Netherlands.,3 Department of Rheumatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arthur de Gast
- 1 Clinical Orthopedic Research Centre - mN, Zeist, Utrecht, The Netherlands
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Rutherford M, O'Connor JD, Hill JC, Beverland DE, Lennon AB, Dunne NJ. Patient positioning and cup orientation during total hip arthroplasty: assessment of current UK practice. Hip Int 2019; 29:89-95. [PMID: 29783888 DOI: 10.1177/1120700018760818] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION: Acetabular cup orientation during total hip arthroplasty (THA) remains a challenge. This is influenced by patient positioning during surgery and the method used to orientate the acetabular cup. The aim of this study was to assess current UK practice for patient positioning and cup orientation, particularly with respect to patient supports and techniques used to achieve target version and inclination. METHODS: A literature review and pilot study were initially conducted to develop the questionnaire, which was completed by British Hip Society members ( n = 183). As the majority of THA surgical procedures within the UK are performed with the patient in lateral decubitus, orthopaedic surgeons who operated with the patient in the supine position were excluded ( n = 18); a further 6% were incomplete and also excluded ( n = 11). RESULTS: Of those who operated in lateral decubitus, 76.6% ( n = 118/154) used the posterior approach. Only 31% ( n = 47/154) considered their supports to be completely rigid. More than 35% ( n = 55/154) were unhappy with the supports that they presently use. The most common methods for controlling operative inclination and version were a mechanical alignment guide (MAG; n = 78/154; 50.6%) and the transverse acetabular ligament (TAL; n = 82/154; 53.2%); 31.2% (48/154) used a freehand technique to control operative inclination. CONCLUSION: Limited studies have been conducted whereby patient supports have been analysed and key design principles outlined. With 35.7% of the orthopaedic surgeons surveyed having issues with their current supports, a greater awareness of essential characteristics for patient supports is required.
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Affiliation(s)
- Megan Rutherford
- 1 School of Mechanical and Aerospace Engineering, Queen's University of Belfast, Belfast, UK
| | - John D O'Connor
- 1 School of Mechanical and Aerospace Engineering, Queen's University of Belfast, Belfast, UK
| | - Janet C Hill
- 2 Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
| | | | - Alex B Lennon
- 1 School of Mechanical and Aerospace Engineering, Queen's University of Belfast, Belfast, UK
| | - Nicholas J Dunne
- 3 Centre for Medical Engineering Research, School of Mechanical and Manufacturing Engineering, Dublin City University, Ireland.,7 School of Mechanical and Manufacturing Engineering, Dublin City University,Ireland
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Zhao JX, Su XY, Zhao Z, Xiao RX, Zhang LC, Tang PF. Three-dimensional orientation and location-dependent varying rules of radiographic angles of the acetabular cup. INTERNATIONAL ORTHOPAEDICS 2018; 42:1819-1825. [PMID: 29453586 DOI: 10.1007/s00264-018-3809-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
Abstract
AIM The aim of this study is to demonstrate the varying rules of radiographic angles following varying three-dimensional (3D) orientations and locations of cup using an accurate mathematical model. METHODS A cone model is established to address the quantitative relationship between the opening circle of cup and its ellipse projection on radiograph. The varying rules of two-dimensional (2D) radiographic anteversion (RA) and inclination (RI) angles can be analyzed. RESULTS When the centre of cup is located above X-ray source, with proper 3D RI/RA angles, 2D RA angle can be equal to its 3D counterpart, and 2D RI angle is usually greater than its 3D counterpart. Except for the original point on hip-centered anterior-posterior radiograph, there is no area on radiograph where both 2D RA and RI angles are equal to their 3D counterparts simultaneously. DISCUSSION This study proposes an innovative model for accurately explaining how 2D RA/RI angles of cup are varying following different 3D RA/RI angles and location of cup. The analysis results provide clinicians an intuitive grasp of knowledge about 2D RA/RI angles greater or smaller than their 3D counterparts post-operatively. The established model may allow determining the effects of pelvic rotations on 2D radiographic angles of cup.
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Affiliation(s)
- Jing-Xin Zhao
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiu-Yun Su
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhe Zhao
- Department of Orthopaedics, Beijing Tsinghua Chang Gung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Ruo-Xiu Xiao
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Li-Cheng Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Pei-Fu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China.
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