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van Erp JHJ, Schlösser TPC, Baijense AW, Snijders TE, Stevenson R, Gielis WP, Castelein RM, Weinans H, de Gast A. Calculation of the 3-D femoral component's orientation in total hip arthroplasty using a trigonometric algorithm. Sci Rep 2022; 12:3499. [PMID: 35241700 PMCID: PMC8894411 DOI: 10.1038/s41598-022-07331-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/11/2022] [Indexed: 11/09/2022] Open
Abstract
Femoral component orientation plays a key role in implant stability and therefore the success rate of total hip arthroplasty. To date, this topic has been studied using various definitions and a variety of imaging modalities and protocols. The aim of this study is a proof of concept that a new algorithm can be used to describe the femoral component’s 3D orientation on the three orthogonal anatomical planes and relative to its mechanical axis using input from two orthogonal planes. CT scans of 18 patients with a total of 22 hip arthroplasties were collected. From these, orthogonal coronal and sagittal projections of the complete femur were acquired in the scanning position (MIPs) and relative to the femoral mechanical axis (corrected MIPs). On these images, the orientation of the neck of the femoral component in space and relative to the femoral axis, respectively, was measured by coronal inclination (CIF), sagittal inclination (SIF) and transverse version (TVF). With the algorithm, TVF was also calculated based on CIF and SIF. Differences between measured and calculated TVF and intra- and inter-observer reliability were evaluated using intra-class correlation coefficients (ICC). The error of non-orthogonal imaging (85° angle between the sagittal and coronal reconstructions) was tested on a third series of MIPs. The ICC between the calculated TVF and manually measured TVF, in space and relative to the femoral axis, was 0.98 for both with median absolute differences of 1.3 and 1.5°. For non-orthogonal images this was 0.70 with a median absolute difference of 5°. ICCs for intra-observer and inter-observer reliability for the calculated TVF values were 0.98 and 0.88, respectively. With this algorithm the transverse orientation of the neck of the femoral component can be assessed in space and relative to the mechanical femoral axis by combining its sagittal and coronal orientation. As long as the imaging visualizes two orthogonal planes, the orientation of an implant can be assessed in 3-D, regardless of the imaging modality.
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Affiliation(s)
- Joost H J van Erp
- Clinical Orthopedic Research Center-mN, Zeist, The Netherlands. .,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, The Netherlands. .,Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Tom P C Schlösser
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Thom E Snijders
- Clinical Orthopedic Research Center-mN, Zeist, The Netherlands.,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - Rob Stevenson
- Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem Paul Gielis
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Biomechanical Engineering, TU Delft, Delft, The Netherlands
| | - Arthur de Gast
- Clinical Orthopedic Research Center-mN, Zeist, The Netherlands
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Snijders TE, Schlösser TPC, van Straalen M, Castelein RM, Stevenson RP, Weinans H, de Gast A. Reply to the Letters to the Editor: The Effect of Postural Pelvic Dynamics on the Three-dimensional Orientation of the Acetabular Cup in THA Is Patient Specific. Clin Orthop Relat Res 2021; 479:1876-1877. [PMID: 34213503 PMCID: PMC8277261 DOI: 10.1097/corr.0000000000001872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Thom E. Snijders
- Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tom P. C. Schlösser
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marijn van Straalen
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - René M. Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rob P. Stevenson
- Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, the Netherlands
| | - Harrie Weinans
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Biomechanical Engineering, TU Delft, Delft, the Netherlands
| | - Arthur de Gast
- Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
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Snijders TE, Schlösser TPC, van Stralen M, Castelein RM, Stevenson RP, Weinans H, de Gast A. The Effect of Postural Pelvic Dynamics on the Three-dimensional Orientation of the Acetabular Cup in THA Is Patient Specific. Clin Orthop Relat Res 2021; 479:561-571. [PMID: 33009235 PMCID: PMC7899699 DOI: 10.1097/corr.0000000000001489] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/19/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sagittal pelvic dynamics mainly consist of the pelvis rotating anteriorly or posteriorly while the hips flexes, and this affects the femoroacetabular or THA configuration. Thus far, it is unknown how the acetabular cup of the THA in the individual patient reorients with changing sagittal pelvic dynamics. QUESTIONS/PURPOSES The aim of this study was to validate a method that establishes the three-dimensional (3-D) acetabular cup orientation with changing sagittal pelvic dynamics and describe these changes during functional pelvic dynamics. METHODS A novel trigonometric mathematical model, which was incorporated into an easy-to-use tool, was tested. The model connected sagittal tilt, transverse version, and coronal inclination of the acetabular cup during sagittal pelvic tilt. Furthermore, the effect of sagittal pelvic tilt on the 3-D reorientation of acetabular cups was simulated for cups with different initial positions. Twelve pelvic CT images of patients who underwent THA were taken and rotated around the hip axis to different degrees of anterior and posterior sagittal pelvic tilt (± 30°) to simulate functional pelvic tilt in various body positions. For each simulated pelvic tilt, the transverse version and coronal inclination of the cup were manually measured and compared with those measured in a mathematical model in which the 3-D cup positions were calculated. Next, this model was applied to different acetabular cup positions to simulate the effect of sagittal pelvic dynamics on the 3-D orientation of the acetabular cup in the coronal and transverse plane. After pelvic tilt was applied, the intraclass correlation coefficients of 108 measured and calculated coronal and transverse cup orientation angles were 0.963 and 0.990, respectively, validating the clinical use of the mathematical model. RESULTS The changes in 3-D acetabular cup orientation by functional pelvic tilt differed substantially between cups with different initial positions; the change in transverse version was much more pronounced in cups with low coronal inclination (from 50° to -29°) during functional pelvic tilt than in cups with a normal coronal inclination (from 39° to -11°) or high coronal inclination (from 31° to 2°). However, changes in coronal inclination were more pronounced in acetabular cups with high transverse version. CONCLUSION Using a simple algorithm to determine the dynamic 3-D reorientation of the acetabular cup during functional sagittal pelvic tilt, we demonstrated that the 3-D effect of functional pelvic tilt is specific to the initial acetabular cup orientation and thus per THA patient. CLINICAL RELEVANCE Future studies concerning THA (in)stability should not only include the initial acetabular cup orientation, but also they need to incorporate the effect of sagittal pelvic dynamics on the individual 3-D acetabular cup orientation. Clinicians can also use the developed tool, www.3d-hip.com, to calculate the acetabular cup's orientation in other instances, such as for patients with spinopelvic imbalance.
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Affiliation(s)
- Thom E Snijders
- T. E. Snijders, A. de Gast, Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- T. E. Snijders, T. P. C. Schlösser, R. M. Castelein, H. Weinans, Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- M. van Stralen, Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- R. P. Stevenson, Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, the Netherlands
- H. Weinans, Department of Biomechanical Engineering, TU Delft, Delft, the Netherlands
- A. de Gast, Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Tom P C Schlösser
- T. E. Snijders, A. de Gast, Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- T. E. Snijders, T. P. C. Schlösser, R. M. Castelein, H. Weinans, Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- M. van Stralen, Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- R. P. Stevenson, Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, the Netherlands
- H. Weinans, Department of Biomechanical Engineering, TU Delft, Delft, the Netherlands
- A. de Gast, Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Maartje van Stralen
- T. E. Snijders, A. de Gast, Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- T. E. Snijders, T. P. C. Schlösser, R. M. Castelein, H. Weinans, Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- M. van Stralen, Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- R. P. Stevenson, Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, the Netherlands
- H. Weinans, Department of Biomechanical Engineering, TU Delft, Delft, the Netherlands
- A. de Gast, Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Renee M Castelein
- T. E. Snijders, A. de Gast, Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- T. E. Snijders, T. P. C. Schlösser, R. M. Castelein, H. Weinans, Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- M. van Stralen, Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- R. P. Stevenson, Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, the Netherlands
- H. Weinans, Department of Biomechanical Engineering, TU Delft, Delft, the Netherlands
- A. de Gast, Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Rob P Stevenson
- T. E. Snijders, A. de Gast, Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- T. E. Snijders, T. P. C. Schlösser, R. M. Castelein, H. Weinans, Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- M. van Stralen, Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- R. P. Stevenson, Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, the Netherlands
- H. Weinans, Department of Biomechanical Engineering, TU Delft, Delft, the Netherlands
- A. de Gast, Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Harrie Weinans
- T. E. Snijders, A. de Gast, Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- T. E. Snijders, T. P. C. Schlösser, R. M. Castelein, H. Weinans, Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- M. van Stralen, Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- R. P. Stevenson, Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, the Netherlands
- H. Weinans, Department of Biomechanical Engineering, TU Delft, Delft, the Netherlands
- A. de Gast, Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Arthur de Gast
- T. E. Snijders, A. de Gast, Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- T. E. Snijders, T. P. C. Schlösser, R. M. Castelein, H. Weinans, Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- M. van Stralen, Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- R. P. Stevenson, Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, the Netherlands
- H. Weinans, Department of Biomechanical Engineering, TU Delft, Delft, the Netherlands
- A. de Gast, Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
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Schwarz TJ, Weber M, Renkawitz T, Greimel F, Leiss F, Grifka J, Schaumburger J. [Radiographic inclination and anteversion do not correspond to the actual cup slope and forward rotation]. DER ORTHOPADE 2020; 49:821-822. [PMID: 32734455 DOI: 10.1007/s00132-020-03962-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- T J Schwarz
- Klinik und Poliklinik für Orthopädie, Lehrstuhl für Orthopädie, Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - M Weber
- Klinik und Poliklinik für Orthopädie, Lehrstuhl für Orthopädie, Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - T Renkawitz
- Klinik und Poliklinik für Orthopädie, Lehrstuhl für Orthopädie, Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - F Greimel
- Klinik und Poliklinik für Orthopädie, Lehrstuhl für Orthopädie, Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - F Leiss
- Klinik und Poliklinik für Orthopädie, Lehrstuhl für Orthopädie, Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Klinik und Poliklinik für Orthopädie, Lehrstuhl für Orthopädie, Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - J Schaumburger
- Klinik und Poliklinik für Orthopädie, Lehrstuhl für Orthopädie, Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
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Zhao JX, Su XY, Zhao Z, Xiao RX, Zhang LC, Tang PF. Radiographic assessment of the cup orientation after total hip arthroplasty: a literature review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:130. [PMID: 32175423 DOI: 10.21037/atm.2019.12.150] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Optimal acetabular cup orientation is of substantial importance to good long-term function and low complication rates after total hip arthroplasty (THA). The radiographic anteversion (RA) and inclination (RI) angles of the cup are typically studied due to the practicability, simplicity, and ease of interpretation of their measurements. A great number of methods have been developed to date, most of which have been performed on pelvic or hip anteroposterior radiographs. However, there are primarily two influencing factors for these methods: X-ray offset and pelvic rotation. In addition, there are three types of pelvic rotations about the transverse, longitudinal, and anteroposterior axes of the body. Their effects on the RA and RI angles of the cup are interactively correlated with the position and true orientation of the cup. To date, various fitted or analytical models have been established to disclose the correlations between the X-ray offset and pelvic rotation and the RA and RI angles of the cup. Most of these models do not incorporate all the potential influencing parameters. Advanced methods for performing X-ray offset and pelvic rotation corrections are mainly performed on a single pelvic AP radiograph, two synchronized radiographs, or a two-dimensional/three-dimensional (2D-3D) registration system. Some measurement systems, originally developed for evaluating implant migration or wear, could also be used for correcting the X-ray offset and pelvic rotation simultaneously, but some drawbacks still exist with these systems. Above all, the 2D-3D registration technique might be an alternative and powerful tool for accurately measuring cup orientation. In addition to the current methods used for postoperative assessment, navigation systems and augmented reality are also used for the preoperative planning and intraoperative guidance of cup placement. With the continuing development of artificial intelligence and machine learning, these techniques could be incorporated into robot-assisted orthopaedic surgery in the future.
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Affiliation(s)
- Jing-Xin Zhao
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Xiu-Yun Su
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,Intelligent and Digital Surgery Innovation Center, Southern University of Science and Technology Hospital, Shenzhen, Guangdong 518055, 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
| | - Li-Cheng Zhang
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Pei-Fu Tang
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
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