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Chen X, Li S, Wang Y, Liu X, Zhang Y, Qiu G, Qian W. Artificially Intelligent Three-Dimensionally-Printed Patient-Specific Instrument Improves Total Hip Arthroplasty Accuracy. J Arthroplasty 2023; 38:2060-2067.e1. [PMID: 36535443 DOI: 10.1016/j.arth.2022.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/03/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patient-specific instrumentation (PSI) has the potential to improve the accuracy of implant positioning in total hip arthroplasty (THA). This prospective clinical study aimed to develop artificial intelligence to increase PSI production efficiency and assess accuracy, clinical outcomes, and learning curves. METHODS A convolutional neural network was applied to automatically process computer tomography images. PSI size and position were designed to guide the acetabular preparation and femoral neck resection. Thirty patients who underwent PSI-assisted THAs were matched to thirty patients who underwent free-hand THAs, and the component positions, as well as radiographic and clinical outcomes were analyzed. RESULTS PSI-assisted THA was significantly more accurate than free-hand THA at achieving the target component position. The mean absolute errors of cup inclination (P = .004) and anteversion (P < .001) were significantly smaller in the PSI group with fewer outliers. Calcar length (P = .002) and neck length (P = .026) were also more accurate in the PSI group. The leg length discrepancy was significantly lower in the PSI group (P = .002). There were no significant differences in operation time, blood loss, leg length discrepancy, or cup position among the first, second, and last 10 cases. CONCLUSION PSI-assisted THA offered more accurate component positions and better radiographic outcomes than free-hand THA. There was no evidence of a learning curve. Our findings suggest that PSI is a convenient and practical option to help surgeons achieve accurate surgical outcomes.
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Affiliation(s)
- Xi Chen
- Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China; Department of Orthopedic Surgery, West China Hospital, Sichuan, China; Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Songlin Li
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Yiou Wang
- Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Xingyu Liu
- School of Life Sciences, Tsinghua University, Beijing, China; Institute of Biomedical and Health Engineering (iBHE), Tsinghua Shenzhen International Graduate School, Shenzhen, China; Department of Biomedical Engineering, School of Medicine, Tsinghua Univsersity, Beijing, China; Longwood Valley Medical Technology Co Ltd, Beijing, China
| | - Yiling Zhang
- Longwood Valley Medical Technology Co Ltd, Beijing, China
| | - Guixing Qiu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Wenwei Qian
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
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Effectiveness of a patient-specific guide for femoral stem implantation in primary total hip arthroplasty: a randomized control trial. INTERNATIONAL ORTHOPAEDICS 2022; 46:805-814. [PMID: 35088177 DOI: 10.1007/s00264-021-05287-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of the present study was to evaluate the efficacy and feasibility of a novel CT-based patient-specific femoral alignment guide (PSG) as compared with conventional pre-operative planning during THA. METHODS From March 2020 to September 2020, patients receiving unilateral primary THA were enrolled and randomly allocated to the conventional pre-operative planning group and the PSG group. Primary outcomes were radiographic measurements including lower limb length, femoral offset, femoral anteversion and stem varus/valgus angle, and post-operative perception of leg length discrepancy (LLD). Secondary outcomes were surgical time, intra-operative blood loss, total blood loss, visual analogue scale (VAS), and Harris Hip Score (HHS). The occurrence of post-operative complications was also recorded. RESULTS Of the 104 patients screened, 80 cases were enrolled for analysis. The demographics of the two groups were similar. The PSG group illustrated significant improvements (p < 0.001) in lower limb length, femoral offset, femoral anteversion, and stem varus/valgus angle. Patients in the PSG group showed more favourable HHS (p < 0.001) at seven day, four week, andthree month (p = 0.003) follow-up. Perception of LLD was found significantly lower in the PSG group at three tmonth (p = 0.043), six month (p = 0.025), and 12-month (p = 0.048) follow-up. Utilization of the PSG had no significant increase in operative time, intra-operative blood loss, total blood loss, or VAS. No complication was noted in either group. CONCLUSION Relative to conventional pre-operative planning, the application with the PSG could potentially provide a simple and reliable solution for improving femoral prosthesis orientation in THA with high accessibility and low healthcare costs. TRN: ChiCTR2000031043 Date of registration: 2020/3/21.
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Fujii H, Hayama T, Abe T, Takahashi M, Matsushita Y, Sato R, Otani T, Saito M. Improving MiniHip femoral prosthesis positioning using a cross-laser projection system in total hip arthroplasty by an anterolateral supine approach. Int J Med Robot 2021; 17:e2214. [PMID: 33369069 PMCID: PMC7988605 DOI: 10.1002/rcs.2214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/20/2020] [Accepted: 12/21/2020] [Indexed: 11/17/2022]
Abstract
Background The authors developed a cross‐laser projection system (CLP) to place a femoral neck‐sparing short stem using the minimally invasive anterolateral supine approach in total hip arthroplasty. This study aimed to verify the utility of CLP. Methods Thirty joints were assessed with the MiniHip (Corin). The authors compared femoral component implantation with a patient‐specific femoral osteotomy guide (PSG) for the femoral neck‐cut (PSG group), with the CLP attached to the rasp handle to irradiate the cross‐laser to the target of PSG (CLP group), and without PSG or CLP (control group). Results In the CLP group, the positional deviation of anteversion, anterior/posterior tilt and varus/valgus placement of the stem postoperatively were 1.8° ± 0.2°, 2.0° ± 2.0° and 2.0° ± 0.1°, respectively. The positional deviation of anteversion (p < 0.001) and anterior/posterior tilt (p = 0.036) were significantly smaller than those in the other groups. Conclusions CLP improves the accuracy of MiniHip femoral prosthesis placement.
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Affiliation(s)
- Hideki Fujii
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuo Hayama
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiomi Abe
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Motoi Takahashi
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yohei Matsushita
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryuichi Sato
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takuya Otani
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Xing QQ, Zhong D, Pan YX, An SB, Wang CG, Su SL, Wang L, Hu YH. A Comparative Study of Patients' Subjective Feelings Toward Total Hip Arthroplasty with Patient-Specific Instruments and Traditional Total Hip Arthroplasty. Orthop Surg 2020; 12:269-276. [PMID: 32077264 PMCID: PMC7031611 DOI: 10.1111/os.12626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/25/2019] [Accepted: 01/03/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To determine whether differences exist in patients' subjective feelings, daily life, and surgical satisfaction between those who underwent surgery for developmental dysplasia of the hip (DDH) using patient-specific instruments (PSIs) and those who underwent traditional surgical total hip arthroplasty (THA). METHODS We selected 30 adult patients with various types of DDH who underwent surgery during 2016-2017 at our hospital. The patients were divided into PSI surgery group and the traditional surgery group. All patients underwent follow-up, and we collected data on the Harris Hip Score, Oxford University Hip Score (OHS), Forgotten Joint Score (FJS-12), Visual Analogue Scale (VAS) score, patient satisfaction score, intraoperative surgical time, amount of bleeding and postoperative complications incidence for both groups. We then performed statistical analyses on the data. RESULTS The Harris Hip Score, OHS, VAS score, patient satisfaction score, and mean bleeding volume did not differ statistically significantly (t-tests, P > 0.05). No statistically significant differences were found between surgical groups in the incidence of complication and sub-trochanteric osteotomy, or in the surgical side (chi-square tests, P > 0.05). For the experimental group, the FJS-12 score was 80.0 ± 12.0, and for the control group the score was 68.5 ± 16.1. The operative time of the experimental group was 138.4 ± 32.2 min, while that of the control group was 88.9 ± 26.8 min. The values of these data differed significantly (t-tests, P < 0.05). CONCLUSIONS The novel PSI designed by our group has certain advantages for the short-term subjective feelings of patients after THA, but it may cause prolonged operative times.
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Affiliation(s)
- Qi-Qi Xing
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Da Zhong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yi-Xiao Pan
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Sen-Bo An
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Cheng-Gong Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Shi-Long Su
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Long Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yi-He Hu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
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Kida D, Hashimoto H, Ito N, Kito Y, Mori K, Takahashi N, Tomita Y. An Open-Label, Single-Arm Study of a Patient-Specific Femoral Guide for Total Hip Arthroplasty via the Anterolateral Supine Approach, Linked with Three-Dimensional Surgical Support Software: Study Protocol. Kurume Med J 2019; 65:71-75. [PMID: 30197407 DOI: 10.2739/kurumemedj.ms652002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In total hip arthroplasty (THA), it is generally accepted that the bones of the acetabular cup and femur of hip joint must be accurately cut and components (artificial joint parts) be implanted in exact positions at exact angles to achieve improvement of daily living (ADL) and quality of life (QOL). However, with the conventional surgical method, it is difficult to grasp and measure the acetabular cup and femoral stem precisely during surgery, making some kind of reliable guide necessary. Although it was reported that an accurate angle was achieved in acetabular cup implantation by support instruments for surgical planning, an effective support instrument is now being developed for stem implantation on the out-of-reach femur side. This is the first clinical study to assess the efficacy and safety of anterolateral approach THA using an extracorporeal patient-specific femoral guide (PSG) for stem implantation with three-dimensional (3D) surgical support software in patients with hip joint disease.
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Affiliation(s)
- Daihei Kida
- Department of Orthopedic Surgery and Rheumatology, National Hospital Organization Nagoya Medical Center
| | - Hiroya Hashimoto
- Clinical Research Center, National Hospital Organization Nagoya Medical Center
| | - Noriko Ito
- Clinical Research Center, National Hospital Organization Nagoya Medical Center
| | | | - Kouichi Mori
- Department of Orthopedic Surgery and Rheumatology, National Hospital Organization Nagoya Medical Center
| | - Nobunori Takahashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine
| | - Yasushi Tomita
- Department of Cardiology, National Hospital Organization Nagoya Medical Center
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Abstract
Surgeons and engineers constantly search for methods to improve the surgical positioning of implants used for joint arthroplasty. Rapid prototyping is being used to develop patient-specific instrumentation (PSI) and has already been successfully translated into large-scale clinical use for knee arthroplasty. PSI has been used in shoulder arthroplasty; however, it is not yet known whether PSI provides improved accuracy and outcomes compared with conventional methods in either shoulder arthroplasty or knee arthroplasty. In the hip, PSI has been limited to the positioning of custom-manufactured implants and a small number of surgeons testing the emerging solutions from different manufacturers. Early results indicate consistent accurate positioning of implants with the use of PSI in hip arthroplasty but with added costs and uncertain effect on clinical outcomes.
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Lee S, Kim JY, Hong J, Baek SH, Kim SY. CT-based Navigation System Using a Patient-Specific Instrument for Femoral Component Positioning: An Experimental in vitro Study with a Sawbone Model. Yonsei Med J 2018; 59:769-780. [PMID: 29978614 PMCID: PMC6037596 DOI: 10.3349/ymj.2018.59.6.769] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The intraoperative version of the femoral component is usually determined by visual appraisal of the stem position relative to the distal femoral condylar axis. However, several studies have suggested that a surgeon's visual assessment of the stem position has a high probability of misinterpretation. We developed a computed tomography (CT)-based navigation system with a patient-specific instrument (PSI) capable of three-dimensional (3D) printing and investigated its accuracy and consistency in comparison to the conventional technique of visual assessment of the stem position. MATERIALS AND METHODS A CT scan of a femur sawbone model was performed, and pre-experimental planning was completed. We conducted 30 femoral neck osteotomies using the conventional technique and another 30 femoral neck osteotomies using the proposed technique. The femoral medullary canals were identified in both groups using a box chisel. RESULTS For the absolute deviation between the measured and planned values, the mean two-dimensional anteversions of the proposed and conventional techniques were 1.41° and 4.78°, while their mean 3D anteversions were 1.15° and 3.31°. The mean θ₁, θ₂, θ₃, and d, all of which are parameters for evaluating femoral neck osteotomy, were 2.93°, 1.96°, 5.29°, and 0.48 mm for the proposed technique and 4.26°, 3.17°, 4.43°, and 3.15 mm for the conventional technique, respectively. CONCLUSION The CT-based navigation system with PSI was more accurate and consistent than the conventional technique for assessment of stem position. Therefore, it can be used to reduce the frequency of incorrect assessments of the stem position among surgeons and to help with accurate determination of stem anteversion.
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Affiliation(s)
- Seongpung Lee
- Department of Robotics Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea
| | - Jun Young Kim
- Department of Orthopaedic Surgery, Daegu Catholic University College of Medicine, Daegu, Korea.
| | - Jaesung Hong
- Department of Robotics Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea
| | - Seung Hoon Baek
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Shin Yoon Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
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