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Lu X, Zhang Z, Xu H, Wang W, Zhang H. A new designed full process coverage robot-assisted total hip arthroplasty: a multicentre randomized clinical trial. Int J Surg 2024; 110:2141-2150. [PMID: 38241325 PMCID: PMC11020098 DOI: 10.1097/js9.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVE To compare the effect of a new complete robot-assisted total hip arthroplasty (RA-THA) with that of the manual total hip arthroplasty (MTHA) and to verify the accuracy and safety of the former. METHODS Overall, 148 patients were enroled from 3 March 2021 to 28 December 2021 in this study and classified into RA-THA ( n =74 patients) and MTHA ( n =74 patients) groups. The sex, age, operative side, BMI, diagnosis, other basic information, operative time, acetabular prosthesis anteversion and inclination, femoral prosthesis anteversion and angulation, femoral prosthesis filling rate, leg length discrepancy (LLD), Harris hip score, and visual analogue scale (VAS) score of the two groups were compared. RESULTS No significant differences were observed in the two groups regarding sex, age, operative side, BMI, diagnosis, Harris hip score, VAS score, acetabular inclination, acetabular prosthesis anteversion, femoral prosthesis anteversion, combined anteversion, and femoral prosthesis filling rate ( P >0.05). The operative time was significantly longer in the RA-THA group than in the MTHA group (106.71±25.22 min vs. 79.42±16.16 min; t=7.30, P <0.05). The femoral angulation (1.78°±0.64°) and LLD (2.87±1.55 mm) in the RA-THA group were significantly lesser than those in the MTHA group (2.22°±1.11° and 5.81±6.27 mm, respectively; t=-2.95 and t=-3.88, P <0.05). CONCLUSION The complete RA-THA has some advantages over the traditional procedure in restoring the lower limb length and controlling the femoral prosthesis angulation. Thus, this study verifies the accuracy and safety of the robot-assisted system.
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Affiliation(s)
| | | | | | | | - Haining Zhang
- Department of Joint Surgery, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Buchalter DB, Gall AM, Buckland AJ, Schwarzkopf R, Meftah M, Hepinstall MS. Creating Consensus in the Definition of Spinopelvic Mobility. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202306000-00005. [PMID: 37294841 PMCID: PMC10256344 DOI: 10.5435/jaaosglobal-d-22-00290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/29/2023] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The term "spinopelvic mobility" is most often applied to motion within the spinopelvic segment. It has also been used to describe changes in pelvic tilt between various functional positions, which is influenced by motion at the hip, knee, ankle and spinopelvic segment. In the interest of establishing a consistent language for spinopelvic mobility, we sought to clarify and simplify its definition to create consensus, improve communication, and increase consistency with research into the hip-spine relationship. METHODS A literature search was performed using the Medline (PubMed) library to identify all existing articles pertaining to spinopelvic mobility. We reported on the varying definitions of spinopelvic mobility including how different radiographic imaging techniques are used to define mobility. RESULTS The search term "spinopelvic mobility" returned a total of 72 articles. The frequency and context for the varying definitions of mobility were reported. 41 papers used standing and upright relaxed-seated radiographs without the use of extreme positioning, and 17 papers discussed the use of extreme positioning to define spinopelvic mobility. DISCUSSION Our review suggests that the definitions of spinopelvic mobility is not consistent in the majority of published literature. We suggest descriptions of spinopelvic mobility independently consider spinal motion, hip motion, and pelvic position, while recognizing and describing their interdependence.
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Affiliation(s)
- Daniel B. Buchalter
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Ashley M. Gall
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Aaron J. Buckland
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Ran Schwarzkopf
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Morteza Meftah
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
| | - Matthew S. Hepinstall
- From the Department of Orthopedic Surgery, NYU Langone Health, New York, NY (Dr. Buchalter, Ms. Gall, Dr. Buckland, Dr. Schwarzkopf, Dr. Meftah, and Dr. Hepinstall); and the Melbourne Orthopaedic Group, Spine and Scoliosis Research Associates, Melbourne, Australia (Dr. Buckland)
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Bose VC, Pichai S, Ashok Kumar PS, Kanniyan K, Yadlapalli S, Patil S. Does Balancing a Total Hip Arthroplasty Require a New Paradigm? Functional 3-Dimensional Balancing in Total Hip Arthroplasty. Indian J Orthop 2021; 55:1240-1249. [PMID: 34824725 PMCID: PMC8586388 DOI: 10.1007/s43465-021-00505-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/29/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Traditional principles for successful outcomes in Total Hip Arthroplasty (THA) have relied largely on placing the socket in the native position and trying to restore static anatomical femoral parameters gauged on X-rays or intra-operative measurement. Stability is conventionally achieved by making appropriate changes during the time of trial reduction. Post-operative complications of dislocation and significant Limb Length Discrepancy (LLD) requiring foot wear modification represents opposite ends of the spectrum from a biomechanical perspective and these continue to be relatively high. A move towards giving more importance to functional dynamic parameters rather than static anatomical parameters and less reliance on stability testing at trial reduction is warranted. METHODS Intraoperative 3D functional balancing of THA without stability testing at trial reduction was practiced in all subjects undergoing THA in our unit from April 2014. To date 1019 patients have had their hips replaced with the same technique. They were followed up till April 2020 for post-operative complications of dislocation and significant LLD needing footwear modification. A secondary cohort of 114 patients from 1st January to December 31st 2017 within this primary group were analyzed clinically and radiologically to ascertain the implications of functional 3D balancing on X-ray parameters, clinical outcome scores (Harris Hip Score and Oxford Hip Score), ability to squat, and subtle subjective post-operative perception of limb lengthening (POPLL). RESULTS In the primary group of 1019 patients, there were only two dislocations and no patient needed footwear modification for LLD. In the detailed analysis of the secondary cohort of 114 patients, the correlation with restoration of static radiological parameters was inconsistent. 40 patients could not squat and 4 patients had subtle subjective post-operative perceived limb lengthening (POPLL). Measured outcomes such as HHS and OHS were improved in all patients with significant statistical significance (P < 0.001). CONCLUSION This study underlines the fact that more importance must be given to functional dynamic parameters by 3D balancing of the THA and not on static anatomical X-rays parameters and stability testing during trial reduction. This represents a paradigm shift in the evolution of total hip arthroplasty. LEVEL OF EVIDENCE A Level II study. (Data collected from the ongoing prospective study) (http://www.spine.org/Documents/LevelsofEvidenceFinal.pdf). SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00505-3.
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Affiliation(s)
- Vijay C. Bose
- Asian Joint Reconstruction Institute @ SIMS Hospitals, Chennai, Tamil Nadu India
| | - Suryanarayan Pichai
- Asian Joint Reconstruction Institute @ SIMS Hospitals, Chennai, Tamil Nadu India
| | - P. S. Ashok Kumar
- Asian Joint Reconstruction Institute @ SIMS Hospitals, Chennai, Tamil Nadu India
| | - Kalaivanan Kanniyan
- Asian Joint Reconstruction Institute @ SIMS Hospitals, Chennai, Tamil Nadu India
| | | | - Shantanu Patil
- SRM Medical College, SRM IST, Kattankulathur, Tamil Nadu India
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Kay A, Klavas D, Haghshenas V, Phan M, Le D. Two year follow up of supercapsular percutaneously assisted total hip arthroplasty. BMC Musculoskelet Disord 2021; 22:478. [PMID: 34030681 PMCID: PMC8147097 DOI: 10.1186/s12891-021-04351-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dislocation after primary total hip arthroplasty (THA) has an incidence of 2-3%. Approximately 77% of dislocations occur within the first year after surgery. The SuperPATH technique is a minimally invasive approach for THA that preserves soft tissue attachments. The purpose of this study is to describe the dislocation rate at 1 year after SuperPATH primary THA. METHODS All elective primary THAs performed by the senior author using the SuperPATH approach. Exclusion criteria were acute femoral neck fracture, revision surgery, or malignancy. There were 214 of 279 eligible patients available for telephone interviews (76.7%). Medical records were reviewed for secondary outcomes including early and late complications, cup positioning, distance ambulated on postoperative day one, discharge destination, and blood transfusions. RESULTS Mean age at surgery was 64 ± 10.8 years and mean time to telephone follow up was 773 ± 269.7 days. There were 104 female and 110 male patients. There were zero dislocations reported. Blood transfusions were performed in 3.7% of patients, and 75.7% were discharged to home at an average of 2.3 ± 1.0 days. Cup position averaged 43.6 ± 5.2° abduction and 20.9 ± 6.2° anteversion, with an average leg length discrepancy of 3.6 ± 3.32 mm. Complications included three intraoperative calcar fractures, one periprosthetic femur fracture, one early femoral revision, three superficial infections, and one instance of wound necrosis. CONCLUSION SuperPATH approach is safe for use in primary THA resulting in a low dislocation rate.
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Affiliation(s)
- Andrew Kay
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Fannin St. Suite 2500, Houston, TX, 77030, USA
| | - Derek Klavas
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Fannin St. Suite 2500, Houston, TX, 77030, USA
| | - Varan Haghshenas
- Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Fannin St. Suite 2500, Houston, TX, 77030, USA.
| | - Mimi Phan
- Texas A&M College of Medicine, 8447 Bryan Rd, Bryan, TX, 77807, USA
| | - Daniel Le
- Department of Orthopedics and Sports Medicine, Houston Methodist Willowbrook Hospital, 18220 TX-249, Houston, TX, 77070, USA
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Kaku N, Tagomori H, Tsumura H. Comparison of Cup Setting Angle Accuracy between Computed Tomography-Based and Computed Tomography-Free Navigation in the Same Patients with Crowe's Classification I or II Hip Dysplasia. Clin Orthop Surg 2021; 13:144-151. [PMID: 34094004 PMCID: PMC8173244 DOI: 10.4055/cios20145] [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] [Received: 06/08/2020] [Revised: 09/28/2020] [Accepted: 11/25/2020] [Indexed: 12/21/2022] Open
Abstract
Backgroud In total hip arthroplasty, the cup setting angle may affect the postoperative results. In recent years, both computed tomography-based navigation and computed tomography-free (imageless) navigation have been reported to produce high accuracy in cup installation; however, no direct comparison between these two methods has been performed. The present study aimed to directly compare the cup installation angle accuracy between computed tomography-based navigation and computed tomography-free navigation in patients with Crowe's classification stage I or II dysplastic osteoarthritis and to examine the factors affecting the cup installation accuracy. Methods Using both navigation systems for the same technique, primary total hip arthroplasty was performed by the same surgeon in 36 patients. A cup was installed using computed tomography-based navigation, and the installed cup was measured again using computed tomography-free navigation. We compared the error between the target angle and the intraoperative installation angle for each navigation method by performing statistical analyses. Results For computed tomography-based navigation, errors in the inclination and the anteversion angles compared to the target angle were 3.14° ± 1.55° and 1.47° ± 0.99°, respectively. For computed tomography-free navigation, the inclination and anteversion angle errors were significantly larger, i.e., 6.84° ± 4.78° and 5.43° ± 5.22°, respectively (p < 0.01). The inclination and anteversion angles of computed tomography-free navigation were correlated, and there were no significant factors influencing the error. Conclusions Computed tomography-based navigation is more accurate for cup installation than computed tomography-free navigation. When using computed tomography-free navigation, it is necessary to add technical schemes before and during surgery to improve the cup installation accuracy.
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Affiliation(s)
- Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroaki Tagomori
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
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Fujihara Y, Fukunishi S, Fukui T, Nishio S, Takeda Y, Okahisa S, Yoshiya S. Comparison of G-guide and Image-free Navigation System in Accuracy of Stem Anteversion Assessment During Total Hip Arthroplasty. Open Orthop J 2019. [DOI: 10.2174/1874325001913010109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Introduction:
We have developed and utilized the Gravity-guide (G-guide) as a simple manual instrument for intraoperative assessment and adjustment of stem anteversion (AV). Since 2013, we simultaneously measured stem AV using the G-guide and image-free navigation during THA procedure. The purpose of this study was to compare the measurement accuracy of the G-guide and navigation system using the postoperative CT results as a reference.
Methods:
In total, 59 hips in 56 patients who underwent primary THA using both the G-guide and image-free navigation system were included in the study. All patients underwent postoperative CT examination, and the femoral stem AV was assessed using a 3D image analysis system (Zed hip, LEXI, Japan). The AV angle derived from the postoperative CT image analysis was used as the reference value to assess the accuracy of the two intraoperative measurement systems.
Results:
The discrepancy between the G-guide and the postoperative CT-measured values averaged 5.0° ± 3.9°, while the corresponding value for the navigation system was 5.2° ± 4.1°. Acceptable accuracy with a measurement error of less than 10° was achieved in 86% and 90% of the cases for the G-guide and navigation measurements respectively.
Conclusion:
Consequently, it was shown that both navigation and G-guide measurements can achieve comparative accuracy and are clinically useful.
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Fujihara Y, Fukunishi S, Fukui T, Nishio S, Okahisa S, Takeda Y, Kurosaka K, Yoshiya S. Use of the G-guide for Measuring Stem Antetorsion During Total Hip Arthroplasty. Orthopedics 2016; 39:e271-5. [PMID: 26881466 DOI: 10.3928/01477447-20160201-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/17/2015] [Indexed: 02/03/2023]
Abstract
Implant positioning is one of the critical factors influencing postoperative outcomes in total hip arthroplasty (THA). Several studies have reported that the postoperative antetorsion (AT) measurement for the femoral stem inserted without navigation showed wide variability. The current authors developed a simple instrument, the Gravity-guide (G-guide), for intraoperative assessment of stem AT and adjustment. They evaluated the effectiveness of the G-guide with postoperative computed tomography (CT) examination. Ninety patients (96 hips) who underwent primary THA using the G-guide for stem adjustment were evaluated. The G-guide consists of 2 parts: one attached to the lower leg and the other attached to the handle of the rasp. The G-guide was used to evaluate the AT at the time of inserting the final rasp. In addition, the AT value in the G-guide evaluation system required correction by the angle obtained in the preoperative epicondylar view. Intraoperative stem AT was defined as the sum of the intraoperative G-guide value and the correction angle. Postoperative AT was evaluated by CT examination. The discrepancy between the intra- and postoperative measurements was 4.6°±4.1°. Acceptable accuracy with discrepancy of less than 5° and 10° was achieved in 66 (69%) hips and 85 (89%) hips, respectively. The use of the G-guide could effectively reduce the variability of stem anteversion compared with manual adjustment. This study proved the effectiveness of the newly developed G-guide system in intraoperative stem AT adjustment.
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Wada H, Mishima H, Yoshizawa T, Sugaya H, Nishino T, Yamazaki M. Initial Results of an Acetabular Center Axis Registration Technique in Navigated Hip Arthroplasty with Deformed Acetabular Rims. Open Orthop J 2016; 10:26-35. [PMID: 27073586 PMCID: PMC4807411 DOI: 10.2174/1874325001610010026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 12/04/2015] [Accepted: 12/07/2015] [Indexed: 11/22/2022] Open
Abstract
Background In cementless total hip arthroplasty, imageless computer-assisted navigation is usually used to register the anterior pelvic plane (APP). The accuracy of this method is influenced by the subcutaneous tissues overlying the registration landmarks. On the other hand, the acetabular center axis (ACA) is determined from the acetabular rim. Precise registration of the ACA is possible because of direct palpation using a pointer. Imageless navigation using the ACA usually targets patients with normal acetabular morphology. The aim of this study was to investigate the accuracy of imageless navigation using the ACA instead of the APP in patients with normal or deformed acetabular rims. Methods The intraoperative cup position was compared with that obtained from the postoperative computed tomography (CT) images in 18 cases. Results The inclination angle derived from the navigation system was 3.4 ± 5.3 degrees smaller and the anteversion angle was 1.4 ± 3.1 degrees larger than those derived from the CT images. Conclusion The inclination cup angle of the navigation system was significantly inferior to the true value, particularly in cases with large anterior osteophytes.
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Affiliation(s)
- Hiroshi Wada
- Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hajime Mishima
- Department of Orthopaedic Surgery, Institute of Clinical Medicine, and University Hospital, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Tomohiro Yoshizawa
- Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hisashi Sugaya
- Division of Regenerative Medicine for Musculoskeletal System, Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Tomofumi Nishino
- Department of Orthopaedic Surgery, Institute of Clinical Medicine, and University Hospital, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Institute of Clinical Medicine, and University Hospital, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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Renkawitz T, Weber M, Springorum HR, Sendtner E, Woerner M, Ulm K, Weber T, Grifka J. Impingement-free range of movement, acetabular component cover and early clinical results comparing ‘femur-first’ navigation and ‘conventional’ minimally invasive total hip arthroplasty. Bone Joint J 2015; 97-B:890-8. [DOI: 10.1302/0301-620x.97b7.34729] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We report the kinematic and early clinical results of a patient- and observer-blinded randomised controlled trial in which CT scans were used to compare potential impingement-free range of movement (ROM) and acetabular component cover between patients treated with either the navigated ‘femur-first’ total hip arthroplasty (THA) method (n = 66; male/female 29/37, mean age 62.5 years; 50 to 74) or conventional THA (n = 69; male/female 35/34, mean age 62.9 years; 50 to 75). The Hip Osteoarthritis Outcome Score, the Harris hip score, the Euro-Qol-5D and the Mancuso THA patient expectations score were assessed at six weeks, six months and one year after surgery. A total of 48 of the patients (84%) in the navigated ‘femur-first’ group and 43 (65%) in the conventional group reached all the desirable potential ROM boundaries without prosthetic impingement for activities of daily living (ADL) in flexion, extension, abduction, adduction and rotation (p = 0.016). Acetabular component cover and surface contact with the host bone were > 87% in both groups. There was a significant difference between the navigated and the conventional groups’ Harris hip scores six weeks after surgery (p = 0.010). There were no significant differences with respect to any clinical outcome at six months and one year of follow-up. The navigated ‘femur-first’ technique improves the potential ROM for ADL without prosthetic impingement, although there was no observed clinical difference between the two treatment groups. Cite this article: Bone Joint J 2015; 97-B:890–8.
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Affiliation(s)
- T. Renkawitz
- Regensburg University Medical Centre, Asklepios
Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077
Bad Abbach, Germany
| | - M. Weber
- Regensburg University Medical Centre, Asklepios
Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077
Bad Abbach, Germany
| | - H-R. Springorum
- Regensburg University Medical Centre, Asklepios
Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077
Bad Abbach, Germany
| | - E. Sendtner
- Regensburg University Medical Centre, Asklepios
Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077
Bad Abbach, Germany
| | - M. Woerner
- Regensburg University Medical Centre, Asklepios
Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077
Bad Abbach, Germany
| | - K. Ulm
- Technische Universität München, Institut
für Medizinische Statistik und Epidemiologie, Germany
| | - T. Weber
- Regensburg University Medical Centre, Asklepios
Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077
Bad Abbach, Germany
| | - J. Grifka
- Regensburg University Medical Centre, Asklepios
Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077
Bad Abbach, Germany
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Accuracy of combined anteversion in image-free navigated total hip arthroplasty: stem-first or cup-first technique? INTERNATIONAL ORTHOPAEDICS 2015; 40:9-13. [DOI: 10.1007/s00264-015-2784-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/27/2015] [Indexed: 11/26/2022]
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Xie W, Franke J, Chen C, Grützner PA, Schumann S, Nolte LP, Zheng G. A complete-pelvis segmentation framework for image-free total hip arthroplasty (THA): methodology and clinical study. Int J Med Robot 2014; 11:166-80. [PMID: 25258044 DOI: 10.1002/rcs.1619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 08/25/2014] [Accepted: 08/27/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Complete-pelvis segmentation in antero-posterior pelvic radiographs is required to create a patient-specific three-dimensional pelvis model for surgical planning and postoperative assessment in image-free navigation of total hip arthroplasty. METHODS A fast and robust framework for accurately segmenting the complete pelvis is presented, consisting of two consecutive modules. In the first module, a three-stage method was developed to delineate the left hemi-pelvis based on statistical appearance and shape models. To handle complex pelvic structures, anatomy-specific information processing techniques were employed. As the input to the second module, the delineated left hemi-pelvis was then reflected about an estimated symmetry line of the radiograph to initialize the right hemi-pelvis segmentation. The right hemi-pelvis was segmented by the same three-stage method, RESULTS Two experiments conducted on respectively 143 and 40 AP radiographs demonstrated a mean segmentation accuracy of 1.61±0.68 mm. A clinical study to investigate the postoperative assessment of acetabular cup orientations based on the proposed framework revealed an average accuracy of 1.2°±0.9° and 1.6°±1.4° for anteversion and inclination, respectively. Delineation of each radiograph costs less than one minute. CONCLUSIONS Despite further validation needed, the preliminary results implied the underlying clinical applicability of the proposed framework for image-free THA.
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Affiliation(s)
- Weiguo Xie
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Switzerland.,BG Trauma Centre Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Jochen Franke
- BG Trauma Centre Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Cheng Chen
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland
| | - Paul A Grützner
- BG Trauma Centre Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Steffen Schumann
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland
| | - Lutz-P Nolte
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland
| | - Guoyan Zheng
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland
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Abstract
Dislocation remains one of the most common complications after total hip arthroplasty, regardless of the surgical approach. While multiple reasons as laxity, implant position, improper implant choice, and impingement etc. might be leading factors for dislocation, an exact identification of the exact reason is of major importance, to plan for a proper surgical or nonsurgical correction. This article describes in detail the definition, etiology, reduction, and possible treatment options for dislocation after primary and revision total hip arthroplasty that are currently used at the Endo Klinik in Hamburg. It furthermore includes a distinct overview of possible surgical treatment options, based on the main pathology leading to dislocation.
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