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Luo Y, Tang Z, Zhou S, Zhu T, Xu Z, Yang H. Effect of lumbosacral transitional vertebra on developmental alterations of the hip: a quantitative investigation of the lumbo-pelvic-hip complex via whole-body computed tomography. Quant Imaging Med Surg 2024; 14:4635-4647. [PMID: 39022269 PMCID: PMC11250340 DOI: 10.21037/qims-23-1816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/09/2024] [Indexed: 07/20/2024]
Abstract
Background Lumbosacral transitional vertebra (LSTV) is a common spinal variant, with the reported prevalence varying from 8.1% to 36%. LSTV has been shown to alter the lumbo-pelvic parameters and reduce the benefits of total hip arthroplasty, but the specific effects of LSTV on hip development remain unclear. The aim of this study was thus to investigate the impact of LSTV on developmental alterations of the hip. Methods A total of 310 individuals were categorized into three groups according to whole-body computed tomography (CT) imaging: a group with sacralization of 23 presacral vertebrae (PSV) (n=102), a group with lumbarization of 25 PSV (n=108), and a normal control group with 24 PSV (n=100). Quantitative parameters of the lumbo-pelvic-hip complex (LPHC) including lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), axial and sagittal acetabular anteversion angle (AAA), center-edge (CE) angle, Sharp angle, and femoral neck-shaft angle (FNSA) were measured and analyzed. Statistical analyses were used to compare the differences of these quantitative parameters among the three groups and to assess the relationship between hip and lumbar-pelvic parameters. Results Significant differences between each pair of three groups and the LSTV subgroups were only found in the sagittal AAA (left side: P=0.008; right side: P<0.001), with no differences found for the other parameters. Compared to the normal group (24 PSV), both the 23 PSV and 25 PSV groups exhibited increased values in the sagittal AAA, especially in the right side of the 23 PSV group. Only the sagittal AAA showed low-to-moderate positive correlations with pelvic parameters of PI (r=0.195-0.429; P=0.001-0.08) and PT (r=0.239-0.605; P=0.001-0.03). Conclusions Variations of LSTV are correlated with the hip anatomical development via LPHC transmission and may potentially reduce the sagittal acetabular coverage, particularly in the 23 PSV subtype on the right side.
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Affiliation(s)
- Yuxi Luo
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ziyi Tang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Suying Zhou
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tongxin Zhu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhangyan Xu
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haitao Yang
- Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Mancino F, Fontalis A, Magan A, Plastow R, Haddad FS. The Value of Computed Tomography Scan in Three-dimensional Planning and Intraoperative Navigation in Primary Total Hip Arthroplasty. Hip Pelvis 2024; 36:26-36. [PMID: 38420736 DOI: 10.5371/hp.2024.36.1.26] [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: 06/15/2023] [Revised: 07/24/2023] [Accepted: 08/10/2023] [Indexed: 03/02/2024] Open
Abstract
Total hip arthroplasty (THA) is a frequently performed procedure; the objective is restoration of native hip biomechanics and achieving functional range of motion (ROM) through precise positioning of the prosthetic components. Advanced three-dimensional (3D) imaging and computed tomography (CT)-based navigation are valuable tools in both the preoperative planning and intraoperative execution. The aim of this study is to provide a thorough overview on the applications of CT scans in both the preoperative and intraoperative settings of primary THA. Preoperative planning using CT-based 3D imaging enables greater accuracy in prediction of implant sizes, leading to enhancement of surgical workflow with optimization of implant inventory. Surgeons can perform a more thorough assessment of posterior and anterior acetabular wall coverage, acetabular osteophytes, anatomical landmarks, and thus achieve more functional implant positioning. Intraoperative CT-based navigation can facilitate precise execution of the preoperative plan, to attain optimal positioning of the prosthetic components to avoid impingement. Medial reaming can be minimized preserving native bone stock, which can enable restoration of femoral, acetabular, and combined offsets. In addition, it is associated with greater accuracy in leg length adjustment, a critical factor in patients' postoperative satisfaction. Despite the higher costs and radiation exposure, which currently limits its widespread adoption, it offers many benefits, and the increasing interest in robotic surgery has facilitated its integration into routine practice. Conducting additional research on ultra-low-dose CT scans and examining the potential for translation of 3D imaging into improved clinical outcomes will be necessary to warrant its expanded application.
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Affiliation(s)
- Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Ahmed Magan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
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Cacciola G, Giustra F, Bosco F, De Meo F, Bruschetta A, De Martino I, Risitano S, Sabatini L, Massè A, Cavaliere P. Trabecular titanium cups in hip revision surgery: a systematic review of the literature. ANNALS OF JOINT 2023; 8:36. [PMID: 38529221 PMCID: PMC10929389 DOI: 10.21037/aoj-23-28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/24/2023] [Indexed: 03/27/2024]
Abstract
Background Hip revision surgery in extensive acetabular bone defects represents a complex challenge for hip surgeons. The primary goal is to obtain a stable acetabular component and restore the hip biomechanics. Through the years, different prosthetic implants have been developed to perform acetabular revision depending on bone loss location and extension. This systematic review aims to summarize the clinical outcomes and complications reported with trabecular titanium (TT) cups in hip revision surgery. Methods A literature search of four databases (PubMed, Embase, Scopus and the Cochrane Database of systematic reviews) was performed according to the PRISMA guideline from January 2008 to December 2022. All studies written in English and reporting the clinical outcome of patients undergoing revision total hip arthroplasty using Delta TT cups were included. The initial screening identified 378 studies. Each eligible clinical article was analyzed according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence (LoE), and the papers' methodological quality was evaluated using The Methodological Index for Non-Randomized Studies Criteria (MINORS) score. Results Eight clinical studies were included in the analysis. A total of 523 hip revisions were analyzed. Delta TT cups were used in 3.9%, Delta TT one cups in 46.8%, and Delta TT revisions in 49.3%. Paprosky IIIa was the most frequent acetabular bone defect reported in 26.4% of cases. The overall survival rate of TT cups was 93.4%. The dislocation was the most frequent complication in 4.1% of patients, while the prevalence of aseptic loosening was 1.5. Conclusions Managing severe acetabular bone defects remains a complex challenge for hip surgeons. Since their introduction, TT cups have exhibited good clinical results, with complication rates in line with or lower than those reported by similar implants.
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Affiliation(s)
- Giorgio Cacciola
- Department of Orthopaedics and Traumatology, Città della Salute e della Scienza di Torino, CTO Hospital, Turin, Italy
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, Città della Salute e della Scienza di Torino, CTO Hospital, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino – ASL Città di Torino, Turin, Italy
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, Città della Salute e della Scienza di Torino, CTO Hospital, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino – ASL Città di Torino, Turin, Italy
| | - Federico De Meo
- Orthopaedic Institute of Southern Italy “Franco Scalabrino”, Messina, Italy
| | | | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Salvatore Risitano
- Department of Orthopaedics and Traumatology, Città della Salute e della Scienza di Torino, CTO Hospital, Turin, Italy
| | - Luigi Sabatini
- Department of Orthopaedics and Traumatology, Città della Salute e della Scienza di Torino, CTO Hospital, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, Città della Salute e della Scienza di Torino, CTO Hospital, Turin, Italy
| | - Pietro Cavaliere
- Orthopaedic Institute of Southern Italy “Franco Scalabrino”, Messina, Italy
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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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Guezou-Philippe A, Clave A, Marchadour W, Letissier H, Lefevre C, Stindel E, Dardenne G. Functional safe zone for THA considering the patient-specific pelvic tilts: An ultrasound-based approach. Int J Med Robot 2023; 19:e2486. [PMID: 36427293 DOI: 10.1002/rcs.2486] [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: 06/17/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022]
Abstract
The usual Lewinnek orientation for cup positioning in total hip arthroplasty is not suitable for all patients as it does not consider the patient mobility. We propose an ultrasound-based approach to compute a Functional Safe Zone (FSZ) considering daily positions. Our goal was to validate it, and to evaluate how the input parameters impact the FSZ size and barycentre. The accuracy of the FSZ was first assessed by comparing the FSZ computed by the proposed approach and the true FSZ determined by 3D modelling. Then, the input parameters' impact on the FSZ was studied using a principal component analysis. The FSZ was estimated with errors below 0.5° for mean anteversion, mean inclination, and at edges. The pelvic tilts and the neck orientation were found correlated to the FSZ mean orientation, and the target ROM and the prosthesis dimensions to the FSZ size. Integrated into the clinical workflow, this non-ionising approach can be used to easily determine an optimal patient-specific cup orientation minimising the risks of dislocation.
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Affiliation(s)
- Aziliz Guezou-Philippe
- LaTIM - UMR1101, Brest, France.,Université de Bretagne Occidentale, Brest, France.,CHRU de Brest, Brest, France
| | - Arnaud Clave
- LaTIM - UMR1101, Brest, France.,Clinique Saint George, Nice, France
| | - Wistan Marchadour
- LaTIM - UMR1101, Brest, France.,Université de Bretagne Occidentale, Brest, France
| | - Hoel Letissier
- LaTIM - UMR1101, Brest, France.,CHRU de Brest, Brest, France
| | - Christian Lefevre
- LaTIM - UMR1101, Brest, France.,Université de Bretagne Occidentale, Brest, France.,CHRU de Brest, Brest, France
| | - Eric Stindel
- LaTIM - UMR1101, Brest, France.,CHRU de Brest, Brest, France
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6
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Dial BL, Hills JM, Smith JS, Sardi JP, Lazaro B, Shaffrey CI, Bess S, Schwab FJ, Lafage V, Lafage R, Kelly MP, Bridwell KH. The impact of lumbar alignment targets on mechanical complications after adult lumbar scoliosis surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1573-1582. [PMID: 35428916 DOI: 10.1007/s00586-022-07200-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/02/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to determine the discriminatory ability of age-adjusted alignment offset and the global alignment and proportion (GAP) score parameters to predict postoperative mechanical complications. METHODS Surgical patients from the Adult Symptomatic Lumbar Scoliosis cohort were reviewed at 2 year follow up. Age-adjusted alignment offsets and GAP parameters were calculated for each patient. A series of nonlinear logistic regression models were fit, and the odds of mechanical complications were calculated. The discriminatory ability of the GAP score, GAP score parameters, and age-adjusted alignment offsets were determined plotting receiver operative characteristic (ROC) with the C statistic (AUC). RESULTS A total of 165 patients were included. A total of 49 mechanical complications occurred in 41 patients (21 proximal junctional kyphosis and 28 pseudoarthrosis). The GAP score had no discriminatory ability in this cohort. Relative lumbar lordosis 15 degrees greater than ideal lumbar lordosis was associated with greater mechanical complications. A lumbar distribution index of 90% was associated with fewer mechanical complications compared to a lumbar distribution index of 65%. Age-adjusted offset alignment targets had no discriminatory ability to predict mechanical complications. CONCLUSION Radiographic alignment targets using either age-adjusted alignment target offset or GAP score parameters had minimal ability to predict mechanical complications in isolation. Mechanical complications following adult spinal deformity surgery are complex, and patient factors play a critical role. Clinical trial registeration This study was registered at ClinicalTrials.gov (number NCT00854828) in March 2009.
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Affiliation(s)
- Brian L Dial
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Jeffrey M Hills
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
| | - Justin S Smith
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
| | - Juan Pablo Sardi
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
| | - Bruno Lazaro
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
| | | | - Shay Bess
- Denver International Spine Center, Denver, CO, USA
| | - Frank J Schwab
- Spine Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Spine Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Renaud Lafage
- Spine Research Laboratory, Hospital for Special Surgery, New York, NY, USA
| | - Michael P Kelly
- Department of Orthopedic Surgery, Rady Children's Hospital, University of California, San Diego, 3020 Children's Way, San Diego, CA, 92123, USA.
| | - Keith H Bridwell
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA
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7
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Augmented Reality in Orthopedic Surgery and Its Application in Total Joint Arthroplasty: A Systematic Review. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12105278] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The development of augmented reality (AR) and its application in total joint arthroplasty aims at improving the accuracy and precision in implant components’ positioning, hopefully leading to increased outcomes and survivorship. However, this field is far from being thoroughly explored. We therefore performed a systematic review of the literature in order to examine the application, the results, and the different AR systems available in TJA. A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A comprehensive search of PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was conducted for English articles on the application of augmented reality in total joint arthroplasty using various combinations of keywords since the inception of the database to 31 March 2022. Accuracy was intended as the mean error from the targeted positioning angle and compared as mean values and standard deviations. In all, 14 articles met the inclusion criteria. Among them, four studies reported on the application of AR in total knee arthroplasty, six studies on total hip arthroplasty, three studies reported on reverse shoulder arthroplasty, and one study on total elbow arthroplasty. Nine of the included studies were preclinical (sawbones or cadaveric), while five of them reported results of AR’s clinical application. The main common feature was the high accuracy and precision when implant positioning was compared with preoperative targeted angles with errors ≤2 mm and/or ≤2°. Despite the promising results in terms of increased accuracy and precision, this technology is far from being widely adopted in daily clinical practice. However, the recent exponential growth in machine learning techniques and technologies may eventually lead to the resolution of the ongoing limitations including depth perception and their high complexity, favorably encouraging the widespread usage of AR systems.
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8
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Perna A, Proietti L, Smakaj A, Velluto C, Meluzio MC, Rovere G, Florio D, Zirio G, Tamburrelli FC. The role of femoral obliquity angle and T1 pelvic angle in predicting quality of life after spinal surgery in adult spinal deformities. BMC Musculoskelet Disord 2021; 22:999. [PMID: 34847906 PMCID: PMC8630841 DOI: 10.1186/s12891-021-04823-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adult spinal deformities (ASD) represent a growing clinical condition related to chronic pain, disability and reduction in quality of life (QoL). A strong correlation among spinal alignment, spinopelvic parameters and QoL after spinal fusion surgery in ASD patients was thoroughly investigated over the last decade, However, only few studies focused on the relationship between lumbo-pelvic-femoral parameters - such as Femoral Obliquity Angle (FOA), T1 Pelvic Angle (TPA) and QoL. METHODS Radiological and clinical data from 43 patients surgically treated with thoracolumbar posterior spinal fusion for ASD between 2015 and 2018 were retrospectively analyzed. The primary outcomes were the correlation between preoperative spino-pelvic-femoral parameters and postoperative clinical, functional outcomes and QoL. Secondary outcomes were: changes in sagittal radiographic parameters spino-pelvic-femoral, clinical and functional outcomes and the rate of complications after surgery. RESULTS Using Spearman's rank correlation coefficients, spinopelvic femoral parameters (FOA, TPA, pre and post-operative) are directly statistically correlated to the quality of life (ODI, SRS-22, pre and post-operative; > 0,6 strong correlation, p < 0.05). Stratifying the patients according pre preoperative FOA value (High FOA ≥ 10 and Normal/Low FOA < 10), those belonging to the first group showed worse clinical (VAS: 5.2 +/- 1.4 vs 2.9 +/- 0.8) and functional outcomes (ODI: 35.6+/- 6.8 vs 23.2 +/- 6.5) after 2 years of follow-up and a greater number of mechanical complications (57.9% vs 8.3% p < 0.0021). CONCLUSION Based on our results, preoperative FOA and TPA could be important prognostic parameters for predicting disability and quality of life after spinal surgery in ASD patients and early indicators of possible spinal sagittal malalignment. FOA and TPA, like other and better known spinopelvic parameters, should always be considered when planning corrective surgery in ASD patients.
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Affiliation(s)
- Andrea Perna
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Proietti
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Amarildo Smakaj
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Calogero Velluto
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Concetta Meluzio
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Rovere
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Florio
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianfranco Zirio
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Istituto di Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, Rome, Italy
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Mancino F, Di Matteo V, Mocini F, Cacciola G, Malerba G, Perisano C, De Martino I. Survivorship and clinical outcomes of proximal femoral replacement in non-neoplastic primary and revision total hip arthroplasty: a systematic review. BMC Musculoskelet Disord 2021; 22:933. [PMID: 34749680 PMCID: PMC8576938 DOI: 10.1186/s12891-021-04711-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Several studies have evaluated the survivorship and clinical outcomes of proximal femoral replacement (PFR) in complex primary and revision total hip arthroplasty with severe proximal femoral bone loss; however, there remains no consensus on the overall performance of this implant. We therefore performed a systematic review of the literature in order to examine survivorship and complication rates of PFR usage. METHODS A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A comprehensive search of PubMed, MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews was conducted for English articles using various combinations of keywords. RESULTS In all, 18 articles met the inclusion criteria. A total of 578 PFR were implanted. The all-cause reoperation-free survivorship was 76.6%. The overall complication rate was 27.2%. Dislocation was the most common complication observed and the most frequent reason for reoperation with an incidence of 12.8 and 7.6%, respectively. Infection after PFR had an incidence of 7.6% and a reoperation rate of 6.4%. The reoperation rate for aseptic loosening of the implant was 5.9%. Overall, patients had improved outcomes as documented by postoperative hip scores. CONCLUSION PFR usage have a relatively high complication rate, however, it remains an efficacious treatment option in elderly patients with osteoporotic bone affected by severe proximal femoral bone loss. Modular designs have shown reduced dislocations rate and higher survivorship free from dislocation. However, PFR should only be used as salvage procedure when no other reconstruction options are available.
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Affiliation(s)
- Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy.
- Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168, Rome, Italy.
- Adult Reconstruction and Joint Replacement Service, Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico, Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Roma, RM, Italy.
| | - Vincenzo Di Matteo
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
- Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Fabrizio Mocini
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
- Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Giorgio Cacciola
- Orthopaedic Institute of Southern Italy "Franco Scalabrino", Messina, Italy
| | - Giuseppe Malerba
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Carlo Perisano
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head-Neck studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
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10
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Malahias MA, Mancino F, Agarwal A, Roumeliotis L, Gu A, Gkiatas I, Togninalli D, Nikolaou VS, Alexiades MM. Cement-in-cement technique of the femoral component in aseptic total hip arthroplasty revision: A systematic review of the contemporary literature. J Orthop 2021; 26:14-22. [PMID: 34276146 DOI: 10.1016/j.jor.2021.06.002] [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] [Received: 05/13/2021] [Accepted: 06/27/2021] [Indexed: 10/21/2022] Open
Abstract
Background Clinical outcomes of cemented femoral stems revisions using the cement-in-cement technique in aseptic conditions after total hip arthroplasty have been widely described. Methods The US National Library of Medicine (PubMed/MEDLINE), EMBASE, and the Cochrane Database of Systematic Reviews were queried. Results Twelve articles were included (620 revision THA). Revision rate for complications related to the femoral side was 1.4% at mid-term follow-up (5.4 years). Periprosthetic femoral fracture rate was 1.1%, aseptic loosening of the femoral component 0.3%. Conclusions Cement-in-cement revision technique of the femoral component is associated with a high mid-term success rates (98.6%) and is potentially less challenging than other revision techniques.
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Affiliation(s)
- Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.,Department of Orthopedics and Traumatology, Clinica ARS Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland
| | - Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Amil Agarwal
- Department of Orthopedic Surgery, George Washington School of Medicine and Health Sciences, 2300 M St NW, Washington, DC, 20037, USA
| | - Leonidas Roumeliotis
- Department of Trauma and Orthopaedics, Hampshire Hospitals NHS Foundation Trust, Basingstoke, Hampshire, UK
| | - Alex Gu
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Ioannis Gkiatas
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Danilo Togninalli
- Department of Orthopedics and Traumatology, Clinica ARS Medica, Via Grumo 16, 6929, Gravesano, Ticino, Switzerland
| | - Vasileios S Nikolaou
- 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Michael M Alexiades
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
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11
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Cacciola G, Aprato A, Branca Vergano L, Sallam A, Masse A. Is non-operative management of acetabular fracture a viable option for older patients? A systematic review of the literature for indication, treatments, complications and outcome. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021555. [PMID: 35604268 PMCID: PMC9437683 DOI: 10.23750/abm.v92is3.12544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/02/2021] [Indexed: 11/26/2022]
Abstract
There is no consensus about the best treatment for acetabular fracture in older patients. The purpose of this study was to review the current literature looking for indication, perioperative information and outcome of nonoperative management for acetabular fractures in elderly.A systematic review of literature was performed on different research database by using various combination of the keywords "acetabular fracture", "elderly patients", "60 years", "nonoperative", "nonsurgical" and "conservative treatment".Six articles met our inclusion criteria, 315 patients aged 60 or more treated nonoperatively for acetabular fracture were included in the analysis. The average age was 78.1 years, the average follow-up length was 48.7 months. The main criteria for indication of nonoperative management for acetabular fractures were, old age (75 years or more), two or more important medical comorbidities, and minimally or undisplaced fracture. The most frequent fracture pattern was anterior column in 25.3% of cases. Fall from standard height was the most frequent causative mechanism in 80% of patients. A conversion total hip arthroplasty was performed after 8.3% of cases. A 1-year mortality of 18% was reported, an overall mortality of 33.1% at last follow-up was reported.The management of acetabular fractur in elderly is a challenging problem and there is no consensus about the best treatment. Currently, multiple treatment options have been suggested, depending on fracture pattern and patients' general conditions. Although operatively treatment allow for an early recovery, there is not an high level of evidence about the superiority in terms or complications and mortality rate compared to nonoperative treatment.
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Affiliation(s)
- Giorgio Cacciola
- University of Turin, Department of Orthopaedic Surgery, C.T.O., Turin, Italy
| | - Alessandro Aprato
- University of Turin, Department of Orthopaedic Surgery, C.T.O., Turin, Italy
| | | | - Adel Sallam
- University of Turin, Department of Orthopaedic Surgery, C.T.O., Turin, Italy
| | - Alessandro Masse
- University of Turin, Department of Orthopaedic Surgery, C.T.O., Turin, Italy
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