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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] [What about the content of this article? (0)] [Affiliation(s)] [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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van Erp JHJ, Snijders TE, Weinans H, Castelein RM, Schlösser TPC, de Gast A. The role of the femoral component orientation on dislocations in THA: a systematic review. Arch Orthop Trauma Surg 2022; 142:1253-1264. [PMID: 34101017 PMCID: PMC9110501 DOI: 10.1007/s00402-021-03982-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Dislocation remains a major complication in total hip arthroplasty (THA), in which femoral component orientation is considered a key parameter. New imaging modalities and definitions on femoral component orientation have been introduced, describing orientation in different planes. This study aims to systematically review the relevance of the different orientation parameters on implant stability. METHODS A systematic review was performed according to the PRISMA guidelines to identify articles in the PubMed and EMBASE databases that study the relation between any femoral component orientation parameters and implant stability in primary THA. RESULTS After screening for inclusion and exclusion criteria and quality assessment, nine articles were included. Definitions to describe the femoral component orientation and methodologies to assess its relevance for implant stability differed greatly, with lack of consensus. Seven retrospective case-control studies reported on the relevance of the transversal plane orientation: Low femoral- or low combined femoral and acetabular anteversion was statistical significantly related with more posterior dislocations, and high femoral- or combined femoral and acetabular anteversion with anterior dislocations in two studies. There were insufficient data on sagittal and coronal component orientation in relation to implant stability. CONCLUSION Because of incomparable definitions, limited quality and heterogeneity in methodology of the included studies, there is only weak evidence that the degree of transverse component version is related with implant stability in primary THA. Recommendations about the optimal orientation of the femoral component in all three anatomical planes cannot be provided. Future studies should uniformly define the three-dimensional orientation of the femoral component and systematically describe implant stability.
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Affiliation(s)
- Joost H. J. van Erp
- Department of Orthopedics, Diakonessenhuis, Utrecht, Zeist, The Netherlands ,Clinical Orthopedic Research Center m-N, Zeist, The Netherlands ,Department of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| | - Thom E. Snijders
- Department of Orthopedics, Diakonessenhuis, Utrecht, Zeist, The Netherlands ,Clinical Orthopedic Research Center m-N, Zeist, The Netherlands
| | - Harrie Weinans
- Department of Orthopedics, UMC Utrecht, Utrecht, The Netherlands ,Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | | | | | - Arthur de Gast
- Department of Orthopedics, Diakonessenhuis, Utrecht, Zeist, The Netherlands ,Clinical Orthopedic Research Center m-N, Zeist, The Netherlands
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Abstract
AIMS The aetiologies of common degenerative spine, hip, and knee pathologies are still not completely understood. Mechanical theories have suggested that those diseases are related to sagittal pelvic morphology and spinopelvic-femoral dynamics. The link between the most widely used parameter for sagittal pelvic morphology, pelvic incidence (PI), and the onset of degenerative lumbar, hip, and knee pathologies has not been studied in a large-scale setting. METHODS A total of 421 patients from the Cohort Hip and Cohort Knee (CHECK) database, a population-based observational cohort, with hip and knee complaints < 6 months, aged between 45 and 65 years old, and with lateral lumbar, hip, and knee radiographs available, were included. Sagittal spinopelvic parameters and pathologies (spondylolisthesis and degenerative disc disease (DDD)) were measured at eight-year follow-up and characteristics of hip and knee osteoarthritis (OA) at baseline and eight-year follow-up. Epidemiology of the degenerative disorders and clinical outcome scores (hip and knee pain and Western Ontario and McMaster Universities Osteoarthritis Index) were compared between low PI (< 50°), normal PI (50° to 60°), and high PI (> 60°) using generalized estimating equations. RESULTS Demographic details were not different between the different PI groups. L4 to L5 and L5 to S1 spondylolisthesis were more frequently present in subjects with high PI compared to low PI (L4 to L5, OR 3.717; p = 0.024 vs L5 to S1 OR 7.751; p = 0.001). L5 to S1 DDD occurred more in patients with low PI compared to high PI (OR 1.889; p = 0.010), whereas there were no differences in L4 to L5 DDD among individuals with a different PI. The incidence of hip OA was higher in participants with low PI compared to normal (OR 1.262; p = 0.414) or high PI (OR 1.337; p = 0.274), but not statistically different. The incidence of knee OA was higher in individuals with a high PI compared to low PI (OR 1.620; p = 0.034). CONCLUSION High PI is a risk factor for development of spondylolisthesis and knee OA. Low pelvic incidence is related to DDD, and may be linked to OA of the hip. Level of Evidence: 1b Cite this article: Bone Joint J 2020;102-B(9):1261-1267.
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Affiliation(s)
- Joost H J van Erp
- Clinical Orthopedic Research Center Midden-Nederland, Zeist, Netherlands.,Department of Orthopedics, Diakonessenhuis Utrecht, Netherlands.,Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Willem P Gielis
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Vahid Arbabi
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands.,Orthopaedic-BiMechanics Research Group, Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran
| | - Arthur de Gast
- Clinical Orthopedic Research Center Midden-Nederland, Zeist, Netherlands.,Department of Orthopedics, Diakonessenhuis Utrecht, Netherlands
| | - Harrie Weinans
- Clinical Orthopedic Research Center Midden-Nederland, Zeist, Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Saeed Arbabi
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands.,Image Sciences Institute, University Medical Center Utrecht, Utrecht, Netherlands
| | - F Cumhur Öner
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - René M Castelein
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tom P C Schlösser
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
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van Erp JHJ, Massier JRA, Halma JJ, Snijders TE, de Gast A. 2-year results of an RCT of 2 uncemented isoelastic monoblock acetabular components: lower wear rate with vitamin E blended highly cross-linked polyethylene compared to ultra-high molecular weight polyethylene. Acta Orthop 2020; 91:254-259. [PMID: 32098534 PMCID: PMC8023900 DOI: 10.1080/17453674.2020.1730073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The long-term survival of arthroplasty components may be limited by polyethylene wear-related problems such as periprosthetic osteolysis and aseptic loosening. Highly cross-linked polyethylene (HXLPE) blended with vitamin E was introduced to improve oxidative stability and to avoid long-term embrittlement. This study clinically compares the tribological behavior and clinical outcome of vitamin E blended HXLPE with ultra-high molecular weight polyethylene (UHMWPE) in an isoelastic monoblock cup for uncemented total hip arthroplasty.Patients and methods - In this randomized controlled trial (RCT), 199 patients were included: 102 patients received the vitamin E blended HXLPE cup, 97 patients the UHMWPE cup. Clinical and radiographic parameters were obtained preoperatively, directly postoperative and at 3, 12, and 24 months. Wear rates were compared using the mean linear femoral head penetration (FHP) rate.Results - 188 patients (94%) completed the 2-year follow-up. Mean patient satisfaction was higher in the vitamin E blended HXLPE group (8.9 [1]) than in in the control group (8.5 [2], p = 0.03). The Harris Hip Score (HHS) was higher in the vitamin E blended HXLPE group (95 [8]) than in the control group (92 [11], p = 0.3). The FHP rate was lower in the vitamin E blended HXLPE group: 0.046 mm/year compared with 0.056 mm/year in the control group (p = 0.05). No adverse reactions associated with the clinical application of vitamin E blended HXLPE were observed during follow-up, with an excellent 2-year survival to revision rate of 98% for both cups.Interpretation - This study shows the superior performance of the HXLPE blended with vitamin E acetabular cup with lower linear femoral head penetration rates and better clinical results compared with the UHMWPE acetabular cup after 2 years.
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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,Correspondence::
| | - Julie R A Massier
- Clinical Orthopedic Research Center—mN, Zeist, the Netherlands; ,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Jelle J Halma
- Clinical Orthopedic Research Center—mN, Zeist, the Netherlands;
| | - Thom E Snijders
- Clinical Orthopedic Research Center—mN, Zeist, the Netherlands;
| | - Arthur de Gast
- Clinical Orthopedic Research Center—mN, Zeist, the Netherlands; ,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
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van Erp JHJ, de Gast A, Bruekers SE, Bekkers JEJ. Giant Seromal Cyst Development After Tourniquet Use During Total Knee Arthroplasty: A Case Report. JBJS Case Connect 2020; 10:e0466. [PMID: 32224646 DOI: 10.2106/jbjs.cc.19.00466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE An 84-year old woman developed 2 large seromal cysts at the medial side of her right thigh, 4 months after total knee arthroplasty (TKA). The cysts were located at the place where the tourniquet, during surgery, had been applied. The diagnosis was confirmed with echography and magnetic resonance imaging. Both cysts were resected, and the patient recovered completely, after one relapse in which a lymphatic vessel was sutured. CONCLUSION Development of seromal cyst after tourniquet use during TKA is a rare but serious complication.
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Affiliation(s)
- Joost H J van Erp
- Clinical Orthopedic Research Center-mN, Zeist, the Netherlands.,Department of Orthopedics, Diakonessenhuis, Utrecht, the Netherlands
| | - Arthur de Gast
- Clinical Orthopedic Research Center-mN, Zeist, the Netherlands.,Department of Orthopedics, Diakonessenhuis, Utrecht, the Netherlands
| | - Sven E Bruekers
- Department of Plastic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Joris E J Bekkers
- Clinical Orthopedic Research Center-mN, Zeist, the Netherlands.,Department of Orthopedics, Diakonessenhuis, Utrecht, the Netherlands
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Snijders TE, van Erp JHJ, de Gast A. Restoring femoral offset and leg length; the potential of a short curved stem in total hip arthroplasty. J Orthop 2019; 16:396-399. [PMID: 31110402 DOI: 10.1016/j.jor.2019.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/15/2019] [Indexed: 12/23/2022] Open
Abstract
Background Total hip arthroplasty (THA) is a very successful procedure in orthopedics. Still polyethylene wear and gait deficits are limiting the clinical success.It is important to reconstruct leg length (LL) and femoral offset (FO) anatomically in order to have the best possible result of a THA. Gait deficits can arise due to leg length discrepancy as well as changes in the abductor moment arm. In THA, LL and FO are strongly determined by the orientation, size and geometry of the femoral stem. Methods This radio-anatomical study used the data of a prospective cases series of 112 patients who underwent 126 primary THAs and had completed a 1-year follow-up examination. FO and LL were compared between the conventional straight stem in vivo and a computed simulated implantation of a short curved stem, using the pre- and postoperative pelvic radiographs of the same patients. Results In this simulation of the short curved stem statistically significantly restored native FO (p = 0.010) and LL (p = 0.000) better, compared to the conventional straight stem. Conclusions Thus, the short curved stem restores FO and LL better, and could potentially prevent gait deficits.
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Affiliation(s)
- Thom E Snijders
- Clinical Orthopedic Research Center - mN, Diakonessenhuis Zeist, Zeist, the Netherlands
| | - Joost H J van Erp
- Clinical Orthopedic Research Center - mN, Diakonessenhuis Zeist, Zeist, the Netherlands.,Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Arthur de Gast
- Clinical Orthopedic Research Center - mN, Diakonessenhuis Zeist, Zeist, the Netherlands.,Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
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