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Sidhu VS, Plaskos C, Smith GH, Pierrepont JW, Solomon MI. Femoral components implanted through a direct anterior approach have higher postoperative anteversion compared to those implanted through a posterior approach in total hip arthroplasty. Bone Joint J 2025; 107-B:55-61. [PMID: 40306718 DOI: 10.1302/0301-620x.107b5.bjj-2024-1101.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2025]
Abstract
Aims There have been few studies that have investigated the effect of surgical approach on femoral component version in total hip arthroplasty (THA). The purpose of this study was to investigate the influence of the direct anterior approach (DAA) and the posterior approach (PA) on femoral component version in THA. Methods A retrospective database review of 807 THAs in 807 patients who had both preoperative and postoperative CT scans was performed. Femoral component version was measured in the second CT scan and compared to the native neck axis measured in the first CT scan, using the posterior femoral condyles as the reference for both. Operations were performed using either a DAA (n = 291) or a PA (n = 516), with one of four femoral component designs: quadrangular taper, calcar-guided short stem, flat taper, or fit-and-fill. Subgroup analyses investigated changes in version for low (≤ 5°), neutral (5° to 25°), and high (≥ 25°) native version subgroups and for the different femoral component types. Results Overall, DAA components had more mean anteversion relative to the native neck axis versus PA components (6.0° (SD 9.8°) vs 1.3° (SD 10.1°); p < 0.001). Predictors of increased femoral component anteversion postoperatively on multivariable regression analyses were approach (DAA), decreased native version preoperatively, decreased femoral sagittal bow angle, and component type (quadrangular taper). DAA components had greater mean anteversion relative to native than PA in hips with high native version (3.5° (SD 11.1°) vs -5.8° (SD 10.5°); p < 0.001) and neutral native version (5.2° (SD 9.3°) vs 1.3° (SD 9.4°); p < 0.001), but did not reach significance in the low native version subgroup (9.0° (SD 10.3°) vs 5.9° (SD 9.6°); p = 0.109). Quadrangular taper and calcar-guided short-component types had significantly more mean anteversion than native for DAA versus PA. Conclusion Femoral components implanted with a DAA had more mean anteversion than those implanted with a PA. Future studies should aim to investigate the effect of femoral component version on postoperative clinical outcomes.
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Affiliation(s)
- Verinder S Sidhu
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | | | | | | | - Michael I Solomon
- Department of Orthopaedic Surgery, Prince of Wales Private Hospital, St Vincent's Private Hospital, Mater Hospital, Sydney, Australia
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Palit A, Williams MA, Seemala V, Donnelly M, Renkawitz T, Weber M. Pelvic Tilt Increases the Risk of Impingement and Alters Impingement Type in Total Hip Arthroplasty: A Patient-Specific Simulation Study. J Orthop Res 2025. [PMID: 40221867 DOI: 10.1002/jor.26085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 02/05/2025] [Accepted: 03/25/2025] [Indexed: 04/15/2025]
Abstract
Impingement is a significant complication following total hip arthroplasty (THA), resulting in restricted range of motion (ROM). Pelvic tilt (PT) and its variation could alter both post-THA ROM and impingement types, which remains relatively unexplored in the literature. Therefore, this study aims to investigate the impact of PT changes on post-THA ROM and impingement types. Subject-specific ROM was simulated using 3D-CT and clinical data for 56 THA patients. Subsequently, the effect of no-PT, standing preoperative (StPT0) and postoperative PT at 6 (StPT6) and 12 months (StPT12) on maximum ROM (flexion, extension, abduction, adduction, external rotation (ER) and internal rotation at 90° Flexion (IR@90°Flex)) and impingement types (implant-to-implant impingement (ITII), implant-to-bone impingement (ITBI), and bone-to-bone impingement (BTBI)) were investigated. Stong correlations existed between PT and flexion (R2 ≥ 0.686), extension (R2 ≥ 0.527), and IR@90°Flex (R2 ≥ 0.547). Anterior PT exceeding 8.1° and 11.8° were linked to decreased flexion below 110° and IR@90°Flex below 30°, respectively. Each 10° increase in anterior PT resulted in a 10° reduction in flexion and a 10.7° reduction in IR@90°Flex. Impingement types due to PT remained unchanged for flexion/extension, with increased ITII for abduction (8.9%), adduction (23.2%), and IR@90°Flex (16.1%), and increased BTBI (16.1%) for ER. In total, 12.5% and 19.6% of patients experienced clinically relevant ROM change for flexion and IR@90°Flex, respectively for StPT0-StPT6. However, it affected below 5.4% cases when comparing StPT6 and StPT12. Minor changes in impingement type (< 6% of cases) were observed due to changes in PT before and after THA, as well as temporal changes in PT post-THA. However, PT had a substantial impact on impingement types when comparing ROM without considering PT to ROM with PT included. Specifically, anterior PT was associated with reduced flexion and IR@90°Flex, indicating a higher risk of impingement. PT changes over time may lead to clinically relevant alterations in ROM but not impingement types. Trial Registration: German Clinical Trials Register; Main ID: DRKS00000739.
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Affiliation(s)
- Arnab Palit
- WMG, The University of Warwick, Coventry, UK
| | | | | | | | - Tobias Renkawitz
- Department of Orthopaedic Surgery, Regensburg University, Regensburg, Bad Abbach, Germany
| | - Markus Weber
- Department of Orthopedic and Trauma Surgery, Barmherzige Brueder Regensburg, Regensburg, Bad Abbach, Germany
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Pongkunakorn A, Wongkamthong N, Ruktrakul R. Cup positioning relative to the acetabular rim planned with three-dimensional computed tomography improves precision in total hip arthroplasty: a randomized controlled trial. J Orthop Surg Res 2025; 20:318. [PMID: 40140896 PMCID: PMC11948801 DOI: 10.1186/s13018-025-05704-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2025] [Accepted: 03/11/2025] [Indexed: 03/28/2025] Open
Abstract
BACKGROUND Accurate acetabular cup positioning is essential for successful total hip arthroplasty (THA) outcomes. The conventional mechanical alignment guide (MAG) method provides moderate accuracy. We developed a novel technique for cup positioning that utilizes preoperative three-dimensional computed tomography (3D-CT) planning based on the native acetabular rim's relative position and compared cup orientation between this method and the MAG technique. METHODS A randomized controlled trial with 120 patients undergoing primary THA via the posterolateral approach targeted cup positions of 40° radiographic inclination (RI) and 20° radiographic anteversion (RA). The control group (n = 40) used a MAG for cup placement, while the study group (n = 80) utilized preoperative 3D-CT to measure native RI, calculate RA, and determine the cup overhang distance (COD). The cup inclination was positioned relative to the superior rim point and the transverse acetabular notch. The cup anteversion was adjusted to achieve overhang at the posterior or anterior rim point according to the planned COD. Postoperative RI and RA were assessed using tilt-adjusted plain radiographs and CT scans. The percentages of cups positioned within 5° of the target position (RI/RA of 40°/20° ± 5°), and within the Grammatopoulos aiming zone (RI/RA of 40°/20° ± 10°) were compared between the two groups. RESULTS The mean RI was 41.7° ± 5.4° (range, 33°-59°) in the control group and 39.9° ± 3.2° (range, 33.8°-45.5°) in the study group (p = 0.019). The mean RA was 19.5° ± 7.6° (range, 3°-33°) in the control group and 20.2° ± 3.3° (range, 12.9°-28.3°) in the study group (p = 0.356). Cup alignment within 5° of the target was achieved in 86.2% (69 hips) of the study group and 32.5% (13 hips) of the control group (p < 0.001). The study group had a significantly higher percentage of cups within Grammatopoulos aiming zone (100% vs. 77.5%, p < 0.001). CONCLUSIONS 3D-CT-guided cup positioning relative to the acetabular rim can enhance the precision of cup placement in THA to achieve alignment within 5° of the target position. TRIAL REGISTRATION Thai Clinical Trials Registry (TCTR 20201220001). Registered on 20 December 2020. Prospectively registered.
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Affiliation(s)
- Anuwat Pongkunakorn
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, 280 Paholyothin Road, Mueang District, Lampang, 52000, Thailand.
| | - Napon Wongkamthong
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, 280 Paholyothin Road, Mueang District, Lampang, 52000, Thailand
| | - Rukthanin Ruktrakul
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Education Center, 280 Paholyothin Road, Mueang District, Lampang, 52000, Thailand
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Imai N, Hirano Y, Homma D, Komuta Y, Horigome Y, Kawashima H. Impact of Hip Rotation Angle Following Total Hip Arthroplasty with Leg Lengthening. J Clin Med 2025; 14:1564. [PMID: 40095527 PMCID: PMC11899766 DOI: 10.3390/jcm14051564] [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: 02/02/2025] [Revised: 02/17/2025] [Accepted: 02/24/2025] [Indexed: 03/19/2025] Open
Abstract
Background/Objectives: Few studies report on hip rotation after total hip arthroplasty (THA); however, details of the factors affecting the hip rotation angle are unknown. We aimed to investigate the factors related to hip rotation after THA. Methods: This study included 124 consecutive patients who underwent THA. We retrospectively analyzed the correlation between changes in the rotation angle of the femur relative to the pelvis, global femoral offset, and femoral version and leg lengthening. Moreover, we performed a multivariate regression analysis of these parameters to calculate the efficacy of the change in the rotation angle of the femur relative to the pelvis. Results: Leg lengthening and femoral version change were negatively correlated, whereas change in global femoral offset was positively correlated with leg lengthening, with correlation coefficients of 0.376, 0354, and 0.334, respectively. Regarding the multiple regression analysis, only leg lengthening was correlated with the change in rotation angle of the femur relative to the pelvis, with a coefficient of -0.336. Conclusions: The change in the rotation angle of the femur relative to the pelvis is only associated with leg lengthening in multivariate analysis. In actual planning, in cases where the hip is internally rotated, it may be better not to excessively increase leg length, decrease anterior stem anteversion, or increase global femoral offset. Thus, physicians should avoid large leg lengthening for patients with highly external rotation in their hip joint as it may lead to increased internal rotation of the hip, consequently resulting in relative malpositioning and subsequent implant impingement and/or dislocation following THA.
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Affiliation(s)
- Norio Imai
- Division of Comprehensive Musculoskeletal Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City 951-8510, Japan
| | - Yuki Hirano
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City 951-8510, Japan
| | - Daisuke Homma
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City 951-8510, Japan
| | - Yuki Komuta
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City 951-8510, Japan
| | - Yoji Horigome
- Division of Comprehensive Musculoskeletal Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City 951-8510, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-ku, Niigata City 951-8510, Japan
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Du H, Qiao H, Zhai ZJ, Zhang JW, Li HW, Mao YQ, Zhu ZA, Zhao J, Yu DG, Zhao CQ. Acetabular component position significantly influences the rebalancing of pelvic sagittal inclination following total hip arthroplasty in patients with Crowe type III/IV developmental dysplasia of the hip. Bone Joint J 2025; 107-B:149-156. [PMID: 39889760 DOI: 10.1302/0301-620x.107b2.bjj-2024-0485.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2025]
Abstract
Aims Sagittal lumbar pelvic alignment alters with posterior pelvic tilt (PT) following total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH). The individual value of pelvic sagittal inclination (PSI) following rebalancing of lumbar-pelvic alignment is unknown. In different populations, PT regresses in a linear relationship with pelvic incidence (PI). PSI and PT have a direct relationship to each other via a fixed individual angle ∠γ. This study aimed to investigate whether the new PI created by acetabular component positioning during THA also has a linear regression relationship with PT/PSI when lumbar-pelvic alignment rebalances postoperatively in patients with Crowe type III/IV DDH. Methods Using SPINEPARA software, we measured the pelvic sagittal parameters including PI, PT, and PSI in 61 patients with Crowe III/IV DDH. Both PSI and PT represent the pelvic tilt state, and the difference between their values is ∠γ (PT = PSI + ∠γ). The regression equation between PI and PT at one year after THA was established. By substituting ∠γ, the relationship between PI and PSI was also established. The Bland-Altman method was used to evaluate the consistency between the PSI calculated by the linear regression equation (ePSI) and the actual PSI (aPSI) measured one year postoperatively. Results The mean PT and PSI changed from preoperative values of 7.0° (SD 6.5°) and -8.0° (SD 6.7°), respectively, to 8.4° (SD 5.5°) and -4.5° (SD 5.9°) at one year postoperatively. This change shows that the pelvis tilted posteriorly following THA. In addition, when lumbar-pelvic alignment rebalanced, the linear regression equation between PI and PT was PT = 0.45 × PI - 10.5°, and PSI could be expressed as PSI = 0.45 × PI - 10.5° - ∠γ. The absolute difference between ePSI and aPSI was less than 5° in 55 of 61 patients (90.16%). Conclusion The new PI created by the positioning of the acetabular component significantly affects the PSI when lumbar-pelvic alignment changes and rebalances after THA in patients with Crowe III/IV DDH.
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Affiliation(s)
- Han Du
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Han Qiao
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zan-Jing Zhai
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing-Wei Zhang
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui-Wu Li
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan-Qing Mao
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhen-An Zhu
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zhao
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - De-Gang Yu
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chang-Qing Zhao
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ueno S, Iwakiri K, Ohta Y, Minoda Y, Kobayashi A, Nakamura H. Impact of the difference between preoperative planning and intraoperative femoral neck osteotomy level on stem alignment. Arch Orthop Trauma Surg 2024; 145:24. [PMID: 39666028 DOI: 10.1007/s00402-024-05656-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 10/21/2024] [Indexed: 12/13/2024]
Abstract
BACKGROUND The combined anteversion theory is used for implant placement in total hip arthroplasty (THA). While majority of the research emphasizes the precise placement of the acetabular cup, there's less focus on stem alignment. This study aimed to investigate the impact of the discrepancy between the preoperatively planned femoral neck osteotomy level and the actual osteotomy level during surgery on stem alignment. MATERIALS AND METHODS The study involved 232 patients (258 joints) who had a total hip arthroplasty (THA) between April 2018 and December 2022 at our hospital. They were implanted with either the ACTIS stem (Depuy Synthes) or Taperloc Complete XR 123° (Zimmer Biomet)-147 joints with ACTIS stem and 111 with Taperloc stem. Three-dimensional templating software was used to evaluate preoperative planning and postoperative stem placement angles. The difference between the actual and preoperatively planned osteotomy levels was also measured. The impact of this difference in femoral neck osteotomy level on stem alignment was evaluated. RESULTS In the ACTIS stem group, the femoral neck osteotomy level was - 0.3 ± 3.7 mm. The stem alignment had a varus of 1.8 ± 1.9°, extension of 0.1 ± 1.5°, and anteversion of 2.4 ± 5.9°, compared to preoperative plans. A positive correlation was identified between osteotomy level and varus/valgus alignment (r = 0.607, p < 0.01), with a weak correlation for anteversion (r = 0.236, p < 0.01). No correlation existed with flexion/extension. In the Taperloc stem group, osteotomy level was 2.2 ± 3.1 mm. The postoperative stem showed a varus of 1.6 ± 1.5°, extension of 0.5 ± 1.7°, and anteversion of 4.9 ± 6.5°. A correlation was observed between osteotomy level and varus/valgus alignment (r = 0.476, p < 0.01), but not with flexion/extension or anteversion. CONCLUSIONS The study examined how differences in planned vs. actual femoral neck osteotomy affect stem alignment in THA using ACTIS stem and Taperloc stem. We found that osteotomy level influenced varus/valgus alignment; mildly affected flexion/extension; and had no effect on anteversion.
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Affiliation(s)
- Shuhei Ueno
- Department of Orthopaedic Surgery, Shiraniwa Hospital Joint, Arthroplasty Center. 6-10-1 Shiraniwadai Ikoma-city, Nara, 630-0136, Japan
| | - Kentaro Iwakiri
- Department of Orthopaedic Surgery, Shiraniwa Hospital Joint, Arthroplasty Center. 6-10-1 Shiraniwadai Ikoma-city, Nara, 630-0136, Japan.
| | - Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku Osaka-city, Osaka, 545-8585, Japan
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku Osaka-city, Osaka, 545-8585, Japan
| | - Akio Kobayashi
- Department of Orthopaedic Surgery, Shiraniwa Hospital Joint, Arthroplasty Center. 6-10-1 Shiraniwadai Ikoma-city, Nara, 630-0136, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-machi Abeno-ku Osaka-city, Osaka, 545-8585, Japan
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Anatone AJ, Hughes AJ, Schiller NC, Vigdorchik JM, Sculco TP, Sculco PK. Decreased "Polar Axis Angle" is Associated With Instability After Total Hip Arthroplasty: A New Method to Assess Functional Component Position on Lateral-Seated Radiographs. J Arthroplasty 2024; 39:3021-3027. [PMID: 38909855 DOI: 10.1016/j.arth.2024.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Research on hip instability has focused on establishing "safe" ranges of combined component position in supine posture or functional placement of the acetabular component based on the hip-spine relationship. A new angle, the polar axis angle (PAA), of the total hip arthroplasty (THA) components describes the concentricity of both components and can be evaluated in functional positions that confer a greater risk of instability (ie, sitting). The goal of this study was to compare the PAA in functional positions between patients who experienced a postoperative dislocation and a matched control group who did not have a dislocation. METHODS An institutional database was searched for patients experiencing a dislocation after primary THA. Patients who had postoperative full-length standing and lateral-seatedradiographs were included in the dislocator group. A control group of nondislocator patients was matched 2:1 by age, body mass index, sex, and hip-spine classification. Radiographic measurements of the neck angle, acetabular ante-inclination, and PAA were performed by 2 separate blinded, trained reviewers. RESULTS The lateral-seated neck angle and lateral-seated PAA measurements were significantly lower in the dislocator groups (n = 37) than the control group (n = 74) (23 versus 33 degrees, P < .001; 74 versus 83 degrees, P = .012, respectively). Significant differences were also observed in changes in the polar axes and neck angles between standing and seated positions (P < .001 and P < .001, respectively). When comparing patients who have mobile spines versus stiff spines within the dislocator group, there were no differences in the acetabular, neck, or PAAs. The effect of neck angle on the PAA showed a linear trend across cohorts. CONCLUSIONS Patients who experience postoperative instability have a significantly lower PAA on lateral-seated radiographs when matched for age, sex, body mass index, and hip-spine classification. In addition, the lower seated PAA is driven more strongly by decreased functional femoral anteversion, which emphasizes the role of functional femoral version on stability in THA.
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Affiliation(s)
- Alex J Anatone
- Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Andrew J Hughes
- Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Nicholas C Schiller
- Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Thomas P Sculco
- Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Peter K Sculco
- Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
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Goshi A, Takeda Y, Nakai T, Fukunishi S. Mechanical studies for the rotational stability of a cemented stem in cases with stem anteversion adjustment in the cement mantle. J Orthop Sci 2024:S0949-2658(24)00199-4. [PMID: 39603903 DOI: 10.1016/j.jos.2024.10.006] [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: 07/04/2024] [Revised: 10/11/2024] [Accepted: 10/15/2024] [Indexed: 11/29/2024]
Abstract
INTRODUCTION The cemented stem can accommodate various shapes of femurs and is a stable stem with long-term results. Additionally, the cemented stem is a highly versatile stem that can be used to adjust stem anteversion in patients with variable femoral anteversion. On the other hand, rotating a stem with increasing cement viscosity may result in reduced postoperative rotational stability. MATERIALS AND METHODS Rotational stability was compared using two different cementing techniques via in vitro models. Six stems in Group S (Static) were inserted and fixed until the cement was completely hardened. Six stems in Group R (Rotation) were inserted and then rotated 15° before the cement had fully cured. After the cement had completely set, a static rotation testing was performed in which the stem was rotated at a rate of 1°/sec to 20° while a vertical load of 600 N was applied. For the dynamic testing, a vertical load of 600 N and 10,000 cycles of repetitive rotation were applied at 10° around the stem axis at 0.1 Hz. After 10,000 cycles, maximum torque was compared between Groups S and R. RESULTS In both groups, the torque value increased proportionally to the rotation angle. There were no significant differences in resistance to static rotation between Groups S and R (P = 0.599). In the dynamic testing, there was no significant difference between Groups S and R in both minimum torque and maximum torque in any of the cycles. There were no differences in the rotational torque between Groups S and R at 10,000 cycles (P = 0.693). CONCLUSIONS The rotational stability of the cemented stems did not decrease in vitro when stem version control was performed up to 15° before the cement had completely hardened.
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Affiliation(s)
- Ariha Goshi
- Department of Orthopedic Surgery, Goshi Hospital, 10-8-20, Nagasunishidoori, Amagasaki City, Hyogo, 660-0807, Japan
| | - Yu Takeda
- Depertment of Orthopedic Surgery, Hyogo Medical University Hospital, 1-1, Mukogawa-cho, Nishinomiya City, Hyogo, 663-8501, Japan
| | - Takuya Nakai
- Department of Orthopedic Surgery, Nishinomya Kaisei Hospital, 1-4, Ohama-cho, Nishinomiya City, Hyogo, 662-0957, Japan
| | - Shigeo Fukunishi
- Department of Orthopedic Surgery, Nishinomya Kaisei Hospital, 1-4, Ohama-cho, Nishinomiya City, Hyogo, 662-0957, Japan.
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Lee WS, Yoon SP, Lee JH, Park KK, Kang KT, Cho BW. Intraoperative estimation of natural femoral anteversion from proximal femoral osseous orientation during total hip arthroplasty. J Orthop Surg Res 2024; 19:590. [PMID: 39342364 PMCID: PMC11438123 DOI: 10.1186/s13018-024-05084-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 09/14/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND The purpose of this study was to elucidate the relationship between the orientation of the osseous structure of the proximal femur encountered during total hip arthroplasty (THA) and preoperative femoral anteversion (FA). METHODS Three-dimensional models were constructed using full-length lower extremity computed tomography images from a total of 80 participants. Femoral neck cutting was performed at heights of 5, 10, and 15 mm relative to the lesser trochanter. Following neck cutting, the angles formed by the anterior outer cortex and posterior outer cortex with the posterior condylar line (PCL) were defined as the anterior cortical angle (ACA) and posterior cortical angle (PCA), respectively. Univariate linear regression analysis was conducted using the remaining measurements with FA as the dependent variable. RESULTS The mean age of the participants was 60.98 ± 10.82 years (males, 60.50 ± 11.36 years; females, 61.45 ± 10.37 years) (p = 0.697). All cortical angles and FA were larger in women compared to those in men. When comparing measurements by age groups, no statistically significant differences were observed. Univariate linear regression analysis with FA as the dependent variable showed statistical significance for all cortical angles. The adjusted R2 values were 0.711 (ACA5), 0.677 (ACA10), 0.572 (ACA15), 0.493 (PCA5), 0.574 (PCA10), and 0.446 (PCA15). CONCLUSION Natural FA can be inferred from the anterior cortical angle (ACA) from femoral neck cutting plane observed during the THA procedure without preoperative images. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Woo-Suk Lee
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211Eonju-ro, Gangnam-gu, Seoul, 06273, Korea
| | - Soon-Phil Yoon
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211Eonju-ro, Gangnam-gu, Seoul, 06273, Korea
| | - Ju Hyung Lee
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211Eonju-ro, Gangnam-gu, Seoul, 06273, Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, Korea
| | - Byung-Woo Cho
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211Eonju-ro, Gangnam-gu, Seoul, 06273, Korea.
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10
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Sonoda K, Kubo Y, Komiyama K, Nakamura T, Hara T. Error of intraoperative measurement of stem anteversion is decreased by measuring in neutral hip position during total hip arthroplasty. J Orthop Sci 2024; 29:1235-1241. [PMID: 37596167 DOI: 10.1016/j.jos.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/15/2023] [Accepted: 08/08/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Intraoperative stem anteversion, which is the angle between the lower leg axis and the trial-stem axis with hip flexion and adduction, is generally evaluated by the surgeon's visual estimation during total hip arthroplasty (THA). However, the conventional approach can be influenced by knee osteoarthritis or uncertain surgeon's observation point. Therefore, we developed a new method for measuring the stem anteversion angle in the neutral hip position using an original rod attached to the trial-stem perpendicular to the long axis and parallel to the stem neck. This study aimed to assess the accuracy of our method in comparison with the conventional method of measuring intraoperative stem anteversion angle. METHODS We measured the intraoperative stem anteversion angle in consecutive 106 hips of 106 patients who underwent cementless primary THA with a tapered wedge stem. Absolute error in the stem anteversion angle was expressed as the difference between intraoperative (common vs. neutral hip positions) and postoperative computed tomography measurements, i.e., true stem anteversion. Additionally, we investigated the factors affecting these errors. RESULTS The absolute error of measurement was significantly smaller in the neutral hip position than in the common position (3.0° ± 2.5° vs. 8.0° ± 3.9°; p < 0.0001). The factor associated with the error was advanced knee osteoarthritis in the common position, whereas it was not statistically significant in the neutral hip position. CONCLUSIONS This study suggests that the error in the intraoperative measurement of stem anteversion is decreased by measuring in the neutral hip position during THA.
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Affiliation(s)
- Kazuhiko Sonoda
- Department of Orthopaedic Surgery, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka 820-8505, Japan.
| | - Yusuke Kubo
- Department of Orthopaedic Surgery, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka 820-8505, Japan.
| | - Keisuke Komiyama
- Department of Orthopaedic Surgery, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka 820-8505, Japan.
| | - Tetsuro Nakamura
- Department of Orthopaedic Surgery, Fukuoka Mirai Hospital, 3-5-1 Higashi-Ku, Fukuoka 813-0017, Japan.
| | - Toshihiko Hara
- Department of Orthopaedic Surgery, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka 820-8505, Japan.
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11
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Marcovigi A, Grandi G, Bianchi L, Zambianchi F, Pavesi M, Catani F. Stem anteversion is not affected by proximal femur geometry in robotic-assisted total hip arthroplasty. ARTHROPLASTY 2024; 6:27. [PMID: 38824601 PMCID: PMC11144328 DOI: 10.1186/s42836-024-00248-0] [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: 10/19/2023] [Accepted: 03/07/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND In the present study, the surgeon aimed to align the stem at 5° to 25° in anteversion. The robotic technology was used to measure stem anteversion with respect to proximal femur anteversion at different levels down the femur. METHODS A total of 102 consecutive patients underwent robotic-arm-assisted total hip arthroplasty (RTHA). 3D CT-based preoperative planning was performed to determine femoral neck version (FNV), posterior cortex anteversion (PCA), anterior cortex anteversion (ACA), and femoral metaphyseal axis anteversion (MAA) at 3 different levels: D (10 mm above lesser trochanter), E (the midpoint of the planned neck resection line) and F (head-neck junction). The robotic system was used to define and measure stem anteversion during surgery. RESULTS Mean FNV was 6.6° (SD: 8.8°) and the mean MAA was consistently significantly higher than FNV, growing progressively from proximal to distal. Mean SV was 16.4° (SD: 4.7°). There was no statistically significant difference (P = 0.16) between SV and MAA at the most distal measured level. In 96.1% cases, the stem was positioned inside the 5°-25° anteversion range. CONCLUSIONS Femoral anteversion progressively increased from neck to proximal metaphysis. Aligning the stem close to femoral anteversion 10 mm above the lesser trochanter often led to the desired component anteversion.
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Affiliation(s)
- Andrea Marcovigi
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Via del Pozzo 71, Modena, MO, 41125, Italy
| | - Gianluca Grandi
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Via del Pozzo 71, Modena, MO, 41125, Italy
| | - Luca Bianchi
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Via del Pozzo 71, Modena, MO, 41125, Italy
| | - Francesco Zambianchi
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Via del Pozzo 71, Modena, MO, 41125, Italy.
| | - Marco Pavesi
- Ab Medica S.p.A., Cerro Maggiore, MI, 20023, Italy
| | - Fabio Catani
- Department of Orthopaedic Surgery, Azienda Ospedaliero-Universitaria Policlinico di Modena, University of Modena and Reggio-Emilia, Via del Pozzo 71, Modena, MO, 41125, Italy
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12
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Habe Y, Hamada H, Uemura K, Takashima K, Ando W, Sugano N. Cup safe zone and optimal stem anteversion in total hip arthroplasty for patients with highly required range of motion. J Orthop Res 2024; 42:1283-1291. [PMID: 38084832 DOI: 10.1002/jor.25769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/29/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
To avoid dislocation after total hip arthroplasty, it is desirable to avoid implant impingement during activities of daily living. Numerous simulation studies have been performed at 30° of internal rotation (IR) with 90° of flexion. However, these studies may not reflect the impingement that occurs during activities such as floor sitting, which require a larger IR during flexion. The purpose of this study was to assess the impact of varying IR angles during flexion on the impingement-free safe zone and optimal stem anteversion. In this study, implant impingement simulation was evaluated in computer simulation. The prosthesis used a flat liner, and a 32- or 40-mm femoral head and stem. Three patterns of required IR angle (30° IR/40° IR/50° IR with 90° flexion) combined with 13 directions of the required range of motion were simulated. The optimal stem anteversion to maximize the safe zone was analyzed. Increasing the required IR at 90° flexion decreased the safe zone, particularly with small stem anteversion angles. With a 32-mm head, the desirable stem anteversion at 40° of cup inclination was 15°/25°/35° in required 30° IR/40° IR/50° IR with 90° flexion, respectively. The safe zone area of the 32-mm head was smaller than that of the 40-mm head. For patients who require a larger IR with 90° flexion, the stem and cup target anteversion should be adjusted according to the implant design, head diameter, and patient's required IR at flexion in their lifestyle.
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Affiliation(s)
- Yukihiro Habe
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Medical Division, KYOCERA Corporation, Fushimi-ku, Kyoto, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuma Takashima
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Liu C, Xu Z, Zeng JF, Song ZQ, Xie YY, Tang ZW, Wen J, Xiao S. Roles of combined femoral and acetabular anteversion in pathological changes of hip dysplasia and hip reconstructive surgery. World J Orthop 2024; 15:390-399. [PMID: 38835688 PMCID: PMC11145975 DOI: 10.5312/wjo.v15.i5.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/10/2024] [Accepted: 04/24/2024] [Indexed: 05/15/2024] Open
Abstract
Combined femoral and acetabular anteversion is the sum of femoral and acetabular anteversion, representing their morphological relationship in the axial plane. Along with the increasing understanding of hip dysplasia in recent years, numerous scholars have confirmed the role of combined femoral and acetabular anteversion in the pathological changes of hip dysplasia. At present, the reconstructive surgery for hip dysplasia includes total hip replacement and redirectional hip preservation surgery. As an important surgery index, combined femoral and acetabular anteversion have a crucial role in these surgeries. Herein, we discuss the role of combined femoral and acetabular anteversion in pathological changes of hip dysplasia, total hip replacement, and redirectional hip preservation surgery.
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Affiliation(s)
- Can Liu
- Department of Anatomy, Hunan Normal University School of Medicine, Changsha 410003, Hunan Province, China
| | - Zheng Xu
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Jian-Fa Zeng
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zhen-Qi Song
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Yu-Yin Xie
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zhong-Wen Tang
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Sheng Xiao
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
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14
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Hidaka R, Matsuda K, Nakamura S, Nakamura M, Kawano H. Clinical effects of combined anteversion and offset on postoperative dislocation in total hip arthroplasty. ARTHROPLASTY 2024; 6:22. [PMID: 38704579 PMCID: PMC11070079 DOI: 10.1186/s42836-024-00245-3] [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: 09/27/2023] [Accepted: 02/29/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Implant impingement and soft tissue tension are factors involved in dislocation after total hip arthroplasty (THA). Combined anteversion (CA) has been used as an indicator for implant placement. However, optimal implant placement remains a challenge. Moreover, the effect of changes in offset on dislocation is still unclear. In this study, we aimed to clarify the effects of postoperative CA and pre- and postoperative changes in offset on dislocation. METHODS Included were patients who underwent primary cementless THA between 2013 and 2020. The mean values of CA and offset in the dislocation and non-dislocation groups were compared. The CA values within ± 10% of the recommended values were defined as good CA, and those outside the range were rated as poor CA. The dislocation rates were compared between the good and poor CA groups and between the groups with and without increased offset. RESULTS A total of 283 hips were included. The mean values of CA in the dislocation and non-dislocation groups were significantly different (P < 0.05). The dislocation rate was significantly lower in the good CA group (P < 0.05). The dislocation rates in the groups with and without increased total offset were 0.5% and 4.3%, respectively (P = 0.004). There were no dislocations in patients with good CA and increased offset. CONCLUSIONS The dislocation rate was significantly lower when implants were placed within ± 10% of the recommended CA value. Our results suggest that dislocation can be avoided by placing the implant in the good CA range and considering the increase in total offset on the operative side.
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Affiliation(s)
- Ryo Hidaka
- Department of Orthopedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
| | - Kenta Matsuda
- Department of Orthopedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan.
| | - Shigeru Nakamura
- Department of Orthopedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19, Shibakubo-Cho, Nishitokyo, Tokyo, 188-0014, Japan
| | - Masaki Nakamura
- Department of Orthopedic Surgery, Toranomon Hospital, 2-2-2, Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Hirotaka Kawano
- Department of Orthopedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
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15
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Gold PA, McCarthy TF, Borukhov I, Danoff J. How to Estimate Femoral Stem Anteversion During Direct Anterior Approach Total Hip Arthroplasty. Arthroplast Today 2024; 26:101326. [PMID: 38433872 PMCID: PMC10907387 DOI: 10.1016/j.artd.2024.101326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/25/2023] [Accepted: 01/27/2024] [Indexed: 03/05/2024] Open
Abstract
Background There are various traditional landmarks used to estimate the femoral component version, yet none are widely accepted by direct anterior surgeons. The purpose of this study was to compare bony landmarks easily accessible to direct anterior surgeons and to estimate which one provides the best estimate of femoral component anteversion. Methods A computed tomography database was used to identify 736 left entire-femur computed tomography scans. Seven visible anatomic landmarks were identified using a computer model in which a 45° virtual neck resection was made at 10 mm above the lesser trochanter. Thirteen axes, to reference the femoral stem position, were created between the 7 landmarks. Means and standard deviations (SDs) of angles between each axis and the transepicondylar axis (TEA) were compared for their precision. Results The traditional lesser trochanter predicted anteversion from the TEA was 34.1° (SD 9.7°). Predicted anteversion from the TEA was 3.3° (SD 8.1°) when aligned from the center of the canal to the middle of the medial calcar; 14.0° (SD 8.1°) from the center of the canal to the anterior 1/3 of the medial calcar; and 24.8° (SD 8.5°) from the center of the canal to the most anterior point on the medial calcar. Conclusions Compared to the lesser trochanter, 7 axes were more precise (lower SD) when predicting the version. Estimating the femoral component position, via simulated data, using 3 points along the medial calcar is a relatively precise and easily accessible tool for surgeons.
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Affiliation(s)
- Peter A. Gold
- Department of Orthopedics, Panorama Orthopedic & Spine Center, Golden, CO, USA
| | | | - Ilya Borukhov
- Department of Orthopedics, Stryker Orthopaedics, Mahwah, NJ, USA
| | - Jonathan Danoff
- Department of Orthopedics, Northwell Health, Great Neck, NY, USA
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16
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Shao H, Huang Y, Yang D, Deng W, Wu XD, Zhou Y. Variety of femoral anteversion and its measurement in cementless total hip arthroplasty: Does robotic technology improve accuracy? J Orthop Surg Res 2024; 19:47. [PMID: 38195511 PMCID: PMC10775668 DOI: 10.1186/s13018-024-04527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 01/01/2024] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND High-performance total hip arthroplasty (THA) depends on the accurate position of components. However, femoral anteversion is variable, and current studies only used traditional instruments to evaluate it, such as protractor and spirit level with limited cases. This study aimed to identify the variability in the measured femoral native anteversion and intraoperative stem anteversion under different measurement methods, including intraoperative robotic method. We hypothesized that robotic technology was more accurate than traditional instruments for femoral anteversion evaluation. METHODS This study included 117 hips of patients who underwent robotic-assisted THA between November 2019 and March 2021. Preoperative native femoral anteversion was measured using a robotic system. Intraoperative femoral stem anteversion was evaluated visually, and then measured with a goniometer and a robotic system, respectively. Variability in the measured femoral native anteversion and intraoperative femoral stem anteversion was calculated and compared. Intraclass correlation coefficient (ICC) and Pearson correlation analysis were used to assess the consistency and correlation of anteversion of different measurements and postoperative CT-measured stem anteversion, respectively. RESULTS The result of measurement for preoperative native femoral anteversion was more variable than the intraoperative robotic-measured stem anteversion. Intraoperative robotic-measured stem version showed the highest correlation with postoperative CT measurement of stem version (r = 0.806, P < 0.001), while intraoperative surgeon estimation had the lowest correlation coefficient (r = 0.281, P = 0.025). As for the consistency with postoperative CT measurement of femoral stem anteversion, the intraoperative robotic-measured femoral stem version also had the highest value (ICC = 0.892, P < 0.001). CONCLUSION Native femoral anteversion was variable preoperatively. Using cementless stems, anteversion was also highly variable. Robotic assessment for stem anteversion during surgery was more consistent with the final position than the preoperative assessment and conventional intraoperative estimation.
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Affiliation(s)
- Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing, 100035, China
| | - Yong Huang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing, 100035, China
| | - Dejin Yang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing, 100035, China
| | - Wang Deng
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing, 100035, China
| | - Xiang-Dong Wu
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing, 100035, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Fourth Clinical College of Peking University, National Center for Orthopaedics, Beijing, 100035, China.
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Dimitriou D, Zindel C, Winkler E, Cornaz F, Mazel P, Zingg PO. Combined Anteversion Threshold to Avoid Anterior Dislocation in Primary Total Hip Arthroplasty Performed Through the Direct Anterior Approach. J Arthroplasty 2024; 39:145-150. [PMID: 37331442 DOI: 10.1016/j.arth.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Component malposition in total hip arthroplasty (THA) can lead to dislocation, early implant failure, and revision surgery. As the surgical approach might affect the targeted combined anteversion (CA) of THA components, the present study aimed to evaluate the optimal CA threshold to avoid anterior dislocation in primary THA performed through a direct anterior approach (DAA). METHODS A total of 1,176 THAs in 1,147 consecutive patients (men: 593, women: 554) who had an average age of 63 years (range, 24 to 91) and a mean body mass index of 29 (range, 15 to 48) were identified. Medical records were reviewed for dislocation, whereas postoperative radiographs were assessed to measure the acetabular inclination and CA using a previously validated radiographic method. RESULTS An anterior dislocation occurred in 19 patients at an average of 40 days postoperatively. The average CA in patients who did and did not have a dislocation was 66 ± 8° and 45 ± 11°, respectively (P < .001). In 5 of 19 of the patients, a THA was performed for secondary osteoarthritis and 17 of 19 had a 28-mm femoral head. A CA ≥ 60° yielded a sensitivity of 93% and specificity of 90% for predicting an anterior dislocation in the present cohort. A CA ≥ 60° was associated with a significantly higher risk of anterior dislocation (odds ratio = 75.6; P < .001) compared to patients who had a CA<60 points. CONCLUSION The optimal CA to avoid anterior dislocations in THA performed through the DAA should be less than 60°. LEVEL OF EVIDENCE Cross-sectional study, Level III.
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Affiliation(s)
- Dimitris Dimitriou
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Christoph Zindel
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Elin Winkler
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Frédéric Cornaz
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Peter Mazel
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
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Geelen H, Vanryckeghem V, Leirs G. Evaluation of the native femoral neck and stem version reproducibility using robotic-arm assisted direct-anterior total hip arthroplasty. Acta Orthop Belg 2023; 89:595-602. [PMID: 38205747 DOI: 10.52628/89.4.10411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
The intraoperative measurement of the femoral version (FV) has gained attention in wake of an optimised combined version (CV) philosophy. Whereas some data is available utilising different approaches, to our belief this study provides the first in vivo FV data in DA-THA using the MAKO™ robot. To improve the accuracy of the femoral stem version in DA-THA, we want to ask the following question: How effectively can we reproduce the native femoral version in DA- THA using the MAKO™ robot? The first 125 total hip cases through DAA with the use of the combined anteversion concept and the help of the MAKO™ robot from a single institution, single surgeon from January 2020 to July 2021 were retrospectively analysed. The native version (NV) and broach version (BV) were determined with the use of the MAKO™ preoperative computed tomography planning software. The data of the NV and BV of 115 withheld patients was normally distributed. The native femoral version ranged from -12° till 33° (mean 7,8° +/- 8,1) and the broach version ranged from -18° till 43° (mean 8,2° +/- 9,9). The Pearson correlation coefficient between the NV and BV was 0,78. The native femoral version can be reproduced by broaching the proximal femur, in a robotically implanted direct anterior cementless THA, with 78% effectiveness. Stem placement seemed to be more precise with growing experience, however this appeared not to be significant.
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Soliman MM, Islam MT, Chowdhury MEH, Alqahtani A, Musharavati F, Alam T, Alshammari AS, Misran N, Soliman MS, Mahmud S, Khandakar A. Advancement in total hip implant: a comprehensive review of mechanics and performance parameters across diverse novelties. J Mater Chem B 2023; 11:10507-10537. [PMID: 37873807 DOI: 10.1039/d3tb01469j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
The UK's National Joint Registry (NJR) and the American Joint Replacement Registry (AJRR) of 2022 revealed that total hip replacement (THR) is the most common orthopaedic joint procedure. The NJR also noted that 10-20% of hip implants require revision within 1 to 10 years. Most of these revisions are a result of aseptic loosening, dislocation, implant wear, implant fracture, and joint incompatibility, which are all caused by implant geometry disparity. The primary purpose of this review article is to analyze and evaluate the mechanics and performance factors of advancement in hip implants with novel geometries. The existing hip implants can be categorized based on two parts: the hip stem and the joint of the implant. Insufficient stress distribution from implants to the femur can cause stress shielding, bone loss, excessive micromotion, and ultimately, implant aseptic loosening due to inflammation. Researchers are designing hip implants with a porous lattice and functionally graded material (FGM) stems, femur resurfacing, short-stem, and collared stems, all aimed at achieving uniform stress distribution and promoting adequate bone remodeling. Designing hip implants with a porous lattice FGM structure requires maintaining stiffness, strength, isotropy, and bone development potential. Mechanical stability is still an issue with hip implants, femur resurfacing, collared stems, and short stems. Hip implants are being developed with a variety of joint geometries to decrease wear, improve an angular range of motion, and strengthen mechanical stability at the joint interface. Dual mobility and reverse femoral head-liner hip implants reduce the hip joint's dislocation limits. In addition, researchers reveal that femoral headliner joints with unidirectional motion have a lower wear rate than traditional ball-and-socket joints. Based on research findings and gaps, a hypothesis is formulated by the authors proposing a hip implant with a collared stem and porous lattice FGM structure to address stress shielding and micromotion issues. A hypothesis is also formulated by the authors suggesting that the utilization of a spiral or gear-shaped thread with a matched contact point at the tapered joint of a hip implant could be a viable option for reducing wear and enhancing stability. The literature analysis underscores substantial research opportunities in developing a hip implant joint that addresses both dislocation and increased wear rates. Finally, this review explores potential solutions to existing obstacles in developing a better hip implant system.
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Affiliation(s)
- Md Mohiuddin Soliman
- Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Mohammad Tariqul Islam
- Centre for Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Muhammad E H Chowdhury
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
| | - Abdulrahman Alqahtani
- Department of Medical Equipment Technology, College of Applied, Medical Science, Majmaah University, Majmaah City 11952, Saudi Arabia
- Department of Biomedical Technology, College of Applied Medical Sciences in Al-Kharj, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia.
| | - Farayi Musharavati
- Department of Mechanical & Industrial Engineering, Qatar University, Doha 2713, Qatar.
| | - Touhidul Alam
- Pusat Sains Ankasa (ANGKASA), Institut Perubahan Iklim, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Selangor, Malaysia.
| | - Ahmed S Alshammari
- Department of Electrical Engineering, College of Engineering, University Hail, Hail 81481, Saudi Arabia.
- Department of Electrical Engineering, College of Engineering, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
| | - Norbahiah Misran
- Centre for Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Mohamed S Soliman
- Department of Electrical Engineering, College of Engineering, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
- Department of Electrical Engineering, Faculty of Energy Engineering, Aswan University, Aswan, 81528, Egypt
| | - Sakib Mahmud
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
| | - Amith Khandakar
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
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Dimitriou D, Zindel C, Winkler E, Cornaz F, Mazel P, Zingg PO. A novel method for evaluating combined component anteversion in total hip arthroplasty on cross-table lateral hip radiographs. Arch Orthop Trauma Surg 2023; 143:5977-5984. [PMID: 36899142 PMCID: PMC10449991 DOI: 10.1007/s00402-023-04825-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION Accurate measurement of combined component anteversion (CA) is important in evaluating the radiographic outcomes following total hip arthroplasty (THA). The aim of the present study was to evaluate the accuracy and reliability of a novel radiographic method in estimating CA in THA. MATERIALS AND METHODS The radiographs and computer tomography of patients who underwent a primary THA were retrospectively reviewed, to measure the radiographic CA (CAr), defined as the angle between a line connecting the center of the femoral head to the most anterior rim of the acetabular cup and a line connecting the center of the femoral head to the base of the femoral head to allow a comparison with the CA measured on the CT (CACT). Subsequently, a computational simulation was performed to evaluate the effect of cup anteversion, inclination, stem anteversion, and leg rotation on the CAr and develop a formula that would correct the CAr according to the acetabular cup inclination based on the best-fit equation. RESULTS In the retrospective analysis of 154 THA, the average CAr_cor, and CACT were 53 ± 11° and 54 ± 11° (p > 0.05), respectively. A strong correlation was found between CAr and CACT (r = 0.96, p < 0.001), with an average bias of - 0.5° between CAr_cor and CACT. In the computational simulation, the CAr was strongly affected by the cup anteversion, inclination, stem anteversion, and leg rotation. The formula to convert the CAr to CA_cor was: CA-cor = 1.3*Car - (17* In (Cup Inclination) - 31. CONCLUSION The combined anteversion measurement of THA components on the lateral hip radiograph is accurate and reliable, implying that it could be routinely used postoperatively but also in patients with persistent complaints following a THA. LEVEL OF EVIDENCE Cross-sectional study, Level III.
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Affiliation(s)
- Dimitris Dimitriou
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Christoph Zindel
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Elin Winkler
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Frédéric Cornaz
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Peter Mazel
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
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21
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Brush PL, Santana A, Toci GR, Slotkin E, Solomon M, Jones T, Saxena A. Surgeon Estimations of Acetabular Cup Orientation Using Intraoperative Fluoroscopic Imagining Are Unreliable. Arthroplast Today 2023; 20:101109. [PMID: 36938353 PMCID: PMC10018435 DOI: 10.1016/j.artd.2023.101109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/12/2022] [Accepted: 01/22/2023] [Indexed: 03/21/2023] Open
Abstract
Background Accurate acetabular cup orientation is associated with decreased revision rates and improved outcomes of primary total hip arthroplasty. This study assesses surgeon's ability to estimate both the acetabular component inclination and anteversion angles via intraoperative fluoroscopy (IF) images. Methods We surveyed orthopedic surgeons to estimate acetabular component inclination and anteversion based on 20 IF images of total hip arthroplasty through a direct anterior approach. Postoperative computed-tomography scans were used to calculate the true inclination and anteversion component angles. The absolute difference between the true and estimated values was calculated to determine the mean and standard deviation of the survey results. Interrater reliability was determined through interclass correlation coefficients. Results A majority of surgeons preferred the direct anterior approach (83.3%) and utilized IF during surgery (70%). Surgeons surveyed were on average 5.9° away from the true value of inclination (standard deviation = 4.7) and 8.8° away from the true value of anteversion (standard deviation = 6.0). Respondents were within 5° of both inclination and anteversion in 19.7% of cases, and within 10° in 57.3% of cases. All surgeons were determined to have poor reliability in estimating anteversion (interclass correlation coefficient < 0.5). Only 2 surgeons were determined to have moderate reliability when estimating inclination. Conclusions Surgeons, when solely relying on IF for the estimation of anteversion and inclination, are unreliable. Utilization of other techniques in conjunction with IF would improve observer reliability.
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Affiliation(s)
- Parker L. Brush
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
- Corresponding author. Rothman Orthopaedic Institute, 925 Chestnut Street, Philadelphia, PA, USA. Tel.: +1 316 993 3876.
| | - Adrian Santana
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Gregory R. Toci
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Eric Slotkin
- Orthopaedic Associates of Reading, Tower Health, Reading Hopsital, West Reading, PA, USA
| | - Michael Solomon
- Sydney Orthopaedic Specialists, Prince of Wales Private Hospital, Randwick, Australia
| | | | - Arjun Saxena
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
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22
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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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23
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LeBrun DG, Ondeck NT, Nessler JP, Marchand RC, Illgen RL, Westrich GH. Variability of pre-operative functional pelvic tilt in total hip arthroplasty patients. INTERNATIONAL ORTHOPAEDICS 2023; 47:1243-1247. [PMID: 36864185 DOI: 10.1007/s00264-023-05748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE Pelvic tilt (PT) is important to consider when planning total hip arthroplasty (THA) due to its dynamic impact on acetabular orientation. The degree of sagittal pelvic rotation varies during functional activities and can be difficult to measure without proper imaging. The purpose of this study was to evaluate PT variation in the supine, standing, and seated positions. METHODS A multi-centre cross-sectional study was performed that included 358 THA patients who had preo-perative PT measured from supine CT scan and standing and upright seated lateral radiographs. Supine, standing, and seated PT and associated changes between functional positions were evaluated. Anterior PT was assigned a positive value. RESULTS In the supine position, mean PT was 4° (range, -35° to 20°), where 23% had posterior PT and 69% anterior PT. In the standing position, mean PT was 1° (range, -23° to 29°), where 40% had posterior PT and 54% anterior PT. In the seated position, mean PT was -18° (range, -43° to 47°), where 95% had posterior PT and 4% anterior PT. From standing to seated, the pelvis rotated posteriorly in 97% of cases (maximum 60°) with 16% of cases considered stiff (change ≤ 10°) and 18% of cases considered hypermobile (change ≥ 30°). CONCLUSION Patients undergoing THA have marked PT variation in the supine, standing, and seated positions. There was wide variability in PT change from standing to seated, with 16% of patients considered stiff and 18% considered hypermobile. Functional imaging should be performed on patients prior to THA to allow for more accurate planning.
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Affiliation(s)
- Drake G LeBrun
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, 535 East 70 th Street, New York, NY, 10021, USA.
| | - Nathaniel T Ondeck
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, 535 East 70 th Street, New York, NY, 10021, USA
| | - Joseph P Nessler
- St. Cloud Orthopedics, 1901 Connecticut Ave S, MN, 56377, Sartell, USA
| | - Robert C Marchand
- Ortho Rhode Island, 285 Promenade Street, RI, 02908, Providence, USA
| | - Richard L Illgen
- University of Wisconsin-Madison, 4602 Eastpark Blvd, Madison, WI, 53706, USA
| | - Geoffrey H Westrich
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, 535 East 70 th Street, New York, NY, 10021, USA
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24
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Iwakiri K, Ohta Y, Minoda Y, Kobayashi A, Nakamura H. A comparison of accuracy and safety between stem-first and cup-first total hip arthroplasty: a prospective randomised controlled trial. Hip Int 2023; 33:231-240. [PMID: 34392737 DOI: 10.1177/11207000211039767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The combined anteversion theory to prevent impingement in total hip arthroplasty (THA) has been proposed. However, because stem-anteversion is influenced by the native femoral anteversion and the stem flexion/extension angle, it is often difficult to adjust stem anteversion during surgery. Therefore, the stem-first (combined anteversion) technique may be useful to adjust and achieve appropriate cup anteversion during surgery with respect to the implanted stem anteversion angle. However, the technique may adversely affect cup or stem angle accuracy and result in intra-operative bleeding, post-operative adverse events, and prolonged operative time. It is inconclusive whether either the stem-first or cup-first technique is safe or accurate. Therefore, this study assessed the accuracy and safety of stem-first THA compared to those of cup-first THA. MATERIALS AND METHODS This prospective randomised controlled trial analysed 114 patients who were randomly divided into 2 groups (stem-first group: n = 57, cup-first group (control group): n = 57). Primary outcomes included cup and stem angle, the discrepancies from the targeted angle and combined anteversion (evaluated via CT at 3 months postoperatively). Secondary outcomes included intraoperative blood loss, operative time, WOMAC, and adverse events. RESULTS There were no significant differences in age, gender, BMI or in the primary and secondary outcomes between the 2 groups. CONCLUSIONS Performing stem-first in THA did not adversely affect cup and stem angle accuracy, or result in intraoperative bleeding, prolongation of operative time, or postoperative adverse events. Thus, performing stem-first may be advantageous for achieving combined anteversion theory. TRIAL REGISTRATION University Hospital Medical Information Network (UMIN) registration number UMIN000025189.
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Affiliation(s)
- Kentaro Iwakiri
- Department of Orthopaedic Surgery, Shiraniwa Hospital Joint Arthroplasty Centre, Nara, Japan
| | - Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akio Kobayashi
- Department of Orthopaedic Surgery, Shiraniwa Hospital Joint Arthroplasty Centre, Nara, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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25
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Mitsutake R, Tanino H, Ito H. The effect of range of motion simulated with a patient-specific three-dimensional simulation analysis on dislocation after total hip arthroplasty. Hip Int 2023; 33:313-322. [PMID: 34538126 DOI: 10.1177/11207000211044807] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Dislocation continues to be a common complication following total hip arthroplasty (THA). Although previous studies of computed simulation analysis investigated the range of motion (ROM), it is unclear whether the ROM before impingement simulated using computed tomography-based 3-dimensional simulation analysis (simulated ROM) is related to dislocation after THA. It is also unclear what angles are required in computed simulation analyses for stable hips after THA. In this study, we compared the simulated ROM in patients with and without dislocation. METHODS 16 patients with posterior dislocation were compared with 48 matched patients without dislocation. Risk factors including preoperative bone morphology of the hip, implant position, change of femoral offset, change of leg length, anterior aspect of the greater trochanter (GTa) length, and anterior inferior iliac spine length were also compared. RESULTS The mean flexion angle, internal-rotation at 90° flexion (IR) angle, cup anteversion based on the anterior pelvic plane (APP), tilt-adjusted cup anteversion and GTa length were significantly different between patients with dislocation and patients without dislocation (p = 0.033, 0.002, 0.010, 0.047, 0.046). A receiver-operating characteristic curve analysis suggested cutoff points for flexion angle, IR angle, cup anteversion based on the APP, tilt-adjusted cup anteversion and GTa length, of 114.5°, 45.5°, 19.5°, 12.0° and 15.3 mm. CONCLUSIONS This study suggests that preoperative planning to achieve a larger simulated ROM, flexion angle and IR angle, may reduce the risk of posterior dislocation. This study also suggests that fine-tuning of cup anteversion and/or trimming of the overhanging GTa during preoperative planning may reduce the risk of posterior dislocation.
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Affiliation(s)
- Ryo Mitsutake
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiromasa Tanino
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiroshi Ito
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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26
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Zhang T, Jia Z, Han W, Wang J, Li J, Gong M, Jiang X. Effectiveness and Accuracy of a Patient-Specific Instrumentation System for Total Hip Arthroplasty. Orthop Surg 2023; 15:878-887. [PMID: 36636925 PMCID: PMC9977596 DOI: 10.1111/os.13665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Traditional total hip arthroplasty (THA) is often performed by visual inspection due to the lack of reliable reference, which results in inappropriate position of prosthesis and poor outcomes. This study attempts to introduce a novel patient-specific instrumentation (PSI) system and assess its effectiveness and accuracy compared with freehand operation and robot system through bone model experiments. METHODS Equally divide 30 sawbone models into the freehand group, PSI group, and robot group. Ten sets of prosthesis parameters were randomly generated as planning, and the three groups underwent simulated THA depending on these parameters. After the placement of the femoral prosthesis, the acetabular anteversion plan was adjusted in the PSI and robot groups so that the combined anteversion was maintained before and after adjustment. After the surgery, the actual prosthesis parameters of all bone models were measured and analyzed statistically. RESULTS No statistically significant difference was found in femoral anteversion error among the three groups (p = 0.951). The errors of acetabular cup anteversion, acetabular cup abduction, and combined anteversion in PSI group were 3.92° (2.94°, 4.62°), 5.65° (4.63°, 6.70°), and 3.93° (2.94°, 4.62°), respectively, which were significantly smaller than those in the freehand group [11.84° (9.92°, 13.87°), 13.54° (9.81°, 15.21°), 16.04° (8.18°, 19.25°), respectively, p < 0.05], but significantly larger than those in the robot group [1.34° (0.98°, 1.70°), 1.80° (1°, 2.02°), 1.34° (0.98°, 1.70°), respectively, p < 0.05]. CONCLUSION Compared with the traditional freehand operation, the patient-specific instrumentation system is feasible in total hip arthroplasty because it improves the accuracy of prosthesis placement. In addition, the rapid measurement of intraoperative femoral prosthesis parameters can help surgeons optimize preoperative planning.
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Affiliation(s)
- Teng Zhang
- Beijing Jishuitan HospitalTrauma OrthopedicsBeijingChina
| | - Zhao Jia
- Beijing Jishuitan Orthopaedic Robot Engineering Research Center Co., LTDBeijingChina
| | - Wei Han
- Beijing Jishuitan HospitalTrauma OrthopedicsBeijingChina
| | - Junqiang Wang
- Beijing Jishuitan HospitalTrauma OrthopedicsBeijingChina
| | - Jinqi Li
- Beijing Jishuitan Orthopaedic Robot Engineering Research Center Co., LTDBeijingChina
| | - Maoqi Gong
- Beijing Jishuitan HospitalTrauma OrthopedicsBeijingChina
| | - Xieyuan Jiang
- Beijing Jishuitan HospitalTrauma OrthopedicsBeijingChina
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27
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Mittal A, Chetty N, Pham T, Shah I, Raji R, Leasure J, McGann WA, DeMayo E. Pelvic stability during simulated total hip arthroplasty motions: Comparing different hip positioners. J Orthop 2022; 34:398-403. [PMID: 36325517 PMCID: PMC9618677 DOI: 10.1016/j.jor.2022.08.004] [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: 04/12/2022] [Revised: 07/19/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Total hip arthroplasty (THA) requires forceful maneuvers that can cause the pelvis to shift from its original position. Various methods for stabilizing the pelvis in the lateral decubitus position exist, but there is limited data quantifying the relative stability of each hip positioner. We sought to quantify the pelvic movement that occurred in four commercially available hip positioners during surgeon induced motion of the hip. Methods An infrared marker was attached to the ilium of a cadaver secured in the lateral decubitus position. Four commercially available hip positioners were used for positioning: Beanbag, Pegboard, Stulberg, and ExactFit. Rotation and translation was captured using an infrared marker and camera system while the hip was moved through six motions (Flexion, Extension, Internal Rotation, External Rotation, Push, and Pull). Results The Beanbag had the greatest amount of rotation and translation of the pelvis, with maximum hip rotation of 41.5°. The Stulberg and Pegboard positioners showed intermediate stability, with a maximum rotation of 7.8° and 17.1°, respectively. The ExactFit hip positioner resulted in the least amount of motion of the pelvis, with a maximum rotation of the pelvis of up to 3.2°. Of the simulated motions performed, internal rotation and flexion of the hip led to the greatest changes in pelvic rotation and translation. Conclusion The ExactFit positioner was associated with the smallest amount of pelvic motion during simulated motions of hip arthroplasty, followed by the Stulberg, Pegboard, and Beanbag positioners. Further studies are required to correlate this information with clinical outcomes following total hip arthroplasty.
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Affiliation(s)
- Ashish Mittal
- San Francisco Orthopedic Residency Program, St. Mary's Medical Center, San Francisco, CA, USA
| | - Nikole Chetty
- The Taylor Collaboration, St. Mary's Medical Center, San Francisco, CA, USA
| | - Tuan Pham
- The Taylor Collaboration, St. Mary's Medical Center, San Francisco, CA, USA
| | - Ishan Shah
- San Francisco Orthopedic Residency Program, St. Mary's Medical Center, San Francisco, CA, USA
| | - Richard Raji
- The Taylor Collaboration, St. Mary's Medical Center, San Francisco, CA, USA
| | - Jeremi Leasure
- The Taylor Collaboration, St. Mary's Medical Center, San Francisco, CA, USA
| | - William A. McGann
- San Francisco Orthopedic Residency Program, St. Mary's Medical Center, San Francisco, CA, USA
| | - Edward DeMayo
- San Francisco Orthopedic Residency Program, St. Mary's Medical Center, San Francisco, CA, USA
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28
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Fischer MCM, Tokunaga K, Okamoto M, Habor J, Radermacher K. Implications of the uncertainty of postoperative functional parameters for the preoperative planning of total hip arthroplasty. J Orthop Res 2022; 40:2656-2662. [PMID: 35266575 DOI: 10.1002/jor.25291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/23/2021] [Accepted: 01/30/2022] [Indexed: 02/04/2023]
Abstract
The functional parameters pelvic tilt (PT) and hip joint force (HJF) are required to calculate patient-specific target zones based on the range of motion (ROM) and implant loading for preoperative planning of total hip arthroplasty (THA). Both functional parameters may change after THA. The preoperative prediction of the postoperative PT and HJF is associated with a specific amount of uncertainty. The prediction uncertainty has to be considered in the preoperative planning process to avoid a suboptimal implantation. So far, very little attention has been paid to the necessary reduction of patient-specific target zones by the prediction uncertainties of postoperative functional parameters. Prediction models for the postoperative PT in standing position and for the HJF during one-leg stance as a surrogate for the peak force phase during level walking were used to quantify the reduction of the ROM- and load-based target zones of 196 Japanese THA patients. The prediction uncertainty was about 14° for the postoperative standing PT and ranged from 17% body weight to 37% body weight for the components of the HJF. On average, the prosthetic ROM-based target zone had to be significantly reduced by 43% and the load-based target zone by 39%. This led to a median reduction of the combined prosthetic ROM- and load-based target zone of 96%. The study sharpens the awareness for the substantial reduction of ROM- and load-based target zones by prediction uncertainties of the postoperative PT and HJF and highlights the importance of further research to improve prediction models for both functional parameters.
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Affiliation(s)
- Maximilian C M Fischer
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Kunihiko Tokunaga
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City, Japan
| | - Masashi Okamoto
- Department of Radiology, Kameda Daiichi Hospital, Niigata City, Japan
| | - Juliana Habor
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Klaus Radermacher
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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Hardwick-Morris M, Twiggs J, Kacker K, Miles B, Balakumar J. Functional Femoral Anteversion: Axial Rotation of the Femur and its Implications for Stem Version Targets in Total Hip Arthroplasty. Arthroplast Today 2022; 18:16-23. [PMID: 36267395 PMCID: PMC9576488 DOI: 10.1016/j.artd.2022.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/13/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background Acetabular and femoral component positioning are important considerations in reducing adverse outcomes after total hip arthroplasty (THA). Previous assessments of femoral anteversion examined anatomic femoral anteversion (AFA) referenced to anatomic landmarks. However, this does not provide a functional understanding of the femur's relationship to the hip. We investigate a new measurement, functional femoral anteversion (FFA), and sought to measure its variability across a large sample of patients undergoing THA. Methods A total of 1008 consecutive patients underwent THA surgery between September 2019 and July 2021. All patients were measured for supine and standing functional femoral rotation (FFR), AFA, and FFA. Results The mean standing FFA was 13.2° ± 12.2° (-27.8° to 52.3°). The mean change in FFR from supine to standing was -2.2° ± 11.8° (-43.0° to 41.9°). Of all, 161 (16%) patients had standing FFA version greater than 25°. Four hundred sixty (46%) patients had standing FFR (internal or external) greater than 10°. One hundred twenty-three (12%) patients exhibited an increase in external rotation from supine to standing of greater than 10°. A moderate, negative linear relationship was observed between AFA and standing external femoral rotation (P <<.001, R = -0.46), indicating people may externally rotate their femur as AFA decreases with age. Conclusions Functional alignment of the femur in patients requiring THA is understudied. It is now understood that the femur, like the pelvis, can rotate substantially between functional positions. Enhancing our understanding of FFA and FFR may improve both acetabular and femoral component positioning.
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Affiliation(s)
- Max Hardwick-Morris
- Flinders University, Adelaide, South Australia, Australia,360 Med Care, Sydney, New South Wales, Australia,Corresponding author. 360 Med Care, Suite 3, Building 1/20 Bridge Street, Pymble, New South Wales, Australia. Tel.: +61 406 937 050.
| | | | | | - Brad Miles
- 360 Med Care, Sydney, New South Wales, Australia
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Jiang Z, Cheng R, Kernkamp WA, Xia C, Liang J, Wang L, Tsai TY. The midcortical-line is more reliable than the T-line in predicting stem anteversion in patients with developmental hip dysplasia after total hip arthroplasty. Front Surg 2022; 9:966617. [PMID: 36117825 PMCID: PMC9474688 DOI: 10.3389/fsurg.2022.966617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 08/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background Precise preoperative planning improves postoperative outcomes in total hip arthroplasty (THA), especially in developmental dysplasia of the hip (DDH) cases. Previous studies used the T-line and midcortical-line as preoperative landmarks to predict postoperative stem anteversion (PSA). However, the most reliable landmark in predicting PSA in DDH patients remains unclear. To find the most reliable measurement to predict the PSA in DDH patients, this study compared the midcortical-line and T-line at different femoral neck levels. Methods Pre- and postoperative Computed Tomography (CT) scans of 28 hips in 21 DDH patients who received THA were obtained for three-dimensional femoral models. The preoperative CT scan was used to measure the anteversion of the midcortical-line on the axial cross-sectional plane images (AM-CT), the anteversion of the midcortical-line from 3D models (AM-3D), and the T-line from 3D models (AT-3D) at simulated osteotomy planes at 5 and 10 mm heights proximal to the base of the lesser trochanter. The correlation between the preoperative femoral anteversion (AM-CT, AM-3D, AT-3D) and the PSA was assessed to evaluate the prediction accuracy. Results The correlations between the AM-CT and the PSA were 0.86 (mean difference (MD) = 1.9°) and 0.92 (MD = −3.0°) at 5 and 10 mm heights, respectively. The correlation between the AM-3D and the PSA were 0.71 (MD = −11.6°) and 0.61 (MD = −12.9°) at 5 and 10 mm heights. The AT-3D was significantly greater (MD = 15.4°) than the PSA (p-value <0.01) at 5 mm cutting height, and the correlation between the AT-3D and the PSA was 0.57 (MD = 7.8°) at 10 mm cutting height. Conclusions The AM-CT at the 10 mm height had the strongest correlation with the PSA and was more reliable in predicting the PSA when compared with the AM-3D and the AT-3D in DDH patients.
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Affiliation(s)
- Ziang Jiang
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Jiao Tong University School of Medicine, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
| | - Rongshan Cheng
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Jiao Tong University School of Medicine, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
| | | | - Chunjie Xia
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Junjie Liang
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Guangxi Clinical Research Center for Digital Medicine and 3D Printing, Guigang City People's Hospital, Guigang, China
| | - Liao Wang
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Jiao Tong University School of Medicine, Shanghai, China
- Correspondence: Liao Wang Tsung-Yuan Tsai
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Jiao Tong University School of Medicine, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Correspondence: Liao Wang Tsung-Yuan Tsai
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Relationship between the Accuracy of the Acetabular Cup Angle and BMI in Posterolateral Total Hip Arthroplasty with CT-Based Navigation. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070856. [PMID: 35888575 PMCID: PMC9324398 DOI: 10.3390/medicina58070856] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 12/23/2022]
Abstract
Background and Objectives: Precise acetabular cup placement is essential for successful total hip arthroplasty (THA). In obese patients, its accuracy is often difficult to achieve because of the thickness of the soft tissues. This study aimed to determine the relationship between the accuracy of acetabular cup angle and body mass index (BMI) in posterolateral THA using the computed tomography-based navigation (CT-navi) system. Materials and Methods: We retrospectively reviewed 145 consecutive primary THAs using the CT-navi system between January 2015 and January 2018. All surgeries were performed using cementless cups employing the posterolateral approach with the patient in the decubitus position. We compared the radiographic inclination and anteversion obtained intraoperatively from the CT-navi with those measured by postoperative CT using three-dimensional templating software. We evaluated the relationship between the extent of errors and correlation with BMI. Results: In non-overweight patients (BMI < 25, 88 hips), the mean navigation errors for inclination were 2.8 ± 2.2° and for anteversion were 2.6 ± 2.3°. Meanwhile, in overweight patients (BMI ≥ 25, 57 hips), the mean navigation errors were 2.6 ± 2.4° for inclination and 2.4 ± 2.4° for anteversion. We found no significant difference between overweight and non-overweight patients in both inclination and anteversion. There was no correlation between the extent of errors and BMI. Conclusions: In posterolateral THA, CT-navi can aid the precise placement of the acetabular cup irrespective of a patient’s BMI.
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Danaei B, McPhee J. Model-Based Acetabular Cup Orientation Optimization Based On Minimizing the Risk of Edge-Loading and Implant Impingement Following Total Hip Arthroplasty. J Biomech Eng 2022; 144:1141865. [PMID: 35748611 DOI: 10.1115/1.4054866] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Indexed: 11/08/2022]
Abstract
In this paper, a computationally-efficient model-based method for determining patient-specific optimal acetabular cup alignment for total hip arthroplasty (THA) is presented. The proposed algorithm minimizes the risk of implant impingement and edge-loading, which are reported as the major causes of hip dislocation following THA. First, by using motion capture data recorded from the patient performing different daily activities, the hip contact force and the relative orientation of the femur and pelvis are calculated by a musculoskeletal model. Then, by defining two quantitative indices i.e., angular impingement distance and angular edge-loading distance, the risk of impingement and edge-loading are assessed for a wide range of cup alignments. And finally, three optimization criteria are introduced to estimate the optimal cup alignment with a tradeoff between the risk of impingement and edge-loading. The results show that patient-specific characteristics such as pelvic tilt could significantly change the optimal cup alignment, especially the value of cup anteversion. Therefore, in some cases, the well-known Lewinnek safe zone may not be optimal, or even safe. Unlike other dynamic model-based methods, in this work, the need for force plate measurements is eliminated by estimating the ground reaction forces and moments, which makes this method more practical and cost-efficient. Furthermore, the low computational complexity due to analytical formulas makes this method suitable for both preoperative and intra-operative planning.
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Affiliation(s)
- Behzad Danaei
- Motion Research Group, Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - John McPhee
- Motion Research Group, Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
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Marcovigi A, Sandoni D, Ciampalini L, Perazzini P, Zambianchi F, Hozack WJ, Catani F. Dislocation risk after robotic arm-assisted total hip arthroplasty: a comparison of anterior, lateral and posterolateral approaches. Hip Int 2022; 33:426-433. [PMID: 35504896 DOI: 10.1177/11207000221094513] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIMS Dislocation is a major cause of early failure after THA and is highly influenced by surgical approach and component positioning. Robotic-arm assisted arthroplasty has been developed in an attempt to improve component positioning and reduce postoperative complications.The purpose of this study was to compare the rate of dislocation after robotic total hip arthroplasty through 3 different surgical approaches. MATERIALS AND METHODS All patients who had undergone robotic arm-assisted THA at 3 centres between 2014 and 2019 were reviewed. After applying exclusion criteria, 1059 patients were included in the study. An anterior approach was used in 323 patients, a lateral approach in 394 and a posterior approach in 342 patients.Episodes of dislocation were recorded after 6 months follow-up. Stem anteversion, cup anteversion, cup inclination and combined anteversion were collected using the integrated navigation system.Cumulative incidence (CI), incidence rate (IR) and risk ratio (RR) were calculated with a confidence interval of 95%. RESULTS 3 cases of dislocation (2 posterior approach, 1 anterior approach) were recorded, with a dislocation rate of 0.28% and an IR of 0.14%.The rate of placement of the cup in the Lewinnek safe zone was 82.2% for the posterior approach, 82.0% for the lateral approach and 95.4% for the anterior approach.The rate of placement in the combined version safe zone was 98.0% for the posterior approach, 73.0% for the lateral approach and 47.1% for the anterior approach.The incidence rate of dislocation was 0.30% for the anterior approach, 0.34% for the posterior approach and 0% for the lateral approach. CONCLUSIONS The robotic arm-assisted technique is associated with a low risk of dislocation. The combined version technique appears to be a reliable way to reduce the risk of dislocation through the posterolateral approach but does not appear to be essential when using the lateral and anterior approaches.
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Affiliation(s)
- Andrea Marcovigi
- Department of Orthopaedic Surgery, University Hospital Policlinico di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Dario Sandoni
- Department of Orthopaedic Surgery, University Hospital Policlinico di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - Luigi Ciampalini
- U.O.S.D. Orthopaedics and Traumatology, Hospital Valdarno "La Gruccia", Montevarchi, Italy
| | | | - Francesco Zambianchi
- Department of Orthopaedic Surgery, University Hospital Policlinico di Modena, University of Modena and Reggio-Emilia, Modena, Italy
| | - William J Hozack
- The Rothman Institute of Orthopedics at Thomas Jefferson University, PA, USA
| | - Fabio Catani
- Department of Orthopaedic Surgery, University Hospital Policlinico di Modena, University of Modena and Reggio-Emilia, Modena, Italy
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Hakim R, Weinstein A, Dabby D, Rozen N, Shabshin N, Rubin G. Successful reconstruction of natural femoral anteversion using a short femoral stem in total hip arthroplasty surgery. J Int Med Res 2022; 50:3000605221091500. [PMID: 35443831 PMCID: PMC9047853 DOI: 10.1177/03000605221091500] [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] [Indexed: 11/29/2022] Open
Abstract
Objective Total hip arthroplasty (THA) involves postoperative risks, such as thigh
pain, periprosthetic fractures, and stress yielding. Short, anatomical,
metaphyseal-fitting, cementless femoral stems were developed to reduce these
postoperative risks. This study aimed to examine the “MiniMAX” prosthesis,
which is a new generation, short, anatomical femoral stem made by
Medacta. Methods Patients underwent a low-dose computed tomography scan. Femoral anteversion
was measured. We assessed the position and anteversion of the femoral
component and compared them with the unoperated side. We also assessed the
patients’ satisfaction and functional levels at 6 months postsurgery using
the Harris Hip Score (HHS) and the Oxford Hip Score (OHS). Results Nineteen individuals were recruited in this study. We found no significant
difference in femoral anteversion between the operated hip and the native
hip. Using the HHS and OHS questionnaires, we found clinical improvement in
the 6-month postoperative scores compared with the preoperative scores. Discussion The new-generation, short, anatomical femoral stem made by Medacta is
successful in reproducing natural femoral anteversion, while also improving
patients’ functioning and lifestyle. Future large-scale, prospective
comparison trials are required to further investigate this topic.
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Affiliation(s)
- Raja Hakim
- Orthopedic Department, Emek Medical Center, Afula, Israel
| | | | - Dan Dabby
- Orthopedic Department, Emek Medical Center, Afula, Israel
| | - Nimrod Rozen
- Orthopedic Department, Emek Medical Center, Afula, Israel.,Faculty of Medicine, Technion, Haifa, Israel
| | - Nogah Shabshin
- Orthopedic Department, Emek Medical Center, Afula, Israel.,Penn Medicine, Philadelphia, PA, USA
| | - Guy Rubin
- Orthopedic Department, Emek Medical Center, Afula, Israel.,Faculty of Medicine, Technion, Haifa, Israel
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Hidaka R, Matsuda K, Nakamura M, Nakamura S, Kawano H. Optimal combined anteversion range for obtaining a wider range of motion without prosthetic impingement after total hip arthroplasty: a three-dimensional analysis study. J Orthop Surg Res 2022; 17:226. [PMID: 35399103 PMCID: PMC8996486 DOI: 10.1186/s13018-022-03112-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Obtaining a larger theoretical range of motion (ROM) is crucial to avoid prosthetic impingement after total hip arthroplasty (THA); however, no reports have examined the permissible range values of combined anteversion (CA) satisfying targeted ROM without prosthetic impingement. This retrospective study aimed to evaluate the possible postoperative CA extent that would allow meeting target ROM criteria according to Yoshimine’s theory using computed tomography (CT)-based three-dimensional motion analysis after THA. Methods This study included 114 patients (133 hips) who underwent cementless primary THA using a CT-based navigation system and implants (oscillation angle ≥ 135°). Implant positions were determined using Yoshimine's CA formula. Postoperative evaluation was conducted using a three-dimensional templating software for CT data. The postoperative Yoshimine’s and Widmer’s CA was calculated, and the difference between the target and postoperative values was defined as the error of Yoshimine’s CA and Widmer’s CA. Prosthetic ROM was assessed by Yoshimine’s stringent criteria for activities of daily living. Based on fulfilling these criteria, all patients were divided into the ROM (+) and ROM (−) groups. Evaluation items were compared between the two groups. Results There were 111 and 22 hips in the ROM (+) and ROM (−) groups, respectively. A significant difference was noted in the absolute error of Yoshimine’s and Widmer’s CA between the two groups. Using receiver operating characteristic analysis, threshold values of 6.0 (higher values indicate greater disability; sensitivity 90.9%, specificity 72.1%) for the absolute Yoshimine’s CA difference (area under the curve [AUC] 0.87, P < 0.01) and 6.9 (higher values indicate greater disability; sensitivity 68.2%, specificity 88.3%) for the absolute Widmer’s CA difference (AUC 0.83, P < 0.01) were predictors in the ROM (−) group. Conclusions The target range of Yoshimine’s CA (90.8° ± 6.0°) and Widmer’s CA values (37.3° ± 6.9°) was crucial in implant orientation for obtaining theoretical ROM without prosthetic impingement after THA.
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Eslam Pour A, Lazennec JY, Patel KP, Anjaria MP, Beaulé PE, Schwarzkopf R. Small Random Angular Variations in Pelvic Tilt and Lower Extremity Can Cause Error in Static Image-based Preoperative Hip Arthroplasty Planning: A Computer Modeling Study. Clin Orthop Relat Res 2022; 480:818-828. [PMID: 35014975 PMCID: PMC8923586 DOI: 10.1097/corr.0000000000002106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/14/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many THA simulation models rely on a limited set of preoperative static radiographs to replicate sagittal pelvic tilt during functional positions and to recommend an implant orientation that minimizes the risk of prosthetic impingement. However, possible random changes in pelvic or lower extremity angular motions and the effect of coronal and axial pelvic tilt are not included in these preoperative models. QUESTIONS/PURPOSES (1) Can prosthetic impingement occur if the pelvic tilt or lower extremity alignment randomly varies up to ± 5° from what is measured on a single preoperative static radiographic image? (2) Do changes in coronal and axial pelvic tilt or lower extremity alignment angles have a similar effect on the risk of prosthetic impingement? METHODS A de-identified pelvis and lower-body CT image of a male patient without previous THA or lower extremity surgery was used to import the pelvis, femur, and tibia into a verified MATLAB computer model. The motions of standing, pivoting, sitting, sit-to-stand, squatting, and bending forward were simulated. THA implant components included a full hemispherical acetabular cup without an elevated rim, polyethylene liner without an elevated rim, femoral head (diameter: 28 mm, 32 mm, 36 mm, or 40 mm), and a triple-taper cementless stem with three different neck shaft angles (127°, 132°, or 135°) with a trapezoidal neck were used in this model. A static model (cup anatomical abduction 40°, cup anatomical anteversion 20°, stem anatomical anteversion 10°) with a predefined range of sagittal pelvic tilt and hip alignment (0° coronal or axial tilt, without random ± 5° change) was used to simulate each motion. We then randomly varied pelvic tilt in three different pelvic planes and hip alignments (flexion, extension, abduction, adduction, rotation) up to ± 5° and assessed the same motions without changing the implant's anatomical orientation. Prosthetic impingement as the endpoint was defined as mechanical abutment between the prosthetic neck and polyethylene liner. Multiple logistic regression was used to investigate the effect of variation in pelvic tilt and hip alignment (predictors) on prosthetic impingement (primary outcome). RESULTS The static-based model without the random variation did not result in any prosthetic impingement under any conditions. However, with up to ± 5° of random variation in the pelvic tilt and hip alignment angles, prosthetic impingement occurred in pivoting (18 possible combinations), sit-to-stand (106 possible combinations), and squatting (one possible combination) when a 28-mm or a 32-mm head was used. Variation in sagittal tilt (odds ratio 4.09 [95% CI 3.11 to 5.37]; p < 0.001), axial tilt (OR 3.87 [95% CI 2.96 to 5.07]; p < 0.001), and coronal tilt (OR 2.39 [95% CI 2.03 to 2.83]; p < 0.001) affected the risk of prosthetic impingement. Variation in hip flexion had a strong impact on the risk of prosthetic impingement (OR 4.11 [95% CI 3.38 to 4.99]; p < 0.001). CONCLUSION The combined effect of 2° to 3° of change in multiple pelvic tilt or hip alignment angles relative to what is measured on a single static radiographic image can result in prosthetic impingement. Relying on a few preoperative static radiographic images to minimize the risk of prosthetic impingement, without including femoral implant orientation, axial and coronal pelvic tilt, and random angular variation in pelvis and lower extremity alignment, may not be adequate and may fail to predict prosthetic impingement-free ROM. CLINICAL RELEVANCE Determining a safe zone for THA implant positioning with respect to impingement may require a dynamic computer simulation model to fully capture the range of possible impingement conditions. Future work should concentrate on devising simple and easily available methods for dynamic motion analysis instead of using a few static radiographs for preoperative planning.
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Affiliation(s)
- Aidin Eslam Pour
- Department of Orthopaedic Surgery, Yale University, New Haven, CT, USA
| | - Jean Yves Lazennec
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpétrière Hospital Assistance Publique–Hopitaux de Paris, UPMC, Paris, France
| | - Kunj P. Patel
- Department of Orthopaedic Surgery, Yale University, New Haven, CT, USA
| | - Manan P. Anjaria
- Department of Orthopaedic Surgery, Yale University, New Haven, CT, USA
| | - Paul E. Beaulé
- Division of Orthopaedic Surgery, Department of Surgery, the Ottawa Hospital, Ottawa, ON, Canada
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, New York University, New York, NY, USA
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Tang H, Li Y, Zhou Y, Wang S, Zhao Y, Ma Z. A Modeling Study of a Patient-specific Safe Zone for THA: Calculation, Validation, and Key Factors Based on Standing and Sitting Sagittal Pelvic Tilt. Clin Orthop Relat Res 2022; 480:191-205. [PMID: 34495893 PMCID: PMC8673979 DOI: 10.1097/corr.0000000000001923] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/13/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lumbar-pelvic stiffness and sagittal imbalance have been reported to increase the risk of dislocation and wear after THA. One potential way to approach this concern is by identifying patient-specific safe zones for THA components based on the standing and sitting sagittal pelvic tilt. However, there is no algorithm to integrate the standing and sitting pelvic tilt into the surgical plan of component orientations. QUESTIONS/PURPOSES We established a new mathematical algorithm for determining a patient-specific safe zone for THA by integrating the impingement-free ROM requirements of standing and sitting while preventing edge loading while standing. We aimed to determine (1) the accuracy of this new method for predicting the impingement-free ROM for a given component orientation, (2) the sensitivity and specificity of detecting an impingement-free acetabular cup position for standing and sitting, and (3) the influences of key factors including pelvic tilt while standing and pelvic tilt while sitting and implant parameters on patient-specific safe zones. METHODS A strategy for calculating the intersection of standing and sitting impingement-free safe zones and the zone of a standing radiographic inclination of ≤ 45° was used to develop patient-specific safe zones. We conducted a computer simulation study including the pelvis and THA prosthesis to answer the three study questions. We enrolled 10 patients who underwent robot-assisted THA for avascular necrosis of the femoral head (mean age 49 ± 19 years; five were women) from October 2019 to December 2019. We used a prosthesis model with a conical stem neck and a non-hooded liner, with the femoral head diameter ranging between 28 mm and 40 mm, and the corresponding head-neck ratio ranging between 2.33 and 3.33. We tested 1680 movements for the accuracy of impingement-free ROM (Question 1), and 80 marginal points and 120 non-marginal points of the comprehensive impingement-free safe zone, which combines the standing and sitting postures (Question 2). For Question 3, we explored the influences of standing and sitting pelvic tilt, femoral head diameter, and ROM criteria on the size of the patient-specific safe zone. RESULTS With the simulation method as a reference for detecting impingement, the mean absolute error (arithmetic mean of all the absolute errors) of the calculated impingement-free ROM was 1.4° ± 2.3°, and the limit of agreement of errors was between -3.6° and 3.7°. The sensitivity of detecting a safe cup orientation within the comprehensive impingement-free safe zone for a given ROM criterion was 98.9% (95% CI 93.6% to 99.9%), and specificity was 97.1% (95% CI 91.0% to 99.2%). There were no impingement-free safe zones for 29% (pelvic tilt combinations without an impingement-free safe zone and all tested combinations) and no patient-specific safe zones for 46% (pelvic tilt combinations without a patient-specific safe zone and all tested combinations) of the tested combinations of standing and sitting pelvic tilt. The patient-specific safe zone was sensitive to changes in standing and sitting pelvic tilt, femoral head diameter, stem version, and ROM criteria. Stem anteversions beyond 10° to 20° dramatically reduced the size of the patient-specific safe zone to 0 within a change of 10° to 20°. CONCLUSION The patient-specific safe zone algorithm can be an accurate method for determining the optimal orientation for acetabular cups and femoral stems in THA. The patient-specific safe zone is sensitive to changes in standing and sitting pelvic tilt, stem version, ROM criteria, and the femoral head diameter. A narrow zone of 10° to 20° for stem anteversion is recommended to maximize the size of the patient-specific safe zone. CLINICAL RELEVANCE This study suggests the potential of a mathematical algorithm to optimize the orientation of THA components and illustrates how key parameters affect the patient-specific safe zone.
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Affiliation(s)
- Hao Tang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Ya Li
- Tian Ji Laboratory, Beijing Tinavi Medical Technology Co., Beijing, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Siyuang Wang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
| | - Yongqiang Zhao
- Tian Ji Laboratory, Beijing Tinavi Medical Technology Co., Beijing, China
| | - Zhuyi Ma
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Beijing, China
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38
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Habor J, Fischer MCM, Tokunaga K, Okamoto M, Radermacher K. The Patient-Specific Combined Target Zone for Morpho-Functional Planning of Total Hip Arthroplasty. J Pers Med 2021; 11:jpm11080817. [PMID: 34442461 PMCID: PMC8402039 DOI: 10.3390/jpm11080817] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/09/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background Relevant criteria for total hip arthroplasty (THA) planning have been introduced in the literature which include the hip range of motion, bony coverage, anterior cup overhang, leg length discrepancy, edge loading risk, and wear. The optimal implant design and alignment depends on the patient’s anatomy and patient-specific functional parameters such as the pelvic tilt. The approaches proposed in literature often consider one or more criteria for THA planning. but to the best of our knowledge none of them follow an integrated approach including all criteria for the definition of a patient-specific combined target zone (PSCTZ). Questions/purposes (1) How can we calculate suitable THA implant and implantation parameters for a specific patient considering all relevant criteria? (2) Are the resulting target zones in the range of conventional safe zones? (3) Do patients who fulfil these combined criteria have a better outcome score? Methods A method is presented that calculates individual target zones based on the morphology, range of motion and load acting on the hip joint and merges them into the PSCTZ. In a retrospective analysis of 198 THA patients, it was calculated whether the patients were inside or outside the Lewinnek safe zone, Dorr combined anteversion range and PSCTZ. The postoperative Harris Hip Scores (HHS) between insiders and outsiders were compared. Results 11 patients were inside the PSCTZ. Patients inside and outside the PSCTZ showed no significant difference in the HHS. However, a significant higher HHS was observed for the insiders of two of the three sub-target zones incorporated in the PSCTZ. By combining the sub-target zones in the PSCTZ, all PSCTZ insiders except one had an HHS higher than 90. Conclusions The results might suggest that, for a prosthesis implanted in the PSCTZ a low outcome score of the patient is less likely than using the conventional safe zones by Lewinnek and Dorr. For future studies, a larger cohort of patients inside the PSCTZ is needed which can only be achieved if the cases are planned prospectively with the method introduced in this paper. Clinical Relevance The method presented in this paper could help the surgeon combining multiple different criteria during THA planning and find the suitable implant design and alignment for a specific patient.
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Affiliation(s)
- Juliana Habor
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (J.H.); (M.C.M.F.)
| | - Maximilian C. M. Fischer
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (J.H.); (M.C.M.F.)
| | - Kunihiko Tokunaga
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City 950-0165, Japan;
| | - Masashi Okamoto
- Department of Radiology, Kameda Daiichi Hospital, Niigata City 950-0165, Japan;
| | - Klaus Radermacher
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (J.H.); (M.C.M.F.)
- Correspondence:
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The Hip-Spine Relationship: The Importance of Femoral Version. J Arthroplasty 2021; 36:S99-S103. [PMID: 33526396 DOI: 10.1016/j.arth.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 02/02/2023] Open
Abstract
Recent investigations have confirmed the impact of spinopelvic mobility upon functional acetabular position. However, it is critical to remember the impact of femoral component position as it contributes to combined version of the hip joint. It has been demonstrated that implant position can affect articular wear, the potential for prosthetic impingement as well as a cause of joint instability. Ensuring an impingement-free range of motion at the time of hip replacement is critical to long-term survivorship. During hip reconstruction, there is significant latitude in acetabular component positioning but femoral component version is often dictated by native femoral anatomy and in some instances cannot be adjusted. Understanding the role that femoral version plays in prosthetic hip joint kinematics should provide surgeons with a better understanding of this complex relationship.
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Pour AE, Schwarzkopf R, Patel KP, Anjaria M, Lazennec JY, Dorr LD. Is Combined Anteversion Equally Affected by Acetabular Cup and Femoral Stem Anteversion? J Arthroplasty 2021; 36:2393-2401. [PMID: 33653630 PMCID: PMC8197737 DOI: 10.1016/j.arth.2021.02.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/16/2021] [Accepted: 02/04/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To create a safe zone, an understanding of the combined femoral and acetabular mating during hip motion is required. We investigated the position of the femoral head inside the acetabular liner during simulated hip motion. We hypothesized that cup and stem anteversions do not equally affect hip motion and combined hip anteversion. METHODS Hip implant motion was simulated in standing, sitting, sit-to-stand, bending forward, squatting, and pivoting positions using the MATLAB software. A line passing through the center of the stem neck and the center of the prosthetic head exits at the polar axis (PA) of the prosthetic head. When the prosthetic head and liner are parallel, the PA faces the center of the liner (PA position = 0, 0). By simulating hip motion in 1-degree increments, the maximum distance of the PA from the liner center and the direction of its movement were measured (polar coordination system). RESULTS The effect of modifying cup and stem anteversion on the direction and distance of the PA's change inside the acetabular liner was different. Stem anteversion influenced the PA position inside the liner more than cup anteversion during sitting, sit-to-stand, squatting, and bending forward (P = .0001). This effect was evident even when comparing stems with different neck angles (P = .0001). CONCLUSION Cup anteversion, stem anteversion, and stem neck-shaft angle affected the PA position inside the liner and combined anteversion in different ways. Thus, focusing on cup orientation alone when assessing hip motion during different daily activities is inadequate.
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Affiliation(s)
| | | | | | - Manan Anjaria
- Department of Orthopaedic Surgery, University of Michigan
| | - Jean Yves Lazennec
- Department of Orthopaedic and Trauma Surgery, Pitié-Salpétrière Hospital Assistance Publique–Hopitaux de Paris, UPMC, Paris, France
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The Effect of a Degenerative Spine and Adverse Pelvic Mobility on Prosthetic Impingement in Patients Undergoing Total Hip Arthroplasty. J Arthroplasty 2021; 36:2523-2529. [PMID: 33692000 DOI: 10.1016/j.arth.2021.02.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite the placement of acetabular components in the traditional "safe-zone", dislocations and all parts of the instability spectrum, including impingement, continue to be an issue. Recent research has established the importance of a degenerative spine and adverse pelvic mobility on functional acetabular orientation. The purpose of this study is to quantify the clinical consequences of a degenerative spine and adverse pelvic mobility on prosthetic impingement in patients undergoing total hip arthroplasty. METHODS Between January 2018 and December 2019, a series of 1592 patients undergoing total hip arthroplasty had functional lateral radiographs and a computed tomography scan taken. Two spinal parameters and 2 pelvic mobility parameters were investigated for their association with impingement. Each patient was evaluated for anterior and posterior impingement, at all orientations within a traditional supine safe zone and a patient-specific functional safe zone. RESULTS Patients with limited lumbar flexion (stiff spine), higher pelvic incidence-lumbar lordosis mismatch (sagittal imbalance), and more anterior pelvic mobility from stand to flexed-seated, exhibit increased anterior impingement. Patients with larger posterior pelvic mobility from supine-to-stand exhibited increased posterior impingement. Impingement was reduced 3-fold when the target cup orientation was tailored to a patient's functional safe zone rather than a generic target. Six percent of patients showed unavoidable impingement even with an optimized functional cup orientation. CONCLUSION Our results support growing evidence that patients with a degenerative spine and adverse pelvic mobility are likely to have unfavorable functional cup orientations, resulting in prosthetic impingement. Preoperative functional radiographic screening is recommended to assess the likelihood of a patient experiencing impingement due to their unique spinopelvic mobility.
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Song SK, Choi WK, Jung SH, Kim HC, Kim TH, Cho MR. Changes of acetabular anteversion according to pelvic tilt on sagittal plane under various acetabular inclinations. J Orthop Res 2021; 39:806-812. [PMID: 32603527 DOI: 10.1002/jor.24790] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/15/2020] [Accepted: 06/24/2020] [Indexed: 02/04/2023]
Abstract
Improper functional orientation of the acetabular cup can result in improper positions when dynamic pelvic positions are not considered. The purpose of this study was to evaluate changes on acetabular anteversion according to pelvic tilt under various acetabular inclinations. Two artificial pelvic models were selected for this study. Acetabular inclinations on the coronal plane were 25°, 32°, 50°, and 60°. Acetabular anteversion of all components were 15°. Changes of anteversion according to pelvic tilt were measured at angles of 0°, 10°, 20°, 30°, and 40°. Computer Navigation, PolyWare 3D pro, CT, and plain radiography were used to measure each angle. The anatomical anteversions against pelvic tilt were calculated using the following formulae: anatomical anteversion (°) = -14.48Χ + 90.18 (inclination angle 25°); anatomical anteversion (°) = -12.26Χ + 80.10 (inclination angle 32°); anatomical anteversion (°) = -7.468Χ + 61.13 (inclination angle 50°); and anatomical anteversion (°) = -5.328Χ + 44.84 (inclination angle 60°) (Χ: pelvic tilt angle). Radiographic anteversion against pelvic tilt were calculated using the following formulae: radiographic anteversion (°) = -9.50Χ + 57.09 (inclination angle 25°); radiographic anteversion (°) = -8.577Χ + 50.89 (inclination angle 32°); radiographic anteversion (°) = -6.794Χ + 45.73 (inclination angle 50°); radiographic anteversion (°) = -5.226Χ + 33.08 (inclination angle 60°). In conclusion, changes in anteversion according to pelvic tilt were lesser at higher degrees of acetabular inclination.
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Affiliation(s)
- Suk Kyoon Song
- Department of Orthopedics, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Won Kee Choi
- Department of Orthopedics, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Suk Han Jung
- Department of Orthopedics, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Hee Chan Kim
- Department of Orthopedics, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Tae Hoon Kim
- Department of Orthopedics, Suseong Metro Hospital, Daegu, South Korea
| | - Myung Rae Cho
- Department of Orthopedics, Daegu Catholic University Medical Center, Daegu, South Korea
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Pongkunakorn A, Phetpangnga N, Kananai N. Accuracy of intraoperative estimation of femoral stem anteversion in cementless total hip arthroplasty by using a digital protractor and a spirit level. J Orthop Surg Res 2021; 16:27. [PMID: 33413529 PMCID: PMC7792124 DOI: 10.1186/s13018-020-02183-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background The femoral component anteversion during surgery is traditionally assessed by a visual assessment of the surgeon and has proven to be imprecise. We sought to determine the accuracy of a digital protractor and a spirit level to measure the stem anteversion during cementless THA. Methods A prospective study was conducted among 107 patients (114 hips) who underwent primary cementless THA via posterolateral approach. A pipe with a spirit level was attached to the tibial tubercle and intermalleolar midpoint. While the leg was held perpendicularly to the floor, stem anteversion was estimated by 3 methods: method A by visual assessment; method B by a digital protractor alone; and method C by a digital protractor combined with a spirit level. The angles were compared with the true anteversion measured by postoperative CT scan. Results The average anteversion by method C (22.8° ± 6.9°, range -2° to 40°) was significantly lower than method A (24.6° ± 5.2°, range 0° to 30°) (p=0.033), but not different from the true anteversion (22.1° ± 8.2°, range -5.4° to 43.1°) (p=0.445). There were no significant differences between method B (23.2° ± 8.2°, range -4° to 45°) and method A, C or the true anteversion. The mean deviation of the intraoperative estimation from the true anteversion was 0.8° ± 3.7° (range -7.1° to 8.0°) by method C; 1.2° ± 5.1° (range -8.8° to 14.3°) by method B; and 2.5° ± 7.4° (range -19.0° to 16.0°) by method A. Estimation error within 5° was found in 107 hips (93.9%) with method C; 86 hips (75.4%) with method B; and 59 hips (51.8%) with method A. Conclusion Accurate estimation of stem anteversion during cementless THA can be determined intraoperatively by the use of a digital protractor and a spirit level. Trial registration Thai Clinical Trials Registry (TCTR 20180326003). Registered on 20 March 2018. Retrospectively registered.
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Affiliation(s)
- Anuwat Pongkunakorn
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Educational Center, Lampang, Thailand.
| | - Nawakun Phetpangnga
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Educational Center, Lampang, Thailand
| | - Narawit Kananai
- Department of Orthopaedic Surgery, Lampang Hospital and Medical Educational Center, Lampang, Thailand
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Xu J, Su B, Zhang W, Sun H, Li D, Cai Z, Chen M, Qiu M, Ma R. 3D simulation of radiographic projections to test and reduce the effect of pelvic tilt on the accuracy of cross-table lateral radiography. BMC Musculoskelet Disord 2020; 21:843. [PMID: 33317489 PMCID: PMC7737258 DOI: 10.1186/s12891-020-03858-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background Cross-table lateral (CL) radiography is a convenient and feasible method to assess cup version angle (VA) after total hip arthroplasty; However, pelvic tilt (PT) may contribute to its measurement inaccuracy. How PT affects CL radiographic measurements have not been well studied. We sought (1) to determine the effect of the PT on cup version measurement on CL radiography and (2) to develop a method for reducing measurement errors caused by the PT. Methods We used 3D technique to construct standard model and capture CL radiography simulation. A linear regression model was created to analyze the relationship between PT and VA. CL radiography and computed tomography (CT) were performed for the enrolled patients after surgery. The consistency between CL and CT measurements were verified by intra-class correlation coefficient (ICC). Results There was a high correlation between the VA and PT. For each 1-degree increased in the PT, the VA decreased by 0.76° (R2 = 0.995, p < 0.001). Based on the data, we created a corrective formula to convert the radiographic measurements into values approximating the actual VA under a natural pelvic position. The VA measurements corrected by our equation was in high agreement with the CT-measured values with reference to the corresponding PT (ICC = 0.988, p < 0.001), which was in sharp contrast to that without PT control (ICC = 0.454, p = 0.203). Conclusions The PT may contribute to cup version measurement inaccuracies on CL radiography. Our mathematical algorithm can serve as a reliable method to improve the accuracy of CL radiography.
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Affiliation(s)
- Jie Xu
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Baohua Su
- Department of Orthopedic Surgery, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenhui Zhang
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao Sun
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Deng Li
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiqing Cai
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Meiyi Chen
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Meiling Qiu
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruofan Ma
- Department of Joint Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Veilleux NJ, Kalore NV, Vossen JA, Wayne JS. Automatic Characterization of Pelvic and Sacral Measures from 200 Subjects. J Bone Joint Surg Am 2020; 102:e130. [PMID: 32881722 DOI: 10.2106/jbjs.20.00343] [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: 02/01/2023]
Abstract
BACKGROUND An understanding of pelvic and acetabular morphology and orientation is required for accurate surgical reconstruction of the hip and spine, as well for component placement in a total hip arthroplasty. Our objectives were to develop an automated system for measuring pelvic and sacral orientations utilizing computed tomographic (CT) scans and to characterize these measures across 200 asymptomatic subjects. METHODS An automated feature recognition algorithm was created to identify acetabular and pelvic orientation across 200 scans generated for non-musculoskeletal conditions. Three-dimensional models were generated from CT data to serve as inputs to the algorithm. Acetabular orientation was defined by comparing a plane fit to the acetabular rim with the anterior pelvic plane. Pelvic inclination, pelvic tilt, and sacral slope were defined as the angles between landmarks identified across the pelvis: pubic tubercles, acetabular center, left and right anterior superior iliac spines, and sacral plate. RESULTS The mean sacral slope was 36.49°, the mean pelvic tilt was 15.60°, and the mean pelvic incidence was 52.05°. The mean sacropubic angle was 32.48° and the mean pelvic-Lewinnek angle was 8.93°. Significant differences between male and female subjects were observed in the sacral slope (mean difference, 4.72°; p < 0.05), pelvic tilt α (mean difference, 4.17°; p < 0.05), pelvic tilt γ (mean difference, 3.06°; p < 0.05), and the pelvic-Lewinnek angle (mean difference, 1.76°; p < 0.05). The comparison of acetabular orientation measures with those in a prior study of the same cohort yielded intraclass correlation coefficients (ICCs) all above 0.97. The validation of sacral orientation via manual measurement also yielded ICC values all at or above 0.97. CONCLUSIONS Our algorithm showed a high degree of consistency in acetabular orientation measures with respect to a prior study of the same cohort. The measures of pelvic orientation were found to be accurate and reliable when compared with manual measurements of the same data set. All measurements of pelvic orientation were consistent with the means reported in the literature. CLINICAL RELEVANCE An accurate and reproducible, automated technique for determining pelvic and acetabular orientation provides a way to characterize these measures as an aid in clinical diagnosis and preoperative planning.
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Affiliation(s)
- Nathan J Veilleux
- Orthopaedic Research Laboratory, Department of Biomedical Engineering (N.J.V.), Department of Orthopaedic Surgery (N.V.K.), and Department of Radiology (J.A.V.), Virginia Commonwealth University, Richmond, Virginia
| | - Niraj V Kalore
- Orthopaedic Research Laboratory, Department of Biomedical Engineering (N.J.V.), Department of Orthopaedic Surgery (N.V.K.), and Department of Radiology (J.A.V.), Virginia Commonwealth University, Richmond, Virginia
| | - Josephina A Vossen
- Orthopaedic Research Laboratory, Department of Biomedical Engineering (N.J.V.), Department of Orthopaedic Surgery (N.V.K.), and Department of Radiology (J.A.V.), Virginia Commonwealth University, Richmond, Virginia
| | - Jennifer S Wayne
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia
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Li L, Zhang Y, Lin YY, Li ZX, Chen L, Chen DS, Fan P. A Specific Anteversion of Cup and Combined Anteversion for Total Hip Arthroplasty Using Lateral Approach. Orthop Surg 2020; 12:1663-1673. [PMID: 32924261 PMCID: PMC7767786 DOI: 10.1111/os.12790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/27/2020] [Accepted: 06/30/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine the implant orientation, especially the combined anteversion measurements in total hip arthroplasty (THA) using lateral approach, and to compare with implant orientation using posterior-lateral (P-L) approach. The secondary goal was to identify the factors associated with implant orientation. METHODS Five hundred and one patients (545 hips) who underwent primary THA with the modified Hardinge approach between January 2016 and November 2019 by one senior surgeon in our department in a retrospective study were followed up. A survey to inquire about the history of dislocation of the hip after THA was designed and responses were gathered by telephone, WeChat software, and outpatient follow-up. The mean age of the patients was 61.97 ± 11.72 years, and there were 254 males and 247 females. The average follow-up time was 25.2 ± 13.7 months (range, 3.2-49.7 months). Among the patients who were followed up, 97 patients (104 hips) underwent computed tomography (CT) scans from L4 to the tuberosity of the tibia. The implant orientation, including the anteversion and inclination of the cup, anteversion of the stem, combined anteversion, and pelvic tilt were measured based on CT scans of these patients. The results were compared with the implant orientation reported in previous reports measured by CT. Factors that may be associated with implant orientation were investigated, including the patient's age, sex, body mass index (BMI), and diagnosis; size of the cup; diameter of the femoral head component; and pelvic tilt. Data and statistical analyses were performed using SPSS 20.0. RESULTS No cases of dislocation were found in the 501 patients (545 hips) who underwent primary THA during this period. The mean inclination and anteversion of the cups were 38.83° ± 5.04° (24.5°-53.1°) and 9.26° ± 11.19° (-15°-48°), respectively. The mean anteversion of the stem was 13.83° ± 10.7° (-10.2°-42.3°). The combined anteversion was 23.1° ± 13.4° (-7.4°-54.6°). Compared with the reported combined anteversion and anteversion of the cup, the mean anteversion of the cup and combined anteversion using the lateral approach were much lower than the reported values in the literature using the P-L approach. Pelvic tilt was found to be the only independent factor for cup anteversion. Factors including age, sex, BMI, diagnosis, cup size, and diameter of the femoral head component were not associated with implant orientation. CONCLUSION THA using the lateral approach yields smaller cup anteversion and combined anteversion values than using the P-L approach. Pelvic tilt is the only predictor for cup anteversion.
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Affiliation(s)
- Li Li
- Zhejiang Provincial Key Laboratory of Anesthesiology, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Yu Zhang
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Yuan-Yuan Lin
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Zhen-Xing Li
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Liang Chen
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Dao-Sen Chen
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
| | - Pei Fan
- Zhejiang Provincial Key Laboratory of Orthopedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China.,Department of Orthopaedics, The Second Affiliated Hospital of Wenzhou Medical University, Yuying Children's Hospital, Wenzhou, China
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Kobayashi D, Choe H, Kobayashi N, Tezuka T, Ike H, Inaba Y. Association of Femoral Rotation With Whole-Body Alignment in Patients Who Underwent Total Hip Arthroplasty. Arthroplast Today 2020; 6:532-537. [PMID: 32743036 PMCID: PMC7387674 DOI: 10.1016/j.artd.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/06/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022] Open
Abstract
Background Although rotational changes in lower limb alignment after total hip arthroplasty (THA) affect functional stem anteversion, less is known about the effects of femoral rotational alignment in the standing position. This study investigated postoperative changes in femoral rotation and evaluated the association with whole-body alignment in patients who underwent THA. Methods Sixty-five patients with unilateral hip osteoarthritis who underwent THA were enrolled. Preoperative and postoperative femoral rotation in the standing and supine positions were measured using EOS 2D/3D X-ray imaging system and computed tomography. Negative and positive changes in femoral rotation angle were indicative of internal and external rotation, respectively. The associations between femoral rotation and preoperative clinical and radiological factors were investigated. Results Femoral rotation showed significant internal changes in both the standing (-4.7° ± 11.0°) and supine (-3.5°± 10.9°) positions after THA. The preoperative femoral rotation angle, knee flexion angle, sagittal vertical axis (SVA), lumbar lordosis, body mass index, age, and internal and external rotation angles of the hip range of motion on the contralateral side were significantly correlated with femoral rotation in the standing position after THA. Multiple regression analysis showed that preoperative femoral rotation (β = 0.416, P < .001) and SVA (β = 0.216, P = .040) were significant predictors of postoperative femoral rotation in the standing position. Conclusions Femoral rotation had significant association with the patient-inherent posture represented by the SVA in the standing position. Because extensive external change of femoral rotation may increase the risk of hip impingement and dislocation, careful attention is required in patients with external femoral rotation and forward bent posture in the preoperative standing position.
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Affiliation(s)
- Daigo Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Hyonmin Choe
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Naomi Kobayashi
- Department of Orthopedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
| | - Taro Tezuka
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan
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Widmer KH. The Impingement-free, Prosthesis-specific, and Anatomy-adjusted Combined Target Zone for Component Positioning in THA Depends on Design and Implantation Parameters of both Components. Clin Orthop Relat Res 2020; 478:1904-1918. [PMID: 32732575 PMCID: PMC7371099 DOI: 10.1097/corr.0000000000001233] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/04/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lewinnek's recommendation for orienting the cup in THA is criticized because it involves a static assessment of the safe zone and because it does not consider stem geometry. A revised concept of the safe zone should consider those factors, but to our knowledge, this has not been assessed. QUESTIONS/PURPOSES (1) To determine the shape, size, and location of target zones for combined cup and stem orientation for a straight stem/hemispheric cup THA to maximize the impingement-free ROM and (2) To determine whether and how these implant positions change as stem anteversion, neck-shaft angle, prosthetic head size and target range of movements are varied. METHODS A three-dimensional computer-assisted design model, in which design geometry was expressed in terms of parameters, of a straight stem/hemispheric cup hip prosthesis was designed, its design parameters modified systematically, and each prosthesis model was implanted virtually at predefined component orientations. Functional component orientation referencing to body planes was used: cups were abducted from 20° to 70°, and anteverted from -10° to 40°. Stems were rotated from -10° to 40° anteversion, neck-shaft angles varied from 115° to 143°, and head sizes varied from 28 to 40 mm. Hip movements up to the point of prosthetic impingement were tested, including simple flexion/extension, internal/external rotation, ab/adduction, combinations of these, and activities of daily living that were known to trigger dislocation. For each combination of parameters, the impingement-free combined target zone was determined. Maximizing the size of the combined target zone was the optimization criterion. RESULTS The combined target zones for impingement-free cup orientation had polygonal boundaries. Their size and position in the diagram changed with stem anteversion, neck-shaft angle, head size, and target ROM. The largest target zones were at neck-shaft angles from 125° to 127°, at stem anteversions from 10° to 20°, and at radiographic cup anteversions between 17° and 25°. Cup anteversion and stem anteversion were inverse-linearly correlated supporting the combined-anteversion concept. The range of impingement-free cup inclinations depended on head size, stem anteversion, and neck-shaft angle. For a 127°-neck-shaft angle, the lowest cup inclinations that fell within the target zone were 42° for the 28-mm and 35° for the 40-mm head. Cup anteversion and combined version depended on neck-shaft angle. For head size 32-mm cup, anteversion was 6° for a 115° neck-shaft angle and 25° for a 135°-neck-shaft angle, and combined version was 15° and 34° respectively. CONCLUSIONS The shape, size, and location of the combined target zones were dependent on design and implantation parameters of both components. Changing the prosthesis design or changing implantation parameters also changed the combined target zone. A maximized combined target zone was found. It is mandatory to consider both components to determine the accurate impingement-free prosthetic ROM in THA. CLINICAL RELEVANCE This study accurately defines the hypothetical impingement-free, design-specific component orientation in THA. Transforming it into clinical precision may be the case for navigation and/or robotics, but this is speculative, and as of now, unproven.
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Affiliation(s)
- Karl-Heinz Widmer
- K.-H. Widmer, Medical Faculty University of Basel, Basel, Switzerland
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49
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Perazzini P, Trevisan M, Sembenini P, Alberton F, Laterza M, Marangon A, Magnan B. The Mako ™ robotic arm-assisted total hip arthroplasty using direct anterior approach: surgical technique, skills and pitfals. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:21-30. [PMID: 32555073 PMCID: PMC7944824 DOI: 10.23750/abm.v91i4-s.9659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 12/13/2022]
Abstract
In the last decades many innovations have improved the hip replacement and the hip reconstruction surgery such as the introduction of the robotic-arm assisted surgery associated with the direct anterior approach (DAA). This surgical approach for total hip arthroplasty (THA) is growing in popularity and its effectiveness has been demonstrated to improve patients’ outcomes, especially regarding more accurate implant placement, less post operative pain, faster recovery and lower of prosthesis dislocation risk. The robotic-arm assisted surgery is another really great innovation for the orthopedic surgeons. It allows to create a patient-specific THA pre-operative planning and to perform a much more accurate surgical procedure. This article outlines authors’ surgical technique of performing accurate pre-operative planning and robotic-assisted THA using direct anterior approach based on the experience of 534 patients and to discuss details of this technique. (www.actabiomedica.it)
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Affiliation(s)
| | | | | | | | | | | | - Bruno Magnan
- Department of Orthopedics and Trauma surgery, University of Verona (Italy).
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50
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Putame G, Pascoletti G, Franceschini G, Dichio G, Terzini M. Prosthetic Hip ROM from Multibody Software Simulation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:5386-5389. [PMID: 31947073 DOI: 10.1109/embc.2019.8856993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The pre-operative planning of a hip arthroplasty entails the choice of the prosthetic hip model and of the position of both joint components with reference to bone. Assessing the impact of geometrical factors on the final hip range of motion (ROM) is not trivial, since it requires performing 3D evaluations. Nonetheless, it deserves to be studied since hip impingement and dislocation are still relevant complications in hip arthroplasty. This work pertains a numerical model for the assessment of the hip ROM in relation to cotyle position. External/internal rotation is considered as a benchmark, and multiple combinations of acetabular anteversion/inclination are considered. According to results, over two hundred different geometric configurations can be examined in few minutes, and the cotyle position can be so optimized with relevant benefits in term of hip ROM.
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