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Leal J, Heimann AF, Dilbone ES, Ryan SP, Wellman SS. How Much Does a Computed Tomography-Based Mixed-Reality Navigation System Change Freehand Acetabular Component Position? Arthroplast Today 2025; 32:101661. [PMID: 40166080 PMCID: PMC11957531 DOI: 10.1016/j.artd.2025.101661] [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: 12/07/2024] [Revised: 01/14/2025] [Accepted: 02/10/2025] [Indexed: 04/02/2025] Open
Abstract
Background This study evaluates how a computed tomography-based mixed-reality (MR) navigation system impacts acetabular component orientation compared to freehand positioning in total hip arthroplasty. Methods A series of 79 patients who underwent total hip arthroplasty utilizing a computed tomography-based MR navigation system were reviewed. The surgeon initially placed the acetabular cup freehand, attempting to achieve the preoperative plan, and this initial intraoperative orientation was recorded. The cup was then adjusted to the planned position. The difference between freehand and planned tilt-adjusted operative anteversion (OA) and inclination (OI) determined the navigation tool's impact. Results The mean preoperative planned OA was 30.1 ± 2.0 (range: 25, 35) degrees, and the mean freehand intraoperative OA was 30.2 ± 9.1 (range: 4, 57) degrees (P = .885), requiring a mean adjustment of 6.8 ± 5.1 (range: 0, 23) degrees. Freehand OA was corrected at least 5 degrees in 54.4% (43/79) of cases. The mean preoperative planned OI was 40.8 ± 0.6 (range: 39, 42) degrees, and the mean freehand intraoperative OI was 37.8 ± 6.6 (range: 18, 53) degrees (P < .001), requiring a mean adjustment of 5.7 ± 4.5 (range: 0, 22) degrees to achieve. Freehand OI was corrected at least 5 degrees in 43.0% (34/79) of cases. Conclusions Freehand acetabular component positioning in the lateral position is variable when attempting to execute patient-specific numerical cup orientation targets. Use of this navigation tool led the surgeon to correct more than 5 degrees in both OA and OI in roughly half of the hips.
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Affiliation(s)
- Justin Leal
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Alexander F. Heimann
- Department of Orthopaedic Surgery and Traumatology, HFR Fribourg – Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Eric S. Dilbone
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Sean P. Ryan
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
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Sonoda K, Kubo Y, Hara T. A novel patient-specific free-hand method using fluoroscopic templating for accurate cup placement in supine position total hip arthroplasty. Arch Orthop Trauma Surg 2025; 145:205. [PMID: 40116988 DOI: 10.1007/s00402-025-05828-6] [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: 08/06/2024] [Accepted: 03/07/2025] [Indexed: 03/23/2025]
Abstract
INTRODUCTION We developed a fluoroscopic templating technique for accurate cup placement based on the acetabular morphology of individual patients during supine position total hip arthroplasty (THA) to reduce the risk of dislocation. This study aimed to evaluate cup positioning accuracy with and without this technique. MATERIALS AND METHODS We evaluated 75 consecutive hips of 70 patients undergoing cementless anterolateral supine THA. The target angle for radiographic inclination (RI) and radiographic anteversion (RA) were set using a computed tomography (CT)-based functional pelvic plane. In 25 hips, we implanted the cup using a mechanical alignment guide (C-group). A fluoroscopic templating technique was used in 50 hips (FT-group), and a reference line based on the acetabular morphology was preoperatively set in each patient for the RI guide. A reference diagram was made for the RA guide. Postoperative CT scans were used to compare cup positioning accuracy between groups. RESULTS The absolute values of the error from the target angle were 3.2 ± 2.0° (RI) and 6.5 ± 3.8° (RA) in the C-group, and 1.5 ± 1.2° (RI) and 2.6 ± 1.9° (RA) in the FT-group. The errors of both RI and RA were significantly smaller in the FT-group than in the C-group. The rates of cases within ± 5° of the target angles for both RI and RA were 48% (C-group) and 92% (FT-group). The mean fluoroscopic times were 32.2 s (C-group) and 17.4 s (FT-group). CONCLUSION Our simple patient-specific technique achieved accurate cup positioning; this may reduce the risk of dislocation.
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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
| | - Toshihiko Hara
- Department of Orthopaedic Surgery, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, 820-8505, Japan
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Ueyama H, Yamamura M, Koyanagi J, Fukunaga K, Takemura S, Nakamura S, Kagiyama H. Postoperative posterior pelvic tilt progression is a risk factor for cup revision after total hip arthroplasty with a conventional polyethylene liner: a 25-year follow-up study. Hip Int 2025:11207000251326473. [PMID: 40108807 DOI: 10.1177/11207000251326473] [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: 03/22/2025]
Abstract
BACKGROUND Whether postoperative posterior pelvic tilt progression is an independent risk factor for cup revision after total hip arthroplasty (THA) with a conventional polyethylene (PE) liner is unclear. This long-term follow-up study assessed the association between posterior pelvic tilt and cup revision after THA using the porous-coated anatomic (PCA) total hip system. METHODS This retrospective cohort study included 94 patients who underwent THA using the PCA total hip system and participated in postoperative follow-up for a mean of 25 years. The Japanese Orthopaedic Association (JOA) hip score was the clinical outcome, and prosthetic alignment and the change in pelvic tilt were measured as radiological outcomes. Prosthetic survival rates for revision as the endpoint were evaluated, and risk factors for cup revision were identified using a multivariate logistic regression analysis. RESULTS The JOA hip score improved significantly (p < 0.001) after THA (before THA: 41 ± 6.3 points; after THA: 86 ± 8.9 points). The postoperative posterior pelvic tilt progressed 3.6 ± 3.2°. Survival rates of the cup and stem at 27 years postoperatively were 60.8% and 87.5%, respectively (p < 0.001). The main reason for revision (81% of all revisions) was aseptic loosening. Postoperative posterior pelvic tilt progression was an independent risk factor for cup revision (odds ratio, 1.53; 95% confidence interval, 1.06-2.20; p = 0.022). CONCLUSIONS When the PCA total hip system was used, the stem exhibited good longevity during a mean follow-up period of 25 years; however, the cup was vulnerable because of aseptic loosening. Postoperative posterior pelvic tilt progression was an independent risk factor for cup revision.
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Affiliation(s)
- Hideki Ueyama
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | | | | | - Kenji Fukunaga
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Susumu Takemura
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Suguru Nakamura
- Department of Orthopaedic Surgery, Sano Memorial Hospital, Osaka, Japan
| | - Hiroshi Kagiyama
- Department of Orthopaedic Surgery, Sano Memorial Hospital, Osaka, Japan
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Feng T, Tang H, Zhang X, Zhang Y, Zhou Y, Jin Z. A novel preoperative prosthetic position planning algorithm for total hip arthroplasty based on the no-impingement principle: A case study. Proc Inst Mech Eng H 2025; 239:321-331. [PMID: 40079481 DOI: 10.1177/09544119251319960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2025]
Abstract
Most preoperative planning calculations of impingement-free range of motion (IFROM) and impingement-free safe zone (IFSZ) rarely consider non-standard shaped prostheses and bony impingement (BI) for total hip arthroplasty (THA). This research developed a novel algorithm that considers BI, prosthetic impingement, pelvic tilt angle (PT) in the sagittal plane, and non-standard-shaped hip prostheses. This research aimed to investigate the effect of BI and PT on hip IFROM, IFSZ, and the BI rate. Using this algorithm to calculate a case, we found that when considering BI, (1) the upper limit of the hip IFROM was decreased, and the different PT affected the upper limit of the hip IFROM of various movements; (2) the BI rate of the flat-rim liner in standing and sitting postures were 54.6% and 67%; and (3) the maximum IFSZ size of the flat-rim liner was reduced by 12%, the reduction rate of the combined pelvic position with a non-zero IFSZ size was 83.2% for the flat-rim liner. Consideration of BI further reduces the IFROM, the IFSZ size, and the number of the combined position of the pelvis with a non-zero IFSZ size of the hip joint. Importantly, this algorithm provides a reliable tool for personalized prosthesis positioning for THA. This algorithm has excellent applications in personalized surgical planning and surgical robotics.
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Affiliation(s)
- Tao Feng
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Hao Tang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xiaogang Zhang
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Yali Zhang
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Zhongmin Jin
- Tribology Research Institute, School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, Sichuan, China
- School of Mechanical Engineering, University of Leeds, Leeds, UK
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Singh A, Kumar P, Kalyan K, Gundalli AC, Mane SS, Swarnkar H, Singh L. Accuracy of acetabular cup positioning in robotic-assisted total hip arthroplasty: a CT-based evaluation. SICOT J 2024; 10:57. [PMID: 39705556 DOI: 10.1051/sicotj/2024057] [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: 08/16/2024] [Accepted: 11/24/2024] [Indexed: 12/22/2024] Open
Abstract
INTRODUCTION Robot-assisted instrumentation during total hip arthroplasty (THA) has the potential to improve acetabular cup positioning. This study aimed to evaluate the precision of robotic-arm-assisted THA (rTHA) and assess whether the system can provide accurate cup positioning comparable to conventional THA (cTHA). METHODS A single-center prospective cohort study consisting of 151 patients who underwent THA (108 rTHA and 43 cTHA). The robotically assisted system was used to match the postoperative computed tomography (CT) image of the pelvis with the planned and intraoperative anatomical landmarks. The cTHA cohort underwent hip replacement using the standard manual procedure, with acetabular component locations assessed during and after surgery. RESULTS The rTHA cohort was significantly younger, but no other significant differences were found between the two cohorts in preoperative baseline data. In rTHA cohort, the planned inclination (40.0 ± 0.3°) closely matched the intraoperative (40.2 ± 2.7°; p = 0.54) and postoperative (40.7 ± 4.0°; p = 0.07) measurements. However, anteversion showed a significant increase from planned (19.4 ± 1.5°) to postoperative CT scan (28.7 ± 7.0°; p < 0.001). There was evidence of proportional bias in the measurements (p < 0.001). In the cTHA cohort, the mean inclination (43.1 ± 5.1°) did not show any significant change between the preoperative plans and postoperative assessments (p = 0.12); however, there was a remarkable change in the mean anteversion (17.6 ± 6.4°) between postoperative measurements and the preoperative plans (p < 0.001). The average anteversion in the preoperative plans did not differ remarkably between the rTHA and cTHA cohorts. However, the average inclination was substantially different between the two cohorts (p < 0.001). Both groups had no significant differences in the proportion of cups outside the referenced safe zones. CONCLUSION The results suggest that while robotic-assisted guidance ensures consistent cup inclination, there may be more variability in achieving the planned anteversion, which warrants further investigation into the factors influencing postoperative changes in acetabular orientation.
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Affiliation(s)
- Ashish Singh
- Anup Institute of Orthopaedics & Rehabilitation, G75-77, P.C. Colony, Kankarbagh, Patna, Bihar, 800020, India
| | - Purushotam Kumar
- Anup Institute of Orthopaedics & Rehabilitation, G75-77, P.C. Colony, Kankarbagh, Patna, Bihar, 800020, India
| | - Kanukuntla Kalyan
- Anup Institute of Orthopaedics & Rehabilitation, G75-77, P.C. Colony, Kankarbagh, Patna, Bihar, 800020, India
| | | | - Sudhir Shankar Mane
- Anup Institute of Orthopaedics & Rehabilitation, G75-77, P.C. Colony, Kankarbagh, Patna, Bihar, 800020, India
| | - Himanshu Swarnkar
- Anup Institute of Orthopaedics & Rehabilitation, G75-77, P.C. Colony, Kankarbagh, Patna, Bihar, 800020, India
| | - Lavanya Singh
- The Hazeley Academy, Emperor Drive, Hazeley, Milton Keynes, MK8 0PT, United Kingdom
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Okamoto M, Takegami Y, Osawa Y, Tanaka S, Nobori T, Imagama S. Accelerometer-based portable navigation system shows no superior accuracy over pelvic alignment guide for acetabular cup placement in total hip arthroplasty in lateral decubitus position. Arch Orthop Trauma Surg 2024; 144:4849-4856. [PMID: 39347968 DOI: 10.1007/s00402-024-05571-4] [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: 06/18/2024] [Accepted: 09/09/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Total hip arthroplasty (THA) using a portable navigation system (PNS) incurs costs per procedure. However, it does not require a large console. This study aimed to compare the accuracy of acetabular cup placement using a pelvic alignment guide (PAG) attached to the pelvis and an accelerometer-based PNS in THA performed in the lateral decubitus position. METHODS We retrospectively analyzed 100 hips that underwent primary THA in the lateral decubitus position between July 2018 and January 2021. The PAG was used in 50 hips, whereas the PNS was used in the other 50. Cup placement accuracy was measured using postoperative computed tomography scans, comparing errors in inclination and anteversion angles. The surgical time, blood loss, and complications were recorded. The follow-up period was at least 2 years in all cases. RESULTS The mean absolute error of the inclination angle was similar between the groups (the PAG group: 3.7° ± 2.3° [range, 0.0-9.0]; the PNS group: 3.7° ± 2.3° [range, 0.2-10.5], p = 0.705). The mean absolute error of the anteversion angle was significantly smaller in the PAG group than in the PNS group (3.0° ± 2.4° [range, 0.0-9.7] vs. 6.5° ± 4.8° [range, 0.3-17.3], p < 0.001). The PAG group had a higher proportion of hips within 5° and 10° of the target angle (64 vs. 42%, P = 0.028, and 100 vs. 74%, p < 0.001, respectively). The PNS group had six hips with anteversion errors of 15° or more. Surgical time and blood loss were lower in the PAG group. The PNS group had one dislocation, whereas the PAG group did not. CONCLUSION The accelerometer-based PNS did not demonstrate superior cup alignment accuracy compared to the PAG in THA performed in the lateral decubitus position. This finding informs surgeons that computer-assisted surgery is not necessarily superior to conventional THA using a PAG.
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Affiliation(s)
- Masanori Okamoto
- Department of Orthopaedic Surgery, Yokkaichi Municipal Hospital, 11 2-2-37, Shibata, Yokkaichi-shi, Mie, 510-8567, Japan.
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, 466-8550, Japan
| | - Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, 466-8550, Japan
| | - Shinya Tanaka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, 466-8550, Japan
| | - Tatsuya Nobori
- Department of Orthopaedic Surgery, Yokkaichi Municipal Hospital, 11 2-2-37, Shibata, Yokkaichi-shi, Mie, 510-8567, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, 466-8550, Japan
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Lunn DE, Redmond AC, Chapman GJ, Lund ME, Ferguson SJ, De Pieri E. Hip contact force pathways in total hip replacement differ between patients and activities of daily living. J Biomech 2024; 176:112309. [PMID: 39260233 DOI: 10.1016/j.jbiomech.2024.112309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 09/05/2024] [Accepted: 09/05/2024] [Indexed: 09/13/2024]
Abstract
One of the main causes of implant failure and revision surgery in total hip replacement (THR) is aseptic loosening often caused by the accumulation of wear debris arising between the contact surfaces of the acetabular cup and femoral head during activities of daily living (ADL's). However, limited information is available regarding the contact force pathways between these two surfaces during specific ADL's. In this study, through musculoskeletal modelling, we aimed to estimate the orientation of the hip contact force pathway on the acetabular cup. One hundred and thirty-two THR patients underwent motion capture analysis whilst undertaking locomotor and non-locomotor ADL's. Musculoskeletal simulations were performed to calculate contact force pathways using inverse dynamics analysis. We then qualitatively compared differences in the contact force pathways between patients and between ADL's. Walking resulted in a typical figure-of-eight pattern, with the peak contact forces occurring in the superior-anterior area of the cup. The non-locomotive activities such as stand up, sit down and squat had a more linear shape, spanning across the superior-posterior quarter of the cup. Our results showed a large inter-patient variability in the shape and location of the contact force pathway. There is a distinct difference in the location and shape of the pathway between locomotor and non-locomotor activities and this could result in different wear accumulations. These results could enhance our understanding why revision rates vary across the population and could inform the development of personalised implant design.
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Affiliation(s)
- David E Lunn
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds, UK.
| | - Anthony C Redmond
- NIHR Leeds Biomedical Research Centre, Leeds, UK; Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
| | - Graham J Chapman
- Allied Health Research Unit, University of Central Lancashire, Preston, UK.
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Kokubu Y, Kawahara S, Ayabe Y, Motomura G, Hamai S, Hara T, Nakashima Y. Evaluation of Leg Length Difference on Perioperative Radiographs of Total Hip Arthroplasty Considering Lower Limb Malposition. Cureus 2024; 16:e70790. [PMID: 39493174 PMCID: PMC11531339 DOI: 10.7759/cureus.70790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2024] [Indexed: 11/05/2024] Open
Abstract
BACKGROUND During total hip arthroplasty (THA) in lateral decubitus, perioperative radiography allows the surgeon a simple evaluation of the leg length difference (LLD) by measuring the proximal femoral length. However, the effect of femoral malpositioning on proximal femoral length measurements during the evaluation of perioperative radiographs is not adequately understood. We aimed to (1) investigate the effects of malposition on proximal femoral length using three-dimensional computer simulations and (2) verify whether a simple correction formula can improve the accuracy of LLD evaluation on perioperative radiographs. METHODS We analyzed 86 patients who underwent THA. Digitally reconstructed radiography (DRR) images were reconstructed in various limb positions (femoral abduction, adduction, and flexion), and proximal femoral length measurements in those malpositions were simulated. Additional morphological measurements of the femoral neck torsion angle in the sagittal plane were performed to elucidate the simulation findings. The malposition angle of abduction-adduction was evaluated with actual perioperative radiographs, and trigonometric correction was attempted. RESULTS The leg length measurement decreased as the femoral DRR image shifted from neutral to abduction and adduction, demonstrating approximately 1 mm per 10° of abduction or adduction. The leg length measurement increased as the femoral image shifted from neutral to 10° and 20° of flexion, demonstrating approximately 3 mm per 10° of flexion. With a peak at 20° of flexion, the proximal femoral length measurement decreased in the DRR images at 30°, 40°, 50° and 60° of flexion. The femoral neck torsion angle was 21.1 ± 5.6° on the operative side. The effect of coronal malposition on leg length discrepancy was so small that the difference following trigonometric correction was not statistically significant (p=0.108). CONCLUSION In the present simulation, coronal malposition had a small effect on LLD evaluation. As the femoral neck has a torsion of approximately 20°, the proximal femoral length is projected the longest when the femur is flexed 20°. With careful positioning of the limb in the coronal plane, the use of a correction formula for LLD evaluation would not be necessary. Surgeons should ensure that both lower limbs are in the same position in the sagittal plane during THA in lateral decubitus.
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Affiliation(s)
- Yasuhiko Kokubu
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JPN
| | - Shinya Kawahara
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JPN
| | - Yusuke Ayabe
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JPN
| | - Goro Motomura
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JPN
| | - Satoshi Hamai
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JPN
| | - Toshihiko Hara
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JPN
- Department of Orthopedic Surgery, Aso-Iizuka Hospital, Iizuka, JPN
| | - Yasuharu Nakashima
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, JPN
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Nemati HM, Christensson A, Pettersson A, Németh G, Flivik G. Precision of Cup Positioning Using a Novel Computed Tomography Based Navigation System in Total Hip Arthroplasty. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1589. [PMID: 39459376 PMCID: PMC11509289 DOI: 10.3390/medicina60101589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 09/09/2024] [Accepted: 09/24/2024] [Indexed: 10/28/2024]
Abstract
Background and Objectives: Navigation systems are designed to enhance surgical precision, improving patient outcomes and reducing the risk of implant misplacement. In this study, we have evaluated a novel orthopedic surgical platform that utilizes CT imaging with AI-based algorithms to automate several critical aspects of total hip arthroplasty. It contains three modules-preoperative planning, navigation during surgery, and follow-up analysis. The primary objective of the current study was to evaluate the precision of the navigation tool in cup placement, i.e., whether the information displayed for navigation correctly reflected the actual position of the implant. Materials and Methods: Surgery outcomes of 15 inter-rater measurements on human cadavers and 18 surgeries on patients who underwent total hip replacement using the navigation tool were analyzed. Results: In the inter-rater assessment, the mean errors were -0.31 ± 1.42° for anteversion, 1.06 ± 1.73° for inclination, and -0.94 ± 1.76 mm for cup position depth. In patients' surgeries, the mean errors were -0.07 ± 2.72° for anteversion, -0.2 ± 0.86° for inclination, and 0.28 ± 0.78 mm for cup depth. Conclusions: The navigation tool offers intra-operative guidance on notable precision in cup placement, thereby effectively mitigating the risk of cup malpositioning outside the patient-specific safe zone.
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Affiliation(s)
| | - Albin Christensson
- Department of Orthopedics, Clinical Sciences, Skåne University Hospital, Lund University, 221 84 Lund, Sweden
| | | | | | - Gunnar Flivik
- Department of Orthopedics, Clinical Sciences, Skåne University Hospital, Lund University, 221 84 Lund, Sweden
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Rivera F, Comba LC, Colombo M, Benazzo F, Cavaliere P, Solarino G. Management of intracapsular hip fracture: Current trends from a national survey. Injury 2024; 55 Suppl 4:111539. [PMID: 39542582 DOI: 10.1016/j.injury.2024.111539] [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: 11/24/2023] [Revised: 03/08/2024] [Accepted: 04/01/2024] [Indexed: 11/17/2024]
Abstract
Proximal femoral fractures are a major public health issue due to an increasing ageing population, with an important impact on patients' quality of life. This study was designed by the Authors through a national survey with the purpuse to investigate the italian experience and practice about management and perioperative/operative trends of intracapsular proximal femoral fractures (PFF). In February-March 2022 a national survey was submitted online to the members of SIOT (Società Italiana Ortopedici e Traumatologi) and SIDA (Società Italiana dell'Anca) societies. Demographic data of the participants such as age, type of workplace and years of working experiences were registered. The questionnarie included 21 multiple choice questions about: demographic data, preoperative management, surgical indications (treatment of non-displaced and displaced fractures), management of the geriatric patient and surgical technique. Resulting data were collected and stored in a database, the results were then processed and compared with the international literature and registries. The Survey was completed by 372 surgeons; answers reported were often in accordance with the literature and national and international guidelines, with, on the other hand, important controversies regarding preoperative management (radiological studies and preoperative planning), some surgical indications and choice of stem fixation. Management of proximal femoral fractures is not always clear and univocal; it is mandatory to produce a diagnostic-therapeutic process supported by scientific evidence. In this context the SIOT Guidelines 2021 offer a real help for the surgeon managing a PPF.
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Affiliation(s)
- Fabrizio Rivera
- Orthopedics and Trauma Department, SS Annunziata Hospital, ASL CN1, Savigliano (CN), Italy
| | - Luca Costanzo Comba
- Orthopedics and Trauma Department, SS Annunziata Hospital, ASL CN1, Savigliano (CN), Italy.
| | - Massimiliano Colombo
- ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milano, Italy
| | | | - Pietro Cavaliere
- Istituto Ortopedico del Mezzogiorno d'Italia "Franco Scalabrino", Messina, Italy
| | - Giuseppe Solarino
- Orthopaedics Unit, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
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Deshmukh S, Gupta N, Heo KS, Shon WY, Jo SM, Pancholiya A. Change of Sacral Slope according to the Surgical Position in Total Hip Arthroplasty. Hip Pelvis 2024; 36:187-195. [PMID: 39210571 PMCID: PMC11380543 DOI: 10.5371/hp.2024.36.3.187] [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: 10/29/2023] [Revised: 02/24/2024] [Accepted: 02/24/2024] [Indexed: 09/04/2024] Open
Abstract
PURPOSE Pelvis tilting in sagittal plane influences the acetabular cup position. Majority of total hip arthroplasty (THA) are performed in lateral decubitus surgical position. This study is to assess whether there is any difference in sacral slope between standing and lateral decubitus position and influence of this variation in planning acetabular cup anteversion. MATERIALS AND METHODS This is a prospective study including 50 patients operated between January 2020 to March 2022. Preoperative radiograph included lumbosacral spine lateral X-ray in standing, supine and lateral decubitus positions to calculate the sacral slope for assessment of anterior or posterior pelvic tilting. In our study, we determined the position of the acetabular cup based on changes in sacral slope between standing and lateral decubitus postures. For patients whose sacral slope increased from lateral decubitus to standing, we implanted the acetabular component with a higher degree of anteversion. Conversely, for patients with reverse phenomenon, the cup was inserted at lower anteversion. RESULTS Twenty-four patients (48.0%) had increase in sacral slope from lateral decubitus to standing whereas 26 patients (52.0%) had decrease in sacral slope. There was linear correlation between difference in preoperative sacral slope and postoperative cross table lateral cup anteversion. Harris hip scores improved from 40.78 to 85.43. There was no subluxation or dislocation in any patient at minimum 2-year follow-up. CONCLUSION Individualized acetabular cup placement is important for better functional outcome in THA. Evaluation of pelvic tilting in lateral decubitus position is necessary for better positioning of acetabular cup and avoid postoperative complications.
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Affiliation(s)
- Shobit Deshmukh
- Department of Orthopaedic Surgery, Busan Bumin Hospital, Busan, Korea
| | - Nirav Gupta
- Department of Orthopaedic Surgery, Busan Bumin Hospital, Busan, Korea
| | - Ki Seong Heo
- Department of Orthopaedic Surgery, Busan Bumin Hospital, Busan, Korea
| | - Won Yong Shon
- Department of Orthopaedic Surgery, Busan Bumin Hospital, Busan, Korea
| | - Se Myoung Jo
- Department of Orthopaedic Surgery, Busan Bumin Hospital, Busan, Korea
| | - Anshul Pancholiya
- Department of Orthopaedic Surgery, Busan Bumin Hospital, Busan, Korea
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Huan SW, Wu WR, Peng SJ, Zhuang TF, Liu N. Total hip arthroplasty after pelvic osteotomy: a meta-analysis. Acta Orthop Belg 2024; 90:523-533. [PMID: 39851025 DOI: 10.52628/90.3.10758] [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: 01/25/2025]
Abstract
Several studies suggested that total hip arthroplasty (THA) was more technical demanding following previous pelvic osteotomy (PO), resulting in poor outcomes compared with primary THA. However, the other studies regarding this topic had reported contradictory results. Therefore, we conducted this meta-analysis to compare the clinical results and other parameters between total hip arthroplasty following pelvic osteotomy and primary total hip arthroplasty. We systematically searched PubMed, the Cochrane Library, EMBASE, Web of Science, Scopus, EBSCO and Web of science from inception to September 2020. This study compared the outcomes between THA following previous PO and primary THA with respect to operative time, blood loss, Harris hip score (HHS), revision rates, complication rates, cup position, cup size, cup coverage and hip joint center. 14 studies with 3913 participants were included. The THA after PO group had longer operative time (MD, 13.8 mins; 95% CI, 4.73 to 22.87 mins; P=0.003), greater blood loss (MD, 82.21 ml; 95% CI, 27.94 to 136.48 ml; P=0.003), worse HHS (MD, -2.79 points; 95% CI, -4.08 to -1.50 points; P<0.00001), smaller acetabular anteversion angle (MD, -3.98°; 95% CI, -6.72 to -1.24°; P=0.004), larger cup size (MD, 1.52 mm; 95% CI, 0.75 to 2.28 mm; P=0.0001), more lateral (MD, 2.83 mm; 95% CI, 1.22 to 4.43 mm; P=0.0005) and superior (MD, 2.26 mm; 95% CI, 1.11 to 3.40 mm; P=0.0001) hip joint center. No statistically significant differences were demonstrated between the THA after PO group and primary THA group in revision rates, complication rates, acetabular abduction angle, cup coverage. THA after pelvic osteotomy was associated with inferior intraoperative outcomes, lower functional scores and worse inferior positioning of acetabular component compared with primary THA. Due to the alerted anatomical structure after PO, the findings of current study implicated that preoperative assessment such as computed tomography scan should be conducted in order to achieve satisfactory results.
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Ong CB, Buchan GBJ, Hecht CJ, Kanaji A, Kendoff DO, Kamath AF. Robotic-assisted total hip arthroplasty utilizing a fluoroscopy-guided system produced similar cup accuracy and precision relative to a computerized tomography-based robotic platform. J Robot Surg 2024; 18:273. [PMID: 38949665 DOI: 10.1007/s11701-024-02033-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/21/2024] [Indexed: 07/02/2024]
Abstract
Robotic assistance for total hip arthroplasty (THA) has been demonstrated to improve accuracy of acetabular cup placement relative to manual, unassisted technique. The purpose of this investigation was to compare the accuracy and precision between a fluoroscopy-based robotic total hip arthroplasty platform (FL-RTHA) and a computerized tomography-based (CT-RTHA) platform. The study included 98 consecutive FL-RTHA and 159 CT-RTHA procedures performed via direct anterior approach (DAA). All cases were performed for a pre-operative diagnosis of osteoarthritis, avascular necrosis, or rheumatoid arthritis. Primary outcome variables included cup implantation accuracy and precision (variance). Implantation accuracy was calculated as the absolute value of the difference between pre-operative target cup angles (inclination and anteversion) and the same post-operative angles. Percentage placement in the Lewinnek safe zone was also measured for both cohorts. The FL-RTHA and CT-RTHA cohorts demonstrated a 1.2° difference in absolute values for cup inclination accuracy (4.6° ± 3.6 vs. 3.4 ± 2.7; p = 0.005), and no difference in absolute values for cup anteversion accuracy (4.7° ± 4.1 vs. 4.6 ± 3.4; p = 0.991). Cohorts demonstrated similar precision for cup inclination and anteversion placement parameters, as well as equivalent Lewinnek safe zone placement. The use of a fluoroscopy-based robotic assistance platform for primary DAA THA resulted in similar accuracy and precision of acetabular cup placement when compared to a CT-based robotic assistance system.
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Affiliation(s)
- Christian B Ong
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Graham B J Buchan
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Christian J Hecht
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Arihiko Kanaji
- Department of Orthopedic Surgery, Restorative Medicine of Neuro-Musculoskeletal System, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Daniel O Kendoff
- Chefarzt Zentrum für Orthopädie und Unfallchirurgie, HELIOS Kliniken Berlin-Buch, Schwanebecker Chaussee 25, 13125, Berlin, Germany
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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14
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Tanaka S, Takegami Y, Osawa Y, Okamoto M, Imagama S. Retrospective study comparing the accuracies of handheld infrared stereo camera and augmented reality-based navigation systems for total hip arthroplasty. Arch Orthop Trauma Surg 2024; 144:2811-2821. [PMID: 38704436 DOI: 10.1007/s00402-024-05330-5] [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: 11/24/2023] [Accepted: 04/14/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The use of portable navigation systems (PNS) in total hip arthroplasty (THA) has become increasingly prevalent, with second-generation PNS (sPNS) demonstrating superior accuracy in the lateral decubitus position compared to first-generation PNS. However, few studies have compared different types of sPNS. This study retrospectively compares the accuracy and clinical outcomes of two different types of sPNS instruments in patients undergoing THA. METHODS A total of 158 eligible patients who underwent THA at a single institution between 2019 and 2022 were enrolled in the study, including 89 who used an accelerometer-based PNS with handheld infrared stereo cameras in the Naviswiss group (group N) and 69 who used an augmented reality (AR)-based PNS in the AR-Hip group (group A). Accuracy error, navigation error, clinical outcomes, and preparation time were compared between the two groups. RESULTS Accuracy errors for Inclination were comparable between group N (3.5° ± 3.0°) and group A (3.5° ± 3.1°) (p = 0.92). Accuracy errors for anteversion were comparable between group N (4.1° ± 3.1°) and group A (4.5° ± 4.0°) (p = 0.57). The navigation errors for inclination (group N: 2.9° ± 2.7°, group A: 3.0° ± 3.2°) and anteversion (group N: 4.3° ± 3.5°, group A: 4.3° ± 4.1°) were comparable between the groups (p = 0.86 and 0.94, respectively). The preparation time was shorter in group A than in group N (p = 0.036). There were no significant differences in operative time (p = 0.255), intraoperative blood loss (p = 0.387), or complications (p = 0.248) between the two groups. CONCLUSION An Accelerometer-based PNS using handheld infrared stereo cameras and AR-based PNS provide similar accuracy during THA in the lateral decubitus position, with a mean error of 3°-4° for both inclination and anteversion, though the AR-based PNS required a shorter preparation time.
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Affiliation(s)
- Shinya Tanaka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya-Shi, 466-8550, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya-Shi, 466-8550, Japan.
| | - Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya-Shi, 466-8550, Japan
| | - Masanori Okamoto
- Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi-Shi, Mie, 510-8567, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya-Shi, 466-8550, Japan
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Pagan CA, Karasavvidis T, Vigdorchik JM, DeCook CA. Spinopelvic Motion: A Simplified Approach to a Complex Subject. Hip Pelvis 2024; 36:77-86. [PMID: 38825817 PMCID: PMC11162876 DOI: 10.5371/hp.2024.36.2.77] [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: 10/02/2023] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 06/04/2024] Open
Abstract
Knowledge of the relationship between the hip and spine is essential in the effort to minimize instability and improve outcomes following total hip arthroplasty (THA). A detailed yet straightforward preoperative imaging workup can provide valuable information on pelvic positioning, which may be helpful for optimum placement of the acetabular cup. For a streamlined preoperative assessment of THA candidates, classification systems with a capacity for providing a more personalized approach to performance of THA have been introduced. Familiarity with these systems and their clinical application is important in the effort to optimize component placement and reduce the risk of instability. Looking ahead, the principles of the hip-spine relationship are being integrated using emerging innovative technologies, promising further streamlining of the evaluation process.
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Affiliation(s)
- Cale A. Pagan
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Jonathan M. Vigdorchik
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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16
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Meermans G, Fawley D, Zagra L, Ten Broeke RHM, Johnson K, Bernard T, Thomason HC. Accuracy of cup placement compared with preoperative surgeon targets in primary total hip arthroplasty using standard instrumentation and techniques: a global, multicenter study. J Orthop Traumatol 2024; 25:25. [PMID: 38727945 PMCID: PMC11087417 DOI: 10.1186/s10195-024-00766-2] [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: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Acetabular cup positioning in total hip arthroplasty (THA) is closely related to outcomes. The literature has suggested cup parameters defined by the Lewinnek safe zone; however, the validity of such measures is in question. Several studies have raised concerns about the benefits of using the Lewinnek safe zone as a predictor of success. In this study we elected to use prospective surgeon targets as the basis for comparison to see how successful surgeons are positioning their cup using standard instruments and techniques. METHODS A prospective, global, multicenter study was conducted. Cup positioning success was defined as a composite endpoint. Both cup inclination and version needed to be within 10° of the surgeon target to be considered a success. Radiographic analysis was conducted by a third-party reviewer. RESULTS In 170 subjects, inclination, target versus actual, was 44.8° [standard deviation (SD 0.9°)] and 43.1° (SD 7.6°), respectively (p = 0.0029). Inclination was considered successful in 84.1% of cases. Mean version, target versus actual, was 19.4° (SD 3.9°) and 27.2° (SD 5.6°), respectively (p < 0.0001). Version was considered successful in 63.4% of cases, and combined position (inclination and version) was considered successful in 53.1%. CONCLUSION This study shows that with traditional methods of placing the cup intraoperatively, surgeons are only accurate 53.1% of the time compared with a predicted preoperative plan. This study suggests that the inconsistency in cup positioning based on the surgeon's planned target is potentially another important variable to consider while using a mechanical guide or in freehand techniques for cup placement in THA. TRIAL REGISTRATION This study is registered on ClinicalTrials.gov, NCT03189303.
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Affiliation(s)
- Geert Meermans
- Department of Orthopaedics, Bravis Hospital, Bergen op Zoom, Roosendaal, The Netherlands.
| | - David Fawley
- DePuy Synthes, 700 Orthopaedic Drive, Warsaw, IN, USA
| | - Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - René H M Ten Broeke
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, 6202 AZ, Maastricht, The Netherlands
| | - Kory Johnson
- Orthopaedic Associates of Michigan, 555 Mid Towne St Suite 105, Grand Rapids, MI, USA
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17
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Yi N, Yuan H, Xu N, Liu R, Wang Y, Zhuang C. Digital protractor as an intraoperative guide to cup anteversion in total hip arthroplasty. BMC Surg 2024; 24:27. [PMID: 38238716 PMCID: PMC10795370 DOI: 10.1186/s12893-023-02297-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 12/15/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION To explore if digital protractor could guide the anteversion of acetabular cup during primary THA and make it consistent with preoperative. METHODS We retrospectively reviewed 172 cases of primary THA with direct anterior approach (DAA) over 2 years. The anteversion of acetabular cup were measured from computed tomography (CT) scan preoperative and de-identified plain radiographs postoperative by two blinded investigators who were not involved in the surgery. The effect of the digital protractor on the anteversion was determined using regression analysis. RESULTS The mean anteversion for the THAs in digital protractor group was 15.5°and 21.4°in control group (P < 0.01). The mean anteversion bias for the THAs in digital protractor group was 1.59° and 6.63° in control group (P < 0.01).Regression analysis identified a 10.7% difference in anteversion due to the use of digital protractor (P < 0.01), and THAs performed without digital protractor were six times more likely to result in anteversion of > 25°. The correlation coefficient for the interobserver reliability of the measurement of the two investigators was 0.94. CONCLUSION The digital protractor is a practical tool in the DAA for THA to determine the anteversion of the acetabular prosthesis.
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Affiliation(s)
- Ning Yi
- Graduate School of Dalian Medical University, Dalian, China
| | - Hang Yuan
- Bengbu Medical College, Bengbu, China
| | - Nanwei Xu
- Department of Orthopedics, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Ruiping Liu
- Department of Orthopedics, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yuji Wang
- Department of Orthopedics, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Chao Zhuang
- Department of Orthopedics, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China.
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Hamawaki M, Hamada H, Uemura K, Takashima K, Mae H, Nakamura N, Sugano N. Rigid fixation of pelvic tracker essential for accurate cup placement in CT-based navigation total hip arthroplasty. J Artif Organs 2024:10.1007/s10047-023-01426-8. [PMID: 38195733 DOI: 10.1007/s10047-023-01426-8] [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: 09/25/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024]
Abstract
Research is lacking on the effect of intraoperative pelvic tracker displacement relative to the pelvis on cup orientation accuracy in computed tomography (CT)-based navigation (CTN) or multivariable analysis to detect factors associated with CTN accuracy. Here, we asked: (1) how pelvic tracker displacement influences the CTN accuracy of cup orientation in total hip arthroplasty (THA)? and (2) what factors are associated with CTN accuracy on multivariable analysis? Regarding cup orientation in 446 THA procedures using CTN, we evaluated clinical error defined as the difference between postoperative measurement and preoperative planning and measurement error defined as the difference between postoperative and intraoperative measurements. Multivariable regression analyses detected the associated factors. Subjects with an intraoperative tracker displacement of < 2 mm were classified in the verified group. Mean absolute clinical and measurement errors were < 1.5° in the verified group, whereas the measurement error of 2.6° for cup inclination and 1.3° for anteversion was larger in the non-verified versus verified group. Tracker displacement and screw fixation were associated with larger clinical errors, while tracker displacement and surgeon inexperience were associated with larger measurement errors. Clinical and measurement accuracies were high for CTN cup placement with rigid pelvic tracker fixation.
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Affiliation(s)
- Makoto Hamawaki
- Center of Arthroplasty, Kyowakai Hospital, 1-24-1 Kishibe-Kita, Suita City, Osaka, 564-0001, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Kazuma Takashima
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Hirokazu Mae
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Nobuo Nakamura
- Center of Arthroplasty, Kyowakai Hospital, 1-24-1 Kishibe-Kita, Suita City, Osaka, 564-0001, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
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Ong CB, Buchan GBJ, Hecht Ii CJ, Kendoff DO, Homma Y, Kamath AF. Fluoroscopy-based robotic assistance for total hip arthroplasty improves acetabular cup placement accuracy for obese patients compared to the manual, fluoroscopic- assisted technique. Technol Health Care 2024; 32:3703-3712. [PMID: 37980587 DOI: 10.3233/thc-231127] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND Patient obesity is a risk factor for poor acetabular cup positioning in total hip arthroplasty (THA). OBJECTIVE To assess the impact of using a novel, fluoroscopy-based robotic THA system on acetabular cup placement in obese versus non-obese patients. METHODS A review of 105 consecutive manual unassisted (mTHA) (47 Obese/58 Non-obese) and 102 robotic-assisted (RA-THA) (50 Obese/52 Non-obese) primary, direct anterior approach THA procedures was conducted. All cases were performed by a single surgeon, for a pre-operative diagnosis of osteoarthritis, avascular necrosis, or rheumatoid arthritis. Obesity was defined as a Body Mass Index (BMI) ⩾ 30 kg/m2. Outcomes included acetabular cup inclination and anteversion, and the proportion of cups within the Lewinnek safe-zone. RESULTS Obese patients in the mTHA cohort had larger cup inclination angles on average compared to non-obese patients (44.82∘± 6.51 vs. 41.39∘± 6.75; p= 0.009). Obese mTHA patients were less likely to have cup placement within the Lewinnek zone compared to non-obese mTHA patients (0.48 vs. 0.67; p= 0.027). Obesity had no effect on the accuracy of RA-THA. CONCLUSION Obesity affects the placement of the acetabular component in manual THA. The novel, fluoroscopy-based robotic THA system in this study demonstrated accurate cup placement regardless of obesity status.
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Affiliation(s)
- Christian B Ong
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Graham B J Buchan
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Christian J Hecht Ii
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel O Kendoff
- Chefarzt Zentrum für Orthopädie und Unfallchirurgie, HELIOS Kliniken Berlin-Buch, Berlin, Germany
| | - Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organs, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Ong CB, Buchan GBJ, Hecht Ii CJ, Homma Y, Harmon DJ, Kendoff DO, Petterwood J, Kamath AF. Fluoroscopy-based robotics in total hip arthroplasty mitigates laterality-based differences in acetabular cup placement when compared to the manual, fluoroscopic- assisted technique. Technol Health Care 2024; 32:3693-3701. [PMID: 37980586 DOI: 10.3233/thc-231126] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND Robotic assistance in total hip arthroplasty (RA-THA) has been shown to minimize laterality-based differences in acetabular cup positioning. OBJECTIVE To determine if the use of a novel, fluoroscopy-based RA-THA system mitigates differences in acetabular cup placement between left (L) and right (R) side hip procedures, when compared to manual, fluoroscopic-assisted technique. METHODS We conducted a retrospective review of 106 consecutive mTHA (40 L/66 R) and 102 RA-THA (48 L/54 R) primary direct anterior approach procedures. All cases were performed by a single right-hand-dominant surgeon, for a pre-operative diagnosis of osteoarthritis, avascular necrosis, or rheumatoid arthritis. Outcomes included acetabular cup inclination and anteversion, and the proportion of cups within the Lewinnek safe-zone. RESULTS The average inclination of mTHA L cases was smaller than that of mTHA R cases (41.10∘± 7.38 vs. 43.97∘± 6.27; p= 0.04). For RA-THA, L and R cup angles were similar. There were fewer overall mTHA hips within the Lewinnek safe-zone compared to RA-THA (0.59 vs. 0.78; p= 0.003), as well as fewer mTHA R cases than RA-THA R cases (0.59 vs. 0.80; p= 0.03) within safe zone. CONCLUSION Use of a novel, fluoroscopy-based robotic system mitigates laterality-based differences in acetabular cup placement that were observed in a manual, fluoroscopic-assisted cohort.
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Affiliation(s)
- Christian B Ong
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Graham B J Buchan
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Christian J Hecht Ii
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organs, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Daniel J Harmon
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel O Kendoff
- Chefarzt Zentrum für Orthopädie und Unfallchirurgie, HELIOS Kliniken Berlin-Buch, Berlin, Germany
| | - Joshua Petterwood
- Department of Orthopaedics, Royal Hobart Hospital, Hobart, TAS, Australia
- Department of Orthopaedics, Calvary Hospital, Hobart, TAS, Australia
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Lin C, Chen W, Weng P, Huang Y, Liaw C. Liaw's Ellipse Anteversion Method for Distinguishing Acetabular Component Retroversion from Anteversion on Plain Radiographs. Orthop Surg 2024; 16:276-281. [PMID: 37986662 PMCID: PMC10782236 DOI: 10.1111/os.13902] [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: 04/14/2023] [Revised: 08/19/2023] [Accepted: 08/27/2023] [Indexed: 11/22/2023] Open
Abstract
Improper acetabulum component position is a significant risk factor for postoperative dislocation after total hip arthroplasty. Several radiographic two-dimensional methods exist for measuring acetabulum component anteversion, but they cannot distinguish between anteversion and retroversion. "Liaw's version," initially proposed as a simple mathematical standardized two-dimensional method, was modified to the computerized ellipse method, proving superior accuracy to traditional two-dimensional methods. In this article, we demonstrated its application in detecting and measuring retroverted acetabulum component. We obtained anteroposterior pelvis radiographs from a patient undergoing total hip arthroplasty on the day of surgery and 2 weeks postoperatively. The computerized ellipse method was used to measure the acetabulum component orientation. Upon comparison, the difference between θ assigned to be retroverted (9.52-8.56 = 0.96) is much smaller than the difference between θ assigned to be anteverted (23.81-18.86 = 4.95), leading us to determine retroversion. This was further confirmed by computed tomography at the 6-week follow-up. We propose that using the computerized ellipse method to measure Liaw's version can be a valuable tool in identifying acetabulum component retroversion on anteroposterior radiographs during routine postoperative follow-up and retrospective assessments of total hip arthroplasty patients.
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Affiliation(s)
- Chun‐Hao Lin
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
| | - Wei‐Cheng Chen
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
| | - Pei‐Wei Weng
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
- Department of Orthopaedics, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
- International PhD Program in Biomedical Engineering, College of Biomedical EngineeringTaipei Medical UniversityTaipeiTaiwan
- Research Center of Biomedical DevicesTaipei Medical UniversityTaipeiTaiwan
| | - Yu‐min Huang
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
- Department of Orthopaedics, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Chen‐Kun Liaw
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
- Department of Orthopaedics, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
- Research Center of Biomedical DeviceCollege of Biomedical Engineering, Graduate Institute of Biomedical Optomechatronics, Taipei Medical UniversityTaipeiTaiwan
- TMU Biodesign CenterTaipei Medical UniversityTaipeiTaiwan
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22
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Mouri K, Madachi A, Karita T. Intraoperative Pelvic Tilt and Axial Rotation During Total Hip Arthroplasty Through the Direct Anterior Approach is Affected by the Acetabular Retractor and Cup Impactor. Arthroplast Today 2023; 24:101251. [PMID: 38023653 PMCID: PMC10665692 DOI: 10.1016/j.artd.2023.101251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 08/03/2023] [Accepted: 09/13/2023] [Indexed: 12/01/2023] Open
Abstract
Background Intraoperative pelvic motion during total hip arthroplasty (THA) in the supine position affects acetabular cup placement and occurs at each step of THA; however, there are no reports of pelvic motion changes during each stage of THA via the direct anterior approach (DAA). This study aimed to evaluate pelvic motion at each step of THA through the DAA. Methods From March to October 2022, 71 hips were prospectively measured for intraoperative pelvic tilt and axial rotation during THA through the DAA at a single center. These parameters were measured during each surgical step using the augmented reality-hip navigation system. Results Both pelvic tilt and axial rotation were maximal during acetabular cup placement. The mean intraoperative pelvic tilt and axial rotation during cup placement were 4.8 ± 2.6° (95% confidence interval, 4.19-5.41°) and 4.2 ± 3.3° (95% confidence interval, 3.42-4.98°), respectively. The effects of the acetabular retractor and cup impactor on pelvic tilt and axial rotation were comparable. Spearman's correlation tests showed significant correlation between axial rotation and body mass index (r = -0.444, P = .00011). Conclusions The pelvis tilts forward and rotates toward the surgical side during THA through the DAA. The effects of the acetabular retractor and cup impactor on pelvic motion are comparable. Cup implantation must take into account pelvic movement, and it must be recognized that the pelvis is moving at that time, even with only the acetabular retractor inserted, compared to before the skin incision.
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Affiliation(s)
- Kanto Mouri
- Orthopedics Department, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Atsushi Madachi
- Orthopedics Department, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Tatsuro Karita
- Orthopedics Department, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
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23
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Teh HL, Selvaratnam V, Low WJ, Kassim AF, Ganapathy SS, Chopra S. Outcomes of Impaction Bone Grafting in the Management of Acetabular Defects with the Use of Uncemented Acetabular Cups: Do Autografts and Irradiated Femoral Head Allografts Integrate? Indian J Orthop 2023; 57:1842-1849. [PMID: 37881276 PMCID: PMC10593662 DOI: 10.1007/s43465-023-00983-7] [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: 07/08/2023] [Accepted: 08/18/2023] [Indexed: 10/27/2023]
Abstract
Introduction Acetabular impaction bone grafting (AIBG) has been used widely to reconstruct acetabular defects in complex primary and revision cases. The aim of this study was to look at the outcomes AIBG using either frozen irradiated femoral head allografts or autografts with uncemented acetabular cups. Method We retrospectively reviewed 38 patients who had AIBG and uncemented cup reconstruction of the acetabulum performed between 2008 and 2021 for complex primary and revision surgery. Graft incorporation, radiological loosening and cup migration were evaluated in follow-up X-rays. Result There were 24 complex primary and 14 revision total hip arthroplasty. Autografts were used in 10 hips with smaller defects, while 28 hips with larger defects required frozen irradiated femoral head allografts. Using Paprosky classification to evaluate acetabular defects; 8 patients were classified as 2A, 12 as 2B, 7 as 2C, 8 as 3A and 3 as 3B. The Kaplan-Meier survival rate for AIBG with uncemented cups in our series is 89.70% in 10 years. Acetabular cup position was anatomically restored in all autograft AIBG cases and in 25 out of 28 in the allograft group. The mean pre-operative Oxford Hip Score (OHS) was 19 (range 10-24) and post-operative OHS was 39 (range 21-48) (p < 0.001). Conclusions The mid- to long-term results for AIBG and uncemented acetabular cups is good. With newer and more porous uncemented cups especially revision cups, it may serve as an extended indication to achieve solid fixation together with AIBG technique in managing acetabular defects of ≤ 3A.
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Affiliation(s)
- Hak Lian Teh
- Arthroplasty Unit, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Malaysia
| | - Veenesh Selvaratnam
- Arthroplasty Unit, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Malaysia
- Joint Reconstruction Unit, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Wei Jian Low
- Arthroplasty Unit, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Malaysia
- Joint Reconstruction Unit, National Orthopedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ahmad Fauzey Kassim
- Arthroplasty Unit, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Malaysia
| | - Shubash Shander Ganapathy
- Institute for Public Health, National Institute of Health, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Suresh Chopra
- Arthroplasty Unit, Sultanah Bahiyah Hospital, Ministry of Health Malaysia, Alor Setar, Malaysia
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Yon CJ, Lee KJ, Choi BC, Suh HS, Min BW. The Validation of Two-Dimensional and Three-Dimensional Radiographic Measurements of Host Bone Coverage in Total Hip Arthroplasty for Hip Dysplasia: A Comparison with Intra-Operative Measurements. J Clin Med 2023; 12:6227. [PMID: 37834870 PMCID: PMC10573884 DOI: 10.3390/jcm12196227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Several methods have been introduced to measure the host bone coverage of the acetabular component after total hip arthroplasty (THA). The aims of this study were (1) to validate two-dimensional- and three-dimensional-based host bone coverage measurements by comparing intra-operative measurements, and (2) to determine the minimum host bone coverage for achieving stable cup fixation after THA in hip dysplasia. The clinical outcomes of each patient were evaluated during their final follow-up period using the Harris Hip score (HHS). The coverage of the host bone was analyzed by comparing 2D-based, 3D-based, and intraoperative assessments. The mean HHS was increased significantly from 60.84 ± 14.21 pre-operatively to 93.13 ± 4.59 (p < 0.0001). The host bone coverage ratio measured intraoperatively was 83.67 ± 3.40%, while the ratio measured by 3D CT reconstruction was 82.72 ± 3.59%. There was a strong positive correlation between the intra-operative host bone coverage and the 3D-based one (r = 0.826, p < 0.0001). It is recommended that 3D-based measurements are used to evaluate the host bone coverage after THA in patients with hip dysplasia. In addition, achieving a minimum host bone coverage of 75% is recommended for the attainment of stable cup fixation.
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Affiliation(s)
| | | | | | | | - Byung-Woo Min
- Department of Orthopaedic Surgery, School of Medicine & Institute for Medical Science, Keimyung University, Daegu 42601, Republic of Korea; (C.-J.Y.); (K.-J.L.); (B.-C.C.); (H.-S.S.)
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25
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Cho Y, Shin J, Kim S. Acetabular, Femoral, and Combined Anteversion in a Province in South Korea: Computed Tomography-Based Study. Clin Orthop Surg 2023; 15:567-573. [PMID: 37529189 PMCID: PMC10375808 DOI: 10.4055/cios22350] [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: 11/01/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 08/03/2023] Open
Abstract
Background The purpose of this study was to investigate the femoral, acetabular, and combined anteversion of the hip joint in South Koreans using computed tomography (CT). Methods We measured anteversion using CT venograms taken from 2016 to 2020. Of the total 1,073 patients, 952 patients were included in the study except for those with pelvic fractures, previous femoral fractures, childhood hip joint disease, osteoarthritis, or hip dysplasia (lateral center-edge angle, < 20), foreigners, and hip and knee replacement patients. Measurements were taken twice by two orthopedic surgeons. Results The femoral anteversion in women was 10.64° ± 10.26° (≤ 49 years), 15.75° ± 9.40° (50-59 years), 10.81° ± 9.14° (60-69 years), 12.38° ± 8.55° (70-79 years), and 11.23° ± 8.44° (≥ 80 years). The femoral anteversion in men was 12.02° ± 11.38° (≤ 49 years), 10.62° ± 9.11° (50-59 years), 6.09° ± 9.95° (60-69 years), 6.57° ± 9.51° (70-79 years), and 5.53° ± 9.29° (≥ 80 years). The acetabular anteversion in women was 17.65° ± 6.58° (≤ 49 years), 19.24° ± 6.42° (50-59 years), 20.30° ± 6.25° (60-69 years), 22.38° ± 7.36° (70-79 years), and 23.34° ± 6.98° (≥ 80 years). The acetabular anteversion in men was 15.21° ± 8.14° (≤ 49 years), 17.68° ± 6.00° (50-59 years), 17.54° ± 5.93° (60-69 years), 18.68° ± 6.62° (70-79 years), and 18.19° ± 6.94° (≥ 80 years). The combined anteversion in women was 28.29° ± 14.30° (≤ 49 years), 34.99° ± 10.62° (50-59 years), 31.11° ± 11.52° (60-69 years), 34.76° ± 10.86° (70-79 years), and 34.57° ± 11.45° (≥ 80 years). The combined anteversion in men was 27.23° ± 15.11° (≤ 49 years), 28.30° ± 11.23° (50-59 years), 23.63° ± 11.77° (60-69 years), 25.25° ± 12.02° (70-79 years), and 23.72° ± 11.88° (≥ 80 years). Conclusions Femoral anteversion tended to decrease with age in men and acetabular anteversion tended to increase in both men and women. Combined anteversion showed a tendency to increase slightly in women.
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Affiliation(s)
- Youngho Cho
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Jaeuk Shin
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
| | - Sangwoo Kim
- Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea
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Patamarat A, Laoruengthana A, Kitcharanant N, Khantasit J, Thremthakanpon W. Direct Anatomic Registration in Computer-Assisted Total Hip Arthroplasty Improves Accuracy of Acetabular Cup Alignment. Arthroplast Today 2023; 21:101148. [PMID: 37274835 PMCID: PMC10238448 DOI: 10.1016/j.artd.2023.101148] [Citation(s) in RCA: 4] [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: 02/14/2023] [Revised: 04/13/2023] [Accepted: 04/23/2023] [Indexed: 06/07/2023] Open
Abstract
Background Computer-assisted total hip arthroplasty using direct anatomic registration (DAR) with acetabular center axis software is an alternative method to the indirect anterior pelvic plane method. The software maps the center of hip rotation and orientation of the native acetabulum in 3 dimensions. This study aimed to evaluate the accuracy of acetabular cup alignment using DAR navigation combined with a mechanical guide device (MGD). Methods This prospective nonrandomized controlled study included 106 patients who underwent primary cementless total hip arthroplasty through the posterolateral approach. Fifty-four patients in the study group underwent DAR combined with MGD, whereas 52 patients underwent MGD only for acetabular cup positioning. Plain radiographs of both hips and computerized tomographic scans were obtained 2 months postoperatively for the evaluation of acetabular cup inclination and anteversion, respectively. Results The acetabular cup alignment in the study group was within the Lewinnek safe zone more than that in the control group (81.5% vs 59.6%, P < .05). The study group had a mean inclination angle of 43.88°° (standard deviation [SD] 5.38) and anteversion angle of 12.82° (SD 5.99), whereas the control group had 41.10° (SD 6.79) and 12.82° (SD 9.53), respectively. There were no significant differences in estimated blood loss, length of stay, and Harris hip scores at preoperative and 3 and 6 months postoperatively, except for the operative time, which was longer in the study group (P < .01). There was 1 posterior hip dislocation in each group. Conclusions DAR navigation combined with MGD provides better accuracy for acetabular cup positioning within the Lewinnek safe zone compared with the conventional technique.
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Affiliation(s)
- Apisit Patamarat
- Department of Orthopaedic Surgery, Phra Nakhon Si Ayutthaya Hospital, Ayutthaya, Thailand
| | - Artit Laoruengthana
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Nitchanant Kitcharanant
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Sun D, Murphy WS, Amundson A, Lane P, Kowal J, Murphy SB. Validation of a Novel Method of Measuring Cup Orientation using BiPlanar Simultaneous Radiographic Images. J Arthroplasty 2023:S0883-5403(23)00357-1. [PMID: 37075906 DOI: 10.1016/j.arth.2023.04.011] [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: 12/07/2022] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Accurate acetabular component positioning is paramount to the success of total hip arthroplasty. Two-dimensional imaging alone remains a popular tool for implant position assessment despite known limitations. We investigated the accuracy of a novel method for assessing acetabular component position based upon orthogonal simultaneous biplanar Xray images. METHODS There were forty consecutive patients who had a pre-existing total hip arthroplasty (THA) on the contralateral side who underwent both computed tomography (CT) and simultaneous orthogonal biplanar radiographic scans for pre-operative planning of THA. The operative inclination (OI) and operative anteversion (OA) of the acetabular cup were calculated by a new measurement method using the biplanar simultaneous scans. Those measurements were compared to measurement of the cup orientation on CT. The measurements were made by two independent observers. Interobserver correlation coefficients were calculated between the two observers to measure reliability. RESULTS The mean error in OA measurement of the acetabular cup between simultaneous orthogonal biplanar radiographic and CT imaging was 0.5° (Standard Deviation (SD): 1.9°, minimum -4.0°, maximum 5.0°), the mean error in OI was 0.0° (SD: 1.7°, minimum -5.0°, maximum 4.0°). The average absolute error was 1.5° for OA, and 1.2° for OI. Interobserver correlation coefficient was 0.83 for OA and 0.93 for OI. CONCLUSION The novel method of measuring cup orientation using simultaneous biplanar radiographic scans utilized in this study was accurate and reproducible between observers compared to CT measurements.
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Affiliation(s)
- Dan Sun
- Tufts Medical Center, Boston, MA, USA
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28
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Ning D, Xu F, Zhang Z, Yang X, Wei J. Application of transverse acetabular ligament in total hip arthroplasty: a systematic review. BMC Musculoskelet Disord 2023; 24:284. [PMID: 37055756 PMCID: PMC10099633 DOI: 10.1186/s12891-023-06410-0] [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: 09/09/2022] [Accepted: 04/07/2023] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION In total hip arthroplasty (THA), the correct position of the acetabular component directly determines the outcome of the surgery, or the success of the surgery. Therefore, how to accurately locate the position of the acetabular component has become a very critical step in THA. As an important anatomical structure of the hip joint, the transverse acetabular ligament (TAL) is helpful for acetabular component orientation in THA. The aim of this systematic review was to investigate application of TAL in THA. MATERIALS AND METHODS A systematic literature search of PUBMED, EMBASE, and Cochrane Library was performed (January and February 2023) using keywords "total hip arthroplasty," "total hip replacement," "total hip replacements," "total hip arthroplasties," "total hip prosthesis," and "transverse acetabular ligament" in all possible combinations. Reference lists of included articles were reviewed. Study design, surgical approach, patient demographics, TAL identification rate, appearance of the TAL, anteversion and inclination angle and rate of dislocations were recorded. RESULTS In total, 19 studies met the screening criteria. Study designs were prospective cohorts (42%), retrospective cohorts (32%), Case series (21%), and randomized controlled trial (5%). Twelve of the 19 (63.2%) studies investigated the application of TAL as an anatomical landmark for locating acetabular component position in THA. Analysis revealed that TAL is a reliable anatomical landmark for acetabular component orientation within the safe zone in THA. CONCLUSIONS TAL can reliably be used to align the acetabular component in the safe zone for anteversion and inclination in THA. However, TAL has individual variation influenced by some risk factors. More randomized controlled studies with larger numbers of patients are needed to investigate the precision and accuracy of TAL as an intraoperative landmark in THA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Dongfang Ning
- Department of Bone and Joint Surgery, Liuzhou Municipal Liutie Central Hospital, Liuzhou, Guangxi, 545007, China.
| | - Feng Xu
- Department of Bone and Joint Surgery, Liuzhou Municipal Liutie Central Hospital, Liuzhou, Guangxi, 545007, China
| | - Zhongxing Zhang
- Department of Bone and Joint Surgery, Liuzhou Municipal Liutie Central Hospital, Liuzhou, Guangxi, 545007, China
| | - Xiaolong Yang
- Department of Bone and Joint Surgery, Liuzhou Municipal Liutie Central Hospital, Liuzhou, Guangxi, 545007, China
| | - Jun Wei
- Department of Bone and Joint Surgery, Liuzhou Municipal Liutie Central Hospital, Liuzhou, Guangxi, 545007, China
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Hamada H, Uemura K, Takashima K, Ando W, Takao M, Sugano N. What Changes in Pelvic Sagittal Tilt Occur 20 Years After THA? Clin Orthop Relat Res 2023; 481:690-699. [PMID: 36040725 PMCID: PMC10013667 DOI: 10.1097/corr.0000000000002382] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/04/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cup orientation in THA in the supine, standing, and sitting positions is affected by pelvic sagittal tilt (PT). Patterns of PT shift between these positions may increase the risk of dislocation and edge loading. The PT has also been reported to change during the aging process; however, there is limited research regarding long-term changes in PT and PT shifts after THA. QUESTIONS/PURPOSES (1) What changes occur in PT in the supine, standing, and sitting positions during 20 years of follow-up after THA in patients who have not had revision or dislocation? (2) What factors are associated with the differences between preoperative supine PT and postoperative sitting or standing PT (Δ sitting and Δ standing, respectively) 20 years postoperatively? METHODS Between January 1998 and December 1999, 101 consecutive patients underwent THA for appropriate indications. AP radiographs of the pelvis in the supine, standing, and sitting positions preoperatively and at 1, 10, and 20 years after THA were longitudinally performed to evaluate changes in PT. Fifty-nine percent (60 of 101) of patients were lost before 20 years of follow-up or had incomplete sets of imaging tests, leaving 41% (41 of 101) eligible for analysis here. There were no patients who had recurrent dislocation or underwent revision arthroplasty in the cohort; therefore, this analysis regarding postoperative changes in PT indicates the natural course of the change in PT during follow-up of THA. PT was measured based on the anterior pelvic plane. PT shifts with positional changes, Δ standing, and Δ sitting during the follow-up period were calculated. Posterior changes and shifts are represented by negative values. To analyze the factors associated with Δ standing and Δ sitting after 20 years, the correlations between these parameters and preoperative factors (including sex, age, pelvic incidence [PI], lumbar lordosis [LL], preoperative PT, and preoperative PT shift) and postoperative factors (including the occurrence of new lumbar vertebral fractures, lumbar spondylolisthesis, contralateral THA performed during follow-up, and PI-LL 20 years after THA) were determined. RESULTS Median (IQR) supine and standing PTs changed (moved posteriorly) by -5° (-11° to -2°; p < 0.01) and -10° (-15° to -7°; p < 0.01), respectively. Sitting PT did not change during the 20-year follow-up period. Median (IQR) PT shift from standing to sitting changed from -34° preoperatively (-40° to -28°) to -23° after 20 years (-28° to -20°). There were posterior changes in median (range) Δ standing (median -12° at 20 years [-19° to -7°]); Δ sitting did not change during the follow-up period (median -36° at 20 years [-40° to -29°]). Patients with a large preoperative posterior PT shift from supine to standing demonstrated larger posterior tilt of Δ standing at 20 years. Patients with lumbar vertebral fractures during follow-up demonstrated larger posterior tilt of Δ standing at 20 years. CONCLUSION Patients who demonstrate a large preoperative posterior shift from supine to standing deserve special consideration when undergoing THA. In such circumstances, we recommend that the anteversion of the cup not be excessive, given that there is a relatively high risk of further posterior tilt in PT, which may lead to anterior dislocation and edge loading. Further longitudinal study in a larger cohort of patients with complications including postoperative dislocation and revision, as well as older patients, is needed to verify these assumptions on the potential risk for dislocation and edge loading after THA. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Hidetoshi Hamada
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuma Takashima
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
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30
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Achieving Precise Cup Positioning in Direct Anterior Total Hip Arthroplasty: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020271. [PMID: 36837472 PMCID: PMC9959722 DOI: 10.3390/medicina59020271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 02/01/2023]
Abstract
Malpositioned implants in total hip arthroplasty are associated with impingement, increased wear, and dislocations, thus precise cup positioning is crucial. However, significant deviations between targeted and actually achieved cup positions have been found even in patients operated by experienced surgeons. When aiming for higher accuracy, various methods based on freehand positioning lead by anatomic landmarks, C-arm fluoroscopy, imageless navigation, or robotic-assisted-surgery have been described. There is a constant development of new products aiming to simplify and improve intraoperative guidance. Both the literature and expert opinions on this topic are often quite controversial. This article aims to give an overview of the different methods and systems with their specific advantages and potential pitfalls while also taking a look into the future of cup positioning in anterior hip replacements.
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Thorne TJ, Wright AR, Opanova MI, Mitsumori LM, Lawton DRY, Unebasami EM, Nakasone CK. Impact of intraoperative fluoroscopic beam positioning relative to the hip and pelvis on perceived acetabular component position. J Orthop 2023; 35:115-119. [PMID: 36467427 PMCID: PMC9712816 DOI: 10.1016/j.jor.2022.11.014] [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: 09/06/2022] [Revised: 11/07/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Parallax is poorly understood and can mislead surgeons using intraoperative fluoroscopy (IF) to guide cup placement during anterior approach (AA) total hip arthroplasty. The purpose of this study was to examine how changes in fluoroscopic beam positioning in relation to the hip and pelvis affects the projected acetabular image. Methods An acetabular component was positioned in an anatomic pelvis model in 45° and 20° of abduction and anteversion, respectively using a computer assisted cup targeting system. Fluoroscopic images were taken at various caudal and cranially directed angles with the fluoroscopic beam centered over the hip then pelvis. In each position, four independent observers measured the abduction and anteversion angles of the projected cup image using the same computer targeting system. Results Cup abduction and anteversion measured 43.5° and 19.5° when IF was centered over the hip and 40.5 and 27.5° when centered over the pelvis in the neutral position. Increasing the caudal direction of the beam 20° increased the projected abduction/anteversion angles by approximately 7°/12° and 9°/16° when centered over the hip and pelvis respectively. Increasing the cranial direction of the beam 20° decreased the measured abduction/anteversion angles by roughly 4°/20° and 4°/24° when centered over the hip and pelvis, respectively. Conclusion The projected image of the acetabular component can change dramatically depending on fluoroscopic beam position relative to the hip and pelvis. Recognizing the approximate direction and magnitude of change with differing fluoroscopy positions may help surgeons avoid cup malpositioning.
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Affiliation(s)
- Tyler J. Thorne
- The University of Hawai'i, John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Anne R. Wright
- The University of Hawai'i, John A. Burns School of Medicine, Department of Surgery, 1356 Lusitana Street, Honolulu, HI, 96813, USA
| | - Mariya I. Opanova
- The University of Hawai'i, John A. Burns School of Medicine, Department of Surgery, 1356 Lusitana Street, Honolulu, HI, 96813, USA
| | - Lee M. Mitsumori
- Straub Medical Center, Bone & Joint Center, 888 South King Street, Honolulu, HI, 96818, USA
| | - Dylan RY. Lawton
- Straub Medical Center, Bone & Joint Center, 888 South King Street, Honolulu, HI, 96818, USA
| | - Emily M. Unebasami
- Straub Medical Center, Bone & Joint Center, 888 South King Street, Honolulu, HI, 96818, USA
| | - Cass K. Nakasone
- The University of Hawai'i, John A. Burns School of Medicine, Department of Surgery, 1356 Lusitana Street, Honolulu, HI, 96813, USA
- Straub Medical Center, Bone & Joint Center, 888 South King Street, Honolulu, HI, 96818, USA
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Jamari J, Ammarullah MI, Santoso G, Sugiharto S, Supriyono T, Permana MS, Winarni TI, van der Heide E. Adopted walking condition for computational simulation approach on bearing of hip joint prosthesis: review over the past 30 years. Heliyon 2022; 8:e12050. [PMID: 36506403 PMCID: PMC9730145 DOI: 10.1016/j.heliyon.2022.e12050] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/23/2022] [Accepted: 11/24/2022] [Indexed: 12/11/2022] Open
Abstract
Bearing on artificial hip joint experiences friction, wear, and surface damage that impact on overall performance and leading to failure at a particular time due to continuous contact that endangers the user. Assessing bearing hip joint using clinical study, experimental testing, and mathematical formula approach is challenging because there are some obstacles from each approach. Computational simulation is an effective alternative approach that is affordable, relatively fast, and more accessible than other approaches in examining various complex conditions requiring extensive resources and several different parameters. In particular, different gait cycles affect the sliding distance and distribution of gait loading acting on the joints. Appropriate selection and addition of gait cycles in computation modelling are crucial for accurate and reliable prediction and analysis of bearing performance such as wear a failure of implants. However, a wide spread of gait cycles and loading data are being considered and studied by researchers as reported in literature. The current article describes a comprehensive literature review adopted walking condition that has been carried out to study bearing using computational simulation approach over the past 30 years. Many knowledge gaps related to adoption procedures, simplification, and future research have been identified to obtain bearing analysis results with more realistic computational simulation approach according to physiological human hip joints.
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Affiliation(s)
- J. Jamari
- Department of Mechanical Engineering, Faculty of Engineering, Diponegoro University, Semarang 50275, Central Java, Indonesia
- Undip Biomechanics Engineering & Research Centre (UBM-ERC), Diponegoro University, Semarang 50275, Central Java, Indonesia
| | - Muhammad Imam Ammarullah
- Undip Biomechanics Engineering & Research Centre (UBM-ERC), Diponegoro University, Semarang 50275, Central Java, Indonesia
- Department of Mechanical Engineering, Faculty of Engineering, Pasundan University, Bandung 40153, West Java, Indonesia
- Biomechanics and Biomedics Engineering Research Centre, Pasundan University, Bandung 40153, West Java, Indonesia
| | - Gatot Santoso
- Department of Mechanical Engineering, Faculty of Engineering, Pasundan University, Bandung 40153, West Java, Indonesia
- Biomechanics and Biomedics Engineering Research Centre, Pasundan University, Bandung 40153, West Java, Indonesia
| | - S. Sugiharto
- Department of Mechanical Engineering, Faculty of Engineering, Pasundan University, Bandung 40153, West Java, Indonesia
- Biomechanics and Biomedics Engineering Research Centre, Pasundan University, Bandung 40153, West Java, Indonesia
| | - Toto Supriyono
- Department of Mechanical Engineering, Faculty of Engineering, Pasundan University, Bandung 40153, West Java, Indonesia
- Biomechanics and Biomedics Engineering Research Centre, Pasundan University, Bandung 40153, West Java, Indonesia
| | - Muki Satya Permana
- Department of Mechanical Engineering, Faculty of Engineering, Pasundan University, Bandung 40153, West Java, Indonesia
- Biomechanics and Biomedics Engineering Research Centre, Pasundan University, Bandung 40153, West Java, Indonesia
| | - Tri Indah Winarni
- Undip Biomechanics Engineering & Research Centre (UBM-ERC), Diponegoro University, Semarang 50275, Central Java, Indonesia
- Department of Anatomy, Faculty of Medicine, Diponegoro University, Semarang 50275, Central Java, Indonesia
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Diponegoro University, Semarang 50275, Central Java, Indonesia
| | - Emile van der Heide
- Department of Mechanics of Solids, Surfaces & Systems (MS3), Faculty of Engineering Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, the Netherlands
- Laboratory for Surface Technology and Tribology, Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
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A laser guide technique: a novel method for accurate acetabular cup alignment in total hip arthroplasty. Sci Rep 2022; 12:18247. [PMID: 36309552 PMCID: PMC9617895 DOI: 10.1038/s41598-022-21975-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 10/07/2022] [Indexed: 12/31/2022] Open
Abstract
For accurate cup alignment without navigation in total hip arthroplasty (THA), we developed a "laser guide technique." The major purposes of this paper are to introduce the technique and compare its accuracy with a conventional manual technique. As a clinical outcome, the dislocation rate was reviewed. Our laser guide technique, which includes preoperative postural adjustment and intraoperative angular reference, has been detailed in the manuscript. 599 hips in 523 patients who underwent primary THA with piriformis-sparing posterolateral approach in April 2010-March 2016 were reviewed. Patients were divided into three groups: conventional group (135 hips), laser guide group (80 hips), and laser + radiographic alignment guide group (384 hips). Radiographic inclination (RI) and radiographic anteversion (RA) errors were evaluated. The dislocation rate was reviewed in 540 hips in 476 patients who were followed up > 2 years postoperatively. Absolute values of the RI/RA error in the three groups were 5.3° ± 4.0°/6.5° ± 4.5°, 4.0° ± 2.8°/4.9° ± 4.4°, and 3.3° ± 2.6°/3.6° ± 2.8°, respectively, indicating substantially enhanced accuracy with laser and radiographic alignment guide. The dislocation rates were 2.5% (3/119) and 0.2% (1/421) in the conventional and laser groups, respectively. Our novel laser guide technique considerably enhanced cup alignment accuracy, suggesting its potential applicability for THA in the lateral decubitus position.
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A Review of Biomaterials and Associated Performance Metrics Analysis in Pre-Clinical Finite Element Model and in Implementation Stages for Total Hip Implant System. Polymers (Basel) 2022; 14:polym14204308. [PMID: 36297885 PMCID: PMC9607025 DOI: 10.3390/polym14204308] [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: 08/31/2022] [Revised: 10/01/2022] [Accepted: 10/06/2022] [Indexed: 11/30/2022] Open
Abstract
Total hip replacement (THR) is a common orthopedic surgery technique that helps thousands of individuals to live normal lives each year. A hip replacement replaces the shattered cartilage and bone with an implant. Most hip implants fail after 10–15 years. The material selection for the total hip implant systems is a major research field since it affects the mechanical and clinical performance of it. Stress shielding due to excessive contact stress, implant dislocation due to a large deformation, aseptic implant loosening due to the particle propagation of wear debris, decreased bone remodeling density due to the stress shielding, and adverse tissue responses due to material wear debris all contribute to the failure of hip implants. Recent research shows that pre-clinical computational finite element analysis (FEA) can be used to estimate four mechanical performance parameters of hip implants which are connected with distinct biomaterials: von Mises stress and deformation, micromotion, wear estimates, and implant fatigue. In vitro, in vivo, and clinical stages are utilized to determine the hip implant biocompatibility and the unfavorable local tissue reactions to different biomaterials during the implementation phase. This research summarizes and analyses the performance of the different biomaterials that are employed in total hip implant systems in the pre-clinical stage using FEA, as well as their performances in in vitro, in vivo, and in clinical studies, which will help researchers in gaining a better understanding of the prospects and challenges in this field.
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Thomas C, Gupta V, Parsons H, Metcalfe A, Foguet P, King R. Does functional planning, 3D templating and patient-specific instrumentation improve accuracy in total hip replacement?- a randomized controlled trial. ARTHROPLASTY (LONDON, ENGLAND) 2022; 4:43. [PMID: 36183111 PMCID: PMC9526907 DOI: 10.1186/s42836-022-00143-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/01/2022] [Indexed: 11/05/2022]
Abstract
AIMS Debate continues as to the optimal orientation of the acetabular component in total hip arthroplasty (THA) and how to reliably achieve this. The primary objective of this study was to compare functional CT-based planning and patient-specific instruments with conventional THA using 2D templating. METHODS A pragmatic single-center, patient-assessor blinded, randomized control trial of patients undergoing THA was performed. 54 patients (aged 18-70) were recruited to either Corin Optimized Positioning System (OPS) or conventional THA. All patients received a cementless acetabular component. All patients underwent pre- and postoperative CT scans, and four functional X-rays. Patients in the OPS group had a 3D surgical plan and bespoke guides made. Patients in the conventional group had a surgical plan based on 2D templating X-rays. The primary outcome measure was the mean error in acetabular anteversion as determined by postoperative CT scan. RESULTS There was no statistically significant difference in the mean error in angle of acetabular anteversion when comparing OPS and conventional THA. In the OPS group, the achieved acetabular anteversion was within 10° of the planned anteversion in 96% of cases, compared with only 76% in the conventional group. The clinical outcomes were comparable between the groups. CONCLUSION Large errors in acetabular orientation appear to be reduced when CT-based planning and patient-specific instruments are used compared to the standard technique but no significant differences were seen in the mean error.
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Affiliation(s)
- Christopher Thomas
- grid.15628.380000 0004 0393 1193University Hospitals Coventry & Warwickshire NHS Trust, Coventry, England ,grid.414081.80000 0004 0400 1166Present address: Dorset County Hospital, Williams Avenue, Dorchester, DT1 2JY UK
| | - Vatsal Gupta
- grid.15628.380000 0004 0393 1193University Hospitals Coventry & Warwickshire NHS Trust, Coventry, England
| | - Helen Parsons
- grid.7372.10000 0000 8809 1613University of Warwick, Coventry, England
| | - Andrew Metcalfe
- grid.15628.380000 0004 0393 1193University Hospitals Coventry & Warwickshire NHS Trust, Coventry, England ,grid.7372.10000 0000 8809 1613University of Warwick, Coventry, England
| | - Pedro Foguet
- grid.15628.380000 0004 0393 1193University Hospitals Coventry & Warwickshire NHS Trust, Coventry, England
| | - Richard King
- grid.15628.380000 0004 0393 1193University Hospitals Coventry & Warwickshire NHS Trust, Coventry, England
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Stewart NJ, Stewart JL, Brisbin A. A Comparison of Component Positioning Between Fluoroscopy-Assisted and Robotic-Assisted Total Hip Arthroplasty. J Arthroplasty 2022; 37:1602-1605.e3. [PMID: 35314287 DOI: 10.1016/j.arth.2022.03.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This single-surgeon retrospective study examined a consecutive series of direct anterior approach total hip arthroplasties (THAs). Differences for the accuracy of acetabular component placement, leg length discrepancy, femoral offset, and absolute global offset difference were measured for patients who underwent hip replacement surgery with either fluoroscopic or robotic guidance. METHODS One hundred THAs were included in both the fluoroscopically guided and robotically guided groups in the study. The program TraumaCad was used to analyze the preoperative and 6-week postoperative standing anteroposterior pelvic radiographs used in this study to evaluate the accuracy of component positioning. RESULTS Robotic-guided surgery demonstrated a small improvement in acetabular inclination error, 3.8° average robotic error vs 4.63° average fluoroscopic error (P < .01). There was no statistically significant difference in accuracy for acetabular anteversion, leg length discrepancy, femoral offset, or global offset difference between the 2 groups. There was also no significant difference in the placement of acetabular components into the Lewinnek safe zone or Callanan safe zone. Both fluoroscopically guided and robotically guided THA patients had similar patterns of error, with excessive anteversion and inclination being more common than inadequate anteversion or inclination. CONCLUSION The findings from our study question the use of haptic robotic guidance during direct anterior approach THA when compared to fluoroscopic guidance.
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Affiliation(s)
| | - James L Stewart
- Chippewa Valley Orthopedics and Sports Medicine, Altoona, Wisconsin
| | - Abra Brisbin
- Department of Mathematics, University of Wisconsin Eau Claire, Eau Claire, Wisconsin
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Moreta J, Gayoso Ó, Donaire-Hoyas D, Roces-García J, Gómez-Vallejo J, Moya-Gómez E, Raya-Roldán D, Albert-Ullibarri A, Marqués-López F, Albareda J. Orthopedic Surgeons' Accuracy When Orienting an Acetabular Cup. A Comparison with Untrained Individuals. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:973. [PMID: 35888692 PMCID: PMC9317603 DOI: 10.3390/medicina58070973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 06/29/2022] [Accepted: 07/18/2022] [Indexed: 12/04/2022]
Abstract
Background and Objectives: Previous studies demonstrated a huge variability among surgeons when it comes to reproducing the position of an acetabular cup in total hip arthroplasty. Our main objective is to determine if orthopedic surgeons can replicate a given orientation on a pelvic model better than untrained individuals. Our secondary objective is to determine if experience has any influence on their ability for this task. Materials and Methods: A group of specialist orthopedic hip surgeons and a group of volunteers with no medical training were asked to reproduce three given (randomly generated) acetabular cup orientations (inclination and anteversion) on a pelvic model. Error was measured by means of a hip navigation system and comparisons between groups were made using the appropriate statistical methods. Results: The study included 107 individuals, 36 orthopedic surgeons and 71 untrained volunteers. The mean error among surgeons was slightly greater as regards both inclination (7.84 ± 5.53 vs. 6.70 ± 4.03) and anteversion (5.85 ± 4.52 vs. 5.48 ± 3.44), although statistical significance was not reached (p = 0.226 and p = 0.639, respectively). Similarly, although surgeons with more than 100 procedures a year obtained better results than those with less surgical experience (8.01 vs. 7.67 degrees of error in inclination and 5.83 vs. 5.87 in anteversion), this difference was not statistically significant, either (p = 0.852 and p = 0.981). Conclusions: No differences were found in the average error made by orthopedic surgeons and untrained individuals. Furthermore, the surgeons' cup orientation accuracy was not seen to improve significantly with experience.
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Affiliation(s)
- Jesús Moreta
- Department of Orthopedic Surgery and Traumatology, Hospital Galdakao-Usansolo, 48960 Galdakao, Spain
| | - Óscar Gayoso
- Department of Orthopedic Surgery and Traumatology, Hospital San Rafael, 15006 A Coruña, Spain;
| | - Daniel Donaire-Hoyas
- Department of Orthopedic Surgery and Traumatology, Hospital de Poniente, 04700 El Ejido, Spain; (D.D.-H.); (D.R.-R.); (A.A.-U.)
| | - Jorge Roces-García
- Department of Construction and Manufacturing Engineering, Polytechnic School of Engineering of Gijón, University of Oviedo, 33204 Gijón, Spain;
| | - Jesús Gómez-Vallejo
- Department of Orthopedic Surgery and Traumatology, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain; (J.G.-V.); (J.A.)
| | - Esther Moya-Gómez
- Department of Orthopedic Surgery and Traumatology, Hospital de la Santa Cruz y San Pablo, 08025 Barcelona, Spain;
| | - David Raya-Roldán
- Department of Orthopedic Surgery and Traumatology, Hospital de Poniente, 04700 El Ejido, Spain; (D.D.-H.); (D.R.-R.); (A.A.-U.)
| | - Alberto Albert-Ullibarri
- Department of Orthopedic Surgery and Traumatology, Hospital de Poniente, 04700 El Ejido, Spain; (D.D.-H.); (D.R.-R.); (A.A.-U.)
| | - Fernando Marqués-López
- Department of Orthopedic Surgery and Traumatology, Parc de Salut Mar, 08003 Barcelona, Spain;
| | - Jorge Albareda
- Department of Orthopedic Surgery and Traumatology, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain; (J.G.-V.); (J.A.)
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Tanaka S, Ito H. Wear of a Highly Cross-Linked Polyethylene Liner of the Acetabular Component Placed With Excessive Acetabular Inclination. Orthopedics 2022; 45:e96-e100. [PMID: 35021024 DOI: 10.3928/01477447-20220105-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Few studies have investigated the influence of excessive acetabular inclination during total hip arthroplasty (THA) on the wear of highly cross-linked polyethylene (HXLPE). The goal of this study was to determine whether excessive acetabular inclination during THA causes prominent wear of the HXLPE liner. We retrospectively evaluated 62 hips of 54 women and 8 men who underwent primary THA with an HXLPE liner between January 2006 and September 2011. Postoperative anteroposterior pelvic radiographs were used to measure acetabular inclination and analyze polyethylene wear. Patients were divided into the following groups: the excessive acetabular inclination group (acetabular inclination angle ≥50°; n=20) and the control group (acetabular inclination angle <50°; n=42). Clinical information and imaging findings were compared and examined between the 2 groups. Further, we evaluated the correlation between the acetabular inclination angle and the polyethylene wear rate. In all cases, mean follow-up duration was 6.3 years. The annual liner wear was 0.00446 and 0.0254 mm/y in the control and excessive acetabular inclination groups, respectively. The excessive acetabular inclination group had significantly higher polyethylene liner wear compared with the control group (P=.00991). A weak correlation was seen between acetabular inclination angle and polyethylene wear rate in all cases (Spearman's rank correlation, r=0.283, P=.0258). Excessive acetabular inclination may increase HXLPE liner wear in the long term. [Orthopedics. 2022;45(2):e96-e100.].
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Grammatopoulos G, Falsetto A, Sanders E, Weishorn J, Gill HS, Beaulé PE, Innmann MM, Merle C. Integrating the Combined Sagittal Index Reduces the Risk of Dislocation Following Total Hip Replacement. J Bone Joint Surg Am 2022; 104:397-411. [PMID: 34767540 DOI: 10.2106/jbjs.21.00432] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aims of this matched cohort study were to (1) assess differences in spinopelvic characteristics between patients who sustained a dislocation after total hip arthroplasty (THA) and a control group without a dislocation, (2) identify spinopelvic characteristics associated with the risk of dislocation, and (3) propose an algorithm including individual spinopelvic characteristics to define an optimized cup orientation target to minimize dislocation risk. METHODS Fifty patients with a history of THA dislocation (29 posterior and 21 anterior dislocations) were matched for age, sex, body mass index (BMI), index diagnosis, surgical approach, and femoral head size with 200 controls. All patients underwent detailed quasi-static radiographic evaluations of the coronal (offset, center of rotation, and cup inclination/anteversion) and sagittal (pelvic tilt [PT], sacral slope [SS], pelvic incidence [PI], lumbar lordosis [LL], pelvic-femoral angle [PFA], and cup anteinclination [AI]) reconstructions. The spinopelvic balance (PI - LL), combined sagittal index (CSI = PFA + cup AI), and Hip-User Index were determined. Parameters were compared between the control and dislocation groups (2-group analysis) and between the controls and 2 dislocation groups identified according to the direction of the dislocation (3-group analysis). Important thresholds were determined from receiver operating characteristic (ROC) curve analyses and the mean values of the control group; thresholds were expanded incrementally in conjunction with running-hypothesis tests. RESULTS There were no coronal differences, other than cup anteversion, between groups. However, most sagittal parameters (LL, PT, CSI, PI - LL, and Hip-User Index) differed significantly. The 3 strongest predictors of instability were PI - LL >10° (sensitivity of 70% and specificity of 65% for instability regardless of direction), CSIstanding of <216° (posterior instability), and CSIstanding of >244° (anterior instability). A CSI that was not between 205° and 245° on the standing radiograph (CSIstanding) was associated with a significantly increased dislocation risk (odds ratio [OR]: 4.2; 95% confidence interval [CI]: 2.2 to 8.2; p < 0.001). In patients with an unbalanced and/or rigid lumbar spine, a CSIstanding that was not 215° to 235° was associated with a significantly increased dislocation risk (OR: 5.1; 95% CI: 1.8 to 14.9; p = 0.001). CONCLUSIONS Spinopelvic imbalance (PI - LL >10°) determined from a preoperative standing lateral spinopelvic radiograph can be a useful screening tool, alerting surgeons that a patient is at increased dislocation risk. Measurement of the PFA preoperatively provides valuable information to determine the optimum cup orientation to aim for a CSIstanding of 205° to 245°, which is associated with a reduced dislocation risk. For patients at increased dislocation risk due to spinopelvic imbalance (PI - LL >10°), the range for the optimum CSI is narrower. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Amedeo Falsetto
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ethan Sanders
- Department of Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Johannes Weishorn
- Department of Orthopaedics and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Harinderjit S Gill
- Department of Mechanical Engineering, University of Bath, Bath, United Kingdom
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Moritz M Innmann
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Orthopaedics and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
| | - Christian Merle
- Department of Orthopaedics and Trauma Surgery, University of Heidelberg, Heidelberg, Germany
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Nishihara S, Hayashida K. Comparison between freehand technique and computed tomography-based navigation in acetabular cup placement through direct anterior approach for total hip arthroplasty. Arch Orthop Trauma Surg 2022; 142:323-329. [PMID: 33929597 DOI: 10.1007/s00402-021-03920-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 04/19/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION In total hip arthroplasty (THA), improper cup orientation can result in dislocation, early excessive polyethylene wear, and pain following THA. The supine position during THA provides a more reproducible functional pelvic position than the lateral decubitus position and may allow freehand cup placement as reliable as that obtained by computer navigation. The purpose of this study was to investigate the accuracy of freehand cup placement through a supine direct anterior approach (DAA) compared with computed tomography (CT)-based navigation. MATERIALS AND METHODS The same surgeon performed primary cementless THA through the DAA in 144 supine patients. Seventy-two patients underwent freehand cup placement with standard mechanical guidance-oriented radiographic target cup positioning, and 72 underwent placement with CT-based navigation guidance. Using three-dimensional templating software, the study group calculated cup inclination and anteversion on postoperative CT scans. RESULTS The navigation method resulted in a significantly smaller deviation of inclination from the target (p < 0.05); the difference in anteversion was not significant. In addition, the navigation method resulted in significantly fewer cups placed ± 10° outside the target position (0% for inclination, 0% for anteversion) than did the freehand procedure (26% for inclination, 25% for anteversion) (p < 0.0001). CONCLUSIONS Freehand cup placement is less reliable even in the supine position. Use of a CT-based navigation system can significantly improve cup positioning in THA through the DAA by reducing the incidence of outliers.
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Affiliation(s)
- Shunsaku Nishihara
- Department of Orthopaedic Surgery, Daini Osaka Police Hospital, 2-6-40 Karasugatsuji, Tennouji-ku, Osaka, 543-8922, Japan.
| | - Kenji Hayashida
- Department of Orthopaedic Surgery, Daini Osaka Police Hospital, 2-6-40 Karasugatsuji, Tennouji-ku, Osaka, 543-8922, Japan
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Di Maro A, Creaco S, Albini M, Latiff M, Merlo M. Radiographic results on acetabular cup placement with the SuperPath technique: a retrospective study of 756 cases. BMC Musculoskelet Disord 2022; 23:101. [PMID: 35101011 PMCID: PMC8802501 DOI: 10.1186/s12891-022-05065-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Supercapsular percutaneously assisted total hip (SuperPath) technique is a relatively new minimally invasive approach for total hip arthroplasty (THA). Good clinical outcomes related to its use are reported in the literature. Nonetheless, there are still uncertainties about its validity in terms of radiographic outcomes. Main purpose of the study is to evaluate the effectiveness of the SuperPath in acetabular cup positioning through radiographic evaluation of acetabular inclination angle (IA) and acetabular anteversion (AA) angle within the safe zone described by Lewinnek. The leg length discrepancy (LLD), femoral offset (FO), and acetabular offset (AO) were also measured to ascertain the radiographic effectiveness of SuperPath in the acetabular cup placement. Methods Between January 2016 and December 2019, all SuperPath cases eligible for the study were included. They were operated by three orthopaedic surgeons with long-standing experience in THA via conventional posterolateral approach and who have performed SuperPath training fellowship. The Mann-Whitney U test was used for statistical assessments (p-value < 0.05). Means ± standard deviation (SD) of the radiographic IA and AA were calculated for each year. Results A retrospective analysis of 756 THAs was performed. The average percentage of IA within the Lewinnek’s safe zone was from 80 to 85%, while the average percentage of AA was from 76 to 79%. Both IA and AA showed no statistically significant difference between two consecutive years. Good results, in the ranges of normal values, were also obtained for LLD, FO and AO, with homogeneous outcomes between 1 year and the following one. Conclusion It is possible to achieve good radiographic values of acetabular cup orientation through the SuperPath within the Lewinnek’s safe zone. These results are similar to those reported in the literature by authors using SuperPath. Low rate (0,3%) of hip dislocations were reported. Therefore, the SuperPath technique represents a good alternative THA approach. Nevertheless, there is not a statistically significant improvement in these radiographic parameters over a four-year time. Level of evidence Level IV, retrospective study.
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Affiliation(s)
- Agostino Di Maro
- Department of Orthopaedics and Trauma Surgery of Ospedale di Circolo Busto Arsizio, ASST Valle Olona, Via Arnaldo da Brescia,1, Varese, Italy.
| | - Santo Creaco
- Department of Orthopaedics and Trauma Surgery of Ospedale di Circolo Busto Arsizio, ASST Valle Olona, Via Arnaldo da Brescia,1, Varese, Italy
| | - Mattia Albini
- Department of Orthopaedics and Trauma Surgery of Ospedale di Circolo Fondazione Macchi Varese, ASST Sette Laghi, Viale Borri 57, Varese, Italy
| | - Mahfuz Latiff
- Department of Orthopaedics and Trauma Surgery of Ospedale di Circolo Fondazione Macchi Varese, ASST Sette Laghi, Viale Borri 57, Varese, Italy
| | - Marco Merlo
- Department of Orthopaedics and Trauma Surgery of Ospedale di Circolo Busto Arsizio, ASST Valle Olona, Via Arnaldo da Brescia,1, Varese, Italy
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Walter WL, Baker NA, Marsden-Jones D, Sadeghpour A. Novel Measure of Acetabular Cup Inclination and Anteversion During Total Hip Arthroplasty. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2022; 15:1-14. [PMID: 35115849 PMCID: PMC8806051 DOI: 10.2147/mder.s339669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/20/2021] [Indexed: 12/03/2022] Open
Abstract
PURPOSE The purposes of the present research were to assess the accuracy and usability of the inertial navigation system (INS). MATERIALS AND METHODS The accuracy of the device navigation subsystem was assessed using benchtop testing. The usability was assessed through simulated use with surgeons. These results were compared to recent cadaveric results for the same system. RESULTS The navigation subsystem had an overall mean absolute error of 1.21° and a maximum absolute error across all devices of 4.79°. The device was found to be usable and to add an estimated 7 minutes to surgery time. CONCLUSION The INS uses a novel approach to provide the surgeon with accurate and fast acetabular cup inclination and anteversion angles during THA.
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Affiliation(s)
- William L Walter
- Orthopaedics and Traumatic Surgery, University of Sydney, Sydney, New South Wales, Australia
| | - Neri A Baker
- Innovation Department, Navbit, Sydney, New South Wales, Australia
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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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Anjiki K, Kamenaga T, Hayashi S, Hashimoto S, Kuroda Y, Nakano N, Fujishiro T, Hiranaka T, Niikura T, Kuroda R, Matsumoto T. Effectiveness of an accelerometer-based portable navigation for intraoperative adjustment of leg length discrepancy in total hip arthroplasty in the supine position. J Orthop Sci 2022; 27:169-175. [PMID: 33341355 DOI: 10.1016/j.jos.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to examine the accuracy of the HipAlign® accelerometer-based portable navigation system by measuring the intraoperative leg length change of patients who underwent total hip arthroplasty (THA) and comparing the measured leg length discrepancy (LLD) determined by the navigation system and a freehand technique. METHODS A total of 61 patients who underwent THA using the anterolateral approach in the supine position were included in this study and divided into two groups: those who underwent THA with navigation (Group N; N = 31) and with the freehand technique (Group F; N = 30). Statistical analyses were performed to compare the intraoperative leg length change, pre- and post-LLD, absolute values of post-LLD, and the number of patients with the postoperative LLD within 10 mm and 5 mm between the two groups. Additionally, we examined the correlation between the leg length change obtained through intraoperative navigation and measured from the radiographs. Moreover, to evaluate the navigation accuracy, we examined the correlation between the absolute error of leg length change and cup orientation. RESULTS The postoperative LLD was significantly lower and the number of patients with the postoperative LLD within 5 mm was significantly higher in Group N, compared with Group F. Additionally, the amount of leg length change measured intraoperatively by the navigation system was strongly correlated with the values obtained by the postoperative radiographic measurement with a small absolute error and minimal wasted time. Moreover, a significant positive correlation was found between the absolute error of the leg length change and that of the cup inclination. CONCLUSIONS Our study demonstrates that the accelerometer-based portable navigation system is useful for the intraoperative adjustment of leg length discrepancy during THA for patients in the supine position, as it provides good accuracy and minimizes required time for use.
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Affiliation(s)
- Kensuke Anjiki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Orthopaedic Surgery, Takatsuki General Hospital, Osaka, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Orthopaedic Surgery, Takatsuki General Hospital, Osaka, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takaaki Fujishiro
- Department of Orthopaedic Surgery, Takatsuki General Hospital, Osaka, Japan
| | - Takafumi Hiranaka
- Department of Orthopaedic Surgery, Takatsuki General Hospital, Osaka, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Differences in the setting of acetabular component alignment guides between the supine and lateral positions for total hip arthroplasty. Sci Rep 2021; 11:21978. [PMID: 34754017 PMCID: PMC8578565 DOI: 10.1038/s41598-021-01420-1] [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: 05/31/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022] Open
Abstract
The acetabular component orientation in total hip arthroplasty is of critical importance to clinical results. Although navigation systems and surgical robots have been introduced, most surgeons still use acetabular component alignment guides. This study aimed to compare the accuracy between modern acetabular component alignment guides for the lateral position and those for the supine position. Thirteen alignment guides for the lateral position and 10 for the supine position were investigated. All the lateral position alignment guides indicated cup alignment in operative definition, and the supine position alignment guides indicated cup alignment in radiographic definition. For lateral position alignment guides, the anteversion actually indicated by the alignment guide itself was smaller than that indicated by the manufacturer by a mean of 6° (maximum, 9°), and the inclination actually indicated by alignment guides themselves was larger than that by the manufacturer (p < 0.01) by a mean of 2° (maximum, 4°). For supine position alignment guides, the inclination and anteversion indicated by the alignment guide itself were identical with those indicated by the manufacturer. The current study showed that the angles actually indicated and those stated by manufacturers were not identical for lateral position alignment guides.
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Bruce-Brand R, Magill P, O'Neill C, Karayiannis P, Hill J, Beverland D. Mechanical and Anatomical Alignment Guide Techniques Are Superior to Freehand in Achieving Target Orientation of an Acetabular Component. Arthroplast Today 2021; 11:222-228. [PMID: 34692959 PMCID: PMC8516817 DOI: 10.1016/j.artd.2021.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/26/2021] [Accepted: 08/29/2021] [Indexed: 11/16/2022] Open
Abstract
Background Achieving accurate and consistent acetabular component orientation remains a major challenge in total hip arthroplasty. Methods We used a pelvic model to compare freehand techniques vs mechanical and anatomical alignment guides in achieving a target operative inclination (OI) and operative anteversion (OA). Thirty subjects comprising consultant orthopedic surgeons, orthopedic trainees, and nonsurgical staff positioned an acetabular component in a pelvic model using 3 different methods for guiding inclination and another 3 for guiding version. Results Using either a standard mechanical alignment guide (MAG) or a spirit level MAG technique eliminated outliers from target OI, while the freehand method resulted in 46.7% of measurements outside the OI target range. The spirit level MAG technique significantly outperformed the standard MAG technique in median unsigned deviation from target OI (0.8° vs 2.1°, P < .001). Either method of referencing the transverse acetabular ligament for version yielded lower deviations from target OA than the freehand method and fewer outliers from the ±5° target range. Surgical experience was not a significant factor for accurately achieving target OI and OA. Conclusions Even in an idealized in vitro model, a wide range of OI and OA is seen with the freehand technique of cup placement by subjects of all levels of surgical experience. Using either a standard MAG or a spirit level MAG reduces deviations in target OI, with the spirit level MAG method yielding the best accuracy. Using the transverse acetabular ligament to guide cup anteversion yields more accurate OA.
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Affiliation(s)
| | - Paul Magill
- Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
| | | | | | - Janet Hill
- Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
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Somerville CM, Geddes JA, Tofighi M, Boddu K. Accuracy and reproducibility of visual estimation of the acetabular cup positioning in total hip arthroplasty on plain radiographs by orthopaedic surgeons. J Perioper Pract 2021; 32:265-269. [PMID: 34396823 DOI: 10.1177/17504589211026074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine whether trauma and orthopaedic surgeons could visually assess the anteversion and inclination of a total hip replacement acetabular component from standard anteroposterior radiograph and anteversion on a standard lateral radiograph with accuracy or reproducibility.Main outcome measurement: The main outcome was accuracy of visual estimations of angles. The secondary outcome was whether these estimations were reproducible though intra-observer variability. RESULTS Mean angles of anteversion on the anteroposterior, inclination on the anteroposterior and anteversion on the lateral on formal measurements were 15.2°, 45.4° and 19.9°; and the visual estimates were 17.5°, 45.9° and 18.2°, respectively. When comparing the visual estimates of surgeons and formal measurements, the results ranged from very poor to very good. Intra-observer reproducibility was moderate for all angles. The difference between the consultants and speciality registrars was not significant. CONCLUSION This study illustrated that not all orthopaedic surgeons were able to visually estimate angles well. Although some of our participants were very accurate, there were some who statistically were very poor. This level of inaccuracy can lead to inconsistency and we strongly suggested specialist software is used to assess acetabular cup position on postoperative plane radiographs rather than relying on 'visual estimations'.
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Affiliation(s)
| | - James Arthur Geddes
- Department of Trauma and Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mehdi Tofighi
- Department of Trauma and Orthopaedics, Kings College Hospital London, London, UK
| | - Krishna Boddu
- Department of Trauma and Orthopaedics, Princess Royal University Hospital, London, UK
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Okamoto M, Kawasaki M, Okura T, Ochiai S, Yokoi H. Comparison of accuracy of cup position using portable navigation versus alignment guide in total hip arthroplasty in supine position. Hip Int 2021; 31:492-499. [PMID: 32126836 DOI: 10.1177/1120700020908788] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Accelerometer-based portable navigation systems in supine total hip arthroplasty (THA) have been developed, but there are no reports on the accuracy of cup placement. We aimed to investigate and compare the accuracy of the accelerometer-based portable navigation system versus the acetabular alignment guide placed on the pelvis in THA using the direct anterior approach (DAA). Both devices tracked changes in the pelvic position. METHODS In this single-centre, retrospective study, we reviewed 115 hips in 113 patients who underwent primary THA via the DAA using an accelerometer-based portable navigation system in the supine position (portable navigation group) and 106 hips in 101 patients who underwent THA using an acetabular alignment guide (alignment guide group) as controls. Hips were evaluated postoperatively using computed tomography to measure cup orientation. The accuracy of cup orientation was compared between the 2 groups. RESULTS Absolute values of inclination error were 3.1° ± 2.2° and 2.9° ± 2.3° (p = 0.708) in the portable navigation and alignment guide groups and those of anteversion error were 2.8° ± 2.3° and 3.7° ± 2.7°, respectively (p = 0.005). The number of cups placed within 10° of error was 98.3% and 96.2% in the portable navigation and alignment guide groups, respectively (p = 0.304). The portable navigation group had significantly more hips (72.2%) placed within a 5° margin of error than did the alignment guide group (56.6%) (p = 0.016). CONCLUSION High accuracy in cup placement was achieved using accelerometer-based portable navigation in supine THA. Using a navigation system may contribute to improved long-term outcomes.
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Affiliation(s)
- Masanori Okamoto
- Department of Orthopaedic Surgery, Aichi Koseiren Konan Kosei Hospital, Konan, Aichi, Japan
| | - Masashi Kawasaki
- Department of Orthopaedic Surgery, Aichi Koseiren Konan Kosei Hospital, Konan, Aichi, Japan
| | - Toshiaki Okura
- Department of Orthopaedic Surgery, Aichi Koseiren Konan Kosei Hospital, Konan, Aichi, Japan
| | - Satoshi Ochiai
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Yokoi
- Department of Orthopaedic Surgery, Aichi Koseiren Konan Kosei Hospital, Konan, Aichi, Japan
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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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Okanoue Y, Aso K, Dan J, Takaya S, Izumi M, Kawakami T, Ikeuchi M. Accuracy of acetabular cup placement using an angle-adjusting alignment guide with laser pointer in total hip arthroplasty. J Orthop Surg (Hong Kong) 2021; 28:2309499020962860. [PMID: 33078676 DOI: 10.1177/2309499020962860] [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: 11/15/2022] Open
Abstract
PURPOSE To evaluate cup-positioning accuracy in total hip arthroplasty (THA) using a novel angle-adjusting alignment guide with laser pointer and determine whether level of surgical experience affects accuracy of cup placement or not. METHODS We included 117 hips in 104 patients who underwent THA using the novel guide. We retrospectively reviewed 44 hips in 40 patients who underwent THA before the novel guide was introduced. We compared differences in cup angles between the novel guide group and the conventional guide group as well as the discrepancies in targeted angles between the experienced surgeon group and the inexperienced surgeon group. RESULTS There were 114/117 hips (97.4%) within the Lewinnek safe zone in the novel guide group and 32/44 hips (72.7%) within the safe zone in the conventional guide group. There were significantly fewer outliers in the novel guide group (p < 0.001). In the experienced surgeon group, the mean absolute errors in inclination and anteversion were 2.0 ± 1.7° and 2.1 ± 2.3°, respectively; which were not significantly different from those in the inexperienced surgeon group (2.3 ± 2.1° and 2.8 ± 2.3°, respectively). CONCLUSION The novel angle-adjusting alignment guide with laser pointer is a simple tool that provides better accuracy of cup position than that obtained using conventional guides. Accurate cup placement is possible using the novel guide, regardless of surgeons' experience.
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Affiliation(s)
- Yusuke Okanoue
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Koji Aso
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Junpei Dan
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Shogo Takaya
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Masashi Izumi
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Teruhiko Kawakami
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
| | - Masahiko Ikeuchi
- Department of Orthopaedic Surgery, Kochi Medical School, Nankoku, Japan
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