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Liu Y, Yao D, Zhai Z, Wang H, Chen J, Wu C, Qiao H, Li H, Shi Y. Fusion of multimodality image and point cloud for spatial surface registration for knee arthroplasty. Int J Med Robot 2022; 18:e2426. [DOI: 10.1002/rcs.2426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/15/2022] [Accepted: 05/24/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Yanjing Liu
- Digital Medical Research Center School of Basic Medical Sciences Fudan University Shanghai China
- Shanghai Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention Shanghai China
| | - Demin Yao
- Digital Medical Research Center School of Basic Medical Sciences Fudan University Shanghai China
- Shanghai Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention Shanghai China
| | - Zanjing Zhai
- Shanghai Key Laboratory of Orthopaedic Implants Shanghai China
- Department of Orthopaedic Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Hui Wang
- Digital Medical Research Center School of Basic Medical Sciences Fudan University Shanghai China
- Shanghai Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention Shanghai China
| | - Jiayi Chen
- Digital Medical Research Center School of Basic Medical Sciences Fudan University Shanghai China
- Shanghai Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention Shanghai China
| | - Chuanfu Wu
- Digital Medical Research Center School of Basic Medical Sciences Fudan University Shanghai China
- Shanghai Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention Shanghai China
| | - Hua Qiao
- Shanghai Key Laboratory of Orthopaedic Implants Shanghai China
- Department of Orthopaedic Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Huiwu Li
- Shanghai Key Laboratory of Orthopaedic Implants Shanghai China
- Department of Orthopaedic Surgery Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Yonghong Shi
- Digital Medical Research Center School of Basic Medical Sciences Fudan University Shanghai China
- Shanghai Key Laboratory of Medical Imaging Computing and Computer Assisted Intervention Shanghai China
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Laparoscopic augmented reality registration for oncological resection site repair. Int J Comput Assist Radiol Surg 2021; 16:1577-1586. [PMID: 33797689 PMCID: PMC8354909 DOI: 10.1007/s11548-021-02336-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: 10/29/2020] [Accepted: 02/25/2021] [Indexed: 10/31/2022]
Abstract
PURPOSE Resection site repair during laparoscopic oncological surgery (e.g. laparoscopic partial nephrectomy) poses some unique challenges and opportunities for augmented reality (AR) navigation support. This work introduces an AR registration workflow that addresses the time pressure that is present during resection site repair. METHODS We propose a two-step registration process: the AR content is registered as accurately as possible prior to the tumour resection (the primary registration). This accurate registration is used to apply artificial fiducials to the physical organ and the virtual model. After the resection, these fiducials can be used for rapid re-registration (the secondary registration). We tested this pipeline in a simulated-use study with [Formula: see text] participants. We compared the registration accuracy and speed for our method and for landmark-based registration as a reference. RESULTS Acquisition of and, thereby, registration with the artificial fiducials were significantly faster than the initial use of anatomical landmarks. Our method also had a trend to be more accurate in cases in which the primary registration was successful. The accuracy loss between the elaborate primary registration and the rapid secondary registration could be quantified with a mean target registration error increase of 2.35 mm. CONCLUSION This work introduces a registration pipeline for AR navigation support during laparoscopic resection site repair and provides a successful proof-of-concept evaluation thereof. Our results indicate that the concept is better suited than landmark-based registration during this phase, but further work is required to demonstrate clinical suitability and applicability.
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Hsieh CM, Howell SM, Hull ML. Errors in femoral anteversion, femoral offset, and vertical offset following robot-assisted total hip arthroplasty. Int J Med Robot 2020; 16:e2104. [PMID: 32163669 DOI: 10.1002/rcs.2104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 03/03/2020] [Accepted: 03/10/2020] [Indexed: 11/12/2022]
Abstract
The objectives were to determine errors in femoral anteversion (FA), femoral offset (FO), and vertical offset (VO) with robot-assisted total hip arthroplasty (THA) and how consistently these errors are within clinically desirable limits of ±5° and ±5 mm. After preoperative planning, robot-assisted THAs were performed on twelve cadaveric specimens. The error between achieved and planned component placements was used to determine bias (mean error) and precision (SD of error). The percent of the population within clinically desirable limits was determined. Bias of 1.5° and 2.7 mm occurred for FA and VO, respectively. Precision was 1.2° for FA and better than 1.5 mm for FO and VO. The percent of population within clinically desirable limits was at least 95% for FA and at least 99% for FO. With limits of ±7 mm, at least 95% of the population was within these limits for VO. Robot-assisted THA may improve clinical outcomes.
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Affiliation(s)
- Chih-Ming Hsieh
- Department of Biomedical Engineering, University of California, Davis, Sacramento, California, USA
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California, Davis, Sacramento, California, USA
| | - Maury L Hull
- Department of Biomedical Engineering, University of California, Davis, Sacramento, California, USA.,Department of Mechanical Engineering, University of California, Davis, Sacramento, California, USA.,Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
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Han PF, Chen CL, Zhang ZL, Han YC, Wei L, Li PC, Wei XC. Robotics-assisted versus conventional manual approaches for total hip arthroplasty: A systematic review and meta-analysis of comparative studies. Int J Med Robot 2019; 15:e1990. [PMID: 30746868 PMCID: PMC6594016 DOI: 10.1002/rcs.1990] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 02/02/2019] [Accepted: 02/07/2019] [Indexed: 12/13/2022]
Abstract
Background Several studies have compared robotics‐assisted (RA) and conventional manual (CM) approaches for total hip arthroplasty (THA), but their results are controversial. Methods A literature search was conducted for controlled clinical trials (CCTs) comparing the clinical efficacy of the RA and CM approaches for THA and published between August 1998 and August 2018. The obtained data were analyzed using the statistical software Review Manager 5.3. Results Fourteen articles were included in the meta‐analysis, which revealed that the RA group had less intraoperative complications, better cup angle, and more cases of cup placement in the safe zone than the CM group. However, the operation time required for the CM group was less than that required for the RA group. Moreover, postoperative complications (eg, dislocation and revision surgery) were less frequent in the CM group than in the RA group. However, the two groups had similar functional scores, total number of complications, and rate of occurrence of limb length discrepancy. Conclusion Compared with the CM approach, the RA approach yields better radiological outcomes and fewer intraoperative complications in THA, but similar functional scores.
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Affiliation(s)
- Peng-Fei Han
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Cheng-Long Chen
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Zhi-Liang Zhang
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Yi-Chen Han
- Department of Upper School, Subsidiary High School of Taiyuan Normal University, Taiyuan, China
| | - Lei Wei
- Department of Orthopaedics, The Alpert Medical School of Brown University, Providence, Rhode Island
| | - Peng-Cui Li
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Xiao-Chun Wei
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
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Sato R, Takao M, Hamada H, Sakai T, Marumo K, Sugano N. Clinical accuracy and precision of hip resurfacing arthroplasty using computed tomography-based navigation. INTERNATIONAL ORTHOPAEDICS 2018; 43:1807-1814. [PMID: 30135983 DOI: 10.1007/s00264-018-4113-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/13/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE To avoid malalignment of components during hip resurfacing arthroplasty (HRA), we used a computed tomography (CT)-based navigation system for guidance. This study aimed to evaluate the clinical accuracy and precision of HRA performed using the CT-based navigation systems. METHODS HRA was performed on 17 hips guided by the CT-based navigation systems. We measured cup alignment deviation, deviation of the stem position, and alignment from the plan by image matching between pre-operative and post-operative CT images. RESULTS Cup anteversion was within 5° of that in the plan in all cases. Cup inclination was within 5° of that in the plan in 82.4% and within 10° in all cases. The angular difference of the stem was within 5° in all cases, and the entry point of the stem was within 4 mm in all cases. CONCLUSION The CT-based navigation system for HRA guided accurate component placement according to the plan.
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Affiliation(s)
- Ryuichi Sato
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masaki Takao
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Keishi Marumo
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Nakahara I, Kyo T, Kuroda Y, Miki H. Effect of improved navigation performance on the accuracy of implant placement in total hip arthroplasty with a CT-based navigation system. J Artif Organs 2018; 21:340-347. [PMID: 29611147 DOI: 10.1007/s10047-018-1041-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 03/27/2018] [Indexed: 12/28/2022]
Abstract
A computed tomography (CT)-based navigation system is one of the support tools to place implant with appropriate alignment and position in total hip arthroplasty (THA). To determine whether the higher performance of the navigation would further improve the accuracy of implant placement in the clinical setting, we retrospectively compared the navigation accuracy of two different versions of a navigation system. The newer version of the navigation system had an upgraded optical sensor with superior positional accuracy. Navigation accuracy, defined as differences between postoperative measurements on CT images and intraoperative records on the navigation system, of 49 THAs performed with the newer version of the navigation system was compared with that of 49 THAs performed with the older version. With the newer version, the mean absolute accuracy (95% limits of agreement) of implant alignment was 1.2° (± 3.3°) for cup inclination, 1.0° (± 2.4°) for cup anteversion, 2.0° (± 4.9°) for stem anteversion, and 1.1° (± 2.4°) for stem valgus angle. The accuracy of the implant position was 1.5 mm (± 3.1 mm), 1.3 mm (± 3.0 mm), and 1.5 mm (± 3.1 mm) for cup x-, y-, and z-axes, respectively, 1.6 mm (± 3.2 mm), 1.4 mm (± 2.9 mm), and 1.5 mm (± 2.7 mm) for stem x-, y-, and z-axes, respectively, and 2.4 mm (± 4.5 mm) for leg length discrepancy. The values for the newer version were significantly more accurate with less variation compared to those of the older version. With upgraded navigation performance, more accurate implant placement was demonstrated in the clinical setting.
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Affiliation(s)
- Ichiro Nakahara
- Department of Orthopaedic Surgery, Osaka National Hospital, 2-1-14 oenzaka, Chuo-ku, Osaka, 5400006, Japan.
| | - Takayuki Kyo
- Department of Orthopaedic Surgery, Bellland General Hospital, 500-3 Higashiyama, Naka-ku, Sakai-city, Osaka, Japan
| | - Yasuo Kuroda
- Department of Orthopaedic Surgery, Osaka National Hospital, 2-1-14 oenzaka, Chuo-ku, Osaka, 5400006, Japan
| | - Hidenobu Miki
- Department of Orthopaedic Surgery, Osaka National Hospital, 2-1-14 oenzaka, Chuo-ku, Osaka, 5400006, Japan
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A Novel Ultrasound-Based Lower Extremity Motion Tracking System. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1093:131-142. [PMID: 30306478 DOI: 10.1007/978-981-13-1396-7_11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Tracking joint motion of the lower extremity is important for human motion analysis. In this study, we present a novel ultrasound-based motion tracking system for measuring three-dimensional (3D) position and orientation of the femur and tibia in 3D space and quantifying tibiofemoral kinematics under dynamic conditions. As ultrasound is capable of detecting underlying bone surface noninvasively through multiple layers of soft tissues, an integration of multiple A-mode ultrasound transducers with a conventional motion tracking system provides a new approach to track the motion of bone segments during dynamic conditions. To demonstrate the technical and clinical feasibilities of this concept, an in vivo experiment was conducted. For this purpose the kinematics of healthy individuals were determined in treadmill walking conditions and stair descending tasks. The results clearly demonstrated the potential of tracking skeletal motion of the lower extremity and measuring six-degrees-of-freedom (6-DOF) tibiofemoral kinematics and related kinematic alterations caused by a variety of gait parameters. It was concluded that this prototyping system has great potential to measure human kinematics in an ambulant, non-radiative, and noninvasive manner.
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Takao M, Nishii T, Sakai T, Sugano N. Comparison of rotational acetabular osteotomy performed with navigation by surgeons with different levels of experience of osteotomies. Int J Comput Assist Radiol Surg 2016; 12:841-853. [PMID: 27783201 DOI: 10.1007/s11548-016-1494-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Rotational acetabular osteotomy (RAO) is used to treat developmental hip dysplasia (DDH). It requires detailed anatomical knowledge of the pelvic anatomy and three-dimensional cognitive skills. We addressed whether a computer navigation system combined with a preoperative computed tomography-based plan enabled surgeons to perform RAO safely and reliably through a mini-incision regardless of their level of experience with performing osteotomies. METHODS We enrolled 24 patients (25 hips) with DDH (radiographic grade 0 or 1 osteoarthritic changes: Tönnis classification). Using the navigation system, four surgeons performed RAO via a mini-incision transtrochanteric approach. Two experienced surgeons treated 15 patients (16 hips). Two surgeons with low-level RAO experience treated nine patients (9 hips). Operative data and clinical and radiographic outcomes were compared. Average follow-up was 3.2 years. RESULTS There were no significant differences in the (1) incision length, operation time, or intraoperative blood loss; (2) numerical pain rating scale score and Western Ontario and McMaster Universities Osteoarthritis Index Scale score at 1, 2 years, and at the latest follow-up; (3) preoperative and postoperative acetabular coverage of the femoral head, postoperative joint congruency, postoperative medial and distal femoral head displacement, or acetabular thickness; and (4) positional accuracy of iliac, pubic, and ischial osteotomy and accuracy of acetabular coverage of the femoral head. CONCLUSIONS Clinical and radiographic outcomes of RAO with navigation were not influenced by the surgeons' level of osteotomy experience.
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Affiliation(s)
- Masaki Takao
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Takashi Nishii
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Murphy RJ, Gordon CR, Basafa E, Liacouras P, Grant GT, Armand M. Computer-assisted, Le Fort-based, face-jaw-teeth transplantation: a pilot study on system feasiblity and translational assessment. Int J Comput Assist Radiol Surg 2014; 10:1117-26. [PMID: 25230895 DOI: 10.1007/s11548-014-1114-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 08/24/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Le Fort-based face-jaw-teeth transplantation (FJTT) attempts to marry bone and teeth geometry of size-mismatched face-jaw-teeth segments to restore function and form due to severe mid-facial trauma. Recent development of a computer-assisted planning and execution (CAPE) system for Le Fort-based FJTT in a pre-clinical swine model offers preoperative planning, and intraoperative navigation. This paper addresses the translation of the CAPE system to human anatomy and presents accuracy results. METHODS Single-jaw, Le Fort-based FJTTs were performed on plastic models, one swine and one human, and on a human cadaver. Preoperative planning defined the goal placement of the donor's Le Fort-based FJTT segment on the recipient. Patient-specific navigated cutting guides helped achieve planned osteotomies. Intraoperative cutting guide and donor fragment placement were compared with postoperative computed tomography (CT) data and the preoperative plan. RESULTS Intraoperative measurement error with respect to postoperative CT was less than 1.25 mm for both mock transplants and 3.59 mm for the human cadaver scenario. Donor fragment placement (as compared to the planned position) was less accurate for the human model test case (2.91 mm) compared with the swine test (2.25 mm) and human cadaver (2.26 mm). CONCLUSION The results indicate the viability of the CAPE system for assisting with Le Fort-based FJTT and demonstrate the potential in human surgery. This system offers a new path forward to achieving improved outcomes in Le Fort-based FJTT and can be modified to assist with a variety of other surgeries involving the head, neck, face, jaws and teeth.
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Affiliation(s)
- Ryan J Murphy
- Research and Exploratory Development Department, Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA
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Kuroda K, Kabata T, Maeda T, Kajino Y, Watanabe S, Iwai S, Kenji F, Hasegawa K, Inoue D, Tsuchiya H. The value of computed tomography based navigation in revision total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2013; 38:711-6. [PMID: 24240519 DOI: 10.1007/s00264-013-2166-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 10/23/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE This study investigates the accuracy of a computed tomography (CT)-based navigation system for accurate acetabular component placement during revision total hip arthroplasty (THA). METHODS We performed a retrospective review of 30 hips in 26 patients who underwent cementless revision THA using a CT-based navigation system; the control group consisted of 25 hips in 25 patients who underwent cementless primary THA using the same system. We analysed the deviation of anteversion and inclination angles among the pre-operative plan, intra-operative records from the navigation system and data from postoperative CT scans. RESULTS There were no significant differences between groups (P < 0.05) in terms of mean deviation between pre-operative planning and postoperative measurements or between intraoperative records and postoperative measurements. CONCLUSION CT-based navigation in revision THA is a useful tool that enables the surgeon to implant the acetabular component at the precise angle determined in pre-operative planning.
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Affiliation(s)
- Kazunari Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
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Abstract
BACKGROUND Although navigated THA provides improved precision in implant positioning and alignment, it is unclear whether these translate into long-term implant survival. QUESTIONS/PURPOSES We compared survivorship, dislocation rate, and incidence of radiographic failures such as loosening and bearing breakage after THA with and without navigation at a minimum 10-year followup. METHODS We retrospectively reviewed 46 patients (60 hips) and 97 patients (120 hips) receiving THA with or without a CT-based navigation system, respectively, using cementless THA ceramic-on-ceramic bearing couples. There were no differences in age, sex, diagnosis, height, weight, BMI, or preoperative clinical score between groups. We evaluated survivorship, mode of acetabular and femoral component fixation, osteolysis, and implant wear or breakage at a minimum followup of 10 years (average, 11 years; range, 10-13 years). RESULTS Survival at 13 years was 100% with navigation and 95.6% (95% CI, 88.4%-98.4%) without navigation. With navigation, all cups were placed within a zone of 40° (range, 30°-50°) of radiographic inclination and 15° (range, 5°-15°) of radiographic anteversion; without navigation, 31 cups (26%) were placed outside this zone. Hips treated without navigation had a higher rate of dislocation (8%) than the navigated cases (0%). Revision was performed in four nonnavigated cases, all of which showed evidence of neck impingement on the ceramic liner. Moreover, seven other cases without navigation showed posterior neck erosion on radiographs. These 11 impingement-related mechanical complications correlated with cup malorientation, and the incidence of impingement-related complications was higher in nonnavigated cases. CONCLUSIONS Navigation reduced the rates of dislocation and impingement-related mechanical complications leading to revision in cementless THA using ceramic-on-ceramic bearing couples over a minimum 10-year followup. LEVEL OF EVIDENCE Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Accessing 3D Location of Standing Pelvis: Relative Position of Sacral Plateau and Acetabular Cavities versus Pelvis. Radiol Res Pract 2012; 2012:685497. [PMID: 22567279 PMCID: PMC3337515 DOI: 10.1155/2012/685497] [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: 07/04/2011] [Revised: 10/24/2011] [Accepted: 01/30/2012] [Indexed: 11/17/2022] Open
Abstract
The goal of this paper is to access to pelvis position and morphology in standing posture and to determine the relative locations of their articular surfaces. This is obtained from coupling biplanar radiography and bone modeling. The technique involves different successive steps. Punctual landmarks are first reconstructed, in space, from their projected images, identified on two orthogonal standing X-rays. Geometric models, of global pelvis and articular surfaces, are determined from punctual landmarks. The global pelvis is represented as a triangle of summits: the two femoral head centers and the sacral plateau center. The two acetabular cavities are modeled as hemispheres. The anterior sacral plateau edge is represented by an hemi-ellipsis. The modeled articular surfaces are projected on each X-ray. Their optimal location is obtained when the projected contours of their models best fit real outlines identified from landmark images. Linear and angular parameters characterizing the position of global pelvis and articular surfaces are calculated from the corresponding sets of axis. Relative positions of sacral plateau, and acetabular cavities, are then calculated. Two hundred standing pelvis, of subjects and scoliotic patients, have been studied. Examples are presented. They focus upon pelvis orientations, relative positions of articular surfaces, and pelvis asymmetries.
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Heck DA, Stiehl JB. Six sigma analysis of minimally invasive acetabular arthroplasty: a preliminary investigation. Clin Orthop Relat Res 2009; 467:2025-31. [PMID: 19462215 PMCID: PMC2706362 DOI: 10.1007/s11999-009-0852-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Accepted: 04/08/2009] [Indexed: 01/31/2023]
Abstract
Minimally invasive techniques in THA may increase the difficulty of acetabular component insertion relative to the optimized position. We sought to determine the ability of eight surgeons to position an acetabular component placed using an anterior-lateral minimally invasive surgical (MIS) approach with conventional instruments or computer navigation using an optical imageless protocol compared with conventional true values determined by computed tomography (CT). We introduce a new approach, the Six Sigma process capability index, to assess outliers. Using the Six Sigma process capability index (Cp > 1.3) and the criteria of Lewinnek et al. of +/- 10 degrees for adequate precision, three-dimensional (3D) CT was capable for inclination and anteversion. Computer navigation and visual cues with conventional instrumentation were precise for anteversion but not for inclination. We conclude image-free computer navigation was not better than conventional instrumentation with the surgeons' visual cues for acetabular cup placement. Six Sigma analysis allows comparison of various methods of referencing with literature controls, and our data suggest CT referencing is the most precise method.
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Affiliation(s)
- David A. Heck
- Department of Surgery, Methodist Dallas Medical Center, Dallas, TX USA
| | - James B. Stiehl
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Columbia St Mary’s Hospital, Milwaukee, WI USA ,575 W Riverwoods Parkway, #204, 53212 Milwaukee, WI USA
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Hafez MA, DiGioia III AM. Computer-assisted total hip arthroplasty: the present and the future. ACTA ACUST UNITED AC 2006. [DOI: 10.2217/17460816.1.1.121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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