1
|
Khouri N, Georges S, Berton P, Le Gangneux M, du Cluzel de Remaurin X, Badina A. 3D pre-operative planning and patient-specific guides for re-directional peri-acetabular osteotomy in children and adolescents. Orthop Traumatol Surg Res 2024; 110:103891. [PMID: 38641206 DOI: 10.1016/j.otsr.2024.103891] [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: 06/02/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 04/21/2024]
Abstract
Surgical procedures to correct hip dysplasia associated with subluxation or dislocation of the femoral head are complex. The 3D geometric abnormalities of the acetabulum and proximal femur vary across patients. We, therefore, suggest a patient-specific surgical treatment involving computer-assisted 3D planning of the peri-acetabular osteotomies, taking into account the femoral head position; 3D printing of patient-specific guides for the cuts, repositioning, and fixation; and intra-operative application of the simulated displacements with their fixation. LEVEL OF EVIDENCE: IV.
Collapse
Affiliation(s)
- Nejib Khouri
- Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker-Enfants-malades, 149, rue de Sèvres, 75015 Paris, France.
| | - Samuel Georges
- Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker-Enfants-malades, 149, rue de Sèvres, 75015 Paris, France
| | | | - Morgane Le Gangneux
- Newclip Technics, 45, rue Garottieres-Pa-De-La-Lande-Saint-Martin, 44115 Haute-Goulaine, France
| | - Xavier du Cluzel de Remaurin
- Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker-Enfants-malades, 149, rue de Sèvres, 75015 Paris, France
| | - Alina Badina
- Service de chirurgie orthopédique pédiatrique, hôpital universitaire Necker-Enfants-malades, 149, rue de Sèvres, 75015 Paris, France
| |
Collapse
|
2
|
Fujii M, Kawano S, Ueno M, Sonohata M, Kitajima M, Tanaka S, Mawatari D, Mawatari M. Clinical results of periacetabular osteotomy with structural bone allograft for the treatment of severe hip dysplasia. Bone Joint J 2023; 105-B:743-750. [PMID: 37399069 DOI: 10.1302/0301-620x.105b7.bjj-2023-0056.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Aims To clarify the mid-term results of transposition osteotomy of the acetabulum (TOA), a type of spherical periacetabular osteotomy, combined with structural allograft bone grafting for severe hip dysplasia. Methods We reviewed patients with severe hip dysplasia, defined as Severin IVb or V (lateral centre-edge angle (LCEA) < 0°), who underwent TOA with a structural bone allograft between 1998 and 2019. A medical chart review was conducted to extract demographic data, complications related to the osteotomy, and modified Harris Hip Score (mHHS). Radiological parameters of hip dysplasia were measured on pre- and postoperative radiographs. The cumulative probability of TOA failure (progression to Tönnis grade 3 or conversion to total hip arthroplasty) was estimated using the Kaplan-Meier product-limited method, and a multivariate Cox proportional hazard model was used to identify predictors for failure. Results A total of 64 patients (76 hips) were included in this study. The median follow-up period was ten years (interquartile range (IQR) five to 14). The median mHHS improved from 67 (IQR 56 to 80) preoperatively to 96 (IQR 85 to 97) at the latest follow-up (p < 0.001). The radiological parameters improved postoperatively (p < 0.001), with the resulting parameters falling within the normal range in 42% to 95% of hips. The survival rate was 95% at ten years and 80% at 15 years. Preoperative Tönnis grade 2 was an independent risk factor for TOA failure. Conclusion Our findings suggest that TOA with structural bone allografting is a viable surgical option for correcting severely dysplastic acetabulum in adolescents and young adults without advanced osteoarthritis, with favourable mid-term outcomes.
Collapse
Affiliation(s)
- Masanori Fujii
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Shunsuke Kawano
- Research Center for Arthroplasty, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaya Ueno
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, JCHO Saga Central Hospital, Saga, Japan
| | - Masaru Kitajima
- Department of Orthopedic Surgery, Shiroishi Kyoritsu Hospital, Saga, Japan
| | - Shiori Tanaka
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Daisuke Mawatari
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Masaaki Mawatari
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| |
Collapse
|
3
|
Kitamura K, Fujii M, Iwamoto M, Ikemura S, Hamai S, Motomura G, Nakashima Y. Is Anterior Rotation of the Acetabulum Necessary to Normalize Joint Contact Pressure in Periacetabular Osteotomy? A Finite-element Analysis Study. Clin Orthop Relat Res 2022; 480:67-78. [PMID: 34228657 PMCID: PMC8673984 DOI: 10.1097/corr.0000000000001893] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/11/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Inappropriate sagittal plane correction can result in an increased risk of osteoarthritis progression after periacetabular osteotomy (PAO). Individual and postural variations in sagittal pelvic tilt, along with acetabular deformity, affect joint contact mechanics in dysplastic hips and may impact the direction and degree of acetabular correction. Finite-element analyses that account for physiologic pelvic tilt may provide valuable insight into the effect of PAO on the contact mechanics of dysplastic hips, which may lead to improved acetabular correction during PAO. QUESTIONS/PURPOSES We performed virtual PAO using finite-element models with reference to the standing pelvic position to clarify (1) whether lateral rotation of the acetabulum normalizes the joint contact pressure, (2) risk factors for abnormal contact pressure after lateral rotation of the acetabulum, and (3) whether additional anterior rotation of the acetabulum further reduces contact pressure. METHODS Between 2016 and 2020, 85 patients (92 hips) underwent PAO to treat hip dysplasia. Eighty-two patients with hip dysplasia (lateral center-edge angle < 20°) were included. Patients with advanced osteoarthritis, femoral head deformity, prior hip or spine surgery, or poor-quality images were excluded. Thirty-eight patients (38 hips) were eligible to participate in this study. All patients were women, with a mean age of 39 ± 10 years. Thirty-three women volunteers without a history of hip disease were reviewed as control participants. Individuals with a lateral center-edge angle < 25° or poor-quality images were excluded. Sixteen individuals (16 hips) with a mean age of 36 ± 7 years were eligible as controls. Using CT images, we developed patient-specific three-dimensional surface hip models with the standing pelvic position as a reference. The loading scenario was based on single-leg stance. Four patterns of virtual PAO were performed in the models. First, the acetabular fragment was rotated laterally in the coronal plane so that the lateral center-edge angle was 30°; then, anterior rotation in the sagittal plane was added by 0°, 5°, 10°, and 15°. We developed finite-element models for each acetabular position and performed a nonlinear contact analysis to calculate the joint contact pressure of the acetabular cartilage. The normal range of the maximum joint contact pressure was calculated to be < 4.1 MPa using a receiver operating characteristic curve. A paired t-test or Wilcoxon signed rank test with Bonferroni correction was used to compare joint contact pressures among acetabular positions. We evaluated the association of joint contact pressure with the patient-specific sagittal pelvic tilt and acetabular version and coverage using Pearson or Spearman correlation coefficients. An exploratory univariate logistic regression analysis was performed to identify which of the preoperative factors (CT measurement parameters and sagittal pelvic tilt) were associated with abnormal contact pressure after lateral rotation of the acetabulum. Variables with p values < 0.05 (anterior center-edge angle and sagittal pelvic tilt) were included in a multivariable model to identify the independent influence of each factor. RESULTS Lateral rotation of the acetabulum decreased the median maximum contact pressure compared with that before virtual PAO (3.7 MPa [range 2.2-6.7] versus 7.2 MPa [range 4.1-14 MPa], difference of medians 3.5 MPa; p < 0.001). The resulting maximum contact pressures were within the normal range (< 4.1 MPa) in 63% of the hips (24 of 38 hips). The maximum contact pressure after lateral acetabular rotation was negatively correlated with the standing pelvic tilt (anterior pelvic plane angle) (ρ = -0.52; p < 0.001) and anterior center-edge angle (ρ = -0.47; p = 0.003). After controlling for confounding variables such as the lateral center-edge angle and sagittal pelvic tilt, we found that a decreased preoperative anterior center-edge angle (per 1°; odds ratio 1.14 [95% CI 1.01-1.28]; p = 0.01) was independently associated with elevated contact pressure (≥ 4.1 MPa) after lateral rotation; a preoperative anterior center-edge angle < 32° in the standing pelvic position was associated with elevated contact pressure (sensitivity 57%, specificity 96%, area under the curve 0.77). Additional anterior rotation further decreased the joint contact pressure; the maximum contact pressures were within the normal range in 74% (28 of 38 hips), 76% (29 of 38 hips), and 84% (32 of 38 hips) of the hips when the acetabulum was rotated anteriorly by 5°, 10°, and 15°, respectively. CONCLUSION Via virtual PAO, normal joint contact pressure was achieved in 63% of patients by normalizing the lateral acetabular coverage. However, lateral acetabular rotation was insufficient to normalize the joint contact pressure in patients with more posteriorly tilted pelvises and anterior acetabular deficiency. In patients with a preoperative anterior center-edge angle < 32° in the standing pelvic position, additional anterior rotation is expected to be a useful guide to normalize the joint contact pressure. CLINICAL RELEVANCE This virtual PAO study suggests that biomechanics-based planning for PAO should incorporate not only the morphology of the hip but also the physiologic pelvic tilt in the weightbearing position in order to customize acetabular reorientation for each patient.
Collapse
Affiliation(s)
- Kenji Kitamura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Miho Iwamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
4
|
Wu J, Chen X. [Recent research progress of hip-preserving treatment for adolescents and adults with developmental dysplasia of the hip]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1513-1518. [PMID: 34913305 DOI: 10.7507/1002-1892.202108073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the imaging evaluation, treatment progress, and controversy related to developmental dysplasia of the hip (DDH) in adolescents and adults. Methods The domestic and abroad hot issues related to adolescents and adults with DDH in recent years, including new imaging techniques for assessing cartilage, controversies over the diagnosis and treatment of borderline DDH (BDDH), and the improvement and prospect of peracetabular osteotomy (PAO) were summarized and analyzed. Results DDH is one of the main factors leading to hip osteoarthritis. As the understanding of the pathological changes of DDH continues to deepen, the use of delayed gadolinium-enhanced MRI of cartilage can further evaluate the progress of osteoarthritis and predict the prognosis after hip preservation. There are still controversies about the diagnosis and treatment of BDDH. At the same time, PAO technology and concepts are still being improved. Conclusion Cartilage injury and bony structure determine the choice of surgical methods and postoperative prognosis of hip preservation surgery. The hip preservation of adolescent and adult DDH patients will move towards the goal of individualization and accuracy.
Collapse
Affiliation(s)
- Jinyan Wu
- Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P.R.China.,Department of Orthopedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, P.R.China
| | - Xiaodong Chen
- Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P.R.China.,Department of Orthopedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, P.R.China
| |
Collapse
|
5
|
Huang X, Wei Z, Wen F. Image processing technology in high frequency vibration direction and amplitude measurement. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2021. [DOI: 10.3233/jifs-219105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In recent years, with the development of computer software and hardware and artificial intelligence technology, photoelectric imaging equipment has gradually developed in the direction of digitization and intelligence. This paper mainly studies the application of image processing technology in the measurement of high-frequency vibration direction and amplitude. According to the corresponding relationship between the vibration blur image and the still image in the frequency spectrum, the image is preprocessed. This article adopts the traditional camera calibration method, which uses a special standard template to calibrate the internal and external parameters of the camera. The three-dimensional search algorithm is used to analyze and compare the recognition images of the left and right cameras in each state, and finally calculate the internal and external parameters of the camera. The data shows that the fundamental frequency is about 4.9 Hz, and the fundamental frequency order basically fluctuates around 16. The calculated amplitudes are 0.89, 0.93 and 0.99μm, respectively. The results show that the image processing technology can restore image edge details to a certain extent, suppress noise, and effectively shorten the matching time between feature points.
Collapse
Affiliation(s)
- Xiaoping Huang
- College of Mechanical and Electrical Engineering, Nanning University, Nanning, Guangxi, China
| | - Zhongxin Wei
- Guangxi Quality Technical Engineering School, Nanning, Guangxi, China
| | - Fangyi Wen
- Guangxi Quality Technical Engineering School, Nanning, Guangxi, China
| |
Collapse
|
6
|
Iwamoto M, Fujii M, Komiyama K, Sakemi Y, Shiomoto K, Kitamura K, Yamaguchi R, Nakashima Y. Is lateral acetabular rotation sufficient to correct anterolateral deficiency in periacetabular reorientation osteotomy? A CT-Based simulation study. J Orthop Sci 2020; 25:1008-1014. [PMID: 32035753 DOI: 10.1016/j.jos.2019.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/27/2019] [Accepted: 12/28/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Residual acetabular deficiency after periacetabular reorientation osteotomy can result in suboptimal outcome. The optimal algorithm of acetabular fragment correction to achieve normal anterolateral acetabular coverage is not well characterized. The aim of this study was to determine the prevalence of residual anterolateral deficiency after lateral acetabular rotation and to evaluate the ability of additional sagittal and axial rotation of the acetabulum to normalize the acetabular coverage in periacetabular osteotomy. METHODS We performed computed tomography-based simulated periacetabular osteotomy on 85 patients (85 hips) with hip dysplasia. The acetabular fragment was rotated laterally to achieve a lateral center-edge angle (CEA) of 30°. For hips with residual anterolateral deficiency, which were identified based on the reference interval of the anterior CEA, the acetabulum was further rotated in the sagittal or axial direction in 5-degree increments from 5° to 20°, and the ability of these two manoeuvres to restore a normal anterior CEA was assessed. RESULTS After lateral acetabular rotation, 16 hips (19%) had residual anterolateral deficiency, 67 hips (79%) had normal acetabular coverage, and 2 hips (2.4%) had acetabular overcoverage. A preoperative anterior CEA <37° predicted residual deficiency (sensitivity, 94%; specificity, 81%). Additional anterior sagittal rotation was more effective than posterior axial rotation in normalizing the anterior CEA, while minimizing the decrease in posterior CEA. The highest number of hips with normal anterior and posterior CEA was noted at 10° sagittal rotation (81%), which was followed by 15° sagittal rotation (63%). CONCLUSIONS Normal anterolateral coverage was achieved in 79% of patients after rotating the acetabulum laterally. However, lateral rotation of the acetabulum may be insufficient to correct the anterolateral deficiency in patients with an anterior CEA of <37°. In them, additional 10°-15° anterior sagittal rotation may be appropriate to achieve sufficient anterolateral coverage while retaining posterolateral coverage.
Collapse
Affiliation(s)
- Miho Iwamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Masanori Fujii
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Keisuke Komiyama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yuta Sakemi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kyohei Shiomoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kenji Kitamura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Ryosuke Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| |
Collapse
|
7
|
Computer assistance in hip preservation surgery-current status and introduction of our system. INTERNATIONAL ORTHOPAEDICS 2020; 45:897-905. [PMID: 32914216 DOI: 10.1007/s00264-020-04788-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Preservation surgery of the hip with open or arthroscopic approach has always been challenging as complex 3-D anatomy and limited surgical access make intraoperative evaluation difficult. Recent advances in computer technology offer a wide range of innovative solutions with a goal to improve accuracy and safety of corrective procedures on human joints. METHOD The author critically reviews currently available literature in the field of computer assistance in hip preservation surgery. Basic features of unique planning software and navigation surgical system used in treatment of femoroacetabular impingement and hip dysplasia are introduced. RESULTS Currently available software provides preoperative identification of hip deformity on CT-based 3-D model and planning of the surgical correction using kinematic protocols. Real-time intraoperative 3-D orientation is possible, and execution of surgical correction can be performed either with navigation of surgical tools or with printed templates. Computer assistance in hip preservation surgery is in the developing phase. First clinical experiences of its use in treatment of femoroacetabular impingement, hip dysplasia, hip tumors, and avascular necrosis of the femoral head are promising. CONCLUSION Computer assistance has been applied for treatment of several hip disorders. Technical advances are suggested and quality basic studies and clinical trials are encouraged for the novel technology to become more user friendly and widely accepted.
Collapse
|
8
|
Wang K, Yu Q. Simulation analysis of 3D medical image reconstruction based on ant colony optimization algorithm. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2020. [DOI: 10.3233/jifs-179613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kailing Wang
- Modern Education Technology Center, Qiqihar Medical University, China
| | - Qinglian Yu
- Modern Education Technology Center, Qiqihar Medical University, China
| |
Collapse
|
9
|
Wang X, Liu S, Peng J, Zhu Z, Zhang L, Guan J, Chen X. Development of a novel customized cutting and rotating template for Bernese periacetabular osteotomy. J Orthop Surg Res 2019; 14:217. [PMID: 31311557 PMCID: PMC6636020 DOI: 10.1186/s13018-019-1267-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/08/2019] [Indexed: 11/18/2022] Open
Abstract
Background Bernese periacetabular osteotomy (PAO) has been shown to be applicable as a hip-preserving technique for the treatment of developmental dysplasia of the hip (DDH). The approach could be designed preoperatively using various types of reverse-engineering software and finite element analysis, but how to implement it in the actual PAO remains a challenge. This study examines and evaluates a solution to achieve higher accuracy when performing a PAO. Methods A patient-specific cutting and rotating template was predesigned through computer-aided design (CAD) with three-dimensional (3D) modeling programs. The templates were then reproduced with rapid prototyping (RP) technology and used in the actual PAO. Finally, the clinical and radiographic effects were assessed and compared between the newly developed PAO and conventional PAO groups. Results The customized cutting template fit well with the bone surface and served as a guide for surgeons as they slid the osteotome to the precise location that had been determined prior to surgery. A very similar acetabular fragment was reproduced, and no major complications occurred when performing the osteotomy along the edge of the cutting template. The acetabular fragment was then corrected to the predetermined position through one-off manipulation with the customized rotating template. The final position of the acetabular fragment in the new developed PAO group was highly consistent with the planned position, and the postoperative morphological parameters were consistent with the preoperative planned data compared to the conventional PAO group. The duration of the operation and the number of irradiation decreased significantly. The Harris hip score (HHS) and visual analogue scale (VAS) score improved significantly with the use of the new developed PAO. Conclusions We demonstrate that our system, which was based on CAD-RP technology, is feasible and could realize the predicted results accurately during the actual PAO.
Collapse
Affiliation(s)
- Xuyi Wang
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China.,Department of Orthopaedics, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shixian Liu
- The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Jianping Peng
- Department of Orthopaedics, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhonglian Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Linlin Zhang
- Department of Biomedical Engineering, Shanghai University Of Technology, Shanghai, China
| | - Jianzhong Guan
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China.
| | - Xiaodong Chen
- Department of Orthopaedics, Xinhua Hospital affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
| |
Collapse
|
10
|
Selzer DJ. Overview of Simulation in Surgery. COMPREHENSIVE HEALTHCARE SIMULATION: SURGERY AND SURGICAL SUBSPECIALTIES 2019. [DOI: 10.1007/978-3-319-98276-2_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
11
|
Augustine AS, Ewen AM, Wallace DT, Picard F. Variations in pelvic dimensions: An anatomical and computed tomography study. Clin Anat 2018; 31:981-987. [PMID: 30203862 DOI: 10.1002/ca.23273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/17/2018] [Accepted: 08/22/2018] [Indexed: 11/09/2022]
Abstract
The anterior pelvic plane (APP) is a useful anatomical reference with both clinical and research applications in orthopedic surgery and rehabilitation medicine. It is used as a marker for computer-assisted total hip replacement and image-guided assessment of the hip center in clinical gait analysis. Despite its common use, no published data exist on the variations in height and width in an adult population. The aim of this study was to determine the range of dimensions for the anterior pelvic plane found in the Scottish adult population. Thirty-five human cadavers and 100 pelvic computed tomography (CT) scans were examined. Pelvic height and width were measured, and the ratios were determined. The mean width and height for combined cadaver and CT pelves were found to be 238.0 mm (SD 20.1, range 188.3-273.8) and 92.7 mm (SD 10.5, range 71.2-114.7), respectively. The mean width-to-height ratio for all pelves was 2.59 (SD 0.31, range 1.73-3.50). There were no statistically significant differences in means between males and females. The variations of APP dimensions within an adult population are presented. These will be of value in the validation of algorithms for computer navigation and hip joint center calculation in total hip arthroplasty and gait analysis. Furthermore, differences in dimensions between cadaveric and CT measurements have been shown which may have implications for further research and the validity of reference data dependent on data-point acquisition. Clin. Anat. 31:981-987, 2018. © 2018 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Angelica S Augustine
- Golden Jubilee National Hospital, Clydebank, West Dunbartonshire, G81 4DY, United Kingdom
| | - Alistair M Ewen
- Golden Jubilee National Hospital, Clydebank, West Dunbartonshire, G81 4DY, United Kingdom
| | - David T Wallace
- Golden Jubilee National Hospital, Clydebank, West Dunbartonshire, G81 4DY, United Kingdom
| | - Frederic Picard
- Golden Jubilee National Hospital, Clydebank, West Dunbartonshire, G81 4DY, United Kingdom
| |
Collapse
|
12
|
Improving registration accuracy during total hip arthroplasty: a cadaver study of a new, 3-D mini-optical navigation system. Hip Int 2018; 28:33-39. [PMID: 28885648 DOI: 10.5301/hipint.5000533] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Maintaining accuracy of component placement is an important step in ensuring the long-term stability of components during total hip arthroplasty (THA). Computer-assisted navigation has improved accuracy but errors associated with the registration process are known to impact the accuracy of final measurements. The purpose of this cadaver study was to determine the registration error associated with a novel mini-navigation system. METHODS 3 board-certified orthopaedic surgeons performed 4 THA procedures each via the posterolateral approach on 6 cadavers (12 hips) using the mini-navigation tool. Pre- and post-operative radiographs and post-operative computed tomography (CT) images were obtained. Image analysis was performed by 2 radiologists not involved in the surgical procedures. During registration, surgeons aligned the alignment rod with the anterior pelvic plane (APP) to provide a reference plane for comparison with traditional navigation. Cup position from the device was compared with measurements gathered from post-op imaging. RESULTS The mean difference between CT and device measurements for inclination was -1.7° (standard deviation [SD] 4.9°), while the mean absolute difference was 4.2° (SD 3.2°). The mean difference between anteversion angles calculated from CT scans and from the device was -3.5° (SD 4.5°), with an absolute difference of 4.0° (SD 4.0°). 100% (12/12) of inclination measurements and 92% (11/12) of anteversion measurements fell within both the clinical and statistical limits of agreement when analyzed via the Bland-Altman technique. CONCLUSIONS This study demonstrates that the registration error associated with this new mini-navigation system compares favourably with the known registration error associated with traditional navigation systems.
Collapse
|
13
|
Schwarzkopf R, Vigdorchik JM, Miller TT, Bogner EA, Muir JM, Cross MB. Quantification of Imaging Error in the Measurement of Cup Position: A Cadaveric Comparison of Radiographic and Computed Tomography Imaging. Orthopedics 2017; 40:e952-e958. [PMID: 28934535 DOI: 10.3928/01477447-20170918-03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/31/2017] [Indexed: 02/03/2023]
Abstract
Postoperative radiographs remain the standard for assessment of component placement following total hip arthroplasty (THA), despite the known limitations of radiographs. Computed tomography (CT) scanning offers improved accuracy, but its costs and radiation exposure are prohibitive. The authors performed a cadaver study to compare the error associated with radiographs with that of CT scans following THA. The authors also compared imaging with a novel mini-navigation system. Three board-certified orthopedic surgeons each performed 4 THA procedures (6 cadavers, 12 hips) via the posterior approach using a mini-navigation tool to assist with component placement. Cup position from imaging was compared with corrected CT values for anteversion and inclination, created by correcting the initial scan to align the anterior pelvic plane coplanar with the CT table, thus representing cup position not distorted by imaging or positioning. Anteversion from standard CT scans was within 2.5° (standard deviation [SD], 1.5°) of reference values (P=.25); radiographs showed an average error of 7.8° (SD, 4.3°) vs reference values (all values absolute means) (P<.01). The mini-navigation system provided anteversion values within an average of 4.0° (SD, 4.0°) of reference anteversion (P<.01). Standard CT values for inclination were within 2.4° (SD, 2.0°) of reference values (P=.53), whereas radiographic inclination values were within 2.5° (SD, 2.3°) (P=.12). Mini-navigation values for inclination were within 3.9° (SD, 3.2°) of reference inclination (P=.26). This study demonstrated that cup position as measured by radiographs is significantly less accurate than CT scans and that the mini-navigation system provided anteversion measurements that were of comparable accuracy to CT scans. [Orthopedics. 2017; 40(6):e952-e958.].
Collapse
|
14
|
Incidence of delayed union one year after peri-acetabular osteotomy based on computed tomography. INTERNATIONAL ORTHOPAEDICS 2017; 42:1029-1034. [DOI: 10.1007/s00264-017-3656-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/24/2017] [Indexed: 11/24/2022]
|
15
|
MR Arthrography versus conventional MRI in evaluation of labral and chondral lesions in different types of femoroacetabular impingement. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
16
|
Xie MM, Xia K, Zhang HX, Cao HH, Yang ZJ, Cui HF, Gao S, Tang KL. Individual headless compression screws fixed with three-dimensional image processing technology improves fusion rates of isolated talonavicular arthrodesis. J Orthop Surg Res 2017; 12:17. [PMID: 28114949 PMCID: PMC5259994 DOI: 10.1186/s13018-017-0516-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 01/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Screw fixation is a typical technique for isolated talonavicular arthrodesis (TNA), however, no consensus has been reached on how to select most suitable inserted position and direction. The study aimed to present a new fixation technique and to evaluate the clinical outcome of individual headless compression screws (HCSs) applied with three-dimensional (3D) image processing technology to isolated TNA. METHODS From 2007 to 2014, 69 patients underwent isolated TNA by using double Acutrak HCSs. The preoperative three-dimensional (3D) insertion model of double HCSs was applied by Mimics, Catia, and SolidWorks reconstruction software. One HCS oriented antegradely from the edge of dorsal navicular tail where intersected interspace between the first and the second cuneiform into the talus body along the talus axis, and the other one paralleled the first screw oriented from the dorsal-medial navicular where intersected at the medial plane of the first cuneiform. The anteroposterior and lateral X-ray examinations certified that the double HCSs were placed along the longitudinal axis of the talus. Postoperative assessment included the American Orthopaedic Foot & Ankle Society hindfoot (AOFAS), the visual analogue scale (VAS) score, satisfaction score, imaging assessments, and complications. RESULTS At the mean 44-months follow-up, all patients exhibited good articular congruity and solid bone fusion at an average of 11.26 ± 0.85 weeks (range, 10 ~ 13 weeks) without screw loosening, shifting, or breakage. The overall fusion rates were 100%. The average AOFAS score increased from 46.62 ± 4.6 (range, 37 ~ 56) preoperatively to 74.77 ± 5.4 (range, 64-88) at the final follow-up (95% CI: -30.86 ~ -27.34; p < 0.001). The mean VAS score decreased from 7.01 ± 1.2 (range, 4 ~ 9) to 1.93 ± 1.3 (range, 0 ~ 4) (95% CI: 4.69 ~ 5.48; p < 0.001). One cases (1.45%) and three cases (4.35%) experienced wound infection and adjacent arthritis respectively. The postoperative satisfaction score including pain relief, activities of daily living, and return to recreational activities were good to excellent in 62 (89.9%) cases. CONCLUSIONS Individual 3D reconstruction of HCSs insertion model can be designed with three-dimensional image processing technology in TNA. The technology is safe, effective, and reliable to isolated TNA method with high bone fusion rates, low incidences of complications.
Collapse
Affiliation(s)
- Mei-Ming Xie
- Department of Orthopaedic Surgery, Southwest Hospital, The Third Military Medical University, Gaotanyan Str. 30, Chongqing city, 400038, People's Republic of China
| | - Kang Xia
- Department of Orthopaedic Surgery, Southwest Hospital, The Third Military Medical University, Gaotanyan Str. 30, Chongqing city, 400038, People's Republic of China
| | - Hong-Xin Zhang
- Department of Orthopaedic Surgery, Southwest Hospital, The Third Military Medical University, Gaotanyan Str. 30, Chongqing city, 400038, People's Republic of China
| | - Hong-Hui Cao
- Department of Orthopaedic Surgery, Southwest Hospital, The Third Military Medical University, Gaotanyan Str. 30, Chongqing city, 400038, People's Republic of China
| | - Zhi-Jin Yang
- Department of Orthopaedic Surgery, Southwest Hospital, The Third Military Medical University, Gaotanyan Str. 30, Chongqing city, 400038, People's Republic of China
| | - Hai-Feng Cui
- Department of Orthopaedic Surgery, Southwest Hospital, The Third Military Medical University, Gaotanyan Str. 30, Chongqing city, 400038, People's Republic of China
| | - Shang Gao
- Department of Orthopaedic Surgery, Southwest Hospital, The Third Military Medical University, Gaotanyan Str. 30, Chongqing city, 400038, People's Republic of China
| | - Kang-Lai Tang
- Department of Orthopaedic Surgery, Southwest Hospital, The Third Military Medical University, Gaotanyan Str. 30, Chongqing city, 400038, People's Republic of China.
| |
Collapse
|
17
|
Wang X, Peng J, Li D, Zhang L, Wang H, Jiang L, Chen X. Does the optimal position of the acetabular fragment should be within the radiological normal range for all developmental dysplasia of the hip? A patient-specific finite element analysis. J Orthop Surg Res 2016; 11:109. [PMID: 27716351 PMCID: PMC5050724 DOI: 10.1186/s13018-016-0445-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 09/27/2016] [Indexed: 01/12/2023] Open
Abstract
Background The success of Bernese periacetabular osteotomy depends significantly on how extent the acetabular fragment can be corrected to its optimal position. This study was undertaken to investigate whether correcting the acetabular fragment into the so-called radiological “normal” range is the best choice for all developmental dysplasia of the hip with different severities of dysplasia from the biomechanical view? If not, is there any correlation between the biomechanically optimal position of the acetabular fragment and the severity of dysplasia? Methods Four finite element models with different severities of dysplasia were developed. The virtual periacetabular osteotomy was performed with the acetabular fragment rotated anterolaterally to incremental center-edge angles; then, the contact area and pressure and von Mises stress in the cartilage were calculated at different correction angles. Results The optimal position of the acetabular fragment for patients 1, 2, and 3 was when the acetabular fragment rotated 17° laterally (with the lateral center-edge angle of 36° and anterior center-edge angle of 58°; both were slightly larger than the “normal” range), 25° laterally following further 5° anterior rotation (with the lateral center-edge angle of 31° and anterior center-edge angle of 51°; both were within the “normal” range), and 30° laterally following further 10° anterior rotation (with the lateral center-edge angle of 25° and anterior center-edge angle of 40°; both were less than the “normal” range), respectively. Conclusions The optimal corrective position of the acetabular fragment is severity dependent rather than within the radiological “normal” range for developmental dysplasia of the hip. We prudently proposed that the optimal correction center-edge angle of mild, moderate, and severe developmental dysplasia of the hip is slightly larger than the “normal” range, within the “normal” range, and less than the lower limit of the “normal” range, respectively. Electronic supplementary material The online version of this article (doi:10.1186/s13018-016-0445-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Xuyi Wang
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China.,Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jianping Peng
- Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - De Li
- Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Linlin Zhang
- Department of Biomedical Engineering, Shanghai University of Technology, Shanghai, China
| | - Hui Wang
- Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Leisheng Jiang
- Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Xiaodong Chen
- Department of Orthopaedics, Xinhua Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
| |
Collapse
|
18
|
Long-term results of a modified Spitzy shelf operation for residual hip dysplasia and subluxation. A fifty year follow-up study of fifty six children and young adults. INTERNATIONAL ORTHOPAEDICS 2016; 41:415-421. [PMID: 27638709 DOI: 10.1007/s00264-016-3286-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/25/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The purposes of this study were to establish long-term outcome of the Spitzy shelf-operation and evaluate whether the procedure would delay osteoarthritis. METHODS During 1954-1976, 56 patients (70 hips) underwent Spitzy shelf operation at a mean age of 11.9 years (5 to 22). Indications included residual hip dysplasia or subluxation with Centre-Edge angle < 20°. We used survival analysis with conversion to total hip replacements as end-point. For patients without total hip replacement, information was provided from case records and radiographs. Avascular necrosis was assessed in pre-Spitzy radiographs, when available. Kaplan-Meier product-limit method was used to estimate survival function of the Spitzy shelf operation. Survival was assessed by Cox regression. Univariable Cox regression was performed separately for each variable. Potential predictors (p-value < 0.10) were entered into a multivariable regression model; p-value < 0.05 was considered significant. RESULTS Mean survival of the shelf procedure was 39.9 years (21 to 53). Survival fell from 83 % 30 years post-operatively, to 22 % at 50 years. Fifty-three hips (76 %) had undergone total hip replacement at mean age of 49.4 years (33 to 64). Seventeen hips had not received total hip replacement, mean survival 47.9 years (39 to 53). CONCLUSION The study showed that Spitzy shelf-operation had satisfactory long-term outcome with hip-survival in almost 90 % at patient age 40 years. The results indicate that Spitzy shelf-operation postpone total hip replacement. We consider Spitzy shelf-operation a good alternative in patients above 8 years. In younger children the procedure is not recommended due to increased frequency of graft resorption.
Collapse
|
19
|
Kanezaki S, Nakamura S, Nakamura M, Yokota I, Matsushita T. Curtain osteophytes are one of the risk factors for the poor outcome of rotational acetabular osteotomy. INTERNATIONAL ORTHOPAEDICS 2016; 41:265-270. [PMID: 27125434 DOI: 10.1007/s00264-016-3183-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 03/27/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Rotational acetabular osteotomy (RAO) is one of the surgical procedures for painful dysplastic hips. Although several risk factors for poor outcome of RAO have been reported, the presence of a curtain osteophyte in the acetabulum has not been evaluated as a possible risk factor. This study aimed to analyze the risk factors affecting the outcome of RAO and to clarify whether curtain osteophytes are one of the risk factors. METHODS We retrospectively analyzed 87 hips in 78 patients with a mean age of 36 (range, 13-54) years. The mean follow-up period was 8.3 (range, 2.1-19.5) years. The radiographic severity of osteoarthritis was classified into four stages: pre-arthrosis, initial stage, advanced stage, and terminal stage. The Japanese Orthopaedic Association (JOA) hip score was used for clinical evaluation. Poor outcome was defined as a hip with a JOA score < 80 points or terminal-stage osteoarthritis at final follow-up. Several factors were evaluated by logistic regression analysis. RESULTS At final follow-up, ten hips had a JOA score < 80 and nine hips had progressed to terminal-stage osteoarthritis. Since five hips had a JOA score < 80 as well as terminal-stage osteoarthritis, a total of 14 hips were determined to have poor outcome. An additional ten years of age at surgery, pre-operative minimal joint space < 2 mm, presence of a curtain osteophyte, and fair/poor congruency in abduction were identified as significant risk factors for poor outcome of RAO. CONCLUSIONS Hips with curtain osteophyte should be evaluated carefully before RAO.
Collapse
Affiliation(s)
- Shiho Kanezaki
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
| | - Shigeru Nakamura
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masaki Nakamura
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Isao Yokota
- Department of Biostatistics, Kyoto Prefectural University of Medicine, Tokyo, Japan
| | - Takashi Matsushita
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| |
Collapse
|