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Inaba Y, Tezuka T, Oba M, Choe H, Ike H. Periacetabular osteotomy using computed tomography-based navigation: preoperative planning and accuracy evaluation. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03210-2. [PMID: 38888819 DOI: 10.1007/s11548-024-03210-2] [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: 11/01/2023] [Accepted: 06/03/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE Since 2011, we have used computed tomography (CT)-based navigation to perform safe and accurate rotational acetabular osteotomy (RAO) for treating developmental dysplasia of the hip. We developed a new method with four fiducial points to improve the accuracy of a published technique. In this study, we introduced a new method to achieve reorientation in accordance with planning and evaluated its accuracy. METHODS This study included 40 joints, which underwent RAO used CT-based navigation. In 20 joints, reorientation was confirmed by touching the lateral aspect of the rotated fragment with navigation and checking whether it matched the preoperative plan. A new fiducial point method was adopted for the remaining 20 joints. To assess the accuracy of the position of the rotated fragment in each group, postoperative radial reformatted CT images were obtained around the acetabulum and three-dimensional evaluation was performed. The accuracy of acetabular fragment repositioning was evaluated using the acetabular sector angle (ASA). RESULTS The absolute value of ΔASA, which represents the error between preoperative planning and the actual postoperative position, was significantly smaller in the new fiducial method group than the previous method group in the area from 11:30 to 13:30 (p < 0.05). The Harris Hip Score at 1 year after surgery did not differ significantly between the previous and new fiducial point methods. CONCLUSION The new fiducial point method significantly reduced reorientation error in the superior-lateral area of the acetabulum: significantly fewer errors and fewer cases of under-correction of lateral acetabular coverage were recorded. The four-reference fiducial method facilitates reorientation of the acetabulum as planned, with fewer errors. The effect of the improved accuracy of the fiducial point method on clinical outcomes will be investigated in the future work.
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Affiliation(s)
- Yutaka Inaba
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan.
| | - Taro Tezuka
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Masatoshi Oba
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Hyonmin Choe
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Hiroyuki Ike
- Department of Orthopedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
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Liu X, Zhang Z, Han W, Zhao Z, Kim BS, Yan Y, Chen X, Wang X, Li X, Yang X, Wang B, Xu H, Lin L, Chai G. Efficacy of navigation system-assisted distraction osteogenesis for hemifacial microsomia based on artificial intelligence for 3 to 18 years old: study protocol for a randomized controlled single-blind trial. Trials 2024; 25:42. [PMID: 38216974 PMCID: PMC10785481 DOI: 10.1186/s13063-023-07809-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/20/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Mandibular distraction osteogenesis (MDO) is a major part of the treatment for hemifacial microsomia patients. Due to the narrow surgical field of the intraoral approach, osteotomy accuracy is highly dependent on the surgeons' experience. Electromagnetic (EM) tracking systems can achieve satisfying accuracy to provide helpful real-time surgical navigation. Our research team developed an EM navigation system based on artificial intelligence, which has been justified in improving the accuracy of osteotomy in the MDO in animal experiments. This study aims to clarify the effect of the EM navigation system in improving the MDO accuracy for hemifacial microsomia patients. METHODS This study is designed as a single-centered and randomized controlled trial. Altogether, 22 hemifacial microsomia patients are randomly assigned to the experiment and control groups. All patients receive three-dimensional CT scans and preoperative surgical plans. The EM navigation system will be set up for those in the experiment group, and the control group will undergo traditional surgery. The primary outcome is the surgical precision by comparing the osteotomy position of pre- and postoperative CT scan images through the Geomagic Control software. The secondary outcomes include mandibular symmetry (occlusal plane deviation angle, mandibular ramus height, and body length), pain scale, and complications. Other indications, such as the adverse events of the system and the satisfactory score from patients and their families, will be recorded. DISCUSSION This small sample randomized controlled trial intends to explore the application of an EM navigation system in MDO for patients, which has been adopted in other surgeries such as orthognathic procedures. Because of the delicate structures of children and the narrow surgical view, accurate osteotomy and protection of nearby tissue from injury are essential for successful treatment. The EM navigation system based on artificial intelligence adopted in this trial is hypothesized to provide precise real-time navigation for surgeons and optimally improve patient outcomes, including function and aesthetic results. The results of this trial will extend the application of new navigation technology in pediatric plastic surgery. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200061565. Registered on 29 June 2022.
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Affiliation(s)
- Xiangqi Liu
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Ziwei Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Wenqing Han
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Zhijie Zhao
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Byeong Seop Kim
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Yingjie Yan
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Xiaojun Chen
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Xuetong Wang
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Xin Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Xianxian Yang
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Bingshun Wang
- Department of Biostatistics, Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, 227 Chong Qing Nan Rd., Shanghai, 200025, China
| | - Haisong Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Li Lin
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China.
| | - Gang Chai
- Department of Plastic and Reconstructive Surgery, Shanghai 9Th People's Hospital, School of Medicine, Shanghai Jiao Tong University, 639 Zhi Zao Ju Rd., Shanghai, 200011, China.
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Hoch A, Grossenbacher G, Jungwirth-Weinberger A, Götschi T, Fürnstahl P, Zingg PO. The periacetabular osteotomy: angulation of the supraacetabular osteotomy for quantification of correction. Hip Int 2023; 33:934-940. [PMID: 35672882 DOI: 10.1177/11207000221103079] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Malcorrection of the acetabular fragment in periacetabular osteotomy (PAO) is associated with inferior outcomes. 2-dimensional radiographic parameters are being used for intraoperative verification of a satisfactory result. After reorientation of the fragment, the acetabular version must be verified with an intraoperative radiograph. In the case of an unsatisfactory correction, a reorientation would be required. A slim and radiation-free intraoperative navigation method to directly quantify the correction is highly desirable. AIM To find out whether the measurable angulation of the supraacetabular osteotomy can be used for this purpose. METHODS To determine the angulation, 13 consecutive patients who underwent a PAO were investigated. The preoperative and postoperative standard radiographs as well as CT scans were available. The surgically produced alteration of radiographic parameters was correlated to tilting and spreading of the supraacetabular osteotomy planes. RESULTS Tilting of the supraacetabular osteotomy planes correlates strongly to alteration of the lateral centre-edge angle (LCEA) and the acetabular index (ACI), whereas spreading of the same planes showed also a strong correlation, but to the LCEA only. 1° of tilting resulted in a 0.2° alteration of the LCEA and a 0.5° alteration of the ACI, whereas 1° of spreading resulted in a 0.5° alteration of the LCEA. CONCLUSIONS This study shows that the measurable angulation of the supraacetabular osteotomy planes can be used to monitor the three-dimensional reorientation of the acetabular fragment in PAO. As long as sophisticated modalities are lacking, this technique offers an easy way to intraoperatively navigate the correction in PAO.
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Affiliation(s)
- Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | | | | | - Tobias Götschi
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopaedic Computer Science, Balgrist University Hospital, University of Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
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Curley AJ, Bruning RE, Padmanabhan S, Jimenez AE, Laude F, Domb BG. Periacetabular osteotomy with intraoperative computer-assisted modalities: a systematic review. J Hip Preserv Surg 2023; 10:104-118. [PMID: 37900886 PMCID: PMC10604052 DOI: 10.1093/jhps/hnad005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/08/2023] [Accepted: 03/06/2023] [Indexed: 10/31/2023] Open
Abstract
The role of intraoperative computer-assisted modalities for periacetabular osteotomy (PAO), as well as the perioperative and post-operative outcomes for these techniques, remains poorly defined. The purpose of this systematic review was to evaluate the techniques and outcomes of intraoperative computer-assisted modalities for PAO. Three databases (PubMed, CINAHL/EBSCOHost and Cochrane) were searched for clinical studies reporting on computer-assisted modalities for PAO. Exclusion criteria included small case series (<10 patients), non-English language and studies that did not provide a description of the computer-assisted technique. Data extraction included computer-assisted modalities utilized, surgical techniques, demographics, radiographic findings, perioperative outcomes, patient-reported outcomes (PROs), complications and subsequent surgeries. Nine studies met the inclusion criteria, consisting of 208 patients with average ages ranging from 26 to 38 years. Intraoperative navigation was utilized in seven studies, patient-specific guides in one study and both modalities in one study. Three studies reported significantly less intraoperative radiation exposure (P < 0.01) in computer-assisted versus conventional PAOs. Similar surgical times and estimated blood loss (P > 0.05) were commonly observed between the computer-assisted and conventional groups. The average post-operative lateral center edge angles in patients undergoing computer-assisted PAOs ranged from 27.8° to 37.4°, with six studies reporting similar values (P > 0.05) compared to conventional PAOs. Improved PROs were observed in all six studies that reported preoperative and post-operative values of patients undergoing computer-assisted PAOs. Computer-assisted modalities for PAO include navigated tracking of the free acetabular fragment and surgical instruments, as well as patient-specific cutting guides and rotating templates. Compared to conventional techniques, decreased intraoperative radiation exposure and similar operative lengths were observed with computer-assisted PAOs, although these results should be interpreted with caution due to heterogeneous operative techniques and surgical settings.
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Affiliation(s)
- Andrew J Curley
- American Hip Institute, 999 East Touhy Ave, Suite 450, Chicago, IL 60018, USA
| | - Rachel E Bruning
- American Hip Institute, 999 East Touhy Ave, Suite 450, Chicago, IL 60018, USA
| | | | - Andrew E Jimenez
- American Hip Institute, 999 East Touhy Ave, Suite 450, Chicago, IL 60018, USA
| | - Frédéric Laude
- Hip & Pelvis Surgery at Clinique du Sport, 36, Boulevard Saint-Marcel, Paris 75005, France
| | - Benjamin G Domb
- American Hip Institute, 999 East Touhy Ave, Suite 450, Chicago, IL 60018, USA
- American Hip Institute Research Foundation, 999 East Touhy Ave, Suite 450, Chicago, IL 60018, USA
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Li C, Zhang X, Meng X, Pu L, Chen H, Su Y, Bu P, Xu Y, Liu T. Treatment of symptomatic hip dysplasia by posterolateral small incision assisted Bernese periacetabular osteotomy. BMC Surg 2022; 22:217. [PMID: 35668407 PMCID: PMC9169320 DOI: 10.1186/s12893-022-01666-0] [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: 11/29/2021] [Accepted: 05/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background For periacetabular osteotomy, traditional approaches usually have a long learning curve. We aimed to evaluate the postoperative results and complications of periacetabular osteotomy under a new double-incision approach. Methods The records of 58 consecutive patients (65 hips) who underwent periacetabular osteotomy using the new approach were retrospectively reviewed and evaluated. There were 52 women and 6 men with a mean age of 28.1 years at the time of surgery. Results The average follow-up period was 35.2 months, during which no patients were converted to total hip arthroplasty. Complications included 6 hips (9.2%) with nerve dysesthesias and 1 hip (1.5%) with delayed wound healing. The mean operative time and intraoperative blood loss were 88.6 min and 402.8 ml, respectively. The mean modified Harris hip score had improved from 72.2 points preoperatively to 91.3 points at the last follow-up. Fifty-five patients (62 hips, 95.4%) were satisfied to their outcomes, and good preoperative functional score was associated with a satisfactory outcome. Furthermore, the average lateral center–edge angle, anterior center–edge angle and acetabular index angle were corrected well after surgery. Conclusion Periacetabular osteotomy using modified Smith-Petersen or Bikini approach with posterolateral assisted small incision can be performed safely and with satisfactory results. In addition, this technique shortens the learning curve, and reduces the operating complexity, especially for beginner.
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Affiliation(s)
- Chuan Li
- Department of Orthopedics, The 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Yunnan, 650032, Kunming, China
| | - Xianghong Zhang
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, 139# Middle Renmin Road, Changsha, Hunan, 410011, China
| | - Xuhan Meng
- Department of Orthopedics, The 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Yunnan, 650032, Kunming, China
| | - Luqiao Pu
- Department of Orthopedics, The 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Yunnan, 650032, Kunming, China
| | - Hongxuan Chen
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, 139# Middle Renmin Road, Changsha, Hunan, 410011, China
| | - Yongyue Su
- Department of Orthopedics, The 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Yunnan, 650032, Kunming, China
| | - Pengfei Bu
- Department of Orthopedics, The 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Yunnan, 650032, Kunming, China
| | - Yongqing Xu
- Department of Orthopedics, The 920th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Yunnan, 650032, Kunming, China.
| | - Tang Liu
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, 139# Middle Renmin Road, Changsha, Hunan, 410011, China.
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Pairojboriboon S, Sacino A, Pennington Z, Lubelski D, Yang R, Morris CD, Suk I, Sciubba DM, Lo SFL. Nerve Root Sparing En Bloc Resection of Sacral Chondrosarcoma: Technical Note and Review of the Literature. Oper Neurosurg (Hagerstown) 2021; 21:497-506. [PMID: 34791405 DOI: 10.1093/ons/opab333] [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: 05/03/2021] [Accepted: 07/18/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Total en bloc sacrectomy provides the best long-term local control for large primary bony sacral tumors, but often requires lumbosacral nerve root sacrifice leading to loss of ambulation and/or bowel, bladder, and/or sexual dysfunction. Nerve-sparing techniques may be an option for some patients that avoid these outcomes and accordingly improve postoperative quality of life. OBJECTIVE To describe the technique for a posterior-only en bloc hemisacrectomy with maximal nerve root preservation and to summarize the available literature. METHODS A 38-yr-old woman with a 7.7 × 5.4 × 4.5 cm biopsy-proven grade 2 chondrosarcoma involving the left L5-S2 posterior elements underwent a posterior-only left hemisacrectomy tri-rod L3-pelvis fusion. A systematic review of the English literature was also conducted to identify other descriptions of high sacrectomy with distal sacral nerve root preservation. RESULTS Computer-aided navigation facilitated an extracapsular resection that allowed preservation of the left-sided L5 and S3-Co roots. Negative margins were achieved and postoperatively the patient retained ambulation and good bowel/bladder function. Imaging at 9-mo follow-up showed no evidence of recurrence. The systematic review identified 4 prior publications describing 6 total patients who underwent nerve-sparing sacral resection. Enneking-appropriate resection was only obtained in 1 case though. CONCLUSION Here we describe a technique for distal sacral nerve root preservation during en bloc hemisacrectomy for a primary sacral tumor. Few prior descriptions exist, and the present technique may help to reduce the neurological morbidity of sacral tumor surgery.
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Affiliation(s)
- Sutipat Pairojboriboon
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Department of Orthopaedic Surgery, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Amanda Sacino
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Robin Yang
- Department of Plastic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Carol D Morris
- Department of Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ian Suk
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.,Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York, USA
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Hayashi S, Hashimoto S, Kuroda Y, Nakano N, Matsumoto T, Ishida K, Shibanuma N, Kuroda R. Robotic-arm assisted THA can achieve precise cup positioning in developmental dysplasia of the hip : a case control study. Bone Joint Res 2021; 10:629-638. [PMID: 34592109 PMCID: PMC8559969 DOI: 10.1302/2046-3758.1010.bjr-2021-0095.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIMS This study aimed to evaluate the accuracy of implant placement with robotic-arm assisted total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). METHODS The study analyzed a consecutive series of 69 patients who underwent robotic-arm assisted THA between September 2018 and December 2019. Of these, 30 patients had DDH and were classified according to the Crowe type. Acetabular component alignment and 3D positions were measured using pre- and postoperative CT data. The absolute differences of cup alignment and 3D position were compared between DDH and non-DDH patients. Moreover, these differences were analyzed in relation to the severity of DDH. The discrepancy of leg length and combined offset compared with contralateral hip were measured. RESULTS The mean values of absolute differences (postoperative CT-preoperative plan) were 1.7° (standard deviation (SD) 2.0) (inclination) and 2.5° (SD 2.1°) (anteversion) in DDH patients, and no significant differences were found between non-DDH and DDH patients. The mean absolute differences for 3D cup position were 1.1 mm (SD 1.0) (coronal plane) and 1.2 mm (SD 2.1) (axial plane) in DDH patients, and no significant differences were found between two groups. No significant difference was found either in cup alignment between postoperative CT and navigation record after cup screws or in the severity of DDH. Excellent restoration of leg length and combined offset were achieved in both groups. CONCLUSION We demonstrated that robotic-assisted THA may achieve precise cup positioning in DDH patients, and may be useful in those with severe DDH. Cite this article: Bone Joint Res 2021;10(10):629-638.
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Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.,Kobe Kaisei Hospital, 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
| | - Tomoyuki Matsumoto
- 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
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Augmented Reality Based Surgical Navigation of Complex Pelvic Osteotomies—A Feasibility Study on Cadavers. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11031228] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Augmented reality (AR)-based surgical navigation may offer new possibilities for safe and accurate surgical execution of complex osteotomies. In this study we investigated the feasibility of navigating the periacetabular osteotomy of Ganz (PAO), known as one of the most complex orthopedic interventions, on two cadaveric pelves under realistic operating room conditions. Preoperative planning was conducted on computed tomography (CT)-reconstructed 3D models using an in-house developed software, which allowed creating cutting plane objects for planning of the osteotomies and reorientation of the acetabular fragment. An AR application was developed comprising point-based registration, motion compensation and guidance for osteotomies as well as fragment reorientation. Navigation accuracy was evaluated on CT-reconstructed 3D models, resulting in an error of 10.8 mm for osteotomy starting points and 5.4° for osteotomy directions. The reorientation errors were 6.7°, 7.0° and 0.9° for the x-, y- and z-axis, respectively. Average postoperative error of LCE angle was 4.5°. Our study demonstrated that the AR-based execution of complex osteotomies is feasible. Fragment realignment navigation needs further improvement, although it is more accurate than the state of the art in PAO surgery.
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9
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Mihalič R, Brumat P, Trebše R. Bernese peri-acetabular osteotomy performed with navigation and patient-specific templates is a reproducible and safe procedure. INTERNATIONAL ORTHOPAEDICS 2021; 45:883-889. [PMID: 33427896 DOI: 10.1007/s00264-020-04897-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/03/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To present a novel surgical technique for the Bernese peri-acetabular osteotomy (PAO) using electromagnetic navigation (EMN) and patient-specific templates (PST), and to evaluate it against the traditional fluoroscopic technique. METHODS We included 40 dysplastic hips. All PAOs were performed using PST and EMN. We recorded learning-related complications. For the purpose of acetabular fragment correction analysis, patients were divided into two groups. In the study group (EMN group, 30 hips), the acetabular fragment was reoriented with the help of EMN. In the control group (XR group, 10 hips), the acetabular fragment was reoriented using fluoroscopy. We compared the difference between the planned and achieved position of the acetabular fragment and outcomes between both groups. RESULTS Two major complications occurred in four PAOs in the XR group only (first ten PAOs). The average absolute difference in planned and achieved lateral centre -edge angle (LCEA) and acetabular index (AI) was 1.2° ± 1.5° and 1.1° ± 2° for the EMN and 7° ± 6.1° and 6.3° ± 6.3° for the XR group (p = 0.02; p = 0.03). The average surgery duration was 183 ± 32 minutes for the EMN and 203 ± 42 minutes for the XR group (p = 0.19). At the last follow-up, the average Harris Hip Score (HHS) value was 88 ± 12 in the EMN and 86 ± 14 in the XR group (p = 0.84). CONCLUSIONS Our study indicates that PAO performed with EMN and PST seems to be a safe and reproducible procedure with a short learning curve. Additionally, navigated reorientation of the acetabular fragment is significantly more accurate than the fluoroscopic technique.
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Affiliation(s)
- Rene Mihalič
- Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280, Ankaran, Slovenia.
| | - Peter Brumat
- Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280, Ankaran, Slovenia
| | - Rihard Trebše
- Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280, Ankaran, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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10
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Liu B, Wu Z, Zhuang Z, Liu S, Li H, Han Y. Diagnosis, preoperative evaluation, classification and total hip arthroplasty in patients with long-term unreduced hip joint dislocation, secondary osteoarthritis and pseudoarthrosis. BMC Musculoskelet Disord 2020; 21:661. [PMID: 33032581 PMCID: PMC7545563 DOI: 10.1186/s12891-020-03678-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/28/2020] [Indexed: 12/25/2022] Open
Abstract
Background Neglected long-term unreduced hip joint dislocation with secondary osteoarthritis and pseudoarthrosis poses a great challenge to hip surgeons. However, as this is an uncommon injury, few studies have systematically investigated these patients. Methods We retrospectively reviewed 16 patients from 2010 to 2017. The diagnostic values of three different types of common radiological examinations were evaluated. We evaluated the bone conditions of the original acetabulum and classified the patients into three types (four subtypes). The surgical procedures and prognosis of the patients were also investigated. Results With the combined application of X-ray, CT scans and 3D reconstruction, 93.8% of these patients (sensitivity = 93.8%, Youden’s index = 0.93, intraclass correlation coefficient = 0.95) could be diagnosed correctly. There were 6/16 (37.5%) type A patients, 4/16 (25.0%) type B1 patients, 5/16 (31.3%) type B2 patients and 1/16 (6.3%) type C patient. For patients with type A injury, the surgical procedures for total hip arthroplasty were similar to “standard” total hip arthroplasty. For patients with type B injury, due to atrophy or partial bone deficiency of the original acetabulum, the surgical procedure for total hip arthroplasty was probably similar to those for patients with developmental dysplasia of the hip. For patients with type C injury, the situation was similar to that of revision surgery. The average Harris hip score postoperatively was 89.94 ± 5.78 points (range: 79–98 points). Conclusions The new classification system could help surgeons estimate potential difficulties during total hip arthroplasty. The prognosis of most patients after total hip arthroplasty is expected to be excellent or good.
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Affiliation(s)
- Bo Liu
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province, P.R. China
| | - Zhaoke Wu
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province, P.R. China.,Department of Orthopedic Surgery, Quanzhou Orthopedic-Traumatological Hospital, Quanzhou, Fujian, P.R. China
| | - Zhikun Zhuang
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province, P.R. China.,Department of Orthopedic Surgery, Quanzhou Orthopedic-Traumatological Hospital, Quanzhou, Fujian, P.R. China
| | - Sikai Liu
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province, P.R. China
| | - Huijie Li
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province, P.R. China
| | - Yongtai Han
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province, P.R. China.
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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.
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Letter to the Editor on "Outcomes of computer-assisted peri-acetabular osteotomy compared with conventional osteotomy in hip dysplasia". INTERNATIONAL ORTHOPAEDICS 2020; 44:2473. [PMID: 32451656 DOI: 10.1007/s00264-020-04613-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
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