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Heimann AF, Murmann V, Schwab JM, Tannast M. Influence of acetabular and femoral morphology on pelvic tilt. Bone Joint J 2024; 106-B:3-10. [PMID: 38688494 DOI: 10.1302/0301-620x.106b5.bjj-2023-0690.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Aims The aim of this study was to investigate whether anterior pelvic plane-pelvic tilt (APP-PT) is associated with distinct hip pathomorphologies. We asked: is there a difference in APP-PT between young symptomatic patients being evaluated for joint preservation surgery and an asymptomatic control group? Does APP-PT vary among distinct acetabular and femoral pathomorphologies? And does APP-PT differ in symptomatic hips based on demographic factors? Methods This was an institutional review board-approved, single-centre, retrospective, case-control, comparative study, which included 388 symptomatic hips in 357 patients who presented to our tertiary centre for joint preservation between January 2011 and December 2015. Their mean age was 26 years (SD 2; 23 to 29) and 50% were female. They were allocated to 12 different morphological subgroups. The study group was compared with a control group of 20 asymptomatic hips in 20 patients. APP-PT was assessed in all patients based on supine anteroposterior pelvic radiographs using validated HipRecon software. Values in the two groups were compared using an independent-samples t-test. Multiple regression analysis was performed to examine the influences of diagnoses and demographic factors on APP-PT. The minimal clinically important difference (MCID) for APP-PT was defined as > 1 SD. Results There were no significant differences in APP-PT between the control group and the overall group (1.1° (SD 3.0°; -4.9° to 5.9°) vs 1.8° (SD 3.4°; -6.9° to 13.2°); p = 0.323). Acetabular retroversion and overcoverage groups showed higher mean APP-PTs compared with the control group (p = 0.001 and p = 0.014) and were the only diagnoses with a significant influence on APP-PT in the stepwise multiple regression analysis. All differences were below the MCID. The age, sex, height, weight, and BMI showed no influence on APP-PT. Conclusion APP-PT showed no radiologically significant variation across different pathomorphologies of the hip in patients being assessed for joint-preserving surgery.
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Affiliation(s)
- Alexander F Heimann
- HFR - Cantonal Hospital, Department of Orthopaedic Surgery and Traumatology, University of Fribourg, Fribourg, Switzerland
| | - Valérie Murmann
- HFR - Cantonal Hospital, Department of Orthopaedic Surgery and Traumatology, University of Fribourg, Fribourg, Switzerland
| | - Joseph M Schwab
- HFR - Cantonal Hospital, Department of Orthopaedic Surgery and Traumatology, University of Fribourg, Fribourg, Switzerland
| | - Moritz Tannast
- HFR - Cantonal Hospital, Department of Orthopaedic Surgery and Traumatology, University of Fribourg, Fribourg, Switzerland
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2
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Heimann AF, Schwab JM, Popa V, Zheng G, Tannast M. Measurement of pelvic tilt and rotation on AP radiographs using HipRecon: Validation and comparison to other parameters. J Orthop Res 2023. [PMID: 36691861 DOI: 10.1002/jor.25521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/12/2022] [Accepted: 01/19/2023] [Indexed: 01/25/2023]
Abstract
In this paper, we present and evaluate HipRecon, a noncommercial software package that simultaneously calculates pelvic tilt and rotation from an anteroposterior pelvis radiograph. We asked: What is the (1) accuracy and precision, (2) robustness, and (3) intra-/interobserver reliability/reproducibility of HipRecon to analyze both pelvic tilt and rotation on conventional AP pelvis radiographs? (4) How does the prediction of pelvic tilt on AP pelvis radiographs using HipRecon compare to established measurement methods? We compared the actual pelvic tilt of 20 adult human cadaveric pelvises with the calculated pelvic orientation based on an AP pelvis radiograph using HipRecon software. The pelvises were mounted on a radiolucent fixture and a total of 380 AP pelvis radiographs with different configurations were acquired. In addition, we investigated the correlation between actual tilt and the tilt calculated using HipRecon and seven other established measurement methods. The calculated software accuracy was 0.2 ± 2.0° (-3.6-4.1) for pelvic tilt and 0.0 ± 1.2° (-2.2-2.3, p = 0.39) for pelvic rotation. The Bland-Altman analysis showed values that were evenly and randomly spread in both directions. HipRecon showed excellent consistency for the measurement of pelvic tilt and rotation (intraobserver intraclass-correlation coefficient [ICC]: 0.99 [95% CI: 0.99-0.99] and interobserver ICC 0.99 [95% CI: 0.99-0.99]). Of all eight analyzed methods, the highest correlation coefficient was found for HipRecon (r = 0.98, p < 0.001). In the future, HipRecon could be used to detect changes in patient-specific pelvic orientation, helping to improve clinical understanding and decision-making in pathologies of the hip.
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Affiliation(s)
- Alexander F Heimann
- Department of Orthopaedic Surgery, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Joseph M Schwab
- Department of Orthopaedic Surgery, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Vlad Popa
- Department of Orthopaedic Surgery, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
| | - Guoyan Zheng
- School of Biomedical Engineering, Institute of Medical Robotics, Center for Image-guided Therapy and Interventions (CITI), Shanghai Jiao Tong University, Shanghai, China
| | - Moritz Tannast
- Department of Orthopaedic Surgery, HFR Cantonal Hospital, University of Fribourg, Fribourg, Switzerland
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Image-Less THA Cup Navigation in Clinical Routine Setup: Individual Adjustments, Accuracy, Precision, and Robustness. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060832. [PMID: 35744095 PMCID: PMC9227241 DOI: 10.3390/medicina58060832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 12/13/2022]
Abstract
Background and Objectives: Even after the ‘death’ of Lewinnek’s safe zone, the orientation of the prosthetic cup in total hip arthroplasty is crucial for success. Accurate cup placement can be achieved with surgical navigation systems. The literature lacks study cohorts with large numbers of hips because postoperative computer tomography is required for the reproducible evaluation of the acetabular component position. To overcome this limitation, we used a validated software program, HipMatch, to accurately assess the cup orientation based on an anterior-posterior pelvic X-ray. The aim of this study were to (1) determine the intraoperative ‘individual adjustment’ of the cup positioning compared to the widely suggested target values of 40° of inclination and 15° of anteversion, and evaluate the (2) ‘accuracy’, (3) ‘precision’, and (4) robustness, regarding systematic errors, of an image-free navigation system in routine clinical use. Material and Methods: We performed a retrospective, accuracy study in a single surgeon case series of 367 navigated primary total hip arthroplasties (PiGalileoTM, Smith+Nephew) through an anterolateral approach performed between January 2011 and August 2018. The individual adjustments were defined as the differences between the target cup orientation (40° of inclination, 15° of anteversion) and the intraoperative registration with the navigation software. The accuracy was the difference between the intraoperative captured cup orientation and the actual postoperative cup orientation determined by HipMatch. The precision was analyzed by the standard deviation of the difference between the intraoperative registered and the actual cup orientation. The outliers were detected using the Tukey method. Results: Compared to the target value (40° inclination, 15° anteversion), the individual adjustments showed that the cups are impacted in higher inclination (mean 3.2° ± 1.6°, range, (−2)−18°) and higher anteversion (mean 5.0° ± 7.0°, range, (−15)−23°) (p < 0.001). The accuracy of the navigated cup placement was −1.7° ± 3.0°, ((−15)−11°) for inclination, and −4.9° ± 6.2° ((−28)−18°) for anteversion (p < 0.001). Precision of the system was higher for inclination (standard deviation SD 3.0°) compared to anteversion (SD 6.2°) (p < 0.001). We found no difference in the prevalence of outliers for inclination (1.9% (7 out of 367)) compared to anteversion (1.63% (6 out of 367), p = 0.78). The Bland-Altman analysis showed that the differences between the intraoperatively captured final position and the postoperatively determined actual position were spread evenly and randomly for inclination and anteversion. Conclusion: The evaluation of an image-less navigation system in this large study cohort provides accurate and reliable intraoperative feedback. The accuracy and the precision were inferior compared to CT-based navigation systems particularly regarding the anteversion. However the assessed values are certainly within a clinically acceptable range. This use of image-less navigation offers an additional tool to address challenging hip prothesis in the context of the hip−spine relationship to achieve adequate placement of the acetabular components with a minimum of outliers.
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Duan L, Sun H, Liu D, Tan Y, Guo Y, Chen J, Ding X. Automatic Femoral Deformity Analysis Based on the Constrained Local Models and Hough Forest. J Digit Imaging 2022; 35:162-172. [PMID: 35013828 PMCID: PMC8921433 DOI: 10.1007/s10278-021-00550-2] [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: 10/27/2020] [Revised: 10/15/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022] Open
Abstract
Clinically, Taylor spatial frame (TSF) is usually used to correct femoral deformity. The first step in correction is to analyze skeletal deformities and measure the center of rotation of angulation (CORA). Since the above work needs to be done manually, the doctor's workload is heavy. Therefore, an automatic femoral deformity analysis system was proposed. Firstly, the Hough forest and constrained local models were trained on the femur image set. Then, the position and size of the femur in the X-ray image were detected by the trained Hough forest. Furthermore, the position and size were served as the initial values of the trained constrained local models to fit the femoral contour. Finally, the anatomical axis line of the proximal femur and the anatomical axis line of the distal femur could be drawn according to the fitting results. According to these lines, CORA can be found. Compared with manual measurement by doctors, the average error of the hip joint orientation line was 1.7°, the standard deviation was 1.75, the average error of the anatomic axis line of the proximal femur was 2.9°, and the standard deviation was 3.57. The automatic femoral deformity analysis system meets the accuracy requirements of orthopedics and can significantly reduce the workload of doctors.
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Affiliation(s)
- Lunhui Duan
- School of Artificial Intelligence and Data Science, Hebei University of Technology, No. 8 Guangrong Road, Hong Qiao, Tianjin, 300130, China
| | - Hao Sun
- School of Artificial Intelligence and Data Science, Hebei University of Technology, No. 8 Guangrong Road, Hong Qiao, Tianjin, 300130, China.
| | - Delong Liu
- School of Artificial Intelligence and Data Science, Hebei University of Technology, No. 8 Guangrong Road, Hong Qiao, Tianjin, 300130, China
| | - Yinglun Tan
- School of Artificial Intelligence and Data Science, Hebei University of Technology, No. 8 Guangrong Road, Hong Qiao, Tianjin, 300130, China
| | - Yue Guo
- Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, No. 1 Ronghua Middle Road, Da Xing, Beijing, 100176, China.,Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, No. 1 Ronghua Middle Road, Da Xing, Beijing, 100176, China
| | - Jianwen Chen
- Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, No. 1 Ronghua Middle Road, Da Xing, Beijing, 100176, China.,Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, No. 1 Ronghua Middle Road, Da Xing, Beijing, 100176, China
| | - Xiaojing Ding
- Tianjin Beichen Hospital, No. 7 Beiyi Road, Bei Chen, Tianjin, 300400, China
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Zhao JX, Su XY, Zhao Z, Xiao RX, Zhang LC, Tang PF. Radiographic assessment of the cup orientation after total hip arthroplasty: a literature review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:130. [PMID: 32175423 DOI: 10.21037/atm.2019.12.150] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Optimal acetabular cup orientation is of substantial importance to good long-term function and low complication rates after total hip arthroplasty (THA). The radiographic anteversion (RA) and inclination (RI) angles of the cup are typically studied due to the practicability, simplicity, and ease of interpretation of their measurements. A great number of methods have been developed to date, most of which have been performed on pelvic or hip anteroposterior radiographs. However, there are primarily two influencing factors for these methods: X-ray offset and pelvic rotation. In addition, there are three types of pelvic rotations about the transverse, longitudinal, and anteroposterior axes of the body. Their effects on the RA and RI angles of the cup are interactively correlated with the position and true orientation of the cup. To date, various fitted or analytical models have been established to disclose the correlations between the X-ray offset and pelvic rotation and the RA and RI angles of the cup. Most of these models do not incorporate all the potential influencing parameters. Advanced methods for performing X-ray offset and pelvic rotation corrections are mainly performed on a single pelvic AP radiograph, two synchronized radiographs, or a two-dimensional/three-dimensional (2D-3D) registration system. Some measurement systems, originally developed for evaluating implant migration or wear, could also be used for correcting the X-ray offset and pelvic rotation simultaneously, but some drawbacks still exist with these systems. Above all, the 2D-3D registration technique might be an alternative and powerful tool for accurately measuring cup orientation. In addition to the current methods used for postoperative assessment, navigation systems and augmented reality are also used for the preoperative planning and intraoperative guidance of cup placement. With the continuing development of artificial intelligence and machine learning, these techniques could be incorporated into robot-assisted orthopaedic surgery in the future.
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Affiliation(s)
- Jing-Xin Zhao
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Xiu-Yun Su
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,Intelligent and Digital Surgery Innovation Center, Southern University of Science and Technology Hospital, Shenzhen, Guangdong 518055, China
| | - Zhe Zhao
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Ruo-Xiu Xiao
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Li-Cheng Zhang
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Pei-Fu Tang
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
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Hettich G, Schierjott RA, Ramm H, Graichen H, Jansson V, Rudert M, Traina F, Grupp TM. Method for quantitative assessment of acetabular bone defects. J Orthop Res 2019; 37:181-189. [PMID: 30345568 PMCID: PMC6588082 DOI: 10.1002/jor.24165] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/08/2018] [Indexed: 02/04/2023]
Abstract
The objective of the study was to suggest a novel quantitative assessment of acetabular bone defects based on a statistical shape model, validate the method, and present preliminary results. Two exemplary CT-data sets with acetabular bone defects were segmented to obtain a solid model of each defect pelvis. The pathological areas around the acetabulum were excluded and a statistical shape model was fitted to the remaining healthy bone structures. The excluded areas were extrapolated such that a solid model of the native pelvis per specimen resulted (i.e., each pelvis without defect). The validity of the reconstruction was tested by a leave-one-out study. Validation results showed median reconstruction errors of 3.0 mm for center of rotation, 1.7 mm for acetabulum diameter, 2.1° for inclination, 2.5° for anteversion, and 3.3 mm3 for bone volume around the acetabulum. By applying Boolean operations on the solid models of defect and native pelvis, bone loss and bone formation in four different sectors were assessed. For both analyzed specimens, bone loss and bone formation per sector were calculated and were consistent with the visual impression. In specimen_1 bone loss was predominant in the medial wall (10.8 ml; 79%), in specimen_2 in the posterior column (15.6 ml; 46%). This study showed the feasibility of a quantitative assessment of acetabular bone defects using a statistical shape model-based reconstruction method. Validation results showed acceptable reconstruction accuracy, also when less healthy bone remains. The method could potentially be used for implant development, pre-clinical testing, pre-operative planning, and intra-operative navigation. © 2018 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 9999:1-9, 2018.
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Affiliation(s)
- Georg Hettich
- Aesculap AG, Research & DevelopmentAm Aesculap‐Platz78532 TuttlingenGermany
| | - Ronja A. Schierjott
- Aesculap AG, Research & DevelopmentAm Aesculap‐Platz78532 TuttlingenGermany,Ludwig‐Maximilians‐University MunichDepartment of Orthopaedic Surgery, Physical Medicine & RehabilitationCampus Grosshadern, Marchioninistrasse 1581377 MunichGermany
| | | | - Heiko Graichen
- Department for Arthroplasty and General Orthopaedic SurgeryOrthopaedic Hospital LindenloheLindenlohe 1892421 SchwandorfGermany
| | - Volkmar Jansson
- Ludwig‐Maximilians‐University MunichDepartment of Orthopaedic Surgery, Physical Medicine & RehabilitationCampus Grosshadern, Marchioninistrasse 1581377 MunichGermany
| | - Maximilian Rudert
- Department of Orthopaedic Surgery, König‐Ludwig‐HausJulius‐Maximilians‐University WürzburgBrettreichstraße 1197074 WürzburgGermany
| | - Francesco Traina
- University of MessinaVia Consolare Valeria 198124 MessinaItaly,Istituto Ortopedico RizzoliVia Giovanni Pupilli 140136 BolognaItaly
| | - Thomas M. Grupp
- Aesculap AG, Research & DevelopmentAm Aesculap‐Platz78532 TuttlingenGermany,Ludwig‐Maximilians‐University MunichDepartment of Orthopaedic Surgery, Physical Medicine & RehabilitationCampus Grosshadern, Marchioninistrasse 1581377 MunichGermany
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Sanjay D, Mondal S, Bhutani R, Ghosh R. The effect of cement mantle thickness on strain energy density distribution and prediction of bone density changes around cemented acetabular component. Proc Inst Mech Eng H 2018; 232:912-921. [PMID: 30105942 DOI: 10.1177/0954411918793448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cement mantle thickness is known to be one of the important parameters to reduce the failure of the cemented acetabular component. The thickness of the cement mantle is also often influenced by the positioning of the acetabular cup. The aim of this study is to determine the effect of uniform and non-uniform cement mantle thickness on strain energy density distribution and prediction of the possibility of bone remodelling around the acetabular region. Furthermore, tensile stress distribution in the cement mantle due to non-uniform cement mantle thickness was also investigated. Three-dimensional finite element models of intact and 17 implanted pelvic bone were developed based on computed tomography data sets. Results indicate that implantation with non-uniform cement thickness variation in the anterior-posterior direction has a significant influence on strain energy density distribution around the acetabulum as compared to thickness variation in the superior-inferior direction. Increase in density is predicted at the anterior part of the acetabulum, whereas density decrease is predicted at the posterior, inferior and superior part of the acetabulum. The non-uniform cement mantle thickness affected the tensile stress distribution in the cement mantle, in particularly superiorly placed acetabular cup. This study concludes that uniform cement thickness is desired for the longer success of the cemented acetabular component.
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Affiliation(s)
- Devismita Sanjay
- 1 Biomechanics Laboratory, School of Engineering, Indian Institute of Technology Mandi, Mandi, India
| | - Subrata Mondal
- 1 Biomechanics Laboratory, School of Engineering, Indian Institute of Technology Mandi, Mandi, India
| | - Richa Bhutani
- 2 Department of Biomedical Engineering, Manipal Institute of Technology, Manipal, India
| | - Rajesh Ghosh
- 1 Biomechanics Laboratory, School of Engineering, Indian Institute of Technology Mandi, Mandi, India
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Correct Assessment of Acetabular Component Orientation in Total Hip Arthroplasty From Plane Radiographs. J Arthroplasty 2018; 33:2652-2659.e3. [PMID: 29615377 DOI: 10.1016/j.arth.2018.02.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/25/2018] [Accepted: 02/03/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Correct positioning of the cup is an important factor in total hip arthroplasty. Assessing its position from a plain anteroposterior pelvic radiograph is known to be hampered by systemic errors. This study focuses on developing a correction method to adjust for these potential sources of error and to eliminate them based on a 3D geometric analysis. METHODS Computed tomography scans of 113 (66 male, 47 female) pelvices were reconstructed and virtually projected onto a plain radiograph with varying rotational and translational positions. Thus cup inclination and anteversion as measured on a 2D-radiograph and in the 3D environment were correlated. Projected offset of the symphysis from the mid-sacrum served as a mean to measure pelvic right/left-rotation. Pelvic tilt was determined from the projected height of the contour of the small pelvis. Correction formulas were verified by projecting a gimbal-mounted artificial pelvis with a cup implanted in a known position. RESULTS We found gender-specific formulas that correct for malrotated and off-centered radiographs. Applying these formulas cup inclination was assessed as close as 1.3° (±1.90°) to the true 3D value and cup anteversion as close as 1° (±1.91°) although deviations between directly measured plain values and corrected values rose up to 18°. CONCLUSION Inherent effects of central projection and malrotations due to pelvic tilt, pelvic rotation, and noncentered radiographs are corrected. Evaluation of radiographic inclination and anteversion of acetabular cups from plain 2D-radiographs show improved precision. Real values are approached better than 1.3° when applying our correction formulas.
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Schwarz T, Weber M, Wörner M, Renkawitz T, Grifka J, Craiovan B. Central X-ray beam correction of radiographic acetabular cup measurement after THA: an experimental study. Int J Comput Assist Radiol Surg 2016; 12:829-837. [PMID: 27714567 DOI: 10.1007/s11548-016-1489-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 09/27/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Accurate assessment of cup orientation on postoperative radiographs is essential for evaluating outcome after THA. However, accuracy is impeded by the deviation of the central X-ray beam in relation to the cup and the impossibility of measuring retroversion on standard pelvic radiographs. METHOD In an experimental trial, we built an artificial cup holder enabling the setting of different angles of anatomical anteversion and inclination. Twelve different cup orientations were investigated by three examiners. After comparing the two methods for radiographic measurement of the cup position developed by Lewinnek and Widmer, we showed how to differentiate between anteversion and retroversion in each cup position by using a second plane. To show the effect of the central beam offset on the cup, we X-rayed a defined cup position using a multidirectional central beam offset. According to Murray's definition of anteversion and inclination, we created a novel corrective procedure to balance measurement errors caused by deviation of the central beam. RESULTS Measurement of the 12 different cup positions with the Lewinnek's method yielded a mean deviation of [Formula: see text] (95 % CI 1.3-2.3) from the original cup anteversion. The respective deviation with the Widmer/Liaw's method was [Formula: see text] (95 % CI 2.4-4.0). In each case, retroversion could be differentiated from anteversion with a second radiograph. Because of the multidirectional central beam offset ([Formula: see text] cm) from the acetabular cup in the cup holder ([Formula: see text] anteversion and [Formula: see text] inclination), the mean absolute difference for anteversion was [Formula: see text] (range [Formula: see text] to [Formula: see text] and [Formula: see text] (range [Formula: see text] to [Formula: see text] for inclination. The application of our novel mathematical correction of the central beam offset reduced deviation to a mean difference of [Formula: see text] for anteversion and [Formula: see text] for inclination. CONCLUSION This novel calculation for central beam offset correction enables highly accurate measurement of the cup position.
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Affiliation(s)
- T Schwarz
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany.
| | - M Weber
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - M Wörner
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - T Renkawitz
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - J Grifka
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - B Craiovan
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
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Nie Y, Pei FX, Li ZM. Finite element modelling for assessing effect of acetabular component orientation on the basic stress path above acetabular dome. Orthop Surg 2015; 7:66-73. [PMID: 25708038 DOI: 10.1111/os.12148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/29/2014] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the effect of acetabular component orientation on the basic stress path above the acetabular dome in the recommended safe zone. METHODS A subject-specific normal hip finite element model was generated and a convergence study carried out to determine the number of material properties for trabecular bone using a normal hip model. Four abduction angles (35°, 40°, 45° and 50°) and four anteversion angles (10°, 15°, 20° and 25°) from the recommended safe zone of acetabular cup orientation were chosen to simulate acetabular reconstruction. The distribution and level of periacetabular stress was assessed using a normal hip model as a control and 16 reconstructed acetabula in simulated single-legged stances. RESULTS The error of the average stress between plans four and five (50 and 100 materials for trabecular bone respectively) was 4.8%, which is less than the previously defined 5% error. The effect of acetabular component orientation on stress distribution in trabecular bone was not pronounced. When the acetabular component was at 15° anteversion and the abduction angle was 40° or 45°, the stress level on posterolateral cortical bone above the acetabular dome was as stable as that in the normal hip model. CONCLUSIONS Acetabular component orientation affects the basic stress path above the acetabular dome. Thus, orientation should be considered when attempting to restore normal biomechanics in the main load-bearing area.
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Affiliation(s)
- Yong Nie
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China
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11
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Xie W, Franke J, Chen C, Grützner PA, Schumann S, Nolte LP, Zheng G. A complete-pelvis segmentation framework for image-free total hip arthroplasty (THA): methodology and clinical study. Int J Med Robot 2014; 11:166-80. [PMID: 25258044 DOI: 10.1002/rcs.1619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 08/25/2014] [Accepted: 08/27/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Complete-pelvis segmentation in antero-posterior pelvic radiographs is required to create a patient-specific three-dimensional pelvis model for surgical planning and postoperative assessment in image-free navigation of total hip arthroplasty. METHODS A fast and robust framework for accurately segmenting the complete pelvis is presented, consisting of two consecutive modules. In the first module, a three-stage method was developed to delineate the left hemi-pelvis based on statistical appearance and shape models. To handle complex pelvic structures, anatomy-specific information processing techniques were employed. As the input to the second module, the delineated left hemi-pelvis was then reflected about an estimated symmetry line of the radiograph to initialize the right hemi-pelvis segmentation. The right hemi-pelvis was segmented by the same three-stage method, RESULTS Two experiments conducted on respectively 143 and 40 AP radiographs demonstrated a mean segmentation accuracy of 1.61±0.68 mm. A clinical study to investigate the postoperative assessment of acetabular cup orientations based on the proposed framework revealed an average accuracy of 1.2°±0.9° and 1.6°±1.4° for anteversion and inclination, respectively. Delineation of each radiograph costs less than one minute. CONCLUSIONS Despite further validation needed, the preliminary results implied the underlying clinical applicability of the proposed framework for image-free THA.
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Affiliation(s)
- Weiguo Xie
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Switzerland.,BG Trauma Centre Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Jochen Franke
- BG Trauma Centre Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Cheng Chen
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland
| | - Paul A Grützner
- BG Trauma Centre Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany
| | - Steffen Schumann
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland
| | - Lutz-P Nolte
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland
| | - Guoyan Zheng
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, CH-3014, Bern, Switzerland
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Is the acetabular cup orientation after total hip arthroplasty on a two dimension or three dimension model accurate? INTERNATIONAL ORTHOPAEDICS 2014; 38:2009-15. [DOI: 10.1007/s00264-014-2336-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
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13
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Ehlke M, Ramm H, Lamecker H, Hege HC, Zachow S. Fast generation of virtual X-ray images for reconstruction of 3D anatomy. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2013; 19:2673-2682. [PMID: 24051834 DOI: 10.1109/tvcg.2013.159] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We propose a novel GPU-based approach to render virtual X-ray projections of deformable tetrahedral meshes. These meshes represent the shape and the internal density distribution of a particular anatomical structure and are derived from statistical shape and intensity models (SSIMs). We apply our method to improve the geometric reconstruction of 3D anatomy (e.g. pelvic bone) from 2D X-ray images. For that purpose, shape and density of a tetrahedral mesh are varied and virtual X-ray projections are generated within an optimization process until the similarity between the computed virtual X-ray and the respective anatomy depicted in a given clinical X-ray is maximized. The OpenGL implementation presented in this work deforms and projects tetrahedral meshes of high resolution (200.000+ tetrahedra) at interactive rates. It generates virtual X-rays that accurately depict the density distribution of an anatomy of interest. Compared to existing methods that accumulate X-ray attenuation in deformable meshes, our novel approach significantly boosts the deformation/projection performance. The proposed projection algorithm scales better with respect to mesh resolution and complexity of the density distribution, and the combined deformation and projection on the GPU scales better with respect to the number of deformation parameters. The gain in performance allows for a larger number of cycles in the optimization process. Consequently, it reduces the risk of being stuck in a local optimum. We believe that our approach will improve treatments in orthopedics, where 3D anatomical information is essential.
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A new method for the measurement of anteversion of the acetabular cup after total hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:897-903. [PMID: 24253955 DOI: 10.1007/s00590-013-1353-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 10/30/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Many methods of determining the anteversion of the acetabular cup have been described in the literature. The advantages and disadvantages of each of these methods are discussed in this paper. We present a new method of measuring the acetabular anteversion at the anteroposterior hip. MATERIALS AND METHODS The formula designed by the authors was anteversion angle (α) = arc sin |PK|/√ |AK| × |BK|. The formula was tested using the AutoCAD software, and an experimental study was conducted to evaluate the accuracy. Three groups were created, and 16 X-ray images were taken and coded. Ten orthopaedic surgeons measured the acetabular anteversion from these X-rays using our formula. RESULTS The results in Group 1 were closer to the actual value; in contrast, the results in Group 2 differed from the actual values. The results in Group 3 were as close to the actual anteversion values as were those in Group 1. CONCLUSION Developments in technology often bring an increase in complications. Despite newly developed surgical methods and technology, the position of the acetabular cup is still used to determine the results of a total hip arthroplasty. Our method is simple, cost-effective and achieves almost 100 % accuracy.
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Xie W, Franke J, Chen C, Grützner PA, Schumann S, Nolte LP, Zheng G. Statistical model-based segmentation of the proximal femur in digital antero-posterior (AP) pelvic radiographs. Int J Comput Assist Radiol Surg 2013; 9:165-76. [PMID: 23900851 DOI: 10.1007/s11548-013-0932-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 07/16/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Weiguo Xie
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, 3014 , Bern, Switzerland,
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Franke J, Zheng G, Wendl K, Grützner PA, von Recum J. Clinical experience with computer navigation in revision total hip arthroplasty. Proc Inst Mech Eng H 2013; 226:919-26. [PMID: 23636955 DOI: 10.1177/0954411912456792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The biomechanically and anatomically correct placement of hip prostheses components is the main challenge in revision hip arthroplasty. The orientation of the cup and stem with the restoration of leg length, offset and hip centre is hampered by the defect situations frequently present. In primary hip arthroplasty, it has been demonstrated that the components can be accurately positioned using computer-navigated procedures. However, such procedures could also be of considerable benefit in revision hip arthroplasty. Systems that not only detect anatomical landmarks using pointers but also use image data for referencing may provide a possible solution for the defect situation. Literature about navigation in revision arthroplasty is very rare. This article comprises general considerations on this subject and presents our experience and possible clinical applications.
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Affiliation(s)
- Jochen Franke
- MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at Heidelberg University Hospital, Ludwigshafen, Germany.
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Cerveri P, Manzotti A, Marchente M, Confalonieri N, Baroni G. Mean-shifted surface curvature algorithm for automatic bone shape segmentation in orthopedic surgery planning: a sensitivity analysis. ACTA ACUST UNITED AC 2012; 17:128-41. [PMID: 22462564 DOI: 10.3109/10929088.2012.670667] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The results of recent studies concerning statistical bone atlases and automated shape analysis are promising with a view to widening the use of surface models in orthopedic clinical practice, both in pre-operative planning and in the intra-operative stages. In this domain, automatic shape analysis is strongly advocated because it offers the opportunity to detect morphological and clinical landmarks with superior repeatability in comparison to human operators. Surface curvatures have been proposed extensively for segmentation and labeling of image and surface regions based on their appearance and shape. The surface curvature is an invariant that can be exploited for reliable detection of geometric features. In this paper, we investigate the potentiality of the algorithm termed mean-shift (MS), as applied to a non-linear combination of the minimum and maximum curvatures of a surface. We exploited a sensitivity analysis of the algorithm parameters across increasing surface resolutions. Results obtained with femur and pelvic bone surface data, reconstructed from cadaveric CT scans, demonstrated that the information content derived by the MS non-linear curvature overcomes both the mean and the Gaussian curvatures and the original non-linear curvature. By applying a threshold-based clustering algorithm to the curvature distribution, we found that the number of clusters yielded by the MS non-linear curvature is significantly lower (by a factor of up to 6) than that obtained by using the original non-linear curvature. In conclusion, this study provides valuable insights into the use of surface curvature for automatic shape analysis.
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Affiliation(s)
- Pietro Cerveri
- Department of Bioengineering, Politecnico di Milano, Milan, Italy.
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