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Wang M, Li D, Shang X, Wang J. A review of computer-assisted orthopaedic surgery systems. Int J Med Robot 2020; 16:1-28. [PMID: 32362063 DOI: 10.1002/rcs.2118] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/07/2020] [Accepted: 04/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Computer-assisted orthopaedic surgery systems have great potential, but no review has focused on computer-assisted surgery systems for the spine, hip, and knee. METHODS A systematic search was performed in Web of Science and PubMed. We searched the literature on computer-assisted orthopaedic surgery systems from 2008 to the present and focused on three aspects of systems: training, planning, and intraoperative navigation. RESULTS AND DISCUSSION In this review study, we reviewed 34 surgical training systems, 31 surgical planning systems, and 41 surgical navigation systems. The functions and characteristics of the surgical systems were compared and analysed, and the current concerns about and the impact of the surgical systems on doctors and surgery were clarified. CONCLUSION Computer-assisted orthopaedic surgery systems are still in the development stage. Future surgical training systems should include synthetic models with patient anatomy. Surgical planning systems with automatic planning should be developed, and surgical navigation systems with multimodal fusion, robotic assistance and imaging should be developed.
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Affiliation(s)
- Monan Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Donghui Li
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Xiping Shang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Jian Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
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2
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Koper MC, Reijman M, van Es EM, Waarsing JH, Koot HWJ, Keizer SB, Jansen I, van Biezen FC, Verhaar JAN, Bos PK. No added value for Computer-Assisted surgery to improve femoral component positioning and Patient Reported Outcomes in Hip Resurfacing Arthroplasty; a multi-center randomized controlled trial. BMC Musculoskelet Disord 2019; 20:473. [PMID: 31651318 PMCID: PMC6814023 DOI: 10.1186/s12891-019-2883-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/07/2019] [Indexed: 12/12/2022] Open
Abstract
Background Computer Assisted Surgery (CAS) has proven to improve the accuracy in several orthopedic procedures. Therefore we used this technique to evaluate femoral component positioning in Hip Resurfacing Arthroplasty (HRA). The aim of this study was to evaluate imageless CAS compared to manually implanted femoral components and subsequently evaluates Patient Related Outcome Measures (PROMs). We hypothesized that the use of CAS optimizes the position of the femoral component and improves PROMs. Methods This is a multicenter, single-blinded, randomized, controlled trial of two groups. In the CAS group guiding of the femoral component was done with imageless navigation. In the Conventional (control) group the femoral component was placed manually according to the preplanned position. The primary outcome measure consists of a maximum of 3 degrees difference between the postoperative Stem Shaft Angle (SSA) and preplanned SSA. Secondary outcome measures consist of the Hip disability and Osteoarthritis Outcome Scale (HOOS), the Harris Hip Score (HHS) and Visual Analogue Scale (VAS) pain score. Results A total of 122 patients were randomized, 61 in the CAS group and 61 in the conventional group. There was no significant differences in accuracy of femoral implant position. The mean difference between the postoperative- and preplanned SSA was − 2.26 and − 1.75 degrees (more varus) respectively in the CAS and Conventional group. After surgery both groups show significant improvement in all PROMs compared to the baseline measurements, with no significant differences between the groups. Conclusion Our cohort indicates no benefit for the use of CAS in accuracy of placement of the femoral component in HRA compared to manual implantation. There are no clinical differences in PROMs after 1 year follow up. This study showed no added value and no justification for the use of CAS in femoral component positioning in HRA. Trial registration This trial is registered at ClinicalTrails.gov (https://clinicaltrials.gov/) on the 25th of October 2006: NCT00391937. Level of incidence Level IIb, multicenter randomized controlled trial.
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Affiliation(s)
- M C Koper
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands.
| | - M Reijman
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - E M van Es
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - J H Waarsing
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - H W J Koot
- Department of Orthopedics, Maxima Medical Center, Eindhoven, The Netherlands
| | - S B Keizer
- Department of Orthopedics, Medical Center Haaglanden, Den Haag, The Netherlands
| | - I Jansen
- Department of Orthopedics, Admiraal de Ruyter Hospital, Goes, The Netherlands
| | - F C van Biezen
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - J A N Verhaar
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
| | - P K Bos
- Department of Orthopedics, Erasmus University Medical Center, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands
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Bai L, Yang J, Chen X, Sun Y, Li X. Medical Robotics in Bone Fracture Reduction Surgery: A Review. SENSORS (BASEL, SWITZERLAND) 2019; 19:E3593. [PMID: 31426577 PMCID: PMC6720500 DOI: 10.3390/s19163593] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 11/17/2022]
Abstract
Since the advantages of precise operation and effective reduction of radiation, robots have become one of the best choices for solving the defects of traditional fracture reduction surgery. This paper focuses on the application of robots in fracture reduction surgery, design of the mechanism, navigation technology, robotic control, interaction technology, and the bone-robot connection technology. Through literature review, the problems in current fracture reduction robot and its future development are discussed.
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Affiliation(s)
- Long Bai
- State Key Laboratory of Mechanical Transmission, Chongqing University, Chongqing 400044, China.
| | - Jianxing Yang
- State Key Laboratory of Mechanical Transmission, Chongqing University, Chongqing 400044, China
| | - Xiaohong Chen
- State Key Laboratory of Mechanical Transmission, Chongqing University, Chongqing 400044, China
| | - Yuanxi Sun
- State Key Laboratory of Mechanical Transmission, Chongqing University, Chongqing 400044, China
| | - Xingyu Li
- State Key Laboratory of Mechanical Transmission, Chongqing University, Chongqing 400044, China
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Sato R, Takao M, Hamada H, Sakai T, Marumo K, Sugano N. Clinical accuracy and precision of hip resurfacing arthroplasty using computed tomography-based navigation. INTERNATIONAL ORTHOPAEDICS 2018; 43:1807-1814. [PMID: 30135983 DOI: 10.1007/s00264-018-4113-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/13/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE To avoid malalignment of components during hip resurfacing arthroplasty (HRA), we used a computed tomography (CT)-based navigation system for guidance. This study aimed to evaluate the clinical accuracy and precision of HRA performed using the CT-based navigation systems. METHODS HRA was performed on 17 hips guided by the CT-based navigation systems. We measured cup alignment deviation, deviation of the stem position, and alignment from the plan by image matching between pre-operative and post-operative CT images. RESULTS Cup anteversion was within 5° of that in the plan in all cases. Cup inclination was within 5° of that in the plan in 82.4% and within 10° in all cases. The angular difference of the stem was within 5° in all cases, and the entry point of the stem was within 4 mm in all cases. CONCLUSION The CT-based navigation system for HRA guided accurate component placement according to the plan.
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Affiliation(s)
- Ryuichi Sato
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masaki Takao
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Keishi Marumo
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Gallart X, Riba J, Fernández-Valencia J, Bori G, Muñoz-Mahamud E, Combalia A. Hip prostheses in young adults. Surface prostheses and short-stem prostheses. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018. [DOI: 10.1016/j.recote.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Gallart X, Riba J, Fernández-Valencia JA, Bori G, Muñoz-Mahamud E, Combalia A. Hip prostheses in young adults. Surface prostheses and short-stem prostheses. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 62:142-152. [PMID: 29196225 DOI: 10.1016/j.recot.2017.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/31/2017] [Accepted: 10/28/2017] [Indexed: 12/22/2022] Open
Abstract
The poor results obtained in young patients when using a conventional prosthesis led to the resurgence of hip resurfacing to find less invasive implants for the bone. Young patients present a demand for additional activity, which makes them a serious challenge for the survival of implants. In addition, new information technologies contribute decisively to the preference for non-cemented prostheses. Maintaining quality of life, preserving the bone and soft tissues, as well as achieving a very stable implant, are the goals of every hip orthopaedic surgeon for these patients. The results in research point to the use of smaller prostheses, which use the metaphyseal zone more and less the diaphyseal zone, and hence the large number of the abovementioned short stem prostheses. Both models are principally indicated in the young adult. Their revision should be a more simple operation, but this is only true for hip resurfacing, not for short stems.
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Affiliation(s)
- X Gallart
- Instituto Clínico de Especialidades Médico-Quirúrgicas (ICEMEQ), Servicio de Cirugía Ortopédica y Traumatología, Unidad de Cadera, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
| | - J Riba
- Instituto Clínico de Especialidades Médico-Quirúrgicas (ICEMEQ), Servicio de Cirugía Ortopédica y Traumatología, Unidad de Cadera, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - J A Fernández-Valencia
- Instituto Clínico de Especialidades Médico-Quirúrgicas (ICEMEQ), Servicio de Cirugía Ortopédica y Traumatología, Unidad de Cadera, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - G Bori
- Instituto Clínico de Especialidades Médico-Quirúrgicas (ICEMEQ), Servicio de Cirugía Ortopédica y Traumatología, Unidad de Cadera, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - E Muñoz-Mahamud
- Instituto Clínico de Especialidades Médico-Quirúrgicas (ICEMEQ), Servicio de Cirugía Ortopédica y Traumatología, Unidad de Cadera, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - A Combalia
- Instituto Clínico de Especialidades Médico-Quirúrgicas (ICEMEQ), Servicio de Cirugía Ortopédica y Traumatología, Unidad de Cadera, Hospital Clínic, Universidad de Barcelona, Barcelona, España
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A single surgeon’s experience of metal-on-metal hip resurfacing arthroplasty in a district general hospital: 9-year clinical results using the Conserve Plus resurfacing system. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dubois L, Jansen J, Schreurs R, Habets PE, Reinartz SM, Gooris PJ, Becking AG. How reliable is the visual appraisal of a surgeon for diagnosing orbital fractures? J Craniomaxillofac Surg 2016; 44:1015-24. [DOI: 10.1016/j.jcms.2016.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 04/12/2016] [Accepted: 05/09/2016] [Indexed: 12/20/2022] Open
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Stiehler M, Goronzy J, Kirschner S, Hartmann A, Schäfer T, Günther KP. Effect of surgical experience on imageless computer-assisted femoral component positioning in hip resurfacing--a preclinical study. Eur J Med Res 2015; 20:18. [PMID: 25890316 PMCID: PMC4355522 DOI: 10.1186/s40001-015-0086-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 01/11/2015] [Indexed: 11/13/2022] Open
Abstract
Background The clinical outcome of hip resurfacing (HR) as a demanding surgical technique associated with a substantial learning curve depends on the position of the femoral component. The aim of the study was to investigate the effects of the level of surgical experience on computer-assisted imageless navigation concerning precision of femoral component positioning, notching, and oversizing rate, as well as operative time. Methods Three surgeons with different levels of experience in both HR and computer-assisted surgery (CAS) prepared the femoral heads of 54 synthetic femurs using the DuromTM Hip Resurfacing (Zimmer, Warsaw, IN, USA) system. Each surgeon prepared a total of 18 proximal femurs using the Navitrack® system (ORTHOsoft Inc., Montreal, Canada) or the conventional free-hand DuromTM K-wire positioning jig. The differences between planned and postoperative stem shaft angle (SSA) and anteversion angle in standardized x-rays were measured and the operative time, not including the time for calibrating the CAS-system, was documented. Notching was evaluated by the three surgeons in a randomized manner. Oversizing was determined by the difference of the preoperative determined cap and the cap size advised by the CAS-system. Results CAS significantly reduced the overall mean deviation between planned and postoperative SSA in comparison with the conventional procedure (mean ± SD, 1 ± 1.7° vs. 7.4 ± 4.4°, P <0.01) regardless of the surgeon’s level of experience. The incidence of either varus or valgus SSA deviations exceeding 5° were 1/27 for CAS and 15/27 for the conventional method, respectively (P <0.001), corresponding to a reduction by 97%. Using CAS, the rate of notching was reduced by 100%. Conclusions The accuracy of femoral HR component orientation is significantly increased by use of CAS regardless of the surgeon’s level of experience in our preclinical study. Thus, imageless computer-assisted navigation can be a valuable tool to improve implant positioning in HR for surgeons at any stage of their learning curve.
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Affiliation(s)
- Maik Stiehler
- University Centre for Orthopaedics & Trauma Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstr. 74, Building 29, D-01307, Dresden, Germany.
| | - Jens Goronzy
- University Centre for Orthopaedics & Trauma Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstr. 74, Building 29, D-01307, Dresden, Germany.
| | - Stephan Kirschner
- Department of Orthopaedics, St. Vincentius Clinic, Steinhäuserstrasse 18, 76135, Karlsruhe, Germany.
| | - Albrecht Hartmann
- University Centre for Orthopaedics & Trauma Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstr. 74, Building 29, D-01307, Dresden, Germany.
| | - Torsten Schäfer
- Dermatological Practice, Kirchplatz 3, 87059, Immenstadt, Germany.
| | - Klaus-Peter Günther
- University Centre for Orthopaedics & Trauma Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, Fetscherstr. 74, Building 29, D-01307, Dresden, Germany.
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Olsen M, Naudie DD, Edwards MR, Sellan ME, McCalden RW, Schemitsch EH. Evaluation of a patient specific femoral alignment guide for hip resurfacing. J Arthroplasty 2014; 29:590-5. [PMID: 24034907 DOI: 10.1016/j.arth.2013.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/28/2013] [Accepted: 08/01/2013] [Indexed: 02/01/2023] Open
Abstract
A novel alternative to conventional instrumentation for femoral component insertion in hip resurfacing is a patient specific, computed tomography based femoral alignment guide. A benchside study using cadaveric femora was performed comparing a custom alignment guide to conventional instrumentation and computer navigation. A clinical series of twenty-five hip resurfacings utilizing a custom alignment guide was conducted by three surgeons experienced in hip resurfacing. Using cadaveric femora, the custom guide was comparable to conventional instrumentation with computer navigation proving superior to both. Clinical femoral component alignment accuracy was 3.7° and measured within ± 5° of plan in 20 of 24 cases. Patient specific femoral alignment guides provide a satisfactory level of accuracy and may be a better alternative to conventional instrumentation for initial femoral guidewire placement in hip resurfacing.
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Affiliation(s)
- Michael Olsen
- Martin Orthopaedic Biomechanics Laboratory, St. Michael's Hospital, University of Toronto, B114 Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Douglas D Naudie
- Department of Surgery, Division of Orthopaedic Surgery, London Health Sciences Centre, Western University, London, ON, Canada
| | - Max R Edwards
- Department of Surgery, Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Michael E Sellan
- Martin Orthopaedic Biomechanics Laboratory, St. Michael's Hospital, University of Toronto, B114 Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Richard W McCalden
- Department of Surgery, Division of Orthopaedic Surgery, London Health Sciences Centre, Western University, London, ON, Canada
| | - Emil H Schemitsch
- Department of Surgery, Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, ON, Canada
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Kitada M, Sakai T, Murase T, Hanada T, Nakamura N, Sugano N. Validation of the femoral component placement during hip resurfacing: a comparison between the conventional jig, patient-specific template, and CT-based navigation. Int J Med Robot 2013; 9:223-9. [PMID: 23460526 DOI: 10.1002/rcs.1490] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Makoto Kitada
- Center of Arthroplasty; Kyowakai-Hospital; Osaka Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery; Osaka University Graduate School of Medicine; Osaka Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery; Osaka University Graduate School of Medicine; Osaka Japan
| | | | | | - Nobuhiko Sugano
- Department of Orthopaedic Surgery; Osaka University Graduate School of Medicine; Osaka Japan
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Sugano N. Computer-assisted orthopaedic surgery and robotic surgery in total hip arthroplasty. Clin Orthop Surg 2013; 5:1-9. [PMID: 23467021 PMCID: PMC3582865 DOI: 10.4055/cios.2013.5.1.1] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 07/23/2012] [Indexed: 11/30/2022] Open
Abstract
Various systems of computer-assisted orthopaedic surgery (CAOS) in total hip arthroplasty (THA) were reviewed. The first clinically applied system was an active robotic system (ROBODOC), which performed femoral implant cavity preparation as programmed preoperatively. Several reports on cementless THA with ROBODOC showed better stem alignment and less variance in limb-length inequality on radiographic evaluation, less incidence of pulmonary embolic events on transesophageal cardioechogram, and less stress shielding on the dual energy X-ray absorptiometry analysis than conventional manual methods. On the other hand, some studies raise issues with active systems, including a steep learning curve, muscle and nerve damage, and technical complications, such as a procedure stop due to a bone motion during cutting, requiring re-registration and registration failure. Semi-active robotic systems, such as Acrobot and Rio, were developed for ease of surgeon acceptance. The drill bit at the tip of the robotic arm is moved by a surgeon's hand, but it does not move outside of a milling path boundary, which is defined according to three-dimensional (3D) image-based preoperative planning. However, there are still few reports on THA with these semi-active systems. Thanks to the advancements in 3D sensor technology, navigation systems were developed. Navigation is a passive system, which does not perform any actions on patients. It only provides information and guidance to the surgeon who still uses conventional tools to perform the surgery. There are three types of navigation: computed tomography (CT)-based navigation, imageless navigation, and fluoro-navigation. CT-based navigation is the most accurate, but the preoperative planning on CT images takes time that increases cost and radiation exposure. Imageless navigation does not use CT images, but its accuracy depends on the technique of landmark pointing, and it does not take into account the individual uniqueness of the anatomy. Fluoroscopic navigation is good for trauma and spine surgeries, but its benefits are limited in the hip and knee reconstruction surgeries. Several studies have shown that the cup alignment with navigation is more precise than that of the conventional mechanical instruments, and that it is useful for optimizing limb length, range of motion, and stability. Recently, patient specific templates, based on CT images, have attracted attention and some early reports on cup placement, and resurfacing showed improved accuracy of the procedures. These various CAOS systems have pros and cons. Nonetheless, CAOS is a useful tool to help surgeons perform accurately what surgeons want to do in order to better achieve their clinical objectives. Thus, it is important that the surgeon fully understands what he or she should be trying to achieve in THA for each patient.
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Affiliation(s)
- Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan.
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The First SICOT Oral Presentation Award 2011: imageless computer-assisted femoral component positioning in hip resurfacing: a prospective randomised trial. INTERNATIONAL ORTHOPAEDICS 2013; 37:569-81. [PMID: 23385606 DOI: 10.1007/s00264-012-1762-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 12/17/2012] [Indexed: 01/16/2023]
Abstract
PURPOSE The aim of the study was to evaluate the effects of imageless computer-assisted surgery (CAS) on the accuracy of positioning of the femoral component and on the short-term clinical outcome in hip resurfacing (HR) using a randomised prospective design. METHODS A total of 75 consecutive patients undergoing HR were randomly allocated to CAS and conventional implantation, respectively. Preoperatively and six months post-operatively standardised pelvic anteroposterior X-ray images, the total Western Ontario and McMaster Universities Osteoarthritis Index, the Harris Hip Score and the EQ-5D utility index were evaluated in a blinded manner. The primary end point of the study was a post-operative femoral component malpositioning in five degrees or more either varus or valgus absolute deviation from the planned stem shaft angle. RESULTS Patient demographics and algofunctional scores did not differ between the CAS and conventional implantation samples. Using CAS fewer femoral components were positioned in five or more degrees absolute deviation (4/37 vs 12/38, Fisher's exact p = 0.047; 95 % confidence interval for the primary end point's incidence difference: +3 %; +39 %); the respective incidences of five or more degrees of varus deviation were 0/37 vs 5/38. One conversion to a stemmed prosthesis (CAS group) was performed for periprosthetic femoral neck fracture. Radiological signs of superolateral femoral neck/implant impingement were observed in two cases (one CAS-based and one conventional implantation). CONCLUSIONS The accuracy of femoral HR component positioning was significantly improved using CAS. However, one major complication necessitated early revision in the CAS group at six months of observation. Apart from that adverse event no inter-group differences were observed for the short-term clinical outcome. Future studies need to address the clinical long-term relevance of CAS in HR.
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Chiron P, Pailhé R, Reina N, Ancelin D, Sharma A, Maubisson L, Laffosse JM. Radiological validation of a fluoroscopic guided technique for femoral implant positioning during hip resurfacing. INTERNATIONAL ORTHOPAEDICS 2013; 37:361-8. [PMID: 23359098 DOI: 10.1007/s00264-013-1777-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 01/04/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The positioning of the femoral cup in hip resurfacing is essential for the survival of the implant. We described a technique in 2005 to position the femoral cup guided by fluoroscopy independent of the approach performed. The main objectives were to study the positioning of the femoral components of the implant and the accuracy of the technique. METHODS Between 2003 and 2011 we conducted a prospective study of 160 consecutive hip resurfacings all operated with this fluoroscopic-guided technique. Three independent observers performed a radiographic analysis at the pre-operative planning stage and on postoperative radiographs using OsiriX software. The statistical analysis was based on comparison of two groups by Student's t test. RESULTS The entire implant was positioned in valgus, with an average of 7.816° valgus (p <0.001). All implants were positioned in neutral or anteverted with a mean of 1.98° (p <0.001). The risk of malpositioning on the antero-posterior plane was less than 1.41° with p <0.019. The risk of profile positioning error was lower than 0.80° with p <0.047. CONCLUSION This study validates a technique of femoral implant positioning for resurfacing. It is simple, precise and independent of the approach performed.
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Affiliation(s)
- Philippe Chiron
- The Service de Chirurgie Orthopédique et de Traumatologie, Centre Hospitalier Universitaire de Rangueil, Toulouse, France
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Morison Z, Mehra A, Olsen M, Donnelly M, Schemitsch E. Computer navigation experience in hip resurfacing improves femoral component alignment using a conventional jig. Indian J Orthop 2013; 47:585-90. [PMID: 24379464 PMCID: PMC3868140 DOI: 10.4103/0019-5413.121585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The use of computer navigation has been shown to improve the accuracy of femoral component placement compared to conventional instrumentation in hip resurfacing. Whether exposure to computer navigation improves accuracy when the procedure is subsequently performed with conventional instrumentation without navigation has not been explored. We examined whether femoral component alignment utilizing a conventional jig improves following experience with the use of imageless computer navigation for hip resurfacing. MATERIALS AND METHODS Between December 2004 and December 2008, 213 consecutive hip resurfacings were performed by a single surgeon. The first 17 (Cohort 1) and the last 9 (Cohort 2) hip resurfacings were performed using a conventional guidewire alignment jig. In 187 cases, the femoral component was implanted using the imageless computer navigation. Cohorts 1 and 2 were compared for femoral component alignment accuracy. RESULTS All components in Cohort 2 achieved the position determined by the preoperative plan. The mean deviation of the stem-shaft angle (SSA) from the preoperatively planned target position was 2.2° in Cohort 2 and 5.6° in Cohort 1 (P = 0.01). Four implants in Cohort 1 were positioned at least 10° varus compared to the target SSA position and another four were retroverted. CONCLUSIONS Femoral component placement utilizing conventional instrumentation may be more accurate following experience using imageless computer navigation.
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Affiliation(s)
- Zachary Morison
- Department of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada,Address for correspondence: Ms. Zachary Morison, Division of Orthopaedic Surgery St. Michael's Hospital, 55 Queen Street East, Suite 800, Toronto, Ontario M5C 1R6, Canada. E-mail:
| | - Akshay Mehra
- Department of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Michael Olsen
- Department of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Michael Donnelly
- Department of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Emil Schemitsch
- Department of Orthopaedic Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Liu H, Li L, Gao W, Wang M, Ni C. Computer navigation vs conventional mechanical jig technique in hip resurfacing arthroplasty: a meta-analysis based on 7 studies. J Arthroplasty 2013; 28:98-102.e1. [PMID: 22771091 DOI: 10.1016/j.arth.2012.05.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 05/23/2012] [Indexed: 02/01/2023] Open
Abstract
The studies on the accuracy of femoral component in hip resurfacing arthroplasty with the help of computer-assisted navigation were not consistent. This study aims to assess at the functional outcomes after computer navigation in hip resurfacing arthroplasty by systematically reviewing and meta-analyzing the data, which were searched up to December 2011 in PubMed, MEDLINE, EMBASE, MetaMed, EBSCO HOST, and the Web site of Google scholar. Totally, 197 articles about hip resurfacing arthroplasty were collected; finally, 7 articles met the inclusion criteria and were included in this meta-analysis (520 patients with 555 hip resurfacing arthroplasty). The odds ratio for the number of outliers was 0.155 (95% confidence interval, 0.048-0.498; P < .003). In conclusion, this meta-analysis suggests that the computer-assisted navigation system makes the femoral component positioning in hip resurfacing arthroplasty easier and more precise.
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Affiliation(s)
- Hao Liu
- Hangzhou First Municipal Hospital and Affiliated Hangzhou Hospital of Nanjing Medical University, Hangzhou, 310006, China
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Schleicher I, Haselbacher M, Mayr E, Kaiser PM, Lenze FW, Keiler A, Nogler M. Accuracy of navigation in hip resurfacing with different surgeons and varying anatomy. ACTA ACUST UNITED AC 2012; 17:77-85. [PMID: 22348660 DOI: 10.3109/10929088.2011.652674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The accuracy of a commercial imageless navigation system for hip resurfacing and its reproducibility among different surgeons and for varying femoral anatomy was tested by comparing conventional and navigated implantation of the femoral component on different sawbones in a hip simulator. The position of the component was measured on postoperative radiographs. Variance for varus/valgus alignment and anteversion was higher for conventional implantation. Among the three surgeons, operation time, chosen implant size and anteversion were significantly different for conventional implantation but not for the navigated method. Using navigation, no difference was found for normal and abnormal anatomy. Values obtained with the navigation system were consistent with those measured on radiographs. Navigation appeared to be accurate and helped to reduce outliers. This was true for the three different surgeons and in varying anatomical situations.
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Affiliation(s)
- Iris Schleicher
- Department of Trauma Surgery, Justus-Liebig-University Giessen, Giessen, Germany.
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Girard J, Krantz N, Bocquet D, Wavreille G, Migaud H. Femoral head to neck offset after hip resurfacing is critical for range of motion. Clin Biomech (Bristol, Avon) 2012; 27:165-9. [PMID: 21925779 DOI: 10.1016/j.clinbiomech.2011.08.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 08/25/2011] [Accepted: 08/25/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Range of motion after hip arthroplasty may be limited by soft tissues around the hip, extra-articular contact and femoral stem-neck contact with the acetabular articular surface. Femoral head-neck diameter ratio is recognized as a major factor influencing hip range of motion. In hip resurfacing, range of motion is constrained by "cup component to femoral neck" contact. To avoid cup-to-bone contact or to increase the degree of flexion at which it occurs, anterior translation of the femoral component relative to the central femoral neck axis may improve anterior head-neck offset and hip flexion. We questioned whether low or high anterior femoral head to neck offset, cup inclination, stem anteversion, and component size influenced postoperative range of motion and hip flexion in patients who had undergone hip resurfacing. METHODS We prospectively followed 66 patients (68 hips) who underwent hip resurfacing at a mean age at operation of 46.4 years (range, 19-60 years). Mean follow-up was 37.5 months (range, 33-41 months). No patient was lost to follow-up. All patients were evaluated clinically and range of motion was precised. Radiological measurement evaluated the anterior femoral head-neck offset. FINDINGS Mean anterior neck-head offset was 7.5mm (range, 5-12 mm). We found significant linear regression correlation between anterior offset and flexion (R=0.66) and between anterior offset and global range of motion (R=0.51). One millimeter of anterior offset increased hip range of motion by 5° in flexion. No significant correlations were found between global range of motion or flexion arc of motion and component size, stem anteversion, cup inclination, gender ratio, preoperative arc of flexion or global range of motion. INTERPRETATION Restoring or improving deficient anterior femoral head-neck offset appears important for restoring postoperative range of motion and specifically hip flexion.
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Affiliation(s)
- J Girard
- University Lille Nord de France, F-59000 Lille, France.
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Zhang YZ, Lu S, Yang Y, Xu YQ, Li YB, Pei GX. Design and primary application of computer-assisted, patient-specific navigational templates in metal-on-metal hip resurfacing arthroplasty. J Arthroplasty 2011; 26:1083-7. [PMID: 20932709 DOI: 10.1016/j.arth.2010.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 08/03/2010] [Indexed: 02/01/2023] Open
Abstract
Total hip resurfacing arthroplasty is increasingly being used. One of its goals is to closely mimic the normal anatomy and normal biomechanics of the hip joint. Prosthesis location has a large impact on implant survival and patient function; but in conventional hip resurfacing arthroplasty, precise positioning sometimes cannot be achieved. We describe a novel method for ensuring accurate prosthesis implantation in hip resurfacing arthroplasty by means of 3-dimensional reconstruction and reverse engineering.
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Affiliation(s)
- Yuan Z Zhang
- Department of Orthopaedics, The Affiliated Hospital of Inner Mongolia Medical College, Hohhot, China
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20
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Abstract
Metal-on-metal hip resurfacing offers some potential for total hip arthroplasty (THA) in the young patient. However, short- and intermediate-term results of the currently available implants have failed to demonstrate advantage over conventional THA. The risks of femoral neck fracture or avascular necrosis have been disappointing early limitations of the procedure. The Australian Joint Registry reports a 5-year revision rate of all hip resurfacings of 3.8%, compared with conventional THAs at 2.8%, and a 9-year cumulative revision rate of 7.2% for hip resurfacings. Recent reports of femoral neck erosion and pseudotumors associated with resurfacing have raised concern about the survivorship of the procedure in some patients. Recently, the British Medicines and Healthcare Product Regulatory Agency issued an alert over adverse reactions associated with metal-on-metal THAs, with particular concern expressed about hip resurfacings. Acetabular bone stock may not be conserved when large-diameter femoral head components are used, depending on the surgical technique and implant design. In hip resurfacing, the minimum diameter femoral component avoids notching of the femoral neck; thus, larger diameter acetabular components may be necessary to accommodate the femoral component. Hip resurfacing is contraindicated in cases of avascular necrosis of the femoral head, especially with cysts >1 cm in diameter, with severe slipped capital femoral epiphysis, and in some posttraumatic arthroses; furthermore, the biomechanics of the resurfaced hip appear to be less reliably restored than with conventional THA. The hypothesis that resurfacing is a more conservative procedure than conventional THA remains unproven at this time. Given the documented intermediate failure rates of resurfacing, metal-on-polyethylene is the more successful implant choice.
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Affiliation(s)
- John M Cuckler
- Alabama Medical Consultants, Inc, 12005 Colliers Reserve Dr, Naples, FL 34110, USA.
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Avoiding short-term femoral neck fracture with imageless computer navigation for hip resurfacing. Clin Orthop Relat Res 2011; 469:1621-6. [PMID: 20936388 PMCID: PMC3094642 DOI: 10.1007/s11999-010-1607-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoral neck fracture in hip resurfacing has been attributed to technical error during femoral head preparation. In the absence of fracture, several radiographic findings have been speculated to increase the risk of femoral component failure. QUESTIONS/PURPOSES We examined whether (1) the use of navigation to reduce technical errors during femoral head preparation reduces the incidence of femoral neck fractures in the short-term followup period; and (2) alignment of the femoral component with the use of computer navigation reduces the incidence of femoral neck thinning, femoral stem radiolucencies, and stem migration. METHODS We retrospectively reviewed the first 100 Birmingham Hip Resurfacings performed in 94 prospectively followed patients between October 2005 and November 2007. We examined all radiographs on last followup. Eighty-six patients of the 94 patients had a minimum followup of 2 years (mean, 2.5 years; range, 2-4.1 years). RESULTS There were no cases of femoral neck notching, varus femoral component alignment, or femoral neck fractures in the series. Neck thinning of greater than 10% was observed in three patients and perimetaphyseal stem lucencies were noted in 10 patients. In three patients, the metaphyseal stem showed varus migration relative to the postoperative stem-shaft angle at latest followup. There was one revision to a total hip arthroplasty for deep sepsis. The overall survivorship at 4 years was 99%. CONCLUSIONS The use of imageless computer navigation to reduce technical errors in hip resurfacing may reduce the incidence of femoral neck fracture in the short-term. However, neck thinning, stem radiolucencies, and stem migration remain radiographic sequelae of hip resurfacing despite the use of navigation for placement of the femoral component.
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Almoussa S, Barton C, Speirs AD, Gofton W, Beaulé PE. Computer-assisted correction of cam-type femoroacetabular impingement: a Sawbones study. J Bone Joint Surg Am 2011; 93 Suppl 2:70-5. [PMID: 21543693 DOI: 10.2106/jbjs.j.01706] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Assessing the adequacy of bone resection when correcting cam-type femoroacetabular impingement can be difficult when the surgeon is inexperienced or when less-invasive arthroscopic surgical techniques are used. The primary purpose of the present study was to compare, using a Sawbones model, the results of computer-assisted navigated osteochondroplasty of the femoral neck junction with correction with use of femoral head spherometer gauges. The second objective was to compare the results of computer-assisted osteochondroplasty performed by surgeons who had varied experience with the procedure. METHODS We calculated and compared the post-resection alpha angle in custom-molded Sawbones models with cam-type impingement following both surgical techniques, performed by three surgeons with varied experience with the procedure. The alpha angle was measured at two positions (the three o'clock and one-thirty positions of the femoral head-neck junction) before and after resection. RESULTS At the three o'clock position, there were no significant differences between the computer-navigation and spherometer groups (p = 0.83). There was undercorrection at the one-thirty position, with the median alpha angle being greater in the navigation group as compared with the spherometer group (71.0 compared with 58.6; p = 0.05). In the navigation group, there were no significant differences in the post-resection mean alpha angle among the three surgeons at either the one-thirty plane or the three o'clock plane. CONCLUSIONS Navigation enabled the inexperienced surgeon to perform an equivalent amount of bone resection as the more experienced surgeons. However, all surgeons did not sufficiently resect the cam deformity as compared with the gold-standard open technique at the one-thirty position.
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Affiliation(s)
- Sulaiman Almoussa
- Division of Orthopaedic Surgery, Ottawa Hospital, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
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Abstract
In this article, a concise review of the current literature on metal-on-metal hip resurfacing (MoMHR) is given. In contrast to conventional total hip arthroplasty, older age, female sex and small femoral head sizes predispose to failure. Neck fracture and metal wear-related complications account for the most frequent reasons for re-operations. Although the long-term consequences of metal ion release remain unknown, the increasing prevalence of soft tissue related problems with potentially devastating functional consequences in this younger patient group are of concern. Outcome after revision for metal wear related failure of MoMHR is poor. In our opinion, patients with this device should be managed in dedicated centers with facilities for data collection and monitoring. The majority of proposed advantages of MoMHR cannot be supported by the published evidence.
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Affiliation(s)
- Gavin J Macpherson
- Department of Orthopaedic Surgery, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
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Abstract
We review the history and literature of hip resurfacing arthroplasty. Resurfacing and the science behind it continues to evolve. Recent results, particularly from the national arthroplasty registers, have spread disquiet among both surgeons and patients. A hip resurfacing arthroplasty is not a total hip replacement, but should perhaps be seen as a means of delaying it. The time when hip resurfacing is offered to a patient may be different from that for a total hip replacement. The same logic can apply to the timing of revision surgery. Consequently, the comparison of resurfacing with total hip replacement may be a false one. Nevertheless, the need for innovative solutions for young arthroplasty patients is clear. Total hip replacement can be usefully delayed in many of these patients by the use of hip resurfacing arthroplasty.
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Affiliation(s)
- J M Simpson
- The Richard Villar Practice, Spire Cambridge Lea Hospital, 30 New Road, Cambridge CB24 9EL, UK.
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Font-Vizcarra L, Fernandez-Valencia JA, Gallart X, Segur JM, Prat S, Riba J. Cortical strut allograft as an adjunct to plate fixation for periprosthetic fractures of the femur. Hip Int 2010; 20 Suppl 7:S43-7. [PMID: 20235076 DOI: 10.1177/11207000100200s708] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2010] [Indexed: 02/04/2023]
Abstract
The use of cortical strut allografts in the treatment of periprosthetic femoral fractures remain controversial. Complications such as infection and the potential transmission of disease remain concerns. A retrospective review at a tertiary-care hospital was completed of 21 patients who had sustained a periprosthetic femoral fracture and who were treated using a plate and a deep-frozen cortical strut allograft, between 1996 and 2007. The average age at the time of surgery was 80.3 years old and included 16 women and 5 men. Three patients were lost to follow-up and four died within a few weeks of discharge. The remaining 14 patients were evaluated clinically and radiographically with a mean follow-up of 3.2 years. Fracture union was observed in 13 patients, and integration of the graft occurred in 12 patients. One of the 14 patients developed a deep infection with Coagulase-Negative Staphylococcus, with a satisfactory outcome after surgical debridement and antibiotic treatment. There were no cases of fixation failure or plate rupture. At the final evaluation, the mean EQ-5D VAS score was 64 (ranging from 40-90 points) and the mean EQ-5D health state index adapted to Spanish value sets was 0.57. The mean Oxford Hip Score was 31.2. The results support the use of cortical allograft for these fractures to increase the likelihood of fracture healing and to improve the bone stock. We consider that cortical strut grafting is specially indicated for B1 and C fractures in which decreased bone density is present.
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Affiliation(s)
- Lluis Font-Vizcarra
- Department of Orthopaedic and Trauma Surgery, Hospital Clínic Barcelona, Barcelona, Spain
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Olsen M, Chiu M, Gamble P, Boyle RA, Tumia N, Schemitsch EH. A comparison of conventional guidewire alignment jigs with imageless computer navigation in hip resurfacing arthroplasty. J Bone Joint Surg Am 2010; 92:1834-41. [PMID: 20686057 DOI: 10.2106/jbjs.i.00648] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Correct positioning of the initial femoral guidewire is vital in order to prepare the femoral head properly for hip resurfacing. The purpose of the present investigation was to determine the accuracy and precision of the placement of the initial femoral guidewire with use of conventional alignment jigs and to compare the results with those of imageless computer navigation. METHODS Five commercially available jigs (two lateral pin jigs, two neck centering jigs, and one head planing jig) were obtained. Four surgeons used each jig and navigation three times to insert a guidewire in 10 degrees of relative valgus and neutral version into individual synthetic femora. A single surgeon then used each jig three times to align the initial guidewire in 10 degrees of relative valgus and neutral version in each of ten human cadaver femora. Radiographs of the synthetic and human femora were made to assess and compare guidewire inclination and version between conventional instrumentation and navigation. RESULTS Navigation provided ranges of error in the coronal guidewire alignment of up to eight times less than the conventional jigs, but both methods provided similar ranges of error for version. In both arms of the study, there were significant differences in coronal alignment accuracy between the two neck centering jigs. Next to navigation, one lateral pin jig provided the most accurate coronal placement of the initial guidewire whereas one neck centering jig provided the most precise coronal placement of the guidewire. Navigation was similar to conventional jigs in terms of the accuracy and precision of guidewire version. CONCLUSIONS In hip resurfacing arthroplasty, the choice of a femoral alignment device may influence the accuracy and precision of guidewire insertion, ultimately impacting femoral component placement. Imageless computer navigation can facilitate accurate and precise coronal alignment of the initial femoral guidewire, superior to that of conventional instrumentation. CLINICAL RELEVANCE The results of this study may aid surgeons in the selection of alignment instruments for placement of the initial femoral guidewire during hip resurfacing.
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Affiliation(s)
- Michael Olsen
- Martin Orthopaedic Biomechanics Laboratory, Institute of Biomaterials and Biomedical Engineering, St. Michael's Hospital, University of Toronto, 5-066 Shuter Wing, 30 Bond Street, Toronto, ON M5B 1W8, Canada.
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Schnurr C, Nessler J, Koebke J, Michael JW, Eysel P, König DP. [Imageless computer navigation of hip resurfacing arthroplasty]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2010; 22:307-16. [PMID: 20676824 DOI: 10.1007/s00064-010-9023-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Precise implantation of hip resurfacing arthroplasty by imageless computer navigation. Hence a malalignment of the femoral component, leading to early loss of the implant, can safely be avoided. INDICATIONS Coxarthrosis in patients with normal bone mineral density; only minor deformity of the femoral head that enables milling around the femoral neck without notching. CONTRAINDICATIONS Osteoporosis; large necrosis of the femoral head; metal allergy; small acetabular seat and corresponding wide femoral neck, leading to needless acetabular bone loss; pregnancy, lactation. SURGICAL TECHNIQUE Hip joint exposure by a standard surgical approach, bicortical placement of a Schanz screw for the navigation array in the lesser trochanter. Referencing of the epicondyles, the four planes around the femoral neck and head by use of the navigation pointer. Planning of the desired implant position on the touchscreen of the navigation device; a guide wire is inserted into the femoral head and neck using the navigated drill guide; navigated depth drilling is performed. The femoral head is milled using the standard instruments. The acetabular bone stock is prepared with the conventional instrumentation; high-viscosity cement is finger-packed on the reamed head and the femoral component is inserted. Hammer blows should be avoided to prevent microfractures. Verification of the implant position by the navigation device; displacement of the Schanz screw; joint reposition and closure of the wound. POSTOPERATIVE MANAGEMENT Standard postoperative management after hip arthroplasty. RESULTS The comparison of 40 navigated and 32 conventionally implanted ASR prostheses resulted in a significant reduction of outliers by use of computer navigation (navigated procedures: one outlier, conventional procedure: nine outliers; p<0.001). Accuracy of the navigation device was tested by analysis of planned and verified implant position: CCD angle accuracy was 1 degrees , antetorsion accuracy was 1 degrees , and offset accuracy was 1.5 mm. An ongoing computed tomography-based anatomic study proved a varus-valgus accuracy of the navigation device of 1 degrees .
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Vendittoli PA, Roy A, Mottard S, Girard J, Lusignan D, Lavigne M. Metal ion release from bearing wear and corrosion with 28 mm and large-diameter metal-on-metal bearing articulations: a follow-up study. ACTA ACUST UNITED AC 2010; 92:12-9. [PMID: 20044673 DOI: 10.1302/0301-620x.92b1.22226] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have updated our previous randomised controlled trial comparing release of chromium (Cr) and cobalt (Co) ions and included levels of titanium (Ti) ions. We have compared the findings from 28 mm metal-on-metal total hip replacement, performed using titanium CLS/Spotorno femoral components and titanium AlloFit acetabular components with Metasul bearings, with Durom hip resurfacing using a Metasul articulation or bearing and a titanium plasma-sprayed coating for fixation of the acetabular component. Although significantly higher blood ion levels of Cr and Co were observed at three months in the resurfaced group than in total hip replacement, no significant difference was found at two years post-operatively for Cr, 1.58 microg/L and 1.62 microg/L respectively (p = 0.819) and for Co, 0.67 microg/L and 0.94 microg/L respectively (p = 0.207). A steady state was reached at one year in the resurfaced group and after three months in the total hip replacement group. Interestingly, Ti, which is not part of the bearing surfaces with its release resulting from metal corrosion, had significantly elevated ion levels after implantation in both groups. The hip resurfacing group had significantly higher Ti levels than the total hip replacement group for all periods of follow-up. At two years the mean blood levels of Ti ions were 1.87 microg/L in hip resurfacing and and 1.30 microg/L in total hip replacement (p = 0.001). The study confirms even with different bearing diameters and clearances, hip replacement and 28 mm metal-on-metal total hip replacement produced similar Cr and Co metal ion levels in this randomised controlled trial study design, but apart from wear on bearing surfaces, passive corrosion of exposed metallic surfaces is a factor which influences ion concentrations. Ti plasma spray coating the acetabular components for hip resurfacing produces significantly higher release of Ti than Ti grit-blasted surfaces in total hip replacement.
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Affiliation(s)
- P-A Vendittoli
- Maisonneueve-Rosemont Hospital, University of Montreal, Quebec, Canada.
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Olsen M, Davis ET, Chiu M, Gamble P, Tumia N, Boyle RA, Schemitsch EH. Imageless computer navigation without pre-operative templating may lead to malpreparation of the femoral head in hip resurfacing. ACTA ACUST UNITED AC 2009; 91:1281-6. [DOI: 10.1302/0301-620x.91b10.22020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The computed neck-shaft angle and the size of the femoral component were recorded in 100 consecutive hip resurfacings using imageless computer-navigation and compared with the angle measured before operation and with actual component implanted. The reliability of the registration was further analysed using ten cadaver femora. The mean absolute difference between the measured and navigated neck-shaft angle was 16.3° (0° to 52°). Navigation underestimated the measured neck-shaft angle in 38 patients and the correct implant size in 11. Registration of the cadaver femora tended to overestimate the correct implant size and provided a low level of repeatability in computing the neck-shaft angle. Prudent pre-operative planning is advisable for use in conjunction with imageless navigation since misleading information may be registered intraoperatively, which could lead to inappropriate sizing and positioning of the femoral component in hip resurfacing.
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Affiliation(s)
- M. Olsen
- Division of Orthopaedic Surgery St. Michael’s Hospital, University of Toronto, 800-55 Queen Street East, Toronto, Ontario, Canada M5C 1R6
| | - E. T. Davis
- Royal Orthopaedic Foundation NHS Trust, Bristol Road South, Northfield, Birmingham B31 2AP, UK
| | - M. Chiu
- Division of Orthopaedic Surgery St. Michael’s Hospital, University of Toronto, 800-55 Queen Street East, Toronto, Ontario, Canada M5C 1R6
| | - P. Gamble
- Division of Orthopaedic Surgery St. Michael’s Hospital, University of Toronto, 800-55 Queen Street East, Toronto, Ontario, Canada M5C 1R6
| | - N. Tumia
- Division of Orthopaedic Surgery St. Michael’s Hospital, University of Toronto, 800-55 Queen Street East, Toronto, Ontario, Canada M5C 1R6
| | - R. A. Boyle
- Division of Orthopaedic Surgery St. Michael’s Hospital, University of Toronto, 800-55 Queen Street East, Toronto, Ontario, Canada M5C 1R6
| | - E. H. Schemitsch
- Division of Orthopaedic Surgery St. Michael’s Hospital, University of Toronto, 800-55 Queen Street East, Toronto, Ontario, Canada M5C 1R6
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Affiliation(s)
- Michael H Huo
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-8883, USA.
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A simple technique for alignment in total hip resurfacing arthroplasty: technical note and preliminary report. HSS J 2009; 5:129-36. [PMID: 19506966 PMCID: PMC2744755 DOI: 10.1007/s11420-009-9117-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 04/24/2009] [Indexed: 02/07/2023]
Abstract
The functioning and survival of hip resurfacing arthroplasty depends on correct positioning and alignment of the implant. Correct positioning of the femoral alignment wire with respect to the femoral neck is the key to avoiding complications. Although the surgeon must align the wire in two planes, we can only control one plane at a time without changing position or relying on the indications of an assistant. Independent placement of two parallel alignment wires, one for varus-valgus orientation and another for version orientation, will help to determine two planes, the valgus sagittal plane and the version coronal plane, at the intersection of which both the optimum point of entry into the femoral head and the orientation line of the femoral alignment wire can be established. The marks on the neck and head and Kirschner wires following these marks define the planes. This simple technique allows us to reduce surgery time, minimize errors, and speed up the learning curve. It can be used with any type of resurfacing arthroplasty.
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Schnurr C, Nessler J, Meyer C, Schild HH, Koebke J, König DP. How accurate is image-free computer navigation for hip resurfacing arthroplasty? An anatomical investigation. J Orthop Sci 2009; 14:497-504. [PMID: 19802660 DOI: 10.1007/s00776-009-1356-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 03/30/2009] [Indexed: 01/25/2023]
Abstract
BACKGROUND The existing studies concerning image-free navigated implantation of hip resurfacing arthroplasty are based on analysis of the accuracy of conventional biplane radiography. Studies have shown that these measurements in biplane radiography are imprecise and that precision is improved by use of three-dimensional (3D) computer tomography (CT) scans. To date, the accuracy of image-free navigation devices for hip resurfacing has not been investigated using CT scans, and anteversion accuracy has not been assessed at all. Furthermore, no study has tested the reliability of the navigation software concerning the automatically calculated implant position. The purpose of our study was to analyze the accuracy of varus-valgus and anteversion using an image-free hip resurfacing navigation device. The reliability of the software-calculated implant position was also determined. METHODS A total of 32 femoral hip resurfacing components were implanted on embalmed human femors using an image-free navigation device. In all, 16 prostheses were implanted with the proposed position generated by the navigation software; the 16 prostheses were inserted in an optimized valgus position. A 3D CT scan was undertaken before and after operation. RESULTS The difference between the measured and planned varus-valgus angle averaged 1 degrees (mean +/- SD: group I, 1 degrees +/- 2 degrees ; group II, 1 degrees +/- 1 degrees ). The mean +/- SD difference between femoral neck anteversion and anteversion of the implant was 4 degrees (group I, 4 degrees +/- 4 degrees ; group II, 4 degrees +/- 3 degrees ). The software-calculated implant position differed 7 degrees +/- 8 degrees from the measured neck-shaft angle. These measured accuracies did not differ significantly between the two groups. CONCLUSIONS Our study proved the high accuracy of the navigation device concerning the most important biomechanical factor: the varus-valgus angle. The software calculation of the proposed implant position has been shown to be inaccurate and needs improvement. Hence, manual adjustment of the implant position in the software-planning step is frequently required.
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Affiliation(s)
- C Schnurr
- Rheinische Klinik für Orthopädie Viersen, Viersen, Germany
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Salvi AE. Femoral component positioning in hip resurfacing with and without navigation. Clin Orthop Relat Res 2009; 467:1639-40; author reply 1641-2. [PMID: 19305960 PMCID: PMC2674188 DOI: 10.1007/s11999-009-0793-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2008] [Accepted: 03/05/2009] [Indexed: 01/31/2023]
Affiliation(s)
- Andrea Emilio Salvi
- Department of Orthopaedics and Traumatology, Mellino Mellini Hospital Trust, Civil Hospital of Iseo, Brescia
, Italy
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Component alignment in hip resurfacing using computer navigation. Clin Orthop Relat Res 2009; 467:917-22. [PMID: 18972176 PMCID: PMC2650050 DOI: 10.1007/s11999-008-0584-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Accepted: 10/03/2008] [Indexed: 01/31/2023]
Abstract
The use of computer navigation during hip resurfacing has been proposed to reduce the risk of a malaligned component and notching with subsequent postoperative femoral neck fracture. Femoral component malalignment and notching have been identified as the major factors associated with femoral neck fracture after hip resurfacing. We performed 37 hip resurfacing procedures using an imageless computer navigation system. Preoperatively, we generated a patient-specific computer model of the proximal femur and planned a target angle for placement of the femoral component in the coronal plane. The mean navigation angle after implantation (135.5 degrees) correlated with the target stem-shaft angle (135.4 degrees). After implantation, the mean stem-shaft angle of the femoral component measured by three-dimensional computed tomography (135.1 degrees) correlated with the navigation target stem-shaft angle (135.4 degrees). The computer navigation system generates a reliable model of the proximal femur. It allows accurate placement of the femoral component and provides precise measurement of implant alignment during hip resurfacing, thereby reducing the risk of component malpositioning and femoral neck notching.
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Olsen M, Davis ET, Waddell JP, Schemitsch EH. Imageless computer navigation for placement of the femoral component in resurfacing arthroplasty of the hip. ACTA ACUST UNITED AC 2009; 91:310-5. [PMID: 19258604 DOI: 10.1302/0301-620x.91b3.21288] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have investigated the accuracy of placement of the femoral component using imageless navigation in 100 consecutive Birmingham Hip Resurfacings. Pre-operative templating determined the native neck-shaft angle and planned stem-shaft angle of the implant. The latter were verified post-operatively using digital anteroposterior unilateral radiographs of the hip. The mean neck-shaft angle determined before operation was 132.7 degrees (118 degrees to 160 degrees ). The mean planned stem-shaft angle was a relative valgus alignment of 9.7 degrees (SD 2.6). The stem-shaft angle after operation differed from that planned by a mean of 2.8 degrees (SD 2.0) and in 86% of cases the final angle measured within +/- 5 degrees of that planned. We had no instances of notching of the neck or varus alignment of the implant in our series. A learning curve was observed in the time taken for navigation, but not for accurate placement of the implant. Navigation in hip resurfacing may afford the surgeon a reliable and accurate method of placement of the femoral component.
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Affiliation(s)
- M Olsen
- Division of Orthopaedic Surgery, Department of Surgery, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8
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