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Wongsak S, Sa-Ngasoongsong P, Pinitkwamdee S, Thongchuea N, Prasai AB, Warinsiriruk E, Jarungvittayakon C, Jaovisidha S, Chanplakorn P. Effectiveness of prophylactic double-looped wiring in cementless Hip arthroplasty: A biomechanical study in osteoporotic bone model using impaction simulation system. Injury 2022; 53:2454-2461. [PMID: 35660012 DOI: 10.1016/j.injury.2022.05.034] [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: 11/12/2021] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Periprosthetic femoral fracture (PFF) is well-known complication in cementless hip arthroplasty (HA), especially in the elderly with osteoporosis. To prevent intraoperative PFFs during HA, prophylactic cerclage wiring on the calcar area during femoral broaching and implant insertion is recommended. However, biomechanical data on the benefits of cerclage wiring in osteoporotic bone during impaction are limited and controversial. This study aimed to assess the efficacy of prophylactic double-looped cerclage wiring (PDLCW) during femoral broaching in the osteoporotic bone model with an impaction simulation system. METHODS Fifteen osteoporotic femur models were prepared and allocated to three groups; control group (no cerclage), PW group (received PDLCW), and CC+PW group (prepared as having calcar crack and received PDLCW). All femurs were broached under impaction force that sequentially increased until the visible fracture or calcar crack propagation was visible. The primary outcomes were mallet impaction force (MIF-CF) and mallet velocity (MV-CF) at the time of calcar fracture. The secondary outcomes were calcar fracture pattern and subsidence during calcar fracture (S-CF). RESULTS PW group showed a significant increase in average MIF-CF, by 40.4% and 120.2% (p<0.001) compared to the control and CC+PW groups, respectively. The average MV-CF in PW group was also significantly greater, 13.1% and 64.6% (p<0.001), compared to the control and CC+PW groups, respectively. Control group revealed significantly greater incidence of complete calcar fracture (60% vs. 0% vs. 0%, p = 0.024), and the highest S-CF compared to those in the PW and CC+PW groups (10.6 ± 6.0 mm, 6.7 ± 4.4 mm, and 1.3 ± 2.0 mm, p = 0.020). CONCLUSIONS This study showed that PDLCW significantly improved hoop stress resistance by increasing the calcar fracture threshold related to mallet impaction, decreasing the risk of complete calcar fracture.
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Affiliation(s)
- Siwadol Wongsak
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Paphon Sa-Ngasoongsong
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
| | - Siwadol Pinitkwamdee
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Nutchanat Thongchuea
- Department of Industrial Engineering, Faculty of Engineering, Mahidol University, 25/25 Salaya, Phuttamonthon, Nakhon Pathom, 73170, Thailand.
| | - Abigyat Babu Prasai
- Department of Industrial Engineering, Faculty of Engineering, Mahidol University, 25/25 Salaya, Phuttamonthon, Nakhon Pathom, 73170, Thailand
| | - Eakkachai Warinsiriruk
- Department of Industrial Engineering, Faculty of Engineering, Mahidol University, 25/25 Salaya, Phuttamonthon, Nakhon Pathom, 73170, Thailand.
| | - Chavarat Jarungvittayakon
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Suphaneewan Jaovisidha
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Pongsthorn Chanplakorn
- Department of Orthopedics, Ramathibodi Hospital, 270, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
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Bishop NE, Wright P, Preutenborbeck M. A parametric numerical analysis of femoral stem impaction. PLoS One 2022; 17:e0268561. [PMID: 35594265 PMCID: PMC9122192 DOI: 10.1371/journal.pone.0268561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 05/02/2022] [Indexed: 11/19/2022] Open
Abstract
Press-fitted implants are implanted by impaction to ensure adequate seating, but without overloading the components, the surgeon, or the patient. To understand this interrelationship a uniaxial discretised model of the hammer/introducer/implant/bone/soft-tissues was developed. A parametric analysis of applied energy, component materials and geometry, and interactions between implant and bone and between bone and soft-tissues was performed, with implant seating and component stresses as outcome variables. To reduce the impaction effort (energy) required by the surgeon for implant seating and also reduce stresses in the hardware the following outcomes were observed: Reduce energy per hit with more hits / Increase hammer mass / Decrease introducer mass / Increase implant-bone resistance (eg stem roughness). Hardware stiffness and patient mechanics were found to be less important and soft tissue forces, due to inertial protection by the bone mass, were so low that their damage would be unlikely. This simple model provides a basic understanding of how stress waves travel through the impacted system, and an understanding of their relevance to implantation technique and component design.
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Affiliation(s)
- Nicholas E. Bishop
- Hamburg University of Applied Sciences, Faculty of Life Sciences, Hamburg, Germany
- * E-mail:
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Brzezinski A, Mascarenhas D, Simon M, Kayiaros S. A Unique Complication of Femoral Broach Fracture and Incarceration During Total Hip Arthroplasty. Arthroplast Today 2021; 11:49-53. [PMID: 34466637 PMCID: PMC8387731 DOI: 10.1016/j.artd.2021.07.011] [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] [Received: 05/18/2021] [Revised: 07/19/2021] [Accepted: 07/25/2021] [Indexed: 12/05/2022] Open
Abstract
In recent years, total hip arthroplasty via the direct anterior approach has been gaining popularity. It offers potential early advantages for less pain and quicker return of hip function; however, compared to other surgical approaches, it is associated with a more difficult femoral reconstruction. Inadequate femoral exposure during the direct anterior approach can result in suboptimal press fit, implant malalignment, and intraoperative fracture. This case report presents a unique complication of femoral broach failure and describes a simple technical solution that is feasible, cost-effective, and safe.
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Affiliation(s)
- Andrzej Brzezinski
- Department of Orthopaedics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Daniel Mascarenhas
- Department of Orthopaedics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Michael Simon
- Department of Orthopaedics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Stephen Kayiaros
- Department of Orthopaedics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.,University Orthopaedic Associates, Somerset, NJ
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Ferrari E, Khan M, Mantel J, Wallbank R. The assessment of muscle fatigue in orthopedic surgeons, by comparing manual versus automated broaching in simulated total hip arthroplasty. Proc Inst Mech Eng H 2021; 235:1471-1478. [PMID: 34281446 DOI: 10.1177/09544119211034386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Total hip arthroplasty procedures are physically demanding for surgeons. Repetitive mallet swings to impact a surgical handle (impactions), can lead to muscle fatigue, discomfort, and injuries. The use of an automated surgical hammer may reduce fatigue and increase surgical efficiency. The aim of this study was to compare the effect of repeated manual and automated impactions on the user's muscle activation, by means of surface electromyography. Surface electromyography signals were recorded from eight muscles of seven (n = 7) orthopedic surgeons during repetitions of manual and automated impactions, to reach the same surgical outcome (broaching depth). Qualitative data was also captured to track the perceived fatigue and preferences of impaction modalities after completion of impaction tasks. Time to complete tasks, muscle activation, and muscle fatigue were quantified. Results showed a significant decrease in time required to reach the same broaching depth for the automated method compared to manual impactions (p = 0.001). A reduction in muscle fatigue and activation of right Brachioradialis muscle was observed during automated impactions (p = 0.018). A significant difference in fatigue was observed, with lower level of fatigue during automated impactions (p = 0.001). These results suggest that an automated surgical workflow might reduce the exposure to the impaction task and, therefore, muscle fatigue, with a reduced activation of the most engaged muscles. The study suggests that the burden on the user can be reduced by a change in the surgical methodology to perform broaching in total hip arthroplasty, which could potentially benefit surgical efficiency and reduce the risk of fatigue-based errors during a procedure.
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Affiliation(s)
| | - Mariam Khan
- DePuy International Limited, Beeston, Leeds, UK
| | - Jack Mantel
- DePuy International Limited, Beeston, Leeds, UK
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Prospective and longitudinal evolution of postoperative periprosthetic findings on metal artifact-reduced MR imaging in asymptomatic patients after uncemented total hip arthroplasty. Skeletal Radiol 2021; 50:1177-1188. [PMID: 33169220 PMCID: PMC8035088 DOI: 10.1007/s00256-020-03666-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/28/2020] [Accepted: 11/01/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To prospectively assess the evolution of postoperative MRI findings in asymptomatic patients after total hip arthroplasty (THA) over 24 months (mo). METHODS This prospective cohort study included 9 asymptomatic patients (56.7 ± 15.0 years) after THA. Metal artifact-reduced 1.5-T MRI was performed at 3, 6, 12, and 24 mo after surgery. The femoral stem and acetabular cup were assessed by two readers for bone marrow edema (BME), periprosthetic bone resorption, and periosteal edema in addition to periarticular soft tissue edema and joint effusion. RESULTS BME was common around the femoral stem in all Gruen zones after 3 mo (range: 50-100%) and 6 mo (range: 33-100%) and in the acetabulum in DeLee and Charnley zone II after 3 mo (100%) and 6 mo (33%). BME decreased substantially after 12 mo (range: 0-78%) and 24 mo (range: 0-50%), may however persist in particular in Gruen zones 1 + 7. Periosteal edema along the stem was common 3 mo postoperatively (range: 63-75%) and rare after 24 mo: 13% only in Gruen zones 2 and 5. Twelve months and 24 mo postoperatively, periprosthetic bone resorption was occasionally present around the femoral stem (range: 11-33% and 13-38%, respectively). Soft tissue edema occurred exclusively along the surgical access route after 3 mo (100%) and 6 mo (89%) and never at 12 mo or 24 mo (0%). CONCLUSION Around the femoral stem, BME (33-100%) and periosteal edema (0-75%) are common until 6 mo after THA, decreasing substantially in the following period, may however persist up to 24 mo (BME: 0-50%; periosteal edema: 0-13%) in few non-adjoining Gruen zones. Soft tissue edema along the surgical access route should have disappeared 12 mo after surgery.
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Bhimani AA, Rizkalla JM, Kitziger KJ, Peters PC, Schubert RD, Gladnick BP. Surgical automation reduces operating time while maintaining accuracy for direct anterior total hip arthroplasty. J Orthop 2020; 22:68-72. [PMID: 32280172 DOI: 10.1016/j.jor.2020.03.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/28/2020] [Indexed: 01/04/2023] Open
Abstract
Objective Investigate the efficiency/accuracy of surgical automation versus manual component implantation in DA THA. Methods Retrospective review of 111 hips: 51 hips via automation and 60 hips via manual technique for DA THA. Results OR time averaged 8 min faster in the Automated group, compared to Manual group (p = 0.0009). Average femoral size was one size larger in the Automated group compared to Manual group (p = 0.007). No clinically significant differences were found between Manual and Automated groups for cup position or limb-length discrepancy. One calcar fracture occurred in the Automated group. Conclusion Surgical automation is efficient and accurate for DA THA.
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Affiliation(s)
- Aamir A Bhimani
- Baylor Univeristy Medical Center, Department of Orthopaedic Surgery, 3500 Gaston Ave, Dallas, TX, 75246, USA
| | - James M Rizkalla
- Baylor Univeristy Medical Center, Department of Orthopaedic Surgery, 3500 Gaston Ave, Dallas, TX, 75246, USA
| | - Kurt J Kitziger
- W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, 9301 N. Central Expressway, Suite 500, Dallas, TX, 75231, USA.,Texas Health Presbyterian Hospital Dallas, Department of Orthopaedic Surgery, 8200 Walnut Hill Lane, Dallas, TX, 75231, USA
| | - Paul C Peters
- W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, 9301 N. Central Expressway, Suite 500, Dallas, TX, 75231, USA.,Texas Health Presbyterian Hospital Dallas, Department of Orthopaedic Surgery, 8200 Walnut Hill Lane, Dallas, TX, 75231, USA
| | - Richard D Schubert
- W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, 9301 N. Central Expressway, Suite 500, Dallas, TX, 75231, USA.,Texas Health Presbyterian Hospital Dallas, Department of Orthopaedic Surgery, 8200 Walnut Hill Lane, Dallas, TX, 75231, USA
| | - Brian P Gladnick
- W.B. Carrell Memorial Clinic, Adult Hip and Knee Reconstruction, 9301 N. Central Expressway, Suite 500, Dallas, TX, 75231, USA.,Texas Health Presbyterian Hospital Dallas, Department of Orthopaedic Surgery, 8200 Walnut Hill Lane, Dallas, TX, 75231, USA
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