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Moralidou M, Di Laura A, Hothi H, Henckel J, Hart AJ. Cemented or uncemented fixation: Which allows a more acceptable prosthetic femoral version in total hip arthroplasty? J Orthop Surg Res 2023; 18:948. [PMID: 38071336 PMCID: PMC10710710 DOI: 10.1186/s13018-023-04331-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 10/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Three-dimensional computed-tomography (3D-CT) planning for primary Total Hip Arthroplasty (THA) typically uses the external femoral surface; as a result, it is difficult to predict the prosthetic femoral version (PFV) for uncemented femoral stems that press-fit to the internal surface of the bone. Cemented fixation allows the surgeon to adjust the version independent of the internal femoral anatomy. We aimed to better understand the effect of the fixation type on PFV. METHODS This was a case series study including a total of 95 consecutive patients (106 hips), who underwent uncemented (n = 81 hips) and cemented (n = 25 hips) primary THA using the posterior approach. The surgeon aimed for a PFV of 20°. Our primary objective was to compare PFV in both groups; our secondary objective was to evaluate the clinical outcomes. RESULTS The mean (± SD) PFV was 13° (± 9°) and 23° (± 8°) for the uncemented and cemented THA groups (P < 0.001), respectively. In the uncemented THA group, 36% of the patients had a PFV of < 10°. In the cemented THA group, this clinically important threshold dropped to 8%. Similarly, the Bland-Altman (BA) plots showed wider 95% limits of agreement for the uncemented group. Satisfactory clinical outcomes were recorded. CONCLUSION We found that the PFV was more clinically acceptable, for the posterior surgical approach, in the cemented group when compared to the uncemented group. Both THA groups reported high variability indicating the need to develop surgical tools to guide the PFV closer to the surgical target.
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Affiliation(s)
- Maria Moralidou
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Anna Di Laura
- The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, HA7 4LP, UK
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Harry Hothi
- The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, HA7 4LP, UK
- Department of Mechanical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK
| | - Johann Henckel
- The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, HA7 4LP, UK
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Brockley Hill, Stanmore, HA7 4LP, UK.
- Cleveland Clinic London Hospital, 33 Grosvenor Pl, London, SW1X 7HY, UK.
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Castagnini F, Bordini B, Cosentino M, Basile T, Giardina F, Traina F. Single-taper conical tapered stem in total hip arthroplasty for developmental dysplasia of the hip: A long-term evaluation. Orthop Traumatol Surg Res 2023; 109:103503. [PMID: 36496161 DOI: 10.1016/j.otsr.2022.103503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 09/29/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Conical tapered stems may be useful implants to manage the reconstruction of complex dysplastic anatomies. The aims of this paper were to assess: 1) the preoperative CT features of the dysplastic femurs; 2) survival rates, complications and reasons for revision; 3) the clinical outcomes; 4) the radiographic outcomes of single-taper conical stems in dysplasia (defined as center edge angle < 20°) at a long-term follow-up. HYPOTHESIS Monoblock conical stem provides a 10-year survival rate of at least 95%, with excellent clinical outcomes and bony ingrowth. MATERIALS AND METHODS In total, 100 THAs in 85 patients (15 bilateral cases) were enrolled. The average age of the patients at surgery was 50.9±11.5 years. Assessment of the native femoral morphology was performed using CT-scan, coronal (neck-shaft angle, offset, center of rotation position) and axial parameters (anteversion, mediolateral and anteroposterior femoral diameters). Clinical (HHS score) and radiological (osseointegration, subsidence and offset reconstruction) outcomes were evaluated at the last available follow-up. RESULTS The mean follow-up was 9.34±5.61 years. Severely distorted anatomies from Crowe I to Crowe IV were included, with a mean canal flare of 4.3 and a mean femoral antetorsion of 34°. The survival rates were stable at long-term (98.9% at 10 and 15 years): no aseptic loosening occurred. The mean postoperative HHS was 89.8±6.8 points. Ninety-nine percent of the stems showed bone ingrowth, from 6 months to the last available follow-up. Subsidence occurred in 18% of the cases (mean value: 2.5mm, range: 1-6mm) in the first month, with subsequent stabilization. A mild proximal stress shielding occurred in 28% of the THAs. Radiolucent lines were detected in the 8% of the cases. There was a postoperative loss of offset in 12% of the cases. DISCUSSION Conical stems in dysplastic hips achieved bony ingrowth at long-term outcome, even in complex anatomies. Subsidence, proximal stress shielding and imperfect offset restoration may occur with this implant. LEVEL OF PROOF IV; retrospective study.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy.
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Monica Cosentino
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Tommaso Basile
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Federico Giardina
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; DIBINEM, Università di Bologna, Bologna, Italy
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Zhang B, Li W, Li M, Ding X, Huo J, Wu T, Han Y. The role of 3-dimensional preoperative planning for primary total hip arthroplasty based on artificial intelligence technology to different surgeons: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e34113. [PMID: 37352023 PMCID: PMC10289585 DOI: 10.1097/md.0000000000034113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 04/04/2023] [Accepted: 06/05/2023] [Indexed: 06/25/2023] Open
Abstract
Preoperative planning with computed tomography (CT)-based 3-dimensiona (3D) templating has been achieved precise placement of hip components. This study investigated the role of the software (3-dimensional preoperative planning for primary total hip arthroplasty [THA] based on artificial intelligence technology, artificial intelligence hip [AIHIP]) for surgeons with different experience levels in primary THA. In this retrospective cohort study, we included patients, who had undergone THA with the help of the AIHIP, and matched to patients, who had undergone THA without the help of the AIHIP, by age and the doctor who operated on them. The subjects were divided into 4 groups, senior surgeon (Chief of Surgery) with AIHIP group, senior surgeon without AIHIP group, junior surgeon (Associate Chief of Surgery) with AIHIP group and junior surgeon without AIHIP group. The general data, imaging index, clinical outcomes and accuracy of stem size prediction and cup size prediction were retrospectively documented for all patients. There was a significant difference in discrepancy in leg length (P = .010), neck-shaft angle (P = .025) and femoral offset (P = .031) between the healthy side and the affected side, operation duration (P < .001), decrease in hemoglobin (Hb) per 24 hours (P = .046), intraoperative radiation exposure frequency (P < .050) and postoperative complications (overall P = .035) among the patients in junior surgeon group. No significant differences were found between senior surgeon groups with respect to discrepancy in leg length (P = .793), neck-shaft angle (P = .088)and femoral offset (P = .946) between the healthy side and the affected side, operation duration (P = .085), decrease in Hb per 24 hours (P = .952), intraoperative radiation exposure frequency (P = .094) and postoperative complications (overall P = .378). The stem sizes of 95% were accurately estimated to be within 1 stem size, and 97% of the cup size estimates were accurate to within 1 cup size in senior surgeon group with AIHIP. A total of 87% stem sizes were accurately estimated to be within 1 stem size, and 85% cup sizes were accurate to within 1 cup size in junior surgeon group with AIHIP. In conclusion, our study suggests that an AI-based preoperative 3D planning system for THA is a valuable adjunctive tool for junior doctor and should routinely be performed preoperatively.
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Affiliation(s)
- Bingshi Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Wenao Li
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Mengnan Li
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Xuzhuang Ding
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Jia Huo
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Tao Wu
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Yongtai Han
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
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Moralidou M, Di Laura A, Henckel J, Hart AJ. Can version of the proximal femur be used for CT planning uncemented femoral stems? Med Eng Phys 2023; 116:103985. [PMID: 37230697 DOI: 10.1016/j.medengphy.2023.103985] [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: 09/30/2022] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023]
Abstract
Three-Dimensional Computed Tomography (3D-CT) planning can predict the prosthetic femoral size in uncemented primary Total Hip Arthroplasty (THA). Correct sizing usually results in optimal varus/valgus femoral alignment; however, its effect on the Prosthetic Femoral Version (PFV) is poorly understood. Most 3D-CT planning systems use Native Femoral Version (NFV) to plan PFV. We aimed to assess the relationship between PFV and NFV in primary uncemented THA using 3D-CT analysis. Pre- and post-operative CT data was retrospectively collected from 73 patients (81 hips) undergoing primary uncemented THA with a straight-tapered stem. 3D-CT models were used to measure PFV and NFV. The clinical outcomes were evaluated. The discrepancy between PFV and NFV was low (<5°) in 43%, moderate (5-10°) in 40%, high (10-15°) in 11% and very high (>15°) in 6% of the cases. We found that NFV is not a useable guide for planning PFV. The 95% limits of agreement were both high at 17° and 15°, respectively. Satisfactory clinical outcomes were recorded. The discrepancy was large enough to recommend against the use of NFV for planning PFV when using straight-tapered uncemented stems. Further work should focus on the internal bony anatomy and the influence of stem design when planning uncemented femoral stems.
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Affiliation(s)
- Maria Moralidou
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Brockley Hill, Stanmore HA7 4LP, United Kingdom
| | - Anna Di Laura
- The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, United Kingdom; Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, United Kingdom
| | - Johann Henckel
- The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, United Kingdom
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London, Brockley Hill, Stanmore HA7 4LP, United Kingdom; The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore HA7 4LP, United Kingdom.
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Nozaki A, Imai N, Funayama K, Horigome Y, Suzuki H, Minato I, Kobayashi K, Kawashima H. Accuracy of ZedView, the Software for Three-Dimensional Measurement and Preoperative Planning: A Basic Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1030. [PMID: 37374236 DOI: 10.3390/medicina59061030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: In the field of orthopedic surgery, novel techniques of three-dimensional shape modeling using two-dimensional tomographic images are used for bone-shape measurements, preoperative planning in joint-replacement surgery, and postoperative evaluation. ZedView® (three-dimensional measurement instrument and preoperative-planning software) had previously been developed. Our group is also using ZedView® for preoperative planning and postoperative evaluation for more accurate implant placement and osteotomy. This study aimed to evaluate the measurement error in this software in comparison to a three-dimensional measuring instrument (3DMI) using human bones. Materials and Methods: The study was conducted using three bones from cadavers: the pelvic bone, femur, and tibia. Three markers were attached to each bone. Study 1: The bones with markers were fixed on the 3DMI. For each bone, the coordinates of the center point of the markers were measured, and the distances and angles between these three points were calculated and defined as "true values." Study 2: The posterior surface of the femur was placed face down on the 3DMI, and the distances from the table to the center of each marker were measured and defined as "true values." In each study, the same bone was imaged using computed tomography, measured with this software, and the measurement error from the corresponding "true values" was calculated. Results: Study 1: The mean diameter of the same marker using the 3DMI was 23.951 ± 0.055 mm. Comparisons between measurements using the 3DMI and this software revealed that the mean error in length was <0.3 mm, and the error in angle was <0.25°. Study 2: In the bones adjusted to the retrocondylar plane with the 3DMI and this software, the average error in the distance from the planes to each marker was 0.43 (0.32-0.58) mm. Conclusion: This surgical planning software could measure the distance and angle between the centers of the markers with high accuracy; therefore, this is very useful for pre- and postoperative evaluation.
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Affiliation(s)
- Asami Nozaki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Norio Imai
- Division of Comprehensive Musculoskeletal Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Kazuhisa Funayama
- Division of Legal Medicine, Department of Community Preventive Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Yoji Horigome
- Division of Comprehensive Musculoskeletal Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Hayato Suzuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Izumi Minato
- Department of Orthopedic Surgery, Niigata Rinko Hospital, Niigata 950-0051, Japan
| | - Koichi Kobayashi
- School of Health Sciences, Faculty of Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Niigata 951-8510, Japan
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Castagnini F, Lucchini S, Bordini B, Cosentino M, Pardo F, Traina F. Which stem in total hip arthroplasty for developmental hip dysplasia? A comparative study using a 3D CT-based software for pre-operative surgical planning. J Orthop Traumatol 2022; 23:33. [PMID: 35840842 PMCID: PMC9287520 DOI: 10.1186/s10195-022-00650-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/12/2022] [Indexed: 11/28/2022] Open
Abstract
Background Stem choice in total hip arthroplasty (THA) for hip dysplasia is still controversial. The aims of the study were to evaluate (1) which stem design provided the highest percentage of adequate reconstructions in THA for dysplasia and (2) any correlation between the reconstructions provided by the stems and the native femoral morphology. Materials and methods 150 CT scans including 200 adult dysplastic hips were randomly selected. Using the 3D CT-based software Hip-Op for surgical planning, the native hip anatomy was studied. Then, a single wedge tapered stem, an anatomical stem and a conical tapered stem were simulated in every hip. An adequate reconstruction of hip biomechanics was obtained when combined anteversion, offset restoration, coronal and sagittal tilt, canal filling and leg lengthening were inside the normal ranges. Results Conical stems achieved the highest percentage of adequate reconstructions (87%, p < 0.0001). The anatomical stem was the worst performer. Single wedge and anatomical stem acceptability was mainly influenced by the combined anteversion. Stem anteversion was correlated with the femoral anteversion (fair correlation), the calcar femorale (fair) and the mediolateral femoral diameter at isthmus (poor). When the femoral anteversion was ≥ 25°, combined anteversion was very acceptable for the conical stem (99.2%), whereas the rate of acceptable combined anteversion for the single wedge tapered stem was 71.4%, and that for the anatomical stem was 51.6% (p < 0.0001). Conclusions Stem choice in developmental hip dysplasia is mainly driven by appropriate combined anteversion, which is dependent on the coronal and axial femoral morphologies. As a rule of thumb, tapered stems are adequate when femoral anteversion is < 25°; conical stems should be adopted for higher anteversions. Level of evidence IV.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
| | - Stefano Lucchini
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Monica Cosentino
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Francesco Pardo
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia protesica e dei reimpianti d'anca e di ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.,DIBINEM, Università di Bologna, Bologna, Italy
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Zinner M, Schroeder L, Pumilia CA, Lee EK, Martin G. THA with Use of Patient-Specific Resurfacing Jigs and a Novel Customized Implant Design. JBJS Rev 2022; 10:01874474-202205000-00008. [PMID: 36995410 DOI: 10.2106/jbjs.rvw.21.00078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Conventional total hip arthroplasty (THA) largely remains an unguided procedure dependent on the ability and experience of the surgeon. New technologies, such as patient-specific instrumentation and robotics, have shown promising results in improving implant positioning, which has the potential to improve patient outcomes. » The use of off-the-shelf (OTS) implant designs, however, limits the success of the technological advances since they are unable to recreate the native anatomy of the joint. The inability to restore femoral offset and version or the presence of implant-related leg-length discrepancies often lead to suboptimal surgical results that increase the risk of dislocation, fractures, and component wear, compromising postoperative functional outcomes and implant longevity. » A customized THA system, whereby the femoral stem is designed to restore patient anatomy, has recently been introduced. The THA system uses computed tomography (CT)-derived 3D imaging to create a custom stem, patient-specific component placement, and patient-specific instrumentation that matches the patient's native anatomy. » The purpose of this article is to provide information on the design and manufacturing process of this new THA implant, to illustrate the associated preoperative planning, and to describe the surgical technique; 3 surgical cases are presented.
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Affiliation(s)
- Matthew Zinner
- Charles E. Schmidt College of Medicine, Boca Raton, Florida
| | - Lennart Schroeder
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
| | - Cyrus A Pumilia
- College of Medicine, University of Central Florida, Orlando, Florida
| | - Eric K Lee
- Department of Orthopedic Surgery, Personalized Orthopaedics of the Palm Beaches, Boynton Beach, Florida
| | - Gregory Martin
- College of Medicine, University of Central Florida, Orlando, Florida
- Department of Orthopedic Surgery, Personalized Orthopaedics of the Palm Beaches, Boynton Beach, Florida
- University of Miami Leonard M. Miller School of Medicine, Miami, Florida
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Reinbacher P, Smolle MA, Friesenbichler J, Draschl A, Leithner A, Maurer-Ertl W. Pre-operative templating in THA using a short stem system: precision and accuracy of 2D versus 3D planning method. J Orthop Traumatol 2022; 23:16. [PMID: 35318558 PMCID: PMC8941012 DOI: 10.1186/s10195-022-00634-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 02/26/2022] [Indexed: 12/19/2022] Open
Abstract
Background Total hip arthroplasty (THA) is the most successful orthopaedic surgery of the past century. The current study aimed to compare the accuracy of digital planning using 2D versus 3D templating. Materials and methods Ninety-five THAs in 90 patients were included in the current study. Pre- and post-operative X-rays (in two planes) and low-dose rotation computed tomography scans from hip to foot were performed. Paired t-test and regression analyses were conducted to compare 2D and 3D templating accuracy of the definitive implant. Results Cup size planned both with 2D (p < 0.0001) and 3D (p = 0.012) templating was significantly different from the definitively used cup size. The difference between the 2D-planned and implanted stem size (p < 0.0001) was statistically significant. In contrast, there were no significant differences in the 3D-planned and implanted stem size (p = 0.181). Three-dimensional templating showed significantly higher accuracy than 2D templating in terms of cup size (1.1 ± 1.4 versus 1.7 ± 1.8; p = 0.007) and stem size (0.3 ± 0.6 versus 0.7 ± 0.7; p < 0.0001). With increasing body mass index (BMI), 2D templating of the stem became more inaccurate (p = 0.041). Remarkably, 3D templating remained accurate for all components (stem, p = 0.533; cup, p = 0.479) despite increasing BMI. Conclusion Despite extended planning time and increased exposure to radiation, 3D-based planning showed higher accuracy than 2D templating, especially in obese patients. On the basis of our results, we believe that 3D-based pre-operative planning in THA is justifiable and beneficial in patients with increased BMI. Level of Evidence III.
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Affiliation(s)
- Patrick Reinbacher
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Maria Anna Smolle
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria.
| | - Joerg Friesenbichler
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Alexander Draschl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Andreas Leithner
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
| | - Werner Maurer-Ertl
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, Austria
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Evaluation of optimal implant alignment in total hip arthroplasty based on postoperative range of motion simulation. Clin Biomech (Bristol, Avon) 2022; 92:105555. [PMID: 35026659 DOI: 10.1016/j.clinbiomech.2021.105555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dislocation after total hip arthroplasty is a frequent cause of revision surgery. This study was performed to determine the optimal implant alignment in total hip arthroplasty by simulating the postoperative range of motion. METHODS All operations were performed via posterolateral approach using combined anteversion of the stem and cup technique. Maximum range of motion without implant impingement was simulated in 79 replaced hips using postoperative computed tomography and the achievement of the required range of motion defined by previous studies was assessed. Optimal cup and stem alignment for impingement-free range of motion were statistically determined using the receiver operator coefficient curve. FINDINGS Cup inclination and anteversion, stem anteversion, and combined anteversion were 37.6°, 20.1°, 26.2°, and 46.3°, respectively. Maximum range of motion in flexion, extension, internal rotation at 90° of flexion, and external rotation were 131.8°, 42.3°, 56.4°, and 64.5°, respectively. Flexion >110°, extension >30°, internal rotation >30° at 90° of flexion, and external rotation >30° were fulfilled by 96%, 86%, 92%, and 96% of all replaced hips, respectively. Optimal implant alignment for impingement-free range of motion was 34°-43° of cup inclination, 18°-26° of cup anteversion, 17°-29° of stem anteversion, and 35°-56° of combined anteversion. Both cup and stem anteversion showed significant relationship with postoperative range of motion. INTERPRETATION Surgeons could gain valuable insights into optimal cup and stem alignment to perform postoperative range of motion simulations.
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Solórzano-Requejo W, Ojeda C, Díaz Lantada A. Innovative Design Methodology for Patient-Specific Short Femoral Stems. MATERIALS 2022; 15:ma15020442. [PMID: 35057160 PMCID: PMC8778668 DOI: 10.3390/ma15020442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/01/2022] [Accepted: 01/04/2022] [Indexed: 12/18/2022]
Abstract
The biomechanical performance of hip prostheses is often suboptimal, which leads to problems such as strain shielding, bone resorption and implant loosening, affecting the long-term viability of these implants for articular repair. Different studies have highlighted the interest of short stems for preserving bone stock and minimizing shielding, hence providing an alternative to conventional hip prostheses with long stems. Such short stems are especially valuable for younger patients, as they may require additional surgical interventions and replacements in the future, for which the preservation of bone stock is fundamental. Arguably, enhanced results may be achieved by combining the benefits of short stems with the possibilities of personalization, which are now empowered by a wise combination of medical images, computer-aided design and engineering resources and automated manufacturing tools. In this study, an innovative design methodology for custom-made short femoral stems is presented. The design process is enhanced through a novel app employing elliptical adjustment for the quasi-automated CAD modeling of personalized short femoral stems. The proposed methodology is validated by completely developing two personalized short femoral stems, which are evaluated by combining in silico studies (finite element method (FEM) simulations), for quantifying their biomechanical performance, and rapid prototyping, for evaluating implantability.
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Affiliation(s)
- William Solórzano-Requejo
- Product Development Laboratory, Department of Mechanical Engineering, Universidad Politécnica de Madrid, C/José Gutiérrez Abascal 2, 28006 Madrid, Spain
- Mechanical Technology Laboratory, Department of Mechanical and Electrical Engineering, Universidad de Piura, Piura 20009, Peru; or
- Correspondence: or (W.S.-R.); (A.D.L.)
| | - Carlos Ojeda
- Mechanical Technology Laboratory, Department of Mechanical and Electrical Engineering, Universidad de Piura, Piura 20009, Peru; or
| | - Andrés Díaz Lantada
- Product Development Laboratory, Department of Mechanical Engineering, Universidad Politécnica de Madrid, C/José Gutiérrez Abascal 2, 28006 Madrid, Spain
- Correspondence: or (W.S.-R.); (A.D.L.)
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Trisolino G, Stallone S, Castagnini F, Bordini B, Cosentino M, Lucchini S, Zarantonello P, Ferrari D, Dallari D, Traina F. Cementless Ceramic-on-Ceramic Total Hip Replacement in Children and Adolescents. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8100858. [PMID: 34682123 PMCID: PMC8534320 DOI: 10.3390/children8100858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 02/07/2023]
Abstract
Background: total hip replacement (THR) is a rare surgical option in children and adolescents with disabling hip diseases. The aim of this study is to report results from a retrospective cohort of patients aged 18 years or less who underwent cementless Ceramic-on-Ceramic (CoC) THR at a single institution, investigating clinical and radiographic outcomes, survival rates, and reasons for revision of the implants. Materials and methods: we queried the Registry of Prosthetic Orthopedic Implants (RIPO) to identify all children and adolescents undergoing THR between 2000 and 2019 at a single Institution. Inclusion criteria were patients undergoing cementless CoC THR, aged less than 18 years at surgery, followed for at least 2 years. Sixty-eight patients (74 hips) matched all the inclusion criteria and were enrolled in the study. We assessed the clinical and radiographic outcomes, the rate of complications, the survival rate, and reasons for revision of the implants. Results: The mean follow-up was 6.6 ± 4.4 years (range 2-20). The most frequent reason for THR was post-traumatic or chemotherapy-induced avascular necrosis (38%). The overall survival rate of the cohort was 97.6% (95% CI: 84.9-99.7%) at 5 years of follow-up, 94.4% (95% CI: 79.8-98.6%) at 10 years and 15 years of follow-up. Two THR in two patients (2.7%) required revision. With the numbers available, Cox regression analysis could not detect any significant interaction between preoperative or intraoperative variables and implant survivorship (p-value 0.242 to 0.989)." The average HOOS was 85 ± 14.3 (range 30.6-100). Overall, 23 patients (48%) reported excellent HOOS scores (>90 points), 21 patients (44%) reported acceptable HOOS scores (60-90 points) while 4 patients (8%) reported poor outcomes (<60 points). Twenty-one patients (43%) were regularly involved into moderate- to high-intensity sport activities (UCLA ≥ 6). Conclusions: Cementless CoC THR is a successful procedure in children and teenagers, having demonstrated high implant survivorship and low rates of complications and failure. A meticulous preoperative planning and implant selection is mandatory, to avoid implant malposition, which is the main reason of failure and revision in these cases. Further studies are needed to assess the impact of the THR on the psychosocial wellbeing of teenagers, as well as risks and benefits and cost-effectiveness in comparison to the hip preserving surgical procedures.
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Affiliation(s)
- Giovanni Trisolino
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.Z.); (D.F.)
- Correspondence: (G.T.); (S.S.)
| | - Stefano Stallone
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.Z.); (D.F.)
- Correspondence: (G.T.); (S.S.)
| | - Francesco Castagnini
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.C.); (S.L.); (F.T.)
| | - Barbara Bordini
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (B.B.); (M.C.)
| | - Monica Cosentino
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (B.B.); (M.C.)
| | - Stefano Lucchini
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.C.); (S.L.); (F.T.)
| | - Paola Zarantonello
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.Z.); (D.F.)
| | - Daniele Ferrari
- Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (P.Z.); (D.F.)
| | - Dante Dallari
- Conservative Orthopedic Surgery and Innovative Techniques, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Francesco Traina
- Orthopaedic-Traumatology and Prosthetic Surgery and Revisions of Hip and Knee, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy; (F.C.); (S.L.); (F.T.)
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Evaluation of the accuracy of resected bone thickness based on patient-specific instrumentation during total knee arthroplasty. Arch Orthop Trauma Surg 2021; 141:1583-1590. [PMID: 33547928 DOI: 10.1007/s00402-021-03805-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 01/25/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND In total knee arthroplasty (TKA) using patient-specific instrumentation (PSI), the correlation between the preoperative surgical plan and intraoperative resection size is unclear. The aims of this study were to evaluate whether the computed tomography (CT)-based PSI surgical plan can be executed accurately and to determine the accuracy of bone resection in TKA using PSI. METHODS Data of 45 consecutive knees undergoing TKA using CT-based PSI were retrospectively evaluated. The preoperative plan was prepared using three-dimensional CT acquisitions of the hip, knee, and ankle joints. Resected bone thicknesses of the femoral condyle of the distal medial, distal lateral, posterior medial, posterior lateral, and medial and lateral tibial plateaus were measured with a Vernier caliper intraoperatively. Then these respective measurements were compared with those in the preoperative CT-predicted bone resection surgical plan, and the measured thickness of resection was subtracted from the planned resection thickness. Errors were defined as: acceptable, ≤ 1.5 mm; borderline, 1.5-2.5 mm; and outliers, > 2.5 mm. RESULTS Overall, 22 (48.9%) knees had no outliers. There were 20 (44.4%) and 3 (6.7%) knees in which only 1 and 2 resection planes were outliers, respectively. The posterior medial tibial plateau had the lowest proportion of acceptable cuts (44.4%). Posterior femoral resection including the medial and lateral condyles had more outliers (n = 18/90 cuts, 20.0%) (p < 0.001) than the tibial condyles (n = 3/90 cuts, 3.3%) and distal femoral cuts (n = 6/90 cuts, 6.7%). The posterior surface of the femur, where the incidence of outliers was higher, tended to have a higher proportion of undercuts than other surfaces of the femur (> 80%). CONCLUSIONS PSI showed only fair-to-moderate accuracy. The cutting guide for the posterior femur was less accurate than that for the tibia and distal femur. Specific attention is required when cutting the posterior femur. The PSI design needs to be improved to reduce errors.
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Jiang M, Coles-Black J, Chen G, Alexander M, Chuen J, Hardidge A. 3D Printed Patient-Specific Complex Hip Arthroplasty Models Streamline the Preoperative Surgical Workflow: A Pilot Study. Front Surg 2021; 8:687379. [PMID: 34513912 PMCID: PMC8427196 DOI: 10.3389/fsurg.2021.687379] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/28/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction: Surgical planning for complex total hip arthroplasty (THA) often presents a challenge. Definitive plans can be difficult to decide upon, requiring unnecessary equipment to be ordered and a long theatre list booked. We present a pilot study utilising patient-specific 3D printed models as a method of streamlining the pre-operative planning process. Methods: Complex patients presenting for THA were referred to the research team. Patient-specific 3D models were created from routine Computed Tomography (CT) imaging. Simulated surgery was performed to guide prosthesis selection, sizing and the surgical plan. Results: Seven patients were referred for this pilot study, presenting with complex conditions with atypical anatomy. Surgical plans provided by the 3D models were more detailed and accurate when compared to 2D CT and X ray imaging. Streamlined equipment selection was of great benefit, with augments avoided post simulation in three cases. The ability to tackle complex surgical problems outside of the operating theatre also flagged potential complications, while also providing teaching opportunities in a low risk environment. Conclusion: This study demonstrated that 3D printed models can improve the surgical plan and streamline operative logistics. Further studies investigating the optimal 3D printing material and workflow, along with cost-benefit analyses are required before this process is ready for routine use.
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Affiliation(s)
- Michael Jiang
- 3dMedLab, Austin Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, VIC, Australia
| | - Jasamine Coles-Black
- 3dMedLab, Austin Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, VIC, Australia
| | - Gordon Chen
- 3dMedLab, Austin Health, The University of Melbourne, Parkville, VIC, Australia
| | - Matthew Alexander
- Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, VIC, Australia
| | - Jason Chuen
- 3dMedLab, Austin Health, The University of Melbourne, Parkville, VIC, Australia
- Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, VIC, Australia
| | - Andrew Hardidge
- Department of Surgery, Austin Health, The University of Melbourne, Heidelberg, VIC, Australia
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Andrade C, Minto B, Dreibi R, Diogo L, Rocha T, Kawamoto F, Franco G, Uscategui R, Dias L. Comparison of radiographic and tomographic evaluations for measurement of the Canal Flare Index in dogs. ARQ BRAS MED VET ZOO 2021. [DOI: 10.1590/1678-4162-11987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The outcome of total hip arthroplasty (THA) in dogs is directly related to surgical planning. Templating of radiographs prior to THA should help the surgeon anticipate prosthesis size and femoral shape allowing canal fill of the proximal metaphysis by the implant ensuring primary stable fixation. The canal flare index (CFI) obtained from radiograph has been used as a measure of risk of complications for the technique in human beings and dogs. However, standard radiographs only provide limited data for the selection of cementless prostheses and the assessment of their fit within the femoral canal, due to factors like radiographic magnification and femoral rotation. Therefore, three-dimensional evaluation based on computed tomography (CT) may be a better tool for CFI measurement. The aim of this study was to compare anatomical measurement with CFI values obtained from craniocaudal radiography and CT. Craniocaudal radiographs using a horizontal radiographic beam (CR), CT, and anatomical macroscopic measurements (A) were obtained from 45 femurs from 23 canine cadavers. The differences between the values of CFI obtained from radiograph (CFI-R), computed tomography on transverse (CFI- TT) and longitudinal axis (CFI-TL) compared to the CFI obtained from macroscopic measurements - gold standard - (CFI-A), and 95% limits of agreement (LOA) between the values, were evaluated by the Bland-Altman method. Dimensions obtained from CT techniques had a greatest mean difference from anatomical and CFI values were also different (P=0.032). Under the experimental conditions, the craniocaudal radiograph, provided the most accurate measurement of the CFI (mean difference: 0.087 ± 0.42).
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Affiliation(s)
| | | | | | | | | | | | - G.G. Franco
- Universidade Federal do Espírito Santo, Brazil
| | - R.A.R. Uscategui
- Universidade Federal dos Vales do Jequitinhonha e Mucuri, Brazil
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15
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Benedetti MG, Cavazzuti L, Amabile M, Tassinari E, Valente G, Zanotti G, Vaienti E, Orsini S, Mariani E, Taddei F. Abductor muscle strengthening in THA patients operated with minimally-invasive anterolateral approach for developmental hip dysplasia. Hip Int 2021; 31:66-74. [PMID: 31544524 DOI: 10.1177/1120700019877174] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE In developmental hip dysplasia (DDH) patients, the chronic dislocation of the femoral head with respect to the true acetabulum determines muscle contracture and atrophy, particularly of the abductor muscles, and leads to secondary osteoarthritis (OA) with severe motor dysfunction, pain and disability. The correct positioning when a total hip replacement (THR) is performed is fundamental to the recovery of gait function. Also, inadequate rehabilitation of the abductor muscles for pelvic stabilisation can be responsible for residual dysfunction. Consensus on a programme for abductor muscle strengthening in these patients is not currently available. The aim of this study was to evaluate the effectiveness of a specific program of exercises for strengthening the abductor muscles in these patients. METHODS A multicentre, prospective, randomised clinical trial was carried out in an outpatient rehabilitation setting on 103 patients given THR for DDH through a minimally-invasive anterolateral approach. Patients were randomly divided into a Study Group, including 46 patients, and a Control Group, including 57 patients. All patients underwent standard early postoperative rehabilitation. In addition, the Study Group were given an extra 2-week rehabilitation once full weight-bearing on the operated limb was allowed, aimed at strengthening the abductor muscles. All patients were evaluated preoperatively, and at about 3 and 6 months postoperatively. Clinical measures (lower limb-length differences, hip range of motion, abductor muscle strength), and functional measures (WOMAC, HHS, 10mt WT, SF-12) were taken. RESULTS Hip range of motion and functional outcome measures showed a progressive improvement at follow ups in both groups, significantly higher in the Study Group. In particular, abductor strength at 6 months post-op improved by 92.5% with respect to 35.7% in the Control Group. CONCLUSION In addition to standard rehabilitation, a rehabilitation programme for strengthening the gluteal muscles in DDH patients who underwent THR determined an increase in muscle strength that improved functional performance and patient satisfaction.
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Affiliation(s)
- Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS - Rizzoli Orthopaedic Institute, Bologna Italy
| | - Lorenzo Cavazzuti
- Physical Medicine and Rehabilitation Unit, IRCCS - Rizzoli Orthopaedic Institute, Bologna Italy
| | - Marilina Amabile
- Orthopaedic-Traumatology and Prosthetic surgery and revisions of hip and knee implants, IRCCS - Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Enrico Tassinari
- Orthopaedic-Traumatology and Prosthetic surgery and revisions of hip and knee implants, IRCCS - Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Giordano Valente
- Bioengineering Computing Laboratory, IRCCS - Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Gabriele Zanotti
- Department of Orthopaedics, Civilian Hospital of Lugo, Lugo, Italy
| | - Enrico Vaienti
- Orthopaedic Clinic, University Hospital of Parma, Parma, Italy
| | - Stefania Orsini
- Physical Medicine and Rehabilitation Unit, IRCCS - Rizzoli Orthopaedic Institute, Bologna Italy
| | - Elisabetta Mariani
- Physical Medicine and Rehabilitation Unit, IRCCS - Rizzoli Orthopaedic Institute, Bologna Italy
| | - Fulvia Taddei
- Bioengineering Computing Laboratory, IRCCS - Rizzoli Orthopaedic Institute, Bologna, Italy
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Moralidou M, Di Laura A, Henckel J, Hothi H, Hart AJ. Three-dimensional pre-operative planning of primary hip arthroplasty: a systematic literature review. EFORT Open Rev 2020; 5:845-855. [PMID: 33425373 PMCID: PMC7784139 DOI: 10.1302/2058-5241.5.200046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Three-dimensional (3D) pre-operative planning in total hip arthroplasty (THA) is being recognized as a useful tool in planning elective surgery, and as crucial to define the optimal component size, position and orientation. The aim of this study was to systematically review the existing literature for the use of 3D pre-operative planning in primary THA.A systematic literature search was performed using keywords, through PubMed, Scopus and Google Scholar, to retrieve all publications documenting the use of 3D planning in primary THA. We focussed on (1) the accuracy of implant sizing, restoration of hip biomechanics and component orientation; (2) the benefits and barriers of this tool; and (3) current gaps in literature and clinical practice.Clinical studies have highlighted the accuracy of 3D pre-operative planning in predicting the optimal component size and orientation in primary THAs. Component size planning accuracy ranged between 34-100% and 41-100% for the stem and cup respectively. The absolute, average difference between planned and achieved values of leg length, offset, centre of rotation, stem version, cup version, inclination and abduction were 1 mm, 1 mm, 2 mm, 4°, 7°, 0.5° and 4° respectively.Benefits include 3D representation of the human anatomy for precise sizing and surgical execution. Barriers include increased radiation dose, learning curve and cost. Long-term evidence investigating this technology is limited.Emphasis should be placed on understanding the health economics of an optimized implant inventory as well as long-term clinical outcomes. Cite this article: EFORT Open Rev 2020;5:845-855. DOI: 10.1302/2058-5241.5.200046.
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Affiliation(s)
- Maria Moralidou
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Anna Di Laura
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Johann Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Harry Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
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Di Laura A, Henckel J, Hothi H, Hart A. Can 3D surgical planning and patient specific instrumentation reduce hip implant inventory? A prospective study. 3D Print Med 2020; 6:25. [PMID: 32965588 PMCID: PMC7513524 DOI: 10.1186/s41205-020-00077-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Modern designs of joint replacements require a large inventory of components to be available during surgery. Pre-operative CT imaging aids 3D surgical planning and implant sizing, which should reduce the inventory size and enhance clinical outcome. We aimed to better understand the impact of the use of 3D surgical planning and Patient Specific Instrumentation (PSI) on hip implant inventory. METHODS An initial feasibility study of 25 consecutive cases was undertaken to assess the discrepancy between the planned component sizes and those implanted to determine whether it was possible to reduce the inventory for future cases. Following this, we performed a pilot study to investigate the effect of an optimized inventory stock on the surgical outcome: we compared a group of 20 consecutive cases (experimental) with the 25 cases in the feasibility study (control). We assessed: (1) accuracy of the 3D planning system in predicting size (%); (2) inventory size changes (%); (3) intra and post-operative complications. RESULTS The feasibility study showed variability within 1 size range, enabling us to safely optimize inventory stock for the pilot study. (1) 3D surgical planning correctly predicted sizes in 93% of the femoral and 89% of the acetabular cup components; (2) there was a 61% reduction in the implant inventory size; (3) we recorded good surgical outcomes with no difference between the 2 groups, and all patients had appropriately sized implants. CONCLUSIONS 3D planning is accurate in up to 95% of the cases. CT-based planning can reduce inventory size in the hospital setting potentially leading to a reduction in costs.
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Affiliation(s)
- Anna Di Laura
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP, UK. .,Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK.
| | - Johann Henckel
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP, UK
| | - Harry Hothi
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP, UK.,Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
| | - Alister Hart
- The Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, London, HA7 4LP, UK.,Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
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A computer simulation study for preserving the tibial posterior slope in open-wedge high tibial osteotomy. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1285-1291. [DOI: 10.1007/s00590-020-02703-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
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Hsieh CM, Howell SM, Hull ML. Errors in femoral anteversion, femoral offset, and vertical offset following robot-assisted total hip arthroplasty. Int J Med Robot 2020; 16:e2104. [PMID: 32163669 DOI: 10.1002/rcs.2104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 03/03/2020] [Accepted: 03/10/2020] [Indexed: 11/12/2022]
Abstract
The objectives were to determine errors in femoral anteversion (FA), femoral offset (FO), and vertical offset (VO) with robot-assisted total hip arthroplasty (THA) and how consistently these errors are within clinically desirable limits of ±5° and ±5 mm. After preoperative planning, robot-assisted THAs were performed on twelve cadaveric specimens. The error between achieved and planned component placements was used to determine bias (mean error) and precision (SD of error). The percent of the population within clinically desirable limits was determined. Bias of 1.5° and 2.7 mm occurred for FA and VO, respectively. Precision was 1.2° for FA and better than 1.5 mm for FO and VO. The percent of population within clinically desirable limits was at least 95% for FA and at least 99% for FO. With limits of ±7 mm, at least 95% of the population was within these limits for VO. Robot-assisted THA may improve clinical outcomes.
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Affiliation(s)
- Chih-Ming Hsieh
- Department of Biomedical Engineering, University of California, Davis, Sacramento, California, USA
| | - Stephen M Howell
- Department of Biomedical Engineering, University of California, Davis, Sacramento, California, USA
| | - Maury L Hull
- Department of Biomedical Engineering, University of California, Davis, Sacramento, California, USA.,Department of Mechanical Engineering, University of California, Davis, Sacramento, California, USA.,Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
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20
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Abstract
Preoperative planning is mandatory to achieve the restoration of a correct and personalized biomechanics of the hip. The radiographic review is the first and fundamental step in the planning. Limb or pelvis malpositioning during the review results in mislead planning. Correct templating is possible using three different methods: acetate templating on digital X-ray, digital 2D templating on digital X-ray and 3D digital templating on CT scan. Time efficiency, costs, reproducibility and accuracy must be considered when comparing different templating methods. Based on these parameters, acetate templating should not be abandoned; digital templating allows a permanent record of planning and can be electronically viewed by different members of surgical team; 3D templating is intrinsically more accurate. There is no evidence in the few recently published studies that 3D templating impacts positively on clinical outcomes except in difficult cases. The transverse acetabular ligament (TAL) is a reliable intraoperative soft tissue reference to set cup position. Spine–hip relations in osteoarthritic patients undergoing hip joint replacement must be considered.
Cite this article: EFORT Open Rev 2019;4:626-632. DOI: 10.1302/2058-5241.4.180075
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Affiliation(s)
- Alessandro Colombi
- Department of Orthopaedic Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Daniele Schena
- Department of Orthopaedic Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
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Schiffner E, Latz D, Jungbluth P, Grassmann JP, Tanner S, Karbowski A, Windolf J, Schneppendahl J. Is computerised 3D templating more accurate than 2D templating to predict size of components in primary total hip arthroplasty? Hip Int 2019; 29:270-275. [PMID: 29781288 DOI: 10.1177/1120700018776311] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The aim of this study was to compare the accuracy of preoperative templating in total hip arthroplasty (THA) using conventional 2-dimensional (2D) and computed tomography (CT)-based 3-dimensional (3D) measures. METHODS One hundred and sixteen consecutive primary THAs were analysed. The preoperative diagnosis was primary osteoarthritis in all cases. The 2D templating and the 3D templating were performed by two different residents. All templating results were available for the orthopaedic surgeon performing the procedure. Accuracies with regard to the predicted and actual implant sizes were determined for each procedure. Implantation of the size as planned was defined as "exact", whereas the use of components within one size larger or smaller (±1) as planned were defined as "accurate." RESULTS The 3D templating was significantly more accurate in predicting implant sizing compared to 2D templating for primary total hip arthroplasty (THA). The difference was statistically significant for the cup templating (''exact'' p = 0.02; ''accurate'' p = 0.01) and for the stem templating (''exact'' p = 0.04; ''accurate'' p = 0.01). CONCLUSION Our results support the superiority of 3D templating over 2D templating in predicting implant size.
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Affiliation(s)
- Erik Schiffner
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
| | - David Latz
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
| | - Pascal Jungbluth
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
| | - Jan P Grassmann
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
| | - Stephan Tanner
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
| | - Alfred Karbowski
- 2 Department of Orthopaedic Surgery, Hospital of the Augustinians, Cologne, Germany
| | - Joachim Windolf
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
| | - Johannes Schneppendahl
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
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Alnahhal A, Aslam-Pervez N, Sheikh HQ. Templating Hip Arthroplasty. Open Access Maced J Med Sci 2019; 7:672-685. [PMID: 30894933 PMCID: PMC6420946 DOI: 10.3889/oamjms.2019.088] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND: Different methods have been developed and employed with variable degrees of success in pre-operative templating for total hip arthroplasty. Preoperative templating, especially digital templating, has been claimed to have increased the effectiveness of total hip arthroplasty by improving the precision of prediction of prosthetic implant size. AIMS: The overall aim of this systematic review is to identify whether the use of pre-operative templating in total hip arthroplasty procedures has resulted in increased accuracy, reliability and precision of the procedure. Various methods of templating, like traditional acetate overlay and digital method of templating that includes a single radiographic marker and double radiographic marker methods, have been compared to establish the most reliable method of templating. METHODS: We searched the PubMed, Google Scholar Cochrane Central Register of Controlled Trials (CENTRAL), and MEDLINE (1966 to present), EMBASE (1980 to present), CINAHL (1982 to present), Psych INFO (1967 to present) and Clinical Trials Gov. CONCLUSION: The results of this systemic review suggest that preoperative templating is resulting in an enormous increase in the accuracy of total hip arthroplasty and among various methods, King Mark is the most reliable method.
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Affiliation(s)
- Amro Alnahhal
- Barnsley District General Hospital NHS Trust, Gawber Road Barnsley S75 2EP, Great Britain
| | - Nayef Aslam-Pervez
- Calderdale and Huddersfield NHS trust, Acre St, Huddersfield HD3 3EA, Great Britain
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Wu P, Liu Q, Fu M, Zhang Z, He S, Liao W, Kang Y. Value of Computed Tomography-Based Three-Dimensional Pre-operative Planning in Cup Placement in Total Hip Arthroplasty With Dysplastic Acetabulum. J INVEST SURG 2018; 32:607-613. [PMID: 30303698 DOI: 10.1080/08941939.2018.1444828] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objects: To investigate the value of CT-based 3D templating software for pre-operative planning in patients with acetabular dysplasia undergoing total hip arthroplasty (THA) with a minimum follow-up of 2 years. Methods: We performed a retrospective review of a single surgeon's cohort of patients with Crowe I to III developmental dysplastic hip (49 hips in 41 patients) who underwent cementless primary THA and were available for follow-up at a mean of 2.7 years after THA. We analyzed the accuracy of cup size prediction, the reliability of pre- and post-operative cup orientation and position of reconstructed rotation center using CT-based 3D templating software. Post-operative Harris Hip Score and lower limb discrepancy was obtained at the last follow-up. Results: The sizes of 71% of the cup components (35/49) were estimated exactly, and 100% of the cup size estimates were accurate to within one-cup size. There was good reproducibility of pre- and post-operative position of reconstructed rotation center (correlation coefficient r = 0.396 for vertical position, p = 0.005; r = 0.326 for horizontal position, p = 0.024). There was no substantial agreement between the planned acetabular orientation and that measured post-operatively (correlation coefficient -0.174 for inclination and 0.045 for anteversion). There were 44 (90%) excellent or good results according to HHS. Seven patients (14%) reported lower limb discrepancy. Conclusions: Pre-operative CT-based 3D templating made it possible to predict accurate cup size and achieve reproducible cup position in patients with dysplastic acetabulum. The reproducibility of cup orientation could not be demonstrated in this study.
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Affiliation(s)
- Peihui Wu
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Qiaoli Liu
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Ming Fu
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Zhiqi Zhang
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Suiwen He
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Weiming Liao
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
| | - Yan Kang
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University , Guangzhou , China
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Montalti M, Castagnini F, Giardina F, Tassinari E, Biondi F, Toni A. Cementless Total Hip Arthroplasty in Crowe III and IV Dysplasia: High Hip Center and Modular Necks. J Arthroplasty 2018; 33:1813-1819. [PMID: 29500091 DOI: 10.1016/j.arth.2018.01.041] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) in severe developmental dysplasia of the hip (DDH) is a challenging procedure. The most used techniques involve anatomic cup positioning, augmentation femoral osteotomy. However, anatomic cup positioning is not always feasible in severe DDH and osteotomy nonunion may ensue. The purpose of the study was to assess the survivorship, the hip score results, the radiological parameters (fixation, loosening, component position) of a large cohort of patients with Crowe III and IV DDH, treated with high hip center and modular necks THAs. METHODS Eighty-four THAs in Crowe III and IV DDH were evaluated, achieving a final follow-up of 15.1 years. All the patients were treated with the same cementless implant (modular necks and ceramic-on-ceramic coupling) and the same approach (high cup placement with slight medialization). The patients were clinically evaluated (Harris Hip score and Merle d'Aubigne and Postel score). A radiographic evaluation was performed, analyzing the orientation of the cup. RESULTS Eighty patients were available at the last follow-up. The clinical scores were good at the final follow-up. Two sciatic lesions occurred: one patient fully recovered. The overall survivorship was 90.5% at 15 years: only 2 cases of aseptic loosening were reported. The mean center of rotation height was 33 ± 8 mm and the medialization was 30 ± 5 mm. CONCLUSION A high cup placement with slight medialization is a valid technique in DDH patients. A good restoration of the offset, ceramic-on-ceramic coupling and a porous socket may provide durable results, overcoming the effects of increasing joint reaction forces related to high cup placement.
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Affiliation(s)
- Maurizio Montalti
- Orthopaedic-Traumatology and Hip and Knee Replacement Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Castagnini
- Orthopaedic-Traumatology and Hip and Knee Replacement Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Giardina
- Orthopaedic-Traumatology and Hip and Knee Replacement Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Enrico Tassinari
- Orthopaedic-Traumatology and Hip and Knee Replacement Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Biondi
- Orthopaedic-Traumatology and Hip and Knee Replacement Department, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Aldo Toni
- Chief of Orthopaedic-Traumatology and Hip and Knee Replacement Department, Istituto Ortopedico Rizzoli, Bologna, Italy
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Total Hip Arthroplasty in a Patient with Oto-Spondylo-Megaepiphyseal Dysplasia Planned by Three-Dimensional Motion Analyses and Full-Scale Three-Dimensional Plaster Model of Bones. Case Rep Orthop 2018; 2018:8384079. [PMID: 29610693 PMCID: PMC5828490 DOI: 10.1155/2018/8384079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/03/2018] [Indexed: 11/18/2022] Open
Abstract
We present the case of a 28-year-old woman with oto-spondylo-megaepiphyseal dysplasia, which is a rare skeletal disorder, who underwent bilateral total hip arthroplasty. Full-scale three-dimensional plaster model of the acetabulum and the femur provided us with a feasible preoperative plan. Pre- and postoperative three-dimensional motion analyses proved a significant improvement in her ambulation and confirmed the efficacy of total hip arthroplasty. In conclusion, full-scale three-dimensional plaster models of the bone and three-dimensional motion analyses were useful for total hip arthroplasty in patients with skeletal dysplasia.
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The 3-dot circle: A reliable method for safe and efficient digital templating of the acetabular component. J Orthop 2018; 15:787-791. [PMID: 30013289 DOI: 10.1016/j.jor.2018.03.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/25/2018] [Indexed: 10/17/2022] Open
Abstract
Background Templating for preoperative planning of joint arthroplasty has followed the evolution of digital templating software. Objective This study aims to provide a safe, reliable and reproducible method for prediction of acetabular component size based on measurement of the radiographic femoral head diameter, with the aid of templating software. Methods A defined methodology for femoral head measurement was applied to 97 consecutive, calibrated digital pelvic radiographs. Based on radiographic femoral head diameter, the minimum acetabular shell diameter was calculated and then compared to the size of the implanted acetabular shells. Results This method predicted safe minimum acetabular component size with an accuracy of 95.9% with a high inter-observer reliability of 97.6%. Conclusions This study presents a simple, reproducible and accurate method for templating of the minimum safest acetabular component diameter.
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Interobserver and Intraobserver Reliability of Three-Dimensional Preoperative Planning Software in Total Hip Arthroplasty. J Arthroplasty 2018; 33:601-607. [PMID: 28927561 DOI: 10.1016/j.arth.2017.08.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/27/2017] [Accepted: 08/22/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to clarify interobserver and intraobserver reliabilities of the three-dimensional (3D) templating of total hip arthroplasty (THA). METHODS We selected preoperative computed tomography from 60 hips in 46 patients (14 men and 32 women) who underwent primary THA. To evaluate interobserver and intraobserver reliability, 6 orthopedic surgeons performed 3D templating twice over a 4-week interval. We investigated intraclass correlation coefficients (ICCs) and percent agreement of component size and alignment, comparing morphological differences in the hip. Reproducibility was also compared between groups with osteoarthritis (OA) and those with osteonecrosis (ON). RESULTS The interobserver reliabilities for mean cup size and stem size were excellent, with ICC = 0.907 and 0.944, respectively. The value was significantly higher in the ON group than in the OA group. In the OA group, the reliability of cup size and alignment decreased in hips with severe subluxation. Percent agreement of stem size was significantly different between the shapes of femoral canal. For intraobserver reliability, the mean ICC of cup size was 0.965 overall, while the value in the ON group was significantly higher than in the OA group. The mean ICC of stem size was 0.972 overall. CONCLUSION Computed tomography-based 3D templating showed excellent reliability for component size and alignment in THA. Deformity of the affected joint influenced the reliability of preoperative planning.
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Ogawa T, Takao M, Sakai T, Sugano N. Factors related to disagreement in implant size between preoperative CT-based planning and the actual implants used intraoperatively for total hip arthroplasty. Int J Comput Assist Radiol Surg 2017; 13:551-562. [DOI: 10.1007/s11548-017-1693-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/06/2017] [Indexed: 12/20/2022]
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Ahmad Fuad ANB, Deep K, Yao W. A multi-modality tracking, navigation and calibration for a flexible robotic drill system for total hip arthroplasty. Int J Med Robot 2017; 14. [PMID: 29230932 DOI: 10.1002/rcs.1878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND This paper presents a novel multi-modality tracking and navigation system that provides a unique capability to guild a flexible drill tip inside the bone with accurate curved tunnelling. METHODS As the flexible drill tip cannot be tracked optically inside the bone, this research focuses on developing a hybrid tracking and navigation system for tracking a flexible drill tip by using both optical and kinematic tracking. The tracking information is used to guide the THA (total hip arthroplasty) procedure, providing a real-time virtual model of the flexible drill. RESULTS The flexible and steerable drill tip system is then tested on total hip arthroplasty followed by evaluation of the positioning and orientation of femoral stem placement by femoral milling. CONCLUSIONS Based on this study, we conclude that the tracking and navigation system is able to guide the flexible drill to mill inside femoral canal.
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Affiliation(s)
| | - Kamal Deep
- Golden Jubilee National Hospital, Clydebank, UK
| | - Wei Yao
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
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Yoshii Y, Kusakabe T, Akita K, Tung WL, Ishii T. Reproducibility of three dimensional digital preoperative planning for the osteosynthesis of distal radius fractures. J Orthop Res 2017; 35:2646-2651. [PMID: 28407287 DOI: 10.1002/jor.23578] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/06/2017] [Indexed: 02/04/2023]
Abstract
A three-dimensional (3D) digital preoperative planning system for the osteosynthesis of distal radius fractures was developed for clinical practice. To assess the usefulness of the 3D planning for osteosynthesis, we evaluated the reproducibility of the reduction shapes and selected implants in the patients with distal radius fractures. Twenty wrists of 20 distal radius fracture patients who underwent osteosynthesis using volar locking plates were evaluated. The 3D preoperative planning was performed prior to each surgery. Four surgeons conducted the surgeries. The surgeons performed the reduction and the placement of the plate while comparing images between the preoperative plan and fluoroscopy. Preoperative planning and postoperative reductions were compared by measuring volar tilt and radial inclination of the 3D images. Intra-class correlation coefficients (ICCs) of the volar tilt and radial inclination were evaluated. For the implant choices, the ICCs for the screw lengths between the preoperative plan and the actual choices were evaluated. The ICCs were 0.644 (p < 0.01) and 0.625 (p < 0.01) for the volar tilt and radial inclination in the 3D measurements, respectively. The planned size of plate was used in all of the patients. The ICC for the screw length between preoperative planning and actual choice was 0.860 (p < 0.01). Good reproducibility for the reduction shape and excellent reproducibility for the implant choices were achieved using 3D preoperative planning for distal radius fracture. Three-dimensional digital planning was useful to visualize the reduction process and choose a proper implant for distal radius fractures. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2646-2651, 2017.
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Affiliation(s)
- Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Japan
| | - Takuya Kusakabe
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Japan
| | | | - Wen Lin Tung
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan
| | - Tomoo Ishii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami 300-0395, Japan
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Nguyen L, Stoter S, Baum T, Kirschke J, Ruess M, Yosibash Z, Schillinger D. Phase-field boundary conditions for the voxel finite cell method: Surface-free stress analysis of CT-based bone structures. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2017; 33. [PMID: 28294574 DOI: 10.1002/cnm.2880] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/21/2017] [Accepted: 03/03/2017] [Indexed: 06/06/2023]
Abstract
The voxel finite cell method uses unfitted finite element meshes and voxel quadrature rules to seamlessly transfer computed tomography data into patient-specific bone discretizations. The method, however, still requires the explicit parametrization of boundary surfaces to impose traction and displacement boundary conditions, which constitutes a potential roadblock to automation. We explore a phase-field-based formulation for imposing traction and displacement constraints in a diffuse sense. Its essential component is a diffuse geometry model generated from metastable phase-field solutions of the Allen-Cahn problem that assumes the imaging data as initial condition. Phase-field approximations of the boundary and its gradient are then used to transfer all boundary terms in the variational formulation into volumetric terms. We show that in the context of the voxel finite cell method, diffuse boundary conditions achieve the same accuracy as boundary conditions defined over explicit sharp surfaces, if the inherent length scales, ie, the interface width of the phase field, the voxel spacing, and the mesh size, are properly related. We demonstrate the flexibility of the new method by analyzing stresses in a human femur and a vertebral body.
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Affiliation(s)
- Lam Nguyen
- Department of Civil, Environmental, and Geo- Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Stein Stoter
- Department of Civil, Environmental, and Geo- Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Thomas Baum
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jan Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Martin Ruess
- School of Engineering, University of Glasgow, Glasgow, UK
| | - Zohar Yosibash
- Department of Mechanical Engineering, Ben-Gurion-University of the Negev, Beer Sheva, Israel
| | - Dominik Schillinger
- Department of Civil, Environmental, and Geo- Engineering, University of Minnesota, Minneapolis, MN 55455, USA
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Wilson L, Humphrey L. Voyaging into the third dimension: A perspective on virtual methods and their application to studies of juvenile sex estimation and the ontogeny of sexual dimorphism. Forensic Sci Int 2017; 278:32-46. [DOI: 10.1016/j.forsciint.2017.06.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/16/2017] [Accepted: 06/16/2017] [Indexed: 02/06/2023]
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Comparison of anatomic vs. straight femoral stem design in total hip replacement - femoral canal fill in vivo. Hip Int 2017; 27:241-244. [PMID: 27886361 DOI: 10.5301/hipint.5000439] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The femoral canal fill between an anatomic and a straight prosthesis design in cementless total hip arthroplasty (THA) was compared. We hypothesised that the anatomic SPS stem has higher proximal fill and lesser distal fill than the straight stem. MATERIAL AND METHODS The femoral canal fill was measured on 3 months routine postoperative x-rays at 5 levels of the stem in 50 consecutive patients, aged 35-83 years, who underwent 56 THA procedures by a single surgeon in this hospital. 22 patients received a straight design Ceramconcept Global stem, 34 patients received an anatomic design Symbios SPS stem. Both anteroposterior (AP) and lateral x-rays were combined to suggest a 3-D measurement. RESULTS On the AP x-rays, the canal fill was significantly higher using the anatomic design stem at the proximal measurement levels, and was significantly higher at the distal levels using the straight stem. With the AP and lateral x-rays combined, the canal fill at the proximal levels was also significantly higher in the anatomic groups, nonsignificantly lower at the central level and significantly lower at the distal levels. DISCUSSION In THA surgery, achieving high fill at the metaphysis of the femur and less fill at the diaphysis has been suggested to result in satisfactory outcome and high stability of the prosthesis. This study demonstrated that, compared to straight stem design, an anatomically designed stem has a significantly higher metaphyseal femoral canal fill.
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FALCINELLI CRISTINA, SCHILEO ENRICO, BARUFFALDI FABIO, CRISTOFOLINI LUCA, TADDEI FULVIA. THE EFFECT OF COMPUTED TOMOGRAPHY CURRENT REDUCTION ON PROXIMAL FEMUR SUBJECT-SPECIFIC FINITE ELEMENT MODELS. J MECH MED BIOL 2017. [DOI: 10.1142/s0219519417500129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Many studies have addressed the modulation of computed tomography (CT) parameters, and particularly of tube current, to obtain a good compromise between the X-ray dose to the patient and the image quality for diagnostic applications. This study aimed at evaluating the influence of dose reduction by means of tube current reduction on the CT-based subject-specific finite element (FE) modeling. To this aim, CT scans at stepwise reduced values of tube current from 180[Formula: see text]mAs to 80[Formula: see text]mAs were performed on: (i) a densitometric phantom, to quantify the changes in the calibration equation; (ii) a fresh-frozen, water submersed, human cadaver femur, to quantify changes in geometry reconstruction and material mapping from CT, as well as strain prediction accuracy, based on the in vitro strain measurements available; (iii) a fresh-frozen human cadaver thigh with soft tissues attached, to quantify FE results changes in conditions similar to those found in vivo. The results showed that the tube current reduction does not affect the 3D modeling and the femur FE analysis. Our pilot study highlights the possibility of performing CT scans with reduced dose to generate biomechanical models, although a confirmation by performing larger studies with clinical CT data is needed.
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Affiliation(s)
- CRISTINA FALCINELLI
- Laboratorio di Bioingegneria Computazionale, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
- Dipartimento di Ingegneria Civile, Università di Roma Tor Vergata, Via del Politecnico 1, 00133 Roma, Italy
| | - ENRICO SCHILEO
- Laboratorio di Bioingegneria Computazionale, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - FABIO BARUFFALDI
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - LUCA CRISTOFOLINI
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
- Dipartimento di Ingegneria Industriale, Università di Bologna Viale Risorgimento 2, 40136 Bologna, Italy
| | - FULVIA TADDEI
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
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CT-based automated planning of acetabular cup for total hip arthroplasty (THA) based on hybrid use of two statistical atlases. Int J Comput Assist Radiol Surg 2016; 11:2253-2271. [PMID: 27344334 DOI: 10.1007/s11548-016-1428-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE This study describes the use of CT images in atlas-based automated planning methods for acetabular cup implants in total hip arthroplasty (THA). The objective of this study is to develop an automated cup planning method considering the statistical distribution of the residual thickness. METHODS From a number of past THA planning datasets, we construct two statistical atlases that represent the surgeon's expertise. The first atlas is a pelvis-cup merged statistical shape model (PC-SSM), which encodes global spatial relationships between the patient anatomy and implant. The other is a statistical residual thickness map (SRTM) of the implant surface, which encodes local spatial constraints of the anatomy and implant. In addition to PC-SSM and SRTM, we utilized the minimum thickness as a threshold constraint to prevent penetration. RESULTS The proposed method was applied to the pelvis shapes segmented from CT images of 37 datasets of osteoarthritis patients. Automated planning results with manual segmentation were compared to the plans prepared by an experienced surgeon. There was no significant difference in the average cup size error between the two methods (1.1 and 1.2 mm, respectively). The average positional error obtained by the proposed method, which integrates the two atlases, was significantly smaller (3.2 mm) than the previous method, which uses single atlas (3.9 mm). In the proposed method with automated segmentation, the size error of the proposed method for automated segmentation was comparable (1.1 mm) to that for manual segmentation (1.1 mm). The average positional error was significantly worse (4.2 mm) than that using manual segmentation (3.2 mm). If we only consider mildly diseased cases, however, there was no significance between them (3.2 mm in automated and 2.6 mm in manual segmentation). CONCLUSION We infer that integrating PC-SSM and SRTM is a useful approach for modeling experienced surgeon's preference during cup planning.
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Zheng G, Schumann S, Balestra S, Thelen B, Nolte LP. 2D-3D Reconstruction-Based Planning of Total Hip Arthroplasty. COMPUTATIONAL RADIOLOGY FOR ORTHOPAEDIC INTERVENTIONS 2016. [DOI: 10.1007/978-3-319-23482-3_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Wen-ming X, Ai-min W, Qi W, Chang-hua L, Jian-fei Z, Fang-fang X. An integrated CAD/CAM/robotic milling method for custom cementless femoral prostheses. Med Eng Phys 2015. [PMID: 26210779 DOI: 10.1016/j.medengphy.2015.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Aseptic loosening is the primary cause of cementless femoral prosthesis failure and is related to the primary stability of the cementless femoral prosthesis in the femoral cavity. The primary stability affects both the osseointegration and the long-term stability of cementless femoral prostheses. A custom cementless femoral prosthesis can improve the fit and fill of the prosthesis in the femoral cavity and decrease the micromotion of the proximal prosthesis such that the primary stability of the custom prosthesis can be improved, and osseointegration of the proximal prosthesis is achieved. These results will help to achieve long-term stability in total hip arthroplasty (THA). In this paper, we introduce an integrated CAD/CAM/robotic method of milling custom cementless femoral prostheses. The 3D reconstruction model uses femoral CT images and 3D design software to design a CAD model of the custom prosthesis. After the transformation matrices between two units of the robotic system are calibrated, consistency between the CAM software and the robotic system can be achieved, and errors in the robotic milling can be limited. According to the CAD model of the custom prosthesis, the positions of the robotic tool points are produced by the CAM software of the CNC machine. The normal vector of the three adjacent robotic tool point positions determines the pose of the robotic tool point. In conclusion, the fit rate of custom pig femur stems in the femoral cavities was 90.84%. After custom femoral prostheses were inserted into the femoral cavities, the maximum gaps between the prostheses and the cavities measured less than 1 mm at the diaphysis and 1.3 mm at the metaphysis.
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Affiliation(s)
- Xi Wen-ming
- School of Physics and Mechanical Engineering, Xiamen University, Xiamen 361005, China
| | - Wang Ai-min
- School of Physics and Mechanical Engineering, Xiamen University, Xiamen 361005, China.
| | - Wu Qi
- The 82 Hospital of People's Liberation Army, Huai'an 223001, China
| | - Liu Chang-hua
- The 174 Hospital of People's Liberation Army, Xiamen 361001, China
| | - Zhu Jian-fei
- The 82 Hospital of People's Liberation Army, Huai'an 223001, China
| | - Xia Fang-fang
- School of Physics and Mechanical Engineering, Xiamen University, Xiamen 361005, China
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Schumann S, Sato Y, Nakanishi Y, Yokota F, Takao M, Sugano N, Zheng G. Cup Implant Planning Based on 2-D/3-D Radiographic Pelvis Reconstruction-First Clinical Results. IEEE Trans Biomed Eng 2015; 62:2665-73. [PMID: 26057528 DOI: 10.1109/tbme.2015.2441378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
GOAL In the following, we will present a newly developed X-ray calibration phantom and its integration for 2-D/3-D pelvis reconstruction and subsequent automatic cup planning. Two different planning strategies were applied and evaluated with clinical data. METHODS Two different cup planning methods were investigated: The first planning strategy is based on a combined pelvis and cup statistical atlas. Thereby, the pelvis part of the combined atlas is matched to the reconstructed pelvis model, resulting in an optimized cup planning. The second planning strategy analyzes the morphology of the reconstructed pelvis model to determine the best fitting cup implant. RESULTS The first planning strategy was compared to 3-D CT-based planning. Digitally reconstructed radiographs of THA patients with differently severe pathologies were used to evaluate the accuracy of predicting the cup size and position. Within a discrepancy of one cup size, the size was correctly identified in 100% of the cases for Crowe type I datasets and in 77.8% of the cases for Crowe type II, III, and IV datasets. The second planning strategy was analyzed with respect to the eventually implanted cup size. In seven patients, the estimated cup diameter was correct within one cup size, while the estimation for the remaining five patients differed by two cup sizes. CONCLUSION While both planning strategies showed the same prediction rate with a discrepancy of one cup size (87.5%), the prediction of the exact cup size was increased for the statistical atlas-based strategy (56%) in contrast to the anatomically driven approach (37.5%). SIGNIFICANCE The proposed approach demonstrated the clinical validity of using 2-D/3-D reconstruction technique for cup planning.
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Wu Z, Fu J, Wang Z, Li X, Li J, Pei Y, Pei G, Li D, Guo Z, Fan H. Three-dimensional virtual bone bank system for selecting massive bone allograft in orthopaedic oncology. INTERNATIONAL ORTHOPAEDICS 2015; 39:1151-8. [PMID: 25772276 DOI: 10.1007/s00264-015-2719-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/18/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE Although structural bone allografts have been used for years to treat large defects caused by tumour or trauma, selecting the most appropriate allograft is still challenging. The objectives of this study were to: (1) describe the establishment of a visual bone bank system and workflow of allograft selection, and (2) show mid-term follow-up results of patients after allograft implantation. METHODS Allografts were scanned and stored in Digital Imaging and Communications in Medicine (DICOM) files. Then, image segmentation was conducted and 3D model reconstructed to establish a visual bone bank system. Based on the volume registration method, allografts were selected after a careful matching process. From November 2010 to June 2013, with the help of the Computer-assisted Orthopaedic Surgery (CAOS) navigation system, the allografts were implanted in 14 patients to fill defects after tumour resection. RESULTS By combining the virtual bone bank and CAOS, selection time was reduced and matching accuracy was increased. After 27.5 months of follow-up, the mean Musculoskeletal Tumor Society (MSTS) 93 functional score was 25.7 ± 1.1 points. Except for two patients with pulmonary metastases, 12 patents were alive without evidence of disease at the time this report was written. CONCLUSIONS The virtual bone bank system was helpful for allograft selection, tumour excision and bone reconstruction, thereby improving the safety and effectiveness of limb-salvage surgery.
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Affiliation(s)
- Zhigang Wu
- Department of Orthopaedic Surgery, Xi-Jing Hospital, The Fourth Military Medical University, Xi'an, 710032, China
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Inoue D, Kabata T, Maeda T, Kajino Y, Fujita K, Hasegawa K, Yamamoto T, Tsuchiya H. Value of computed tomography-based three-dimensional surgical preoperative planning software in total hip arthroplasty with developmental dysplasia of the hip. J Orthop Sci 2015; 20:340-6. [PMID: 25623254 DOI: 10.1007/s00776-014-0683-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 11/28/2014] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Preoperative planning with computed tomography (CT)-based three-dimensional templating has been expanded to achieve more precise placement of hip components. However, few reports have addressed the utility of three-dimensional surgical planning software for secondary osteoarthritis cases. This study therefore investigated the value of CT-based three-dimensional templating software for preoperative planning in primary total hip arthroplasty (THA), with an emphasis on developmental dysplasia of the hip. MATERIALS AND METHODS We performed a retrospective review of 65 hips in 57 patients who underwent cementless primary THA. The preoperative diagnosis was secondary osteoarthritis in all cases due to developmental dysplasia of the hip. All preoperative planning and postoperative evaluations were completed using CT-based three-dimensional templating software. We analyzed the accuracy of stem size prediction and cup size prediction, the reproducibility of preoperative and postoperative stem anteversion, and the absolute error in preoperative and postoperative stem anteversion using CT-based three-dimensional templating software. RESULTS The sizes of 65 % of the femoral stems (42/65) were estimated exactly, and 98 % (63/65) were accurately estimated to within one stem size. The final acetabular cup sizes corresponded exactly to the preoperatively planned size in 92 % of all cases (62/65). 100 % of the cup size estimates were accurate to within one cup size. There was strong reproducibility of preoperative and postoperative stem anteversion (r = 0.88, P < 0.05). The absolute error in stem anteversion was 4.0° ± 3.6°. CONCLUSIONS Using CT-based three-dimensional templating software made it possible to achieve reproducible stem anteversion and choose accurate stem and cup sizes in patients with developmental dysplasia of the hip.
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Affiliation(s)
- Daisuke Inoue
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
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Kagiyama Y, Takao M, Sugano N, Tada Y, Tomiyama N, Sato Y. Optimization of surgical planning of total hip arthroplasty based on computational anatomy. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:2980-3. [PMID: 24110353 DOI: 10.1109/embc.2013.6610166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper describes a method for automated optimization of total hip arthroplasty (THA) planning incorporating joint functionalities. The optimal planning is formulated as maximum a posterior (MAP) estimation, which ensures the best-balance of joint functionalities and bone-implant spatial relations based on their statistical models derived from the training datasets prepared by an experienced surgeon. According to the performance evaluation, four of the six functionalities of the automatically optimized plans were almost equivalent to those of surgeon's plans, and two of them were improved. We consider these results showed a potential usefulness of the proposed method.
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Prediction of three-dimensional femoral offset from AP pelvis radiographs in primary hip osteoarthritis. Eur J Radiol 2013; 82:1278-85. [DOI: 10.1016/j.ejrad.2013.02.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 02/17/2013] [Accepted: 02/25/2013] [Indexed: 12/25/2022]
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Kwon JY, Naito H, Matsumoto T, Tanaka M. Estimation of change of bone structures after total hip replacement using bone remodeling simulation. Clin Biomech (Bristol, Avon) 2013; 28:514-8. [PMID: 23647807 DOI: 10.1016/j.clinbiomech.2013.04.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 03/20/2013] [Accepted: 04/02/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The principal cause of femoral stem failure is the loosening of the total hip replacement due to bone resorption in the vicinity of the prosthesis (stress shielding). Bone rebuilds its structure continuously according to the daily mechanical stimuli. Therefore, surgical intervention alters the mechanical condition of bone severely. In this study, we propose a method to predict the change of bone structure after total hip replacement using bone remodeling simulation. METHOD The bone-stem complex structure model after total hip replacement was reconstructed based on CT-images used for preoperative planning by orthopedic experts. The bone remodeling simulation was conducted under the daily loading condition using our previous remodeling model, and the average equivalent stresses in the Gruen zone were evaluated. FINDINGS The predicted bone loss relevant to stress shielding was consistent to follow-up clinical data. Moreover, the remodeling simulation when using the stems of different size for the same patient could detect the size-dependent change of stress in the Gruen zone. In particular, the zone under the neck of the stem showed significant changes of stress and large bone loss, accompanying the risk of loosening or fracture. INTERPRETATIONS Prediction of bone structure changes after total hip replacement gives us significant information for longevity of prosthesis. Simulation results showed that the present computational framework could be considered to have potential in preoperative planning of total hip replacement.
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Affiliation(s)
- Ji Yean Kwon
- Graduate School of Engineering Science, Osaka University, Japan.
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Li Y, Lin J, Zhang J, Li J, Yao X, Zhuang H, Zeng Y. Significance of proximal femoral computed tomography scanning in the prediction of femoral prosthesis before total hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 23:67-72. [PMID: 23412410 DOI: 10.1007/s00590-012-0941-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 01/07/2012] [Indexed: 11/29/2022]
Abstract
Femoral prosthesis before total hip arthroplasty (THA) predicted by Proximal Femoral CT scanning. Prior to THA, 61 hip bones in 52 cases were scanned by CT to measure the minimum inner diameter of cavum medullare in femur isthmus. The corresponding type of femoral prosthesis was selected according to the size of the cavum medullares. The conventional template measuring method was used as a contrast. The minimum inner diameter of cavum medullare in femur isthmus and the medial diameter of cavum medullare of resected femur had strong correlation with the type of femoral prosthesis (r = 0.97-0.99, P < 0.05). In terms of pre-operative femoral prosthesis selection, the CT-based isthmus-measuring method had an excellence rate of 47.5%. This method had an excellence rate of 52.5%. The CT-based resected-femur-measuring method had better accuracy in pre-operative femoral prosthesis selection for the patients.
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Affiliation(s)
- Yizhong Li
- Department of Orthopedics of the Second Clinical Medical Institute, Fujian Medical University, Quanzhou City 362000, Fujian Province, China.
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Issa K, Pivec R, Boyd B, Harwin SF, Wuestemann T, Nevelos J, Mont MA. Comparing the accuracy of radiographic preoperative digital templating for a second- versus a first-generation THA stem. Orthopedics 2012; 35:1028-34. [PMID: 23218615 DOI: 10.3928/01477447-20121120-03] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study assessed the accuracy of preoperative digital templating for a second-generation cementless stem compared with its first-generation design. A prospective cohort of 100 consecutive patients who had undergone a primary total hip arthroplasty using a new second-generation cementless stem was compared with the prior 100 hips that had received the first-generation stem. The authors believe that the second-generation stem may allow equal or more accurate digital templating compared with its predicate design.
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Affiliation(s)
- Kimona Issa
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, USA
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Abstract
Surgeons have to deal with many devices from different vendors within the operating room during surgery. Independent communication standards are necessary for the system integration of these devices. For implantations, three new extensions of the Digital Imaging and Communications in Medicine (DICOM) standard make use of a common communication standard that may optimise one of the surgeon's presently very time-consuming daily tasks. The paper provides a brief description of these DICOM Supplements and gives recommendations to their application in practice based on workflows that are proposed to be covered by the new standard extension. Two of the workflows are described in detail and separated into phases that are supported by the new data structures. Examples for the application of the standard within these phases give an impression of the potential usage. Even if the presented workflows are from different domains, we identified a generic core that may benefit from the surgical DICOM Supplements. In some steps of the workflows, the surgical DICOM Supplements are able to replace or optimise conventional methods. Standardisation can only be a means for integration and interoperability. Thus, it can be used as the basis for new applications and system architectures. The influence on current applications and communication processes is limited. Additionally, the supplements provide the basis for further applications, such as the support of surgical navigation systems. Given the support of all involved stakeholders, it is possible to provide a benefit for surgeons and patients.
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Cerveri P, Manzotti A, Baroni G. Patient-specific acetabular shape modelling: comparison among sphere, ellipsoid and conchoid parameterisations. Comput Methods Biomech Biomed Engin 2012; 17:560-7. [DOI: 10.1080/10255842.2012.702765] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Barbeito-Andrés J, Anzelmo M, Ventrice F, Sardi ML. Measurement error of 3D cranial landmarks of an ontogenetic sample using Computed Tomography. J Oral Biol Craniofac Res 2012; 2:77-82. [PMID: 25737840 DOI: 10.1016/j.jobcr.2012.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 05/25/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND/AIM Computed Tomography (CT) is a powerful tool in craniofacial research that focuses on morphological variation. In this field, an ontogenetic approach has been taken to study the developmental sources of variation and to understand the basis of morphological evolution. This work aimed to determine measurement error (ME) in cranial CT in diverse developmental stages and to characterize how this error relates to different types of landmarks. MATERIAL AND METHODS We used a sample of fifteen skulls ranging from 0 to 31 years. Two observers placed landmarks in each image three times. Measurement error was assessed before and after Generalized Procrustes Analysis. RESULTS The results indicated that ME is larger in neurocranial structures, which are described mainly by type III landmarks and semilandmarks. In addition, adult and infant specimens showed the same level of ME. These results are specially relevant in the context of craniofacial growth research. CONCLUSION CT images have become a frequent evidence to study cranial variation. Evaluation of ME gives insight into the potential source of error in interpreting results. Neural structures present higher ME which is mainly associated to landmark localization. However, this error is irrespective of age. If landmarks are correctly selected, they can be analyzed with the same level of reliability in adults and subadults.
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Affiliation(s)
- Jimena Barbeito-Andrés
- División Antropología, Museo de La Plata, Paseo del Bosque s/n, La Plata 1900, Buenos Aires, Argentina ; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Marisol Anzelmo
- División Antropología, Museo de La Plata, Paseo del Bosque s/n, La Plata 1900, Buenos Aires, Argentina ; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | - Fernando Ventrice
- Laboratorio de Neuroimágenes, Departamento de Imágenes, Instituto de Investigaciones Neurológicas Raúl Carrea, FLENI, Argentina
| | - Marina L Sardi
- División Antropología, Museo de La Plata, Paseo del Bosque s/n, La Plata 1900, Buenos Aires, Argentina ; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
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Pegg EC, Mellon SJ, Salmon G, Alvand A, Pandit H, Murray DW, Gill HS. Improved radiograph measurement inter-observer reliability by use of statistical shape models. Eur J Radiol 2012; 81:2585-91. [PMID: 22236703 DOI: 10.1016/j.ejrad.2011.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Revised: 12/08/2011] [Accepted: 12/09/2011] [Indexed: 10/14/2022]
Abstract
Pre- and post-operative radiographs of patients undergoing joint arthroplasty are often examined for a variety of purposes including preoperative planning and patient assessment. This work examines the feasibility of using active shape models (ASM) to semi-automate measurements from post-operative radiographs for the specific case of the Oxford™ Unicompartmental Knee. Measurements of the proximal tibia and the position of the tibial tray were made using the ASM model and manually. Data were obtained by four observers and one observer took four sets of measurements to allow assessment of the inter- and intra-observer reliability, respectively. The parameters measured were the tibial tray angle, the tray overhang, the tray size, the sagittal cut position, the resection level and the tibial width. Results demonstrated improved reliability (average of 27% and 11.2% increase for intra- and inter-reliability, respectively) and equivalent accuracy (p>0.05 for compared data values) for all of the measurements using the ASM model, with the exception of the tray overhang (p=0.0001). Less time (15s) was required to take measurements using the ASM model compared with manual measurements, which was significant. These encouraging results indicate that semi-automated measurement techniques could improve the reliability of radiographic measurements.
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Affiliation(s)
- E C Pegg
- University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK.
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Otomaru I, Nakamoto M, Kagiyama Y, Takao M, Sugano N, Tomiyama N, Tada Y, Sato Y. Automated preoperative planning of femoral stem in total hip arthroplasty from 3D CT data: atlas-based approach and comparative study. Med Image Anal 2011; 16:415-26. [PMID: 22119490 DOI: 10.1016/j.media.2011.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 09/04/2011] [Accepted: 10/25/2011] [Indexed: 11/18/2022]
Abstract
Atlas-based methods for automated preoperative planning of the femoral stem implant in total hip arthroplasty are described. Statistical atlases are constructed from a number of past preoperative plans prepared by experienced surgeons in order to represent the surgeon's expertise of the planning. Two types of atlases are considered. One is a statistical distance map atlas, which represents surgeon's preference of the contact pattern between the femoral canal (host bone) and stem (implant) surfaces. The other is an optimal reference plan, which is selected as the best representative plan expected to minimize the deviation from the surgeon's preferred contact pattern. These atlases are fitted to the patient data to automatically generate the preoperative plan of the femoral stem. In this paper, we formulate a general framework of atlas-based implant planning, and then describe the methods for construction and utilization of the two proposed atlases. In the experiments, we used 40 cases to evaluate the proposed methods and compare them with previous methods by defining the errors as differences between automated and surgeon's plans. By using the proposed methods, the positional and orientation errors were significantly reduced compared with the previous methods and the size error was superior to inter-surgeon variability in size selection using 2D templates on an X-ray image reported in previous work.
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MESH Headings
- Algorithms
- Arthroplasty, Replacement, Hip/instrumentation
- Arthroplasty, Replacement, Hip/methods
- Computer Simulation
- Femur Head/diagnostic imaging
- Femur Head/surgery
- Hip Prosthesis
- Humans
- Imaging, Three-Dimensional/methods
- Models, Anatomic
- Models, Biological
- Pattern Recognition, Automated/methods
- Preoperative Care
- Prosthesis Design
- Radiographic Image Enhancement/methods
- Radiographic Image Interpretation, Computer-Assisted/methods
- Reproducibility of Results
- Sensitivity and Specificity
- Tomography, X-Ray Computed/methods
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Affiliation(s)
- Itaru Otomaru
- Graduate School of Engineering, Kobe University, Japan
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