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Schwartz JM, Grant AR, Bhadra AK. The learning curve for robotic-assisted total hip arthroplasty in low, medium, and high-volume surgeons. J Orthop 2024; 55:163-168. [PMID: 38706588 PMCID: PMC11067002 DOI: 10.1016/j.jor.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/14/2024] [Indexed: 05/07/2024] Open
Abstract
Background Robotic systems have been designed to increase the accuracy of implant alignment in total knee and hip arthroplasty. This technology is associated with a learning curve for the operative time to reach peak efficiency in its use. Prior studies done on high-volume orthopedic surgeons have suggested a learning curve of 14-35 cases for robotic-assisted total hip arthroplasty (THA). It is unclear if this learning curve is different for surgeons with lower volumes. Methods Data was collected retrospectively from 299 THA procedures done by three different surgeons, with low (1-15 cases/year), medium (16-50), and high (51+) volume caseload. The learning curve was assessed primarily by average operative time from cases 1-20, 21-50, and 51+. Results The high-volume surgeon had a learning curve of 20 cases, while the low and medium volume surgeons had no significant decrease in their operative time through the cases included in the study (20 and 63, respectively). Conclusions High volume surgeons have a learning curve of about 20 cases, while low and medium volume surgeons have a longer curve, which was not able to be measured in this study.
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Affiliation(s)
- Jake M. Schwartz
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Andrew R. Grant
- New England Baptist Hospital, 125 Parker Hill Ave, Boston, MA, USA
- New York Medical College, Valhalla, New York, USA
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2
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Hecht CJ, Nedder VJ, Porto JR, Morgan KA, Kamath AF. Are robotic-assisted and computer-navigated total hip arthroplasty associated with superior outcomes in patients who have hip dysplasia? J Orthop 2024; 53:125-132. [PMID: 38515529 PMCID: PMC10950562 DOI: 10.1016/j.jor.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction Robotic-assisted (RA) and computer-navigated (CN) total hip arthroplasty (THA) have been demonstrated to improve component placement accuracy compared to manual THA (mTHA) for primary osteoarthritis. As hip dysplasia presents several additional challenges in component placement accuracy and leg length discrepancy (LLD) correction during THA, a systematic review was conducted to evaluate whether utilizing these platforms may be associated with superior outcomes over mTHA in patients who have hip dysplasia. Methods PubMed, Medline, EBSCOhost, and Google Scholar were searched on September 13, 2023 to identify comparative studies published after January 1, 2000 that evaluated outcomes of RA-THA or CN-THA in patients who have hip dysplasia. The query yielded 197 unique articles, which were screened for alignment with the study aims. After screening, 10 studies fulfilled all inclusion criteria, comprising 946 patients. Risk of bias was evaluated via the Methodological Index for Nonrandomized Studies tool, and the mean score was 21.2 ± 1.5. Results Both RA-THA and CN-THA were not associated with improved acetabular anteversion and inclination when evaluating Crowe I-IV types altogether compared to mTHA, but studies reported improved accuracy for each Crowe I and II cases when assessed individually. While studies reporting acetabular cup placement within the Lewinnek and Callanan safe zones consistently found higher odds of accurate positioning for RA-THA versus mTHA, accuracy in achieving targeted center of rotation was mixed. Also, studies reported no difference in LLD restoration for RA-THA and CN-THA compared to mTHA. While operative time may be increased when utilizing these platforms, they may also expedite specific sequences, offsetting most of the increase in operative time. Conclusion This review highlights the advantages of RA-THA and CN-THA for patients who have DDH, particularly when treating Crowe I and II types as superior radiographic outcomes were achieved with these intraoperative technologies. However, there remains a need for studies to investigate whether this results in patient-reported outcome measures.
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Affiliation(s)
- Christian J. Hecht
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Victoria J. Nedder
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Joshua R. Porto
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Kerry A. Morgan
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Atul F. Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
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Liu C, Xu Z, Zeng JF, Song ZQ, Xie YY, Tang ZW, Wen J, Xiao S. Roles of combined femoral and acetabular anteversion in pathological changes of hip dysplasia and hip reconstructive surgery. World J Orthop 2024; 15:390-399. [PMID: 38835688 PMCID: PMC11145975 DOI: 10.5312/wjo.v15.i5.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/10/2024] [Accepted: 04/24/2024] [Indexed: 05/15/2024] Open
Abstract
Combined femoral and acetabular anteversion is the sum of femoral and acetabular anteversion, representing their morphological relationship in the axial plane. Along with the increasing understanding of hip dysplasia in recent years, numerous scholars have confirmed the role of combined femoral and acetabular anteversion in the pathological changes of hip dysplasia. At present, the reconstructive surgery for hip dysplasia includes total hip replacement and redirectional hip preservation surgery. As an important surgery index, combined femoral and acetabular anteversion have a crucial role in these surgeries. Herein, we discuss the role of combined femoral and acetabular anteversion in pathological changes of hip dysplasia, total hip replacement, and redirectional hip preservation surgery.
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Affiliation(s)
- Can Liu
- Department of Anatomy, Hunan Normal University School of Medicine, Changsha 410003, Hunan Province, China
| | - Zheng Xu
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Jian-Fa Zeng
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zhen-Qi Song
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Yu-Yin Xie
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Zhong-Wen Tang
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Jie Wen
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
| | - Sheng Xiao
- Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
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Meermans G, Fawley D, Zagra L, Ten Broeke RHM, Johnson K, Bernard T, Thomason HC. Accuracy of cup placement compared with preoperative surgeon targets in primary total hip arthroplasty using standard instrumentation and techniques: a global, multicenter study. J Orthop Traumatol 2024; 25:25. [PMID: 38727945 PMCID: PMC11087417 DOI: 10.1186/s10195-024-00766-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Acetabular cup positioning in total hip arthroplasty (THA) is closely related to outcomes. The literature has suggested cup parameters defined by the Lewinnek safe zone; however, the validity of such measures is in question. Several studies have raised concerns about the benefits of using the Lewinnek safe zone as a predictor of success. In this study we elected to use prospective surgeon targets as the basis for comparison to see how successful surgeons are positioning their cup using standard instruments and techniques. METHODS A prospective, global, multicenter study was conducted. Cup positioning success was defined as a composite endpoint. Both cup inclination and version needed to be within 10° of the surgeon target to be considered a success. Radiographic analysis was conducted by a third-party reviewer. RESULTS In 170 subjects, inclination, target versus actual, was 44.8° [standard deviation (SD 0.9°)] and 43.1° (SD 7.6°), respectively (p = 0.0029). Inclination was considered successful in 84.1% of cases. Mean version, target versus actual, was 19.4° (SD 3.9°) and 27.2° (SD 5.6°), respectively (p < 0.0001). Version was considered successful in 63.4% of cases, and combined position (inclination and version) was considered successful in 53.1%. CONCLUSION This study shows that with traditional methods of placing the cup intraoperatively, surgeons are only accurate 53.1% of the time compared with a predicted preoperative plan. This study suggests that the inconsistency in cup positioning based on the surgeon's planned target is potentially another important variable to consider while using a mechanical guide or in freehand techniques for cup placement in THA. TRIAL REGISTRATION This study is registered on ClinicalTrials.gov, NCT03189303.
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Affiliation(s)
- Geert Meermans
- Department of Orthopaedics, Bravis Hospital, Bergen op Zoom, Roosendaal, The Netherlands.
| | - David Fawley
- DePuy Synthes, 700 Orthopaedic Drive, Warsaw, IN, USA
| | - Luigi Zagra
- Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - René H M Ten Broeke
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, 6202 AZ, Maastricht, The Netherlands
| | - Kory Johnson
- Orthopaedic Associates of Michigan, 555 Mid Towne St Suite 105, Grand Rapids, MI, USA
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Tanaka S, Takegami Y, Osawa Y, Okamoto M, Imagama S. Retrospective study comparing the accuracies of handheld infrared stereo camera and augmented reality-based navigation systems for total hip arthroplasty. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05330-5. [PMID: 38704436 DOI: 10.1007/s00402-024-05330-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/14/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The use of portable navigation systems (PNS) in total hip arthroplasty (THA) has become increasingly prevalent, with second-generation PNS (sPNS) demonstrating superior accuracy in the lateral decubitus position compared to first-generation PNS. However, few studies have compared different types of sPNS. This study retrospectively compares the accuracy and clinical outcomes of two different types of sPNS instruments in patients undergoing THA. METHODS A total of 158 eligible patients who underwent THA at a single institution between 2019 and 2022 were enrolled in the study, including 89 who used an accelerometer-based PNS with handheld infrared stereo cameras in the Naviswiss group (group N) and 69 who used an augmented reality (AR)-based PNS in the AR-Hip group (group A). Accuracy error, navigation error, clinical outcomes, and preparation time were compared between the two groups. RESULTS Accuracy errors for Inclination were comparable between group N (3.5° ± 3.0°) and group A (3.5° ± 3.1°) (p = 0.92). Accuracy errors for anteversion were comparable between group N (4.1° ± 3.1°) and group A (4.5° ± 4.0°) (p = 0.57). The navigation errors for inclination (group N: 2.9° ± 2.7°, group A: 3.0° ± 3.2°) and anteversion (group N: 4.3° ± 3.5°, group A: 4.3° ± 4.1°) were comparable between the groups (p = 0.86 and 0.94, respectively). The preparation time was shorter in group A than in group N (p = 0.036). There were no significant differences in operative time (p = 0.255), intraoperative blood loss (p = 0.387), or complications (p = 0.248) between the two groups. CONCLUSION An Accelerometer-based PNS using handheld infrared stereo cameras and AR-based PNS provide similar accuracy during THA in the lateral decubitus position, with a mean error of 3°-4° for both inclination and anteversion, though the AR-based PNS required a shorter preparation time.
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Affiliation(s)
- Shinya Tanaka
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya-Shi, 466-8550, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya-Shi, 466-8550, Japan.
| | - Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya-Shi, 466-8550, Japan
| | - Masanori Okamoto
- Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi-Shi, Mie, 510-8567, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya-Shi, 466-8550, Japan
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Zhang S, Ma M, Kong X, Zhou Y, Chen J, Chai W. Robotic-assisted total hip arthroplasty in patients with developmental dysplasia of the hip. INTERNATIONAL ORTHOPAEDICS 2024; 48:1189-1199. [PMID: 38358516 DOI: 10.1007/s00264-024-06115-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Abstract
PURPOSES Due to the morphological diversity of deformities, technical difficulties, improperly designed components, and so on, THA remains a challenging task in dysplastic hips, especially in highly dislocated hips. The purpose of this study was to comprehensively evaluate the clinical outcomes of robot-assisted THA in patients with DDH through a large cohort study, including the precision of acetabular cup positioning, indicators of inflammatory response, indicators of muscle damage, and complications. METHODS We retrospectively analyzed patients with DDH who underwent THA in our prospectively constructed joint registry between August 2018 and August 2022. Finally, 147 manual THAs and 147 robotic-assisted THAs were included in the final analysis. Patient demographics, indicators of inflammation, indicators of muscle damage, operative time, Harris hip scores (HHS), and forgotten joint score (FJS) were recorded for analysis. The precision of the positioning of the acetabular component was assessed with plain radiographs. RESULTS In the Crowe II/III groups, the reconstructed center of rotation (COR) in the robotic-assisted group was closer to the anatomical COR with less variation than the manual group (absolute horizontal distances of COR 3.5 ± 2.8 vs. 5.4 ± 4.9 mm, p < 0.05; absolute vertical distances of COR 6.4 ± 4.1 vs. 11.7 ± 8.2 mm, p = 0.001). For all Crowe subtypes, the robotic-assisted THA significantly increased the proportion of acetabular cups located in the safety zone within 5° (all p < 0.05). Interleukin-6 and creatine kinase levels were slightly lower and significantly different in the robotic-assisted group at three days postoperatively (all p < 0.05). CONCLUSIONS Compared to the manual technique, the robot-assisted technique improved the precision and reproducibility of acetabular component positioning, particularly in DDH patients with Crowe types II/III. The robotic-assisted technique did not increase operative time, bleeding, complications, or revision rates, and had a slighter early inflammatory response and muscle damage.
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Affiliation(s)
- Shuai Zhang
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China
- Department of Orthopedics, the 969th Hospital of the PLA joint Logisitcs Support Force, No. 51 Aimin street, Xincheng District, Huhehaote, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Mingyang Ma
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
| | - Xiangpeng Kong
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Yonggang Zhou
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
| | - Jiying Chen
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
| | - Wei Chai
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
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7
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Huebschmann NA, Lawrence KW, Robin JX, Rozell JC, Hepinstall MS, Schwarzkopf R, Aggarwal VK. Does Surgical Approach Affect Dislocation Rate After Total Hip Arthroplasty in Patients Who Have Prior Lumbar Spinal Fusion? A Retrospective Analysis of 16,223 Cases. J Arthroplasty 2024:S0883-5403(24)00312-7. [PMID: 38604275 DOI: 10.1016/j.arth.2024.03.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Lumbar spinal fusion (LSF) is a risk factor for dislocation following total hip arthroplasty (THA). The effect of the surgical approach on this association has not been investigated. This study examined the association between the surgical approach and dislocation following THA in patients who had prior LSF. METHODS We retrospectively reviewed 16,223 primary elective THAs at our institution from June 2011 to September 2022. Patients who had LSF prior to THA were identified using International Classification of Diseases (ICD) codes. Patients were stratified by LSF history, surgical approach, and intraoperative robot or navigation use to compare dislocation rates. There were 8,962 (55.2%) posterior, 5,971 (36.8%) anterior, and 1,290 (8.0%) laterally based THAs. Prior LSF was identified in 323 patients (2.0%). Binary logistic regressions were used to assess the association of patient factors with dislocation risk. RESULTS There were 177 dislocations identified in total (1.1%). In nonadjusted analyses, the dislocation rate was significantly higher following the posterior approach among all patients (P = .003). Prior LSF was associated with a significantly higher dislocation rate in all patients (P < .001) and within the posterior (P < .001), but not the anterior approach (P = .514) subgroups. Multivariate regressions demonstrated anterior (OR [odds ratio] = 0.64, 95% CI [confidence interval] 0.45 to 0.91, P = .013), and laterally based (OR = 0.42, 95% CI 0.18 to 0.96, P = .039) approaches were associated with decreased dislocation risk, whereas prior LSF (OR = 4.28, 95% CI 2.38 to 7.69, P < .001) was associated with increased dislocation risk. Intraoperative technology utilization was not significantly associated with dislocation in the multivariate regressions (OR = 0.72, 95% CI 0.49 to 1.06, P = .095). CONCLUSIONS The current study confirmed that LSF is a significant risk factor for dislocation following THA; however, anterior and laterally based approaches may mitigate dislocation risk in this population. In multivariate analyses, including surgical approach, LSF, and several perioperative variables, intraoperative technology utilization was not found to be significantly associated with dislocation risk.
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Affiliation(s)
- Nathan A Huebschmann
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Kyle W Lawrence
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Joseph X Robin
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Matthew S Hepinstall
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
| | - Vinay K Aggarwal
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, 301 East 17th Street, 15th Fl Suite 1518, New York, New York 10003
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Jassim SS, Bhatia T, McMahon JRD, Pierrepont JW, McMahon SJ. Reliability of the transverse acetabular ligament as a landmark for functional cup anteversion in total hip arthroplasty. Hip Int 2024:11207000241243035. [PMID: 38572714 DOI: 10.1177/11207000241243035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
BACKGROUND The transverse acetabular ligament (TAL) can be a useful and reproducible landmark in the orientation of the acetabular cup in total hip arthroplasty (THA). Its role in guiding cup orientation when aiming to implant in a functional anteversion orientation is unclear. The aim of this study was to assess the relationship between the TAL and the planned acetabular cup anteversion when implanted in a function orientation. MATERIAL AND METHODS In a retrospective study the anteversion of the TAL in the contralateral un-replaced hip was measured in CT scans of patients undergoing THA and compared to the functional cup anteversion using the patient-specific spinopelvic parameters. Comparative measurements of the native acetabular version were made from the superior rim to the inferior rim and at 10 mm intervals between the 2, all in reference to the anterior pelvic plane. RESULTS 96 hips were measured. The mean TAL anteversion angle was 17.2° ± 4.5°. The mean planned acetabular cup anteversion angle was 26.3° ± 4.7°. Pearson's correlation coefficient of this measurement with the TAL was -0.03 (p = 0.769). There was a significant difference between the planned acetabular cup anteversion and the measurement of the TAL (p < 0.0001). CONCLUSIONS If cups are implanted parallel to the TAL, almost 80% will be >5° different to targeted functional cup version. It should be aimed to implant cups with more anteversion than the TAL indicates.
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Affiliation(s)
| | | | - Jack R D McMahon
- Malabar Orthopaedic Clinic, Windsor, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | | | - Stephen J McMahon
- Malabar Orthopaedic Clinic, Windsor, VIC, Australia
- Monash University, Melbourne, VIC, Australia
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9
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Sun C, Lee WG, Ma Q, Zhang X, Song F, Cai X. The effect of intraoperative fluoroscopy on acetabular component positioning and patient anatomy restoration during posterior or posterolateral approach total hip arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 2024; 144:1781-1792. [PMID: 38147077 DOI: 10.1007/s00402-023-05168-3] [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: 07/10/2023] [Accepted: 11/26/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Positioning implant components and restoring patient anatomy during total hip arthroplasty (THA) are essential for joint stability, polyethylene liner wear, and range of motion. Previous studies comparing intraoperative fluoroscopy with no fluoroscopy during the posterior or posterolateral approach have reported conflicting results. This meta-analysis evaluated if intraoperative fluoroscopy improves component positioning and femoral component position compared to no fluoroscopy during posterior or posterolateral approach total hip arthroplasty. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were followed when conducting the systematic review. We searched Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database in May 2023 to identify studies involving Intraoperative fluoroscopy versus no fluoroscopy during posterior or posterolateral approach total hip arthroplasty. Finally, we identified 1133 patients (1145 hips) assessed in seven studies. RESULTS There were no significant differences in terms of acetabular cup inclination angle (ACIA, P = 0.43), ACIA within safe zone rate (P = 0.58), acetabular cup anteversion angle (ACAA, P = 0.46); ACAA within safe zone rate (P = 0.72), Combined safe zone rate (P = 0.28), dislocation rate (P = 0.64) and infection rate (P = 0.94) between two groups. Compared with the no fluoroscopy group, the intraoperative fluoroscopy group had more operation time (P < 0.00001), less femoral component offset difference (FCOD, P = 0.03), and less LLD (P < 0.00001). CONCLUSION Even though intraoperative fluoroscopy was not related to an improvement in cup location or dislocation incidence. Our findings demonstrate that the restoration of leg lengths and femoral offset can be significantly improved by using intraoperative fluoroscopy to supplement good surgical skills in THA. The advantages of intraoperative fluoroscopy might become more apparent for surgeons with less experience. To ascertain whether intraoperative fluoroscopy for posterior or posterolateral approach total hip arthroplasty will have clinical benefits and improve the survival of prostheses, more well-powered and well-designed long-term follow-up studies were necessary.
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Affiliation(s)
- Changjiao Sun
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Woo Guan Lee
- FRCS (Edinburgh) Kuching Specialist Hospital Sarawak, Tabuan Stutong Commercial Centre, 93350, Kuching Sarawak, Malaysia
| | - Qi Ma
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Xiaofei Zhang
- Department of Clinical Epidemiology and Biostatistics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Fei Song
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China.
| | - Xu Cai
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China.
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10
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Ong J, Ong CB, Grubel J, Chiu YF, Lee GC, Gonzalez Della Valle A. Body morphometry did not affect the accuracy of a second-generation, miniature imageless navigation system for total hip arthroplasty (THA) using a posterior approach. J Clin Orthop Trauma 2024; 51:102404. [PMID: 38638118 PMCID: PMC11021363 DOI: 10.1016/j.jcot.2024.102404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 01/31/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Some modern imageless navigation platforms for total hip arthroplasty (THA) rely on virtual frontal and sagittal planes determined with the patient in the lateral decubitus position. Body morphometry that changes with gender, body mass index, and other demographic factors may affect accuracy in patient positioning and consequently, navigation accuracy. The objective of this study was to analyze the influence of patient factors on the intraoperative accuracy of a second-generation imageless computer-assisted surgery platform. Methods 325 consecutive patients undergoing posterior approach, navigated THA arthroplasty for primary osteoarthritis by a single surgeon were retrospectively reviewed. An optic-based imageless navigation system referenced off a generic sagittal and coronal plane was used to determine acetabular inclination and anteversion. Acetabular accuracy was determined by assessing differences between intraoperative values and those obtained from measuring standardized 6-week follow-up radiographs. The effect of age, gender, BMI, race, ethnicity, and laterality on acetabular accuracy was assessed via t-tests, Pearson correlation and ANOVA. Results Gender had a significant impact on raw inclination accuracy (females and males had an average error of 1.41° and -1.03°, respectively - p < 0.001). There was a weak correlation between acetabular accuracy and patient age and BMI as a continuous variable (both absolute γ < 0.2). No difference was found between acetabular accuracy and BMI groups. Conclusion This second-generation imageless computer assisted device provided accurate cup positioning regardless of patient's BMI. Gender was the only factor impacting inclination accuracy.
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Affiliation(s)
- Justin Ong
- The Department of Orthopaedic Surgery at Hospital for Special Surgery, New York, NY, USA
| | - Christian B. Ong
- The Department of Orthopaedic Surgery at Hospital for Special Surgery, New York, NY, USA
| | - Jacqueline Grubel
- The Department of Orthopaedic Surgery at Hospital for Special Surgery, New York, NY, USA
| | - Yu-Fen Chiu
- The Department of Biostatistics at Hospital for Special Surgery, New York, NY, USA
| | - Gwo-Chin Lee
- The Department of Orthopaedic Surgery at Hospital for Special Surgery, New York, NY, USA
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11
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Coxe FR, Jordan LA, Wong ZP, Spaan JC, Ren R, Su EP. Functional Acetabular Component Positioning During Direct Anterior Approach Hip Arthroplasty Using a Novel Three-Dimensional Virtual Mesh Imaging System With Fluoroscopy. J Arthroplasty 2024:S0883-5403(24)00258-4. [PMID: 38522804 DOI: 10.1016/j.arth.2024.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Optimal position of total hip arthroplasty (THA) components is critical for joint mechanics and stability. Acetabular component positioning during supine surgery in direct anterior approach (DAA) THA may be different in the standing position postoperatively, which traditional fluoroscopy is unable to predict. A novel 3-dimensional (3D) image analysis technology (IAT) that uses artificial intelligence to measure the tilt and rotation of the pelvis has enabled prediction of component positioning from supine to standing. The purpose of this study was to compare intraoperative fluoroscopy, non-3D-IAT, and 3D-IAT with postoperative standing radiographs to assess the accuracy of component positioning. METHODS From 2022 to 2023, 30 consecutive patients (86.6% women, mean age 59 [range, 55 to 67]) undergoing primary DAA THA with the use of the 3D-IAT were identified. A separate cohort of 148 patients from 2020 to 2021 (85% women, mean age 65 [range, 55 to 69]) who underwent DAA THA with non-3D-IAT was used for comparison. Leg length discrepancy (LLD), cup anteversion, and inclination were manually measured on intraoperative fluoroscopic images and digitally measured using IAT. Follow-up evaluation occurred at 1 month with standing pelvis radiographs measured using Ein Bild Röntgen Analyze-Cup software. Measurements were compared via Wilcoxon signed rank tests where P ≤ .05 indicates significantly different measurements. RESULTS Median LLD, inclination, and anteversion measurements via non-3D-IAT and fluoroscopy were significantly different compared to postoperative standing radiographs (P < .001). The 3D-IAT more accurately predicted LLD, abduction, and anteversion, with values not significantly different from postoperative standing measurements (P = .23, P = .93, and P = .36, respectively). CONCLUSIONS The use of the 3D-IAT during DAA THA allowed for the more accurate prediction of acetabular component position in the standing position postoperatively.
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Affiliation(s)
- Francesca R Coxe
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - L Andrew Jordan
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Zachary P Wong
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Jonathan C Spaan
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Renee Ren
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Edwin P Su
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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12
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Manzo MA, Lex JR, Rodriguez-Elizalde SR, Perlus R, Cayen B, Chang JS. Fluoroscopy Versus Imageless Optical Navigation in Direct Anterior Approach Total Hip Arthroplasty. J Am Acad Orthop Surg 2024; 32:e284-e292. [PMID: 38166193 DOI: 10.5435/jaaos-d-23-00790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/16/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Utilization of the direct anterior approach (DAA) for total hip arthroplasty (THA) has risen in popularity. Accurate implant placement is a critical factor that influences patient outcomes. The goal of this study was to compare the accuracy and precision of fluoroscopy with imageless optical navigation in DAA THA. METHODS This was a cohort study of 640 consecutive primary DAA THAs performed with intraoperative fluoroscopy (n = 300 patients) or imageless optical navigation (n = 304 patients). Accuracy was compared by measuring acetabular cup inclination, anteversion, and leg-length discrepancy (LLD). The proportion of implants placed within the Lewinnek safe zone and those placed within a more precise target of 40 ± 5° inclination and 20 ± 5° anteversion was evaluated. RESULTS According to the Lewinnek criteria, there was no difference in the percentage of implants placed within both inclination and anteversion targets (fluoroscopy: 90.3%; navigation: 88.8%, P = 0.519). Using the more precise targets, navigation increased the implants positioned correctly for both inclination and anteversion (fluoroscopy: 50.3%; navigation: 65.6%, P < 0.001). Navigation increased the proportion of implants positioned within the target anteversion zone (fluoroscopy: 71.3%; navigation: 83.8%, P < 0.001) but not inclination (fluoroscopy: 71.9%; navigation: 76.9%, P = 0.147). The mean LLD was higher with the use of fluoroscopy compared with navigation (5.5 mm, standard deviation: 4.1; 4.6 mm, SD: 3.4, P < 0.005). No difference in dislocation rate was observed ( P = 0.643). CONCLUSION Both fluoroscopy and imageless optical navigation demonstrated accurate acetabular implant positioning during DAA THA. Navigation was more precise and associated with improved acetabular anteversion placement and restoration of LLD. Navigation is an accurate alternative to fluoroscopy with decreased radiation exposure.
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Affiliation(s)
- Marc A Manzo
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Manzo), the Department of Surgery, Division of Orthopaedic Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, (Lex, Rodriguez-Elizalde, Perlus, and Cayen, and Chang) and the Division of Orthopaedic Surgery, Humber River Hospital, Toronto, Ontario, Canada (Rodriguez-Elizalde, Perlus, Cayen, and Chang)
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Oeding JF, Yang L, Sanchez-Sotelo J, Camp CL, Karlsson J, Samuelsson K, Pearle AD, Ranawat AS, Kelly BT, Pareek A. A practical guide to the development and deployment of deep learning models for the orthopaedic surgeon: Part III, focus on registry creation, diagnosis, and data privacy. Knee Surg Sports Traumatol Arthrosc 2024; 32:518-528. [PMID: 38426614 DOI: 10.1002/ksa.12085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 03/02/2024]
Abstract
Deep learning is a subset of artificial intelligence (AI) with enormous potential to transform orthopaedic surgery. As has already become evident with the deployment of Large Language Models (LLMs) like ChatGPT (OpenAI Inc.), deep learning can rapidly enter clinical and surgical practices. As such, it is imperative that orthopaedic surgeons acquire a deeper understanding of the technical terminology, capabilities and limitations associated with deep learning models. The focus of this series thus far has been providing surgeons with an overview of the steps needed to implement a deep learning-based pipeline, emphasizing some of the important technical details for surgeons to understand as they encounter, evaluate or lead deep learning projects. However, this series would be remiss without providing practical examples of how deep learning models have begun to be deployed and highlighting the areas where the authors feel deep learning may have the most profound potential. While computer vision applications of deep learning were the focus of Parts I and II, due to the enormous impact that natural language processing (NLP) has had in recent months, NLP-based deep learning models are also discussed in this final part of the series. In this review, three applications that the authors believe can be impacted the most by deep learning but with which many surgeons may not be familiar are discussed: (1) registry construction, (2) diagnostic AI and (3) data privacy. Deep learning-based registry construction will be essential for the development of more impactful clinical applications, with diagnostic AI being one of those applications likely to augment clinical decision-making in the near future. As the applications of deep learning continue to grow, the protection of patient information will become increasingly essential; as such, applications of deep learning to enhance data privacy are likely to become more important than ever before. Level of Evidence: Level IV.
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Affiliation(s)
- Jacob F Oeding
- School of Medicine, Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Linjun Yang
- Orthopedic Surgery Artificial Intelligence Laboratory (OSAIL), Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jón Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Andrew D Pearle
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Anil S Ranawat
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Bryan T Kelly
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Ayoosh Pareek
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
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Hubert J, Ritter J, Krüger L, Simon A, Beil FT, Jandl NM, Rolvien T. Are Synovial Inflammatory Markers Increased in Patients Who Have Aseptic Total Hip Arthroplasty Dislocation Indicated for Revision? J Arthroplasty 2024; 39:787-794.e1. [PMID: 37611677 DOI: 10.1016/j.arth.2023.08.054] [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: 05/17/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Previous studies have speculated on elevated synovial inflammatory markers in patients undergoing surgical revision for total hip arthroplasty (THA) dislocation. However, this assumption is based on small patient series and a full investigation according to International Consensus Meeting (ICM) criteria has not yet been performed. METHODS Patients who had aseptic THA dislocation indicated for revision surgery were identified retrospectively. Only patients who had available diagnostic workup according to ICM 2018 criteria, including preoperative and intraoperative parameters, were included. For comparison, we analyzed a matched cohort of patients indicated for aseptic THA revision for other conditions. The 2 cohorts each consisted of 55 patients and were not different regarding age, sex, BMI, or implant fixation. RESULTS There was no difference in synovial white blood cell count (2,238 ± 2,544 versus 2,533 ± 3,448 c/μL; P = .601), alpha-defensin quotient (0.14 ± 0.11 versus 0.19 ± 0.28; P = .207), or polymorphonuclear neutrophil percentage (% PMN) (36.7 ± 22.6 versus 31.3 ± 24.5%; P = .312) between the groups. In the dislocation cohort, 20% of patients had a synovial white blood cell count of 3,000 c/μL or higher, compared with 18% in the control cohort. However, all patients in the dislocation cohort were below the cutoff for alpha-defensin or % PMN. CONCLUSION In patients who have aseptic THA dislocation, synovial inflammatory markers are not elevated compared with patients undergoing aseptic revision for other complications. A detailed preoperative analysis of synovial inflammatory markers using ICM criteria appears critical in patients who have a THA dislocation to exclude periprosthetic joint infection. LEVEL OF EVIDENCE Level III, retrospective, comparative study.
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Affiliation(s)
- Jan Hubert
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jacob Ritter
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lara Krüger
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Simon
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Timo Beil
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nico Maximilian Jandl
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Rolvien
- Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Arora S, Thakrar K, Krishna A, Garg R, Meena K, Kumar M. Prospective comparative evaluation of intraoperative joint stability and component placement between posterior approach to hip and its quadriceps coxae sparing modification for primary hip arthroplasty. J Clin Orthop Trauma 2024; 49:102363. [PMID: 38370118 PMCID: PMC10873730 DOI: 10.1016/j.jcot.2024.102363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/05/2024] [Accepted: 02/05/2024] [Indexed: 02/20/2024] Open
Abstract
Background Efforts at minimizing the propensity of posterior approach of hip for post-operative dislocation after total hip arthroplasty have been a subject of continual research. We comparatively evaluated the posterior approach to hip and its quadriceps coxae sparing (QCS) modification with regard to joint stability and component placement.Questions/Purposes: (1) Does sparing of Quadriceps Coxae tendons vis a vis their sectioning in posterior approach help in achieving better intraoperative stability? (2) Does sparing of Quadriceps Coxae tendons come in the way of adequate surgical exposure sufficient to place hip components accurately? (3) Does sparing of Quadriceps Coxae tendons result in better early functional outcome? Methods Seventy-two patients requiring THA were enrolled prospectively and randomized into two groups: group A (posterior approach) and group B quadriceps coxae sparing (QCS) approach. They were compared for intraoperative joint stability, accuracy of component placement, duration of surgery, blood loss, any event of hip dislocation, and functional outcome. Results QCS approach resulted in better intraoperative hip stability as the hips tolerated a higher value of 43.50±3.5⁰ mean internal rotation (at 90⁰ of flexion and 20⁰ of adduction) in this group versus a mean value of 33.50±5.5⁰ in posterior approach group (p < 0.01). No significant difference was observed for femoral version, acetabular inclination, and acetabular version in the two groups (p > 0.05). There was no difference between the two groups in terms of duration of surgery, intraoperative blood loss, and functional outcome at one year (p > 0.05). No event of hip dislocation was observed in QCS approach, whereas, one such event happened in the posterior-approach group. Conclusion Preservation of the QC tendons improves the intraoperative stability of THA and they do not cause any hindrance in the exposure required for optimum component placement.
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Affiliation(s)
- Sumit Arora
- Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, 110002, India
| | - Krunal Thakrar
- Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, 110002, India
| | - Anant Krishna
- Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, 110002, India
| | - Rahul Garg
- Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, 110002, India
| | - Kailash Meena
- Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, 110002, India
| | - Manoj Kumar
- Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, 110002, India
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Underwood NT, Madurawe C, Ashton LA. Intraoperative Assessment of Stability in Total Hip Arthroplasty: A Novel Method Utilizing Implant Collinearity. Arthroplast Today 2024; 25:101282. [PMID: 38317708 PMCID: PMC10839581 DOI: 10.1016/j.artd.2023.101282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/04/2023] [Indexed: 02/07/2024] Open
Abstract
Background Hip dislocation remains a leading cause of revision following total hip arthroplasty, and intraoperative assessment of acetabular positioning can be difficult to perform. There are multiple clinical tests, as well as computer and robotic techniques, that aim to reduce dislocation rates after hip arthroplasty. These approaches aim to optimize the relationship between acetabular and femoral component positioning. It is hypothesized in this study that implant collinearity assessment intraoperatively can help determine appropriate acetabular component position. More specifically, implant collinearity, when achieved with a specific leg position, can reliably predict appropriate acetabular positioning. Methods A single-surgeon, single-centered study with 55 patients was undertaken between August 2017 and March 2020. Using preoperative imaging and computer simulation, data points were taken for 3 different acetabular configurations and comparing using 2 femoral positions. The angle differences from the collinear position (0 degrees) were compared between groups. Results A total of 55 patients' imaging was analyzed using 3 acetabular configurations and 2 femoral positions. The test leg position (30-degree flexion/30-degree internal rotation/10-degree adduction) was closer to collinearity than the control position (30-degree flexion/30-degree internal rotation/0-degree adduction) in all 3 acetabular configurations by a mean of 8 degrees (P < .001), 7 degrees (P < .001), and 4 degrees (P < .001), respectively. Conclusions The use of a 10-degree adducted position more reliably recreates implant collinearity when determining acetabular positioning during total hip arthroplasty. This intraoperative test adds another data point to assist the surgeon in achieving safe component positioning.
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Affiliation(s)
- Nathan T. Underwood
- Department of Orthopaedic Surgery, Orange Health Service, Orange, New South Wales, Australia
- Corin Australia Pty Ltd., Pymble, New South Wales, Australia
- Orthopaedic Department, Dudley Private Hospital, Orange, New South Wales, Australia
| | - Chameka Madurawe
- Department of Orthopaedic Surgery, Orange Health Service, Orange, New South Wales, Australia
- Corin Australia Pty Ltd., Pymble, New South Wales, Australia
- Orthopaedic Department, Dudley Private Hospital, Orange, New South Wales, Australia
| | - Lyal A. Ashton
- Department of Orthopaedic Surgery, Orange Health Service, Orange, New South Wales, Australia
- Corin Australia Pty Ltd., Pymble, New South Wales, Australia
- Orthopaedic Department, Dudley Private Hospital, Orange, New South Wales, Australia
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Buchan GBJ, Hecht CJ, Rodriguez-Elizalde S, Kabata T, Kamath AF. Automated digital templating of component sizing is accurate in robotic total hip arthroplasty when compared to predicate software. Med Eng Phys 2024; 124:104105. [PMID: 38418018 DOI: 10.1016/j.medengphy.2024.104105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/17/2023] [Accepted: 01/09/2024] [Indexed: 03/01/2024]
Abstract
Accurate pre-operative templating of prosthesis components is an essential factor in successful total hip arthroplasty (THA), including robotically-assisted THA (RA-THA) techniques. We sought to validate the accuracy of a novel, robotic-optimized THA planning software compared to a predicate THA planner for component sizing. We analyzed a series of 199 patients who received manual THA (mTHA) and fluoroscopy-based RA-THA at a single institution. All cases were templated using a predicate pre-operative templating software. For RA-THA cases, the novel robotic-optimized pre-operative planner software was also used for templating. The differences between templated and implanted acetabular cup, femoral head, and stem component sizes were compared based on matching within 1, 2, and ≥3 sizes. Differences in templated and implanted femoral stem implant geometry were also compared. The robot-optimized pre-operative RA-THA plans demonstrated equivalent accuracy to that of predicate pre-operative plans for both RA-THA and mTHA cases. Templated acetabular cups (90.4 vs. 86.8 vs. 82.8; p = 0.421), femoral stems (76.0 vs. 65.1 vs. 67.7; p = 0.096), and femoral heads (91.3 vs. 96.2 vs. 88.2; p = 0.302) were within +/-1 size of implanted components. No significant differences were detected in the proportion of matching templated and implanted stem geometry across the study cohorts.
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Affiliation(s)
- Graham B J Buchan
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Christian J Hecht
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | | | - Tamon Kabata
- Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Japan
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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Shimizu T, Miyazaki T, Yokota S, Ishizu H, Takahashi D, Iwasaki N. Effect of longer femoral head on leg length, offset, and range of motion in total hip arthroplasty: a simulation study. Sci Rep 2024; 14:1829. [PMID: 38246928 PMCID: PMC10800334 DOI: 10.1038/s41598-024-52264-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 01/16/2024] [Indexed: 01/23/2024] Open
Abstract
In this study, we investigated the relationship between head length, leg length, offset, and dislocation resistance using range of motion (ROM) simulations based on computed tomography data to examine if a longer femoral head reduces the risk of dislocation. The femoral components were set to eliminate leg length differences with a + 0 mm head, and variations for + 4-, + 7-, and + 8-mm heads were analyzed. Offset and ROM were assessed when longer heads were used, with the leg length adjusted to be similar to that of the contralateral side. While internal rotation at flexion and external rotation at extension increased with + 4-mm longer heads, the + 7- and + 8-mm heads did not increase dislocation resistance. When adjusting for leg length, the longer heads showed no significant differences in offset and ROM. Enhancing dislocation resistance by solely increasing the offset with a longer head, while simultaneously adjusting the depth of stem insertion, may be a beneficial intraoperative technique. Although a + 4-mm longer head possibly increases ROM without impingement, heads extended by + 7 or + 8 mm may not exhibit the same advantage. Therefore, surgeons should consider this technique based on the implant design.
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Affiliation(s)
- Tomohiro Shimizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Takuji Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Shunichi Yokota
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hotaka Ishizu
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Daisuke Takahashi
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nish-7, Kita-ku, Sapporo, 060-8638, Japan
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Yi N, Yuan H, Xu N, Liu R, Wang Y, Zhuang C. Digital protractor as an intraoperative guide to cup anteversion in total hip arthroplasty. BMC Surg 2024; 24:27. [PMID: 38238716 PMCID: PMC10795370 DOI: 10.1186/s12893-023-02297-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 12/15/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION To explore if digital protractor could guide the anteversion of acetabular cup during primary THA and make it consistent with preoperative. METHODS We retrospectively reviewed 172 cases of primary THA with direct anterior approach (DAA) over 2 years. The anteversion of acetabular cup were measured from computed tomography (CT) scan preoperative and de-identified plain radiographs postoperative by two blinded investigators who were not involved in the surgery. The effect of the digital protractor on the anteversion was determined using regression analysis. RESULTS The mean anteversion for the THAs in digital protractor group was 15.5°and 21.4°in control group (P < 0.01). The mean anteversion bias for the THAs in digital protractor group was 1.59° and 6.63° in control group (P < 0.01).Regression analysis identified a 10.7% difference in anteversion due to the use of digital protractor (P < 0.01), and THAs performed without digital protractor were six times more likely to result in anteversion of > 25°. The correlation coefficient for the interobserver reliability of the measurement of the two investigators was 0.94. CONCLUSION The digital protractor is a practical tool in the DAA for THA to determine the anteversion of the acetabular prosthesis.
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Affiliation(s)
- Ning Yi
- Graduate School of Dalian Medical University, Dalian, China
| | - Hang Yuan
- Bengbu Medical College, Bengbu, China
| | - Nanwei Xu
- Department of Orthopedics, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Ruiping Liu
- Department of Orthopedics, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yuji Wang
- Department of Orthopedics, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China
| | - Chao Zhuang
- Department of Orthopedics, The Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China.
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Buchan GBJ, Hecht CJ, Sculco PK, Chen JB, Kamath AF. Improved short-term outcomes for a novel, fluoroscopy-based robotic-assisted total hip arthroplasty system compared to manual technique with fluoroscopic assistance. Arch Orthop Trauma Surg 2024; 144:501-508. [PMID: 37740783 DOI: 10.1007/s00402-023-05061-z] [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: 06/12/2023] [Accepted: 09/01/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND While robotic-assisted total hip arthroplasty (RA-THA) has been associated with improved accuracy of component placement, the perioperative and early postoperative outcomes of fluoroscopy-based RA-THA systems have yet to be elucidated. METHODS This retrospective cohort analysis included a consecutive series of patients who received manual, fluoroscopy-assisted THA (mTHA) and fluoroscopy-based RA-THA at a single institution. We compared rates of complications within 90 days of surgery, length of hospital stay (LOS), and visual analog scale (VAS) pain scores. RESULTS No differences existed between groups with respect to demographic data or perioperative recovery protocols. The RA-THA cohort had a significantly greater proportion of outpatient surgeries compared to the mTHA cohort (37.4% vs. 3.8%; p < 0.001) and significantly lower LOS (26.0 vs. 39.5 h; p < 0.001). The RA-THA cohort had a smaller 90-day postoperative complication rate compared to the mTHA cohort (0.9% vs. 6.7%; p = 0.029). The RA-THA cohort had significantly lower patient-reported VAS pain scores at 2-week follow-up visits (2.5 vs. 3.3; p = 0.048), but no difference was seen after 6-week follow visits (2.5 vs. 2.8; p = 0.468). CONCLUSION Fluoroscopy-based RA-THA demonstrates low rates of postoperative complications, improved postoperative pain profiles, and shortened LOS when compared to manual, fluoroscopy-assisted THA.
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Affiliation(s)
- Graham B J Buchan
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Christian J Hecht
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th, New York, NY, 10021, USA
| | - James B Chen
- Mission Orthopaedic Institute, Providence Mission Hospital, Mission Viejo, CA, 92691, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Lin C, Chen W, Weng P, Huang Y, Liaw C. Liaw's Ellipse Anteversion Method for Distinguishing Acetabular Component Retroversion from Anteversion on Plain Radiographs. Orthop Surg 2024; 16:276-281. [PMID: 37986662 PMCID: PMC10782236 DOI: 10.1111/os.13902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/19/2023] [Accepted: 08/27/2023] [Indexed: 11/22/2023] Open
Abstract
Improper acetabulum component position is a significant risk factor for postoperative dislocation after total hip arthroplasty. Several radiographic two-dimensional methods exist for measuring acetabulum component anteversion, but they cannot distinguish between anteversion and retroversion. "Liaw's version," initially proposed as a simple mathematical standardized two-dimensional method, was modified to the computerized ellipse method, proving superior accuracy to traditional two-dimensional methods. In this article, we demonstrated its application in detecting and measuring retroverted acetabulum component. We obtained anteroposterior pelvis radiographs from a patient undergoing total hip arthroplasty on the day of surgery and 2 weeks postoperatively. The computerized ellipse method was used to measure the acetabulum component orientation. Upon comparison, the difference between θ assigned to be retroverted (9.52-8.56 = 0.96) is much smaller than the difference between θ assigned to be anteverted (23.81-18.86 = 4.95), leading us to determine retroversion. This was further confirmed by computed tomography at the 6-week follow-up. We propose that using the computerized ellipse method to measure Liaw's version can be a valuable tool in identifying acetabulum component retroversion on anteroposterior radiographs during routine postoperative follow-up and retrospective assessments of total hip arthroplasty patients.
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Affiliation(s)
- Chun‐Hao Lin
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
| | - Wei‐Cheng Chen
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
| | - Pei‐Wei Weng
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
- Department of Orthopaedics, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
- International PhD Program in Biomedical Engineering, College of Biomedical EngineeringTaipei Medical UniversityTaipeiTaiwan
- Research Center of Biomedical DevicesTaipei Medical UniversityTaipeiTaiwan
| | - Yu‐min Huang
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
- Department of Orthopaedics, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Chen‐Kun Liaw
- Department of Orthopaedics, Shuang Ho HospitalTaipei Medical UniversityNew TaipeiTaiwan
- Department of Orthopaedics, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
- Research Center of Biomedical DeviceCollege of Biomedical Engineering, Graduate Institute of Biomedical Optomechatronics, Taipei Medical UniversityTaipeiTaiwan
- TMU Biodesign CenterTaipei Medical UniversityTaipeiTaiwan
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Higa M, Tanino H, Ito H, Banks SA. Soft-tissue tension during total hip arthroplasty measured in four patients and predicted using a musculoskeletal model. J Exp Orthop 2023; 10:130. [PMID: 38051361 PMCID: PMC10697917 DOI: 10.1186/s40634-023-00689-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 10/29/2023] [Indexed: 12/07/2023] Open
Abstract
PURPOSE Soft-tissue tension around the hip joint is related to the incidence of dislocation after total hip arthroplasty (THA), but it remains difficult to quantify the soft-tissue tension during surgery. In this study, a three-dimensional force sensor-instrumented modular femoral head was developed and used to quantify soft-tissue tension during THA. The forces at the hip joint were also calculated using a three-dimensional musculoskeletal computer model to validate the measured forces. METHODS Soft-tissue tension was investigated by measuring the hip joint forces and directions during intraoperative trialing in four patients through passive range of motion (ROM) from 0° extension to 90° flexion. A musculoskeletal model with THA, which was scaled to one of four patients, was developed. The hip joint forces were calculated under the same motion. RESULTS Through the passive ROM, the magnitude of soft-tissue tension was greatest when the hip was extended, decreased with flexion to 34°, and progressively increased to flexion at 90°. The mediolateral force component was relatively constant, but the supero-inferior and anterior-posterior force components changed significantly. Within-individual variations were small during three repeated cycles of measurement, but magnitudes varied significantly among patients. Similar force patterns and magnitudes were calculated by the musculoskeletal model. CONCLUSIONS This study demonstrates that it is possible to quantify soft-tissue tension and direction during THA with an instrumented head. There was general agreement between the calculated and measured forces in both pattern and magnitude. Including additional subject-specific details would further enhance agreement between the model and measured hip forces.
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Affiliation(s)
- Masaru Higa
- Department of Mechanical Engineering, University of Hyogo, Shosha2167, HimejiHyogo, 671-2280, Japan.
| | - Hiromasa Tanino
- Department of Orthopaedic Surgery and Arthroplasty, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiroshi Ito
- Department of Orthopaedic Surgery and Arthroplasty, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Scott A Banks
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, FL, USA
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Mouri K, Madachi A, Karita T. Intraoperative Pelvic Tilt and Axial Rotation During Total Hip Arthroplasty Through the Direct Anterior Approach is Affected by the Acetabular Retractor and Cup Impactor. Arthroplast Today 2023; 24:101251. [PMID: 38023653 PMCID: PMC10665692 DOI: 10.1016/j.artd.2023.101251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 08/03/2023] [Accepted: 09/13/2023] [Indexed: 12/01/2023] Open
Abstract
Background Intraoperative pelvic motion during total hip arthroplasty (THA) in the supine position affects acetabular cup placement and occurs at each step of THA; however, there are no reports of pelvic motion changes during each stage of THA via the direct anterior approach (DAA). This study aimed to evaluate pelvic motion at each step of THA through the DAA. Methods From March to October 2022, 71 hips were prospectively measured for intraoperative pelvic tilt and axial rotation during THA through the DAA at a single center. These parameters were measured during each surgical step using the augmented reality-hip navigation system. Results Both pelvic tilt and axial rotation were maximal during acetabular cup placement. The mean intraoperative pelvic tilt and axial rotation during cup placement were 4.8 ± 2.6° (95% confidence interval, 4.19-5.41°) and 4.2 ± 3.3° (95% confidence interval, 3.42-4.98°), respectively. The effects of the acetabular retractor and cup impactor on pelvic tilt and axial rotation were comparable. Spearman's correlation tests showed significant correlation between axial rotation and body mass index (r = -0.444, P = .00011). Conclusions The pelvis tilts forward and rotates toward the surgical side during THA through the DAA. The effects of the acetabular retractor and cup impactor on pelvic motion are comparable. Cup implantation must take into account pelvic movement, and it must be recognized that the pelvis is moving at that time, even with only the acetabular retractor inserted, compared to before the skin incision.
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Affiliation(s)
- Kanto Mouri
- Orthopedics Department, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Atsushi Madachi
- Orthopedics Department, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Tatsuro Karita
- Orthopedics Department, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
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Incesoy MA, Yildiz F, Pulatkan MA, Yesiller OF, Toluk O, Erdem AC, Tuncay I. CT-based, robotic-arm assisted total hip arthroplasty (Mako) through anterior approach provides improved cup placement accuracy but no difference in clinical outcomes when compared to conventional technique. Technol Health Care 2023:THC231111. [PMID: 38217557 DOI: 10.3233/thc-231111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
BACKGROUND With the restoration of the natural hip biomechanics, a successful total hip arthroplasty (THA) and long-term survival is pursued. Although robotic THA (rTHA) has been developed to increase accuracy of implant positioning, leg lengths and offsets, discussions about its radiological and clinical advantages over conventional THA (cTHA) continues. OBJECTIVE The aim of this study was to compare clinical and radiological outcomes of robotic and conventional THA. METHODS This retrospective study compares functional and radiological outcomes of 82 rTHA with a matched group of 82 cTHA in terms of age, sex, body mass index and preoperative functional scores. The minimum follow up was 12 months for all patients. Functional outcomes were Harris Hip Score (HHS) and the Western Ontario and McMaster University Osteoarthritis index (WOMAC) evaluated pre- and postoperatively. Radiological evaluations included position of cup placement according to Lewinnek and Callanan safe zones, Canal Fill Ratio (CFR), Leg Length Discrepancy (LLD), Lateral offset (LO) and Femoral Component Alignment (FCA). Complications were also evaluated. RESULTS In the rTHA group, 91.5% (75 out of 82) of the acetabular cups were positioned within the safe zone whereas it was 63.4% (52 out of 82) for the cTHA group (p< 0.001). According to Callanan, they were 84.1% and 50%, respectively (p< 0.001). Between the groups, no statistically significant difference was found in CFR, LLD, HO, FCA, AI, AA, WOMAC, HHS and major complication rates. CONCLUSION rTHA is superior to cTHA in terms of accuracy and reproducibility of the cup placement, however no apparent clinical benefit was found in short term follow.
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Affiliation(s)
- Mustafa Alper Incesoy
- Department of Orthopedics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Fatih Yildiz
- Department of Orthopedics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Anil Pulatkan
- Department of Orthopedics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Omer Faruk Yesiller
- Department of Orthopedics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ozlem Toluk
- Department of Biostatistics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ahmet Can Erdem
- Department of Orthopedics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ibrahim Tuncay
- Department of Orthopedics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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25
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Griffin J, Davis ET, Parsons H, Stevens S, Bradley H, Bruce J, Ellard DR, Haddad F, Hutchinson CE, Mason J, Nwankwo H, Metcalfe A, Smith T, Smith J, Warwick J, Skinner JA, Rees S, Underwood M, Khatri C, Wall PDH. UK robotic arthroplasty clinical and cost effectiveness randomised controlled trial for hips (RACER-Hip): a study protocol. BMJ Open 2023; 13:e079328. [PMID: 37852762 PMCID: PMC10603453 DOI: 10.1136/bmjopen-2023-079328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION The number of robotic-assisted hip replacement procedures has expanded globally with the intended aim of improving outcomes. Intraoperative robotic-arm systems add additional costs to total hip replacement (THR) surgery but may improve surgical precision and could contribute to diminished pain and improved function. Additionally, these systems may reduce the need for expensive revision surgery. Surgery with conventional instruments may be just as successful, quick and affordable. There is timely demand for a robust evaluation of this technology. METHODS AND ANALYSIS The Robotic Arthroplasty Clinical and cost Effectiveness Randomised controlled trial for Hips (RACER-Hip) is a multicentre (minimum of six UK sites), participant-assessor blinded, randomised controlled trial. 378 participants with hip osteoarthritis requiring THR will be randomised (1:1) to receive robotic-assisted THR, or THR using conventional surgical instruments. The primary outcome is the Forgotten Joint Score at 12 months post-randomisation; a patient-reported outcome measure assessing participants' awareness of their joint when undertaking daily activities. Secondary outcomes will be collected post-operatively (pain, blood loss and opioid usage) and at 3, 6, 12, 24 months, then 5 and 10 years postrandomisation (including function, pain, health-related quality of life, reoperations and satisfaction). Allocation concealment will be accomplished using a computer-based randomisation procedure on the day of surgery. Blinding methods include the use of sham incisions for marker clusters and blinded operation notes. The primary analysis will adhere to the intention-to-treat principle. Results will adhere to Consolidated Standards of Reporting Trials statements. ETHICS AND DISSEMINATION The trial was approved by an ethics committee (Solihull Research Ethics Committee, 30 June 2021, IRAS: 295831). Participants will provide informed consent before agreeing to participate. Results will be disseminated using peer-reviewed journal publications, presentations at international conferences and through the use of social media. We will develop plans to disseminate to patients and public with our patient partners. TRIAL REGISTRATION NUMBER ISRCTN13374625.
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Affiliation(s)
- James Griffin
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Edward T Davis
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Helen Parsons
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Siobhan Stevens
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Bradley
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Julie Bruce
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - David R Ellard
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Fares Haddad
- Department of Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Charles E Hutchinson
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - James Mason
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Henry Nwankwo
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Metcalfe
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Toby Smith
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Jane Warwick
- Warwick Medical School, University of Warwick, Coventry, UK
- Patient Representative, Coventry, UK
| | - John A Skinner
- Limb Reconstruction Unit, The Royal National Orthopaedic Hospital, Stanmore, UK
| | - Sophie Rees
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Chetan Khatri
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Buchan GBJ, Hecht CJ, Liu D, Mokete L, Kendoff D, Kamath AF. Improved accuracy of a novel fluoroscopy-based robotically assisted THA system compared to manual THA. J Robot Surg 2023; 17:2073-2079. [PMID: 37209355 DOI: 10.1007/s11701-023-01623-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/14/2023] [Indexed: 05/22/2023]
Abstract
Accurate acetabular cup position remains a persistent challenge in total hip arthroplasty (THA). Studies investigating the early outcomes of robotic-assisted THA (RA-THA) systems have shown improved cup placement compared to manual THA (mTHA) approaches, however, contemporary robotic platforms are reliant on pre-operative CT imaging. The goal of this study was to analyze the accuracy of a novel, fluoroscopy-based RA-THA system compared to an unassisted mTHA approach and determine the effect of the robotic system on operative time. We performed a retrospective cohort analysis on a consecutive series of 198 patients who received mTHA and RA-THA between March 2021 and July 2022. The primary outcome of interest was the accuracy of acetabular component placement, defined by average cup inclination and anteversion. Secondary outcomes included the proportion of acetabular cups positioned within the Lewinnek safe zone, operative time, and overall room time. The RA-THA group demonstrated significantly higher accuracy of acetabular anteversion to target compared to the manual group (18.5 vs. 21.7˚; p < 0.001), and had a significantly greater proportion of acetabular cups placed within the Lewinnek safe zone (81.6 vs. 59.0%; p < 0.001). The RA-THA cohort had longer operative times compared to mTHA group (39.0 vs. 35.3 min; p = 0.003), but no difference was seen in total operating room time (101.2 vs. 101.2 min; p = 0.982). This study demonstrates that the use of a novel, fluoroscopy-based, pin-less THA robotic platform increased the accuracy of acetabular cup placement, including a 22.6% improvement in safe zone placement, compared to mTHA approach, with no increase in overall case time.
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Affiliation(s)
- Graham B J Buchan
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Christian J Hecht
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - David Liu
- Gold Coast Centre for Bone and Joint Surgery, 14 Sixth Ave, Palm Beach, QLD, 4421, Australia
| | - Lipalo Mokete
- Consultant Orthopaedic Surgeon, Charlotte Maxeke Johannesburg Academic Hospital, Busamed Modderfontein Hospital, Lecture University of the Witwatersand, 4 Cransley Crescent, Linbro Park, Sandton, Johannesburg, 2190, South Africa
| | - Daniel Kendoff
- Chefarzt Zentrum für Orthopädie und Unfallchirurgie, HELIOS Kliniken Berlin-Buch, Schwanebecker Chaussee 25, 13125, Berlin, Germany
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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Tigani D, Banci L, Stallone S, Melucci G, Pieratelli G, Castiello E. Evolution and New Generation of Dual Mobility Cups. Orthopedics 2023; 46:e273-e280. [PMID: 37561099 DOI: 10.3928/01477447-20230804-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Although total hip arthroplasty (THA) is considered a successful procedure, hip dislocation remains the main cause of early failure. Dual mobility cups (DMCs) have been shown to significantly reduce the dislocation rate in both primary and revision THAs. During the past several decades, DMCs have evolved in design and fixation interface. There have been three generations of DMCs. This article addresses the rationale for a new cementless highly porous titanium DMC to improve component fixation and implant biocompatibility. [Orthopedics. 2023;46(5):e273-e280.].
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Sun C, Lee WG, Ma Q, Zhang X, Zhao Z, Cai X. Does intraoperative fluoroscopy improve acetabular component positioning and limb-length discrepancy during direct anterior total hip arthroplasty? A meta-analysis. J Orthop Surg Res 2023; 18:586. [PMID: 37553600 PMCID: PMC10410871 DOI: 10.1186/s13018-023-04023-w] [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: 05/22/2023] [Accepted: 07/16/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The positioning of implant components for total hip arthroplasty (THA) is essential for joint stability, polyethylene liner wear, and range of motion. One potential benefit of the direct anterior approach (DAA) for THA is the ability to use intraoperative fluoroscopy for acetabular cup positioning and limb-length evaluation. Previous studies comparing intraoperative fluoroscopy with no fluoroscopy during DAA have reported conflicting results. This meta-analysis aimed to evaluate whether intraoperative fluoroscopy improves component positioning compared to no fluoroscopy during direct anterior total hip arthroplasty. METHODS A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. We searched Web of Science, EMBASE, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database in May 2023 to identify studies involving intraoperative fluoroscopy versus no fluoroscopy during direct anterior total hip arthroplasty. Finally, we identified 1262 hips assessed in seven studies. RESULTS There were no significant differences in terms of acetabular cup inclination angle (ACIA, P = 0.21), ACIA within safe zone rate (P = 0.97), acetabular cup anteversion angle (ACAA, P = 0.26); ACAA within safe zone rate (P = 0.07), combined safe zone rate (P = 0.33), and limb-length discrepancy (LLD, P = 0.21) between two groups. CONCLUSION Even though intraoperative fluoroscopy was not related to an improvement in cup location or LDD. With fewer experienced surgeons, the benefit of intraoperative fluoroscopy might become more evident. More adequately powered and well-designed long-term follow-up studies were required to determine whether the application of the intraoperative fluoroscopy for direct anterior total hip arthroplasty will have clinical benefits and improve the survival of prostheses.
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Affiliation(s)
- Changjiao Sun
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Woo Guan Lee
- FRCS (Edinburgh) Kuching Specialist Hospital Sarawak, Tabuan Stutong Commercial Centre, 93350, Kuching Sarawak, Malaysia
| | - Qi Ma
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Xiaofei Zhang
- Department of Clinical Epidemiology and Biostatistics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China
| | - Zhe Zhao
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China.
| | - Xu Cai
- Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, 102218, China.
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29
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Doehrmann R, Comer BJ, Chatterji R, Diedring B, Knapp P, Afsari A. Accuracy of Leg Length and Hip Offset Measurements Using a Fluoroscopic Grid During Anterior Approach Total Hip Arthroplasty. Arthroplast Today 2023; 22:101154. [PMID: 37502102 PMCID: PMC10369392 DOI: 10.1016/j.artd.2023.101154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/08/2023] [Indexed: 07/29/2023] Open
Abstract
Background Minimizing leg length (LLD) and hip offset (OD) discrepancies is critical for tissue tension and implant longevity in total hip arthroplasty (THA). The direct anterior approach (DAA) helps surgeons recreate these values under fluoroscopy. Several methods to accomplish this have been described, with no consensus on which is superior. This study evaluated the ability to minimize LLD and OD using a surgeon-controlled, adjustable fluoroscopic grid. We hypothesized that this tool would recreate parameters to within 10 mm of the contralateral side. Methods One hundred eleven primary THAs performed with an adjustable radiopaque grid to equalize leg length and hip offset were retrospectively reviewed. These values were measured on postoperative radiographs and compared to the contralateral hip. Patients were excluded if they had inadequate imaging, revision arthroplasty, preexisting deformities, or underwent approaches other than DAA. Results Mean age was 59.1 ± 11.1 years, 63.1% of patients were female, and average body mass index was 27.8 ± 7.0. Mean LLD was 3.7 ± 3.0 mm, while mean OD was 4.6 ± 3.6 mm. 95.5% of hips showed LLD < 10 mm, while 93.7% of hips had OD < 10 mm. Furthermore, 76.6% of hips had LLD < 5 mm, while 62.2% of hips had OD < 5 mm. Conclusions The described technique restored limb length and hip offset during DAA THA. This technique yields consistent results and offers an inexpensive alternative to costly digital software and more cumbersome fixed grid systems.
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Affiliation(s)
- Ross Doehrmann
- Department of Orthopaedic Surgery, Ascension St. John Hospital, Detroit, MI, USA
| | - Brendan J. Comer
- Department of Orthopaedic Surgery, Ascension Providence Hospital, Southfield, MI, USA
| | - Rishi Chatterji
- Department of Orthopaedic Surgery, Ascension Providence Hospital, Southfield, MI, USA
| | - Benjamin Diedring
- Department of Orthopaedic Surgery, Ascension St. John Hospital, Detroit, MI, USA
| | - Paul Knapp
- Department of Orthopaedic Surgery, Ascension St. John Hospital, Detroit, MI, USA
| | - Alan Afsari
- Department of Orthopaedic Surgery, Ascension St. John Hospital, Detroit, MI, USA
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Hamilton WG, Sershon RA, Gupta A, Goldstein L, Kabiri M, Holy CE, Diaz R. Readmission rate and healthcare utilization outcomes of computer-assisted fluoroscopy-based hip navigation versus manual total hip arthroplasty. Expert Rev Med Devices 2023; 20:779-789. [PMID: 37466357 DOI: 10.1080/17434440.2023.2238609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION The study evaluates the technology of fluoroscopy-based hip navigation that has shown to improve implant positioning in total hip arthroplasty (THA). METHODS Premier Healthcare data for patients undergoing manual THA or fluoroscopy-based hip navigation THA between 1 January 2016-30 September 2021, were analyzed 90- and 365-day post-THA. The primary outcome was inpatient readmission. Secondary outcomes were operating room (OR) time, length of stay, discharge status, and hospital costs. Baseline covariate differences were balanced using fine stratification and analyzed using generalized linear models. RESULTS Among 4,080 fluoroscopy-based hip navigation THA and 429,533 manual THA balanced patients, hip-related readmission rates were statistically significantly lower for the fluoroscopy-based hip navigation THA cohort vs. manual THA for both 90-day (odd ratio [95% CI]: 0.69 [0.52 to 0.91] and 365-day (0.63 [0.49 to 0.81] follow-up. OR time was higher with fluoroscopy-based hip navigation THA vs. manual THA (134.65 vs. 132.04 minutes); however, fluoroscopy-based hip navigation THA patients were more likely to be discharged to home (93.73% vs. 90.11%) vs. manual THA. Hospital costs were not different between cohorts at 90- and 365-day post-operative. CONCLUSIONS Fluoroscopy-based hip navigation THA resulted in fewer readmissions, greater discharge to home, and similar hospital costs compared to manual THA.
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Affiliation(s)
| | | | - Anshu Gupta
- Epidemiology & Real-World Data Sciences, Johnson & Johnson MedTech, New Brunswick, NJ, USA
| | - Laura Goldstein
- DePuy Synthes Digital, Robotics & Emerging Channels, Raynham, MA, USA
| | - Mina Kabiri
- DePuy Synthes Digital, Robotics & Emerging Channels, Raynham, MA, USA
| | - Chantal E Holy
- Epidemiology & Real-World Data Sciences, Johnson & Johnson MedTech, New Brunswick, NJ, USA
| | - Rodrigo Diaz
- DePuy Synthes, Medical Affairs, Palm Beach Gardens, FL, USA
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Kumar V, Patel S, Baburaj V, Rajnish RK, Aggarwal S. Does robotic-assisted surgery improve outcomes of total hip arthroplasty compared to manual technique? A systematic review and meta-analysis. Postgrad Med J 2023; 99:375-383. [PMID: 37294729 DOI: 10.1136/postgradmedj-2021-141135] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/01/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Robot-assisted total hip arthroplasty (THA) is an emerging technology that claims to position implants with very high accuracy. However, there is currently limited data in literature on whether this improved accuracy leads to better long-term clinical outcomes. This systematic review compares the outcomes of THA done with the help of robotic assistance (RA) to those done with conventional manual techniques (MTs). METHODS Four electronic databases were searched for eligible articles that directly compared robot-assisted THA to manual THA and had data on the radiological or clinical outcomes of both. Data on various outcome parameters were collected. Meta-analysis was conducted using a random-effects model with 95% CIs. RESULTS A total of 17 articles were found eligible for inclusion, and 3600 cases were analysed. Mean operating time in the RA group was significantly longer than in the MT group. RA resulted in significantly more acetabular cups being placed inside Lewinnek's and Callanan's safe zones (p<0.001) and had significantly reduced limb length discrepancy compared with MT. There were no statistically significant differences in the two groups in terms of incidence of perioperative complications, need for revision surgery and long-term functional outcome. CONCLUSION RA leads to highly accurate implant placement and leads to significantly reduced limb length discrepancies. However, the authors do not recommend robot-assisted techniques for routine THAs due to lack of adequate long-term follow-up data, prolonged surgical times and no significant differences in the rate of complications and implant survivorship compared with conventional MTs.
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Bahl JS, Arnold JB, Saxby DJ, Taylor M, Solomon LB, Thewlis D. The effect of surgical change to hip geometry on hip biomechanics after primary total hip arthroplasty. J Orthop Res 2023; 41:1240-1247. [PMID: 36200414 PMCID: PMC10947254 DOI: 10.1002/jor.25455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/23/2022] [Accepted: 09/22/2022] [Indexed: 02/04/2023]
Abstract
The aim of this study was to determine the effect of surgical change to the acetabular offset and femoral offset on the abductor muscle and hip contact forces after primary total hip arthroplasty (THA) using computational methods. Thirty-five patients undergoing primary THA were recruited. Patients underwent a computed tomography scan of their pelvis and hip, and underwent gait analysis pre- and 6-months postoperatively. Surgically induced changes in acetabular and femoral offset were used to inform a musculoskeletal model to estimated abductor muscle and hip joint contact forces. Two experiments were performed: (1) influence of changes in hip geometry on hip biomechanics with preoperative kinematics; and (2) influence of changes in hip geometry on hip biomechanics with postoperative kinematics. Superior and medial placement of the hip centre of rotation during THA was most influential in reducing hip contact forces, predicting 63% of the variance (p < 0.001). When comparing the preoperative geometry and kinematics model, with postoperative geometry and kinematics, hip contact forces increased after surgery (0.68 BW, p = 0.001). Increasing the abductor lever arm reduced abductor muscle force by 28% (p < 0.001) and resultant hip contact force by 17% (0.6 BW, p = 0.003), with both preoperative and postoperative kinematics. Failure to increase abductor lever arm increased resultant hip contact force 11% (0.33 BW, p < 0.001). In conclusion, increasing the abductor lever arm provides a substantial biomechanical benefit to reduce hip abductor and resultant hip joint contact forces. The magnitude of this effect is equivalent to the average increase in hip contact force seen with improved gait from pre-to post-surgery.
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Affiliation(s)
- Jasvir S. Bahl
- Centre for Orthopaedic and Trauma Research (COTR), Adelaide Medical SchoolUniversity of AdelaideAdelaideAustralia
| | - John B. Arnold
- Alliance for Research in Exercise, Nutrition & Activity (ARENA), Allied Health & Human Performance UnitUniversity of South AustraliaAdelaideAustralia
- IIMPACT in Health, Allied Health & Human Performance UnitUniversity of South AustraliaAdelaideAustralia
| | - David J. Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
| | - Mark Taylor
- Medical Device Research Institute, College of Science and EngineeringFlinders UniversityAdelaideAustralia
| | - Lucian B. Solomon
- Centre for Orthopaedic and Trauma Research (COTR), Adelaide Medical SchoolUniversity of AdelaideAdelaideAustralia
- Department of Orthopaedics and TraumaRoyal Adelaide HospitalAdelaideAustralia
| | - Dominic Thewlis
- Centre for Orthopaedic and Trauma Research (COTR), Adelaide Medical SchoolUniversity of AdelaideAdelaideAustralia
- Department of Orthopaedics and TraumaRoyal Adelaide HospitalAdelaideAustralia
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Sun D, Murphy WS, Amundson A, Lane P, Kowal J, Murphy SB. Validation of a Novel Method of Measuring Cup Orientation using BiPlanar Simultaneous Radiographic Images. J Arthroplasty 2023:S0883-5403(23)00357-1. [PMID: 37075906 DOI: 10.1016/j.arth.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/05/2023] [Accepted: 04/08/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Accurate acetabular component positioning is paramount to the success of total hip arthroplasty. Two-dimensional imaging alone remains a popular tool for implant position assessment despite known limitations. We investigated the accuracy of a novel method for assessing acetabular component position based upon orthogonal simultaneous biplanar Xray images. METHODS There were forty consecutive patients who had a pre-existing total hip arthroplasty (THA) on the contralateral side who underwent both computed tomography (CT) and simultaneous orthogonal biplanar radiographic scans for pre-operative planning of THA. The operative inclination (OI) and operative anteversion (OA) of the acetabular cup were calculated by a new measurement method using the biplanar simultaneous scans. Those measurements were compared to measurement of the cup orientation on CT. The measurements were made by two independent observers. Interobserver correlation coefficients were calculated between the two observers to measure reliability. RESULTS The mean error in OA measurement of the acetabular cup between simultaneous orthogonal biplanar radiographic and CT imaging was 0.5° (Standard Deviation (SD): 1.9°, minimum -4.0°, maximum 5.0°), the mean error in OI was 0.0° (SD: 1.7°, minimum -5.0°, maximum 4.0°). The average absolute error was 1.5° for OA, and 1.2° for OI. Interobserver correlation coefficient was 0.83 for OA and 0.93 for OI. CONCLUSION The novel method of measuring cup orientation using simultaneous biplanar radiographic scans utilized in this study was accurate and reproducible between observers compared to CT measurements.
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Affiliation(s)
- Dan Sun
- Tufts Medical Center, Boston, MA, USA
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Ning D, Xu F, Zhang Z, Yang X, Wei J. Application of transverse acetabular ligament in total hip arthroplasty: a systematic review. BMC Musculoskelet Disord 2023; 24:284. [PMID: 37055756 PMCID: PMC10099633 DOI: 10.1186/s12891-023-06410-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 04/07/2023] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION In total hip arthroplasty (THA), the correct position of the acetabular component directly determines the outcome of the surgery, or the success of the surgery. Therefore, how to accurately locate the position of the acetabular component has become a very critical step in THA. As an important anatomical structure of the hip joint, the transverse acetabular ligament (TAL) is helpful for acetabular component orientation in THA. The aim of this systematic review was to investigate application of TAL in THA. MATERIALS AND METHODS A systematic literature search of PUBMED, EMBASE, and Cochrane Library was performed (January and February 2023) using keywords "total hip arthroplasty," "total hip replacement," "total hip replacements," "total hip arthroplasties," "total hip prosthesis," and "transverse acetabular ligament" in all possible combinations. Reference lists of included articles were reviewed. Study design, surgical approach, patient demographics, TAL identification rate, appearance of the TAL, anteversion and inclination angle and rate of dislocations were recorded. RESULTS In total, 19 studies met the screening criteria. Study designs were prospective cohorts (42%), retrospective cohorts (32%), Case series (21%), and randomized controlled trial (5%). Twelve of the 19 (63.2%) studies investigated the application of TAL as an anatomical landmark for locating acetabular component position in THA. Analysis revealed that TAL is a reliable anatomical landmark for acetabular component orientation within the safe zone in THA. CONCLUSIONS TAL can reliably be used to align the acetabular component in the safe zone for anteversion and inclination in THA. However, TAL has individual variation influenced by some risk factors. More randomized controlled studies with larger numbers of patients are needed to investigate the precision and accuracy of TAL as an intraoperative landmark in THA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Dongfang Ning
- Department of Bone and Joint Surgery, Liuzhou Municipal Liutie Central Hospital, Liuzhou, Guangxi, 545007, China.
| | - Feng Xu
- Department of Bone and Joint Surgery, Liuzhou Municipal Liutie Central Hospital, Liuzhou, Guangxi, 545007, China
| | - Zhongxing Zhang
- Department of Bone and Joint Surgery, Liuzhou Municipal Liutie Central Hospital, Liuzhou, Guangxi, 545007, China
| | - Xiaolong Yang
- Department of Bone and Joint Surgery, Liuzhou Municipal Liutie Central Hospital, Liuzhou, Guangxi, 545007, China
| | - Jun Wei
- Department of Bone and Joint Surgery, Liuzhou Municipal Liutie Central Hospital, Liuzhou, Guangxi, 545007, China
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Moghnie A, Tigani D, Consoli A, Castiello E, Ganci M, Amendola L. Modular dual mobility articulation in primary and revision hip arthroplasty: lights and shadows. J Orthop Surg Res 2023; 18:278. [PMID: 37020227 PMCID: PMC10074885 DOI: 10.1186/s13018-023-03730-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/17/2023] [Indexed: 04/07/2023] Open
Abstract
PURPOSE The use of dual mobility cups in total hip arthroplasty has gained popularity in light of the fact it enables to reduce dislocation through increased jumping distance (JD) and impingement-free arc of movement. Modular Dual Mobility Cup (modular DMC) systems have been recently introduced to enable the use of dual mobility cups with standard metal-backed shells. The objective of this study was twofold: calculate the JD for each modular DMC system and conduct a systematic literature review to report clinical outcomes and reasons for failure of this construct. METHODS The JD was calculated using the Sariali formula: JD = 2Rsin [(π/2 - Ψ - arcsin (offset/R))/2]. A qualitative systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search for English and French articles between January 2000 and July 2020 was run on PubMed, EMBASE, Google Scholar, and Scopus with the primary objective of finding articles about modular DMC systems. RESULTS We identified eight 8 different manufacturers of modular DMC systems and 327 publications on the subject. After screening for duplicates and eligibility, we identified 229 publications: 206 articles were excluded because they contained no reports on modular DMC systems, whereas other three were not included because they focused on biomechanical aspects. Among the 11 included articles, 2 were prospective case series, 9 were retrospective case series. True dislocation occurred in 25 cases (0.9%), and six of them were solved by closed reduction without necessity of revision, while all 5 intraprosthetic dislocations were operated. CONCLUSIONS Modular DMCs are a valid method to deal with complex THA instability, with good clinical and patient-reported outcomes, low complication rates, and low revision rates at early follow-up. We would advise cautious optimism on the role of modular DMC implants, as it seems safer to use ceramic instead of metallic heads whenever possible to avoid the increase cobalt and chromium trace ion serum levels.
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Affiliation(s)
- Alessandro Moghnie
- Department of Orthopaedic Surgery, Ospedale Maggiore C.A. Pizzardi, Largo B. Nigrisoli 2, 40133, Bologna, Italy.
| | - Domenico Tigani
- Department of Orthopaedic Surgery, Ospedale Maggiore C.A. Pizzardi, Largo B. Nigrisoli 2, 40133, Bologna, Italy
| | - Alberto Consoli
- Department of Orthopaedic Surgery, Ospedale Maggiore C.A. Pizzardi, Largo B. Nigrisoli 2, 40133, Bologna, Italy
| | - Emanuela Castiello
- Department of Orthopaedic Surgery, Ospedale Maggiore C.A. Pizzardi, Largo B. Nigrisoli 2, 40133, Bologna, Italy
| | - Marco Ganci
- Department of Orthopaedic Surgery, Ospedale Maggiore C.A. Pizzardi, Largo B. Nigrisoli 2, 40133, Bologna, Italy
| | - Luca Amendola
- Department of Orthopaedic Surgery, Ospedale Maggiore C.A. Pizzardi, Largo B. Nigrisoli 2, 40133, Bologna, Italy
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Posterior Approach Total Hip Arthroplasty Utilizing a Monoblock Dual-Mobility Construct Without Posterior Hip Precautions: A Series of 580 Hips with One Dislocation. J Arthroplasty 2023:S0883-5403(23)00250-4. [PMID: 36933682 DOI: 10.1016/j.arth.2023.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Instability remains a devastating complication following total hip arthroplasty (THA). Here we describe a mini-posterior approach with a monoblock dual-mobility implant without "traditional posterior hip precautions" yielding excellent results. METHODS There were 580 consecutive hips in 575 patients who underwent THA utilizing a monoblock dual-mobility implant and a mini-posterior approach. With this technique, the acetabular component positioning does not rely on tradition intra-operative radiographic abduction and anteversion goals, but rather uses patient-specific anatomic landmarks (anterior acetabular rim and, when visible, the transverse acetabular ligament) to set cup position; stability is assessed with a significant, dynamic intra-operative test of range of motion. Patients' mean age was 64 years (range, 21 to 94) and 53.7% were women. RESULTS Mean abduction was 48.4° (range, 29° to 68°) and mean anteversion was 24.7° (range, -1 to 51°). Patient Reported Outcomes Measurement Information System scores improved in every measured domain from preoperative to final postoperative visit. There were seven (1.2%) patients who required reoperation, with mean time to reoperation of 1.3 months (range, one to 176 days). Only one patient (0.2%) who had a pre-operative history of spinal cord injury and Charcot arthropathy dislocated. CONCLUSION A posterior approach hip surgeon may want to consider using a monoblock dual-mobility construct and avoidance of traditional posterior hip precautions to achieve early hip stability with an extremely low dislocation rate and high patient satisfaction scores.
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LeBrun DG, Ondeck NT, Nessler JP, Marchand RC, Illgen RL, Westrich GH. Variability of pre-operative functional pelvic tilt in total hip arthroplasty patients. INTERNATIONAL ORTHOPAEDICS 2023; 47:1243-1247. [PMID: 36864185 DOI: 10.1007/s00264-023-05748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE Pelvic tilt (PT) is important to consider when planning total hip arthroplasty (THA) due to its dynamic impact on acetabular orientation. The degree of sagittal pelvic rotation varies during functional activities and can be difficult to measure without proper imaging. The purpose of this study was to evaluate PT variation in the supine, standing, and seated positions. METHODS A multi-centre cross-sectional study was performed that included 358 THA patients who had preo-perative PT measured from supine CT scan and standing and upright seated lateral radiographs. Supine, standing, and seated PT and associated changes between functional positions were evaluated. Anterior PT was assigned a positive value. RESULTS In the supine position, mean PT was 4° (range, -35° to 20°), where 23% had posterior PT and 69% anterior PT. In the standing position, mean PT was 1° (range, -23° to 29°), where 40% had posterior PT and 54% anterior PT. In the seated position, mean PT was -18° (range, -43° to 47°), where 95% had posterior PT and 4% anterior PT. From standing to seated, the pelvis rotated posteriorly in 97% of cases (maximum 60°) with 16% of cases considered stiff (change ≤ 10°) and 18% of cases considered hypermobile (change ≥ 30°). CONCLUSION Patients undergoing THA have marked PT variation in the supine, standing, and seated positions. There was wide variability in PT change from standing to seated, with 16% of patients considered stiff and 18% considered hypermobile. Functional imaging should be performed on patients prior to THA to allow for more accurate planning.
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Affiliation(s)
- Drake G LeBrun
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, 535 East 70 th Street, New York, NY, 10021, USA.
| | - Nathaniel T Ondeck
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, 535 East 70 th Street, New York, NY, 10021, USA
| | - Joseph P Nessler
- St. Cloud Orthopedics, 1901 Connecticut Ave S, MN, 56377, Sartell, USA
| | - Robert C Marchand
- Ortho Rhode Island, 285 Promenade Street, RI, 02908, Providence, USA
| | - Richard L Illgen
- University of Wisconsin-Madison, 4602 Eastpark Blvd, Madison, WI, 53706, USA
| | - Geoffrey H Westrich
- Adult Reconstruction Joint Replacement Service, Hospital for Special Surgery, 535 East 70 th Street, New York, NY, 10021, USA
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Mitsutake R, Tanino H, Ito H. The effect of range of motion simulated with a patient-specific three-dimensional simulation analysis on dislocation after total hip arthroplasty. Hip Int 2023; 33:313-322. [PMID: 34538126 DOI: 10.1177/11207000211044807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Dislocation continues to be a common complication following total hip arthroplasty (THA). Although previous studies of computed simulation analysis investigated the range of motion (ROM), it is unclear whether the ROM before impingement simulated using computed tomography-based 3-dimensional simulation analysis (simulated ROM) is related to dislocation after THA. It is also unclear what angles are required in computed simulation analyses for stable hips after THA. In this study, we compared the simulated ROM in patients with and without dislocation. METHODS 16 patients with posterior dislocation were compared with 48 matched patients without dislocation. Risk factors including preoperative bone morphology of the hip, implant position, change of femoral offset, change of leg length, anterior aspect of the greater trochanter (GTa) length, and anterior inferior iliac spine length were also compared. RESULTS The mean flexion angle, internal-rotation at 90° flexion (IR) angle, cup anteversion based on the anterior pelvic plane (APP), tilt-adjusted cup anteversion and GTa length were significantly different between patients with dislocation and patients without dislocation (p = 0.033, 0.002, 0.010, 0.047, 0.046). A receiver-operating characteristic curve analysis suggested cutoff points for flexion angle, IR angle, cup anteversion based on the APP, tilt-adjusted cup anteversion and GTa length, of 114.5°, 45.5°, 19.5°, 12.0° and 15.3 mm. CONCLUSIONS This study suggests that preoperative planning to achieve a larger simulated ROM, flexion angle and IR angle, may reduce the risk of posterior dislocation. This study also suggests that fine-tuning of cup anteversion and/or trimming of the overhanging GTa during preoperative planning may reduce the risk of posterior dislocation.
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Affiliation(s)
- Ryo Mitsutake
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiromasa Tanino
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiroshi Ito
- Department of Orthopaedic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
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Free MD, Barnes I, Hutchinson M, Harvie P. Preoperative radiographs to predict component malposition in direct anterior approach total hip arthroplasty. Hip Int 2023; 33:207-213. [PMID: 34424781 DOI: 10.1177/11207000211037596] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION There is conflicting evidence as to whether or not patients undergoing total hip arthroplasty (THA) via the direct anterior approach (DAA) have increased risk of component malposition. The aim of this study was to investigate whether specific preoperative radiographic features were predictive of postoperative component malposition in DAA THA. PATIENTS AND METHODS We examined 204 THA operations performed for osteoarthritis via the DAA at a single institution. Preoperative radiographs were analysed with numerous pre-specified measurements and classifications being recorded. Postoperative radiographs were analysed to determine if any of these preoperative radiographic factors correlated with component malposition in regard to cup inclination, cup version, femoral stem coronal alignment, leg-length discrepancy (LLD) and femoral offset discrepancy. RESULTS Numerous preoperative factors were associated with component malposition. Coxa profunda was found to be a significant predictor of cup anteversion being outside of the target range (p = 0.0089) and an increased centre-edge angle was a significant predictor for a postoperative LLD (p = 0.0134). A decreased neck-shaft angle (p = 0.0007) and a lower preoperative LLD (p = 0.0019) were both predictive of femoral stem coronal malalignment. CONCLUSIONS Preoperative radiographs can be a valuable tool for surgeons in predicting patients at risk of component malposition in DAA THA.
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Affiliation(s)
- Matthew D Free
- Orthopaedics Department, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Ian Barnes
- Orthopaedics Department, Royal Hobart Hospital, Hobart, TAS, Australia
| | | | - Paul Harvie
- Orthopaedics Department, Royal Hobart Hospital, Hobart, TAS, Australia
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Sadowitz PM, Karlin WM, Lirtzman RA, Kowaleski MP. Fluoroscopic Categorization of Cementless Acetabular Component Positioning. Vet Comp Orthop Traumatol 2023; 36:163-168. [PMID: 36812935 DOI: 10.1055/s-0043-1761247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate a fluoroscopic method of angle of lateral opening (ALO) categorization based on identification of the visible portion of a pre-existing, circular recess within the metal shell of the BioMedtrix BFX acetabular component, which projects as an ellipse at clinically relevant ALO values. Our hypothesis was that there will be an association between the actual ALO and the categorization of ALO based on identification of the visible portion of the elliptical recess on a lateral fluoroscopic image at clinically relevant values. METHODS A custom plexiglass jig was fitted with a two-axis inclinometer and a 24 mm BFX acetabular component attached to its tabletop. Fluoroscopic reference images were obtained with the cup positioned at an ALO of 35, 45 and 55 degrees with a fixed 10 degrees of retroversion. Thirty study fluoroscopic images (10 images at each ALO) were obtained based on randomization at an ALO of 35, 45 and 55 degrees (±0.5 degrees) with 10 degrees of retroversion. The order of the study images was randomized, and a single, blinded observer categorized the 30 study images as representing an ALO of 35, 45 or 55 degrees by comparison to the reference images. RESULTS Analysis showed perfect (30/30) agreement with a weighted kappa coefficient of 1 (95% confidence interval: -0.717 to 1). CLINICAL RELEVANCE The results demonstrate that accurate categorization of ALO can be achieved using this fluoroscopic method. This method may prove to be a simple but effective method of estimating intraoperative ALO.
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Affiliation(s)
- Peter M Sadowitz
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, United States
| | - William M Karlin
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, United States
| | - Ross A Lirtzman
- Arizona Canine Orthopedics and Sports Medicine, Scottsdale, Arizona, United States
| | - Michael P Kowaleski
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, United States
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Achieving Precise Cup Positioning in Direct Anterior Total Hip Arthroplasty: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020271. [PMID: 36837472 PMCID: PMC9959722 DOI: 10.3390/medicina59020271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 02/01/2023]
Abstract
Malpositioned implants in total hip arthroplasty are associated with impingement, increased wear, and dislocations, thus precise cup positioning is crucial. However, significant deviations between targeted and actually achieved cup positions have been found even in patients operated by experienced surgeons. When aiming for higher accuracy, various methods based on freehand positioning lead by anatomic landmarks, C-arm fluoroscopy, imageless navigation, or robotic-assisted-surgery have been described. There is a constant development of new products aiming to simplify and improve intraoperative guidance. Both the literature and expert opinions on this topic are often quite controversial. This article aims to give an overview of the different methods and systems with their specific advantages and potential pitfalls while also taking a look into the future of cup positioning in anterior hip replacements.
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Xu J, Veltman ES, Chai Y, Walter WL. Accuracy of acetabular component alignment with surgical guidance systems during hip arthroplasty. SICOT J 2023; 9:12. [PMID: 37144949 PMCID: PMC10161875 DOI: 10.1051/sicotj/2023010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/12/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Navigation in total hip arthroplasty has been shown to improve acetabular positioning and can decrease the incidence of mal-positioned acetabular components. This study aimed to assess two surgical guidance systems by comparing intra-operative measurements of acetabular component inclination and anteversion with a post-operative CT scan. METHODS We prospectively collected intra-operative navigation data from 102 hips receiving conventional THA or hip resurfacing arthroplasty through either a direct anterior or posterior approach. Two guidance systems were used simultaneously: an inertial navigation system (INS) and an optical navigation system (ONS). Acetabular component anteversion and inclination were measured on a post-operative CT. RESULTS The average age of the patients was 64 years (range: 24-92) and the average BMI was 27 kg/m2 (range 19-38). 52% had hip surgery through an anterior approach. 98% of the INS measurements and 88% of the ONS measurements were within 10° of the CT measurements. The mean (and standard deviation) of the absolute difference between the postoperative CT and the intra-operative measurements for inclination and anteversion were 3.0° (2.8) and 4.5° (3.2) respectively for the ONS, along with 2.1° (2.3) and 2.4° (2.1) respectively for the INS. There was a significantly lower mean absolute difference to CT for the INS when compared to ONS in both anteversions (p < 0.001) and inclination (p = 0.02). CONCLUSIONS We found that both inertial and optical navigation systems allowed for adequate acetabular positioning as measured on postoperative CT, and thus provide reliable intraoperative feedback for optimal acetabular component placement. LEVEL OF EVIDENCE Therapeutic Level II.
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Affiliation(s)
- Joshua Xu
- University of Sydney, Sydney, New South Wales, Australia - Department of Orthopaedic and Trauma Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia - Tom Reeve Academic Clinic, Ground Floor Kolling Building, 10 Westbourne Street, St Leonards, NSW 2065, Australia
| | - Ewout S Veltman
- Department of Orthopaedic and Trauma Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
| | - Yuan Chai
- University of Sydney, Sydney, New South Wales, Australia
| | - William L Walter
- University of Sydney, Sydney, New South Wales, Australia - Department of Orthopaedic and Trauma Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
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Budzińska MB, Maciąg BM, Żarnovsky K, Kordyaczny T, Kowalczyk IM, Adamska O, Stolarczyk A. How to analyze postoperative radiographs after total hip replacement. Jpn J Radiol 2023; 41:14-18. [PMID: 36063354 DOI: 10.1007/s11604-022-01332-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/22/2022] [Indexed: 01/07/2023]
Abstract
Total hip replacement is one of the most widely performed surgeries. It is stated as the most efficient method of treating end-stage osteoarthritis of the hip joint. What is more, it significantly improves the quality of patients' lives, relieves them from pain and restores decreased range of motion, provided that is conducted properly. Aim of this article is to indicate which constituents of prosthetic placement can be easily measured on postoperative radiographs and point out how to interpret obtained results. Multiple mechanical factors, such as center of rotation, femoral offset, acetabular offset, acetabular inclination, acetabular anteversion and leg length discrepancy can be measured on postoperative radiographs. To provide a successful surgery and to acquire both radiological and clinical satisfying results, proper prosthetic placement is crucial. Malpositioning of each element, in varying degrees may lead to dislocation or reoperation.
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Affiliation(s)
- Martyna Barbara Budzińska
- Department of Orthopaedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa Str., 04-749, Warsaw, Poland
| | - Bartosz Michał Maciąg
- Department of Orthopaedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa Str., 04-749, Warsaw, Poland.
| | - Krystian Żarnovsky
- Department of Orthopaedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa Str., 04-749, Warsaw, Poland
| | - Tomasz Kordyaczny
- Department of Orthopaedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa Str., 04-749, Warsaw, Poland
| | - Inga Magdalena Kowalczyk
- Department of Orthopaedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa Str., 04-749, Warsaw, Poland
| | - Olga Adamska
- Department of Orthopaedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa Str., 04-749, Warsaw, Poland
| | - Artur Stolarczyk
- Department of Orthopaedics and Rehabilitation, Medical University of Warsaw, Międzyleski Specialist Hospital, 2 Bursztynowa Str., 04-749, Warsaw, Poland
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Min Lee J, Baek SH, Soo Lee Y. Vital protocols for PolyWare™ measurement reliability and accuracy. Front Surg 2022; 9:997848. [PMID: 36632526 PMCID: PMC9826794 DOI: 10.3389/fsurg.2022.997848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/21/2022] [Indexed: 12/27/2022] Open
Abstract
Background and objective PolyWare™ software (PW) has been exclusively used in the majority of polyethylene wear studies of total hip arthroplasty (THA). PW measurements can be significantly inaccurate and unrepeatable, depending on imaging conditions or subjective manipulation choices. In this regard, this study aims to shed light on the conditions needed to achieve the best accuracy and reliability of PW measurements. Methods The experiment looked at how PW fluctuated based on several measurement conditions. x-ray images of in-vitro THA prostheses were acquired under a clinical x-ray scanning condition. A linear wear rate of 6.67 mm was simulated in combination with an acetabular lateral inclination of 36.6° and anteversion of 9.0°. Results Among all the imported x-ray images, those with a resolution of 1,076 × 1,076 exhibited the best standard deviation in wear measurements as small as 0.01 mm and the lowest frequencies of blurriness. The edge detection area specified as non-square and off the femoral head center exhibited the most blurriness. The x-ray image that scans a femoral head eccentrically placed by 15 cm superior to the x-ray beam center led to a maximum acetabular anteversion measurement error of 5.3°. Conclusion Because PW has been the only polyethylene wear measurement tool used, identifying its sources of error and devising a countermeasure are of the utmost importance. The results call for PW users to observe the following measurement protocols: (1) the original x-ray image must be a 1,076 × 1,076 square; (2) the edge detection area must be specified as a square with edge lengths of 5 times the diameter of the femoral head, centered at the femoral head center; and (3) the femoral head center or acetabular center must be positioned as close to the center line of the x-ray beam as possible when scanning.
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Affiliation(s)
- Jong Min Lee
- Department of BioMedical Engineering, School of BioMedical Science, Daegu Catholic University, Gyungbuk, South Korea
| | - Seung-Hoon Baek
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea,Correspondence: Yeon Soo Lee Seung-Hoon Baek
| | - Yeon Soo Lee
- Department of BioMedical Engineering, School of BioMedical Science, Daegu Catholic University, Gyungbuk, South Korea,Correspondence: Yeon Soo Lee Seung-Hoon Baek
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Tian Y, Liu Z, Liu S, Jing W, Li L, Ma W, Han Y. Efficacy of bed exercise in elderly patients after total hip arthroplasty: A retrospective study of 539 patients. Medicine (Baltimore) 2022; 101:e31779. [PMID: 36451424 PMCID: PMC9704895 DOI: 10.1097/md.0000000000031779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The purpose of this study was to observe the necessity of bed exercise therapy in the rehabilitation of elderly patients after hip replacement and to analyze whether bed exercise therapy has an impact on patients' psychological scores, hip function and postoperative complications. From January 2018 to January 2021, a total of 539 patients with end-stage femoral head necrosis or hip osteoarthritis were retrospectively analyzed. According to the method of postoperative rehabilitation exercise, patients were divided into 2 groups: Group A (routine gait) and Group B (bed exercise). There was no significant difference in general information between the 2 groups. There was no significant difference in baseline pain scores between patients in Group A and Group B (25.2 ± 9.6 vs 24.8 ± 10.4, P = .429). However, at 5 weeks post-operatively, the pain scores of patients in Group A were significantly higher than those in Group B (38.6 ± 7.7 vs 34.1 ± 8.1, P = .016). At 17 weeks post-operatively, the difference between Group A and Group B remained (40.9 ± 6.9 vs 37.5 ± 7.5, P = .041). Similar to the pain score, the hip function score compared between the 2 groups was significantly different at 5 weeks (39.7 ± 8.4 in Group A, 45.9 ± 9.2 in Group B, P < .001) and 17 weeks post-operatively (41.5 ± 7.6 in Group A, 47.2 ± 8.8 in Group B, P < .001). At 17 weeks post-operatively, between the 2 groups, only the range of motion (ROM) of abduction showed no significant difference. Patients in Group B exhibited a better ROM in any other movement posture. The results showed that compared with Group A, bed exercise rehabilitation training could reduce the incidence of deep venous thrombosis. This study demonstrates that bed exercise can improve the hip function and quality of life of elderly patients with total hip arthroplasty (THA) at an early postoperative stage. It can reduce the incidence of deep venous thrombosis of the lower limbs after surgery. For these patients, systematic bed exercise rehabilitation training is recommended in the early postoperative period.
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Affiliation(s)
- Yancha Tian
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Zeming Liu
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Sikai Liu
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Wenyu Jing
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Lin Li
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Wenhui Ma
- 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
- *Correspondence: Yongtai Han, Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang, Hebei Province, P.R. China (e-mail: )
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Hardwick-Morris M, Twiggs J, Kacker K, Miles B, Balakumar J. Functional Femoral Anteversion: Axial Rotation of the Femur and its Implications for Stem Version Targets in Total Hip Arthroplasty. Arthroplast Today 2022; 18:16-23. [PMID: 36267395 PMCID: PMC9576488 DOI: 10.1016/j.artd.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/13/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background Acetabular and femoral component positioning are important considerations in reducing adverse outcomes after total hip arthroplasty (THA). Previous assessments of femoral anteversion examined anatomic femoral anteversion (AFA) referenced to anatomic landmarks. However, this does not provide a functional understanding of the femur's relationship to the hip. We investigate a new measurement, functional femoral anteversion (FFA), and sought to measure its variability across a large sample of patients undergoing THA. Methods A total of 1008 consecutive patients underwent THA surgery between September 2019 and July 2021. All patients were measured for supine and standing functional femoral rotation (FFR), AFA, and FFA. Results The mean standing FFA was 13.2° ± 12.2° (-27.8° to 52.3°). The mean change in FFR from supine to standing was -2.2° ± 11.8° (-43.0° to 41.9°). Of all, 161 (16%) patients had standing FFA version greater than 25°. Four hundred sixty (46%) patients had standing FFR (internal or external) greater than 10°. One hundred twenty-three (12%) patients exhibited an increase in external rotation from supine to standing of greater than 10°. A moderate, negative linear relationship was observed between AFA and standing external femoral rotation (P <<.001, R = -0.46), indicating people may externally rotate their femur as AFA decreases with age. Conclusions Functional alignment of the femur in patients requiring THA is understudied. It is now understood that the femur, like the pelvis, can rotate substantially between functional positions. Enhancing our understanding of FFA and FFR may improve both acetabular and femoral component positioning.
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Affiliation(s)
- Max Hardwick-Morris
- Flinders University, Adelaide, South Australia, Australia,360 Med Care, Sydney, New South Wales, Australia,Corresponding author. 360 Med Care, Suite 3, Building 1/20 Bridge Street, Pymble, New South Wales, Australia. Tel.: +61 406 937 050.
| | | | | | - Brad Miles
- 360 Med Care, Sydney, New South Wales, Australia
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Deckey DG, Rosenow CS, Lai C, Christopher ZK, Verhey JT, Schwartz AJ, Bingham JS. Abnormal Spinopelvic Motion and Spine Deformity are Associated With Native Femoral Retroversion in the Setting of Total Hip Arthroplasty. Arthroplast Today 2022; 17:150-154. [PMID: 36158464 PMCID: PMC9493293 DOI: 10.1016/j.artd.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/28/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background The effect of spinopelvic pathology on femoral version is unclear. This study investigated variability in native femoral anteversion in patients undergoing total hip arthroplasty (THA) and its relationship to the patient’s underlying spinopelvic pattern. Methods A retrospective chart review was performed to include in the study all patients undergoing robot-assisted THA over a 3-year period. Native femoral version was measured for each patient using a preoperative computed tomography scan and categorized as excessive, normal, or retroverted. Additionally, a subset analysis was performed for all patients with sit-to-stand dynamic pelvic radiographs available, and cases were classified by spinopelvic pattern. Results A total of 119 patients were included in the study with a mean age of 68.6 years; 61 (51%) were female. The median femoral anteversion for the entire study group was 6.0° (−32° to 40°, interquartile range 13.5°). Eleven patients (9.2%) had excessive femoral anteversion, 54 of the 119 (45.4%) had normal femoral version, and 54 of the 119 (45.4%) had native retroversion. Forty-two patients (35.3%) had sit-to-stand radiographs available and were subclassified by femoral version type and spinopelvic parameters. Welch’s analysis of variance demonstrated a significant difference in femoral version among spinopelvic patterns (F = 7.826, P = .003), with Games-Howell post hoc analysis showing increased retroversion in deformity-stiff patients compared to deformity-normal mobility patients (P = .003). Conclusions This study demonstrates that native femoral retroversion is present in a significant number of patients undergoing THA and is more common in patients with stiff spine deformities. Based on this observation, currently available spinopelvic classification systems should be modified to account for native femoral version.
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48
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Abdelaal MS, Sutton RM, Yacovelli S, Pezzulo JD, Farronato DM, Parvizi J. Acetabular Retroversion: Dysplasia in Disguise that Leads to Early Arthritis of the Hip. Orthop Clin North Am 2022; 53:403-411. [PMID: 36208883 DOI: 10.1016/j.ocl.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We aimed to assess the prevalence of acetabular retroversion (AR) in patients undergoing total hip replacement (THA) based on age. We retrospectively compared preoperative anteroposterior pelvic radiographs of patients younger than 40 years of age who underwent THA with the age- and body mass index-matched control of 40 years and older patients. Retroversion was determined based on the presence of cross-over sign, ischial spine sign, posterior wall sign, and elephant's ear sign with data stratified based on presence of dysplasia.
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Affiliation(s)
- Mohammad S Abdelaal
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ryan M Sutton
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Steven Yacovelli
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Joshua D Pezzulo
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Dominic M Farronato
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Javad Parvizi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA.
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ÇATALTEPE A. The length of distal skin incision of the postero-lateral approach affects the cup inclination during the total hip arthroplasty. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1071852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: The primary aim of the study was to determine whether the length of the distal skin incision of the posterolateral approach affects the cup inclination during total hip arthroplasty (THA).
Material and Method: In this study, a cohort of 71 consecutive patients who performed between January 2017 and December 2021 with unilateral THA using a posterolateral approach was retrospectively assessed. Two groups were formed according to acetabular cup inclination with normal anteversion angle. There were 56 hips in the inside group and 17 in the outside group. A curvilinear skin incision of around 13 cm was performed. Component position evaluation was carried out through a radiographic assessment of the acetabular component on an anteroposterior pelvis radiograph. The rate of an outlier was compared between groups according to the safe zone defined as 30° to 50° of inclination and 5° to 25° of anteversion, which was described by Lewinnek et al.
Results: No significant difference in the average total incision length was found between the two groups (p=0.207). While the average distal incision length was 7.91±0.62 cm (range, 6.8-9 cm) in the inside group and 6.37±0.21 cm (range, 6-6.7 cm) in the outside group. According to ROC analysis, a patient with ≤6.7 cm of the distal length of incision (DLI) was 5.71 times more likely to be outside than a patient with >6.7 cm of DLI. Seventeen hips (23.3%) were found outside the safe range. Substantial differences were observed regarding radiographic cup inclination between the two groups (p=0.0001). In the inside group, the average cup inclination was 44.11°±3.44° (range, 37°-50°), whereas, in the outside group, it was 55.41°±2.5° (range, 52°-59°). However, there were no significant differences in the average radiographic cup anteversion between the two groups (p=0.960). Although 11 of 17 (64.5%) patients were classified as obese (BMI ≥30) in the outside group experienced higher rates of inaccurate cup orientation, logistic regression analysis showed that the individual effects of obesity on the occurrence of the inaccurate cup position were not observed (p=0.884). One posterior hip dislocation occurred after one month postoperative in the outside group.
Conclusions: Longer distal portion of the skin incision of the posterolateral approach should be performed to achieve optimal operative inclination angles of the acetabular cup during THA. The surgeon must have no hesitation in extending the distal skin incision when adopting the posterolateral approach.
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Becker L, Taheri N, Haffer H, Muellner M, Hipfl C, Ziegeler K, Diekhoff T, Pumberger M. Lumbosacral Transitional Vertebrae Influence on Acetabular Orientation and Pelvic Tilt. J Clin Med 2022; 11:jcm11175153. [PMID: 36079079 PMCID: PMC9457479 DOI: 10.3390/jcm11175153] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Lumbosacral transitional vertebrae (LSTV) are common congenital variances with a prevalence found in the population up to 35.6%. The literature demonstrates an influence of LSTV on bony pelvic anatomy. The influence on the anatomical acetabular orientation, which is important for cup positioning in total hip arthroplasty, has not yet been described for patients with LSTV. A total of 53 patients with LSTV were identified from a CT Database including 819 subjects. Fifty patients with LSTV could be included and were matched for age and sex against a control group. We examined the influence of LSTV, classified according to Castellvi, on acetabular orientation and pelvic tilt in the supine position. Functional acetabular anteversion and inclination, assessed against the table plane, were compared against anatomical acetabular anteversion and inclination, assessed against the anterior pelvic plane. The anatomical acetabular inclination correlated with the pelvic tilt (r = 0.363, p < 0.001). The anatomical acetabular inclination was significantly larger than the functional acetabular inclination in the supine position (p < 0.001). Castellvi grading of LSTV correlated negatively with pelvic tilt (ρ = −0.387, p = 0.006). Castellvi grading correlated significantly with functional acetabular anteversion (ρ = 0.324, p = 0.022) and anatomical acetabular anteversion (ρ = 0.306, p = 0.022). A higher Castellvi grading was accompanied by a reduced pelvic tilt in the supine position. The functional acetabular anteversion and anatomical acetabular anteversion increased in parallel to the higher Castellvi grading. Therefore, LSTV and Castellvi grading might be assessed on pre-operative X-rays prior to hip arthroplasty and surgeons might consider adjusting cup positioning accordingly.
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Affiliation(s)
- Luis Becker
- Center for Musculoskeletal Surgery, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health, Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité—University Medicine, Augustenburger Pl. 1, 13353 Berlin, Germany
- Correspondence:
| | - Nima Taheri
- Center for Musculoskeletal Surgery, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Henryk Haffer
- Center for Musculoskeletal Surgery, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Maximilian Muellner
- Center for Musculoskeletal Surgery, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Christian Hipfl
- Center for Musculoskeletal Surgery, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Katharina Ziegeler
- Department for Radiology, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Torsten Diekhoff
- Department for Radiology, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Matthias Pumberger
- Center for Musculoskeletal Surgery, Charité—University Medicine, Charitéplatz 1, 10117 Berlin, Germany
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