1
|
Kaneoka T, Imagama T, Okazaki T, Matsuki Y, Kawakami T, Yamazaki K, Sakai T. Evaluation of the reproducibility of preoperative three-dimensional computed tomography planning for posterolateral approach total hip arthroplasty. J Artif Organs 2024; 27:146-153. [PMID: 37081208 DOI: 10.1007/s10047-023-01396-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/12/2023] [Indexed: 04/22/2023]
Abstract
The anteversion of the stem is occasionally intentionally changed by the surgeon for patients with smaller femoral neck anteversion during total hip arthroplasty (THA). However, the reproducibility of preoperative planning with increasing anteversion has been rarely assessed. The present study investigated it using two types of stems. This retrospective study included patients who underwent primary posterolateral THA using taper-wedge (TS group; 73 hips) and anatomical (AS group; 70 hips) stems. Characteristics of sex and age were matched in the two groups by propensity score matching. In both groups, the relationship between the preoperative three-dimensional planning and postoperative stem position, and the relationship between postoperative stem position and femoral neck anteversion (FNA) were evaluated. In the TS group, there were no significant differences in average stem anteversion (SA) between preoperative planning and postoperative placement (36.1° ± 7.0° and 36.6° ± 11.1°, respectively: p = 0.651). The absolute error of SA was 8.1° ± 6.4°. In the AS group, the postoperative SA was significantly smaller than the preoperative planning SA (22.7° ± 11.6° and 30.0° ± 9.3°, respectively: p < 0.001). The absolute error of SA was 9.0° ± 5.8°. The postoperative SA was significantly larger than the FNA in the TS group (36.6° ± 11.1° and 26.3° ± 10.9°, respectively: p < 0.001). However, no significant differences between the two were observed in the AS group (23.7° ± 10.1° and 22.7° ± 11.6°, respectively: p = 0.253). The preoperative planning of intentional increasing anteversion did not show high reproducibility with taper-wedge and anatomical stems. The anatomical stem was placed according to the femoral medullary canal regardless of preoperative planning with increased SA.
Collapse
Affiliation(s)
- Takehiro Kaneoka
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, 755-8505, Japan
| | - Takashi Imagama
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, 755-8505, Japan
| | - Tomoya Okazaki
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, 755-8505, Japan
| | - Yuta Matsuki
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, 755-8505, Japan
| | - Takehiro Kawakami
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, 755-8505, Japan
| | - Kazuhiro Yamazaki
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, 755-8505, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1, Minami-Kogushi, Ube, 755-8505, Japan.
| |
Collapse
|
2
|
Naito Y, Hasegawa M, Tone S, Wakabayashi H, Sudo A. Accuracy of cup placement and pelvic motion in total hip arthroplasty in the lateral decubitus position using a new computed tomography-based navigation system with augmented reality technology. Arch Orthop Trauma Surg 2024; 144:2381-2389. [PMID: 38554208 DOI: 10.1007/s00402-024-05284-8] [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: 11/20/2023] [Accepted: 03/10/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION This study aimed to investigate the accuracy of cup position and assess the changes in pelvic tilt during primary total hip arthroplasty (THA) in the lateral decubitus position using a new computed tomography (CT)-based navigation system with augmented reality (AR) technology. MATERIALS AND METHODS There were 37 cementless THAs performed using a CT-based navigation system with AR technology in the lateral decubitus position and 63 cementless THAs performed using manual implant techniques in the lateral decubitus position in this retrospective study. Postoperative cup radiographic inclination and anteversion were measured using postoperative CT, and the proportion of hips within Lewinnek's safe zone was analyzed and compared between the two groups. The mean absolute values of navigation error were assessed. Intraoperative pelvic tilt angles were also recorded using navigation system. RESULTS The percentage of cups inside Lewinnek's safe zone was 100% in the navigation group and 35% in the control group (p < 0.001). The mean absolute values of navigation error in inclination and anteversion were 2.9° ± 2.1° and 3.3° ± 2.4°, respectively. The mean abduction angle of the pelvis was 5.1° ± 4.8° after placing the patients in the lateral decubitus position and 4.1° ± 6.0° after cup placement. The mean posterior tilt angle was 6.8° ± 5.1° after placing the patients in the lateral decubitus position and 9.3° ± 5.9° after cup placement. The mean internal rotation angle was 14.8° ± 7.4° after cup placement. There were no correlations between the navigation error in inclination or anteversion and the absolute values of changes of the pelvic tilt angle at any phase. CONCLUSIONS Although progressive pelvic motion occurred in THA in the lateral decubitus position, especially during cup placement, the CT-based navigation system with AR technology improved cup placement accuracy.
Collapse
Affiliation(s)
- Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
| |
Collapse
|
3
|
Shimizu J, Nagoya S, Kosukegawa I, Kanaizumi A, Nakahashi N, Teramoto A. The Accuracy of Cup Placement in Total Hip Arthroplasty (THA) Using an Augmented Reality-Based Navigation System. Cureus 2024; 16:e59423. [PMID: 38826595 PMCID: PMC11140827 DOI: 10.7759/cureus.59423] [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] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Background AR HIP Navigation System® (AR-navi; Zimmer-Biomet, Warsaw, IN) is a portable navigation system employing augmented reality via a smartphone app, which was developed in Japan. We retrospectively analyzed the accuracy of cup placement in total hip arthroplasty (THA) using AR-navi, to investigate whether obesity is associated with an absolute value error in cup placement angle. Methods We retrospectively analyzed 45 hips in 43 patients who underwent THA using AR-navi (AR-navi group) and compared them with 45 hips in 45 patients who underwent THA using alignment rods (conventional group). Results The mean absolute error of cup placement (AR-navi group vs. conventional group) was found to be 2.60° (±2.11) in radiographic inclination (RI) for the AR-navi group and 4.61° (±3.28) for the conventional group, which indicates significant difference in the AR-navi group compared to that in the conventional group (p = 0.0036). The mean absolute error of radiographic anteversion (RA) was 3.57° (±3.36) for the AR-navi group and 3.87° (±2.97) for the conventional group (p = 0.4732). The mean absolute error of RI was 2.36° (±2.24) in the obese group and 3.16° (±2.03) in the nonobese group, and the mean absolute error of RA was 4.08° (±4.51) and 3.16° (±2.05) in the obese and nonobese groups, respectively. Conclusions Cup placement accuracy for THA using AR-navi was 2.60 ± 2.11° for RI and 3.87 ± 2.97° for RA. Compared to THA using the conventional method, the RI installation error was significantly improved with AR Navi. There was no significant difference in the mean absolute error of RI and RA among the obese and nonobese groups.
Collapse
Affiliation(s)
- Junya Shimizu
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, JPN
| | - Satoshi Nagoya
- Department of Orthopaedic Surgery, Sapporo Kojinkai Memorial Hospital, Sapporo, JPN
| | - Ima Kosukegawa
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, JPN
| | - Arata Kanaizumi
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, JPN
| | - Naoya Nakahashi
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, JPN
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, JPN
| |
Collapse
|
4
|
Thompson Z, Khoshbin A, Ward S, Brillantes J, Melo L, Waddell JP, Atrey A. The impact of operative approach and intraoperative imaging on leg length discrepancy and acetabular component angle in total hip arthroplasty: a retrospective cohort study. INTERNATIONAL ORTHOPAEDICS 2024; 48:473-479. [PMID: 37715062 DOI: 10.1007/s00264-023-05962-z] [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: 08/22/2023] [Accepted: 08/27/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE Operative approach in total hip arthroplasty (THA) has long been a topic of debate with each approach having unique benefits and disadvantages. One purported benefit of an anterior approach to THA is that it allows for intraoperative positioning using fluoroscopy rather than manual positioning. Proper positioning allows for improved outcomes including leg length discrepancy and acetabular component angle. This study aims to examine if operative approach and use of imaging in intraoperative positioning impact LLD and cup angle post-operatively. METHODS A total of 300 hips were enrolled in the study with 100 hips per approach (anterior with fluoroscopy, lateral, and posterior). Retrospective chart review was conducted to assess patient demographics and radiographic analysis used to determine LLD and acetabular cup angle. RESULTS Of the three groups, those receiving anterior approach THAs were on average older than those in the posterior group. Analysis comparing the LLD and acetabular angle across the three groups showed no statistically significant difference in LLD (p=0.091); this was also reflected when comparing hips that received fluoroscopy with those that did not (p=0.91). For acetabular angle, while no difference existed when comparing hips that received imaging versus those that did not, statistically significant differences were observed when comparing the three intraoperative approaches (p<0.0001). CONCLUSIONS Neither intraoperative approach nor the use of intraoperative imaging in THA has a statistically significant effect on LLD post-operatively. However, approach did impact the acetabular cup angle across all three distinct approaches.
Collapse
Affiliation(s)
- Zoe Thompson
- University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada.
| | - Amir Khoshbin
- University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada
- St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada
| | - Sarah Ward
- University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada
- St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada
| | - Jacqueline Brillantes
- University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada
- St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada
| | - Luana Melo
- St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada
| | - James P Waddell
- St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada
| | - Amit Atrey
- University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada
- St. Michael's Hospital, University of Toronto, 30 Bond St., Toronto, ON, M5B 1W8, Canada
| |
Collapse
|
5
|
Hamawaki M, Hamada H, Uemura K, Takashima K, Mae H, Nakamura N, Sugano N. Rigid fixation of pelvic tracker essential for accurate cup placement in CT-based navigation total hip arthroplasty. J Artif Organs 2024:10.1007/s10047-023-01426-8. [PMID: 38195733 DOI: 10.1007/s10047-023-01426-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024]
Abstract
Research is lacking on the effect of intraoperative pelvic tracker displacement relative to the pelvis on cup orientation accuracy in computed tomography (CT)-based navigation (CTN) or multivariable analysis to detect factors associated with CTN accuracy. Here, we asked: (1) how pelvic tracker displacement influences the CTN accuracy of cup orientation in total hip arthroplasty (THA)? and (2) what factors are associated with CTN accuracy on multivariable analysis? Regarding cup orientation in 446 THA procedures using CTN, we evaluated clinical error defined as the difference between postoperative measurement and preoperative planning and measurement error defined as the difference between postoperative and intraoperative measurements. Multivariable regression analyses detected the associated factors. Subjects with an intraoperative tracker displacement of < 2 mm were classified in the verified group. Mean absolute clinical and measurement errors were < 1.5° in the verified group, whereas the measurement error of 2.6° for cup inclination and 1.3° for anteversion was larger in the non-verified versus verified group. Tracker displacement and screw fixation were associated with larger clinical errors, while tracker displacement and surgeon inexperience were associated with larger measurement errors. Clinical and measurement accuracies were high for CTN cup placement with rigid pelvic tracker fixation.
Collapse
Affiliation(s)
- Makoto Hamawaki
- Center of Arthroplasty, Kyowakai Hospital, 1-24-1 Kishibe-Kita, Suita City, Osaka, 564-0001, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Kazuma Takashima
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Hirokazu Mae
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Nobuo Nakamura
- Center of Arthroplasty, Kyowakai Hospital, 1-24-1 Kishibe-Kita, Suita City, Osaka, 564-0001, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
| |
Collapse
|
6
|
Sun J, Yang B, Koukourakis N, Guck J, Czarske JW. AI-driven projection tomography with multicore fibre-optic cell rotation. Nat Commun 2024; 15:147. [PMID: 38167247 PMCID: PMC10762230 DOI: 10.1038/s41467-023-44280-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
Optical tomography has emerged as a non-invasive imaging method, providing three-dimensional insights into subcellular structures and thereby enabling a deeper understanding of cellular functions, interactions, and processes. Conventional optical tomography methods are constrained by a limited illumination scanning range, leading to anisotropic resolution and incomplete imaging of cellular structures. To overcome this problem, we employ a compact multi-core fibre-optic cell rotator system that facilitates precise optical manipulation of cells within a microfluidic chip, achieving full-angle projection tomography with isotropic resolution. Moreover, we demonstrate an AI-driven tomographic reconstruction workflow, which can be a paradigm shift from conventional computational methods, often demanding manual processing, to a fully autonomous process. The performance of the proposed cell rotation tomography approach is validated through the three-dimensional reconstruction of cell phantoms and HL60 human cancer cells. The versatility of this learning-based tomographic reconstruction workflow paves the way for its broad application across diverse tomographic imaging modalities, including but not limited to flow cytometry tomography and acoustic rotation tomography. Therefore, this AI-driven approach can propel advancements in cell biology, aiding in the inception of pioneering therapeutics, and augmenting early-stage cancer diagnostics.
Collapse
Affiliation(s)
- Jiawei Sun
- Shanghai Artificial Intelligence Laboratory, Longwen Road 129, Xuhui District, 200232, Shanghai, China.
- Competence Center for Biomedical Computational Laser Systems (BIOLAS), TU Dresden, Helmholtzstrasse 18, 01069, Dresden, Germany.
- Laboratory of Measurement and Sensor System Technique (MST), TU Dresden, Dresden, Germany.
| | - Bin Yang
- Laboratory of Measurement and Sensor System Technique (MST), TU Dresden, Dresden, Germany
| | - Nektarios Koukourakis
- Competence Center for Biomedical Computational Laser Systems (BIOLAS), TU Dresden, Helmholtzstrasse 18, 01069, Dresden, Germany
- Laboratory of Measurement and Sensor System Technique (MST), TU Dresden, Dresden, Germany
| | - Jochen Guck
- Max Planck Institute for the Science of Light & Max Planck-Zentrum für Physik und Medizin, 91058, Erlangen, Germany
| | - Juergen W Czarske
- Competence Center for Biomedical Computational Laser Systems (BIOLAS), TU Dresden, Helmholtzstrasse 18, 01069, Dresden, Germany.
- Laboratory of Measurement and Sensor System Technique (MST), TU Dresden, Dresden, Germany.
- Cluster of Excellence Physics of Life, TU Dresden, Dresden, Germany.
- Institute of Applied Physics, TU Dresden, Dresden, Germany.
| |
Collapse
|
7
|
Hasegawa M, Naito Y, Tone S, Sudo A. Accuracy of augmented reality with computed tomography-based navigation in total hip arthroplasty. J Orthop Surg Res 2023; 18:662. [PMID: 37674221 PMCID: PMC10481587 DOI: 10.1186/s13018-023-04155-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: 08/03/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Augmented reality (AR) provides the surgeon with direct visualization of radiological images by overlaying them on the patient. This study aimed to evaluate the accuracy of cup placement using a computed tomography (CT)-based AR navigation system. METHODS Sixty-five prospectively enrolled patients underwent primary cementless total hip arthroplasty (THA) in a supine position using this novel AR navigation system, and changes in pelvic flexion angle (PFA) were evaluated. Absolute navigation errors were defined as the absolute differences between angles in the intraoperative navigation record and those measured on postoperative CT. Factors affecting the absolute navigation error in cup alignment were determined. RESULTS Mean absolute change in PFA between preoperative CT and reduction was 2.1° ± 1.6°. Mean absolute navigation errors were 2.5° ± 1.7° in radiographic inclination (RI) and 2.5° ± 2.2° in radiographic anteversion (RA). While no factors significantly affecting absolute navigation error were found for RI, absolute change in PFA between preoperative CT and reduction correlated significantly with the absolute navigation error for RA. CONCLUSION This CT-based navigation system with AR enabled surgeons to place the cup more accurately than was possible by freehand placement during THA in a supine position.
Collapse
Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| |
Collapse
|
8
|
Matsuki Y, Imagama T, Tokushige A, Yamazaki K, Sakai T. Accuracy of cup placement using computed tomography-based navigation system in total hip arthroplasty through the direct anterior approach. J Orthop Sci 2023; 28:370-375. [PMID: 34823976 DOI: 10.1016/j.jos.2021.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/23/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study aimed to elucidate the accuracy of cup placement with the computed tomography (CT)-based navigation system (CTN) in the direct anterior approach (DAA)-total hip arthroplasty (THA) in the supine position compared with the mechanical cup alignment guide (MG) or the fluoroscopy (FS). METHODS A total of 171 hips of 156 patients undergone primary THA were classified into the following three groups (the MG group: 63 hips, the FS group: 58 hips, the CTN group: 50 hips). Comparing the preoperative planning with postoperative CT measurement by three-dimensional templating software, the accuracy of cup placement was investigated in the three groups. RESULTS There were significant differences in the mean absolute error of radiographic inclination (RI) between the MG group (4.4° ± 3.2°) and the CTN group (2.8° ± 2.5°) (p = 0.01). The mean absolute error of radiographic anteversion (RA) also showed significant differences between the CTN group (2.8° ± 1.9°) and the MG group (5.8° ± 4.7°) (p = 0.0001) or the FS group (4.8° ± 4.1°) (p = 0.02). Regarding the cup center position, the mean absolute error of vertical position from preoperative planning was the smallest in the CTN group (1.8 ± 1.4 mm) compared with those in other groups (MG: 3.3 ± 3.2 mm, p = 0.007, FS: 3.2 ± 3.0 mm, p = 0.017). CONCLUSION The CTN guarantees accurate cup placement in the DAA-THA in the supine position compared with the MG and FS groups.
Collapse
Affiliation(s)
- Yuta Matsuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Takashi Imagama
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan.
| | - Atsunori Tokushige
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, 862-3 Ogori Shimogo, Yamaguchi City, Yamaguchi, 754-0002, Japan
| | - Kazuhiro Yamazaki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan
| |
Collapse
|
9
|
Lourens EC, Kurmis AP, Holder C, de Steiger RN. Early Revision Rates of Total Hip Arthroplasty Using the Intellijoint HIP Computer Navigation System: A Study From the Australian National Joint Replacement Registry of 1911 Procedures. Arthroplast Today 2022; 18:149-156. [PMID: 36338290 PMCID: PMC9633565 DOI: 10.1016/j.artd.2022.09.019] [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: 07/13/2022] [Revised: 08/29/2022] [Accepted: 09/27/2022] [Indexed: 11/08/2022] Open
Abstract
Background Total hip arthroplasty (THA) is an effective treatment for symptomatic hip osteoarthritis. The aim of this study was to determine the revision outcome of commercially available navigation technologies. Methods Data from the Australian Orthopaedic Association National Joint Replacement Registry from January 2016 to December 2020 included all primary THA procedures performed for osteoarthritis. Procedures using the Intellijoint HIP navigation system were identified and compared to procedures using "other" computer navigation systems and to nonnavigated procedures. The cumulative percent revision (CPR) was compared between the 3 groups using Kaplan-Meier estimates of survivorship and hazard ratios from Cox proportional hazards models, adjusted for age and gender. Results There were 1911 procedures that used the Intellijoint system, 4081 used "other" computer navigation systems, and 160,661 were nonnavigated procedures. The all-cause 2-year CPR rate for the Intellijoint system was 1.8% (95% confidence interval [CI], 1.2-2.6), compared to 2.2% (95% CI, 1.8-2.8) for other navigated cases and 2.2% (95% CI, 2.1-2.3) for nonnavigated cases. A prosthesis analysis identified the Paragon/Acetabular Shell THAs combined with the Intellijoint system to have a higher (3.4%) rate of revision than nonnavigated THAs (hazard ratio = 2.00 [95% CI, 1.01-4.00], P = .048). When this combination was excluded, the Intellijoint group demonstrated a 2-year CPR of 1.3%. There was no statistical difference in the CPR between the 3 groups before or after excluding the Paragon/Acetabular Shell system. Conclusions The preliminary data presented demonstrate no statistical difference in all-cause revision rates when comparing the Intellijoint system with "other" navigation systems and "nonnavigated" approaches for primary THAs. Level of evidence III (National registry analysis).
Collapse
Affiliation(s)
| | - Andrew P. Kurmis
- Department of Orthopaedic Surgery, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
- Discipline of Medical Specialties, University of Adelaide, Adelaide, South Australia, Australia
| | - Carl Holder
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Richard N. de Steiger
- Department of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, Australia
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Autralia
| |
Collapse
|
10
|
Ohyama Y, Sugama R, Kim Y, Ohta Y, Minoda Y, Nakamura H. A new accelerometer-based portable navigation system provides high accuracy of acetabular cup placement in total hip arthroplasty in both the lateral decubitus and supine positions. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04675-z. [PMID: 36322198 DOI: 10.1007/s00402-022-04675-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/23/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION No studies have compared the accuracy of acetabular cup placement in total hip arthroplasty (THA) in the supine and lateral decubitus positions using the same portable navigation system. Thus, this study aimed to compare the accuracy of acetabular cup placement using a new accelerometer-based portable navigation system combined with an infrared stereo camera and inertial measurement unit between the supine and lateral decubitus positions. MATERIALS AND METHODS This retrospective study compared 45 THAs performed in the supine position (supine group) and 44 THAs performed in the lateral decubitus position (lateral group) using the same portable navigation system. The primary outcome was the absolute errors of cup placement angles, defined as the absolute values of the differences between cup radiographic inclination and anteversion angles displayed on the navigation system and those measured on postoperative computed tomography images. RESULTS No significant difference in the median absolute error of the cup inclination angle (supine group 1.7° [interquartile range 0.8°-3.1°] vs. lateral group 2.1° [interquartile range 1.0°-3.7°]; p = 0.07) was found between the two groups. Similarly, no significant difference in the median absolute error of the anteversion angle (supine group 1.9° [interquartile range 0.8°-3.4°] vs. lateral group 2.1° [interquartile range 0.9°-3.1°]; p = 0.42) was found. CONCLUSION This new accelerometer-based portable navigation system may provide high accuracy of the cup placement in THA in the lateral decubitus and supine positions.
Collapse
Affiliation(s)
- Yohei Ohyama
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi Abeno-Ku, Osaka, Osaka, 45-8585, Japan.
| | - Ryo Sugama
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi Abeno-Ku, Osaka, Osaka, 45-8585, Japan
| | - Yuha Kim
- Department of Orthopaedic Surgery, Tsuji Surgical Rehabilitation Hospital, 3-24 Ikutama-Machi Tennoji-Ku, Osaka, Osaka, 543-0072, Japan
| | - Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi Abeno-Ku, Osaka, Osaka, 45-8585, Japan
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi Abeno-Ku, Osaka, Osaka, 45-8585, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahi-Machi Abeno-Ku, Osaka, Osaka, 45-8585, Japan
| |
Collapse
|
11
|
A laser guide technique: a novel method for accurate acetabular cup alignment in total hip arthroplasty. Sci Rep 2022; 12:18247. [PMID: 36309552 PMCID: PMC9617895 DOI: 10.1038/s41598-022-21975-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 10/07/2022] [Indexed: 12/31/2022] Open
Abstract
For accurate cup alignment without navigation in total hip arthroplasty (THA), we developed a "laser guide technique." The major purposes of this paper are to introduce the technique and compare its accuracy with a conventional manual technique. As a clinical outcome, the dislocation rate was reviewed. Our laser guide technique, which includes preoperative postural adjustment and intraoperative angular reference, has been detailed in the manuscript. 599 hips in 523 patients who underwent primary THA with piriformis-sparing posterolateral approach in April 2010-March 2016 were reviewed. Patients were divided into three groups: conventional group (135 hips), laser guide group (80 hips), and laser + radiographic alignment guide group (384 hips). Radiographic inclination (RI) and radiographic anteversion (RA) errors were evaluated. The dislocation rate was reviewed in 540 hips in 476 patients who were followed up > 2 years postoperatively. Absolute values of the RI/RA error in the three groups were 5.3° ± 4.0°/6.5° ± 4.5°, 4.0° ± 2.8°/4.9° ± 4.4°, and 3.3° ± 2.6°/3.6° ± 2.8°, respectively, indicating substantially enhanced accuracy with laser and radiographic alignment guide. The dislocation rates were 2.5% (3/119) and 0.2% (1/421) in the conventional and laser groups, respectively. Our novel laser guide technique considerably enhanced cup alignment accuracy, suggesting its potential applicability for THA in the lateral decubitus position.
Collapse
|
12
|
Nakasone S, Takaesu M, Ishihara M, Onaga M, Igei T, Miyata Y, Nishida K. Accuracy of Acetabular Cup Placement During Total Hip Arthroplasty in Supine Position Using a Pelvic Rotation Correction Device. Arthroplast Today 2022; 16:46-52. [PMID: 35647246 PMCID: PMC9133511 DOI: 10.1016/j.artd.2022.04.004] [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: 02/13/2022] [Revised: 03/30/2022] [Accepted: 04/06/2022] [Indexed: 11/26/2022] Open
Abstract
Background Accurate cup placement during total hip arthroplasty (THA) is difficult because the intraoperative pelvic position changes even in supine patient position. We developed a device known as HipPointer; it corrects pelvic rotation and creates a functional pelvic plane as a reference. The aim of this study was to determine the device placement accuracy and investigate causes of error. Material and methods HipPointer was used for cup placement in 353 hips of 308 patients who underwent direct-anterior-approach THA in supine position. The mean age at surgery and body mass index were 63.9 (17-90) years and 24.9 (16.6-42.0) kg/m2, respectively. The mean observation period was 40.5 (12-73) months. To investigate the accuracy of HipPointer, preoperative planning and postoperative cup placement angles relative to the functional pelvic plane were evaluated using a three-dimensional analysis software, and absolute errors were determined. Results The means ± standard deviations of radiographic inclination (RI) and radiographic anteversion (RA) were 40.2 ± 3.0° and 15.8 ± 3.6°, respectively. The absolute errors of RI and RA were 2.2 ± 2.0° and 2.7 ± 2.3°, respectively. The ratio of the cup placement angle for which both RI and RA are ≤10° in the target zone was 99% (350/353 hips), and the ratio of the absolute errors for which both RI and RA are ≤5° was 80.4% (284/353 hips). Conclusions HipPointer is simple in structure, easy to use, and useful for direct-anterior-approach THA in supine position. It provides good cup placement accuracy.
Collapse
Affiliation(s)
- Satoshi Nakasone
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
- Corresponding author. Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Nakagamigun, Okinawa 9030125, Japan. Tel.: +81 9889 51174.
| | - Mika Takaesu
- Department of Orthopedic Surgery, Chubu Tokushukai Hospital, Okinawa, Japan
| | - Masato Ishihara
- Department of Orthopedic Surgery, Nakagami Hospital, Okinawa, Japan
| | - Masamichi Onaga
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takahiro Igei
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yoshihide Miyata
- Department of Orthopedic Surgery, Chubu Tokushukai Hospital, Okinawa, Japan
| | - Kotaro Nishida
- Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| |
Collapse
|
13
|
Liu F, Tang K, Zheng PF, Zhang ZQ, Ling G, Lou Y. Performance of Tönnis triple osteotomy in older children with developmental dysplasia of the hip (DDH) assisted by a 3D printing navigation template. BMC Musculoskelet Disord 2022; 23:712. [PMID: 35883070 PMCID: PMC9317117 DOI: 10.1186/s12891-022-05669-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
Background The objective of this study is to investigate the preparation of a navigation template via a computer-aided design (CAD) and 3D printing (3DP) in order to improve the effectiveness of Tönnis triple osteotomy in older children with developmental dysplasia of the hip (DDH). Method Thirty-eight older children who received Tönnis triple osteotomy were included in this study. Among them, 20 were categorized as the 3DP navigation template group (3DP group), and the remaining 18 were categorized as the conventional surgery group (CS group). Data, including preoperative and postoperative pelvic sharp angle (SA), lateral center-edge angle (LCEA), acetabular roof angle (ARA), acetabular head index (AHI), crossover sign (COS), ischial spine sign (ISS), operation time (OT), intraoperative blood loss (IBL), and number of radiation exposures (NORE) were recorded for both groups. In addition, the therapeutic effect was evaluated at the last follow-up, according to the McKay criteria and Severin’s criteria. Results In the 3DP and CS groups, the mean OT was 126.6 ± 17.6 min and 156.0 ± 18.6 min, respectively; the mean IBL was 115.0 ± 16.9 ml and 135.7 ± 26.5 ml, respectively; the NORE were 3.3 ± 0.8 times and 8.6 ± 1.3 times, respectively. There were significant differences in the OT, IBL, and NORE between the two groups (P = 0.03, 0.05, < 0.001, respectively). At the last follow-up, the 3DP and CS groups displayed SA of 41.8 ± 2.3° and 42.6 ± 3.1°, respectively; LCEA of 35.6 ± 4.2° and 37.1 ± 2.8°, respectively; ARA of 6.9 ± 1.8° and 9.8 ± 2.6°, respectively; and AHI of 86.6 ± 4.1% and 84.3 ± 2.8%, respectively; COS(+) of 5 hips and 4 hips, respectively; ISS(+) of 6 hips and 7 hips. We observed no statistical differences in the SA, LCEA, ARA, AHI, COS and ISS between the two groups (P = 0.918, 0.846, 0.643, 0.891, 0.841, 0.564, respectively). According to the McKay criteria, the 3DP group had 10 excellent, 6 good, and 4 general hips, whereas, the CS group had 12 excellent, 4 good, and 2 general hip. There was no statistical difference between the two groups (P = 0.698). In 3DP group the postoperative Severin’s grading included 13 hips in grade I, 4 in grade II, 3 in grade III. Alternately, in the CS group, the postoperative Severin’s grading included 11 hips in grade I, 5 in grade II, 2 in grade III. The Severin ‘s criteria also showed no statistical difference between the two groups (P = 0.945). Conclusions Base on our analysis, our CAD-3DP-fabricated navigation template assisted Tönnis triple osteotomy in older DDH children, it reduced operation time and number of radiation exposures. However, no significant differences in radiological assessment and functional outcomes were observed when an experienced surgeon performs the surgery. Therefore, Surgeons who have less experience in triple osteotomy profit more from the application of this technology.
Collapse
Affiliation(s)
- Fei Liu
- Department of Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Kai Tang
- Department of Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
| | - Peng-Fei Zheng
- Department of Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Zhi-Qun Zhang
- Department of Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Gang Ling
- Department of Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Yue Lou
- Department of Orthopedics, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| |
Collapse
|
14
|
Relationship between the Accuracy of the Acetabular Cup Angle and BMI in Posterolateral Total Hip Arthroplasty with CT-Based Navigation. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070856. [PMID: 35888575 PMCID: PMC9324398 DOI: 10.3390/medicina58070856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 12/23/2022]
Abstract
Background and Objectives: Precise acetabular cup placement is essential for successful total hip arthroplasty (THA). In obese patients, its accuracy is often difficult to achieve because of the thickness of the soft tissues. This study aimed to determine the relationship between the accuracy of acetabular cup angle and body mass index (BMI) in posterolateral THA using the computed tomography-based navigation (CT-navi) system. Materials and Methods: We retrospectively reviewed 145 consecutive primary THAs using the CT-navi system between January 2015 and January 2018. All surgeries were performed using cementless cups employing the posterolateral approach with the patient in the decubitus position. We compared the radiographic inclination and anteversion obtained intraoperatively from the CT-navi with those measured by postoperative CT using three-dimensional templating software. We evaluated the relationship between the extent of errors and correlation with BMI. Results: In non-overweight patients (BMI < 25, 88 hips), the mean navigation errors for inclination were 2.8 ± 2.2° and for anteversion were 2.6 ± 2.3°. Meanwhile, in overweight patients (BMI ≥ 25, 57 hips), the mean navigation errors were 2.6 ± 2.4° for inclination and 2.4 ± 2.4° for anteversion. We found no significant difference between overweight and non-overweight patients in both inclination and anteversion. There was no correlation between the extent of errors and BMI. Conclusions: In posterolateral THA, CT-navi can aid the precise placement of the acetabular cup irrespective of a patient’s BMI.
Collapse
|
15
|
Image-Less THA Cup Navigation in Clinical Routine Setup: Individual Adjustments, Accuracy, Precision, and Robustness. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060832. [PMID: 35744095 PMCID: PMC9227241 DOI: 10.3390/medicina58060832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 12/13/2022]
Abstract
Background and Objectives: Even after the ‘death’ of Lewinnek’s safe zone, the orientation of the prosthetic cup in total hip arthroplasty is crucial for success. Accurate cup placement can be achieved with surgical navigation systems. The literature lacks study cohorts with large numbers of hips because postoperative computer tomography is required for the reproducible evaluation of the acetabular component position. To overcome this limitation, we used a validated software program, HipMatch, to accurately assess the cup orientation based on an anterior-posterior pelvic X-ray. The aim of this study were to (1) determine the intraoperative ‘individual adjustment’ of the cup positioning compared to the widely suggested target values of 40° of inclination and 15° of anteversion, and evaluate the (2) ‘accuracy’, (3) ‘precision’, and (4) robustness, regarding systematic errors, of an image-free navigation system in routine clinical use. Material and Methods: We performed a retrospective, accuracy study in a single surgeon case series of 367 navigated primary total hip arthroplasties (PiGalileoTM, Smith+Nephew) through an anterolateral approach performed between January 2011 and August 2018. The individual adjustments were defined as the differences between the target cup orientation (40° of inclination, 15° of anteversion) and the intraoperative registration with the navigation software. The accuracy was the difference between the intraoperative captured cup orientation and the actual postoperative cup orientation determined by HipMatch. The precision was analyzed by the standard deviation of the difference between the intraoperative registered and the actual cup orientation. The outliers were detected using the Tukey method. Results: Compared to the target value (40° inclination, 15° anteversion), the individual adjustments showed that the cups are impacted in higher inclination (mean 3.2° ± 1.6°, range, (−2)−18°) and higher anteversion (mean 5.0° ± 7.0°, range, (−15)−23°) (p < 0.001). The accuracy of the navigated cup placement was −1.7° ± 3.0°, ((−15)−11°) for inclination, and −4.9° ± 6.2° ((−28)−18°) for anteversion (p < 0.001). Precision of the system was higher for inclination (standard deviation SD 3.0°) compared to anteversion (SD 6.2°) (p < 0.001). We found no difference in the prevalence of outliers for inclination (1.9% (7 out of 367)) compared to anteversion (1.63% (6 out of 367), p = 0.78). The Bland-Altman analysis showed that the differences between the intraoperatively captured final position and the postoperatively determined actual position were spread evenly and randomly for inclination and anteversion. Conclusion: The evaluation of an image-less navigation system in this large study cohort provides accurate and reliable intraoperative feedback. The accuracy and the precision were inferior compared to CT-based navigation systems particularly regarding the anteversion. However the assessed values are certainly within a clinically acceptable range. This use of image-less navigation offers an additional tool to address challenging hip prothesis in the context of the hip−spine relationship to achieve adequate placement of the acetabular components with a minimum of outliers.
Collapse
|
16
|
Accuracy of a novel accelerometer-based navigation (Naviswiss) for total hip arthroplasty in the supine position. BMC Musculoskelet Disord 2022; 23:537. [PMID: 35658945 PMCID: PMC9166425 DOI: 10.1186/s12891-022-05495-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/31/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND This study aimed to determine the accuracy of acetabular cup insertion using a novel accelerometer-based navigation system in total hip arthroplasty (THA). METHODS A single-surgeon study was conducted in which 62 prospective patients with navigation and 42 retrospective patients without navigation in a supine position were compared. Absolute values for errors of radiographic inclination and anteversion were calculated. Navigation error was also calculated. Factors that affected absolute value of navigation error in cup alignment were determined. RESULTS In the navigation group, mean absolute errors for radiographic inclination and anteversion were 4.1° and 4.3°, respectively. In the control group, mean absolute errors were 6.6° in inclination (p < 0.01) and 5.9° in anteversion (p = 0.04). Mean absolute values of navigation error were 2.8° in inclination and 2.8°in anteversion. Factors affecting navigation errors were not found. CONCLUSION This novel accelerometer-based navigation system significantly increased the accuracy of cup placement during THA in the supine position.
Collapse
|
17
|
Tsukamoto M, Kawasaki M, Suzuki H, Fujitani T, Uchida S, Sakai A. Accurate cup placement using a portable navigation system during total hip arthroplasty based on pelvic orientation in the lateral decubitus position. Artif Organs 2022; 46:2412-2422. [PMID: 35524678 DOI: 10.1111/aor.14281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/17/2022] [Accepted: 04/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND We previously proposed an accurate cup placement procedure using a portable navigation system (PNS) for total hip arthroplasty (THA) in the lateral decubitus position; however, as the accuracy of our proposed procedure has not been shown, the aim of this study was to demonstrate the accuracy. METHODS We prospectively analyzed 79 hips treated with primary THA; 40 hips treated until June 2020 were included in the conventional procedure (CP) group, and 39 hips treated from July 2020 were included in the modified procedure (MP) group. In the MP, pelvic orientation is considered to the set coordinate axes in addition to the CP using the PNS. The accuracy was based on the difference between the navigation record (NR) and postoperative computed tomography measurement. RESULTS The radiographic inclination (RI) and anteversion (RA) accuracies were 1.55° and 2.14°, respectively, in the MP group and 3.03° and 6.20°, respectively, in the CP group (p < 0.001). The error was within 5° of the NR for both the RI and RA in 34 in the MP group (87.2%) and 14 in the CP group (35.0%) (p < 0.001). The error was within 5° of the target angle (RI 40°, RA 15°) for both the RI and RA in 29 hips in the MP group (74.7%) and 12 in the CP group (30.0%) (p < 0.001). CONCLUSIONS Our procedure with the consideration of pelvic orientation achieved dramatically improved the accuracy of PNS and was suitable to facilitate accurate cup placement.
Collapse
Affiliation(s)
- Manabu Tsukamoto
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Makoto Kawasaki
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Hitoshi Suzuki
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Teruaki Fujitani
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Japan
| |
Collapse
|
18
|
Kamimura A, Enokida M, Enokida S, Nagashima H. A method combining the use of a mobile application and a dedicated pelvic positioner for acetabular cup insertion. J Orthop Surg Res 2022; 17:251. [PMID: 35505410 PMCID: PMC9066926 DOI: 10.1186/s13018-022-03138-w] [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: 07/01/2021] [Accepted: 04/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background We developed a mobile device application and dedicated pelvic positioner with the aim of improving the acetabular cup placement accuracy in patients undergoing total hip arthroplasty (THA). The function of the application was to display the intra-operative cup angle. The accuracy and clinical usefulness of this combined method were verified through comparison with the conventional alignment guide method. Methods In total, 60 patients who underwent cementless THA were included in this study. We compared the cup alignment when using this combined method with that when using the conventional alignment guide method. The absolute value error between the intra- and post-operative angles of inclination and anteversion of the cup was calculated. Results The absolute value error of inclination was 2.4° ± 2.1° in the study group and 4.0° ± 3.3° in the control group (P = 0.107). The absolute value error of anteversion was 2.8° ± 2.6° in the study group and 7.4° ± 5.3° in the control group (P < 0.001). Conclusion Using the application and pelvic positioner is simple and can be introduced at a low cost. The more accurate measurement of the intra-operative cup angle using this combined method has improved the cup insertion accuracy compared with that of the conventional alignment guide method.
Collapse
Affiliation(s)
- Atsushi Kamimura
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan.
| | - Makoto Enokida
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Shinpei Enokida
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Hideki Nagashima
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori, 683-8504, Japan
| |
Collapse
|
19
|
Does accelerometer-based portable navigation provide more accurate and precise cup orientation without prosthetic impingement than conventional total hip arthroplasty? A randomized controlled study. Int J Comput Assist Radiol Surg 2022; 17:1007-1015. [DOI: 10.1007/s11548-022-02592-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/04/2022] [Indexed: 11/05/2022]
|
20
|
Hasegawa M, Tone S, Naito Y, Wakabayashi H, Sudo A. Comparison of the accuracies of computed tomography-based navigation and image-free navigation for acetabular cup insertion in total hip arthroplasty in the lateral decubitus position. Comput Assist Surg (Abingdon) 2021; 26:69-76. [PMID: 34874219 DOI: 10.1080/24699322.2021.1949494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Image-free navigation has been proven as reliable as that using computed tomography (CT) in positioning the acetabular cup in total hip arthroplasty (THA), but previous studies rarely included hip dysplasia cases. The purpose of the present study was to determine the accuracies of CT-based navigation and image-free navigation for acetabular cup insertion, including hip dysplasia cases. Sixty-three hips were studied, including 57 with hip dysplasia. The hips were divided into two groups based on the registration point of image-free navigation. In Group I, the ipsilateral anterior superior iliac spine (ASIS) and the L5 spinous process were registered in 31 hips. In Group II, bilateral ASIS points were registered in 32 hips. Final component orientation was measured from postoperative CT scans. The accuracy of cup orientation was compared between CT-based and image-free navigation. In Group I, the cup inclination was more accurate with CT-based navigation (1.9°) than with image-free navigation (4.4°, p=.009). Cup anteversion was also more accurate with CT-based navigation (2.9°) than with image-free navigation (7.1°, p<.001). In Group II, the accuracies of cup inclination and anteversion showed no differences between CT-based and image-free navigation. The accuracy of cup positioning was better with CT-based navigation than with image-free navigation when the ipsilateral ASIS and L5 spinous process were digitized. However, accuracy was similar when bilateral ASIS points were digitized.
Collapse
Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Japan
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Japan
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu City, Japan
| |
Collapse
|
21
|
Naito Y, Hasegawa M, Tone S, Wakabayashi H, Sudo A. The accuracy of acetabular cup placement in primary total hip arthroplasty using an image-free navigation system. BMC Musculoskelet Disord 2021; 22:1016. [PMID: 34863119 PMCID: PMC8645094 DOI: 10.1186/s12891-021-04902-5] [Citation(s) in RCA: 3] [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: 10/04/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intraoperative navigation systems have been shown to improve the accuracy of acetabular component insertion in total hip arthroplasty (THA). The purpose of this study was to investigate the accuracy of cup orientation in primary THA using an image-free navigation system. METHODS A total of 107 consecutive cementless THAs using an image-free navigation system were performed from February 2017 to March 2020 (the navigation group). As a control group, 77 retrospective consecutive cases who underwent THAs with manual implant-techniques between February 2012 and April 2017 were included. Postoperative cup radiographic inclination and radiographic anteversion relative to the functional pelvic plane were assessed using a 3D-template system after computed tomography (CT) examination. RESULTS The mean absolute errors of the postoperative measured angles from the target angles in inclination were 3.4° ± 3.0° in the navigation group and 8.4° ± 6.6° in the control group (p < 0.001). The mean absolute errors in anteversion were 5.1° ± 3.6° in the navigation group and 10.8° ± 6.5° in the control group (p < 0.001). The percentage of cups inside the Lewinnek safe zone was 93% in the navigation group and 44% in the control group (p < 0.001). The mean absolute values of navigation error were 3.3° ± 2.8° in inclination and 5.8° ± 4.9° in anteversion. Among the cases of osteoarthritis, the inclination error was significantly higher in Crowe group 2 to 4 than in Crowe group 1 (5.1° ± 3.5° and 3.0° ± 2.5°, respectively, p < 0.05). The percentage of hips with inclination error over 10° in Crowe group 2 to 4 was significantly higher than in Crowe group 1 (17 and 1%, respectively, p < 0.05). CONCLUSIONS The image-free navigation system improved the accuracy of cup orientation. The accuracy of cup position was less in Crowe group 2 to 4 than in Crowe group 1.
Collapse
Affiliation(s)
- Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
| | - Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan.
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie, 514-8507, Japan
| |
Collapse
|
22
|
Shiode R, Oka K, Shigi A, Miyamura S, Tanaka H, Mae T, Murase T. Arthroscopic Debridement of Elbow Osteoarthritis Using CT-Based Computer-Aided Navigation Systems Is Accurate. Arthrosc Sports Med Rehabil 2021; 3:e1687-e1696. [PMID: 34977621 PMCID: PMC8689228 DOI: 10.1016/j.asmr.2021.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 07/25/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ryoya Shiode
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Kunihiro Oka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
- Address correspondence to Kunihiro Oka, M.D., Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Atsuo Shigi
- Yukioka Hospital Hand Center, Osaka-shi, Osaka, Japan
| | - Satoshi Miyamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| |
Collapse
|
23
|
Tetsunaga T, Yamada K, Tetsunaga T, Furumatsu T, Sanki T, Kawamura Y, Ozaki T. Comparison of the accuracy of CT- and accelerometer-based navigation systems for cup orientation in total hip arthroplasty. Hip Int 2021; 31:603-608. [PMID: 32019376 DOI: 10.1177/1120700020904940] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The accuracies of various navigation systems in total hip arthroplasty (THA) have been described; however, the accuracy of cup orientation with an accelerometer-based navigation system has not been reported. The purpose of this study was to compare the accuracies of computed tomography (CT)- and accelerometer-based navigation systems for cup orientation in THA. METHODS In this prospective study, 30 patients who underwent cementless THA via anterolateral approach in the lateral decubitus position were analysed. A CT-based navigation system (30 hips) and an accelerometer-based navigation system (30 hips) were used simultaneously. The accuracy of cup orientation (absolute difference between intraoperative vs. postoperative measurements) was compared between the navigation systems using postoperative CT. RESULTS The accuracy of cup inclination was 3.2 ± 2.4° in the CT-based navigation group and 4.1 ± 3.7° in the accelerometer-based navigation group (p = 0.3035). The accuracy of cup anteversion was 3.0° ± 2.5° in the CT-based navigation group and 6.8° ± 4.8° in the accelerometer-based navigation group. Cup anteversion was significantly more accurate with the CT-based navigation system than with accelerometer-based navigation (p = 0.0009). Multiple regression analysis demonstrated that the malposition in cup anteversion was positively correlated with the change in pelvic tilt and loosening of the reference antenna. CONCLUSIONS Although, these results are only true for this specific accelerometer system, cup positioning was significantly more accurate with the CT-based navigation system than an accelerometer-based navigation in the lateral decubitus position. This is because of considerable discrepancies in the sagittal pelvic tilt, resulting in variability in cup anteversion angle with the use of an accelerometer-based navigation system.
Collapse
Affiliation(s)
| | - Kazuki Yamada
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
| | - Tomoko Tetsunaga
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
| | | | - Tomoaki Sanki
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
| | - Yoshi Kawamura
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
| |
Collapse
|
24
|
Accuracy of acetabular cup placement positively correlates with level of training. INTERNATIONAL ORTHOPAEDICS 2021; 45:2797-2804. [PMID: 34406431 DOI: 10.1007/s00264-021-05165-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Accurate acetabular component placement may reduce the risk of complication after total hip arthroplasty (THA). While surgeon experience and volume may reduce outliers, little is known how cup positioning accuracy and consistency relates to level of training (resident, fellow, attending) and whether trainee level impacts the magnitude and direction of cup placement errors. METHODS Ninety patients undergoing posterolateral computer-assisted navigation THA were included for analysis. All surgery was performed by two fellowship-trained orthopaedic surgeons and assisted by a trainee (orthopedic resident (PGY 1-5) or fellow in adult reconstruction). In order to determine accuracy of cup placement in trainees and attendings, we used computer navigation to determine freehand cup placement by the trainee, then by the attending surgeon. Final cup inclination and version were determined and recorded by computer-assisted surgical navigation. Comparison of consistency in cup inclination and anteversion was made on values obtained by residents, fellows, and attendings and final values provided by the navigation system. In addition, to assess the role of training and repetition, acetabular cup inclination and version were compared between fellows during the first half and the second half of their training year. All comparisons were performed with the Student t-test except for comparison of rate of deviation from the safe zone, which were performed with the chi-square test. The level of significance was defined as p values ≤ 0.05 with 95% confidence interval, and trend toward significance was defined as p values ≤ 0.1. RESULTS Inclination deviation from the final position and cup version deviation from the final position were statistically significant between resident vs attendings (p < 0.001 (inclination), p < 0.001 (version)), fellow vs attendings (p < 0.001 (inclination), p < 0.001 (version)), and all trainee vs attendings (p < 0.001 (inclination), p < 0.001 (version)). In all comparisons, the attending surgeons placed the cup closer to the final cup position than both resident and fellows. Proportion of inclination deviation from the safe zone of residents was significantly higher than of attendings (p < 0.001) but no significant difference was observed between fellows and attending (p = 1.00). Compared to residents, fellows demonstrated lower proportion of inclination deviation from the safe zone of 3.3% vs 23.3% for fellows vs residents (p = 0.002) and tended to implant the cups in a more horizontal position (45.6 ± 6.6° [SD] and 42.7 ± 4.3°, respectively, p = 0.04). Compared to fellow, residents tended to implant the cup in a more anteverted position than the final cup version (9.6 ± 6.7° and 6.74 ± 5.6° [SD], p = 0.034). There was no statistically significant difference in cup position between attendings' free-hand and final (computer assisted) cup placement. CONCLUSION Accurate and consistent acetabular cup placement improves with level of training. Accurate and consistent acetabular cup version is harder to master as compared to acetabular cup inclination.
Collapse
|
25
|
Okamoto M, Kawasaki M, Okura T, Ochiai S, Yokoi H. Comparison of accuracy of cup position using portable navigation versus alignment guide in total hip arthroplasty in supine position. Hip Int 2021; 31:492-499. [PMID: 32126836 DOI: 10.1177/1120700020908788] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Accelerometer-based portable navigation systems in supine total hip arthroplasty (THA) have been developed, but there are no reports on the accuracy of cup placement. We aimed to investigate and compare the accuracy of the accelerometer-based portable navigation system versus the acetabular alignment guide placed on the pelvis in THA using the direct anterior approach (DAA). Both devices tracked changes in the pelvic position. METHODS In this single-centre, retrospective study, we reviewed 115 hips in 113 patients who underwent primary THA via the DAA using an accelerometer-based portable navigation system in the supine position (portable navigation group) and 106 hips in 101 patients who underwent THA using an acetabular alignment guide (alignment guide group) as controls. Hips were evaluated postoperatively using computed tomography to measure cup orientation. The accuracy of cup orientation was compared between the 2 groups. RESULTS Absolute values of inclination error were 3.1° ± 2.2° and 2.9° ± 2.3° (p = 0.708) in the portable navigation and alignment guide groups and those of anteversion error were 2.8° ± 2.3° and 3.7° ± 2.7°, respectively (p = 0.005). The number of cups placed within 10° of error was 98.3% and 96.2% in the portable navigation and alignment guide groups, respectively (p = 0.304). The portable navigation group had significantly more hips (72.2%) placed within a 5° margin of error than did the alignment guide group (56.6%) (p = 0.016). CONCLUSION High accuracy in cup placement was achieved using accelerometer-based portable navigation in supine THA. Using a navigation system may contribute to improved long-term outcomes.
Collapse
Affiliation(s)
- Masanori Okamoto
- Department of Orthopaedic Surgery, Aichi Koseiren Konan Kosei Hospital, Konan, Aichi, Japan
| | - Masashi Kawasaki
- Department of Orthopaedic Surgery, Aichi Koseiren Konan Kosei Hospital, Konan, Aichi, Japan
| | - Toshiaki Okura
- Department of Orthopaedic Surgery, Aichi Koseiren Konan Kosei Hospital, Konan, Aichi, Japan
| | - Satoshi Ochiai
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Yokoi
- Department of Orthopaedic Surgery, Aichi Koseiren Konan Kosei Hospital, Konan, Aichi, Japan
| |
Collapse
|
26
|
Takasago T, Goto T, Wada K, Hamada D, Sairyo K. Postoperative radiographic evaluation and simulation study for optimal cup placement in high-hip centre total hip arthroplasty. Hip Int 2021; 31:335-341. [PMID: 31646897 DOI: 10.1177/1120700019884547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Achieving favourable outcomes in high-hip centre reconstruction in hip dysplasia requires the optimal cup height and size, which can provide sufficient bone coverage for stable cup fixation that fits the anteroposterior acetabular rim without increasing the cup height more than necessary. METHODS We retrospectively reviewed 214 patients who underwent primary total hip arthroplasty (THA) and identified 30 hips with Crowe II (n = 15) or III (n = 15) developmental dysplasia of the hip (DDH). We measured the cup-centre-edge angle (cup-CE) and the vertical and horizontal distances from the teardrop. In a simulation study, we examined the cup-CE and optimal cup size by changing the cup height in 5-mm increments over a distance of 15-40 mm above the inter-teardrop line using a 3-dimensional template system. RESULTS Postoperative radiographic evaluation revealed a mean cup-CE of 19.9° in Crowe II hips and 15.2° in Crowe III hips; the respective mean vertical distances were 26.6 mm and 27.6 mm (p = 0.511). There was no evidence of cup loosening or lateralisation at a minimum of 7 years (7-11 years) follow-up. Simulation showed that the hip centre needed to be elevated to 20 mm to acquire a cup-CE of more than 0°. More than 10° of cup-CE could be expected by elevating the hip centre to 25 mm in both Crowe II and III. CONCLUSIONS Even in severe DDH, a high-hip centre positioned approximately 25 mm superior to the inter-teardrop line was sufficient to achieve optimal bone coverage, which could lead to more secure cup fixation.
Collapse
Affiliation(s)
- Tomoya Takasago
- Department of Orthopaedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tomohiro Goto
- Department of Orthopaedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Keizo Wada
- Department of Orthopaedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Daisuke Hamada
- Department of Orthopaedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopaedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| |
Collapse
|
27
|
Ando W, Takao M, Hamada H, Uemura K, Sugano N. Comparison of the accuracy of the cup position and orientation in total hip arthroplasty for osteoarthritis secondary to developmental dysplasia of the hip between the Mako robotic arm-assisted system and computed tomography-based navigation. INTERNATIONAL ORTHOPAEDICS 2021; 45:1719-1725. [PMID: 33880612 DOI: 10.1007/s00264-021-05015-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/17/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE We investigated the accuracy of the acetabular cup position and orientation in robotic-assisted total hip arthroplasty (rTHA) compared to navigated THA (nTHA) using computed tomography (CT) for patients with osteoarthritis secondary to developmental dysplasia of the hip (DDH). METHODS We studied 31 hips of 28 patients who underwent rTHA and 119 hips of 112 patients who underwent nTHA with the same target cup orientation. After propensity score matching, each group comprised 29 hips. Post-operative cup position and orientation were measured from the postoperative CT data. Errors from the target cup position and orientation were compared between the two groups. RESULTS Post-operatively, the absolute error of the anteroposterior and superoinferior cup positions from the target position was significantly lower in the rTHA group than in the nTHA group. The change in the post-operative radiographic inclination from the target orientation was lower in the rTHA group than in the nTHA group. Screw fixation for cup implantation was required for three hips in the nTHA group but not in the rTHA group. CONCLUSION rTHA achieved more precise cup implantation with reduced variation from the target orientation compared to nTHA in patients with osteoarthritis secondary to DDH.
Collapse
Affiliation(s)
- Wataru Ando
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masaki Takao
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| |
Collapse
|
28
|
Kaku N, Tagomori H, Tsumura H. Comparison of Cup Setting Angle Accuracy between Computed Tomography-Based and Computed Tomography-Free Navigation in the Same Patients with Crowe's Classification I or II Hip Dysplasia. Clin Orthop Surg 2021; 13:144-151. [PMID: 34094004 PMCID: PMC8173244 DOI: 10.4055/cios20145] [Citation(s) in RCA: 3] [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: 06/08/2020] [Revised: 09/28/2020] [Accepted: 11/25/2020] [Indexed: 12/21/2022] Open
Abstract
Backgroud In total hip arthroplasty, the cup setting angle may affect the postoperative results. In recent years, both computed tomography-based navigation and computed tomography-free (imageless) navigation have been reported to produce high accuracy in cup installation; however, no direct comparison between these two methods has been performed. The present study aimed to directly compare the cup installation angle accuracy between computed tomography-based navigation and computed tomography-free navigation in patients with Crowe's classification stage I or II dysplastic osteoarthritis and to examine the factors affecting the cup installation accuracy. Methods Using both navigation systems for the same technique, primary total hip arthroplasty was performed by the same surgeon in 36 patients. A cup was installed using computed tomography-based navigation, and the installed cup was measured again using computed tomography-free navigation. We compared the error between the target angle and the intraoperative installation angle for each navigation method by performing statistical analyses. Results For computed tomography-based navigation, errors in the inclination and the anteversion angles compared to the target angle were 3.14° ± 1.55° and 1.47° ± 0.99°, respectively. For computed tomography-free navigation, the inclination and anteversion angle errors were significantly larger, i.e., 6.84° ± 4.78° and 5.43° ± 5.22°, respectively (p < 0.01). The inclination and anteversion angles of computed tomography-free navigation were correlated, and there were no significant factors influencing the error. Conclusions Computed tomography-based navigation is more accurate for cup installation than computed tomography-free navigation. When using computed tomography-free navigation, it is necessary to add technical schemes before and during surgery to improve the cup installation accuracy.
Collapse
Affiliation(s)
- Nobuhiro Kaku
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroaki Tagomori
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan
| |
Collapse
|
29
|
Hayashi S, Hashimoto S, Kuroda Y, Nakano N, Matsumoto T, Ishida K, Shibanuma N, Kamenaga T, Kuroda R. Accuracy of cup position following robot-assisted total hip arthroplasty may be associated with surgical approach and pelvic tilt. Sci Rep 2021; 11:7578. [PMID: 33828113 PMCID: PMC8027591 DOI: 10.1038/s41598-021-86849-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/22/2021] [Indexed: 12/16/2022] Open
Abstract
This study aimed to investigate the accuracy of cup placement and determine the predictive risk factors for inaccurate cup positioning in robot-assisted total hip arthroplasty (THA). We retrospectively analyzed 115 patients who underwent robot-assisted THA between August 2018 and November 2019. Acetabular cup alignment and three-dimensional (3D) position were measured using pre- or postoperative computed tomography (CT) data. Absolute differences in cup inclination, anteversion, and 3D position were assessed, and their relation to preoperative factors was evaluated. The average measurement of the absolute differences was 1.8° ± 2.0° (inclination) and 1.9° ± 2.3° (anteversion). The average absolute difference in the 3D cup position was 1.1 ± 1.2 mm (coronal plane) and 0.9 ± 1.0 mm (axial plane). Multivariate analysis revealed that a posterior pelvic tilt [odds ratio (OR, 1.1; 95% confidence interval (CI), 1.00–1.23] and anterior surgical approach (OR, 5.1; 95% CI, 1.69–15.38) were predictive factors for inaccurate cup positioning with robot-assisted THA. This is the first study to demonstrate the predictive risk factors (posterior pelvic tilt and anterior surgical approach) for inaccurate cup position in robot-assisted THA.
Collapse
Affiliation(s)
- Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Shingo Hashimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuichi Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Naoki Nakano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Nao Shibanuma
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| |
Collapse
|
30
|
Shibanuma N, Ishida K, Matsumoto T, Takayama K, Sanada Y, Kurosaka M, Kuroda R, Hayashi S. Early postoperative clinical recovery of robotic arm-assisted vs. image-based navigated Total hip Arthroplasty. BMC Musculoskelet Disord 2021; 22:314. [PMID: 33781263 PMCID: PMC8008585 DOI: 10.1186/s12891-021-04162-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study compared the early clinical recovery of total hip arthroplasty (THA) using computer navigation systems (nTHA) and robotic arm-assisted THA (rTHA). METHODS Thirty prospective subjects who underwent rTHA were clinically compared to 30 subjects who underwent nTHA. Clinical data (surgical time, intraoperative blood loss, pain severity, number of days to independent walking, and Harris Hip Score (HHS) at discharge), and radiographic parameters (inclination and anteversion angles) were statistically compared between the two groups. RESULTS Follow-up times were 24.3 ± 6.0 and 27.0 ± 7.0 days in the rTHA and nTHA groups, respectively. The surgical time (135.1 ± 13.9 min vs. 146.2 ± 12.8 min, p = 0.002), number of days to independent walking (7.2 ± 2.0 vs. 11.5 ± 3.0 days, p < 0.001), and postoperative pain using a numeric rating scale on postoperative days 7, 10,, and 14 (1.4 ± 0.9 vs. 2.2 ± 1.2, p = 0.005; 1.0 ± 0.8 vs. 1.8 ± 1.1, p = 0.002; 0.3 ± 0.5 vs. 1.1 ± 0.9, p < 0.001; respectively) were significantly reduced in the rTHA group compared to the nTHA group. The rTHA group showed a significantly higher postoperative HHS compared to the nTHA group (85.3 ± .3.2 vs. 81.0 ± 8.5, p = 0.014). No statistically significant difference was observed in radiographic parameters between the groups; however, the incidence of intraoperative target angle changes was significantly lower in the rTHA group than in the nTHA group (0/30 subjects [0%] vs. 11/30 subjects [36.7%], p < 0.001). CONCLUSION The surgical time, postoperative pain, and number of days to independent walking were significantly shorter, and the HHS at discharge was significantly higher in the rTHA group than in the nTHA group. Thus, compared to the nTHA group, the rTHA group showed improved early clinical recovery.
Collapse
Affiliation(s)
- Nao Shibanuma
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan.
| | - Kazunari Ishida
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan
| | - Koji Takayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan
| | - Yutaro Sanada
- Rehabilitation Center, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan
| | - Masahiro Kurosaka
- Department of Orthopaedic Surgery, Kobe Kaisei Hospital, 3-11-15, Shinohara-Kita, Nada, Kobe, 657-0068, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki, Chuo, Kobe, 650-0017, Japan
| |
Collapse
|
31
|
Asai H, Takegami Y, Seki T, Ishiguro N. Pelvic Tilt Reduces the Accuracy of Acetabular Component Placement When Using a Portable Navigation System: An In Vitro Study. Arthroplast Today 2021; 7:177-181. [PMID: 33553546 PMCID: PMC7856392 DOI: 10.1016/j.artd.2020.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/15/2020] [Accepted: 12/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background A portable navigation system (PNS) was recently introduced. The PNS enables surgeons to place the acetabular component accurately. While the margin of the error for the cup abduction and anteversion was larger than the values obtained from a computed tomography-based navigation system. We hypothesized that the accuracy of the PNS might be affected by pelvic tilt. Material and Methods A bone substitute model of the pelvis was used in this in vitro study. We set the acetabular component using PNS. We set the acetabular component angle after changing the sagittal, coronal, and axial pelvic tilt. We calculated the difference between the angle displayed on the PNS display and the actual angle of the acetabular component. The difference in inclination angle was defined as ΔRI, and the difference in the anteversion angle was defined as ΔRA. We evaluated the trends in this ΔRI and ΔRA due to the pelvic tilt. Results In this in vitro study, the placement of the acetabular component was accurate in the neutral position; ΔRI was 0.5 ± 0.7° and ΔRA was 1.0 ± 0.7°. Sagittal pelvic tilt and axial pelvic tilt increased both the ΔRA and ΔRI (P = .017). Coronal tilt increased ΔRI but did not change ΔRA. Conclusions While the PNS may enable surgeons to place accurate component placement in the neutral position, its accuracy decreased by pelvic tilt. The surgeons should use a solid pelvic lateral positioner for reducing discrepancies in pelvic tilt when using the PNS in the lateral decubitus position.
Collapse
Affiliation(s)
- Hiroshi Asai
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ishiguro
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
32
|
Fujii H, Hayama T, Abe T, Takahashi M, Matsushita Y, Sato R, Otani T, Saito M. Improving MiniHip femoral prosthesis positioning using a cross-laser projection system in total hip arthroplasty by an anterolateral supine approach. Int J Med Robot 2021; 17:e2214. [PMID: 33369069 PMCID: PMC7988605 DOI: 10.1002/rcs.2214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/20/2020] [Accepted: 12/21/2020] [Indexed: 11/17/2022]
Abstract
Background The authors developed a cross‐laser projection system (CLP) to place a femoral neck‐sparing short stem using the minimally invasive anterolateral supine approach in total hip arthroplasty. This study aimed to verify the utility of CLP. Methods Thirty joints were assessed with the MiniHip (Corin). The authors compared femoral component implantation with a patient‐specific femoral osteotomy guide (PSG) for the femoral neck‐cut (PSG group), with the CLP attached to the rasp handle to irradiate the cross‐laser to the target of PSG (CLP group), and without PSG or CLP (control group). Results In the CLP group, the positional deviation of anteversion, anterior/posterior tilt and varus/valgus placement of the stem postoperatively were 1.8° ± 0.2°, 2.0° ± 2.0° and 2.0° ± 0.1°, respectively. The positional deviation of anteversion (p < 0.001) and anterior/posterior tilt (p = 0.036) were significantly smaller than those in the other groups. Conclusions CLP improves the accuracy of MiniHip femoral prosthesis placement.
Collapse
Affiliation(s)
- Hideki Fujii
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Tetsuo Hayama
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Toshiomi Abe
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Motoi Takahashi
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yohei Matsushita
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryuichi Sato
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takuya Otani
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
33
|
Moralidou M, Di Laura A, Henckel J, Hothi H, Hart AJ. Three-dimensional pre-operative planning of primary hip arthroplasty: a systematic literature review. EFORT Open Rev 2020; 5:845-855. [PMID: 33425373 PMCID: PMC7784139 DOI: 10.1302/2058-5241.5.200046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Three-dimensional (3D) pre-operative planning in total hip arthroplasty (THA) is being recognized as a useful tool in planning elective surgery, and as crucial to define the optimal component size, position and orientation. The aim of this study was to systematically review the existing literature for the use of 3D pre-operative planning in primary THA.A systematic literature search was performed using keywords, through PubMed, Scopus and Google Scholar, to retrieve all publications documenting the use of 3D planning in primary THA. We focussed on (1) the accuracy of implant sizing, restoration of hip biomechanics and component orientation; (2) the benefits and barriers of this tool; and (3) current gaps in literature and clinical practice.Clinical studies have highlighted the accuracy of 3D pre-operative planning in predicting the optimal component size and orientation in primary THAs. Component size planning accuracy ranged between 34-100% and 41-100% for the stem and cup respectively. The absolute, average difference between planned and achieved values of leg length, offset, centre of rotation, stem version, cup version, inclination and abduction were 1 mm, 1 mm, 2 mm, 4°, 7°, 0.5° and 4° respectively.Benefits include 3D representation of the human anatomy for precise sizing and surgical execution. Barriers include increased radiation dose, learning curve and cost. Long-term evidence investigating this technology is limited.Emphasis should be placed on understanding the health economics of an optimized implant inventory as well as long-term clinical outcomes. Cite this article: EFORT Open Rev 2020;5:845-855. DOI: 10.1302/2058-5241.5.200046.
Collapse
Affiliation(s)
- Maria Moralidou
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Anna Di Laura
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Johann Henckel
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Harry Hothi
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| | - Alister J Hart
- Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Stanmore, UK
| |
Collapse
|
34
|
Hasegawa M, Naito Y, Tone S, Wakabayashi H, Sudo A. Accuracy of acetabular cup insertion in an anterolateral supine approach using an accelerometer-based portable navigation system. J Artif Organs 2020; 24:82-89. [PMID: 32880017 DOI: 10.1007/s10047-020-01206-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/24/2020] [Indexed: 01/07/2023]
Abstract
The purpose of this study was to determine the accuracy of acetabular cup insertion during total hip arthroplasty (THA) in a supine position using an accelerometer-based portable navigation system. A single-surgeon study was conducted in which 62 prospective patients with navigation and 42 retrospective patients without navigation as historical controls were compared. The patients underwent THA via an anterolateral supine approach. The absolute values of errors of radiographic inclination and anteversion were calculated. The navigation error was also calculated. The factors that affected the absolute values of errors of cup alignment were determined. The mean absolute error of the postoperative CT measurement from the target angle for radiographic inclination was 3.8° in the navigation group and 6.6° in the control group (P < 0.001). The mean absolute error for anteversion was 3.3° in the navigation group and 5.9° in the control group (P < 0.001). The mean absolute values of navigation error were 3.7° ± 2.8° in inclination and 3.0° ± 2.6° in anteversion. Changes in the pelvic tilt angle among preoperative, intraoperative, and postoperative were the significant risk factors for the absolute values of navigation error of anteversion relative to the anterior pelvic plane. Other factors affecting the absolute values of errors in the navigation group were not found for radiographic inclination and anteversion. The portable navigation system significantly improved the accuracy of cup inclination and anteversion. Changes in the pelvic tilt were the risk factors for the error of anteversion relative to the anterior pelvic plane.
Collapse
Affiliation(s)
- Masahiro Hasegawa
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan.
| | - Yohei Naito
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Shine Tone
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Hiroki Wakabayashi
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan
| |
Collapse
|
35
|
Nakahara I, Kyo T, Kuroda Y, Miki H. Does difference in stem design affect accuracy of stem alignment in total hip arthroplasty with a CT-based navigation system? J Artif Organs 2020; 24:74-81. [PMID: 32710390 DOI: 10.1007/s10047-020-01196-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
The efficacy of a computed tomography (CT)-based navigation system to accurately position the stem for intended alignment is unclear. In addition, the influence of stem design on the accuracy of insertion is unknown. We therefore retrospectively compared the accuracy and precision for the intended alignment of two different designs of femoral stem which were implanted with or without the navigation system. Forty-nine total hip arthroplasties (THAs) using a tapered wedge stem and 91 THAs using an anatomic stem were evaluated for the navigation group. Thirty-three THAs using the tapered wedge stem and 15 THAs using the anatomic stem were controls for the non-navigation group. Differences between postoperative measurement and preoperative planning were compared among the groups. In the navigation groups, accuracy (mean absolute difference) and precision (95% limits of agreement) of stem anteversion were 4.3° and ± 10.1° in the tapered wedge stem and 3.1° and ± 6.9° in the anatomic stem. In the non-navigation groups, these were 6.0° and ± 15.2° and 4.8° and ± 12.4°, respectively. The accuracy and precision in the navigation groups were significantly superior to those in the non-navigation group, and those in the anatomic stem group were significantly superior to those in the tapered wedge group. Using the CT-based navigation system, the accuracy and precision for intended stem anteversion were improved. When compared under guidance of navigation system, the accuracy and precision for intended stem anteversion in the anatomic stem were superior to those in the tapered wedge stem.
Collapse
Affiliation(s)
- Ichiro Nakahara
- Department of Orthopaedic Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 5400006, Japan.
| | - Takayuki Kyo
- Department of Orthopaedic Surgery, Bellland General Hospital, 500-3 Higashiyama, Naka-ku, Sakai-city, Osaka, 5998247, Japan
| | - Yasuo Kuroda
- Department of Orthopaedic Surgery, Suita Municipal Hospital, 5-7 Kishibeshinmachi, Suita-city, Osaka, 5648567, Japan
| | - Hidenobu Miki
- Department of Orthopaedic Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka, 5400006, Japan
| |
Collapse
|
36
|
Wang M, Li D, Shang X, Wang J. A review of computer-assisted orthopaedic surgery systems. Int J Med Robot 2020; 16:1-28. [PMID: 32362063 DOI: 10.1002/rcs.2118] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/07/2020] [Accepted: 04/19/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Computer-assisted orthopaedic surgery systems have great potential, but no review has focused on computer-assisted surgery systems for the spine, hip, and knee. METHODS A systematic search was performed in Web of Science and PubMed. We searched the literature on computer-assisted orthopaedic surgery systems from 2008 to the present and focused on three aspects of systems: training, planning, and intraoperative navigation. RESULTS AND DISCUSSION In this review study, we reviewed 34 surgical training systems, 31 surgical planning systems, and 41 surgical navigation systems. The functions and characteristics of the surgical systems were compared and analysed, and the current concerns about and the impact of the surgical systems on doctors and surgery were clarified. CONCLUSION Computer-assisted orthopaedic surgery systems are still in the development stage. Future surgical training systems should include synthetic models with patient anatomy. Surgical planning systems with automatic planning should be developed, and surgical navigation systems with multimodal fusion, robotic assistance and imaging should be developed.
Collapse
Affiliation(s)
- Monan Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Donghui Li
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Xiping Shang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| | - Jian Wang
- Mechanical & Power Engineering College , Harbin University of Science and Technology, Harbin, China
| |
Collapse
|
37
|
Tetsunaga T, Yamada K, Tetsunaga T, Sanki T, Kawamura Y, Ozaki T. An accelerometer-based navigation system provides acetabular cup orientation accuracy comparable to that of computed tomography-based navigation during total hip arthroplasty in the supine position. J Orthop Surg Res 2020; 15:147. [PMID: 32295628 PMCID: PMC7161129 DOI: 10.1186/s13018-020-01673-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/03/2020] [Indexed: 11/21/2022] Open
Abstract
Background Inadequate acetabular component orientation is associated with postoperative impingement, dislocation, and accelerated polyethylene wear. Computed tomography (CT)-based navigation systems provide accuracy for total hip arthroplasty (THA) but are not available in all facilities. Accelerometer-based navigation systems are inexpensive, but their accuracy remains undetermined. This study compares the accuracy of cup orientation in THA using CT-based and accelerometer-based navigation systems. Methods This retrospective study included 35 consecutive patients (11 males, 24 females; mean age, 65 years) who underwent primary cementless THA via an anterolateral approach in the supine position. Both CT-based and accelerometer-based navigation systems were used simultaneously. The accuracy of cup orientation was compared between the two systems using postoperative CT. Results The accuracy of cup inclination was 2.7° ± 2.0° in the CT-based group and 3.3° ± 2.4° in the accelerometer-based group. The accuracy of cup anteversion was 2.8° ± 2.6° in the CT-based group and 3.4° ± 2.2° in the accelerometer-based group. No significant difference was observed in cup inclination (p = 0.29) or cup anteversion (p = 0.34) between CT-based and accelerometer-based navigation. Conclusions The accuracy of cup positioning did not differ significantly between CT-based and accelerometer-based navigation systems.
Collapse
Affiliation(s)
- Tomonori Tetsunaga
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
| | - Kazuki Yamada
- Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Tomoko Tetsunaga
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Tomoaki Sanki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Yoshi Kawamura
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan
| |
Collapse
|
38
|
Tagomori H, Kaku N, Tabata T, Kubota Y, Tsumura H. Comparison of cementless and cemented cups in revision total hip arthroplasty using a computed tomography-based navigation system. J Clin Orthop Trauma 2020; 11:S206-S210. [PMID: 32189941 PMCID: PMC7067992 DOI: 10.1016/j.jcot.2019.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 05/10/2019] [Accepted: 05/27/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies comparing cementless and cemented cups are lacking, especially for revision total hip arthroplasty (THA). The aim of this study was to investigate and compare the differences in implant accuracy between two fixation methods in revision THA. METHODS We conducted a retrospective study of 85 hips in 70 patients who underwent revision THA using a computed tomography (CT)-based navigation system. Among these, 53 hips underwent cementless THA and 32 hips underwent cemented THA. We measured cup inclination and anteversion using the Kyocera two-dimensional-template with X-ray (Japan-Kyocera, Shiga, Japan) and stem anteversion with CT. We calculated the combined anteversion [cup anteversion+0.7×stem anteversion]. RESULTS There were no significant differences between the two groups with respect to definitive cup inclination and anteversion. The mean deviations in the inclination and anteversion angle were 40.3 ± 4.3 and 19.6 ± 6.2° in the cementless group and 40.5 ± 3.3 and 17.1 ± 5.1° in the cemented group. There were 11 outliers with respect to the Lewinnek safe zone in the cementless group and two in the cemented group (P = 0.072). Although there was no statistically significant difference, the number of safe zone outliers in the cemented group was less than that in the cementless group. CONCLUSION We conclude that when using a navigation system for revision THA, high precision can be obtained for the cup placement angle with or without cement. However, it seems that a major error in the installation angle of the cup is less likely to occur when using a cemented cup than when using a cementless cup in revision THA with a navigation system.
Collapse
Affiliation(s)
| | - Nobuhiro Kaku
- Corresponding author. Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi Yufu city, Oita, 879-5593, Japan.
| | | | | | | |
Collapse
|
39
|
Uemura K, Boughton OR, Logishetty K, Halewood C, Clarke SG, Harris SJ, Sugano N, Cobb JP. A single-use, size-specific, nylon arthroplasty guide: a preliminary study for hip resurfacing. Hip Int 2020; 30:71-77. [PMID: 30947562 DOI: 10.1177/1120700019834918] [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
INTRODUCTION In arthroplasty surgery, positioning of the components must be accurate and reproducible to avoid complications. Conventional guides are often used to align a component, but they require surgical skill and experience, and are prone to error. To this end, a single-use, size-specific, nylon guide (single-use nylon guide) has been developed for the purpose of increasing the accuracy without adding extra cost to the operation. The effectiveness of this type of guide was evaluated in using a synthetic bone study. METHODS A total of 66 synthetic femurs with the same osteoarthritic morphology were prepared. 3 surgeons participated in the experiments, and each surgeon created a drill hole for the femoral component by using the single-use nylon guide or a commercially-available, conventional, metal, neck-based guide (conventional guide). Anteversion, inclination, and insertion point acquired by the guide were compared between the guides, between surgeons, and to the computer-based plan. RESULTS Anteversion acquired by the single-use nylon guide (6.7° [4.9-11.5°]) was significantly closer to the plan (14.6°) than that acquired by the conventional guide (4.3° [2.4-8.6°]) (p = 0.03). The insertion point was also significantly closer to the plan for the single-use nylon guide (3.8 mm ± 1.6 mm) than the conventional guide (5.7 mm ± 2.4 mm) (p < 0.001). No significant difference was found for the inclination (p = 0.76). CONCLUSION A single-use, size-specific nylon guide was effective in acquiring a higher accuracy and precision in anteversion and insertion point than a conventional guide in this synthetic bone, hip resurfacing arthroplasty study. The use of single-use guides in other orthopaedic procedures should be explored.
Collapse
Affiliation(s)
- Keisuke Uemura
- MSk Laboratory, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK.,Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Japan
| | - Oliver R Boughton
- MSk Laboratory, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
| | - Kartik Logishetty
- MSk Laboratory, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
| | - Camilla Halewood
- MSk Laboratory, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
| | - Susannah G Clarke
- MSk Laboratory, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
| | - Simon J Harris
- MSk Laboratory, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Japan
| | - Justin P Cobb
- MSk Laboratory, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
| |
Collapse
|
40
|
Sato R, Takao M, Hamada H, Sakai T, Marumo K, Sugano N. Clinical accuracy and precision of hip resurfacing arthroplasty using computed tomography-based navigation. INTERNATIONAL ORTHOPAEDICS 2018; 43:1807-1814. [PMID: 30135983 DOI: 10.1007/s00264-018-4113-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/13/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE To avoid malalignment of components during hip resurfacing arthroplasty (HRA), we used a computed tomography (CT)-based navigation system for guidance. This study aimed to evaluate the clinical accuracy and precision of HRA performed using the CT-based navigation systems. METHODS HRA was performed on 17 hips guided by the CT-based navigation systems. We measured cup alignment deviation, deviation of the stem position, and alignment from the plan by image matching between pre-operative and post-operative CT images. RESULTS Cup anteversion was within 5° of that in the plan in all cases. Cup inclination was within 5° of that in the plan in 82.4% and within 10° in all cases. The angular difference of the stem was within 5° in all cases, and the entry point of the stem was within 4 mm in all cases. CONCLUSION The CT-based navigation system for HRA guided accurate component placement according to the plan.
Collapse
Affiliation(s)
- Ryuichi Sato
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masaki Takao
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Keishi Marumo
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
| |
Collapse
|
41
|
Nakahara I, Kyo T, Kuroda Y, Miki H. Effect of improved navigation performance on the accuracy of implant placement in total hip arthroplasty with a CT-based navigation system. J Artif Organs 2018; 21:340-347. [PMID: 29611147 DOI: 10.1007/s10047-018-1041-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 03/27/2018] [Indexed: 12/28/2022]
Abstract
A computed tomography (CT)-based navigation system is one of the support tools to place implant with appropriate alignment and position in total hip arthroplasty (THA). To determine whether the higher performance of the navigation would further improve the accuracy of implant placement in the clinical setting, we retrospectively compared the navigation accuracy of two different versions of a navigation system. The newer version of the navigation system had an upgraded optical sensor with superior positional accuracy. Navigation accuracy, defined as differences between postoperative measurements on CT images and intraoperative records on the navigation system, of 49 THAs performed with the newer version of the navigation system was compared with that of 49 THAs performed with the older version. With the newer version, the mean absolute accuracy (95% limits of agreement) of implant alignment was 1.2° (± 3.3°) for cup inclination, 1.0° (± 2.4°) for cup anteversion, 2.0° (± 4.9°) for stem anteversion, and 1.1° (± 2.4°) for stem valgus angle. The accuracy of the implant position was 1.5 mm (± 3.1 mm), 1.3 mm (± 3.0 mm), and 1.5 mm (± 3.1 mm) for cup x-, y-, and z-axes, respectively, 1.6 mm (± 3.2 mm), 1.4 mm (± 2.9 mm), and 1.5 mm (± 2.7 mm) for stem x-, y-, and z-axes, respectively, and 2.4 mm (± 4.5 mm) for leg length discrepancy. The values for the newer version were significantly more accurate with less variation compared to those of the older version. With upgraded navigation performance, more accurate implant placement was demonstrated in the clinical setting.
Collapse
Affiliation(s)
- Ichiro Nakahara
- Department of Orthopaedic Surgery, Osaka National Hospital, 2-1-14 oenzaka, Chuo-ku, Osaka, 5400006, Japan.
| | - Takayuki Kyo
- Department of Orthopaedic Surgery, Bellland General Hospital, 500-3 Higashiyama, Naka-ku, Sakai-city, Osaka, Japan
| | - Yasuo Kuroda
- Department of Orthopaedic Surgery, Osaka National Hospital, 2-1-14 oenzaka, Chuo-ku, Osaka, 5400006, Japan
| | - Hidenobu Miki
- Department of Orthopaedic Surgery, Osaka National Hospital, 2-1-14 oenzaka, Chuo-ku, Osaka, 5400006, Japan
| |
Collapse
|
42
|
Nakamura N, Maeda Y, Hamawaki M, Sakai T, Sugano N. Effect of soft-tissue impingement on range of motion during posterior approach Total Hip Arthroplasty: an in vivo measurement study. Comput Assist Surg (Abingdon) 2018; 21:132-136. [PMID: 27973946 DOI: 10.1080/24699322.2016.1223347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE While implant impingement and bony impingement have been recognized as causes of poor outcomes in total hip arthroplasty (THA), reports of soft-tissue impingement are rare. To clarify the issue, the effect of anterior capsule resection on hip range of motion (ROM) was quantitatively measured in vivo during posterior approach THA using a CT-based hip navigation system. MATERIALS AND METHODS For 47 patients (51 hips), hip ROM was measured intraoperatively before and after resection of the anterior hip capsule, and the difference was compared. RESULTS Resection of the anterior hip capsule brought about an average 6° increase of ROM in the direction of flexion with internal rotation and did not markedly change ROM in other directions. CONCLUSIONS During THA through a posterior approach, soft-tissue impingement by the anterior hip capsule can occur. Clinically, we expect that resection of the anterior hip capsule can reduce the risk of posterior instability without increasing the risk of anterior instability.
Collapse
Affiliation(s)
- Nobuo Nakamura
- a Center of Arthroplasty, Kyowakai Hospital , Suita-city , Osaka , Japan
| | - Yuki Maeda
- a Center of Arthroplasty, Kyowakai Hospital , Suita-city , Osaka , Japan
| | - Makoto Hamawaki
- a Center of Arthroplasty, Kyowakai Hospital , Suita-city , Osaka , Japan
| | - Takashi Sakai
- b Department of Orthopedic Surgery , Osaka University Medical School , Suita-city , Osaka , Japan
| | - Nobuhiko Sugano
- b Department of Orthopedic Surgery , Osaka University Medical School , Suita-city , Osaka , Japan
| |
Collapse
|
43
|
Tsutsui T, Goto T, Wada K, Takasago T, Hamada D, Sairyo K. Efficacy of a computed tomography-based navigation system for placement of the acetabular component in total hip arthroplasty for developmental dysplasia of the hip. J Orthop Surg (Hong Kong) 2018; 25:2309499017727954. [PMID: 28851263 DOI: 10.1177/2309499017727954] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Developmental dysplasia of the hip (DDH) presents a considerable surgical challenge in total hip arthroplasty (THA). Although the usefulness of computed tomography (CT)-based navigation in cup alignment has been reported, few reports have evaluated three-dimensional (3-D) cup positioning against the acetabulum specifically in patients with DDH. The purpose of this study was to evaluate the efficacy of a CT-based navigation system for alignment and spatial positioning of the cup in THA for patients with DDH. METHODS We reviewed 174 DDH THA cases in which CT-based navigation was used, and 75 cases in which a mechanical guide was used as a control group. Postoperative cup alignment and spatial positioning were evaluated by superimposition of a 3-D cup template onto the actual implanted cup using postoperative CT images, with pelvic coordinates matching the preoperative planning. RESULTS The proportion within the combined target zone (inclination and anteversion) was 97.7% in the navigation group and 61.3% in the non-navigation group. The mean absolute error between the intraoperative record and the postoperative measurement was 1.5° ± 1.3° for inclination and 2.1° ± 1.8° for anteversion in the navigation group. For acetabular cup positioning, the mean discrepancy between the preoperative planning and the postoperative measurements was 1.9 ± 1.6 mm on the transverse axis, 2.8 ± 2.3 mm on the longitudinal axis, and 1.7 ± 1.3 mm on the sagittal axis. CONCLUSION THA using a CT-based navigation system achieved quite high accuracy of cup alignment angles and spatial cup positioning in primary THA for patients with DDH.
Collapse
Affiliation(s)
- Takahiko Tsutsui
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tomohiro Goto
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Keizo Wada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Tomoya Takasago
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Daisuke Hamada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| |
Collapse
|
44
|
Takeda Y, Fukunishi S, Nishio S, Fujihara Y, Yoshiya S. Accuracy of Component Orientation and Leg Length Adjustment in Total Hip Arthroplasty Using Image-free Navigation. Open Orthop J 2018; 11:1432-1439. [PMID: 29387288 PMCID: PMC5753031 DOI: 10.2174/1874325001711011432] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/24/2017] [Accepted: 12/01/2017] [Indexed: 11/22/2022] Open
Abstract
Purpose: The purpose of this study was to examine the accuracy of implant orientation and leg length in total hip arthroplasty (THA) with an image-free navigation system based on a comparison of the intraoperative navigation and postoperative CT evaluations. Material and Methods: A consecutive series of 111 patients (118 hips) who underwent THA using the current version of the image-free navigation system constituted the basic study population. Subsequently, a total of 101 patients (108 hips) meeting the inclusion and exclusion criteria were selected as study subjects for the analysis. THA was performed using an image-free navigation system that was capable of adjusting both the prosthetic position and leg length. Postoperative CT examination was performed for all study subjects, and the prosthetic position and leg length were measured on CT images using the image analysis software. Subsequently, the intraoperative navigation results and the corresponding values obtained from the postoperative CT measurements were compared to test the accuracy of the navigation system. Results: The average discrepancies between the intra- and postoperative assessments were 6.8°, 3.7°, and 5.7° for cup anteversion, cup inclination, and stem anteversion, respectively. The corresponding value in leg length averaged 4.1 mm. Conclusion: Average discrepancies between the intra- and postoperative measurements were less than 10° in all prosthetic alignment parameters and less than 5 mm in leg length. Intraoperative assessments with the use of the image-free navigation in THA could afford satisfactory result.
Collapse
Affiliation(s)
- Yu Takeda
- Hyogo College of Medicine, Department of Orthopedic Surgery 1-1, Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Shigeo Fukunishi
- Hyogo College of Medicine, Department of Orthopedic Surgery 1-1, Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Shoji Nishio
- Hyogo College of Medicine, Department of Orthopedic Surgery 1-1, Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Yuki Fujihara
- Hyogo College of Medicine, Department of Orthopedic Surgery 1-1, Mukogawa-cho, Nishinomiya, Hyogo, Japan
| | - Shinichi Yoshiya
- Hyogo College of Medicine, Department of Orthopedic Surgery 1-1, Mukogawa-cho, Nishinomiya, Hyogo, Japan
| |
Collapse
|
45
|
Uemura K, Takao M, Otake Y, Koyama K, Yokota F, Hamada H, Sakai T, Sato Y, Sugano N. Can Anatomic Measurements of Stem Anteversion Angle Be Considered as the Functional Anteversion Angle? J Arthroplasty 2018; 33:595-600. [PMID: 28993085 DOI: 10.1016/j.arth.2017.09.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/02/2017] [Accepted: 09/12/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Stem anteversion angle is important in the combined anteversion theory to avoid implant impingement after total hip arthroplasty (THA). However, anatomic measurements of stem anteversion angle may not represent functional anteversion of the femur if the femur undergoes axial rotation. Herein, the femoral rotational angle (FRA) was measured in supine and standing positions before and after THA to evaluate the difference between anatomic and functional measurements. METHODS A total of 191 hips (174 patients) treated with THA for osteoarthritis were analyzed in this retrospective, case-controlled study. The FRA was measured as the angle between the posterior condylar line and the line through the bilateral anterior superior iliac spines (positive for external rotation) and was measured preoperatively and postoperatively in supine and standing positions with computed tomography segmentation and landmark localization of the pelvis and the femur followed by intensity-based 2D-3D registration. The number of cases in which the absolute FRA remained <15° in both positions was also calculated. RESULTS The average ± standard deviation preoperative FRA was 0.3° ± 8.3° in the supine position and -4.5° ± 8.8° during standing; the postoperative FRA was -3.8° ± 9.0° in supine and -14.3° ± 8.3° during standing. There were 134 cases (70%) in which the preoperative absolute FRA remained <15° in both positions while only 85 hips (45%) remained <15°, postoperatively. CONCLUSION Substantial variability was seen in the FRA, especially during the postoperative period. These results suggest that the anatomic stem anteversion angle may not represent the functional anteversion of the femur.
Collapse
Affiliation(s)
- Keisuke Uemura
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masaki Takao
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshito Otake
- Graduate School of Information Science, Nara Institute of Science and Technology, Ikoma, Nara, Japan
| | - Koki Koyama
- Graduate School of Information Science, Nara Institute of Science and Technology, Ikoma, Nara, Japan
| | - Futoshi Yokota
- Graduate School of Information Science, Nara Institute of Science and Technology, Ikoma, Nara, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshinobu Sato
- Graduate School of Information Science, Nara Institute of Science and Technology, Ikoma, Nara, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| |
Collapse
|
46
|
Yamada K, Endo H, Tetsunaga T, Miyake T, Sanki T, Ozaki T. Accuracy of Cup Positioning With the Computed Tomography-Based Two-dimensional to Three-Dimensional Matched Navigation System: A Prospective, Randomized Controlled Study. J Arthroplasty 2018; 33:136-143. [PMID: 28870743 DOI: 10.1016/j.arth.2017.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/28/2017] [Accepted: 08/01/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The accuracy of various navigation systems used for total hip arthroplasty has been described, but no publications reported the accuracy of cup orientation in computed tomography (CT)-based 2D-3D (two-dimensional to three-dimensional) matched navigation. METHODS In a prospective, randomized controlled study, 80 hips including 44 with developmental dysplasia of the hips were divided into a CT-based 2D-3D matched navigation group (2D-3D group) and a paired-point matched navigation group (PPM group). The accuracy of cup orientation (absolute difference between the intraoperative record and the postoperative measurement) was compared between groups. Additionally, multiple logistic regression analysis was performed to evaluate patient factors affecting the accuracy of cup orientation in each navigation. RESULTS The accuracy of cup inclination was 2.5° ± 2.2° in the 2D-3D group and 4.6° ± 3.3° in the PPM group (P = .0016). The accuracy of cup anteversion was 2.3° ± 1.7° in the 2D-3D group and 4.4° ± 3.3° in the PPM group (P = .0009). In the PPM group, the presence of roof osteophytes decreased the accuracy of cup inclination (odds ratio 8.27, P = .0140) and the absolute value of pelvic tilt had a negative influence on the accuracy of cup anteversion (odds ratio 1.27, P = .0222). In the 2D-3D group, patient factors had no effect on the accuracy of cup orientation. CONCLUSION The accuracy of cup positioning in CT-based 2D-3D matched navigation was better than in paired-point matched navigation, and was not affected by patient factors. It is a useful system for even severely deformed pelvises such as developmental dysplasia of the hips.
Collapse
Affiliation(s)
- Kazuki Yamada
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Hirosuke Endo
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Tomonori Tetsunaga
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Takamasa Miyake
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Tomoaki Sanki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| |
Collapse
|
47
|
Tokunaga K, Okamoto M, Watanabe K. Implant Orientation Measurement After THA Using the EOS X-Ray Image Acquisition System. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1093:335-343. [PMID: 30306493 DOI: 10.1007/978-981-13-1396-7_26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We investigated the accuracy of measuring implant orientation after THA in standing position using EOS system (EOS Imaging Inc., Paris, France). Ninety patients who underwent THA were subjected to this study by comparing angles measured by EOS system and those measured from CT scans using 3D image analyzing software, ZedHip (LEXI, Tokyo, Japan). The radiographic cup inclination and anatomical cup anteversion were measured with respect to the anterior pelvic plane (APP) coordinate. The femoral stem antetorsion was analyzed by measuring the angles between the stem neck axis and the post-condylar axis in the femoral functional axis coordinate.The differences (mean ± SD) (range of 95%CI) between angles measured by EOS system and those from CT scans in the cup inclination, cup anteversion, and stem antetorsion were - 2.3° ± 2.7° (-2.8°∼ - 1.7°), -0.1° ± 5.0° (-1.2°∼0.9°), and - 1.3° ± 6.5° (-2.7°∼0.1°), respectively. Cup inclination measured on 14 hips, cup anteversion measured on 28 hips, and stem antetorsion measured on 27 hips were classified as outliers whose differences were over 5°. Difficulties in defining the reference points for APP correlated with the incidences of the outliers in cup orientation measurements.We could not set new reference points on the 3D bone surface models reconstructed by EOS system, so we have to use reference points defined on 2D images. In addition, the APP coordinate in EOS system was not the same as the standard definition. EOS system may not be used to measure the implant positions after THA until these problems will be improved.
Collapse
Affiliation(s)
- Kunihiko Tokunaga
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City, Japan.
| | - Masashi Okamoto
- Department of Radiology, Kameda Daiichi Hospital, Niigata City, Japan
| | - Kenji Watanabe
- Department of Orthopedic Surgery, Kameda Daiichi Hospital, Niigata City, Japan
| |
Collapse
|
48
|
Ogawa T, Takao M, Sakai T, Sugano N. Factors related to disagreement in implant size between preoperative CT-based planning and the actual implants used intraoperatively for total hip arthroplasty. Int J Comput Assist Radiol Surg 2017; 13:551-562. [DOI: 10.1007/s11548-017-1693-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/06/2017] [Indexed: 12/20/2022]
|
49
|
Iwakiri K, Kobayashi A, Ohta Y, Minoda Y, Takaoka K, Nakamura H. Efficacy of a Pelvic Lateral Positioner With a Mechanical Cup Navigator Based on the Anatomical Pelvic Plane in Total Hip Arthroplasty. J Arthroplasty 2017; 32:3659-3664. [PMID: 28712802 DOI: 10.1016/j.arth.2017.06.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 05/30/2017] [Accepted: 06/19/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The acetabular component orientation in total hip arthroplasty (THA) is of critical importance to the good clinical results. However, traditional widely used cup alignment guides for cup placement are reported to be relatively unreliable. The present study aims at comparing a novel cup alignment guide, which can be attached to our anatomical pelvic plane (APP) pelvic lateral positioner for reducing discrepancies in sagittal pelvic tilt and indicate a targeted cup angle based on the APP, with a conventional cup alignment guide. METHODS The subjects were 136 hips of 136 patients who underwent unilateral THA using the APP positioner. The procedure was performed with the conventional cup alignment guide (conventional group; 60 hips) and with the novel cup navigator (mechanical navigator group; 76 hips). Postoperative cup angles and discrepancies of postoperative cup angles (inclination and anteversion angles) from the targeted angles were compared between the 2 groups to evaluate the usefulness of these navigators. RESULTS The mean cup angles in the conventional group were 39.0° ± 5.3° for the inclination angle and 21.7° ± 6.4° for the anteversion angle, whereas those in the mechanical navigator group were 40.6° ± 3.2° and 18.3° ± 4.6°, respectively (P = .018, P < .0001). The discrepancies from the targeted angles were 3.5° ± 3.1° for the inclination angle and 4.6° ± 3.4° for the anteversion angle in the conventional group and 2.3° ± 2.3° and 3.2° ± 2.7°, respectively, in the mechanical navigator group (P = .020, P = .012). CONCLUSION The mechanical cup navigator easily attachable to the APP positioner is a tool that can improve the accuracy of cup placement in a simple, economical, and noninvasive manner in THA via the lateral position.
Collapse
Affiliation(s)
- Kentaro Iwakiri
- Department of Orthopaedic Surgery, Shiraniwa Hospital, Nara, Japan
| | - Akio Kobayashi
- Department of Orthopaedic Surgery, Shiraniwa Hospital, Nara, Japan
| | - Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kunio Takaoka
- Department of Orthopaedic Surgery, Shiraniwa Hospital, Nara, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
50
|
Tetsunaga T, Fujiwara K, Endo H, Tetsunaga T, Shiota N, Sato T, Ozaki T. Calcar Femorale in Patients with Osteoarthritis of the Hip Secondary to Developmental Dysplasia. Clin Orthop Surg 2017; 9:413-419. [PMID: 29201293 PMCID: PMC5705299 DOI: 10.4055/cios.2017.9.4.413] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/18/2017] [Indexed: 12/02/2022] Open
Abstract
Background We investigated whether the calcar femorale, a cortical septum in the region of the lesser trochanter of the femur, correlates with results of femoral stem implantation in patients with osteoarthritis of the hip secondary to developmental dysplasia using computed tomography. Methods This retrospective study included 277 hips (41 males and 236 females; age, 37 to 92 years) of patients who had presented to Okayama Medical Center with hip pain. Of these, a total of 219 hips (31 males and 188 females) had previously undergone total hip arthroplasty. According to the Crowe classification, 147 hips were classified as Crowe grade I, 72 hips as Crowe grade II–IV, and 58 hips as normal. Results The calcar femorale was identified in 267 hips (96.4%). The calcar femorale was significantly shorter and more anteverted in Crowe grade II–IV hips than in Crowe grade I or normal hips. Significant differences in the shape of the calcar femorale were found according to the severity of hip deformity. Three stem designs were analyzed: single-wedge (59 hips), double-wedge metaphyseal filling (147 hips), and modular (13 hips). Single-wedge stems were inserted more parallel to the calcar femorale rather than femoral neck anteversion, while other types of stems scraped the calcar femorale. Conclusions The angle of the calcar femorale differs according to the severity of hip deformity, and the calcar femorale might thus serve as a more useful reference for stem insertion than femoral neck anteversion in total hip arthroplasty using a single-wedge stem.
Collapse
Affiliation(s)
- Tomonori Tetsunaga
- Department of Orthopaedic Surgery, Okayama University, Okayama, Japan.,Department of Orthopaedic Surgery, Okayama Medical Center, Okayama, Japan
| | - Kazuo Fujiwara
- Department of Intelligent Orthopaedic Systems, Okayama University, Okayama, Japan
| | - Hirosuke Endo
- Department of Orthopaedic Surgery, Okayama University, Okayama, Japan
| | - Tomoko Tetsunaga
- Department of Orthopaedic Surgery, Okayama University, Okayama, Japan
| | - Naofumi Shiota
- Department of Orthopaedic Surgery, Okayama Medical Center, Okayama, Japan
| | - Toru Sato
- Department of Orthopaedic Surgery, Okayama Medical Center, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University, Okayama, Japan
| |
Collapse
|