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Aubert T, Galanzino G, Gerard P, Le Strat V, Rigoulot G, Lhotellier L. Accuracy of Preoperative 3D vs 2D Digital Templating for Cementless Total Hip Arthroplasty Using a Direct Anterior Approach. Arthroplast Today 2023; 24:101260. [PMID: 38023640 PMCID: PMC10652126 DOI: 10.1016/j.artd.2023.101260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/26/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background An important aspect of preoperative planning for total hip arthroplasty is templating. Although two-dimensional (2D) templating remains the gold standard, computerized tomography (CT)-based three-dimensional (3D) templating is a novel preoperative planning technique. This study aims to compare the accuracy of a 2D and 3D plan using an anterior approach for the placement of the same uncemented prosthesis. Methods Two consecutive cohorts of 100 patients each were retrospectively analyzed. We analyzed the accuracy of the size of the implant (stem, cup, head), the length of head, and offset. As a secondary criterion, we analyzed the rates of stems with more than 3° of varus, fracture, and/or subsidence at 3 months postoperatively. Results Within the exact size, the accuracy of the stem and cup size with the 2D plan was 69% and 56%, respectively. With the 3D plan accuracy being 88% (P = .0046) and 96% (P < .0001), respectively. Regarding size and length of the implant head, accuracy was 86% and 82% with the 2D plan and 100% (P < .0001) and 94% (P = .016), respectively, with the 3D plan. The offset of the implants increased beyond 3 mm in 23% of patients in the 2D group and in 5% of patients in the 3D group (P = .0003). The rate of varus stems was 10% in the 2D group and 2% in the 3D group (P = .03). Two fractures and one case of subsidence occurred in the 2D group. None were identified in the 3D cohort. Conclusions A CT-based 3D plan is more accurate for implant size selection, allows better prosthetic offset, and reduces the rate of varus stems.
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Affiliation(s)
- Thomas Aubert
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Giacomo Galanzino
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Philippe Gerard
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Vincent Le Strat
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Guillaume Rigoulot
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Luc Lhotellier
- Orthopedic Department, Diaconesses Croix Saint Simon Hospital, Paris, France
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Marmor S, De Panafieu E, Mouton A, Graff W, Le Strat V, Lhotellier L, Kerroumi Y, Gibon E. Doctor, what does my ceramic-on-ceramic hip arthroplasty weigh? Orthop Traumatol Surg Res 2023; 109:103298. [PMID: 35472457 DOI: 10.1016/j.otsr.2022.103298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND While total hip arthroplasty (THA) is generally very successful, certain patients remain dissatisfied. A common concern, especially in younger and more active patients, is the weight the implant will add to the hip. However, there is very little data available to help guide surgeons in addressing this concern. The goal of this study was therefore to compare the weight of the total hip arthroplasty implants to that of tissue removed. HYPOTHESIS That the weight of the total hip arthroplasty implants would exceed that removed tissue. PATIENTS AND METHODS A prospective study was conducted in 104 patients, without interfering with surgical plans. To account for different implant designs, especially relating to stem fixation, we included both cementless (n=51) and cemented (n=53) femoral stems. During the procedure, the removed bone and soft tissues, as well as the post-implantation cement were collected and weighed. The weight of the implants was provided by the manufacturer. RESULTS Both cemented and cementless THA implants proved significantly heavier than the removed bone and soft tissues. The median weight gained was 145g [IQR: 123-168] with the cementless implant and 241g [221-364] with the cemented implant (p<0.001). Multivariable regression analysis of patient- or implant factors influencing weight gain after THA revealed that weight gain decreased with patient BMI (β=-1.0, 95% CI: -2.0--0.1 (p=0.034)). In contrast, weight gain increased slightly with total implant weight (β=0.7, 95% CI: 0.6-0.8 (p≤0.001)). Further, weight gain was greater for women (β=19.0, 95% CI: 9.1-29.0 (p≤0.001) (men 150g [135-219], women 211g [157-250] (p=0.010)) and patients who received the cemented stem (β=40.0, 95% CI, 19.4-46.5, p≤0.001). DISCUSSION Current models cause a two- to three-fold gain of weight at the hip joint after THA. While it is not clear whether this weight increase has any clinical repercussions, this finding can be helpful when a patient raises questions on this topic during the preoperative counseling. More research is necessary to determine whether lighter implants may be beneficial for patients. LEVEL OF EVIDENCE III, case control study.
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Affiliation(s)
- Simon Marmor
- Department of Orthopedic Surgery, Diaconesses Croix Saint-Simon Hospital, 125, rue d'Avron, 75020 Paris, France.
| | - Emmanuel De Panafieu
- Department of Orthopedic Surgery, Diaconesses Croix Saint-Simon Hospital, 125, rue d'Avron, 75020 Paris, France
| | - Antoine Mouton
- Department of Orthopedic Surgery, Diaconesses Croix Saint-Simon Hospital, 125, rue d'Avron, 75020 Paris, France
| | - Wilfrid Graff
- Department of Orthopedic Surgery, Diaconesses Croix Saint-Simon Hospital, 125, rue d'Avron, 75020 Paris, France
| | - Vincent Le Strat
- Department of Orthopedic Surgery, Diaconesses Croix Saint-Simon Hospital, 125, rue d'Avron, 75020 Paris, France
| | - Luc Lhotellier
- Department of Orthopedic Surgery, Diaconesses Croix Saint-Simon Hospital, 125, rue d'Avron, 75020 Paris, France
| | - Younes Kerroumi
- Department of Orthopedic Surgery, Diaconesses Croix Saint-Simon Hospital, 125, rue d'Avron, 75020 Paris, France
| | - Emmanuel Gibon
- Department of Orthopedic Surgery, Diaconesses Croix Saint-Simon Hospital, 125, rue d'Avron, 75020 Paris, France
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Stévignon T, Mouton A, Meyssonnier V, Kerroumi Y, Yazigi A, Aubert T, Lhotellier L, Le Strat V, Passeron D, Graff W, Zeller V, Heym B, Marmor S. Haematogenous prosthetic knee infections: Prospective cohort study of 58 patients. Orthop Traumatol Surg Res 2019; 105:647-651. [PMID: 31047841 DOI: 10.1016/j.otsr.2019.02.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 01/25/2019] [Accepted: 02/01/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prosthetic joint infection (PJI) is a rare (incidence, 0.15% to 0.9%) but serious complication of knee arthroplasty. Haematogenous PJI of the knee (KhPJI) which accounts for 10% of cases, has been less studied than PJI due to other mechanisms. The primary objective of this study in patients with KhPJI of the knee was to determine the 2-year infection eradication failure rate after either exchange arthroplasty or arthrotomy/synovectomy/irrigation (ASI), combined with prolonged peri-operative antibiotic therapy, at a referral centre for complex osteo-articular infections. HYPOTHESIS ASI within 2 weeks after symptom onset and one-stage exchange arthroplasty produce similar 2-year success rates in patients with KhPJI of the knee. MATERIAL AND METHODS A prospective observational cohort study was performed in patients managed for PJI of the knee between 2003 and 2015. The primary outcome measure was the occurrence of a septic event or of KhPJI -related death during a minimum follow-up of 2 years. RESULTS Of 265 patients with PJI after total knee arthroplasty, 58 (22.1%) had KhPJI with onset more than 3 months after the last arthroplasty procedure and were included in the study. Among them, one-third had immune deficiencies. The most common causative organisms were streptococci (n=25, 43%) and Staphylococcusaureus (n=20, 34%). The primary focus of infection was identified in only 64% of patients and was most often cutaneous (n=19, 33%) or dental (n=11, 19%). A septic event or KhPJI-related death occurred in 5/34 (15%) patients after one-stage exchange arthroplasty and 6/19 (32%) patients after ASI within 15 days after symptom onset (p=0.03). Patient characteristics, type of prosthesis, and causative organism were not significantly associated with failure to eradicate the infection. CONCLUSION ASI carried a high failure rate despite being performed within 15 days after symptom onset. One-stage exchange arthroplasty seems to be the best surgical option, particularly as the exact time of symptom onset may be difficult to determine. Identifying and eradicating the primary focus of infection is crucial. LEVEL OF EVIDENCE II, low-powered prospective cohort study.
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Affiliation(s)
- Thomas Stévignon
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France.
| | - Antoine Mouton
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Vanina Meyssonnier
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Younes Kerroumi
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Alexandre Yazigi
- Service de chirurgie oncologique, institut Curie, 35 rue Dailly, 92210 Saint-Cloud, France
| | - Thomas Aubert
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Luc Lhotellier
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Vincent Le Strat
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Dorick Passeron
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Wilfrid Graff
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Valérie Zeller
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Béate Heym
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Simon Marmor
- Service de chirurgie osseuse et traumatologique, centre de référence des infections ostéo-articulaires complexes, groupe hospitalier Diaconesses-Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
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Gibon E, Mouton A, Passeron D, Le Strat V, Graff W, Marmor S. Doctor, what does my knee arthroplasty weigh? J Arthroplasty 2014; 29:2091-4. [PMID: 25113782 DOI: 10.1016/j.arth.2014.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/06/2014] [Accepted: 07/12/2014] [Indexed: 02/01/2023] Open
Abstract
The aim of this study was to compare the weight of the total knee arthroplasty (TKA) implants and the weight of the natural knee. A prospective study was conducted with two different brands of cemented primary TKA. During the procedure, we collected the removed bone, soft tissues and the post-implantation cement and weighed them all separately at the end. In both groups, the implants plus cement were significantly heavier than the removed bone and soft tissues. The average weight gained was 266.7 ± 35.1 g for group 1 and 279.1 ± 48.7 g for group 2. This significant local weight gained after TKA is a new parameter that should be taken into account for further studies and when creating new implants.
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Affiliation(s)
- Emmanuel Gibon
- Croix-Saint-Simon teaching Hospital, Department of Orthopaedic Surgery, 125 rue d'Avron, 75020, Paris, France
| | - Antoine Mouton
- Croix-Saint-Simon teaching Hospital, Department of Orthopaedic Surgery, 125 rue d'Avron, 75020, Paris, France
| | - Dorick Passeron
- Croix-Saint-Simon teaching Hospital, Department of Orthopaedic Surgery, 125 rue d'Avron, 75020, Paris, France
| | - Vincent Le Strat
- Croix-Saint-Simon teaching Hospital, Department of Orthopaedic Surgery, 125 rue d'Avron, 75020, Paris, France
| | - Wilfrid Graff
- Croix-Saint-Simon teaching Hospital, Department of Orthopaedic Surgery, 125 rue d'Avron, 75020, Paris, France
| | - Simon Marmor
- Croix-Saint-Simon teaching Hospital, Department of Orthopaedic Surgery, 125 rue d'Avron, 75020, Paris, France
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