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Kurishima H, Yamada N, Noro A, Tanaka H, Takahashi S, Tsuchida K, Mori Y, Aizawa T. Preserving medial iliofemoral ligament avoids excessive leg lengthening in total hip arthroplasty using anterolateral-supine approach. J Orthop 2025; 60:29-34. [PMID: 39345678 PMCID: PMC11437599 DOI: 10.1016/j.jor.2024.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Accepted: 09/05/2024] [Indexed: 10/01/2024] Open
Abstract
Background In this study, we compared postoperative leg length discrepancy (LLD) after total hip arthroplasty using the anterolateral-supine approach (ALSA THA) with or without medial iliofemoral ligament (mILFL) preservation and examined the effect of the remaining mILFL on postoperative LLD. Methods This was a single-center, retrospective case control study. Unilateral primary THA with a preoperative LLD <15 mm, in which the contralateral side was intact, was included. After ALSA THA, we compared the absolute values of postoperative LLDs and examined the ratio of postoperative LLD >5 mm with and without mILFL preservation. Demographic data, clinical scores, and operative data were collected. Statistical significance was set at p < 0.05. Results We included 341 hips (preservation group: 283 hips; resection group: 58 hips). The mean (range) absolute values of the postoperative LLDs were 2.3 (0-15.9) mm and 3.4 (0-14.8) mm, respectively. There was no significant difference between the two groups (p = 0.36). The proportion of postoperative LLD >5 mm differed significantly between the groups (4.4 % and 20.0 %, respectively; p < 0.01). Multiple logistic regression analysis showed that resection of the mILFL was the only significant factor that caused excessive leg lengthening (odds ratio, 5.28; 95 % confidence interval, 2.12-13.10, p < 0.01). Significant differences were reported in surgical time (81 (38-132) and 96 (54-157), respectively; p < 0.01) and intraoperative blood loss (297 (50-1170) and 388 (100-1150), respectively; p < 0.01). However, no significant differences in clinical scores, dislocation (including instability), or reoperation rates were observed between the two groups. Conclusion In patients with a preoperative LLD <15 mm, preserving the mILFL in ALSA THA avoids excessive leg lengthening and may lead to shorter LLD without any difficulties.
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Affiliation(s)
- Hiroaki Kurishima
- Department of Orthopaedic Surgery, Japanese Red Cross Sendai Hospital, 2-43-3 Yagiyamahoncho, Taihaku-Ku, Sendai, Miyagi, 982-8501, Japan
| | - Norikazu Yamada
- Department of Orthopaedic Surgery, Japanese Red Cross Sendai Hospital, 2-43-3 Yagiyamahoncho, Taihaku-Ku, Sendai, Miyagi, 982-8501, Japan
| | - Atsushi Noro
- Department of Orthopaedic Surgery, Japanese Red Cross Sendai Hospital, 2-43-3 Yagiyamahoncho, Taihaku-Ku, Sendai, Miyagi, 982-8501, Japan
| | - Hidetatsu Tanaka
- Department of Orthopaedic Surgery, Japanese Red Cross Sendai Hospital, 2-43-3 Yagiyamahoncho, Taihaku-Ku, Sendai, Miyagi, 982-8501, Japan
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Shusuke Takahashi
- Department of Orthopaedic Surgery, Japanese Red Cross Sendai Hospital, 2-43-3 Yagiyamahoncho, Taihaku-Ku, Sendai, Miyagi, 982-8501, Japan
| | - Kyota Tsuchida
- Department of Orthopaedic Surgery, Japanese Red Cross Sendai Hospital, 2-43-3 Yagiyamahoncho, Taihaku-Ku, Sendai, Miyagi, 982-8501, Japan
| | - Yu Mori
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
| | - Toshimi Aizawa
- Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
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Yoon C, Eligulashvili A, Seref-Ferlengez Z, Goker B, Kamara E, Mardakhaev E. Automated Web Tool Measurement of Total Hip Arthroplasty Acetabular Component Inclination and Anteversion Angles. Arthroplast Today 2025; 31:101606. [PMID: 39872119 PMCID: PMC11770501 DOI: 10.1016/j.artd.2024.101606] [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: 08/20/2024] [Revised: 11/24/2024] [Accepted: 12/12/2024] [Indexed: 01/29/2025] Open
Abstract
Background Periprosthetic hip dislocation after total hip arthroplasty is a devastating postoperative complication. It is often associated with suboptimal orientation of the acetabular component, characterized by the acetabular abduction and anteversion angles obtained from anteroposterior pelvic radiographs. We introduce a novel automated web tool to streamline the subjective and lengthy process of this manual measurement and compare it to manual human measurements. Methods One board-certified orthopaedic surgeon used the web tool to make automatic measurements of anteroposterior radiographs of 97 patients who underwent unilateral hip arthroplasty. Manual and web tool measurements included abduction angle and calculated anteversion angle by Liaw's method. Differences between manual and web tool measurements were compared with a paired t-test and Bland-Altman analysis. Results There were no statistically significant differences between the average of manual measurements as compared to the web tool measurement in abduction angle (43.29 ± 7.05 vs 43.00 + 6.22, P = .85), anteversion angle (20.43 ± 7.62 vs 20.82 ± 7.37, P = .52), and ratio of the minor axis of the acetabular cup circumference in the AP radiograph to the total length of the acetabular head (0.42 ± 0.15 vs 0.44 ± 0.15, P = .18). The mean difference of average for abduction angle, anteversion angle, and ratio between the short axis of the transverse ellipse to the total length of the acetabular cup were -0.28, 0.39, and 0.02, respectively. Bland-Altman analysis for all 3 measurements displayed negligible systemic bias with random scattering. Conclusions Automated measurements obtained with a novel web tool are in strong agreement with the manually obtained ground truth measurements. The web tool helps to eliminate interobserver differences that arise with manual annotation. The web tool has the potential to streamline acetabular measurements with enhanced accuracy.
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Affiliation(s)
| | | | | | - Barlas Goker
- Department of Orthopedic Surgery, Montefiore Medical Center, Bronx, NY
| | - Eli Kamara
- Department of Orthopedic Surgery, Montefiore Medical Center, Bronx, NY
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Lin S, Villa JM, Rajschmir K, Higuera CA, Grieco P. The Visual Assessment of Cup Position on Anteroposterior Pelvis Radiographs Before Revision Total Hip Arthroplasty for Instability Is Highly Deceiving. Orthopedics 2025; 48:e22-e26. [PMID: 39724076 DOI: 10.3928/01477447-20241219-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2024]
Abstract
BACKGROUND Is "eyeballing" enough to determine cup malposition on anteroposterior (AP) pelvis radiographs before revision total hip arthroplasty (rTHA) for instability? We aimed to determine the following: (1) the reliability of eyeballing cup inclination/anteversion on AP pelvis radiographs vs geometrical measurements and (2) whether visual assessments are affected by surgeon experience. MATERIALS AND METHODS Fifteen de-identified standing AP pelvis radiographs obtained before rTHA for instability were evaluated by one orthopedic surgeon who measured inclination/anteversion of the cups (n=15) using a new simplified method based on basic geometry. Subsequently, 4 orthopedic surgeons and 4 fellows (postgraduate year 6) assessed inclination/anteversion by eyeballing. A modified Lewinnek safe zone range was employed to categorize each value (in degrees) by geometrical measurements or by raters' eyeballing as within or outside the safe zones. Cohen's kappa (κ) statistics were performed. Mean κ values of attending surgeons and fellows were compared. RESULTS According to geometrical measurements, 8 and 12 cups were in malposition (for inclination and anteversion, respectively). By just eyeballing, no attending surgeon or fellow attained an excellent (κ>0.8) level of agreement when compared with geometrical measurements. Only 1 attending surgeon attained a substantial (κ=0.6-0.8) level of agreement (κ=0.737, for inclination, P=.003). Mean κ values of attending surgeons and fellows were 0.476 and 0.187, respectively, for inclination (P=.2) and 0.416 and 0.428, respectively, for anteversion (P=.9). CONCLUSION Eyeballing cup position on AP pelvis radiographs before rTHA for instability is extremely misleading, regardless of surgeon experience. It is imperative to always measure the inclination and anteversion of the cup. [Orthopedics. 2025;48(1):e22-e26.].
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Tsukada S, Ogawa H, Saito M, Hirasawa N. Correlation of Acetabular Cup Placement Angles Between an Artificial Intelligence-Powered System Using a Smartphone and Human Measurements. Arthroplast Today 2024; 29:101439. [PMID: 39328881 PMCID: PMC11424794 DOI: 10.1016/j.artd.2024.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/26/2024] [Accepted: 05/15/2024] [Indexed: 09/28/2024] Open
Abstract
Background An automated measurement system for the placement angles of acetabular cup in total hip arthroplasty prostheses was developed utilizing artificial intelligence (AI) algorithms. The AI-powered system enables immediate measurement by capturing an anteroposterior pelvic X-ray through a smartphone camera. Methods While developing the AI-powered measurement system, we trained AI utilizing 100 labeled anteroposterior pelvic X-rays to recognize the hip joint and 483 labeled anteroposterior pelvic X-rays to identify anatomical landmarks and the acetabular cup. To validate the AI-powered system, we measured the acetabular cup placement angles of 126 unlabeled post-total hip arthroplasty anteroposterior pelvic X-rays with both the AI-powered system and conventional measurement methods and assessed the correlation between the 2 methods. Results The Pearson's correlation coefficients for the acetabular cup placement angles measured using the AI-powered system and conventional method were 0.88 (95% confidence interval, 0.84-0.92, P < .001) in inclination angle and 0.76 (95% confidence interval, 0.67-0.83, P < .001) in anteversion angle, respectively. Conclusions Both inclination and anteversion angles measured using the AI-powered system showed a strong correlation with angles obtained through conventional methods.
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Affiliation(s)
- Sachiyuki Tsukada
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Hiroyuki Ogawa
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Masayoshi Saito
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
| | - Naoyuki Hirasawa
- Department of Orthopaedic Surgery, Hokusuikai Kinen Hospital, Ibaraki, Japan
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Coxe FR, Jordan LA, Wong ZP, Spaan JC, Ren R, Su EP. Functional Acetabular Component Positioning During Direct Anterior Approach Hip Arthroplasty Using a Novel Three-Dimensional Virtual Mesh Imaging System With Fluoroscopy. J Arthroplasty 2024; 39:S88-S96. [PMID: 38522804 DOI: 10.1016/j.arth.2024.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Optimal position of total hip arthroplasty (THA) components is critical for joint mechanics and stability. Acetabular component positioning during supine surgery in direct anterior approach (DAA) THA may be different in the standing position postoperatively, which traditional fluoroscopy is unable to predict. A novel 3-dimensional (3D) image analysis technology (IAT) that uses artificial intelligence to measure the tilt and rotation of the pelvis has enabled prediction of component positioning from supine to standing. The purpose of this study was to compare intraoperative fluoroscopy, non-3D-IAT, and 3D-IAT with postoperative standing radiographs to assess the accuracy of component positioning. METHODS From 2022 to 2023, 30 consecutive patients (86.6% women, mean age 59 [range, 55 to 67]) undergoing primary DAA THA with the use of the 3D-IAT were identified. A separate cohort of 148 patients from 2020 to 2021 (85% women, mean age 65 [range, 55 to 69]) who underwent DAA THA with non-3D-IAT was used for comparison. Leg length discrepancy (LLD), cup anteversion, and inclination were manually measured on intraoperative fluoroscopic images and digitally measured using IAT. Follow-up evaluation occurred at 1 month with standing pelvis radiographs measured using Ein Bild Röntgen Analyze-Cup software. Measurements were compared via Wilcoxon signed rank tests where P ≤ .05 indicates significantly different measurements. RESULTS Median LLD, inclination, and anteversion measurements via non-3D-IAT and fluoroscopy were significantly different compared to postoperative standing radiographs (P < .001). The 3D-IAT more accurately predicted LLD, abduction, and anteversion, with values not significantly different from postoperative standing measurements (P = .23, P = .93, and P = .36, respectively). CONCLUSIONS The use of the 3D-IAT during DAA THA allowed for the more accurate prediction of acetabular component position in the standing position postoperatively.
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Affiliation(s)
- Francesca R Coxe
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - L Andrew Jordan
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Zachary P Wong
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Jonathan C Spaan
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Renee Ren
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Edwin P Su
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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Kaushik A, Kumar C V, Hegde A, Mathias L, Shetty V. Assessing the Reliability of Postoperative Cross-Table Radiographs Compared to CT Scans for Measuring Acetabular Anteversion Angle Following Total Hip Arthroplasty. Cureus 2024; 16:e68575. [PMID: 39371801 PMCID: PMC11449688 DOI: 10.7759/cureus.68575] [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: 09/03/2024] [Indexed: 10/08/2024] Open
Abstract
AIM This study aimed to evaluate acetabular anteversion following total hip arthroplasty (THA) using cross-table lateral radiographs and CT scans and to determine the reliability of cross-table lateral radiographs compared to computed tomography (CT) scans for measuring acetabular anteversion. MATERIALS AND METHODS We conducted a cross-sectional study of patients undergoing THA at Justice K.S. Hegde Charitable Hospital, Deralakatte, Mangalore, from January 2020 to June 2021. Radiographs are typically taken in both anteroposterior (AP) and lateral views after THA. However, for this study, a cross-table lateral view was used instead of the usual lateral radiograph to measure the angle of anteversion. The anteversion was calculated using the method described by Woo and Morrey. Additionally, CT scans were performed on all patients as part of the study protocol. The anteversion measured in these scans was compared to that in the cross-table radiographs to assess the latter's reliability for routine use. The risk of radiation exposure from CT scans was minimized by adhering to the ALARA (As Low as Reasonably Achievable) principle, with only axial sections of the acetabular cup being scanned. RESULTS The results show that the radiographic acetabular anteversion and CT scan measurements have a mean difference of 0.3036. There is a positive correlation between these measurements. The p-value is not statistically significant (p=0.698). Therefore, the measurements are correlated with each other with a linear relationship (r=0.919). For anteversion measurements using the X-ray method, the mean was 27.16 degrees with a standard deviation of ±9.49. The median was 27.26 degrees, ranging from 10.27 to 42.58 degrees. In comparison, the CT method yielded a mean anteversion of 27.40 degrees with a standard deviation of ±8.50 degrees. The median was 27.64 degrees, ranging from 12.35 to 43.11 degrees. CONCLUSION Cross-table lateral radiographs are a reliable and comparable method to CT scans for measuring acetabular anteversion following total hip arthroplasty.
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Affiliation(s)
- Adhithya Kaushik
- Orthopaedics, Meenakshi Medical College Hospital and Research Institute, Kanchipuram, IND
| | - Vinay Kumar C
- Orthopaedics, K S Hegde Medical Academy, Mangalore, IND
| | - Anoop Hegde
- Orthopaedics, K S Hegde Medical Academy, Mangalore, IND
| | | | - Vikram Shetty
- Orthopaedics, K S Hegde Medical Academy, Mangalore, IND
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Zhang S, Ma M, Kong X, Zhou Y, Chen J, Chai W. Robotic-assisted total hip arthroplasty in patients with developmental dysplasia of the hip. INTERNATIONAL ORTHOPAEDICS 2024; 48:1189-1199. [PMID: 38358516 DOI: 10.1007/s00264-024-06115-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Abstract
PURPOSES Due to the morphological diversity of deformities, technical difficulties, improperly designed components, and so on, THA remains a challenging task in dysplastic hips, especially in highly dislocated hips. The purpose of this study was to comprehensively evaluate the clinical outcomes of robot-assisted THA in patients with DDH through a large cohort study, including the precision of acetabular cup positioning, indicators of inflammatory response, indicators of muscle damage, and complications. METHODS We retrospectively analyzed patients with DDH who underwent THA in our prospectively constructed joint registry between August 2018 and August 2022. Finally, 147 manual THAs and 147 robotic-assisted THAs were included in the final analysis. Patient demographics, indicators of inflammation, indicators of muscle damage, operative time, Harris hip scores (HHS), and forgotten joint score (FJS) were recorded for analysis. The precision of the positioning of the acetabular component was assessed with plain radiographs. RESULTS In the Crowe II/III groups, the reconstructed center of rotation (COR) in the robotic-assisted group was closer to the anatomical COR with less variation than the manual group (absolute horizontal distances of COR 3.5 ± 2.8 vs. 5.4 ± 4.9 mm, p < 0.05; absolute vertical distances of COR 6.4 ± 4.1 vs. 11.7 ± 8.2 mm, p = 0.001). For all Crowe subtypes, the robotic-assisted THA significantly increased the proportion of acetabular cups located in the safety zone within 5° (all p < 0.05). Interleukin-6 and creatine kinase levels were slightly lower and significantly different in the robotic-assisted group at three days postoperatively (all p < 0.05). CONCLUSIONS Compared to the manual technique, the robot-assisted technique improved the precision and reproducibility of acetabular component positioning, particularly in DDH patients with Crowe types II/III. The robotic-assisted technique did not increase operative time, bleeding, complications, or revision rates, and had a slighter early inflammatory response and muscle damage.
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Affiliation(s)
- Shuai Zhang
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China
- Department of Orthopedics, the 969th Hospital of the PLA joint Logisitcs Support Force, No. 51 Aimin street, Xincheng District, Huhehaote, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Mingyang Ma
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
| | - Xiangpeng Kong
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Yonggang Zhou
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
| | - Jiying Chen
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
| | - Wei Chai
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
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Kebbach M, Schulze C, Meyenburg C, Kluess D, Sungu M, Hartmann A, Günther KP, Bader R. Do hip resurfacing and short hip stem arthroplasties differ from conventional hip stem replacement regarding impingement-free range of motion? J Orthop Res 2023; 41:2501-2515. [PMID: 37132090 DOI: 10.1002/jor.25584] [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: 01/06/2023] [Revised: 04/14/2023] [Accepted: 05/01/2023] [Indexed: 05/04/2023]
Abstract
Total hip joint replacement (THR) is clinically well-established. In this context, the resulting range of motion (ROM) is crucial for patient satisfaction when performing joint movements. However, the ROM for THR with different bone preserving strategies (short hip stem and hip resurfacing) raises the question of whether the ROM is comparable with conventional hip stems. Therefore, this computer-based study aimed to investigate the ROM and type of impingement for different implant systems. An established framework with computer-aided design 3D models based on magnetic resonance imaging data of 19 patients with hip osteoarthritis was used to analyse the ROM for three different implant systems (conventional hip stem vs. short hip stem vs. hip resurfacing) during typical joint movements. Our results revealed that all three designs led to mean maximum flexion higher than 110°. However, hip resurfacing showed less ROM (-5% against conventional and -6% against short hip stem). No significant differences were observed between the conventional and short hip stem during maximum flexion and internal rotation. Contrarily, a significant difference was detected between the conventional hip stem and hip resurfacing during internal rotation (p = 0.003). The ROM of the hip resurfacing was lower than the conventional and short hip stem during all three movements. Furthermore, hip resurfacing shifted the impingement type to implant-to-bone impingement compared with the other implant designs. The calculated ROMs of the implant systems achieved physiological levels during maximum flexion and internal rotation. However, bone impingement was more likely during internal rotation with increasing bone preservation. Despite the larger head diameter of hip resurfacing, the ROM examined was substantially lower than that of conventional and short hip stem.
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Affiliation(s)
- Maeruan Kebbach
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Christian Schulze
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Christian Meyenburg
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Daniel Kluess
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Mevluet Sungu
- Research and Development, Aesculap AG, Tuttlingen, Germany
| | - Albrecht Hartmann
- Department of Orthopedic Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Klaus-Peter Günther
- Department of Orthopedic Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Rainer Bader
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
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Zhang S, Liu Y, Ma M, Cao Z, Kong X, Chai W. Is Robotic-Assisted Technology Still Accurate in Total Hip Arthroplasty for Fibrous-Fused Hips? J Arthroplasty 2023; 38:129-134. [PMID: 35940352 DOI: 10.1016/j.arth.2022.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) for fibrous-fused hips is technically demanding. This study aimed to evaluate the precision and accuracy, as well as the rate of conversion of robotic-assisted THA in such difficult patients. METHODS We retrospectively analyzed 67 patients (84 hips) who underwent THA with fibrous-fused hips between August 2018 and June 2021 at our institution. Demographics, acetabular cup positioning, leg-length discrepancies, and postoperative Harris hip scores were recorded for all patients. Thirty-six patients (44 hips) who underwent robotic-assisted THA and 31 patients (40 hips) who underwent manual THA were enrolled in this study. RESULTS The robot accurately executed the preoperative plan, and there were no statistically significant differences between the preoperative planned anteversion, inclination, and postoperative measurements. In the robotic group, the percentage of acetabular cups in the safe zone was significantly higher than in the manual group (87.2 versus 55%, respectively, P = .042). The rate of conversion to manual THA for various reasons in the robotic-assisted THA group was 11.4% (5/44). Compared with manual THA, the mean increase in operative time for conversion from robotic-assisted to manual THA was 24 min (P < .001). CONCLUSION In patients who have fibrous-fused hips, preoperative planning can be accurately executed by robotic-assisted technology. Compared with manual THA, robotic-assisted THA had a remarkable advantage in improving the frequency of achieving cup positioning within the target zone. Overall, robotic-assisted technology was helpful in such difficult cases, and the approximately 11.4% of cases converted to manual THA are reminders that surgeons should be thoroughly prepared preoperatively.
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Affiliation(s)
- Shuai Zhang
- Medical School of Chinese PLA, Beijing, China; Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Yubo Liu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China; School of Medicine, Nankai University, Tianjin, China
| | - Mingyang Ma
- Medical School of Chinese PLA, Beijing, China; Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Zheng Cao
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China; School of Medicine, Nankai University, Tianjin, China
| | - Xiangpeng Kong
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Wei Chai
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China; National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
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Chen WC, Wu TY, Chi KY, Weng PW, Huang YM, Lin YC, Liaw CK. Laser projector method for measuring postoperative acetabular anteversion after total hip replacement. Front Surg 2022; 9:1033453. [PMID: 36353614 PMCID: PMC9637855 DOI: 10.3389/fsurg.2022.1033453] [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: 09/01/2022] [Accepted: 09/30/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION For patients undergoing THR, measuring the postoperative acetabular anteversion precisely plays a pivotal role in the prognosis. However, using elliptical methods mandates computerized equipment that is frequently in shortage in remote areas and developing countries. We invented a laser projector utilizing the ellipse method to measure the acetabular anteversion directly. The aim is to examine the consistency and validity of the laser projector as compared to our original software, Elliversion. MATERIALS AND METHODS We retrospectively collected 50 postoperative pelvis radiographs including acetabulum from our institution. One investigator first measured the anteversion of included radiographs through Elliversion software as the control group. Subsequently, two operators independently used the laser projector for measurements in two separate periods with 1-day intervals as the experimental group. Our analysis was comprised of intra- and inter-observer comparisons and reliability, which investigated both the consistency and validity, by using two-sample student's t-test and intraclass correlation coefficient. RESULTS There was no significant difference in measuring the anteversion through laser projectors between two operators (p = 0.54), with excellent inter-observer reliability (ICC, 0.967). The estimated effect in the anteversion measurement between the Elliversion and laser projector was also comparable, with the ICC level of 0.984, indicating excellent reliability. CONCLUSION Our study reported the consistency and validity of this laser projector as there is no significant difference between Elliversion and Laser projector, notably with excellent intra- and inter-observer reliability. We look forward to helping elevate clinical acumen when doctors provide care to patients after THR, especially in remote areas.
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Affiliation(s)
- Wei-Cheng Chen
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tai-Yin Wu
- Department of Family Medicine, Taipei City Hospital, Taipei, Taiwan,Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuan-Yu Chi
- Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan,Department of Education, Center for Evidence-Based Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Pei-Wei Weng
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yu-Min Huang
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yi-Chia Lin
- Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Chen-Kun Liaw
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan,Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan,Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan,Correspondence: Chen-Kun Liaw
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11
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Zhang S, Liu Y, Yang M, Ma M, Cao Z, Kong X, Chai W. Robotic-assisted versus manual total hip arthroplasty in obese patients: a retrospective case-control study. J Orthop Surg Res 2022; 17:368. [PMID: 35907875 PMCID: PMC9338672 DOI: 10.1186/s13018-022-03263-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/25/2022] [Indexed: 11/12/2022] Open
Abstract
Aims The objective of this study was to evaluate the accuracy of acetabular cup positioning in the obese patients when using robotic-assisted technology during total hip arthroplasty (THA). Methods Data were retrospectively collected from patients who underwent primary (THA) with a body mass index (BMI) ≥ 28 kg/m2 and ≥ 1 year of follow-up between January 2018 and December 2019. Their demographics, diagnosis, acetabular cup positioning, American Society of Anesthesiologists (ASA) score, Harris Hip Score (HHS), and Forgotten Joint Score (FJS) at the final follow-up were recorded for analysis. Results There were no statistically significant differences between the two groups in height, weight, BMI, ASA score, or preoperative Harris Hip Score (HHS). Also, there was no difference in inclination angle between the two groups (R-THA: 41.29° ± 3.04°; manual THA (M-THA): 40.47° ± 5.46°; P = 0.312). However, the mean anteversion angle was greater in the R-THA group (20.71° ± 1.98° vs. 19.08° ± 4.04°; P < 0.001). Compared to M-THA, R-THA more frequently achieved an acetabular cup angle within 5° of the target (anteversion, 98.1% vs. 78.1% P = 0.001; inclination, 88.5% vs. 53.1%, P < 0.001). The R-THA group was more advantageous in restoring the hip center of rotation (COR) and leg length difference (LLD). There was no statistical difference in postoperative HHS (P = 0.404) or FJS (P = 0.497) between the two groups. Conclusions Compared to manual technique, robotic-assisted technique provided more precise acetabular cup positioning and better leg length restoration for obese patients. The robotic-assisted technique was more advantageous in recovering the center of rotation position and achieved a higher proportion of the acetabular cup placed in the target safety zone. Further studies are needed to confirm the clinical outcomes of surgeries in obese patients using robotic-assisted technology.
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Affiliation(s)
- Shuai Zhang
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing, China.,Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Yubo Liu
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, China
| | - Minzhi Yang
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, China
| | - Mingyang Ma
- Medical School of Chinese PLA, No. 28 Fuxing Road, Haidian District, Beijing, China.,Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China
| | - Zheng Cao
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.,School of Medicine, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin, China
| | - Xiangpeng Kong
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China. .,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
| | - Wei Chai
- Senior Department of Orthopedics, the Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 100853, China. .,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, No. 28 Fuxing Road, Haidian District, Beijing, China.
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12
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Chai W, Xu C, Guo RW, Kong XP, Fu J, Tang PF, Chen JY. Does robotic-assisted computer navigation improve acetabular cup positioning in total hip arthroplasty for Crowe III/IV hip dysplasia? A propensity score case-match analysis. INTERNATIONAL ORTHOPAEDICS 2022; 46:769-777. [PMID: 34997288 DOI: 10.1007/s00264-021-05232-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 09/24/2021] [Indexed: 11/25/2022]
Abstract
AIMS Total hip arthroplasty (THA) in patients with hip-dislocation dysplasia remains challenging. This study aims to evaluate whether these patients may benefit from robotic-assisted techniques. METHODS We reviewed 135 THAs (108 conventional THAs and 27 robotic-assisted THAs) for Crowe type III or IV from January 2017 to August 2019 in our institution. Robotic-assisted THAs were matched with conventional THAs at a 1:1 ratio (27 hips each group) using propensity score matching. The accuracy of cup positioning and clinical outcomes were compared between groups. RESULTS The inclination of the cup for conventional THAs and robotic THAs was 42.1 ± 5.7 and 41.3 ± 4.6 (p = 0.574), respectively. The anteversion of the cup for conventional THAs was significantly greater than that of robotic THAs (29.5 ± 8.1 and 18.0 ± 4.6; p < 0.001), respectively. The ratio of the acetabular cup in the Lewinnek safe zone was 37% (10/27) in conventional THAs and 96.3% (26/27) in robotic THAs (p < 0.001). Robotic THAs did not achieve better leg length discrepancy than that of conventional THAs (- 0.4 ± 10.9 mm vs. 0.4 ± 8.8 mm, p = 0.774). There was no difference in Harris Hip Score and WOMAC Osteoarthritis index between groups at the 2-year follow-up. No dislocation occurred in all cases at the final follow-up. CONCLUSION Robotic-assisted THA for patients with high dislocation improves the accuracy of the implantation of the acetabular component with respect to safe zone.
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Affiliation(s)
- Wei Chai
- Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chi Xu
- Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ren-Wen Guo
- Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiang-Peng Kong
- Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jun Fu
- Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Pei-Fu Tang
- Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
- Department of Orthopaedics, General Hospital of People's Liberation Army, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
| | - Ji-Ying Chen
- Senior Department of Orthopedics, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China.
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.
- Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, China.
- Department of Orthopaedics, General Hospital of People's Liberation Army, No. 28 Fuxing Road, Haidian District, Beijing, 100853, China.
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13
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Mouri K, Karita T. Short-term clinical and radiographic outcomes of total hip arthroplasty with PMPC-grafted highly cross-linked polyethylene liners against 32-mm femoral heads. J Artif Organs 2021; 24:234-242. [PMID: 33449228 PMCID: PMC8154771 DOI: 10.1007/s10047-020-01246-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/28/2020] [Indexed: 11/28/2022]
Abstract
We evaluated the clinical and radiographic outcomes of femoral head penetration and total hip arthroplasties with untreated and poly (2-methacryloyloxyethyl phosphorylcholine) (PMPC)-grafted highly cross-linked polyethylene (HXLPE) acetabular liners against 26-, 28-, and 32-mm cobalt-chromium alloy femoral heads 3 years after the index surgery. Three combinations of the articulating surfaces were evaluated in the present study: untreated or PMPC-grafted HXLPE liner against 26- or 28-mm femoral heads (n = 16, 24) [control (26 or 28 mm) and PMPC (26 or 28 mm)] and PMPC-grafted HXLPE liner against 32-mm femoral heads (n = 64) [PMPC (32 mm)]. The clinical outcomes improved at 3 years postoperatively for the groups. No periprosthetic osteolysis or acetabular component migration was detected, and no revision surgery was performed among the groups. The steady-state wear rate of the PMPC (26 or 28 mm) group (0.021 mm/year) was lower than that of the control (26 or 28 mm) group (- 0.015 mm/year); the steady-state wear was under the clinical threshold. In contrast, the steady-state wear rate of the PMPC (32 mm) group (-0.006 mm/year) showed no significant difference when compared to that of the PMPC (26 or 28 mm) group (p < 0.01). The results obtained in the present study clearly demonstrate that PMPC-grafting onto an HXLPE surface improved the wear resistance of acetabular liners, even when coupled with larger femoral heads. Although further follow-up evaluations are required, PMPC-grafted HXLPE acetabular liners may be a promising approach to extend the longevity of artificial joints.
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Affiliation(s)
- Kanto Mouri
- Orthopedics Department, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Tatsuro KaritaFuchu, Tokyo, 183-8524, Japan
| | - Tatsuro Karita
- Orthopedics Department, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Tatsuro KaritaFuchu, Tokyo, 183-8524, Japan.
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14
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Dislocation is a Leading Cause of Decreased Survival Rate in Primary Total Hip Arthroplasty Performed by Low-Volume Surgeons: Long-Term Retrospective Cohort Study. J Arthroplasty 2020; 35:3237-3241. [PMID: 32586657 DOI: 10.1016/j.arth.2020.05.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/08/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the complications and long-term survival of primary total hip arthroplasty (THA) performed by low-volume (LV) surgeons at a LV hospital. We also determined the relationship between complications and revisions. METHODS This retrospective cohort study included 220 THAs in 194 patients treated at our institution between 1998 and 2008, who received a minimum of a 10-year follow-up. The median annual THA volume at this hospital was 23 procedures (range, 11-32), and the annual volume per surgeon ranged from 1 to 19. We investigated the 90-day mortality and rates of periprosthetic joint infections, dislocations, and periprosthetic fractures up to the last visit (median follow-up, 11.8 years). Kaplan-Meier survival was calculated with revision as the end point. RESULTS Postoperative infections, dislocations, and fractures at any time during the follow-up period were reported for 1 hip (0.5%), 23 hips (9.8%), and 4 hips (1.8%), respectively. One death occurred within the first 90 days postoperatively. Fifteen hips required revision surgery, and the survival rate was 95.5% at 5 years and 94.1% at 10 years. Of 10 hips that required early revision surgery within 5 years after the index surgery, 9 were revisions to address recurrent dislocation. CONCLUSION The risk of dislocation was high. A high number of patients who underwent THA by LV surgeons required early revision because of dislocation. To achieve optimal long-term survivorship, LV surgeons should consider measures to reduce the risk of dislocation.
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15
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Kong X, Yang M, Li X, Ni M, Zhang G, Chen J, Chai W. Impact of surgeon handedness in manual and robot-assisted total hip arthroplasty. J Orthop Surg Res 2020; 15:159. [PMID: 32316973 PMCID: PMC7171772 DOI: 10.1186/s13018-020-01671-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/03/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The purpose of this study was to examine whether surgeon handedness could affect cup positioning in manual total hip arthroplasty (THA), and whether robot could diminish or eliminate the impact of surgeon handedness on cup positioning in robot-assisted THA. METHODS Fifty-three patients who underwent bilateral robot-assisted THA and sixty-two patients who underwent bilateral manual THA between August 2018 and July 2019 in our institute were respectively analyzed in this study. When the difference between the bilateral anteversion and inclination was greater than 5°, the patient was regarded as having different cup positioning between bilateral THA. Their demographics, orientation of acetabular cup, and postoperative 3 month Harris hip score (HHS) were recorded for analysis. RESULTS There were no significant differences in the gender, age, BMI, diagnosis's composition, and preoperative and postoperative HHS between the robotic and manual group. Two left hips dislocated in the manual group. The anteversion of left hip was significantly larger than that of right hip (24.77 ± 10.44 vs 22.44 ± 8.67, p = 0.043) in the manual group. There were no significant differences of cup positioning between bilateral robot-assisted THA. The patients in manual group were significantly more likely to have different cup positioning between bilateral hips than those in robotic group (77% vs 45%, p = 0.000). More manual THA were located out of the target zone than robot-assisted THA (70% vs 48%, p = 0.001). CONCLUSIONS Surgeon's handedness showed a trend towards an impact on cup positioning in manual THA and robot might help surgeon eliminate the adverse impact. However, the impact of handedness on the clinical outcomes still needs further observation.
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Affiliation(s)
- Xiangpeng Kong
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Minzhi Yang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian, Beijing, 100853, China.,Medical College, Nankai University, Tianjin, China
| | - Xiang Li
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Ming Ni
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Guoqiang Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian, Beijing, 100853, China
| | - Jiying Chen
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian, Beijing, 100853, China.
| | - Wei Chai
- Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian, Beijing, 100853, China.
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16
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Bachhal V, Saini G, Jindal N, Sament R, Dadra A. GeoGebra: A reliable and free software for measuring acetabular cup anteversion on digitalized plain radiographs. J Clin Orthop Trauma 2020; 11:S201-S205. [PMID: 32189940 PMCID: PMC7068040 DOI: 10.1016/j.jcot.2020.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/14/2020] [Accepted: 02/03/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Although accurate measurement of cup anteversion in hip replacement requires CT scans, however, its routine application, especially during follow-up, remains economically and ethically unreasonable. Thus, several methods have been devised for making this measurement on plain radiographs. In recent years, several ways have been adopted using software on digital radiographs. We present one such method which uses open access mathematical software GeoGebra. METHODS Anteversion was measured on 72 radiographs (36 cemented; 36 uncemented) by three different observers using this software. One observer repeated measurements at three weeks interval. RESULTS The intraclass correlation coefficient for interobserver variability and intraobserver variability was 0.982 (0.973-0.989) and 0.986 (0.978-0.991) respectively. There was a significant difference in the reliability of the method for cemented and uncemented cups with higher reliability for cemented cups (p < 0.001). CONCLUSION GeoGebra software can be used as a reliable alternative for measuring acetabular cup anteversion on good quality well centred digital radiographs of the pelvis.
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Affiliation(s)
- Vikas Bachhal
- Department of Orthopaedics, PGIMER, Sector 12, Chandigarh, India
- Corresponding author.
| | - Gaurav Saini
- Max Superspeciality Hospital, Phase 1, Mohali, Punjab, India
| | - Nipun Jindal
- Government of India, Shimla, Himachal Pradesh, India
| | | | - Ankit Dadra
- ESI Hospital, Sector 15, Rohini, New Delhi, India
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17
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Zhao JX, Su XY, Zhao Z, Xiao RX, Zhang LC, Tang PF. Radiographic assessment of the cup orientation after total hip arthroplasty: a literature review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:130. [PMID: 32175423 DOI: 10.21037/atm.2019.12.150] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Optimal acetabular cup orientation is of substantial importance to good long-term function and low complication rates after total hip arthroplasty (THA). The radiographic anteversion (RA) and inclination (RI) angles of the cup are typically studied due to the practicability, simplicity, and ease of interpretation of their measurements. A great number of methods have been developed to date, most of which have been performed on pelvic or hip anteroposterior radiographs. However, there are primarily two influencing factors for these methods: X-ray offset and pelvic rotation. In addition, there are three types of pelvic rotations about the transverse, longitudinal, and anteroposterior axes of the body. Their effects on the RA and RI angles of the cup are interactively correlated with the position and true orientation of the cup. To date, various fitted or analytical models have been established to disclose the correlations between the X-ray offset and pelvic rotation and the RA and RI angles of the cup. Most of these models do not incorporate all the potential influencing parameters. Advanced methods for performing X-ray offset and pelvic rotation corrections are mainly performed on a single pelvic AP radiograph, two synchronized radiographs, or a two-dimensional/three-dimensional (2D-3D) registration system. Some measurement systems, originally developed for evaluating implant migration or wear, could also be used for correcting the X-ray offset and pelvic rotation simultaneously, but some drawbacks still exist with these systems. Above all, the 2D-3D registration technique might be an alternative and powerful tool for accurately measuring cup orientation. In addition to the current methods used for postoperative assessment, navigation systems and augmented reality are also used for the preoperative planning and intraoperative guidance of cup placement. With the continuing development of artificial intelligence and machine learning, these techniques could be incorporated into robot-assisted orthopaedic surgery in the future.
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Affiliation(s)
- Jing-Xin Zhao
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Xiu-Yun Su
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,Intelligent and Digital Surgery Innovation Center, Southern University of Science and Technology Hospital, Shenzhen, Guangdong 518055, China
| | - Zhe Zhao
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Ruo-Xiu Xiao
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Li-Cheng Zhang
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Pei-Fu Tang
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
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18
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Delagrammaticas DE, Ochenjele G, Rosenthal BD, Assenmacher B, Manning DW, Stover MD. Intraoperative evaluation of acetabular cup position during anterior approach total hip arthroplasty: are we accurately interpreting? Hip Int 2020; 30:40-47. [PMID: 31387397 DOI: 10.1177/1120700019868665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Intraoperative radiographic evaluation during total hip arthroplasty (THA) has shown to improve the accuracy of acetabular component placement, however, differences in interpretation based on radiographic technique has not been established. This study aims to determine if differences exist in the interpretation of acetabular component abduction and anteversion between different radiographic projections. METHODS 55 consecutive direct anterior THAs in 49 patients were prospectively enrolled. Target anteversion and abduction was defined by the Lewinnek zone. Fluoroscopy was used to direct acetabular component placement intraoperatively. After final cup implantation, fluoroscopic posterior-anterior hip and pelvis images were obtained for analysis. After completion of the procedure, an anterior-posterior plain pelvis radiograph was obtained in the operating room. Acetabulum component abduction and anteversion were postoperatively determined using specialised software on each of the 3 image acquisition methods. RESULTS Average acetabular cup abduction for intraoperative fluoroscopic posterior-anterior hip (FH), intraoperative fluoroscopic posterior-anterior pelvis (FP), and postoperative, standard, anteroposterior pelvis radiographs (PP) was 40.95° ± 2.87°, 38.87° ± 3.82° and 41.73° ± 2.96° respectively. The fluoroscopic hip and fluoroscopic pelvis tended to underestimate acetabular cup abduction compared to the postoperative pelvis (p < 0.001). Average acetabular cup anteversion for FH, FP, and PP was 19.89° ± 4.87°, 24.38° ± 5.31° and 13.36° ± 3.52° respectively. Both the fluoroscopic hip and fluoroscopic pelvis overestimated anteversion compared to the AP pelvis, with a 6.38° greater mean value measurement for FH (p < 0.001), and an 11° greater mean value measurement for FP (p < 0.001). CONCLUSIONS Fluoroscopic technique and differences between radiographic projections may result in discrepancies in component position interpretation. Our results support the use of the fluoroscopic posterior-anterior hip as the choice fluoroscopic imaging technique.
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Affiliation(s)
- Dimitri E Delagrammaticas
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - George Ochenjele
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brett D Rosenthal
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Benjamin Assenmacher
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David W Manning
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael D Stover
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Muir JM, Vincent J, Schipper J, Gobin VD, Govindarajan M, Fiaes K, Vigdorchik J. A Novel Method for Correcting Pelvic Tilt on Anteroposterior Pelvic Radiographs. Cureus 2019; 11:e6274. [PMID: 31911867 PMCID: PMC6939981 DOI: 10.7759/cureus.6274] [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] [Indexed: 11/05/2022] Open
Abstract
Background Anteroposterior (AP) pelvic radiographs remain the standard for pre- and postoperative imaging during total hip arthroplasty (THA), despite the known limitation of plain films, including the inability to adequately account for distortion caused by variations in pelvic orientation such as pelvic tilt. The purpose of this study was to develop a reliable method for correcting pelvic tilt on AP pelvic radiographs in patients undergoing THA. Methods CT scans from 20 patients/cadaver specimens (10 male, 10 female) were used to create 3D renderings, from which synthetic radiographs of each pelvis were generated. For each pelvis, 13 synthetic radiographs were generated, showing the pelvis at between -30° and 30° of pelvic tilt, in 5° increments. On each image, eight unique parameters/distances were measured to determine the most appropriate parameters for the calculation of pelvic tilt. The most reliable and accurate of these parameters was determined via regression analysis and used to create gender-specific nomograms from which pelvic tilt measurements could be calculated. The accuracy and reliability of the nomograms and correction method were subsequently validated using both synthetic radiographs (n=50) and stereoradiographic images (n=58). Results Of the eight parameters measured, the vertical distance between the superior margin of the pubic symphysis and the transischial line (PSTI) was determined to be the most reliable (r=-0.96, ICC=0.94). Using that parameter and applying the associated nomograms to 50 synthetic radiographs of random pelvic tilt, the mean difference between the actual pelvic tilt and that calculated using the correction method was 0.1°±5.1° (p=0.98, r=0.96). In 58 stereoradiographic images, the mean difference between actual and measured pelvic tilt was -0.2°±6.4° (p=0.74, r=0.77). The pooled results indicate no significant difference between actual (2.2°±13.9°) and measured pelvic tilt (2.1°±14.3°, p=0.93, r=0.91). No significant differences were noted based on gender. Conclusions Our method of correcting for pelvic tilt using the vertical distance from the pubic symphysis to the transischial line provides a reliable method for correcting for pelvic tilt on AP pelvic radiographs.
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Affiliation(s)
| | - John Vincent
- Medicine, Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, CAN
| | - Joseph Schipper
- Orthopaedics, Research & Development, Intellijoint Surgical, Kitchener, CAN
| | | | - Meinusha Govindarajan
- Epidemiology and Public Health, School of Public Health and Health Systems, University of Waterloo, Waterloo, CAN
| | - Karlina Fiaes
- Epidemiology and Public Health, School of Public Health and Health Systems, University of Waterloo, Waterloo, CAN
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Moon NH, Shin WC, Kim JS, Woo SH, Son SM, Suh KT. Cementless total hip arthroplasty following failed internal fixation for femoral neck and intertrochanteric fractures: A comparative study with 3-13 years' follow-up of 96 consecutive patients. Injury 2019; 50:713-719. [PMID: 30670321 DOI: 10.1016/j.injury.2019.01.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/18/2018] [Accepted: 01/12/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to investigate the postoperative outcomes of cementless Total hip arthroplasty (THA) following failed internal fixation for femoral neck and intertrochanteric fractures. METHOD Ninety-six cementless THAs for failed internal fixation after femoral neck fracture (59, group I) and intertrochanteric fracture (37, group II) with a minimum follow-up of 3 years were analyzed. Clinical and radiologic evaluations were performed on all patients. RESULTS The intraoperative blood loss and operating time were significantly increased in group II (p = 0.001, p = 0.001, respectively). Harris hip score at last follow-up was significantly improved in group I (p = 0.007) but, there were no differences in hospital stay, Koval score at last follow-up, and perioperative complications between both groups. Long femoral stems for diaphyseal fitting were frequently used in group II (32/37, 86%) (p = 0.001). Radiographically, none of the acetabular cups showed evidence of migration, loosening. All cases showed stable fixation of the femoral stem at last follow-up. CONCLUSIONS Outcomes of cementless THA following failed internal fixation for femoral neck and intertrochanteric fractures were satisfactory; increased intraoperative blood loss, operating time, and requirement of long femoral stem should be considered in the latter type of fracture.
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Affiliation(s)
- Nam Hoon Moon
- Department of Orthopaedic Surgery, Pusan National University Hospital, Busan, Republic of Korea.
| | - Won Chul Shin
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
| | - Jung Shin Kim
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
| | - Seung Hun Woo
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
| | - Seung Min Son
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
| | - Kuen Tak Suh
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
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Kagan R, Anderson MB, Peters C, Pelt C, Gililland J. Pinnacle polyethylene liner dissociation: a report of 3 cases. Arthroplast Today 2018; 4:441-446. [PMID: 30569007 PMCID: PMC6287959 DOI: 10.1016/j.artd.2018.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 11/17/2022] Open
Abstract
We describe 3 cases of DePuy Pinnacle polyethylene dissociations, their presentations, and treatment. A 34-year-old female with arthritis secondary to dysplasia, a 51-year-old male with avascular necrosis of the femoral head, and a 57-year-old female with osteoarthritis were treated with total hip arthroplasty. Acute nontraumatic polyethylene liner dissociations occurred at 31, 42, and 2 months postoperatively. They were treated with component retention and modular femoral head and liner revision. The 51-year-old male subsequently developed a prosthetic joint infection requiring explant of his components. Although dissociation of polyethylene liners from the DePuy Pinnacle acetabular components is an uncommon complication, this problem may increase in prevalence with longer term follow-up, and vigilance is recommended.
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Affiliation(s)
- Ryland Kagan
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Mike B Anderson
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Christopher Peters
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Christopher Pelt
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jeremy Gililland
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
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22
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Muir JM, Vincent J, Schipper J, Govindarajan M, Paprosky WG. Evaluation of Tilt-correction of Anteversion on Anteroposterior Pelvic Radiographs in Total Hip Arthroplasty. Cureus 2018; 10:e2647. [PMID: 30034969 PMCID: PMC6051556 DOI: 10.7759/cureus.2647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Despite inaccuracies due to artifact and variations in patient positioning, anteroposterior (AP) radiographs remain the clinical standard for post-operative evaluation of component placement following total hip arthroplasty (THA). However, cup position, specifically anteversion, can be significantly affected by variations in patient positioning on an X-ray. A major cause of such artifact is unaccounted for pelvic tilt. Several methods for correcting the effects of pelvic tilt on radiographic anteversion have been proposed, with varying degrees of accuracy. The purpose of this study was to evaluate the accuracy and reliability of a commonly referenced method for correcting acetabular cup anteversion in a cohort undergoing total hip arthroplasty and determine its appropriateness for use in this population of patients. Radiographs from patients who underwent primary or revision hip arthroplasty between February 2016 and February 2017 were retrospectively reviewed. Corrected anteversion was calculated by measuring the vertical distance between the symphysis pubis and the sacrococcygeal joint, per the method outlined by Tannast et al. This symphococcygeal distance was then applied to Tannast’s nomograms to calculate the magnitude of pelvic tilt. Corrected and uncorrected anteversion values were compared to anteversion values collected intraoperatively using an imageless computer-assisted navigation device. A total of 71 cases were initially eligible for inclusion in the study. The correction method could not be applied in 44% (31/71) of the cases, chiefly due to difficulties in visualizing the required landmarks. In cases where it could be applied, corrected values correlated very poorly with navigation measurements (r = -0.07). Mean corrected anteversion (36.9°, SD: 7.4°) differed from uncorrected anteversion (25.2°, SD: 7.6°) by an average of 13.5° (p<0.001). Mean navigated anteversion (27.4°, SD: 5.7°) differed from corrected values by an average of 10.8° (p=0.16). The evaluated correction method could not be consistently applied to radiographs and did not reliably correct anteversion due to pelvic tilt in this population of patients undergoing hip arthroplasty. This correction method does not appear to be appropriate for use in this patient population.
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Affiliation(s)
| | - John Vincent
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo
| | | | - Meinusha Govindarajan
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo
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23
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Zhao JX, Su XY, Zhao Z, Xiao RX, Zhang LC, Tang PF. Three-dimensional orientation and location-dependent varying rules of radiographic angles of the acetabular cup. INTERNATIONAL ORTHOPAEDICS 2018; 42:1819-1825. [PMID: 29453586 DOI: 10.1007/s00264-018-3809-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
Abstract
AIM The aim of this study is to demonstrate the varying rules of radiographic angles following varying three-dimensional (3D) orientations and locations of cup using an accurate mathematical model. METHODS A cone model is established to address the quantitative relationship between the opening circle of cup and its ellipse projection on radiograph. The varying rules of two-dimensional (2D) radiographic anteversion (RA) and inclination (RI) angles can be analyzed. RESULTS When the centre of cup is located above X-ray source, with proper 3D RI/RA angles, 2D RA angle can be equal to its 3D counterpart, and 2D RI angle is usually greater than its 3D counterpart. Except for the original point on hip-centered anterior-posterior radiograph, there is no area on radiograph where both 2D RA and RI angles are equal to their 3D counterparts simultaneously. DISCUSSION This study proposes an innovative model for accurately explaining how 2D RA/RI angles of cup are varying following different 3D RA/RI angles and location of cup. The analysis results provide clinicians an intuitive grasp of knowledge about 2D RA/RI angles greater or smaller than their 3D counterparts post-operatively. The established model may allow determining the effects of pelvic rotations on 2D radiographic angles of cup.
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Affiliation(s)
- Jing-Xin Zhao
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiu-Yun Su
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhe Zhao
- Department of Orthopaedics, Beijing Tsinghua Chang Gung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Ruo-Xiu Xiao
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Li-Cheng Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Pei-Fu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China.
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24
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Delagrammaticas DE, Alvi HM, Kaat AJ, Sullivan RR, Stover MD, Manning DW. Quantitative Effect of Pelvic Position on Radiographic Assessment of Acetabular Component Position. J Arthroplasty 2018; 33:608-614.e1. [PMID: 29066106 DOI: 10.1016/j.arth.2017.09.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 08/20/2017] [Accepted: 09/19/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Intraoperative fluoroscopy aims to improve component position in total hip arthroplasty. Measurement bias related to image quality, however, has not been quantified. We aim to quantify measurement bias in the interpretation of acetabular component position as a function of pelvis and fluoroscopic beam position in a simulated supine total hip arthroplasty model. METHODS Posterior-anterior pelvis and hip images were obtained using a previously described pelvic model with known acetabular component position. Pelvic position was varied in 5° increments of pelvis rotation (iliac-obturator) and tilt (inlet-outlet), and in 1 cm increments from beam center in cranial-caudal and medial-lateral planes. Multiple regression analyses were conducted to evaluate the relationship between the resulting bias in interpretation of component position relative to pelvis position. RESULTS Anteversion and abduction measurement bias increased exponentially with increasing deviation in rotation and tilt. Greater bias occurred for anteversion than for abduction. Hip centered images were less affected by pelvis malposition than pelvis centered images. Deviations of beam center within 5 cm in the coronal plane did not introduce measurement bias greater than 5°. An arbitrarily defined acceptable bias of ±5° for both abduction and anteversion was used to identify a range of optimum pelvic positioning each for hip and pelvis centered imaging. CONCLUSION Accurate measurement of acetabular component abduction and anteversion, especially anteversion, is sensitive to proper pelvic position relative to the chosen radiographic plane. An acceptable measurement bias of ±5° is achieved when the pelvis is oriented within a newly identified range of optimum pelvic positioning.
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Affiliation(s)
- Dimitri E Delagrammaticas
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hasham M Alvi
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Aaron J Kaat
- Kaat Psychometric and Statistic Consulting, Chicago, Illinois
| | - Ryan R Sullivan
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael D Stover
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David W Manning
- Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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25
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Denisov A, Bilyk S, Kovalenko A. Acetabular cup version modelling and its clinical applying on plain radiograms. World J Orthop 2017; 8:929-934. [PMID: 29312852 PMCID: PMC5745436 DOI: 10.5312/wjo.v8.i12.929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/20/2017] [Accepted: 11/08/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To measure the sensitivity and specificity of the cup version assessment by using only anteroposterior hip and pelvis views, evaluate the incidence of inadequate cup version in patients with repeated dislocations after total hip arthroplasty (THA). METHODS Radiographic retrospective analysis of 2 groups of patients, with follow up of 6-60 mo, after undergoing primary THA. First group of 32 patients (20 female, 12 male) with unilateral THA (32 hips) required early revision arthroplasty for reasons of dislocation. The mean age and mode were 59 (from 38 to 83) and 66 ages respectively. The average body mass index (BMI) was 24.2 (from 17.7 to 36.3), mode 23.9. Second group was consisted of 164 patients (101 female, 63 male) without dislocations during the follow-up period (170 hips). Among them 6 patients required bilateral THA. The mean age was 60 (from 38 to 84) and mode 59. BMI was 24.8 (17.2-36.8), mode 25.2. Clinical significance of the cup anteversion sign was estimated with cross tabulation 2 × 2. RESULTS The value of the χ2 yates was 10.668 (P < 0.01). Sensitivity of SAI (sign of anteversion insufficiency) was 29% (95%CI: 9%-46%), and specificity was 92% (95%CI: 88%-96%). Relative risk of dislocation in patients with SAI was 3.4 (95%CI: 1.8-6.3). CONCLUSION This method provides the surgeons with the ability to perform a reliable and simple qualitative assessment of the acetabular component version. It can be useful during patient examination with early loosening of the implant, dislocations, and impingement. Additionally, it can provide necessary information during planning of revision surgery, especially when considering question about cup replacement, although final assessment of the cup position should be done with a computed tomography scan.
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Affiliation(s)
- Anton Denisov
- Orthopedic Department, Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg 195427, Russia
| | - Stanislav Bilyk
- Orthopedic Department, Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg 195427, Russia
| | - Anton Kovalenko
- Orthopedic Department, Vreden Russian Research Institute of Traumatology and Orthopedics, St. Petersburg 195427, Russia
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Zhao HY, Kang PD, Xia YY, Shi XJ, Nie Y, Pei FX. Comparison of Early Functional Recovery After Total Hip Arthroplasty Using a Direct Anterior or Posterolateral Approach: A Randomized Controlled Trial. J Arthroplasty 2017; 32:3421-3428. [PMID: 28662957 DOI: 10.1016/j.arth.2017.05.056] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Controversy exists as to whether early functional outcomes differ after total hip arthroplasty performed using the direct anterior approach (DAA) or the posterolateral approach (PLA). METHODS One hundred twenty patients were enrolled in this study and were divided into 2 groups based on surgical approach. Group A included patients who had a total hip arthroplasty with a DAA, whereas group B included those with a PLA. Patients were randomized into the DAA or PLA groups (n = 60), and perioperative and postoperative outcomes were recorded. RESULTS When compared with the PLA, the DAA had a shorter incision length (9.1 vs 13.1 cm; P < .01), shorter hospital stay (2.8 vs 3.3 days, P = .04), and lower self-reported pain. Both serum inflammatory and muscle damage markers were lower in the DAA group. However, the PLA had shorter operative times (65.5 vs 83.3 min, P = .03) and less intraoperative blood loss (123.8 vs 165.9 mL, P = .04). The DAA had significantly lower variance in cup inclination and anteversion. Similar rates of intraoperative complications were identified in the 2 groups. The DAA was associated with better functional recovery at 3 months based on the Harris hip score, University of California Los Angeles activity score, and gait analysis; however, functional recovery at 6 months was similar between the 2 groups. CONCLUSION We found functional advantages in early recovery after the DAA compared with the PLA. The DAA can offer rapid functional recovery with less muscle damage, greater pain relief, and lower variance in cup inclination and anteversion. However, no functional difference was found at 6 months follow-up.
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Affiliation(s)
- Hai-Yan Zhao
- Department of Orthopedics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Peng-De Kang
- Department of Orthopedics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Ya-Yi Xia
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou, People's Republic of China
| | - Xiao-Jun Shi
- Department of Orthopedics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Yong Nie
- Department of Orthopedics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
| | - Fu-Xing Pei
- Department of Orthopedics, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, People's Republic of China
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27
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Oshima H, Tanaka S, Takatori Y, Tanaka T, Ishikura H, Moro T. Clinical and Radiographic Outcomes of Total Hip Arthroplasty With a Specific Liner in Small Asian Patients: Influence of Patient-Related, Implant-Related, and Surgical Factors on Femoral Head Penetration. J Arthroplasty 2017; 32:3065-3070. [PMID: 28579445 DOI: 10.1016/j.arth.2017.04.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/23/2017] [Accepted: 04/24/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We evaluated the clinical and radiographic outcomes, including femoral head penetration, of total hip arthroplasty performed using a specific polyethylene (PE) liner in small Asian patients at 10 years after the index surgery. In addition, we investigated whether femoral head penetration was affected by patient-related, implant-related, and surgical factors. METHODS Between August 2002 and June 2005, for cementless primary total hip arthroplasty, we used acetabular PE liners that were manufactured from GUR 1050 resin, machined from isostatic compression-molded bar stock, and sterilized with a gamma ray irradiation in argon gas. We assessed 82 hips in 78 patients who received these liners. RESULTS The mean Harris hip score improved from 41.0 preoperatively to 84.5 at 10 years postoperatively. Periprosthetic osteolysis was observed in 7 hips (9.8%). No acetabular component migration was detected, and no revision surgery was performed 10 years postoperatively. The mean steady-state wear rate was 0.031 mm/y, which was lower than the wear rate for other conventional PE liners of the previous studies. Among the patient-related, implant-related, and surgical factors, sex was significantly associated with the mean steady-state wear rate, with a higher rate in male patients than in female patients. CONCLUSION PE acetabular liners used in small Asian patients show similar clinical outcomes and reduced wear compared with those of other liners. In addition, sex is significantly associated with the mean steady-state wear rate, and the steady-state wear rate is higher in male patients than in female patients.
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Affiliation(s)
- Hirofumi Oshima
- Sensory & Motor System Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan; Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Sensory & Motor System Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshio Takatori
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeyuki Tanaka
- Sensory & Motor System Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hisatoshi Ishikura
- Sensory & Motor System Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toru Moro
- Sensory & Motor System Medicine, Faculty of Medicine, The University of Tokyo, Tokyo, Japan; Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Moro T, Takatori Y, Tanaka S, Ishihara K, Oda H, Kim YT, Umeyama T, Fukatani E, Ito H, Kyomoto M, Oshima H, Tanaka T, Kawaguchi H, Nakamura K. Clinical safety and wear resistance of the phospholipid polymer-grafted highly cross-linked polyethylene liner. J Orthop Res 2017; 35:2007-2016. [PMID: 27813260 DOI: 10.1002/jor.23473] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 10/28/2016] [Indexed: 02/04/2023]
Abstract
To reduce the production of wear particles and subsequent aseptic loosening, we created a human articular cartilage-mimicked surface for a highly cross-linked polyethylene liner, whose surface grafted layer consisted of a biocompatible phospholipid polymer, poly(2-methacryloyloxyethyl phosphorylcholine). Although our previous in vitro findings showed that poly(2-methacryloyloxyethyl phosphorylcholine)-grafted particles were biologically inert and caused no subsequent bone resorptive responses, and poly(2-methacryloyloxyethyl phosphorylcholine) grafting markedly decreased wear in hip joint simulator tests, the clinical safety, and in vivo wear resistance of poly(2-methacryloyloxyethyl phosphorylcholine)-grafted highly cross-linked polyethylene liners remained open to question. Therefore, in the present study, we evaluated clinical and radiographic outcomes of poly(2-methacryloyloxyethyl phosphorylcholine)-grafted highly cross-linked polyethylene liners 5 years subsequent to total hip replacement in 68 consecutive patients. No reoperation was required for any reason, and no adverse events were associated with the implanted liners. The average Harris Hip Score increased from 38.6 preoperatively to 96.5 5 years postoperatively, and health-related quality of life, as indicated by the Short Form 36 Health Survey, improved. Radiographic analyses showed no periprosthetic osteolysis or implant migration. Between 1 and 5 years postoperatively, the mean steady-state wear rate was 0.002 mm/year, which represented a marked reduction relative to other highly cross-linked polyethylene liners, and appeared to be unaffected by patient-related or surgical factors. Although longer follow up is required, poly(2-methacryloyloxyethyl phosphorylcholine)-grafted highly cross-linked polyethylene liners improved mid-term clinical outcomes. The clinical safety and wear-resistance results are encouraging with respect to the improvement of long-term clinical outcomes with poly(2-methacryloyloxyethyl phosphorylcholine)-grafted highly cross-linked polyethylene liners. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2007-2016, 2017.
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Affiliation(s)
- Toru Moro
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Sensory and Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshio Takatori
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Sakae Tanaka
- Sensory and Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazuhiko Ishihara
- Department of Materials Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Hiromi Oda
- Department of Orthopaedic Surgery, Saitama Medical University School of Medicine, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
| | - Yoon Taek Kim
- Department of Orthopaedic Surgery, Saitama Medical University School of Medicine, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
| | - Takashige Umeyama
- Department of Orthopedic Surgery, NTT Medical Center Tokyo, 5-9-22 Higashigotanda, Shinagawa-ku, Tokyo, 141-0022, Japan
| | - Eisei Fukatani
- Department of Orthopaedic Surgery, JR Tokyo General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan
| | - Hideya Ito
- Department of Orthopaedic Surgery, Japan Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Masayuki Kyomoto
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Materials Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan.,Department of Research, KYOCERA Medical Corporation, 3-3-31 Miyahara, Yodogawa-ku, Osaka, 532-0003, Japan
| | - Hirofumi Oshima
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Sensory and Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takeyuki Tanaka
- Sensory and Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Kawaguchi
- Japan Community Healthcare Organization, Tokyo Shinjuku Medical Center, Spine Center, 5-1 Tsukudo, Shinjuku-ku, Tokyo, 162-8543, Japan
| | - Kozo Nakamura
- Sensory and Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Rehabilitation Services Bureau, National Rehabilitation Center for Persons With Disabilities, 4-1, Namiki, Tokorozawa, Saitama, 359-8555, Japan
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Pankaj A, Mittal A, Chawla A. The validity and reproducibility of cross table radiographs compared with CT scans for the measurement of anteversion of the acetabular component after total hip arthroplasty. Bone Joint J 2017; 99-B:1006-1011. [DOI: 10.1302/0301-620x.99b8.bjj-2016-1158.r2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/24/2017] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to assess the reproducibility and validity of cross table radiographs for measuring the anteversion of the acetabular component after total hip arthroplasty (THA) and to compare it with measurements using CT scans. Patients and Methods A total of 29 patients who underwent THA between June 2010 and January 2016 were included. There were 17 men and 12 women. Their mean age was 43 years (26 to 65). Seven patients underwent a bilateral procedure. Thus, 36 THAs were included in the study. Lateral radiographs and CT scans were obtained post-operatively and radiographs repeated three weeks later. The anteversion of the acetabular component was measured using the method described by Woo and Morrey and the ischiolateral method described by Pulos et al and these were compared with the results obtained from CT scans. Results The mean anteversion was 18.35° (3° to 38°) using Woo and Morrey’s method, 51.45° (30° to 85°) using the ischiolateral method and 21.22° (2° to 48°) using CT scans. The Pearson correlation coefficient was 0.754 for Woo and Morrey’s method and 0.925 for the ischiolateral method. There was a linear correlation between the measurements using the ischiolateral method and those using CT scans. We derived a simple linear equation between the value of the CT scan and that of ischiolateral method to deduce the CT scan value from that of ischiolateral method and vice versa. Conclusion The anteversion of the acetabular component measured using both plain radiographic methods was consistently valid with good interobserver reproducibility, but the ischiolateral method which is independent of pelvic tilt was more accurate. As CT is costly, associated with a high dose of radiation and not readily available, the ischiolateral method can be used for assessing the anteversion of the acetabular component. Cite this article: Bone Joint J 2017;99-B:1006–11.
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Affiliation(s)
- A. Pankaj
- Fortis Hospital, A
Block, Shalimar Bagh, Opposite
Kela Godam, New Delhi, Delhi 110088, India
| | - A. Mittal
- Guru Teg Bahadur Hospital, House
No. S4, Block 2, Type
2, Kalyan Vas, Delhi, 110091, India
| | - A. Chawla
- Fortis Hospital, A
Block, Shalimar Bagh, Opposite
Kela Godam, New Delhi, Delhi 110088, India
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Kamara E, Robinson J, Bas MA, Rodriguez JA, Hepinstall MS. Adoption of Robotic vs Fluoroscopic Guidance in Total Hip Arthroplasty: Is Acetabular Positioning Improved in the Learning Curve? J Arthroplasty 2017; 32:125-130. [PMID: 27499519 DOI: 10.1016/j.arth.2016.06.039] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 06/01/2016] [Accepted: 06/21/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Acetabulum positioning affects dislocation rates, component impingement, bearing surface wear rates, and need for revision surgery. Novel techniques purport to improve the accuracy and precision of acetabular component position, but may have a significant learning curve. Our aim was to assess whether adopting robotic or fluoroscopic techniques improve acetabulum positioning compared to manual total hip arthroplasty (THA) during the learning curve. METHODS Three types of THAs were compared in this retrospective cohort: (1) the first 100 fluoroscopically guided direct anterior THAs (fluoroscopic anterior [FA]) done by a surgeon learning the anterior approach, (2) the first 100 robotic-assisted posterior THAs done by a surgeon learning robotic-assisted surgery (robotic posterior [RP]), and (3) the last 100 manual posterior (MP) THAs done by each surgeon (200 THAs) before adoption of novel techniques. Component position was measured on plain radiographs. Radiographic measurements were taken by 2 blinded observers. The percentage of hips within the surgeons' "target zone" (inclination, 30°-50°; anteversion, 10°-30°) was calculated, along with the percentage within the "safe zone" of Lewinnek (inclination, 30°-50°; anteversion, 5°-25°) and Callanan (inclination, 30°-45°; anteversion, 5°-25°). Relative risk (RR) and absolute risk reduction (ARR) were calculated. Variances (square of the standard deviations) were used to describe the variability of cup position. RESULTS Seventy-six percentage of MP THAs were within the surgeons' target zone compared with 84% of FA THAs and 97% of RP THAs. This difference was statistically significant, associated with a RR reduction of 87% (RR, 0.13 [0.04-0.40]; P < .01; ARR, 21%; number needed to treat, 5) for RP compared to MP THAs. Compared to FA THAs, RP THAs were associated with a RR reduction of 81% (RR, 0.19 [0.06-0.62]; P < .01; ARR, 13%; number needed to treat, 8). Variances were lower for acetabulum inclination and anteversion in RP THAs (14.0 and 19.5) as compared to the MP (37.5 and 56.3) and FA (24.5 and 54.6) groups. These differences were statistically significant (P < .01). CONCLUSION Adoption of robotic techniques delivers significant and immediate improvement in the precision of acetabular component positioning during the learning curve. While fluoroscopy has been shown to be beneficial with experience, a learning curve exists before precision improves significantly.
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Affiliation(s)
- Eli Kamara
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
| | - Jonathon Robinson
- Department of Orthopaedic Surgery, Mt. Sinai Hospital, New York, New York
| | - Marcel A Bas
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
| | - Jose A Rodriguez
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
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Schwarz T, Weber M, Wörner M, Renkawitz T, Grifka J, Craiovan B. Central X-ray beam correction of radiographic acetabular cup measurement after THA: an experimental study. Int J Comput Assist Radiol Surg 2016; 12:829-837. [PMID: 27714567 DOI: 10.1007/s11548-016-1489-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 09/27/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Accurate assessment of cup orientation on postoperative radiographs is essential for evaluating outcome after THA. However, accuracy is impeded by the deviation of the central X-ray beam in relation to the cup and the impossibility of measuring retroversion on standard pelvic radiographs. METHOD In an experimental trial, we built an artificial cup holder enabling the setting of different angles of anatomical anteversion and inclination. Twelve different cup orientations were investigated by three examiners. After comparing the two methods for radiographic measurement of the cup position developed by Lewinnek and Widmer, we showed how to differentiate between anteversion and retroversion in each cup position by using a second plane. To show the effect of the central beam offset on the cup, we X-rayed a defined cup position using a multidirectional central beam offset. According to Murray's definition of anteversion and inclination, we created a novel corrective procedure to balance measurement errors caused by deviation of the central beam. RESULTS Measurement of the 12 different cup positions with the Lewinnek's method yielded a mean deviation of [Formula: see text] (95 % CI 1.3-2.3) from the original cup anteversion. The respective deviation with the Widmer/Liaw's method was [Formula: see text] (95 % CI 2.4-4.0). In each case, retroversion could be differentiated from anteversion with a second radiograph. Because of the multidirectional central beam offset ([Formula: see text] cm) from the acetabular cup in the cup holder ([Formula: see text] anteversion and [Formula: see text] inclination), the mean absolute difference for anteversion was [Formula: see text] (range [Formula: see text] to [Formula: see text] and [Formula: see text] (range [Formula: see text] to [Formula: see text] for inclination. The application of our novel mathematical correction of the central beam offset reduced deviation to a mean difference of [Formula: see text] for anteversion and [Formula: see text] for inclination. CONCLUSION This novel calculation for central beam offset correction enables highly accurate measurement of the cup position.
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Affiliation(s)
- T Schwarz
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany.
| | - M Weber
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - M Wörner
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - T Renkawitz
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - J Grifka
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - B Craiovan
- Department of Orthopedic Surgery, Regensburg University Medical Center, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
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Zhao JX, Su XY, Xiao RX, Zhao Z, Zhang LH, Zhang LC, Tang PF. A mathematical method for precisely calculating the radiographic angles of the cup after total hip arthroplasty. Med Eng Phys 2016; 38:1376-1381. [PMID: 27720337 DOI: 10.1016/j.medengphy.2016.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 08/18/2016] [Accepted: 09/23/2016] [Indexed: 11/19/2022]
Abstract
We established a mathematical method to precisely calculate the radiographic anteversion (RA) and radiographic inclination (RI) angles of the acetabular cup based on anterior-posterior (AP) pelvic radiographs after total hip arthroplasty. Using Mathematica software, a mathematical model for an oblique cone was established to simulate how AP pelvic radiographs are obtained and to address the relationship between the two-dimensional and three-dimensional geometry of the opening circle of the cup. In this model, the vertex was the X-ray beam source, and the generatrix was the ellipse in radiographs projected from the opening circle of the acetabular cup. Using this model, we established a series of mathematical formulas to reveal the differences between the true RA and RI cup angles and the measurements results achieved using traditional methods and AP pelvic radiographs and to precisely calculate the RA and RI cup angles based on post-operative AP pelvic radiographs. Statistical analysis indicated that traditional methods should be used with caution if traditional measurements methods are used to calculate the RA and RI cup angles with AP pelvic radiograph. The entire calculation process could be performed by an orthopedic surgeon with mathematical knowledge of basic matrix and vector equations.
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Affiliation(s)
- Jing-Xin Zhao
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, People's Republic of China.
| | - Xiu-Yun Su
- Department of Orthopaedics, Affiliated Hospital of the Academy of Military Medical Sciences, No. 8 Dongdajie Road, Beijing 100071, People's Republic of China; Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, People's Republic of China.
| | - Ruo-Xiu Xiao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, People's Republic of China.
| | - Zhe Zhao
- Department of Orthopaedics, Beijing Tsinghua Chang Gung Hospital, No. 1 Block Tiantongyuan North, Beijing 102218, People's Republic of China; Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, People's Republic of China.
| | - Li-Hai Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, People's Republic of China.
| | - Li-Cheng Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, People's Republic of China.
| | - Pei-Fu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, People's Republic of China.
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Shin WC, Lee SM, Lee KW, Cho HJ, Lee JS, Suh KT. The reliability and accuracy of measuring anteversion of the acetabular component on plain anteroposterior and lateral radiographs after total hip arthroplasty. Bone Joint J 2015; 97-B:611-6. [PMID: 25922453 DOI: 10.1302/0301-620x.97b5.34735] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is no single standardised method of measuring the orientation of the acetabular component on plain radiographs after total hip arthroplasty. We assessed the reliability and accuracy of three methods of assessing anteversion of the acetabular component for 551 THAs using the PolyWare software and the methods of Liaw et al, and of Woo and Morrey. All measurements of the three methods had excellent intra- and inter-observer reliability. The values of the PolyWare software, which determines version of the acetabular component by edge detection were regarded as the reference standard. Although the PolyWare software and the method of Liaw et al were similarly precise, the method of Woo and Morrey was significantly less accurate (p < 0.001). The method of Liaw et al seemed to be more accurate than that of Woo and Morrey when compared with the measurements using the PolyWare software. If the qualified lateral radiograph was selected, anteversion measured using the method of Woo and Morrey was considered to be relatively reliable.
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Affiliation(s)
- W C Shin
- Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Korea
| | - S M Lee
- Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Korea
| | - K W Lee
- Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Korea
| | - H J Cho
- Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Korea
| | - J S Lee
- Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Korea
| | - K T Suh
- Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan, Gyeongsangnam-do, 626-770, Korea
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Rathod PA, Bhalla S, Deshmukh AJ, Rodriguez JA. Does fluoroscopy with anterior hip arthroplasty decrease acetabular cup variability compared with a nonguided posterior approach? Clin Orthop Relat Res 2014; 472:1877-85. [PMID: 24549773 PMCID: PMC4016457 DOI: 10.1007/s11999-014-3512-2] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 02/04/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The direct anterior approach for THA offers some advantages, but is associated with a significant learning curve. Some of the technical difficulties can be addressed by the use of intraoperative fluoroscopy which may improve the accuracy of acetabular component placement. QUESTIONS/PURPOSES The purposes of this study were to determine if (1) there is decreased variability of acetabular cup inclination and anteversion with the direct anterior approach using fluoroscopic guidance as compared with the posterior approach THA without radiographic guidance; (2) if there is a learning curve associated with achieving accuracy with the direct anterior approach THA. We also wanted (3) to assess the frequency of complications including dislocation with the anterior approach, which initially had a learning curve, and the posterior approach. METHODS This retrospective, comparative study of 825 THAs (372 posterior THAs without fluoroscopic guidance and 453 direct anterior THAs, performed by one surgeon, focused on a radiographic analysis to determine cup inclination and anteversion on standardized pelvic radiographs using specialized software. The first 100 direct anterior THAs performed while transitioning from the posterior approach to the direct anterior approach were included in the learning curve group. During this learning curve period, the direct anterior approach was used for all patients except those with conversion of previously fixed intertrochanteric or femoral neck fractures to THAs, gluteus medius tears, and obese patients with an immobile abdominal pannus (100 of 127 THAs). Variability of the acetabular component was compared among the posterior group, learning curve group, and direct anterior group. RESULTS Variances for cup inclination and anteversion were significantly lower in the direct anterior group (19 and 16 respectively, p < 0.01) as compared with the posterior group (50 and 79 respectively).Target inclination and anteversion were achieved better in the direct anterior group (98% and 97% respectively) as compared with the posterior group (86% and 77% respectively) (p < 0.01, OR for inclination = 9.1, 95% CI, 3.5 to 23.4; OR for anteversion = 8, 95% CI, 4 to 16). In the learning curve group, target anteversion achieved (91% of cases) was marginally lower than that of the direct anterior group (p = 0.03; OR = 2.9, 95% CI, 1.1 to 7.3) and target inclination (95%) was similar (p = 0.13). There was one posterior dislocation in the posterior group, two anterior dislocations in the learning curve group, and none in the direct anterior group. CONCLUSIONS Use of fluoroscopy with the patient in the supine position during direct anterior THA enables intraoperative assessment of cup orientation resulting in decreased variability of acetabular cup anteversion. However, there is a learning curve associated with achieving this accuracy. We could not discern whether this difference was the result of the approach or the use of fluoroscopy in the direct anterior group. LEVEL OF EVIDENCE Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Parthiv A Rathod
- Center for Joint Preservation & Reconstruction, NorthshoreLIJ/Lenoxhill Hospital, 130 E 77th Street, 11th Floor, New York, NY, 10075, USA,
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Rodriguez JA, Deshmukh AJ, Rathod PA, Greiz ML, Deshmane PP, Hepinstall MS, Ranawat AS. Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach? Clin Orthop Relat Res 2014; 472:455-63. [PMID: 23963704 PMCID: PMC3890195 DOI: 10.1007/s11999-013-3231-0] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Newer surgical approaches to THA, such as the direct anterior approach, may influence a patient's time to recovery, but it is important to make sure that these approaches do not compromise reconstructive safety or accuracy. QUESTIONS/PURPOSES We compared the direct anterior approach and conventional posterior approach in terms of (1) recovery of hip function after primary THA, (2) general health outcomes, (3) operative time and surgical complications, and (4) accuracy of component placement. METHODS In this prospective, comparative, nonrandomized study of 120 patients (60 direct anterior THA, 60 posterior THAs), we assessed functional recovery using the VAS pain score, timed up and go (TUG) test, motor component of the Functional Independence Measure™ (M-FIM™), UCLA activity score, Harris hip score, and patient-maintained subjective milestone diary and general health outcome using SF-12 scores. Operative time, complications, and component placement were also compared. RESULTS Functional recovery was faster in patients with the direct anterior approach on the basis of TUG and M-FIM™ up to 2 weeks; no differences were found in terms of the other metrics we used, and no differences were observed between groups beyond 6 weeks. General health outcomes, operative time, and complications were similar between groups. No clinically important differences were observed in terms of implant alignment. CONCLUSIONS We observed very modest functional advantages early in recovery after direct anterior THA compared to posterior-approach THA. Randomized trials are needed to validate these findings, and these findings may not generalize well to lower-volume practice settings or to surgeons earlier in the learning curve of direct anterior THA.
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Affiliation(s)
- José A. Rodriguez
- The Center for Joint Preservation and Reconstruction, North Shore LIJ/Lenox Hill Hospital, 130 E 77th Street, 11th Floor, New York, NY 10075 USA
| | - Ajit J. Deshmukh
- The Center for Joint Preservation and Reconstruction, North Shore LIJ/Lenox Hill Hospital, 130 E 77th Street, 11th Floor, New York, NY 10075 USA
| | - Parthiv A. Rathod
- The Center for Joint Preservation and Reconstruction, North Shore LIJ/Lenox Hill Hospital, 130 E 77th Street, 11th Floor, New York, NY 10075 USA
| | - Michelle L. Greiz
- The Center for Joint Preservation and Reconstruction, North Shore LIJ/Lenox Hill Hospital, 130 E 77th Street, 11th Floor, New York, NY 10075 USA
| | - Prashant P. Deshmane
- The Center for Joint Preservation and Reconstruction, North Shore LIJ/Lenox Hill Hospital, 130 E 77th Street, 11th Floor, New York, NY 10075 USA
| | - Matthew S. Hepinstall
- The Center for Joint Preservation and Reconstruction, North Shore LIJ/Lenox Hill Hospital, 130 E 77th Street, 11th Floor, New York, NY 10075 USA
| | - Amar S. Ranawat
- The Center for Joint Preservation and Reconstruction, North Shore LIJ/Lenox Hill Hospital, 130 E 77th Street, 11th Floor, New York, NY 10075 USA
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Jain K, Badge R, Bansal R, Gambhir A, Hemmady M. Intrarater and Interrater Reliability of the Socket Version Marker in Total Hip Replacement. Open Orthop J 2013; 7:630-4. [PMID: 24285989 PMCID: PMC3841964 DOI: 10.2174/1874325001307010630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 10/28/2013] [Accepted: 10/29/2013] [Indexed: 12/01/2022] Open
Abstract
The aim of this study was to evaluate the intraobserver and interobserver variability in determining the socket version using the wire marker. 100 anteroposterior pelvis radiographs of cemented primary total hip replacements were reviewed by two orthopaedic consultants and registrars, twice. Intrarater and interrater reliability were assessed using Cohen’s kappa. Intrarater kappas for junior doctors were 0.78 and 0.80, 0.73 and 0.62 for Consultants. Interrater kappas were 0.60 between the two Consultants and 0.63 between the two Junior Doctors. The kappas between Consultant A and Junior Doctor A was 0.61, between Consultant A and Junior Doctor B was 0.59, between Consultant B and Junior Doctor A was 0.53 and between Consultant B and Junior Doctor B was 0.46. Intrarater reliability was substantial for the two junior doctors and the two consultants. Interrater reliability was moderate-to-substantial between the two consultants, between the two junior doctors and between each pair of junior doctors/consultants.
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Liaw CK, Wu TY, Hou SM, Yang RS, Shih KS, Fuh CS. Computerized ellipse method for measuring acetabular version after total hip replacement--a precision study using synthetic and real radiographs. ACTA ACUST UNITED AC 2013; 18:195-200. [PMID: 23528151 DOI: 10.3109/10929088.2013.779749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Previous work by our group to address the problem of acetabular positioning based on 2D methods resulted in the development of a measurement method with better precision--Liaw's version. This method may help the early diagnosis of acetabular loosening. In the present study, we hypothesized that our computerized ellipse method could improve the precision of measuring acetabular version. METHODS We developed our Elliversion software to measure acetabular version. Using total hip replacement (THR) Simulator, 96 radiographs were synthesized with random femoral inclination and 5° to 52° version, half with the femoral head included and half without. These synthetic radiographs and 28 real radiographs were measured with both Elliversion and the trigonometric method twice by one of the authors with a one-week interval between measurements. We then calculated the difference in the repeated measurements. Student's t-test was used for statistical analysis of the measuring error and inter-measurement difference. RESULTS In the precision study, for synthetic radiographs including the femoral head, the ellipse method was significantly better than the trigonometric method (p < 0.01). For synthetic radiographs without the femoral head, there was no significant difference between the ellipse method and the trigonometric method (p = 0.19). As for the repeated measurements, for synthetic radiographs including the femoral head, the ellipse method was significantly better than the trigonometric method (p = 0.001), whereas for synthetic radiographs without the femoral head, there was no significant difference between the two methods (p = 0.17). For real radiographs, there was no significant difference between the two measuring methods (p = 0.12). However, if we excluded the four poor-quality radiographs, there was a significant difference between the two measuring methods (p = 0.04). DISCUSSION We developed a computerized ellipse method for measuring acetabular version on synthetic radiographs and good-quality real radiographs. This method is characterized by its superior precision as compared to the trigonometric method. With the 2D standardized method (Liaw's version), improving the precision of measurement will help earlier diagnosis of acetabular loosening.
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Affiliation(s)
- Chen-Kun Liaw
- Department of Orthopaedics, Shin Kong Wu Ho-Su Memorial Hospital and Health System , Taipei , Taiwan
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McArthur B, Cross M, Geatrakas C, Mayman D, Ghelman B. Measuring acetabular component version after THA: CT or plain radiograph? Clin Orthop Relat Res 2012; 470:2810-8. [PMID: 22395871 PMCID: PMC3441984 DOI: 10.1007/s11999-012-2292-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 02/14/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although cross-table lateral radiographs are commonly used to measure acetabular component version after THA, recent studies suggest that CT-based measurement is more accurate. This has been attributed to variations in pelvic tilt, pelvic rotation, and component inclination. Furthermore, it has been suggested, based on limited data, that even with ideal positioning of the cross-table lateral radiograph, CT remains the more accurate modality. QUESTIONS/PURPOSES We determined whether appropriately positioned cross-table lateral radiographs could provide accurate measurements of acetabular component version, and compared accuracy and reliability of measurements from modified cross-table lateral radiographs with those from standard cross-table lateral radiographs and CT. METHODS We implanted 27 Sawbones pelves with an acetabular cup using computer navigation. CT, an AP view of the pelvis, and cross-table lateral and modified cross-table lateral radiographs were performed for each specimen. For the modified cross-table lateral radiograph, the beam angle varied based on the cup inclination as measured on an AP view of the pelvis. Two independent observers measured acetabular component version and inclination. We calculated intraobserver and interobserver reliabilities for each method and compared these with values obtained from navigation presuming that to be the standard for judging accuracy. RESULTS Interobserver and intraobserver reliabilities were greater than 0.95 (95% CI, 0.904-0.999) for all measurements. Correlation with navigated values was 0.96 or greater (95% CI, 0.925-0.998) for all methods. Although CT had the highest correlation with navigated values, the correlations for the modified cross-table lateral and cross-table lateral radiographs were similar. CONCLUSION CT allows for accurate measurement of acetabular component version; however, when properly positioned, cross-table lateral radiograph-derived measurements are similarly accurate. CLINICAL RELEVANCE Our results support the use of plain radiographs to obtain important measurements after THA.
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Affiliation(s)
- Benjamin McArthur
- Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021, USA.
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Bachhal V, Jindal N, Saini G, Sament R, Kumar V, Chouhan D, Dhillon M. A new method of measuring acetabular cup anteversion on simulated radiographs. INTERNATIONAL ORTHOPAEDICS 2012; 36:1813-8. [PMID: 22648556 DOI: 10.1007/s00264-012-1583-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 05/13/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Optimal positioning of acetabular components is crucial for maintaining stability of THA. Postoperative assessment of acetabular anteversion is a vital but difficult task. Various methods have been devised with good results for measuring anteversion on plain radiographs but these methods are either too complicated or require special objects like scientific calculators, special protectors, tables, etc. A new simplified method of measuring anteversion on plain radiographs was created based on basic geometry. METHODS Anteversion of acetabular components was estimated on computer generated images of the acetabular cup by our method and compared with two previously established methods of Liaw and Pradhan. Measurement was done at 400 different positions of acetabular cup and compared with actual values. Another analysis was done after adding the femoral head to the acetabular component, thus obscuring some of the acetabular rim. RESULTS Mean and standard deviation of error for our method was 0.77° ± 0.75° as compared to 0.93° ± 0.86° and 0.72° ± 0.68° for the methods of Liaw and Pardhan, respectively, with no significant differences from actual values. Maximal errors for our method, Liaw's and Pradhan's method were 3°, 4°, and 2.91°, respectively. On analysis, after the adding femoral head, there was a significant error of measurement with Liaw's method, while our method as well as Pardhan's remained accurate. All methods showed high inter- and intraobserver reliability. CONCLUSION Our new simplified method of measuring acetabular anteversion on plain radiographs is acceptable in comparision to other established methods and requires only routinely used goniometer and calliper.
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Affiliation(s)
- Vikas Bachhal
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
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Nho JH, Lee YK, Kim HJ, Ha YC, Suh YS, Koo KH. Reliability and validity of measuring version of the acetabular component. ACTA ACUST UNITED AC 2012; 94:32-6. [PMID: 22219244 DOI: 10.1302/0301-620x.94b1.27621] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A variety of radiological methods of measuring version of the acetabular component after total hip replacement (THR) have been described. The aim of this study was to evaluate the reliability and validity of six methods (those of Lewinnek; Widmer; Hassan et al; Ackland, Bourne and Uhthoff; Liaw et al; and Woo and Morrey) that are currently in use. In 36 consecutive patients who underwent THR, version of the acetabular component was measured by three independent examiners on plain radiographs using these six methods and compared with measurements using CT scans. The intra- and interobserver reliabilities of each measurement were estimated. All measurements on both radiographs and CT scans had excellent intra- and interobserver reliability and the results from each of the six methods correlated well with the CT measurements. However, measurements made using the methods of Widmer and of Ackland, Bourne and Uhthoff were significantly different from the CT measurements (both p < 0.001), whereas measurements made using the remaining four methods were similar to the CT measurements. With regard to reliability and convergent validity, we recommend the use of the methods described by Lewinnek, Hassan et al, Liaw et al and Woo and Morrey for measurement of version of the acetabular component.
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Affiliation(s)
- J-H Nho
- Soonchunhyang University Hospital, Department of Orthopaedic Surgery, 22 Daesagwan-gil (657 Hannam-dong), Yongsan-gu, Seoul 140-743, Korea
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Liaw CK, Wu TY, Yang RS, Hsu YN, Wu TJ, Hou SM. Direct measurement of acetabular radiographic version using an ordinary goniometer – a precision study. ACTA ACUST UNITED AC 2011; 16:196-201. [DOI: 10.3109/10929088.2011.583805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Laurent MP, Pourzal R, Fischer A, Bertin KC, Jacobs JJ, Wimmer MA. In vivo wear of a squeaky alumina-on-alumina hip prosthesis: a case report. J Bone Joint Surg Am 2011; 93:e27. [PMID: 21471407 PMCID: PMC6882528 DOI: 10.2106/jbjs.i.00930] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michel P. Laurent
- Department of Orthopaedic Surgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612. E-mail address for M.P. Laurent: . E-mail address for J.J. Jacobs: . E-mail address for M.A. Wimmer:
| | - Robin Pourzal
- Materials Science and Engineering, University of Duisburg-Essen, Lotharstrasse 1, 47057 Duisburg, Germany. E-mail address for R. Pourzal: . E-mail address for A. Fischer:
| | - Alfons Fischer
- Materials Science and Engineering, University of Duisburg-Essen, Lotharstrasse 1, 47057 Duisburg, Germany. E-mail address for R. Pourzal: . E-mail address for A. Fischer:
| | - Kim C. Bertin
- Utah Bone & Joint Center, 5323 Woodrow Street #202, Salt Lake City, UT 84107
| | - Joshua J. Jacobs
- Department of Orthopaedic Surgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612. E-mail address for M.P. Laurent: . E-mail address for J.J. Jacobs: . E-mail address for M.A. Wimmer:
| | - Markus A. Wimmer
- Department of Orthopaedic Surgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612. E-mail address for M.P. Laurent: . E-mail address for J.J. Jacobs: . E-mail address for M.A. Wimmer:
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Hill JC, Gibson DP, Pagoti R, Beverland DE. Photographic measurement of the inclination of the acetabular component in total hip replacement using the posterior approach. ACTA ACUST UNITED AC 2010; 92:1209-14. [PMID: 20798436 DOI: 10.1302/0301-620x.92b9.24476] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The angle of inclination of the acetabular component in total hip replacement is a recognised contributing factor in dislocation and early wear. During non-navigated surgery, insertion of the acetabular component has traditionally been performed at an angle of 45 degrees relative to the sagittal plane as judged by the surgeon's eye, the operative inclination. Typically, the method used to assess inclination is the measurement made on the postoperative anteroposterior radiograph, the radiological inclination. The aim of this study was to measure the intra-operative angle of inclination of the acetabular component on 60 consecutive patients in the lateral decubitus position when using a posterior approach during total hip replacement. This was achieved by taking intra-operative photographs of the acetabular inserter, representing the acetabular axis, and a horizontal reference. The results were compared with the post-operative radiological inclination. The mean post-operative radiological inclination was 13 degrees greater than the photographed operative inclination, which was unexpectedly high. It appears that in the lateral decubitus position with a posterior approach, the uppermost hemipelvis adducts, thus reducing the apparent operative inclination. Surgeons using the posterior approach in lateral decubitus need to aim for a lower operative inclination than when operating with the patient supine in order to achieve an acceptable radiological inclination.
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Affiliation(s)
- J C Hill
- Outcomes Assessment Unit, Musgrave Park Hospital, Stockman's Lane, Belfast, Northern Ireland, UK.
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Ghelman B, Kepler CK, Lyman S, Della Valle AG. CT outperforms radiography for determination of acetabular cup version after THA. Clin Orthop Relat Res 2009; 467:2362-70. [PMID: 19277802 PMCID: PMC2866933 DOI: 10.1007/s11999-009-0774-1] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 02/20/2009] [Indexed: 01/31/2023]
Abstract
Precise evaluation of acetabular cup version is necessary for patients with recurrent hip dislocation after THA. We retrospectively studied 42 patients, who underwent THAs, with multiple cross-table lateral radiographs and CT scans to determine whether radiographic or CT measurement of acetabular component version is more accurate. One observer measured cup version on all radiographs. CT scans were interpreted by one observer. Twenty radiographs were measured twice each by two observers to determine intraobserver and interobserver reliability. We implanted cups in four model pelvises using navigation and compared measurements of anteversion made with radiographs and CT scans. Intraclass correlation coefficients (ICC) for anteversion measurements of two observers were 0.9990 and 0.9998, respectively, when comparing measurements of identical radiographs (intraobserver). Paired values for two observers measuring the same radiograph had an ICC of 0.9686 (interobserver) compared with 0.7412 for measurements from serial radiographs of the same component. The ICC comparing radiographic versus CT-based measurements was 0.6981. CT measurements had stronger correlations with navigated values than radiographic measurements. Accuracy of anteversion measurements on cross-table radiographs depends on radiographic technique and patient positioning whereas properly performed CT measurements are independent of patient position.
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Affiliation(s)
- Bernard Ghelman
- Department of Radiology, Hospital for Special Surgery, New York, NY USA
| | - Christopher K. Kepler
- The Hip and Knee Service—Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Stephen Lyman
- Department of Epidemiology and Biostatistics, Hospital for Special Surgery, New York, NY USA
| | - Alejandro González Della Valle
- The Hip and Knee Service—Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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