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Pretorius J, Baltrunaite J, O'Malley S, Murphy CG. Digital templating for THA planning; efficiency and accuracy improves with institutional familiarity. J Orthop 2025; 67:41-46. [PMID: 39902140 PMCID: PMC11787567 DOI: 10.1016/j.jor.2024.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Accepted: 12/15/2024] [Indexed: 02/05/2025] Open
Abstract
Background Pre-operative templating has become an important routine for many surgeons in planning for total hip arthroplasty surgery. Accurate THA templating reduces surgical time, increases precision, reduces the need for revision and reduces the overall complication rate. Incorrect placement of the scaling ball will lead to a magnification error with a subsequent templating error. Methods Digital radiographs of 211 patients undergoing primary THA by a single surgeon were reviewed. Two separate sets of consecutive digitally templated radiographs where reviewed and compared with regards to: accuracy of scaling ball placement and accuracy of templating. The interval was chosen to allow bedding in of, and familiarity with the templating system between orthopaedics, nursing and radiographers, and to ascertain if consistency improved with time in our institution. The positioning of the scaling ball was as assessed and classified as either ideal or non-ideal. Results The data collected showed significant improvement (p < 0.0001) in the accuracy of SB positioning over time (70 % 2nd series vs 30.7. Ideal placement produced more accurate digital templating. With acetabular templating a 44.2 % (n = 34/77) versus 27.3 % (n = 9/33) accuracy with exact measurement (p = 0.008) and 83.1 % (n = 64/77) versus 63.6 % (n = 21/33) within ±2 sizes (p = 0.046). The study also demonstrated significant improvement in accuracy of SB positioning when the fat apron is absent (p = 0.042). Conclusion In addition to overall efficiencies in planning and preparation, accurate scaling ball positioning, with regards to coronal plane placement, improves the accuracy of both the acetabular and femoral components in digital templating. Ongoing education for all teams (orthopaedic, nursing and radiographers) is essential to optimise hospital templating.
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Nazmy H, Solitro G, Domb B, Amirouche F. Comparative Study of Alternative Methods for Measuring Leg Length Discrepancy after Robot-Assisted Total Hip Arthroplasty. Bioengineering (Basel) 2024; 11:853. [PMID: 39199810 PMCID: PMC11351844 DOI: 10.3390/bioengineering11080853] [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: 05/21/2024] [Revised: 08/05/2024] [Accepted: 08/16/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND Our study addresses the lack of consensus on measuring leg length discrepancy (LLD) after total hip arthroplasty (THA). We will assess the inter-observer variability and correlation between the five most commonly used LLD methods and investigate the use of trigonometric principles in overcoming the limitations of current techniques. METHODS LLD was measured on postoperative AP pelvic radiographs using five conventional methods. CT images created a 3D computer model of the pelvis and femur. The resulting models were projected onto a 2D, used to measure LLD by the five methods. The measurements were evaluated via Taguchi analysis, a statistical method identifying the process's most influential factors. The approach was used to assess the new trigonometric method. RESULTS Conventional methods demonstrated poor correlation. Methods referenced to the centers of the femoral heads were insensitive to LLD originating outside the acetabular cup. Methods referencing either the inter-ischial line or the inter-obturator foramina to the lesser trochanter were sensitive to acetabular and femoral components. Trigonometry-based measurements showed a higher correlation. CONCLUSIONS Our results underscore clinicians' need to specify the methods used to assess LLD. Applying trigonometric principles was shown to be accurate and reliable, but it was contingent on proper radiographic alignment.
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Affiliation(s)
- Hamad Nazmy
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Giovanni Solitro
- Department of Orthopaedics, LSU Health Shreveport, Shreveport, LA 71103, USA;
| | - Benjamin Domb
- American Hip Institute, 999 E. Touhy, Suite 450, Des Plaines, IL 60018, USA;
| | - Farid Amirouche
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA;
- Orthopaedic and Spine Institute, Department of Orthopaedic Surgery, Northshore University Health System, an Affiliate of the University of Chicago Pritzker School of Medicine, 9669 Kenton Avenue, Skokie, IL 60076, USA
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Zampogna B, Parisi FR, Zampoli A, Prezioso A, Vorini F, Laudisio A, Papalia M, Papapietro N, Falez F, Papalia R. Accuracy of two-dimensional digital planning in uncemented primary hip arthroplasty: monocentric analysis of eight hundred implants. INTERNATIONAL ORTHOPAEDICS 2024; 48:1979-1985. [PMID: 38622366 DOI: 10.1007/s00264-024-06172-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/29/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE In the last decades, there has been a refinement in total hip arthroplasty, which allowed surgeons to achieve the highest performance and better patient outcomes. Preoperative planning in primary hip arthroplasty is an essential step that guides the surgeon in restoring the anatomy and biomechanics of the joint. This study aims to evaluate the accuracy of the 2D digital planning, considering cup sizing, stem sizing, and limb length discrepancy. Additionally, we conducted a multivariable analysis of demographic data and comorbidities to find factors influencing preoperative planning. METHODS This retrospective study analyzed the planning accuracy in 800 consecutive uncemented primary total hip arthroplasty. We compared the preoperatively planned total hip arthroplasty with postoperative results regarding the planned component size, the implanted size, and the lower limb length restoration. Therefore, we investigated factors influencing planning accuracy: overweight and obesity, sex, age, past medical history, comorbidities, and implant design. All the surgeries were performed in the posterolateral approach by one expert surgeon who did the preoperative planning. The preoperative planning was determined to be (a) exact if the planned and the implanted components were the same size and (b) accurate if exact ± one size. The restoration of postoperative limb length discrepancy was classified into three groups: ± 3 mm, ± 5 mm, and ± 10 mm. This assessment was performed through a digital method 2D based on a standard hip X-ray. RESULTS This court of 800 implants showed that planning was exact in 60% of the cups and 44% of the stems and was accurate in 94% of the cups and 80% of the stems. The postoperative limb length discrepancy was ± 3 mm in 91% and ± 5 mm in 97%. CONCLUSIONS This study showed preoperative 2D digital planning great precision and reliability, and we demonstrated that it was accurate in 94% of the cups and 80% of the stems. Therefore, the preoperative limb length discrepancy analysis was essential to guarantee the recovery of the operated limb's correct length.
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Affiliation(s)
- Biagio Zampogna
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- BIOMORF Department, Biomedical, Dental and Morphological and Functional Images, University of Messina. A.O.U. Policlinico "G.Martino", Messina, Italy
| | - Francesco Rosario Parisi
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Andrea Zampoli
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Anna Prezioso
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Ferruccio Vorini
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Alice Laudisio
- Department of Medicine, Research Unit of Geriatrics, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Roma, Italy.
- Fondazione Policlinico Universitario Campus Bio-Medico, Operative Research Unit of Geriatrics, Via Alvaro del Portillo, 200, 00128, Roma, Italy.
| | - Matteo Papalia
- Orthopaedic and Traumatology Department, Nuova Itor Clinic, Rome, Italy
| | - Nicola Papapietro
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesco Falez
- Department of Orthopaedics and Traumatology, ASL Roma 1, S. Filippo Neri Hospital, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Stadler C, Feldler S, Stevoska S, Schopper C, Gotterbarm T, Luger M. Gender differences in cementless short stem total hip arthroplasty: significantly higher femoral lengthening in female patients. Sci Rep 2024; 14:1154. [PMID: 38212361 PMCID: PMC10784556 DOI: 10.1038/s41598-024-51621-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 01/08/2024] [Indexed: 01/13/2024] Open
Abstract
Modern cementless short stems in total hip arthroplasty (THA) enable a precise reconstruction of the native pre-arthritic hip geometry. While gender differences have been reported for older generation straight hip stems, there are hardly reports regarding modern cementless short hip stems. Therefore, we aimed to evaluate the influence of gender differences in hip anatomy in cementless short stem THA. A total of 207 patients (109 females, 98 males) with unilateral THA and absence of contralateral joint space narrowing (Kellgren-Lawrence grade ≤ 2) were included. Acetabular height and offset as well as femoral height and offset were measured on pre- and 3-months-postoperative anteroposterior X-rays of the pelvis and compared to the contralateral hip. Additionally, implant position was evaluated on the postoperative radiograph. In male patients, the loss of acetabular offset was significantly greater than in females (p = 0.012), leading to a compensatory increase in femoral offset (p = 0.041). Femoral height discrepancy was significantly higher in females (p < 0.001), accounting for an increased global hip height discrepancy (p < 0.001). The mean acetabular anteversion was significantly greater in female patients (p < 0.001). Female patients are at higher risk of femoral lengthening in THA with a cementless short stem potentially caused by a further proximally conducted femoral neck osteotomy and show significantly higher cup anteversion angles. Therefore, surgeons should take special care to the level of neck resection and implant positioning in female patients.
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Affiliation(s)
- Christian Stadler
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria.
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria.
| | - Sandra Feldler
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Stella Stevoska
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Clemens Schopper
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
| | - Matthias Luger
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Med Campus III, Krankenhausstr. 9, 4020, Linz, Austria
- Johannes Kepler University Linz, Altenberger Str. 96, 4040, Linz, Austria
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More than a feeling?-Overruling the preoperatively templated offset option leads to a minor offset increase in short stem total hip arthroplasty. Arch Orthop Trauma Surg 2023; 143:519-527. [PMID: 34997306 PMCID: PMC9886579 DOI: 10.1007/s00402-021-04331-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/19/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Short stems are increasingly used in total hip arthroplasty (THA) because of advantages in bone and soft tissue preservation and reconstruction of hip geometry. Digital templating is essential in determining the correct offset option and stem size in THA. However, the preoperative template sizes might be intraoperatively overruled. PATIENTS AND METHODS We evaluated the effect of intraoperative overruling of the preoperatively templated offset option of a short curved stem on hip offset, leg length, implant positioning, and femoral canal fill index. The overruling was performed in case of intraoperative instability, telescoping, or both. A series of 1052 consecutive THAs with a cementless short curved stem and press-fit cup was retrospectively screened. One hundred patients with unilateral THA and a contralateral native and morphologically healthy hip as a reference met the inclusion criteria. Measurements were carried out on preoperative and 3 months anterior-posterior postoperative radiographs. Patients were divided according to the overruling by offset option or stem size. RESULTS Hip offset was increased in all groups, but only with significant increase if an offset option + 1 was used intraoperatively (p = 0.025). LLD was restored without significance in all groups (p = 0.323; p = 0.157). CONCLUSION Intraoperative overruling of the preoperative digital template in cementless short stem total hip arthroplasty results in an increase of hip offset compared to a contralateral healthy hip. However, the increase is marginal and clearly under 5 mm compared to the contralateral healthy hip.
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Luger M, Feldler S, Pisecky L, Allerstorfer J, Gotterbarm T, Klasan A. The 'critical trochanter angle' does not show superiority over the CCD angle in predicting varus stem alignment in cementless short-stem total hip arthroplasty. Arch Orthop Trauma Surg 2023; 143:529-537. [PMID: 35020039 PMCID: PMC9886626 DOI: 10.1007/s00402-022-04340-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/03/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE Varus positioning of the femoral stem can affect the hip offset (HO). The critical trochanter angle (CTA) was introduced in 2019 as a novel geometric angle, to predict varus stem alignment in cementless straight stem THA. The aim of this study was to evaluate the applicability of the CTA as a predictor for stem alignment in THA with a cementless neck resecting short stem. PATIENTS AND METHODS In this retrospective study, 106 patients (index surgery 2014-2019) with unilateral THA and a morphologically healthy contralateral hip as a reference (Kellgren-Lawrence ≤ 1) were included. A cementless short stem with meta-diaphyseal fixation and press-fit cup was implanted in all cases. Stem alignment, CCD angle, CTA and offset reconstruction were measured on preoperative and 3 months postoperative AP radiographs of the pelvis. RESULTS Preoperative lower CTA and lower CCD angle were positively correlated (r = 0.472; p < 0.001). Higher varus stem alignment is correlated with lower CTA (r = - 0.384; p < 0.001) and lower CCD angle (r = - 0.474; p < 0.001). A CTA of 23.1° or lower showed a sensitivity of 59.1% and a specificity of 87.1% (AUC: 0.733) and a CCD angle of 132.75° or lower a sensitivity of 68.2% and a specificity of 80.6% (AUC: 0.77) for a varus stem alignment > 3°. CONCLUSION The CTA is also applicable in cementless THA with a neck resecting short stem to evaluate risk of intraoperative varus stem positioning. The CCD angle shows higher sensitivity with marginally lower specificity. Therefore, the CTA is not superior in predicting varus stem alignment in short-stem THA. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Matthias Luger
- grid.473675.4Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria ,grid.9970.70000 0001 1941 5140Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Sandra Feldler
- grid.473675.4Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria ,grid.9970.70000 0001 1941 5140Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Lorenz Pisecky
- grid.473675.4Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria ,grid.9970.70000 0001 1941 5140Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Jakob Allerstorfer
- grid.473675.4Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria ,grid.9970.70000 0001 1941 5140Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Tobias Gotterbarm
- grid.473675.4Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria ,grid.9970.70000 0001 1941 5140Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
| | - Antonio Klasan
- grid.473675.4Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020 Linz, Austria ,grid.9970.70000 0001 1941 5140Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz, Austria
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Al-Ashqar M, Aslam N, Azhar MS, Grayston J, Hahnel J. KingMark's dual-marker versus a conventional single-marker templating system: is there a difference in accuracy of predicting final implant sizes and leg lengths? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:167-175. [PMID: 34842990 DOI: 10.1007/s00590-021-03174-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/19/2021] [Indexed: 01/07/2023]
Abstract
AIMS Pre-operative templating for total hip replacement (THR) surgery leads to more accurate implant sizing and positioning. This study aimed to compare the KingMark™ dual-marker system for magnification calibration to the current gold standard single-marker system in accuracy of predicting implant size and restoration of leg length post-operatively. METHODS This is a retrospective analysis of patients who had primary THR surgery from 2013 to 2019 by a single surgeon. Patients were in two cohorts whose operations were completed at separate healthcare facilities. Patients in the first cohort had pre-operative templating using the KingMark system; patients in the second cohort had templating using a single-marker. For all patients, pre-operative radiographs were reviewed; predicted implants noted; and leg length discrepancies calculated. These were compared to post-operative data. We then tested the null hypothesis that there was no difference between the templating methods for prediction accuracy of implant size and achieving restoration of leg length. RESULTS A total of 121 patients were included in the KingMark cohort, and 104 were included in the single-marker cohort. In the KingMark cohort, 83.5% of patients had implantation of a cup within one size of that predicted, compared to 71.2% of the single-marker cohort. This superiority was statistically significant. There was a greater proportion of exact cup size predictions in the KingMark cohort, but this was not statistically significant. We did not find any significant difference between the cohorts for stem size, or stem placement, or reduction of leg length discrepancy. CONCLUSION We have demonstrated statistically significant superiority of the KingMark over a single-marker templating system for predicting cup size in primary THR surgery. For post-operative restoration of leg length, our study did not show any advantage of KingMark templating compared to single-marker templating.
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Affiliation(s)
- Mohammad Al-Ashqar
- Bradford Royal Infirmary, Bradford, UK.
- Leeds Teaching Hospitals, Leeds, UK.
| | - Nayef Aslam
- Bradford Royal Infirmary, Bradford, UK
- Leeds Teaching Hospitals, Leeds, UK
| | | | - James Grayston
- Bradford Royal Infirmary, Bradford, UK
- Leeds Teaching Hospitals, Leeds, UK
| | - James Hahnel
- Bradford Royal Infirmary, Bradford, UK
- Leeds Teaching Hospitals, Leeds, UK
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Maurer-Ertl W, Friesenbichler J, Pfann M, Maier M, Reinbacher P, Leithner A, Smolle MA. Restoration of hip geometry after total hip arthroplasty: retrospective comparison of two short stems and one straight stem. BMC Musculoskelet Disord 2022; 23:1035. [PMID: 36451134 PMCID: PMC9710174 DOI: 10.1186/s12891-022-05923-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 10/27/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The preservation or restoration of hip geometry following total hip arthroplasty (THA) is of importance, considering that alterations in the centrum-collum-diaphysis (CCD)-angle, femoral offset (FO), acetabular offset (AO) and total offset (TO) change hip biomechanics. Therefore, the most suitable implant should be used. The aim of this study was to compare the ability of two short-stem-systems and one straight-stem-system to reconstruct hip geometry. METHODS Two-hundred-fifty-one patients (mean age: 62.0 ± 10.0 years; 51.8% males) undergoing THA with three different stem types were retrospectively included, after excluding 11 patients with missing radiological follow-up. Pre- and postoperative radiographic images (group I, ANA.NOVA Alpha Schaft Proxy®, ImplanTec, 12 options: n = 99; group II, Optimys® Mathys, 24 options: n = 62; group III: Corail®-System, DePuy-Synthes, 76 options: n = 90) were analyzed. Differences in pre- and postoperative hip geometry (i.e. CCD, FO, AO, TO) were compared between groups with one-way-analysis-of-variance (ANOVA), and post-hoc t-tests. RESULTS The CCD-angle increased by a mean of 8.4° ± 7.2° from pre-to postoperative, with no significant difference between groups (p = 0.097). Significantly larger increases in FO were observed for groups II (4.1 mm ± 7.8 mm) and III (4.9 ± 7.2 mm), in comparison to group I (1.6 ± 6.9 mm; p = 0.006). AO decreased by a mean of 2.2 ± 4.5 mm, with the largest decrease observed in group III (-3.3 ± 5.3 mm), and the smallest for group I (-1.4 ± 3.6 mm; p = 0.011). There was no significant difference in change of TO between groups (p = 0.177). CONCLUSIONS Reconstruction of hip geometry using a single-version novel short-stem-system is achievable with comparable results to stem-systems offering multiple options.
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Affiliation(s)
- Werner Maurer-Ertl
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria ,General Public Hospital Guessing, Grazer Straße 15, 7540 Guessing, Austria
| | - Joerg Friesenbichler
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Michael Pfann
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Michael Maier
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Patrick Reinbacher
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Andreas Leithner
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Maria A. Smolle
- grid.11598.340000 0000 8988 2476Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
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Luger M, Stiftinger J, Allerstorfer J, Hochgatterer R, Gotterbarm T, Pisecky L. High varus stem alignment in short-stem total hip arthroplasty: a risk for reconstruction of femoro-acetabular offset, leg length discrepancy and stem undersizing? Arch Orthop Trauma Surg 2022; 142:2935-2944. [PMID: 34554313 PMCID: PMC9474344 DOI: 10.1007/s00402-021-04176-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/09/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE Short stems are increasingly used in in total hip arthroplasty (THA) because of advantages in bone and soft tissue preservation and reconstruction of hip geometry. Short stems can be inserted in a more varus position compared to conventional straight stems. This poses the risk of final varus misplacement of the femoral component, which is not intended in all femoral short stems. METHODS We wanted to evaluate the effect of a high varus stem positioning in MIS THA on hip offset, leg length and femoral canal fill index. A series of 1052 consecutive THAs with a singular cementless femoral short stem and press-fit cup was retrospectively screened for inclusion. One hundred six patients with unilateral THA and a contralateral healthy hip met the inclusion criteria. Measurements were carried out on preoperative and 3 months anterior-posterior postoperative radiographs. Patients were divided into Group A (varus stem alignment ≤ 3°) and Group B (varus stem alignment > 3°). RESULTS Hip offset (HO) increased significantly in Group B by 4 mm (p = 0.013). No influence on leg length difference was detected in both groups. Preoperative CCD angle was significantly lower in Group B (p < 0.001). Canal Fill Indices (CFI) were significantly lower in Group B (CFI I: p < 0.001; CFI II p = 0.003; CF III p = 0.002). CONCLUSION High varus stem alignment > 3° leads to a statistically significant but minor increase in HO and poses the risk of stem undersizing. A preoperatively low genuine CCD angle pose a risk for varus stem positioning.
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Affiliation(s)
- Matthias Luger
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria. .,Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria. .,Kepler University Hospital Linz, Krankenhausstrasse 9, 4020, Linz, Austria.
| | - Julian Stiftinger
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Jakob Allerstorfer
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Rainer Hochgatterer
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Tobias Gotterbarm
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
| | - Lorenz Pisecky
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Krankenhausstrasse 9, 4020, Linz, Austria
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Luger M, Hochgatterer R, Klotz MC, Allerstorfer J, Gotterbarm T, Schauer B. A single-surgeon experience in reconstruction of femoro-acetabular offset and implant positioning in direct anterior approach and anterolateral MIS approach with a curved short stem. Arch Orthop Trauma Surg 2022; 142:871-878. [PMID: 34076711 PMCID: PMC8994713 DOI: 10.1007/s00402-021-03977-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/26/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE Minimally invasive surgery using short stems in total hip arthroplasty gained more popularity. The differences in change of hip offset and implant positioning in minimally invasive approaches are not fully known. Therefore, this study was conducted to evaluate the difference in reconstruction of hip offset and implant positioning in direct anterior approach (DAA) and minimally invasive anterolateral approach (AL MIS). METHODS A single surgeon series of 117 hips (117 patients; mean age 65.54 years ± 11.47; index surgery 2014-2018) were included and allocated into two groups: group A (DAA) with 70 hips and Group B (AL MIS) with 47 patients operated. In both groups the same type of cementless curved short hip stem and press fit cup was used. RESULTS Both groups showed an equal statistically significant increase of femoral (p < 0.001) and decrease of acetabular offset (p < 0.001). Between both groups no statistically significant difference in offset reconstruction, leg length difference or implant positioning could be found. Leg length increased in both groups significantly and leg length discrepancy showed no difference (group A: - 0.06 mm; group B: 1.11 mm; p < 0.001). A comparable number of cups were positioned outside the target zone regarding cup anteversion. CONCLUSION The usage of a curved short stem shows an equal reconstruction of femoro-acetabular offset, leg length and implant positioning in both MIS approaches. The results of this study show comparable results to the existing literature regarding change of offset and restoration of leg length. Malposition of the acetabular component regarding anteversion poses a risk.
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Affiliation(s)
- Matthias Luger
- Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Rainer Hochgatterer
- Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Matthias C. Klotz
- Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Jakob Allerstorfer
- Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Tobias Gotterbarm
- Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
| | - Bernhard Schauer
- Department of Orthopaedics and Traumatology, Kepler University Hospital Linz, Krankenhausstrasse 9, 4020 Linz, Austria
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Mirghaderi SP, Sharifpour S, Moharrami A, Ahmadi N, Makuku R, Salimi M, Mortazavi SMJ. Determining the accuracy of preoperative total hip replacement 2D templating using the mediCAD ® software. J Orthop Surg Res 2022; 17:222. [PMID: 35399090 PMCID: PMC8996579 DOI: 10.1186/s13018-022-03086-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Templating is a preoperative planning procedure that improves the efficiency of the surgical process and reduces postoperative complications of total hip arthroplasty (THA) by improving the precision of prediction of prosthetic implant size. This study aimed to evaluate the accuracy of the preoperative cup and stem size digital 2D templating of THA with mediCAD® software and find the factors that influence the accuracy, such as indication for surgery, patients' demographics, implant brand, and the assessors' grade of education. METHODS We retrospectively retrieved 420 patient template images of all patients who underwent THA between March 2018 and March 2021. Templating of all included images was processed using mediCAD® software a day before surgery by a newcomer physician to hip arthroplasty course (PGY-2 orthopedic resident or hip surgery fellow). Preoperative templating cup and stem sizes were compared with the actual inserted implant sizes. RESULT After excluding ineligible patients, this study included 391 patients, 193 (49.4%) males and 198 (50.6%) females with a mean age of 43.3 ± 14.9. The average cup sizes predicted before and after surgery were 52.12 ± 14.28 and 52.21 ± 15.05 respectively, and the mean delta cup size (before and after surgery) was 2.79 ± 2.94. The delta stem size before and after surgery has a mean value of 1.53 ± 1.49. The acetabular cup components, measured within ± 0, ± 1, and ± 2 sizes, were 28.9%, 63.9%, 83.1% accurate, respectively. The femoral stem design component measured within ± 0, ± 1, and ± 2 sizes were 27.2%, 61.0%, 78.6% accurate, respectively. Wagner Cone® stem brand, DDH patients, and females showed significantly higher accuracy of stem size templating. Revision THA has the lowest accuracy in terms of cup size templating. The compression of accuracy rate between resident and fellow revealed no significant differences. Also, no significant difference was detected between the accuracy of templating performed in the first months with the second months of the arthroplasty course period. CONCLUSION Our study showed that under mentioned condition, templating using mediCAD® has acceptable accuracy in predicting the sizes of femoral and acetabular components in THA patients. Digital software like mediCAD® remains favorable because of the short learning curve, user-friendly features, and low-cost maintenance, leading to level-up patient care and THA efficacy. Further studies are necessary for clarifying the role of the assessor's experience and expertise in THA preoperative templating. LEVEL OF EVIDENCE Level III (retrospective observational study).
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Affiliation(s)
- Seyed Peyman Mirghaderi
- Joint Reconstruction Research Center (JRRC), Imam Khomeini Hospital, Tehran University of Medical Sciences, End of Keshavarz Blvd, 1419733141 Tehran, Iran
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Sadula Sharifpour
- Joint Reconstruction Research Center (JRRC), Imam Khomeini Hospital, Tehran University of Medical Sciences, End of Keshavarz Blvd, 1419733141 Tehran, Iran
| | - Alireza Moharrami
- Joint Reconstruction Research Center (JRRC), Imam Khomeini Hospital, Tehran University of Medical Sciences, End of Keshavarz Blvd, 1419733141 Tehran, Iran
| | - Negar Ahmadi
- Joint Reconstruction Research Center (JRRC), Imam Khomeini Hospital, Tehran University of Medical Sciences, End of Keshavarz Blvd, 1419733141 Tehran, Iran
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Rangarirai Makuku
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Salimi
- Joint Reconstruction Research Center (JRRC), Imam Khomeini Hospital, Tehran University of Medical Sciences, End of Keshavarz Blvd, 1419733141 Tehran, Iran
| | - Seyed Mohammad Javad Mortazavi
- Joint Reconstruction Research Center (JRRC), Imam Khomeini Hospital, Tehran University of Medical Sciences, End of Keshavarz Blvd, 1419733141 Tehran, Iran
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The morphology of the proximal femur in cementless short-stem total hip arthroplasty: No negative effect on offset reconstruction, leg length difference and implant positioning. J Orthop Surg Res 2021; 16:730. [PMID: 34930358 PMCID: PMC8686665 DOI: 10.1186/s13018-021-02876-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Correct reconstruction of hip offset (HO) and leg length are important for clinical–functional outcome and patient satisfaction in total hip arthroplasty (THA). The morphology of the proximal femur can pose a risk for increased leg length difference (LLD) in cementless straight-stem THA. We therefore wanted to evaluate, if this is also applicable in THA with a cementless meta-diaphyseal short stem. Methods In a retrospective study, 106 patients (index surgery 2014–2019) with unilateral THA and a morphologically healthy hip as a reference (Kellgren–Lawrence ≤ 1) were included. The same cementless short stem with meta-diaphyseal fixation and cementless press-fit cup was implanted. The proximal femur was rated by Dorr’s classification, and subgroups were formed afterward. Measurements were carried out on preoperative and 3 months postoperative anterior–posterior radiographs of the pelvis. Kruskal–Wallis test, Fisher’s exact test and binary logistic regression were performed to evaluate the influence of the anatomical shape on postoperative leg length difference and offset reconstruction. Results The Dorr type did not show any significance influence on LLD (p = 0.532), or postoperative difference in femoral offset (p = 0.243), acetabular offset (p = 0.106) and hip offset (p = 0.698). Stem alignment (p = 0.705) and canal fill indices (CFI I: p = 0.321; CFI II: p = 0.411; CFI III: p = 0.478) were also without significant differences. Logistic regression did not show any significant increased risk for a LLD ≥ 5 mm or ≥ 10 mm as well as HO ≥ 5 mm or ≥ 10 mm. Conclusion Reconstruction of hip offset and postoperative leg length difference is not negatively influenced by Dorr type, canal flare index, cortical index and canal-to-calcar ratio in cementless short-stem THA. Implant positioning and canal fill are also not negatively affected by the anatomical shape of the proximal femur. Level of evidence: Level IV.
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Smith JBV, Bishi H, Wang C, Asopa V, Field RE, Sochart DH. The accuracy and reliability of preoperative digital 2D templating in prosthesis size prediction in uncemented versus cemented total hip arthroplasty: a systematic review and meta-analysis. EFORT Open Rev 2021; 6:1020-1039. [PMID: 34909222 PMCID: PMC8631246 DOI: 10.1302/2058-5241.6.210048] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The purpose of this study was to compare the accuracy and the inter- and intra-observer reliability of preoperative digital 2D templating in prosthesis size prediction for the planning of cemented or uncemented THA. This study was registered in the NIHR PROSPERO database (ID: CRD42020216649) and conducted according to the PRISMA guidelines. A search of electronic databases in March 2021 found 29 papers overall. The quality of evidence was assessed using the IHE Quality Appraisal of Case Series Studies Checklist and the CASP Randomised Controlled Trials Checklist. A meta-analysis was conducted, and the accuracy was presented as proportions and the inter- and intra-observer reliability were measured using intraclass correlation coefficients (ICC). Accuracy within one prosthesis size (±1) for cemented stems was 0.89 (95% confidence interval (CI) 0.83–0.95), cemented cups 0.78 (95% CI 0.67–0.89), uncemented stems 0.74 (95% CI 0.66–0.82) and uncemented cups 0.73 (95% CI 0.67–0.79) (test of group differences: p = 0.010). Inter-observer reliability (ICC) for uncemented cups was 0.88 (95% CI 0.85–0.91), uncemented stems 0.86 (95% CI 0.81–0.91), cemented stems 0.69 (95% CI 0.54–0.84) and cemented cups 0.68 (95% CI 0.55–0.81) (test of group differences: p = 0.004). Due to lack of data, intra-observer reliability (ICC) could only be calculated for uncemented prostheses, which for the stems was 0.90 (95% CI 0.88–0.92) and for the cups was 0.87 (95% CI 0.83–0.90) (test of group differences: p = 0.124). The accuracy of preoperative digital templating is greater for cemented prostheses, but the inter-observer reliability is greater for uncemented prostheses. The intra-observer reliability showed a high level of agreement for uncemented prostheses. Cite this article: EFORT Open Rev 2021;6:1020-1039. DOI: 10.1302/2058-5241.6.210048
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Affiliation(s)
- Joshua B V Smith
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
| | - Habeeb Bishi
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
| | - Chao Wang
- Kingston University and St George's University of London, Tooting, London, UK
| | - Vipin Asopa
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
| | - Richard E Field
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
| | - David H Sochart
- Academic Surgical Unit, South West London Elective Orthopaedic Unit, Epsom, Surrey, UK
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Schiffner E, Latz D, Jungbluth P, Grassmann JP, Tanner S, Karbowski A, Windolf J, Schneppendahl J. Is computerised 3D templating more accurate than 2D templating to predict size of components in primary total hip arthroplasty? Hip Int 2019; 29:270-275. [PMID: 29781288 DOI: 10.1177/1120700018776311] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The aim of this study was to compare the accuracy of preoperative templating in total hip arthroplasty (THA) using conventional 2-dimensional (2D) and computed tomography (CT)-based 3-dimensional (3D) measures. METHODS One hundred and sixteen consecutive primary THAs were analysed. The preoperative diagnosis was primary osteoarthritis in all cases. The 2D templating and the 3D templating were performed by two different residents. All templating results were available for the orthopaedic surgeon performing the procedure. Accuracies with regard to the predicted and actual implant sizes were determined for each procedure. Implantation of the size as planned was defined as "exact", whereas the use of components within one size larger or smaller (±1) as planned were defined as "accurate." RESULTS The 3D templating was significantly more accurate in predicting implant sizing compared to 2D templating for primary total hip arthroplasty (THA). The difference was statistically significant for the cup templating (''exact'' p = 0.02; ''accurate'' p = 0.01) and for the stem templating (''exact'' p = 0.04; ''accurate'' p = 0.01). CONCLUSION Our results support the superiority of 3D templating over 2D templating in predicting implant size.
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Affiliation(s)
- Erik Schiffner
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
| | - David Latz
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
| | - Pascal Jungbluth
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
| | - Jan P Grassmann
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
| | - Stephan Tanner
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
| | - Alfred Karbowski
- 2 Department of Orthopaedic Surgery, Hospital of the Augustinians, Cologne, Germany
| | - Joachim Windolf
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
| | - Johannes Schneppendahl
- 1 Department of Trauma and Hand Surgery, Heinrich Heine University Hospital, Duesseldorf, Germany
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Alnahhal A, Aslam-Pervez N, Sheikh HQ. Templating Hip Arthroplasty. Open Access Maced J Med Sci 2019; 7:672-685. [PMID: 30894933 PMCID: PMC6420946 DOI: 10.3889/oamjms.2019.088] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND: Different methods have been developed and employed with variable degrees of success in pre-operative templating for total hip arthroplasty. Preoperative templating, especially digital templating, has been claimed to have increased the effectiveness of total hip arthroplasty by improving the precision of prediction of prosthetic implant size. AIMS: The overall aim of this systematic review is to identify whether the use of pre-operative templating in total hip arthroplasty procedures has resulted in increased accuracy, reliability and precision of the procedure. Various methods of templating, like traditional acetate overlay and digital method of templating that includes a single radiographic marker and double radiographic marker methods, have been compared to establish the most reliable method of templating. METHODS: We searched the PubMed, Google Scholar Cochrane Central Register of Controlled Trials (CENTRAL), and MEDLINE (1966 to present), EMBASE (1980 to present), CINAHL (1982 to present), Psych INFO (1967 to present) and Clinical Trials Gov. CONCLUSION: The results of this systemic review suggest that preoperative templating is resulting in an enormous increase in the accuracy of total hip arthroplasty and among various methods, King Mark is the most reliable method.
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Affiliation(s)
- Amro Alnahhal
- Barnsley District General Hospital NHS Trust, Gawber Road Barnsley S75 2EP, Great Britain
| | - Nayef Aslam-Pervez
- Calderdale and Huddersfield NHS trust, Acre St, Huddersfield HD3 3EA, Great Britain
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von Engelhardt LV, Breil-Wirth A, Kothny C, Seeger JB, Grasselli C, Jerosch J. Long-term results of an anatomically implanted hip arthroplasty with a short stem prosthesis (MiniHip TM). World J Orthop 2018; 9:210-219. [PMID: 30364820 PMCID: PMC6198291 DOI: 10.5312/wjo.v9.i10.210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 06/17/2018] [Accepted: 06/28/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the clinical and radiological outcome nine and ten years after short-stemmed, bone preserving and anatomical hip arthroplasty with the MiniHipTM system.
METHODS In a prospective study, 186 patients underwent hip arthroplasty with a partial neck preserving short stem (MiniHipTM, Corin). Elderly patients were not excluded from this study, thus the mean age at the time of surgery was 59.3 years (range 32 to 82 years). Surgery and the follow-up assessments were performed at two Centers. Up until now, the mean follow-up was 112.5 ± 8.2 mo. The Oxford Hip Score (OHS) and the Hip Dysfunction Osteoarthritis and Outcome Score (HOOS) was assessed pre- and each year after surgery. The clinical follow-up was accompanied by standardized a.p. and axial radiological examinations. Periprosthetic lucencies, hypertrophies within the Gruen zones one to fourteen were assessed. A subsidence of the stem was investigated according to Morray and heterotopic ossifications were assessed according to Brooker.
RESULTS The OHS and HOOS improved from 18 ± 3.3 to 46 ± 2.0 and from 30 ± 8.3 to 95 ± 4.6 points, P < 0.001 respectively. There were no differences regarding age, etiology, friction pairings, etc., (P > 0.05). Two stems were revised due to a symptomatic subsidence four and twelve months postoperatively. Thus, the survivorship for aseptic loosening at nine to ten years was 98.66%. Including one stem revision due to a symptomatic exostosis, bursitis and thigh pain as well as one revision because of a septic stem loosening, the overall survival for the stem with revision for any reason was 97.32%. Besides one asymptomatic patient, radiological signs of a proximal stress-shielding, such as bone resorptions within the proximal Gruen zones, were not noticed. Findings suggesting a distal loading, e.g., bony hypertrophies or bone appositions of more than 2 mm, were also not detected.
CONCLUSION Regarding these first long-term results on the MiniHipTM, the implant performed exceedingly well with a high rate of survivorship for aseptic loosening. Our radiological results within the Gruen zones support the design rationale of the Minihip to provide a reliable metaphyseal anchoring with the expected proximal, more physiological load transfer. This might minimize or exclude a stress shielding which might be associated with thigh pain, proximal bone loss and an increased risk of aseptic loosening. The MiniHipTM is a reliable partial-neck retaining prosthesis with good a clinical long-term outcome in younger as well as elderly patients.
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Affiliation(s)
- Lars V von Engelhardt
- Faculty of Health, University of Witten/Herdecke, Witten 58448, Germany
- Department of Trauma Surgery Orthopedics and Sports Medicine, Katholisches Karl-Leisner Klinikum, Kleve 47533, Germany
| | - Andreas Breil-Wirth
- Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, Neuss 41462, Germany
| | | | - Jörn Bengt Seeger
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg, Giessen 35392, Germany
| | - Christian Grasselli
- Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, Neuss 41462, Germany
- Department of Orthopaedics and Traumatology, Waldburg-Zeil Clinic Tettnang, Tettnang 88069, Germany
| | - Joerg Jerosch
- Department of Orthopedics, Trauma Surgery and Sports Medicine, Johanna Etienne Hospital, Neuss 41462, Germany
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Khemka A, Mograby O, Lord SJ, Doyle Z, Al Muderis M. Total Hip Arthroplasty by the Direct Anterior Approach Using a Neck-preserving Stem: Safety, efficacy and learning curve. Indian J Orthop 2018; 52:124-132. [PMID: 29576639 PMCID: PMC5858205 DOI: 10.4103/ortho.ijortho_314_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The concept of femoral neck preservation in total hip replacement (THR) was introduced in 1993. It is postulated that retaining cortical bone of the femoral neck offers triplanar stability, uniform stress distribution, and accommodates physiological anteversion. However, data on safety, efficacy and learning curve are lacking. MATERIALS AND METHODS We prospectively assessed all patients who were operated for a THR with a short neck preserving stem (MiniHip) between 2012 and 2014. The safety and learning curve were assessed by recording operative time; stem size; and adverse events including periprosthetic fracture; paresthesia; and limb length discrepancy (LLD). The cohort was divided into equal groups to assess the learning curve effect, and the cumulative sums (CUSUM) test was performed to monitor intraoperative neck fractures. For assessment of efficacy, Oxford Hip Score (OHS) and Short Form-36 (SF-36) scores were compared preoperatively and postoperatively. RESULTS 138 patients with median age 62 years (range 35-82 years) were included with a median followup of 42 months (range 30-56 months). The minimum followup was 2.5 years. The OHS, SF-36 (physical and mental component) scores improved by a mean score of 26, 28, and 27 points, respectively. All patients had LLD of <10 mm (1.9 mm ± 1.3). Adverse events included intraoperative neck fracture (n = 6), subsidence (n = 1), periprosthetic fracture (n = 1), paresthesia (n = 12), and trochanteric bursitis (n = 2). After early modification of the technique to use a smaller finishing broach, the CUSUM test demonstrated acceptable intraoperative neck fracture risk. The second surgery group had a reduced risk of intraoperative neck fracture (5/69 vs. 1/69 P = 0.2), reduced operative time (66 vs. 61 min, P = 0.06), and increased stem size (5 vs. 6, P = 0.09) although these differences were not statistically significant. CONCLUSIONS The MiniHip stem is safe alternative to standard THR with good functional outcomes but with a learning curve for the surgical technique, implants sizing, and the risk of intraoperative neck fractures.
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Affiliation(s)
- Aditya Khemka
- Department of Research, School of Medicine, University of Notre Dame, Fremantle, New South Wales, Australia,Department of Orthopaedics, Norwest Private Hospital, Bella Vista, Fremantle, New South Wales, Australia,Address for correspondence: Dr. Aditya Khemka, Department of Research, School of Medicine, University of Notre Dame Australia, Darlinghurst, Sydney, New South Wales, Australia. E-mail:
| | - Omar Mograby
- Department of Research, School of Medicine, University of Notre Dame, Fremantle, New South Wales, Australia
| | - Sarah J Lord
- Department of Research, School of Medicine, University of Notre Dame, Fremantle, New South Wales, Australia,National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Zelda Doyle
- Department of Epedemiology, Rural Clinical School, University of Notre Dame, Fremantle, New South Wales, Australia
| | - Munjed Al Muderis
- Department of Research, School of Medicine, University of Notre Dame, Fremantle, New South Wales, Australia,Department of Orthopaedics, Norwest Private Hospital, Bella Vista, Fremantle, New South Wales, Australia,Department of Orthopaedics, The Australian School of Advanced Medicine, Macquarie University, New South Wales, Australia
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Preoperative digital planning versus postoperative outcomes in total hip arthroplasty using a calcar-guided short stem: frequent valgization can be avoided. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:643-651. [PMID: 28391517 DOI: 10.1007/s00590-017-1948-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 03/30/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Modern total hip arthroplasty is largely dependent on the successful preservation of hip geometry. Thus, a successful implementation of the preoperative planning is of great importance. The present study evaluates the accuracy of anatomic hip reconstruction predicted by 2D digital planning using a calcar-guided short stem of the newest generation. METHODS A calcar-guided short stem was implanted in 109 patients in combination with a cementless cup using the modified anterolateral approach. Preoperative digital planning was performed including implant size, caput-collum-diaphyseal angle, offset, and leg length using mediCAD II software. A coordinate system and individual scale factors were implemented. Postoperative outcome was evaluated accordingly and was compared to the planning. RESULTS Intraoperatively used stem sizes were within one unit of the planned stem sizes. The postoperative stem alignment showed a minor and insignificant (p = 0.159) mean valgization of 0.5° (SD 3.79°) compared to the planned caput-collum-diaphyseal angles. Compared to the planning, mean femoral offset gained 2.18 (SD 4.24) mm, while acetabular offset was reduced by 0.78 (SD 4.36) mm during implantation resulting in an increased global offset of 1.40 (SD 5.51) mm (p = 0.0094). Postoperative femoroacetabular height increased by a mean of 5.00 (SD 5.98) mm (p < 0.0001) compared to preoperative measures. DISCUSSION Two-dimensional digital preoperative planning in calcar-guided short-stem total hip arthroplasty assures a satisfying implementation of the intended anatomy. Valgization, which has been frequently observed in previous short-stem designs, negatively affecting offset, can be avoided. However, surgeons have to be aware of a possible leg lengthening.
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Pelvic reference selection in patients with unilateral Crowe type IV DDH for measuring leg length inequality. Hip Int 2016; 25:457-60. [PMID: 26109159 DOI: 10.5301/hipint.5000235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2015] [Indexed: 02/04/2023]
Abstract
We identified the presence of deformities in the affected pelvis of unilateral Crowe type IV DDH patients, and if present, whether the teardrop and ischial lines were parallel with the sacral base line. We also verified whether the sacral base line provided a better pelvic landmark than the teardrop line for determining leg length inequality (LLI). After leveling the pelvis by using a block to lift the short leg, standard anterior-posterior full-length radiography was performed on 10 patients and 10 healthy volunteers as controls. The ratio of pelvic heights on each side of the pelvis, the angles formed by the sacral base line and the other 2 lines between 2 groups were measured. LLI were measured by sacral base line and teardrop line respectively. The ratio between the pelvic heights was lower in the patient group than in the control group (0.95 versus 0.99). The angles between the teardrop and ischial lines and the sacral base line in the patient group were both greater than in the control group (6.08° versus 0.92° and 7.13° versus 0.97°). LLI measured from the sacral base line was larger than from the teardrop line in the patient group (5.55 cm versus 4.36 cm). There was pelvic asymmetry and the sacral base line was not parallel with the other 2 lines in unilateral Crowe type IV DDH. The leveled sacral base line was perpendicular to the longitudinal axis of the body, and may be a better choice for accurate LLI measurement in this situation.
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Pourmoghaddam A, Dettmer M, Freedhand AM, Domingues BC, Kreuzer SW. A patient-specific predictive model increases preoperative templating accuracy in hip arthroplasty. J Arthroplasty 2015; 30:622-6. [PMID: 25537432 DOI: 10.1016/j.arth.2014.11.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 10/17/2014] [Accepted: 11/08/2014] [Indexed: 02/01/2023] Open
Abstract
Application of digital radiography during preoperative templating has shown potential to reduce complications in total hip arthroplasty. In this study, we aimed to further improve digital templating by using a predictive model built on patients' specific data. The model was significant in improving the accuracy of templating within ±1 size of acetabular component (χ(2)(1, N=468)=19.314, P<0.0001, Φ=0.604, and odds-ratio: 7.750 (95% CI 2.740-30.220)). We successfully achieved a 99% accuracy within ±2 of templated size. Additionally, patient demographics, such as height and weight, have shown significant effects on the predictive model. The outcome of this study may help reducing the costs of health care in the long term by minimizing implant inventory costs.
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Affiliation(s)
- Amir Pourmoghaddam
- Memorial Bone & Joint Research Foundation, Department of Orthopaedic Surgery, The University of Texas Health Science Center at Houston-Medical School, Houston, Texas
| | - Marius Dettmer
- Memorial Bone & Joint Research Foundation, Department of Orthopaedic Surgery, The University of Texas Health Science Center at Houston-Medical School, Houston, Texas
| | - Adam M Freedhand
- Memorial Bone & Joint Research Foundation, Department of Orthopaedic Surgery, The University of Texas Health Science Center at Houston-Medical School, Houston, Texas
| | - Brian C Domingues
- Memorial Bone & Joint Research Foundation, Department of Orthopaedic Surgery, The University of Texas Health Science Center at Houston-Medical School, Houston, Texas
| | - Stefan W Kreuzer
- Memorial Bone & Joint Research Foundation, Department of Orthopaedic Surgery, The University of Texas Health Science Center at Houston-Medical School, Houston, Texas
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Höhle P, Schröder SM, Pfeil J. Comparison between preoperative digital planning and postoperative outcomes in 197 hip endoprosthesis cases using short stem prostheses. Clin Biomech (Bristol, Avon) 2015; 30:46-52. [PMID: 25434789 DOI: 10.1016/j.clinbiomech.2014.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/31/2014] [Accepted: 11/12/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preservation of hip geometry is important for treatment success in endoprosthesis implantation. Digital planning can be used to estimate postoperative hip geometry. This study examined whether digital planning accurately predicts surgical outcomes for two femoral neck resecting short stem implants, Mayo® (Zimmer) and Metha® (Aesculap). METHODS Preoperative digital planning of the short stem and acetabular cup was performed for 191 patients (197 endoprostheses) with hip osteoarthritis. Digital planning was done with mediCAD II (Hectec) to evaluate types of prosthesis stems and sizes, leg lengthening and offset, and angle of stem inclination within the femur. The predicted values for these parameters were compared to the postoperative measurements. A double coordinate system was developed to measure pelvic and femoral distances separately. Individual scale factors were applied to minimize measurement bias. FINDINGS Implantation of the planned short stem prostheses resulted in a mean femoro-acetabular leg lengthening of 4.2mm (SD 5.8mm) and a mean femoro-acetabular offset-reduction of 4.2mm (SD 5.9mm) in comparison with preoperative planning. Implantation of both stems resulted in increased valgization compared to planning (Metha®, mean 5.4° (SD 3.7°); Mayo®, mean -3.2° (SD 3.4°)). INTERPRETATION Differences between preoperative planning and postoperative outcomes were greater for femoro-acetabular than for cup-related leg length and offset. On average, leg length was longer than predicted and there was loss of femoro-acetabular offset. Compared with the planning, valgization of the implanted stems was frequently observed.
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Affiliation(s)
- Philip Höhle
- Department of Trauma and Orthopaedic Surgery, Hand and Reconstructive Surgery, Hospital Worms, Worms, Germany.
| | - Simon M Schröder
- Department of Trauma, Hand and Reconstructive Surgery, GPR Hospital, Rüsselsheim, Germany.
| | - Joachim Pfeil
- Department of Orthopaedics and Orthopaedic Surgery, St. Josefs Hospital, Wiesbaden, Germany.
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Kutzner KP, Kovacevic MP, Roeder C, Rehbein P, Pfeil J. Reconstruction of femoro-acetabular offsets using a short-stem. INTERNATIONAL ORTHOPAEDICS 2014; 39:1269-75. [PMID: 25522801 DOI: 10.1007/s00264-014-2632-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/02/2014] [Indexed: 12/26/2022]
Abstract
PURPOSE Despite the fact that new and modern short-stems allow bone sparing and saving of soft-tissue and muscles, we still face the challenge of anatomically reconstructing the femoro-acetabular offset and leg length. Therefore a radiological and clinical analysis of a short-stem reconstruction of the femoro-acetabular offset and leg length was performed. METHODS Using an antero-lateral approach, the optimys short-stem (Mathys Ltd, Bettlach, Switzerland) was implanted in 114 consecutive patients in combination with a cementless cup (Fitmore, Zimmer, Indiana, USA; vitamys RM Pressfit, Mathys Ltd, Bettlach, Switzerland). Pre- and postoperative X-rays were done in a standardized technique. In order to better analyse and compare X-ray data a special double coordinate system was developed for measuring femoral- and acetabular offset. Harris hip score was assessed before and six weeks after surgery. Visual analogue scale (VAS) satisfaction, leg length difference and the existence of gluteal muscle insufficiency were also examined. RESULTS Postoperative femoral offset was significantly increased by a mean of 5.8 mm. At the same time cup implantation significantly decreased the acetabular offset by a mean of 3.7 mm, which resulted in an increased combined femoro-acetabular offset of 2.1 mm. Postoperatively, 81.7% of patients presented with equal leg length. The maximum discrepancy was 10 mm. Clinically, there were no signs of gluteal insufficiency. No luxation occurred during hospitalization. The Harris hip score improved from 47.3 before to 90.1 points already at six weeks after surgery while the mean VAS satisfaction was 9.1. CONCLUSION The analysis showed that loss of femoro-acetabular offset can be reduced with an appropriate stem design. Consequently, a good reconstruction of anatomy and leg length can be achieved. In the early postoperative stage the clinical results are excellent.
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Affiliation(s)
- Karl Philipp Kutzner
- Department of Orthopaedic Surgery, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany,
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Khanuja HS, Banerjee S, Jain D, Pivec R, Mont MA. Short bone-conserving stems in cementless hip arthroplasty. J Bone Joint Surg Am 2014; 96:1742-52. [PMID: 25320202 DOI: 10.2106/jbjs.m.00780] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Short bone-conserving femoral stems in total hip arthroplasty were designed to preserve proximal bone stock.➤ Given the distinct fixation principles and location of loading among these bone-conserving stems, a classification system is essential to compare clinical outcomes.➤ Due to the low quality of currently available evidence, only a weak recommendation can be provided for clinical usage of certain stem designs, while some other designs cannot be recommended at this time.➤ A high prevalence of stem malalignment, incorrect sizing, subsidence, and intraoperative fractures has been reported in a subset of these short stem designs.➤ Stronger evidence, including prospective multicenter randomized trials comparing standard stems with these newer designs, is necessary before widespread use can be recommended.
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Affiliation(s)
- Harpal S Khanuja
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, 4942 Eastern Avenue, 6th Floor, Building A, Baltimore, MD 21224
| | - Samik Banerjee
- Department of Orthopaedic Surgery, Albany Medical Center, 43 New Scotland Avenue, Albany, NY 12208
| | - Deepak Jain
- Department of Orthopedic Surgery, Dayanand Medical College and Hospital, Ludhiana, Tagore Nagar, Ludhiana, Punjab 141002, India
| | - Robert Pivec
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215
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Piriou P, Bugyan H, Casalonga D, Lizée E, Trojani C, Versier G. Can hip anatomy be reconstructed with femoral components having only one neck morphology? A study on 466 hips. J Arthroplasty 2013; 28:1185-91. [PMID: 23245588 DOI: 10.1016/j.arth.2012.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Revised: 08/03/2012] [Accepted: 08/17/2012] [Indexed: 02/01/2023] Open
Abstract
This extensive radiographic study asks if there is a statistical relationship between the size of the stem that will best fit the femur and the vertical and lateral offsets of the reconstructed acetabular center, what is the distribution of vertical and lateral offsets in this large and if there is a statistical difference among surgeons in the planned location of the reconstructed acetabular center. On 466 radiographs, five surgeons separately templated stem size and acetabular cup location. The vertical and horizontal coordinates of the reconstructed acetabulum center were measured relative to the planned position of the stem. We found a strong correlation between the stem size and the average lateral and vertical offsets. Acetabular reaming associated with the anatomic variability of native femoral necks, leads to a span of 36 mm in lateral offset, and a span of 39 mm in vertical offset. Statistically significant differences were also found in the way surgeons plan acetabular reaming.
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Issa K, Pivec R, Boyd B, Harwin SF, Wuestemann T, Nevelos J, Mont MA. Comparing the accuracy of radiographic preoperative digital templating for a second- versus a first-generation THA stem. Orthopedics 2012; 35:1028-34. [PMID: 23218615 DOI: 10.3928/01477447-20121120-03] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study assessed the accuracy of preoperative digital templating for a second-generation cementless stem compared with its first-generation design. A prospective cohort of 100 consecutive patients who had undergone a primary total hip arthroplasty using a new second-generation cementless stem was compared with the prior 100 hips that had received the first-generation stem. The authors believe that the second-generation stem may allow equal or more accurate digital templating compared with its predicate design.
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Affiliation(s)
- Kimona Issa
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland 21215, USA
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[Templating and radiological outcome monitoring for elective total hip arthroplasty. Applied quality management principles for safe patient care]. Unfallchirurg 2012; 114:776-85. [PMID: 21870133 DOI: 10.1007/s00113-011-2029-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Implementation of total hip arthroplasty is a successful and reliable treatment for end-stage osteoarthritis. The biomechanics and components as well as the fixation were selected with the aid of templating. Based on a cohort of 114 patients the quality of digital X-rays and the operative results were determined. There was a slight leg lengthening and a good offset reconstruction in these patients. For the patients with replacement of the second hip the leg lengthening was smaller. The cup inclination was at 43° and 44° within the desired range. The prediction of the exact component size used was 40% for the cup and 29% for the stem.Through variation in scaling of the digital X-ray a diminishing prediction accuracy was found in our study. The correction of biomechanics and position of components showed good quality in patient care. Templating and assessment of the postoperative result in total hip arthroplasty is a model for continuous quality management and can be recommended for safe patient care.
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Schmidutz F, Steinbrück A, Wanke-Jellinek L, Pietschmann M, Jansson V, Fottner A. The accuracy of digital templating: a comparison of short-stem total hip arthroplasty and conventional total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2012; 36:1767-72. [PMID: 22476451 DOI: 10.1007/s00264-012-1532-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 03/14/2012] [Indexed: 12/31/2022]
Abstract
PURPOSE Selection of the correct femoral stem size is crucial in total hip arthroplasty for an uncomplicated implantation and good initial stability. Pre-operative templating has been shown to be a valuable tool in predicting the correct implant size. For short-stem total hip arthroplasty (SHA), which recently is increasingly used, it is unknown if templating can be performed as reliable as conventional total hip arthroplasty (THA). METHODS A total of 100 hip arthroplasties, 50 with SHA and 50 with THA, were templated by four orthopaedic surgeons each. The surgeons had different levels of professional experience and performed a digital template of the acetabular and femoral component on the pre-operative radiographs. The results were compared with the truly inserted implant size. RESULTS For the femoral stems the average percentage of agreement (± 1 size) was 89.0 % in SHA and 88.5 % in THA. There was no significant difference among surgeons in the accuracy of templating the correct stem size and no significant difference between templating SHA and THA. For the acetabular component the average percentage of agreement (± 1 size) was 75.8 %. However, the more experienced surgeons showed a significant higher accuracy for templating the correct cup size than the less experienced surgeons. CONCLUSION Digital templating of SHA can predict the stem sizes as accurately as conventional THA. Therefore digital templating is also recommendable for SHA, as it helps to predict the implant size prior to surgery and thereby might help to avoid complications.
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Affiliation(s)
- Florian Schmidutz
- Department of Orthopaedic Surgery, Campus Grosshadern, University Hospital of Munich, LMU, Munich, Germany.
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Fottner A, Steinbrück A, Sadoghi P, Mazoochian F, Jansson V. Digital comparison of planned and implanted stem position in total hip replacement using a program form migration analysis. Arch Orthop Trauma Surg 2011; 131:1013-9. [PMID: 21222126 DOI: 10.1007/s00402-010-1256-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Indexed: 11/29/2022]
Abstract
AIM One main goal in primary total hip replacement is the reconstruction of preoperative biomechanical conditions by adequate implant positioning. Our aim was to compare the planned and effectively implanted stem position in using a program for digital migration measurement. PATIENTS We examined 120 cases with this new method based on a modification of the EBRA-FCA program and compared these results to direct plain radiographic methods. In addition, the intra- and inter-observer reliability was determined in 50 cases. RESULTS We observed a rate of correct prediction of 80% for the size of the stem. The new method revealed a good correlation (0.95 and 0.64 for the position along the stem axis and 0.84 for the stem angle) to direct plain radiographic methods. Regarding the intraclass correlation coefficient for intra- and inter-observer reliability, the results were superior (0.97 vs. 0.81-0.84 and 0.90 vs. 0.74-0.88) compared with direct plain radiographic methods. CONCLUSION We concluded that the comparison of the planned and implanted stem position using a modified EBRA-FCA method is more reproducible than direct radiographic measurements.
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Affiliation(s)
- Andreas Fottner
- Department of Orthopaedic Surgery, Ludwig-Maximilians-University Munich, Campus Grosshadern, Marchioninistr 15, 81377 Munich, Germany.
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Meermans G, Malik A, Witt J, Haddad F. Preoperative radiographic assessment of limb-length discrepancy in total hip arthroplasty. Clin Orthop Relat Res 2011; 469:1677-82. [PMID: 20878559 PMCID: PMC3094616 DOI: 10.1007/s11999-010-1588-x] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 09/10/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pelvic radiographs are helpful in assessing limb-length discrepancy (LLD) before and after THA but are subject to variation. Different methods are used to determine LLDs. As a pelvic reference, both ischial tuberosities and the teardrops are used, and as a femoral reference, the lesser trochanter and center of the femoral head are used. QUESTIONS/PURPOSES We validated the different methods for preoperative radiographic measurement of LLDs and evaluated their reliability. PATIENTS AND METHODS LLDs were measured on full-leg radiographs for 52 patients (29 men, 23 women) with osteoarthritis (OA) of the hip and compared with different methods for measuring LLDs on AP radiographs of the pelvis. RESULTS The true LLD varied from -8.0 to 9.1 mm. When the biischial line was used as a pelvic reference, the LLD measured on AP pelvis radiographs was different from the true LLD. No difference was found when the interteardrop line was used as a pelvic reference. There was substantial interobserver agreement when the lesser trochanter was used as a femoral reference (kappa = 0.66-0.70) and excellent interobserver and intraobserver agreement for all other measurements (kappa = 0.84-0.93). CONCLUSIONS Our data show use of the biischial line as a pelvic reference should be discouraged and the interteardrop line is a better alternative. The center of the femoral head is a more reliable femoral landmark compared with the lesser trochanter.
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Affiliation(s)
- Geert Meermans
- Department of Orthopaedics, University College London Hospital, London, UK ,Marie-Josélaan 19, 2600 Berchem, Belgium
| | - Ahmad Malik
- Department of Orthopaedics, University College London Hospital, London, UK
| | - Johan Witt
- Department of Orthopaedics, University College London Hospital, London, UK
| | - Fares Haddad
- Department of Orthopaedics, University College London Hospital, London, UK
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Steinberg EL, Shasha N, Menahem A, Dekel S. Preoperative planning of total hip replacement using the TraumaCad™ system. Arch Orthop Trauma Surg 2010; 130:1429-32. [PMID: 20069428 DOI: 10.1007/s00402-010-1046-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Templating is now the standard approach for preoperative planning of total joint replacement and fracture fixation. The aim of this study was to assess the accuracy of new software, TraumaCad™, for preoperative planning for total hip replacement. METHODS This software enables the import and export of all picture archiving communication system (PACS) files from local working stations. It can integrate with all PACS systems. We retrospectively reviewed TraumaCad™-generated templates of digitalized preoperative radiographs of 73 consecutive patients. RESULTS The acetabular component, measured within ± 1 size, was accurate in 65 patients (89%), and the femoral stem design component was accurate in 70 patients (97%). The accuracy of the femoral size was predicted in 57 patients within 1 size (87%) and in 65 patients within 2 sizes (96%) out of 68 patients in the Corail femoral component group. TraumaCad™ successfully predicts the sizes of femoral and acetabular component and easily integrates with all PACS files.
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Affiliation(s)
- Ely Liviu Steinberg
- Department of Orthopedic Surgery B, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St., Tel-Aviv, 64239, Israel.
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Olsen M, Gamble P, Chiu M, Tumia N, Boyle RA, Schemitsch EH. Assessment of accuracy and reliability in preoperative templating for hip resurfacing arthroplasty. J Arthroplasty 2010; 25:445-9. [PMID: 19251390 DOI: 10.1016/j.arth.2009.01.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Accepted: 01/30/2009] [Indexed: 02/01/2023] Open
Abstract
The current study investigated the accuracy and reliability of hip resurfacing component selection based on digital preoperative templating. Four surgeons made a template of preoperative radiographs on 2 occasions for acetabular and femoral components in 50 randomly selected hip resurfacing patients. Component selection reliability was variable among surgeons (kappa = 0.16-0.73) and fair between surgeons (kappa = 0.23-0.32). The average percentage of agreement for the acetabular component was 47% (range, 32%-64%) and for the femoral component was 54% (range, 38%-70%). Surgeons tended to underestimate implant size if the correct implant was not chosen (acetabular, 29%; femoral, 32%). Selection of an undersized femoral component may lead to femoral neck notching or varus implant alignment. This study emphasizes the need for intraoperative verification of preoperative templating results to ensure optimal implant selection in hip resurfacing.
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Affiliation(s)
- Michael Olsen
- Division of Orthopedic Surgery, St Michael's Hospital, Toronto, Ontario, Canada
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Crooijmans HJA, Laumen AMRP, van Pul C, van Mourik JBA. A new digital preoperative planning method for total hip arthroplasties. Clin Orthop Relat Res 2009; 467:909-16. [PMID: 18781367 PMCID: PMC2650039 DOI: 10.1007/s11999-008-0486-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Accepted: 08/18/2008] [Indexed: 01/31/2023]
Abstract
Preoperative templating is an important part of a THA. The ability to accurately determine magnification of the hip on the radiograph and apply identical magnification to the radiograph and template will improve accuracy of preoperative templating of THA. We designed a templating method using a new way of determining the hip magnification with a linear relationship between magnification of the hip and the reference object on top of the pubis symphysis; the relationship was determined on 50 radiographs. We then compared our method with two other templating methods: an analog method assuming an average hip magnification of 15% and a digital method determining the hip magnification with a one-to-one relationship between the reference object and the hip. All methods were reproducible. Uniform undersizing occurred when templating with the digital method based on the one-to-one relationship; the analog method best predicted the implanted prosthesis size, closely followed by our new digital templating method; the new method will be particularly applicable for preoperative THA when analog methods are replaced by digital methods.
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