Assessment of an Orthopaedic Templating Software Package for Uncemented Total Hip Arthroplasty

AbstractThe aim of this study was to assess a large, single-surgeon dataset of uncemented total hip arthroplasties that had been templated using software. This assessment compared preoperative templated predictions with what was implanted with regard to (1) femoral prosthesis size and (2) acetabular cup size. The operation notes for two types of uncemented total hip arthroplasty performed by a single surgeon between January 9, 2008, and March 21, 2019, were assessed. The data were refined so that only those that were fully templated on a correctly calibrated pelvic radiograph were included. This provided a total of 153 cases. The predicted software template was compared with actual implanted component sizes. With regard to the femoral stems, the templating software was exactly correct in 45.75% of cases and was accurate to within one size in 87.59% of cases. With regard to the acetabular component, the templating software was exactly correct in 52.94% of cases and was accurate to within one size (2 mm) in 86.94% of cases. Templating software offers an accurate prediction of the size of uncemented femoral and acetabular components. In addition, the benefits of templating include cognitive rehearsal, insight into potentially challenging aspects of surgery, and highlighting intraoperative issues where there is a large intraoperative deviation from what is templated. This study demonstrates the congruence and reproducibility of templating software when compared with other smaller studies performed in the literature.

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Assessment of an Orthopaedic Templating Software Package for Cemented Total Hip Arthroplasty

The Journal of Hip Surgery ◽

10.1055/s-0039-1678746 ◽

2019 ◽

Vol 03 (02) ◽

pp. 059-061

Author(s):

Michael Newman ◽

Grant Shaw ◽

Timothy Kane

Keyword(s):

Femoral Stem ◽

Femoral Prosthesis ◽

Acetabular Cup ◽

Total Hip ◽

Pelvic Radiograph ◽

Tapered Stem ◽

Hip Arthroplasties ◽

Cemented Total Hip Arthroplasty ◽

Operating Surgeon ◽

Insight Into

AbstractThe main aim of this article was to assess a large, multisurgeon dataset of cemented total hip arthroplasties that had been templated using software. This assessment compared preoperative templated predictions with what was implanted with regard to (1) femoral prosthesis size, (2) offset, and (3) acetabular cup size. A database of total hip arthroplasties performed by four surgeons between the dates November 7, 2014 and October 31, 2017 was interrogated. The data was refined so that only primary cemented collarless polished tapered stem hip arthroplasties, fully templated on a correctly calibrated pelvic radiograph, were included. This provided 354 cases. The predicted software template was compared with actual implanted component sizes. With regard to the femoral stem, the software was exactly correct in 70.9% and accurate to within one size in 96.89% of cases. With regard to the femoral offset, the software was exactly correct in 87.01% and accurate to within one size in 99.72% of cases. With regard to the acetabular cup size, the software was exactly correct in 61.3% and accurate to within +/− 2 mm in 87.29% of cases. Templating software offers an accurate prediction of the femoral prosthesis size and offset, as well as acetabular cup size. Preoperative insight into likely component sizes and offset provides the operating surgeon with many benefits; templating the pelvic radiograph is a method of cognitive rehearsal, provides insight into potentially challenging aspects of the upcoming surgery, may highlight intraoperative issues where there is a large intraoperative deviation from what is templated, and enables efficient stock keeping for the healthcare institution.

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Comparison of Acetabular Reamings during Hip Resurfacing versus Uncemented Total Hip Arthroplasty

Journal of Orthopaedic Surgery ◽

10.1177/230949900901700110 ◽

2009 ◽

Vol 17 (1) ◽

pp. 42-46 ◽

Cited By ~ 9

Author(s):

SA Brennan ◽

JA Harty ◽

C Gormley ◽

SK O'Rourke

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Elderly Women ◽

Hip Resurfacing ◽

Acetabular Cup ◽

Total Hip ◽

Uncemented Total Hip Arthroplasty ◽

Neck Fracture ◽

History Of ◽

Resurfacing Hip Arthroplasty

Purpose. To compare the quantity of bone removed from the acetabulum during resurfacing hip arthroplasty versus uncemented total hip arthroplasty (THA). Methods. 62 consecutive patients with osteoarthritis of the hip were prospectively studied. 24 men and 7 women aged 40 to 86 (mean, 59) years underwent Birmingham hip resurfacing. 13 men and 18 women aged 34 to 88 (mean, 61) years underwent uncemented THA using the trident acetabular cup. Obese elderly women at risk of femoral neck fracture and patients with large subchondral pseudocysts or a history of avascular necrosis of the femoral head were assigned to uncemented THA. Acetabular reamings were collected; marginal osteophytes were not included. The reamings were dehydrated, defatted, and weighed. Results. The mean weight of acetabular reamings was not significantly different between patients undergoing hip resurfacing and uncemented THA (p=0.57). Conclusion. In hip resurfacing, the use of an appropriately small femoral component avoids oversizing the acetabular component and removal of excessive bone stock.

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Definition and validation of a system for classifying the undersized Corail femoral stem in total hip arthroplasty

Hip International ◽

10.1177/1120700021996001 ◽

2021 ◽

pp. 112070002199600

Author(s):

Jamie S McConnell ◽

Farhan A Syed ◽

Paul Saunders ◽

Raviprasad Kattimani ◽

Anthony Ugwuoke ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Classification System ◽

Femoral Stem ◽

Observer Agreement ◽

Stem Size ◽

Total Hip ◽

Initial Fixation ◽

Uncemented Total Hip Arthroplasty ◽

Hip Arthroplasties

Introduction: The uncemented total hip arthroplasty relies on a secure initial fixation of the femoral stem to achieve osseointegration. Undersizing of the femoral implant compromises this. Surgeons routinely review postoperative radiographs to assess appropriate sizing, but existing methods of assessment lack standardisation. We present a system of accurately and reliably classifying radiological undersizing, which will help us better understand the factors that might have led to undersizing. Aim: To describe and evaluate a classification system for assessing radiological undersizing of the uncemented stem in hip arthroplasty. Method: We conducted a retrospective review of 1,337 consecutive hip arthroplasties using the Corail stem. Two independent investigators reviewed post-operative radiographs and classified them as either appropriately sized or undersized. Undersized stems were sub-categorised into four subtypes: uniformly undersized, varus undersized, valgus undersized or ‘cocktail-glass’ undersized. Inter- and intra-observer agreement was determined. The accuracy of our classification system was validated by comparison with digital re-templating. We further assessed patient demographics and stem size in relation to sizing. Results: 1 in 5 cases (19.75%) were deemed radiologically undersized. The commonest subtypes of undersizing were uniformly (47%) and varus (39%) undersized. When assessing sizing and subtype categorisation, inter-observer agreement was 89–92% and intra-observer agreement 86%. Classification decisions showed 92% and 97% accuracy for uniformly undersizing and varus undersizing respectively when validated against digital re-templating. Age, gender and smaller stem size were significantly associated with radiological undersizing. The Corail KLA model (125° neck) was found to have a higher incidence of stems undersized in varus. Conclusions: This study describes and validates a classification system for the analysis of radiological undersizing.

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Effect of acetabular cup orientation and femoral stem placement on the functional outcome in uncemented total hip arthroplasty

National Journal of Clinical Orthopaedics ◽

10.33545/orthor.2020.v4.i1a.193 ◽

2020 ◽

Vol 4 (1) ◽

pp. 09-14

Author(s):

Dr. Nitin Manral ◽

Dr. Dharmender ◽

Dr. Aditya Mongia ◽

Dr. Mohit

Keyword(s):

Total Hip Arthroplasty ◽

Functional Outcome ◽

Hip Arthroplasty ◽

Femoral Stem ◽

Acetabular Cup ◽

Total Hip ◽

Uncemented Total Hip Arthroplasty

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Second-generation uncemented total hip arthroplasty: a minimum 20-year follow-up

Bone & Joint Open ◽

10.1302/2633-1462.21.bjo-2020-0157.r1 ◽

2021 ◽

Vol 2 (1) ◽

pp. 33-39

Author(s):

Jeffrey R. McLaughlin ◽

Kyla R. Lee ◽

Mary Ann Johnson

Keyword(s):

Total Hip Arthroplasty ◽

Aseptic Loosening ◽

Femoral Component ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Second Generation ◽

Total Hip ◽

Uncemented Total Hip Arthroplasty ◽

Acetabular Components

Aims We present the clinical and radiological results at a minimum follow-up of 20 years using a second-generation uncemented total hip arthroplasty (THA). These results are compared to our previously published results using a first-generation hip arthroplasty followed for 20 years. Methods A total of 62 uncemented THAs in 60 patients were performed between 1993 and 1994. The titanium femoral component used in all cases was a Taperloc with a reduced distal stem. The acetabular component was a fully porous coated threaded hemispheric titanium shell (T-Tap ST). The outcome of every femoral and acetabular component with regard to retention or revision was determined for all 62 THAs. Complete clinical follow-up at a minimum of 20 years was obtained on every living patient. Radiological follow-up was obtained on all but one. Results Two femoral components (3.2%) required revision. One stem was revised secondary to a periprosthetic fracture one year postoperatively and one was revised for late sepsis. No femoral component was revised for aseptic loosening. Six acetabular components had required revision, five for aseptic loosening. One additional acetabular component was revised for sepsis. Radiologically, all femoral components remained well fixed. One acetabular was judged loose by radiological criteria. The mean Harris Hip Score improved from 46 points (30 to 67) preoperatively to 89 points (78 to 100) at final follow-up. With revision for aseptic loosening as the endpoint, survival of the acetabular component was 95% (95% confidence interval (CI) 90 to 98) at 25 years. Femoral component survival was 100%. Conclusion The most significant finding of this report was the low prevalence of aseptic loosening and revision of the femoral component at a mean follow-up of 22 years. A second important finding was the survival of over 90% of the hemispheric threaded ring acetabular components. While these shells remain controversial, in this series they performed well. Cite this article: Bone Jt Open 2021;2(1):33–39.

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Leg Length Discrepancy in Total Hip Arthroplasty with the use of Cemented and Uncemented Femoral Stems. A Prospective Radiological Study

Hip International ◽

10.1177/112070000901900313 ◽

2009 ◽

Vol 19 (3) ◽

pp. 264-267 ◽

Cited By ~ 9

Author(s):

Riaz Ahmad ◽

Vinod Sharma ◽

Harvey Sandhu ◽

Michael Bishay

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Femoral Stem ◽

Leg Length Discrepancy ◽

Leg Length ◽

Radiological Study ◽

Total Hip ◽

Length Discrepancy ◽

Femoral Stems ◽

Hip Arthroplasties

Leg length discrepancy may occur following total hip arthroplasty, with a potentially impaired functional outcome as a result. The aim of this study was to compare the leg length discrepancy between both cemented and uncemented femoral stems when used in total hip arthroplasty. A prospective radiological study of 200 consecutive primary total hip arthroplasties was performed between June 2005 and December 2006. Pre and post-operative radiographs were analysed. 56 (56%) of the total hip arthroplasties where an uncemented femoral stem was used had a leg length discrepancy over 1 cm. However only 23 (23%) of the total hip arthroplasties with a cemented femoral stem had a leg length discrepancy over 1 cm. The use of cemented femoral stems in total hip arthroplasty results in a lower incidence of leg length discrepancy, with a potentially better functional outcome.

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Ten years on: increased metal ion levels in a cohort of patients who underwent uncemented metal-on-polyethylene total hip arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.102b7.bjj-2019-1372.r1 ◽

2020 ◽

Vol 102-B (7) ◽

pp. 832-837

Author(s):

Caroline Dover ◽

Jan Herman Kuiper ◽

Peter Craig ◽

Phillip Shaylor

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Metal Ion ◽

Revision Arthroplasty ◽

Total Hip ◽

Uncemented Total Hip Arthroplasty ◽

Oxford Hip Score ◽

Hip Arthroplasties ◽

Over Time

Aims We have previously demonstrated raised cobalt and chromium levels in patients with larger diameter femoral heads, following metal-on-polyethylene uncemented total hip arthroplasty. Further data have been collected, to see whether these associations have altered with time and to determine the long-term implications for these patients and our practice. Methods Patients from our previous study who underwent Trident-Accolade primary total hip arthroplasties using a metal-on-polyethylene bearing in 2009 were reviewed. Patients were invited to have their cobalt and chromium levels retested, and were provided an Oxford Hip Score. Serum ion levels were then compared between groups (28 mm, 36 mm, and 40 mm heads) and over time. Results Metal ion levels were repeated in 33 patients. When comparing the results of serum metal ion levels over time, regardless of head size, there was a significant increase in both cobalt and chromium levels (p < 0.001). Two patients with larger head sizes had undergone revision arthroplasty with evidence of trunnion damage at surgery. Two patients within the 40 mm subgroup had metal ion levels above the MHRA (Medicines and Healthcare Products Regulatory Agency) threshold for detailed investigation. The increase in cobalt and chromium, when comparing the 36 mm and 40 mm groups with those of the 28 mm group, was not significant (36 mm vs 28 mm; p = 0.092/p = 0.191; 40 mm vs 28 mm; p = 0.200/p = 0.091, respectively). There was no difference, between femoral head sizes, when comparing outcome as measured by the Oxford Hip Score. Conclusion This study shows an increase in cobalt and chromium levels over time for all modular femoral head sizes in patients with metal-on-polyethylene bearings, with two patients demonstrating ion levels above the MHRA threshold for failure, and a further two patients requiring revision surgery. These results may have clinical implications regarding longer term follow-up of patients and future implant choice, particularly among younger patients. Cite this article: Bone Joint J 2020;102-B(7):832–837.

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