Improving Acetabular Component Positioning in Total Hip Arthroplasty: A Cadaveric Study of an Inertial Navigation Tool and a Novel Registration Method

2021 ◽  
pp. 155633162110517
Author(s):  
Jobe Shatrov ◽  
Daniel Marsden-Jones ◽  
Matt Lyons ◽  
William L. Walter
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Lateral Position ◽  
Cadaveric Study ◽  
Anatomical Landmarks ◽  
Registration Method ◽  
Total Hip ◽  
Cup Positioning ◽  
Cup Position

Background: Incorrect acetabular component positioning in total hip arthroplasty (THA) has been associated with poor outcomes. Computer-assisted hip arthroplasty increases accuracy and consistency of cup positioning compared to conventional methods. Traditional navigation units have been associated with problems such as bulkiness of equipment and reproducibility of anatomical landmarks, particularly in obese patients or the lateral position. Purpose: We sought to evaluate the accuracy of a novel miniature inertial measurement system, the Navbit Sprint navigation device (Navbit, Sydney, Australia), to navigate acetabular component positioning in both the supine and lateral decubitus positions. We also aimed to validate a new method of patient registration that does not require acquisition of anatomical landmarks for navigation. Methods: We performed THA in a cadaveric study in supine and lateral positions using Navbit navigation to record cup position and compared mean scores from 3 Navbit devices for each cup position on post-implantation CT scans. Results: A total of 11 cups (5 supine and 6 lateral) were available for comparison. A difference of 2.34° in the supine direct anterior approach when assessing acetabular version was deemed to be statistically but not clinically significant. There was no statistically significant difference between CT and navigation measurements of cup position in the lateral position. Conclusion: This cadaveric study suggests that a novel inertial-based navigation tool is accurate for cup positioning in THA in the supine and lateral positions. Furthermore, it validates a novel registration method that does not require the identification of anatomical landmarks.

Does Robotic-Assisted Total Hip Arthroplasty Improve Accuracy of Cup Positioning?

2019 ◽  
Vol 03 (04) ◽  
pp. 176-180 ◽  
Author(s):  
Joshua A. Lawson ◽  
Andrew T. Garber ◽  
Jeffrey D. Stimac ◽  
Rama Ramakrishnan ◽  
Langan S. Smith ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Consecutive Series ◽  
Goal Alignment ◽  
Robotic Assisted ◽  
Component Placement ◽  
Total Hip ◽  
Hip Replacements ◽  
Cup Positioning

AbstractAcetabular component malpositioning is a frequent cause of complications in total hip arthroplasty including instability, increased wear, osteolysis, impingement, and revision surgery. Recently, robotics and navigation have been introduced to improve cup positioning in total hip arthroplasty. The purpose of this study was to compare the accuracy of postoperative acetabular component positioning using MAKO robotic-assisted versus manual acetabular component placement. A consecutive series of 100 total hip replacements were performed in 100 patients. The first 50 were performed using manual techniques, while the second 50 were performed using MAKO-guided acetabular component placement. Postoperative anteroposterior pelvis radiographs were used to determine the postoperative anteversion and inclination of the cup relative to the goal of 15 and 45°, respectively. In the manual group, the average anteversion and inclination was 14.3 and 44.2°, respectively, with 28% within 5° and 82% within 10° of the goal alignment, respectively. In the robotic group, the average anteversion and inclination was 15.1 and 45.6°, respectively, with 54 and 88% within 5 and 10° of the goal alignment, respectively. This equated to a statistically significant improvement in the number of acetabular components placed within 5° of the target alignment with the use of robotic guidance (p = 0.0142). From the authors' study, they were able to demonstrate a significant improvement in acetabular component alignment with the use of robotic techniques. Additional studies are needed to demonstrate improvement in clinical outcomes as a result of improved accuracy and precision of acetabular component placement.

Randomised Controlled Trial Comparing two Methods of Acetabular Cup Positioning during Total Hip Arthroplasty

2007 ◽  
Vol 17 (3) ◽  
pp. 137-142 ◽  
Author(s):  
P.-A. Vendittoli ◽  
M. Ganapathi ◽  
N. Duval ◽  
P. Lavoie ◽  
A. Roy ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Reference Points ◽  
Abduction Angle ◽  
Anatomical Landmarks ◽  
Acetabular Cup ◽  
Total Hip ◽  
Increased Risk ◽  
Visuospatial Perception ◽  
Cup Positioning

Background Acetabular cup positioning is an important technical aspect in total hip arthroplasty. Most surgeons estimate cup abduction angle during surgery with the insertion rod position according to the patient's body anatomical landmarks or other reference points in the operating room. High acetabular component abduction angle is associated with an increased risk of dislocation, premature polyethylene wear and osteolysis. Method To evaluate the potential benefits of a new technique for vertical acetabular cup positioning, 100 acetabular cups were randomised to be inserted with or without an inclinometer. Abduction angles were measured on postoperative radiographs by 2 evaluators blind to the treatment group. Results Of the cups, 57% (27/47) were positioned within the desirable abduction angle range of 40°–49° with the inclinometer, compared with 50% (27/53) by visuospatial perception (p=0.454). The proportion of cups positioned outside a safe angle range of 30°–55° was low in both groups: 6% (3/47) for the inclinometer group versus 4% (2/53) for the visuospatial perception group (p=0.536). Conclusion The use of an inclinometer did not significantly improve the acetabular cup abduction angle obtained by our group of surgeons when compared with visuospatial perception. Newer techniques such as navigation may be useful in further optimising cup positioning and reducing the outliers.

scholarly journals Differences in the setting of acetabular component alignment guides between the supine and lateral positions for total hip arthroplasty

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yukihide Minoda ◽  
Ryo Sugama ◽  
Yoichi Ohta ◽  
Susumu Takemura ◽  
Nobuo Yamamoto ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Supine Position ◽  
Clinical Results ◽  
Lateral Position ◽  
Navigation Systems ◽  
Component Alignment ◽  
Total Hip ◽  
Alignment Guide

AbstractThe acetabular component orientation in total hip arthroplasty is of critical importance to clinical results. Although navigation systems and surgical robots have been introduced, most surgeons still use acetabular component alignment guides. This study aimed to compare the accuracy between modern acetabular component alignment guides for the lateral position and those for the supine position. Thirteen alignment guides for the lateral position and 10 for the supine position were investigated. All the lateral position alignment guides indicated cup alignment in operative definition, and the supine position alignment guides indicated cup alignment in radiographic definition. For lateral position alignment guides, the anteversion actually indicated by the alignment guide itself was smaller than that indicated by the manufacturer by a mean of 6° (maximum, 9°), and the inclination actually indicated by alignment guides themselves was larger than that by the manufacturer (p < 0.01) by a mean of 2° (maximum, 4°). For supine position alignment guides, the inclination and anteversion indicated by the alignment guide itself were identical with those indicated by the manufacturer. The current study showed that the angles actually indicated and those stated by manufacturers were not identical for lateral position alignment guides.

Evaluating Surgeon Estimation of Cup Position in Total Hip Arthroplasty: A Cadaver Study

2017 ◽  
Vol 01 (02) ◽  
pp. 105-111
Author(s):  
Jonathan Vigdorchik ◽  
MIchael Cross ◽  
Theodore Miller ◽  
Eric Bogner ◽  
Jeffrey Muir ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Reference Values ◽  
Hip Arthroplasty ◽  
Navigation System ◽  
Surgical Navigation ◽  
Ct Scans ◽  
Anatomical Landmarks ◽  
Total Hip ◽  
Radiographic Measurements ◽  
Cup Position

AbstractInaccurate placement of components during total hip arthroplasty (THA) can lead to significant postoperative complications including revision surgery. Traditionally, surgeons grossly estimate component positioning intraoperatively using anatomical landmarks; however, evidence indicates that this surgeon assessment may not be reliable. The purpose of this study was to determine the accuracy of surgeon estimates of component position as compared with imaging (radiographs and computed tomography [CT] scan) and a new surgical navigation system. Three board-certified orthopaedic surgeons each performed four THA procedures on six cadavers (12 hips). Radiographs and CT scans were obtained postoperatively. The “gold standard” measurements of implanted cup anteversion and inclination were derived from three-dimensional renderings created from postoperative CTs. A reference value for cup position was created by aligning the anterior pelvic plane in each rendering coplanar with the CT table. Following each procedure, surgeons provided their estimate of acetabular cup component orientation. Surgeon estimates were compared with data gathered from postoperative radiographs, CT scans, and the navigation device. Surgeon estimates of anteversion and inclination were within 10 degrees of reference values in 64% (7/11) and 82% (9/11) of cases, respectively. Surgeon estimates of anteversion differed from reference values by a mean of 7.6 ± 5 degrees, whereas inclination differed from reference values by a mean of 6.1 ± 5.1 degrees (all means absolute). Radiographic measurements differed from reference values by 7.8 ± 4.3 degrees (p > 0.05) and 2.7 ± 2.3 degrees (p = 0.06) for anteversion and inclination, respectively, whereas CT values differed by 2.5 ± 1.6 degrees (p = 0.004) and 2.3 ± 2.1 degrees (p = 0.04). The navigation system differed from reference values by 4 ± 4 degrees (p = 0.08) and 4.2 ± 3.2 degrees (p = 0.31). Surgeons underestimated anteversion and inclination by 7.7 ± 4.8 degrees and 6.9 ± 4.8 degrees, respectively. Surgeon underestimation was observed in 8/11 (73%) cases, with anteversion underestimated by > 5 degrees in 5/8 (62%) cases and inclination underestimated by > 5 degrees in 4/8 (50%) cases. Our findings suggest that surgeons tend to underestimate both anteversion and inclination and that the accuracy of their estimates is similar to that of radiographs. CT scans and the navigation system were able to provide more accurate measurements of cup position.

scholarly journals Intraoperative measurement of acetabular component position using imageless navigation during revision total hip arthroplasty

2021 ◽  
Vol 64 (4) ◽  
pp. E442-E448
Author(s):  
Xin Yu Mei ◽  
Ali Etemad-Rezaie ◽  
Oleg A. Safir ◽  
Allan E. Gross ◽  
Paul R. Kuzyk
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Radiographic Measurement ◽  
Absolute Difference ◽  
Total Hip ◽  
Ct Measurements ◽  
Imageless Navigation ◽  
Revision Tha ◽  
Cup Position

Background: Acetabular component malposition is a major cause of dislocation following total hip arthroplasty (THA). Intellijoint HIP is an imageless navigation tool that has been shown to provide accurate intraoperative measurement of cup position during primary THA without substantially increasing operative time. However, its accuracy in revision THA has not been evaluated. This study therefore aims to assess the accuracy of Intellijoint HIP in measuring cup inclination and anteversion in comparison with computed tomography (CT) during revision THA. Methods: Intellijoint HIP was used to measure the position of the preexisting cup in 53 consecutive patients undergoing revision THA between December 2018 and February 2020. Two authors blinded to the intraoperative navigation measurements also independently measured cup position using preoperative CT according to Murray’s radiographic definitions. Pearson correlation coefficients with 95% confidence intervals (CIs), paired t tests and Bland–Altman plots were used to assess agreement between navigation- and CT-measured cup position. Statistical analysis was performed using GraphPad Prism, with p values less than 0.05 indicating statistical significance. Results: There was excellent agreement between navigation and CT measurements for both cup inclination (r = 0.89, 95% CI 0.81–0.93) and anteversion (r = 0.93, 95% CI 0.88–0.96), with the mean absolute difference being 5.2º (standard deviation [SD] 4.0º) for inclination and 4.8º (SD 5.4º) for anteversion. The navigation measurement was within 10º of the radiographic measurement in 47 of 53 (88.7%) cases for inclination and 46 of 53 (86.8%) cases for anteversion. Conclusion: Imageless navigation demonstrated excellent correlation and agreement with CT measurements for both inclination and anteversion over a wide range of acetabular component positions.

scholarly journals Acetabular cup position differs in spinopelvic mobility types: a prospective observational study of primary total hip arthroplasty patients

2021 ◽  
Author(s):  
Henryk Haffer ◽  
Zhen Wang ◽  
Zhouyang Hu ◽  
Christian Hipfl ◽  
Matthias Pumberger
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Sacral Slope ◽  
Acetabular Cup ◽  
Sagittal Vertical Axis ◽  
Total Hip ◽  
Spinal Segments ◽  
Cup Positioning ◽  
Cup Position ◽  
Acetabular Cup Position

Abstract Introduction Spinopelvic mobility was identified as a contributing factor for total hip arthroplasty (THA) instability. The influence of spinopelvic function on acetabular cup positioning has not yet been sufficiently investigated in a prospective setting. Therefore, our study aimed (1) to assess cup inclination and anteversion in standing and sitting based on spinopelvic mobility, (2) to identify correlations between cup position and spinopelvic function, (3) and to determine the influence of the individual spinal segments, spinal sagittal balance, and spinopelvic characteristics on the mobility groups. Materials and methods A prospective study assessing 197 THA patients was conducted with stereoradiography in standing and sitting position postoperatively. Two independent investigators determined cup anteversion and inclination, C7-Sagittal vertical axis, cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope, pelvic tilt (PT), anteinclination (AI), and pelvic femoral angle (PFA). Spinopelvic mobility is defined based on ∆PT = PTstanding − PTsitting as ∆PT < 10° stiff, ∆PT ≥ 10–30° normal, and ∆PT > 30° hypermobile. Pearson coefficient represented correlations between the cup position and spinopelvic parameters. Results Significant differences were demonstrated for cup anteversion (stiff/hypermobile 29.3°/40.1°; p < 0.000) and inclination (stiff/hypermobile 43.5°/60.2°; p < 0.000) in sitting, but not in standing position. ∆ (standing/sitting) of the cup anteversion (stiff/neutral/hypermobile 5.8°/12.4°/19.9°; p < 0.000) and inclination (stiff/neutral/hypermobile 2.3°/11.2°/18.8°; p < 0.000) revealed significant differences between the mobility groups. The acetabular cup position in sitting, was correlated with lumbar flexibility (∆LL) and spinopelvic mobility. Significant differences were detected between the mobility types and acetabular orientation (AI sit:stiff/hypermobile 47.6°/65.4°; p < 0.000) and hip motion (∆PFA:stiff/hypermobile 65.8°/37.3°; p < 0.000). Assessment of the spinal segments highlighted the role of lumbar flexibility (∆LL:stiff/hypermobile 9.9°/36.2°; p < 0.000) in the spinopelvic complex. Conclusion The significantly different acetabular cup positions in sitting and in the ∆ between standing and sitting and the significantly altered spinopelvic characteristics in terms of stiff and hypermobile spinopelvic mobility underlined the consideration for preoperative functional radiological assessment. Identifying the patients with altered spinopelvic mechanics due to a standardized screening algorithm is necessary to provide safe acetabular cup positioning. The proximal spinal segments appeared not to be involved in the spinopelvic function.

scholarly journals Accuracy of cup position following robot-assisted total hip arthroplasty may be associated with surgical approach and pelvic tilt

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shinya Hayashi ◽  
Shingo Hashimoto ◽  
Yuichi Kuroda ◽  
Naoki Nakano ◽  
Tomoyuki Matsumoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Surgical Approach ◽  
Pelvic Tilt ◽  
Robot Assisted ◽  
Total Hip ◽  
Predictive Risk ◽  
Cup Positioning ◽  
Cup Position

AbstractThis study aimed to investigate the accuracy of cup placement and determine the predictive risk factors for inaccurate cup positioning in robot-assisted total hip arthroplasty (THA). We retrospectively analyzed 115 patients who underwent robot-assisted THA between August 2018 and November 2019. Acetabular cup alignment and three-dimensional (3D) position were measured using pre- or postoperative computed tomography (CT) data. Absolute differences in cup inclination, anteversion, and 3D position were assessed, and their relation to preoperative factors was evaluated. The average measurement of the absolute differences was 1.8° ± 2.0° (inclination) and 1.9° ± 2.3° (anteversion). The average absolute difference in the 3D cup position was 1.1 ± 1.2 mm (coronal plane) and 0.9 ± 1.0 mm (axial plane). Multivariate analysis revealed that a posterior pelvic tilt [odds ratio (OR, 1.1; 95% confidence interval (CI), 1.00–1.23] and anterior surgical approach (OR, 5.1; 95% CI, 1.69–15.38) were predictive factors for inaccurate cup positioning with robot-assisted THA. This is the first study to demonstrate the predictive risk factors (posterior pelvic tilt and anterior surgical approach) for inaccurate cup position in robot-assisted THA.

Biomechanical analysis of transverse acetabular fracture fixation in the elderly via the posterior versus the anterior approach with and without a total hip arthroplasty

2020 ◽  
Vol 234 (9) ◽  
pp. 966-974
Author(s):  
Joel Moktar ◽  
Alan Machin ◽  
Habiba Bougherara ◽  
Emil H Schemitsch ◽  
Radovan Zdero
Keyword(s):  
Total Hip Arthroplasty ◽  
Acetabular Component ◽  
Hip Arthroplasty ◽  
Acetabular Fracture ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Failure Load ◽  
The Elderly ◽  
Clinical Failure ◽  
Total Hip

This study provides the first biomechanical comparison of the fixation constructs that can be created to treat transverse acetabular fractures when using the “gold-standard” posterior versus the anterior approach with and without a total hip arthroplasty in the elderly. Synthetic hemipelvises partially simulating osteoporosis (n = 24) were osteotomized to create a transverse acetabular fracture and then repaired using plates/screws, lag screws, and total hip arthroplasty acetabular components in one of four ways: posterior approach (n = 6), posterior approach plus a total hip arthroplasty acetabular component (n = 6), anterior approach (n = 6), and anterior approach plus a total hip arthroplasty acetabular component (n = 6). All specimens were biomechanically tested. No differences existed between groups for stiffness (range, 324.6–387.3 N/mm, p = 0.629), clinical failure load at 5 mm of femoral head displacement (range, 1630.1–2203.9 N, p = 0.072), or interfragmentary gapping (range, 0.67–1.33 mm, p = 0.359). Adding a total hip arthroplasty acetabular component increased ultimate mechanical failure load for posterior (2904.4 vs. 3652.3 N, p = 0.005) and anterior (3204.9 vs. 4396.0 N, p = 0.000) approaches. Adding a total hip arthroplasty acetabular component also substantially reduced interfragmentary sliding for posterior (3.08 vs. 0.50 mm, p = 0.002) and anterior (2.17 vs. 0.29 mm, p = 0.024) approaches. Consequently, the anterior approach with a total hip arthroplasty may provide the best biomechanical stability for elderly patients, since this fixation group had the highest mechanical failure load and least interfragmentary sliding, while providing equivalent stiffness, clinical failure load, and gapping compared to other surgical options.

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