scholarly journals Computer Navigated Total Hip Arthroplasty Via The Direct Superior Approach: A Retrospective Study of The First 30 Consecutive Cases

2021 ◽  
Author(s):  
HIROSHI Watanabe ◽  
Takuya Uematsu ◽  
Yusuke Tabata ◽  
Yoshihiro Mizuno ◽  
Yuki Akashi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Total Hip Arthroplasty ◽  
Minimally Invasive ◽  
Hip Arthroplasty ◽  
Acetabular Cup ◽  
Total Hip ◽  
Positive Effects ◽  
Increased Risk ◽  
Superior Approach ◽  
Cup Positioning

Abstract Background The direct superior approach (DSA), which is one of the muscle-sparing approaches for total hip arthroplasty (THA), has been recently reported with positive outcomes. However, in minimally invasive THA, it has been reported that the visual intraoperative estimation of the cup position is not reliable. Therefore, those minimally invasive approaches are associated with the increased risk of acetabular cup malposition due to the limited exposure. Although the positive effects of computer navigation system on the accuracy of cup positioning have been reported in many studies, those are not unknown in THA via the DSA. In the current study, we investigated the accuracy of acetabular cup positioning in navigated THA via the DSA in the first 30 consecutive cases.Methods We have retroactively included the first 30 consecutive cases of navigated DSA, and the consecutive control cases using conventional posterior approach (PA) were included retroactively up to 30 cases. This retrospective study divided the cases of navigated DSA into 15 initial and 15 recent cases. The postoperative data were assessed on plain computed tomography to measure the radiographic inclination and anteversion of the acetabular component. Statistical analyses were performed using Mann-Whiteney U test for comparison of the mean, and Levene's tests for equality of standard deviations (SD). Results We found no significant differences in the means between navigated DSA and conventional PA for anteversion and inclination. For anteversion, the accuracy of acetabular cup positioning in navigated DSA (SD, 6.9°), including the recent 15 cases (SD, 4.1°), was significantly improved than in conventional PA (SD, 11.7°). For inclination, there were no significant differences in the accuracy of the acetabular cup positioning between navigated DSA (SD, 5.3°) and conventional PA (SD, 6.5°).Conclusions The increased variances of cup anteversion would be due to the frequency of pelvic malposition and the wide variation in pelvic orientation with the patient in the lateral decubitus position. Navigated THA via the DSA could be performed with good accuracy of cup placement in the first 30 cases. The results suggest that computer navigated THA via the DSA as a suitable option for hip replacement.

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.

Does Robotic-Assisted Computer Navigation Affect Acetabular Cup Positioning in Total Hip Arthroplasty in the Obese Patient? A Comparison Study

2015 ◽  
Vol 30 (12) ◽  
pp. 2204-2207 ◽  
Author(s):  
Asheesh Gupta ◽  
John M. Redmond ◽  
Jon E. Hammarstedt ◽  
Alexandra E. Petrakos ◽  
S. Pavan Vemula ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Obese Patient ◽  
Hip Arthroplasty ◽  
Computer Navigation ◽  
Comparison Study ◽  
Acetabular Cup ◽  
Robotic Assisted ◽  
Total Hip ◽  
Cup Positioning

scholarly journals Accuracy of Image-less Navigation for Functional Cup Positioning in Total Hip Arthroplasty

10.29007/3lbz ◽  
2019 ◽  
Author(s):  
Morteza Meftah ◽  
Vinnay Siddappa ◽  
Jeffery Muir ◽  
Peter White
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Weight Bearing ◽  
Safe Zone ◽  
Computer Assisted ◽  
Acetabular Cup ◽  
Assisted Navigation ◽  
Total Hip ◽  
Significant Difference ◽  
Cup Positioning

Computer-assisted navigation has the potential to improve the accuracy of cup positioning during total hip arthroplasty (THA) and prevent leg length discrepancy (LLD). The purpose of this study was to compare acetabular cup position and post- operative LLD after primary THA using posterolateral approach. Between August 2016 to December 2017, 57 THAs using imageless navigation were matched with 57 THA without navigation, based on age, gender and BMI. Post-operative weight-bearing radiographs were assessed using for anteversion, inclination and LLD. Goal for functional cup placement was 40° inclination and 20° anteversion based on preoperative weight bearing pelvic images. Functional LLD was measured as compared to pre- operative radiographs and contralateral side. Proportion of cups within Lewinnek’s safe zone, proximity to a pre-operative target of and the LLD >5 mm was assessed. The mean age was 54.9 ± 9.6 years (30 – 72) and 57.6 ± 12.5 years (20 – 85) in control and navigated groups, respectively. Mean cup orientation in the navigated group was 20.6°± 3.3° (17 - 25) of anteversion and 41.9°± 4.8° (30 - 51) of inclination, vs. 25.0°± 11.1° (10 - 31) and 45.7°± 8.7° (29 – 55) in control group, where were statistically significant (p=0.005 and p=0.0001), respectively. In the navigated group, significantly more acetabular cups were placed within Lewinnek’s safe zone (anteversion: 78% vs. 47%, p=0.005; inclination: 92% vs. 67%, p=0.002). There was no significant difference in mean LLD in navigation and control groups (3.1 ± 1.5 mm vs. 4.6 ± 3.4 mm, p=0.36), although fewer LLDs >5 mm were reported in the navigated group (7.1%) than in controls (31.4%, p=0.007). The use of this image-less computer-assisted navigation improved the accuracy with which acetabular cup components were placed and may represent an important method for limiting post-operative complications related to cup malpositioning and LLD.

Direct superior approach with standard instrumentation for total hip arthroplasty: safety and efficacy in a prospective 200-case series

2019 ◽  
Vol 30 (5) ◽  
pp. 552-558 ◽  
Author(s):  
Eleftherios Tsiridis ◽  
Eustathios Kenanidis ◽  
Michael Potoupnis ◽  
Fares E Sayegh
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Case Series ◽  
Functional Score ◽  
Complication Rates ◽  
Obese Patients ◽  
Total Hip ◽  
Increased Risk ◽  
Superior Approach ◽  
Standard Instrumentation

Introduction: Direct Superior Approach (DSA) is a muscle sparing approach for total hip arthroplasty (THA) implemented using special instrumentation. There is a lack of information in the literature concerning DSA with standard instrumentation. Materials and methods: 238 patients were recruited for primary THA by a single surgeon from January 2016 until May 2017. 209 patients underwent THA through DSA approach with non-offset acetabular reamers and femoral broaches. We evaluated accuracy of implantation, complications and early functional results. Independent orthopaedic surgeons performed the clinical and radiographic assessments. Results: 200 patients were followed for a year. 3 different implants were used. No sciatic nerve palsies, hip dislocations or fractures were recorded. There was one acute deep and superficial wound infection. The mean functional score was significantly improved at all follow-ups ( p < 0.001). 97% of stems were inserted into the neutral coronal and 96% in neutral sagittal alignment. All cups fell within a safe zone of inclination and 91% of anteversion. 2 hips demonstrated heterotopic ossification, Brooker class I. Obese patients had no increased risk of complications. Conclusions: DSA with standard instrumentation is safe and efficacious for THA. It offers fast recovery and facilitates correct implantation of different implants, can be useful even for hip dysplasia and obese patients with minimal complication rates.

Learning Curve of Acetabular Cup Positioning in Total Hip Arthroplasty Using a Cumulative Summation Test for Learning Curve (LC-CUSUM)

2014 ◽  
Vol 29 (3) ◽  
pp. 586-589 ◽  
Author(s):  
Young-Kyun Lee ◽  
David J. Biau ◽  
Byung-Ho Yoon ◽  
Tae-Young Kim ◽  
Yong-Chan Ha ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Learning Curve ◽  
Hip Arthroplasty ◽  
Summation Test ◽  
Acetabular Cup ◽  
Total Hip ◽  
Cumulative Summation ◽  
Cup Positioning

The direct superior approach in total hip arthroplasty

2019 ◽  
Vol 80 (6) ◽  
pp. 320-324 ◽  
Author(s):  
Babar Kayani ◽  
Sujith Konan ◽  
Raja Chandramohan ◽  
Fares S Haddad
Keyword(s):  
Total Hip Arthroplasty ◽  
Minimally Invasive ◽  
Hip Arthroplasty ◽  
Posterior Approach ◽  
Soft Tissue Injury ◽  
Harris Hip Score ◽  
Iliotibial Band ◽  
Total Hip ◽  
Functional Scores ◽  
Superior Approach

The direct superior approach is a modification of the minimally invasive posterior approach for total hip arthroplasty which preserves the iliotibial band and external rotators except for the piriformis or conjoint tendon. This review explores the existing scientific evidence on clinical, functional and radiological outcomes in total hip arthroplasty performed using the direct superior approach. The direct superior approach reduces iatrogenic periarticular soft tissue injury compared to the direct anterior approach for total hip arthroplasty. The learning curve for the direct superior approach is 40 operative cases with operative times comparable to those of conventional approaches for total hip arthroplasty after surgical proficiency has been achieved. The direct superior approach provides improvements in pain and short-term functional outcomes after total hip arthroplasty as assessed using the Harris Hip Score. The minimally invasive posterior approach provides comparable pain scores and improved University of California, Los Angeles (UCLA) activity scale functional scores to the direct superior approach at 1-year follow up. Existing studies using plain radiographs have shown that the direct superior approach enables accurate femoral and acetabular implant positioning.

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