Patient specific surgical guide improve the accuracy of acetabular component placement in total hip arthroplasty with dysplastic acetabulum

To investigate the accuracy of a novel 3D CT scan-based preoperative planning software linked to patient-specific instrumentation (PSI) for placing acetabular components planning in patients with acetabular dysplasia undergoing total hip arthroplasty (THA). A total of 30 consecutive patients were prospectively enrolled and the accuracy of placement of the acetabular component was measured using post- operative CT scans. There was good reproducibility of preoperative and postoperative position of reconstructed rotation center. The mean absolute deviation from the planned inclination and anteversion was 6.2° and 4.8°, respectively. In 90% of cases the planned target of +/-5° was achieved for both inclination and anteversion. And 95% of cases of planned target of +/-3mm were achieved for vertical height of rotation center. Accurate placement of the acetabular component can be achieved using patient-specific guides and is superior to free hand techniques.

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Patient-specific instrumentation improves the accuracy of acetabular component placement in total hip arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.98b10.37808 ◽

2016 ◽

Vol 98-B (10) ◽

pp. 1342-1346 ◽

Cited By ~ 32

Author(s):

L. Spencer-Gardner ◽

J. Pierrepont ◽

M. Topham ◽

J. Baré ◽

S. McMahon ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Patient Specific ◽

Component Placement ◽

Total Hip ◽

Patient Specific Instrumentation

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Patient-Specific Surgical Guide for Total Hip Arthroplasty

Computer Assisted Orthopaedic Surgery for Hip and Knee ◽

10.1007/978-981-10-5245-3_10 ◽

2018 ◽

pp. 119-127

Author(s):

Takashi Sakai

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Patient Specific ◽

Surgical Guide ◽

Total Hip

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Advances and innovations in total hip arthroplasty

SICOT-J ◽

10.1051/sicotj/2021025 ◽

2021 ◽

Vol 7 ◽

pp. 26

Author(s):

Andreas Fontalis ◽

Jean-Alain Epinette ◽

Martin Thaler ◽

Luigi Zagra ◽

Vikas Khanduja ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Three Dimensional ◽

Young Patients ◽

Cost Effective ◽

Patient Specific ◽

Three Dimensional Printing ◽

Total Hip ◽

Patient Specific Instrumentation ◽

Dimensional Printing

Total hip arthroplasty (THA) has been quoted as one of the most successful and cost-effective procedures in Orthopaedics. The last decade has seen an exponential rise in the number of THAs performed globally and a sharp increase in the percentage of young patients hoping to improve their quality of life and return to physically demanding activities. Hence, it is imperative to review the various applications of technology in total hip arthroplasty for improving outcomes. The development of state-of-the-art robotic technology has enabled more reproducible and accurate acetabular positioning, while long-term data are needed to assess its cost-effectiveness. This opinion piece aims to outline and present the advances and innovations in total hip arthroplasty, from virtual reality and three-dimensional printing to patient-specific instrumentation and dual mobility bearings. This illustrates and reflects the debate that will be at the centre of hip surgery for the next decade.

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Patient-Specific Surgical Guide for Total Hip Arthroplasty

Advances in Experimental Medicine and Biology - Intelligent Orthopaedics ◽

10.1007/978-981-13-1396-7_23 ◽

2018 ◽

pp. 307-314 ◽

Cited By ~ 1

Author(s):

Takashi Sakai

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Patient Specific ◽

Surgical Guide ◽

Total Hip

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Correction of pelvic adduction during total hip arthroplasty reduces variability in radiographic inclination: findings of a randomised controlled trial

Hip International ◽

10.1177/1120700018777480 ◽

2018 ◽

Vol 28 (3) ◽

pp. 240-245 ◽

Cited By ~ 1

Author(s):

Christopher K J O’Neill ◽

Paul Magill ◽

Janet C Hill ◽

Christopher C Patterson ◽

Dennis O Molloy ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Controlled Trial ◽

Primary Outcome Measure ◽

Patient Specific ◽

Operating Table ◽

Absolute Deviation ◽

Total Hip ◽

Lateral Decubitus ◽

Randomised Controlled

Introduction: The study aims were to identify the incidence of pelvic adduction during total hip arthroplasty (THA) in lateral decubitus and to determine, when aiming for 35° of apparent operative inclination (AOI), which of 3 operating table positions most accurately obtained a target radiographic inclination (RI) of 42°: (1) horizontal; (2) 7° head-down; (3) patient-specific position based on correction of pelvic adduction. Methods: With patients seated on a levelled theatre table, a ruler incorporating a spirit level was used to draw transverse pelvic lines (TPLs) on the skin overlying the pelvis and sacrum. Subsequently, when positioned in lateral decubitus these lines provided a measure of pelvic adduction. 270 participants were recruited, with 90 randomised to each group for operating table position. In all cases target AOI was 35°, aiming to achieve a target RI of 42°. The primary outcome measure was absolute (unsigned) deviation from the target RI of 42°. Results: 266/270 patients demonstrated pelvic adduction (overall mean 4.4°, range 0– 9.2°). No patients demonstrated pelvic abduction. There were significant differences in RI between each of the 3 groups. The horizontal table group displayed the highest mean RI. The patient specific table position group achieved the smallest absolute deviation from target RI of 42°. Discussion: In lateral decubitus, unrecognised pelvic adduction is common and is an important contributor to unexpectedly high RI. The use of preoperative TPLs helps identify pelvic adduction and its subsequent correction reduces variability in RI. Clinical Trial Protocol number: NCT01831401.

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A Patient-specific Navigational Template for Precise Acetabular Placement in Unilateral Total Hip Arthroplasty: A Cadaveric Study

10.21203/rs.3.rs-26022/v1 ◽

2020 ◽

Author(s):

Jinlong LIANG ◽

Xinjian Gao ◽

Xuewei Fang ◽

Yonghui Zhao ◽

Yongqing Xu ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Contralateral Side ◽

Patient Specific ◽

Abduction Angle ◽

Anteversion Angle ◽

Acetabular Fossa ◽

Total Hip ◽

Significant Difference

Abstract Background Total hip arthroplasty (THA) is a widely performed reconstructive surgical intervention. In this paper, we describe a novel patient-specific navigational template to assist in acetabular component implantation in unilateral THA. Methods The template was produced based on data preoperatively acquired with computed tomography (CT) scan. We used the mirror image of the healthy contralateral acetabular anatomical structure to ensure accurate acetabular component implantation in unilateral THA. The surface of the template was designed to conform to the unique contours of the cadaveric acetabular fossa by reverse engineering technology. The orientation of the navigation channel was defined by the acetabular central axis which was determined by the contralateral acetabular centre of rotation, anteversion angle and abduction angle. Each template was formed from acrylate resin by using rapid prototyping (RP) technique. Finally, the template was tested in 20 cadavers scheduled for unilateral THA and postoperative medical imaging was used to evaluate the accuracy and validity of the template. Results During the operation, the acetabular fossa template was easy to obtain in all cases. The abduction angle ( β ) of the cup was (49.9°±4.1°) versus (49.5°±4.7°) on the contralateral side. The anteversion angle (α) of the cup was (17.7° ± 3.1°) versus (18.3°±3.5°) on the contralateral side. In the operative hip, the height of the prosthesis centre(H)was (21.6 mm±2.8 mm) versus (21.9 mm±3.4 mm) in the contralateral side, and the horizontal location of the prosthesis centre(W) was (29.7 mm±3.1 mm) versus (30.90 mm±3.31 mm) in the contralateral side. There was no significant difference in the cup abduction (β) or anteversion (α) angle between the operative and contralateral sides (P=0.7531>0.05 for β and P=0.5996>0.05 for α); In addition, there was no significant difference in the height(H)or horizontal location(W) of the acetabular centre between the operative and contralateral sides (P=0.6494>0.05 for W and P=0.5143>0.05 for H). Conclusion The navigational template is a promising tool for facilitating preoperative planning and intraoperative techniques. With the aid of the template, an acetabular prosthesis can be precisely implanted to the expected position in unilateral THA.

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Effects of the depth of the acetabular component during simulated acetabulum reaming in total hip arthroplasty

Scientific Reports ◽

10.1038/s41598-021-89292-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jianlin Zuo ◽

Meng Xu ◽

Xin Zhao ◽

Xianyue Shen ◽

Zhongli Gao ◽

...

Keyword(s):

Stress Concentration ◽

Total Hip Arthroplasty ◽

Acetabular Component ◽

Hip Arthroplasty ◽

Peak Stress ◽

Element Model ◽

Coverage Rate ◽

Acetabular Cup ◽

Total Hip ◽

Rotation Center

AbstractWe aimed to evaluate whether there are differences in the rotation center, cup coverage, and biomechanical effects between conventional and anatomical technique. Computed tomography scans of 26 normal hips were used to simulate implantation of acetabular component. The hip rotation center and acetabular component coverage rate were calculated. Moreover, a finite element model of the hip joint was generated to simulate and evaluate the acetabular cup insertion. Micromotion and the peak stress distribution were used to quantify the biomechanical properties. The medial and superior shifts of the rotation center were 5.2 ± 1.8 mm and 1.6 ± 0.7 mm for the conventional reaming technique and 1.1 ± 1.5 mm and 0.8 ± 0.5 mm for anatomical technique, respectively. The acetabular component coverage rates for conventional reaming technique and anatomical technique were 86.8 ± 4% and 70.0 ± 7%, respectively. The micromotion of the cup with conventional reaming technique was greater than that with anatomical technique. The peak stress concentration was highest in the superior portion with conventional reaming technique, whereas with anatomical technique, there was no stress concentration. Paradoxically although the acetabular component coverage rate is larger with conventional reaming technique, anatomical technique provides less micromotion and stress concentration for initial cup stability. Thus, anatomical technique may be more suitable for acetabulum reaming during primary total hip arthroplasty.

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The Accuracy of Patient-Specific Instrumentation with Laser Guidance in a Dynamic Total Hip Arthroplasty: A Radiological Evaluation

Sensors ◽

10.3390/s21124232 ◽

2021 ◽

Vol 21 (12) ◽

pp. 4232

Author(s):

Andrea Ferretti ◽

Ferdinando Iannotti ◽

Lorenzo Proietti ◽

Carlo Massafra ◽

Attilio Speranza ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Patient Specific ◽

X Rays ◽

Surgical Time ◽

Dynamic Planning ◽

Total Hip ◽

Patient Specific Instrumentation ◽

Significant Difference ◽

The Mean

The functional positioning of components in a total hip arthroplasty (THA) and its relationship with individual lumbopelvic kinematics and a patient’s anatomy are being extensively studied. Patient-specific kinematic planning could be a game-changer; however, it should be accurately delivered intraoperatively. The main purpose of this study was to verify the reliability and accuracy of a patient-specific instrumentation (PSI) and laser-guided technique to replicate preoperative dynamic planning. Thirty-six patients were prospectively enrolled and received dynamic hip preoperative planning based on three functional lateral spinopelvic X-rays and a low dose CT scan. Three-dimensional (3D) printed PSI guides and laser-guided instrumentation were used intraoperatively. The orientation of the components, osteotomy level and change in hip length and offset were measured on postoperative CT scans and compared with the planned preoperative values. The length of surgery was compared with that of a matched group of thirty-six patients who underwent a conventional THA. The mean absolute deviation from the planned inclination and anteversion was 3.9° and 4.4°, respectively. In 92% of cases, both the inclination and anteversion were within +/− 10° of the planned values. Regarding the osteotomy level, offset change and limb length change, the mean deviation was, respectively, 1.6 mm, 2.6 mm and 2 mm. No statistically significant difference was detected when comparing the planned values with the achieved values. The mean surgical time was 71.4 min in the PSI group and 60.4 min in the conventional THA group (p < 0.05). Patient-specific and laser-guided instrumentation is safe and accurately reproduces dynamic planning in terms of the orientation of the components, osteotomy level, leg length and offset. Moreover, the increase in surgical time is negligible.

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

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1177/0954411920935759 ◽

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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