Elimination of the Femoral Neck in Measuring Femoral Version Allows for Less Variance in Interobserver Reliability

Background and Objectives: Producing consistent measures of femoral version amongst observers are necessary to allow for an assessment of version for possible corrective procedures. The purpose of this study was to compare two computed tomography (CT)-based techniques for the reliability of measuring femoral version amongst observers. Materials and Methods: Review was performed for 15 patients post-femoral nailing for comminuted (Winquist III and IV) femoral shaft fractures where CT scanograms were obtained. Two CT-based techniques were utilized to measure femoral version by five observers. Results: The mean femoral version, when utilizing a proximal line drawn down the center of the femoral head-neck through CT, was 9.50 ± 4.82°, while the method utilizing the head and shaft at lesser trochanter centers produced a mean version of 18.73 ± 2.69°. A significant difference was noted between these two (p ≤ 0.001). The method of measuring in the center of the femoral head and neck produced an intraclass correlation coefficient (ICC) of 0.960 with a 95% confidence interval lower bound of 0.909 and upper bound of 0.982. For the method assessing version via the center of the head and shaft at the lesser trochanter region, the ICC was 0.993 with a 95% confidence interval lower bound of 0.987 and an upper bound of 0.996. Conclusions: The method of measuring version proximally through a CT image of the femoral head–neck versus overlaying the femoral head with the femoral shaft at the most prominent aspect of the lesser trochanter produces differing version measurements by roughly 10° while yielding an almost perfect interobserver reliability in the new technique. Both techniques result in significantly high interobserver reliability.

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Standard Radiographic Assessment of Femoral Cam Morphology is Influenced by Neck-Shaft Angle and Femoral Version

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00392 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0039

Author(s):

Layla Haidar ◽

Ryan Warth ◽

Erinn Pemberton Annie Waite ◽

Alfred Mansour

Keyword(s):

Femoral Head ◽

Alpha Angle ◽

Three Dimensional ◽

Neck Shaft Angle ◽

Incremental Change ◽

Observer Reliability ◽

Angle Measurements ◽

Femoral Version ◽

Shaft Angle ◽

Head Neck

Objectives: Cam-type femoroacetabular impingement (FAI) is a three-dimensional (3D) deformity that is still difficult to assess using traditional two-dimensional (2D) radiographic views. While measurements of alpha angle and head-neck offset are used to estimate the likelihood of actual impingement, these 2D measurements do not account for z-axis variations in femoral version (FV) and neck-shaft angle (NSA). The purpose of this qualitative proof-of-concept study was to evaluate the potential variation in alpha angle and neck-shaft offset measurements with incremental changes in NSA and FV by simulating traditional radiographic views with software-generated Digitally-Reconstructed Radiographs (DRRs). We hypothesize that incremental changes in hip morphology will produce qualitative changes in alpha angle and neck-shaft offset. Methods: 3D-CT reconstruction images were obtained from one subject with symptomatic cam-type FAI. The 3D reconstruction was cleaned to include only the femoral head, neck and subtrochanteric region along with the ipsilateral hemipelvis. Using 3D medical image processing software (Mimics; Materialise, Inc.; Belgium), the pre-processed 3D model was manipulated in a standardized manner to simulate 5-degree incremental variations in FV and NSA (-15 degrees to +15 degrees for FV; -15 degrees to +10 degrees for NSA). Negative FV reflected external rotation of the femoral head-neck unit, whereas negative NSA reflected abduction of the femoral head-neck unit. Each modified 3D model was then used to generate DRRs corresponding to traditional 2D radiographic views used for assessment of cam-FAI (Anteroposterior [AP], False Profile [FP]), Cross Table Lateral [CTL], Frog Leg Lateral [FLL], 45- and 90-degree Dunn [45D and 90D, respectively]. Alpha angle and head-neck offset were measured on each radiographic view corresponding to each incremental change in FV and NSA. All measurements utilized the perfect circle technique and were made by two independent observers for assessment of inter-observer reliability. Two-way random effects ANOVA was used for statistical assessment of inter-observer reliability and reported as intra-class correlation coefficients (κ). Comparisons between groups were performed using two-tailed paired t-tests assuming unequal variance. P-values less than 0.05 were considered statistically significant. Results: Inter-observer reliability (κ) for head-neck offset and alpha angles were 0.46 (fair) and 0.88 (excellent), respectively. Variations in head-neck offset and alpha angle with incremental variations in FV and NSA are summarized in Figure 1. There were statistically significant changes in mean alpha angles when the NSA was adjusted from Neutral to -5 degrees (p=0.01) and from -5 degrees to -10 degrees (p<0.001). There were no statistically significant differences in alpha angles or head-neck offsets between each incremental change in FV (p<0.05). Alpha angle measurements were significantly more variable than head-neck offset measurements for all variations in FV (p<0.001) and NSA (p=0.02) (Figure 2). Conclusion: Two-dimensional evaluation of three-dimensional Cam morphology (alpha angle and head-neck offset) was found to be significantly affected by alterations in femoral version and head-neck offset. Head-neck offset measurements were significantly less variable than alpha angle measurements across all FVs and NSAs within each radiographic view. Future work should be done to develop standardized procedures for routine 3D radiographic assessment of cam-type FAI. [Figure: see text][Figure: see text]

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The Bipolar Hip: Combined Acetabular and Femoral Pathomorphology Determine Hip Motion

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00421 ◽

2019 ◽

Vol 7 (7_suppl5) ◽

pp. 2325967119S0042

Author(s):

Jessica Shin ◽

Temitope F. Adeyemi ◽

Taylor Hobson ◽

Christopher L. Peters ◽

Travis G. Maak

Keyword(s):

Logistic Regression ◽

Femoral Head ◽

Internal Rotation ◽

External Rotation ◽

Alpha Angle ◽

Acetabular Version ◽

Femoral Version ◽

Hip Flexion ◽

Hip Internal Rotation ◽

Head Neck

Objectives: Prior studies have suggested femoral version may outweigh the effect of cam impingement on hip internal rotation; however, the effects of acetabular morphology were considered. This study investigates the influences of acetabular and femoral morphology on hip range of motion (ROM) in patients with femoroacetabular impingement syndrome (FAIS). Methods: With IRB approval, a retrospective chart review and radiographic analysis was performed of patients presenting with hip pain to the clinic of a single surgeon. Patients were included in the study if their hip pain was thought to be intra-articular in origin, had full physical exam documentation (including bilateral hip evaluations and measurements of passive hip ROM), Tönnis grade ≤ 1, and had full imaging including: AP pelvis, 45⁰ Dunn lateral, and false profile radiographs and a CT scan with 3-D reconstructions of the affected hip. Patients were excluded if they had prior hip surgery, prior hip trauma or other underlying hip pathology. Femoral head/neck angle, femoral version, size and clock-face location of the maximum femoral alpha angle, mid-coronal center edge angle (CEA), mid-sagittal CEA, acetabular version at the 1, 2 and 3 o’clock positions and the McKibbin index were measured on CT scan. Univariable and multivariable logistic regression analyses were performed to determine which measurements correlated with hip ROM. Results: 200 hips from 200 patients were included in the final analysis. Mean age was 31.9 ±10 years, 145 (72%) patients were female, and mean BMI of the cohort was 25.2 ± 5. Univariable logistic regression analysis found femoral head/neck angle, mid-sagittal CEA, acetabular version at 1 and 2 o’clock, and McKibbin Index all significantly correlated with hip flexion (all q’s > 0.05 after adjusting for false discovery rate). Femoral head-neck angle, femoral version, and McKibbin index all significantly correlated with external rotation. Femoral neck version, mid-sagittal CEA, acetabular version at all three clock positions, McKibbin index, max femoral alpha angle, and alpha position all significantly correlated with internal rotation. In the multivariate logistic regression analysis mid-sagittal CEA was the only measurement correlating with flexion, femoral head/neck angle and McKibbin index were the only significant variables correlating with external rotation, and McKibbin index and maximum femoral alpha angle were the only variables correlating with internal rotation. The results of the logistic regressions are summarized in Figure 1. Conclusion: Our univariate data supported previous data that suggested femoral version significantly correlated with hip internal rotation. However, multivariate analysis including acetabular version demonstrated that combined acetabular and femoral version significantly correlated with internal and external rotation while femoral version in isolation did not. In contrast to prior studies, an increased cam deformity, as defined by max femoral alpha angle, remained a significant contributor to reduced internal rotation but did not affect hip flexion. Rather, the increased mid-sagittal CEA remained the sole significant contributor to reduced hip flexion in the multivariable analysis. These data suggest that hip ROM is affected in a bipolar fashion and careful multiplanar evaluation of the femoral and acetabular pathomorpohlogy should be conducted prior to attempting to increase hip ROM with corrective osteoplasty or osteotomy. [Figure: see text]

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STUDI EKSPLANATORI DAN KONFIRMATORI TENTANG KOMPETENSI TENAGA PENDIDIK BERDASARKAN INJIL YOHANES DI KALANGAN DOSEN UNIVERSITAS PGRI SEMARANG (EXPLANATORY AND CONFIRMATORY STUDY ON EDUCATOR POWER COMPETENCY BASED ON THE GOSPEL OF JOHN FOR LECTURERS)

QUAERENS: Journal of Theology and Christianity Studies ◽

10.46362/quaerens.v2i2.25 ◽

2020 ◽

Vol 2 (2) ◽

pp. 102-127

Author(s):

Adhi Kusmantoro ◽

Muner Daliman ◽

Ragil Kristiawan ◽

Gidion Gidion

Keyword(s):

Lower Bound ◽

Linear Regression ◽

Confidence Interval ◽

Upper Bound ◽

Quantitative Research ◽

Teaching Staff ◽

Significance Level ◽

Quantitative Research Methods ◽

Teacher Colleges ◽

Binary Segmentation

The location of the lecturer competency research was carried out at the PGRI University of Semarang. Based on preliminary research observations there has been a decrease in lecturer competence. Therefore the aim of this research is to determine the most dominant competence, the level of competence implementation between Christian and non-Christian lecturers, and the most dominant level of functional positions. This research uses quantitative research methods. From the results of data analysis carried out with Confidence Interval at the 5% significance level, the lower bound and upper bound values were obtained in the medium category so that they were in accordance with the first hypothesis. From the results of the analysis using linear regression, the personality competency dimension (D3) has about 42%. These results indicate that pedagogical competence is the most dominant dimension because it is closely related as a competent teaching staff in teacher colleges. The level of implementation of Christian lecturers and non-Christian lecturers is in the medium category. But with the analysis of the score acquisition, the score for the implementation of Christian lecturers' competence was higher, namely 99.10%. Based on the results of the analysis using Linear Regression and Binary segmentation on the fourth hypothesis Head Lector becomes the most dominant functional background category category, being able to improve 0.637 times. Efforts or policies need to be made to improve the quality of lecturers. Lokasi penelitian kompetensi dosen dilaksanakan di Universitas PGRI Semarang. Berdasarkan observasi awal penelitian telah terjadi penurunan kompetensi dosen. Oleh karena itu tujuan dalam penelitian ini adalah untuk mengetahui kompetensi yang paling dominan, tingkat implementasi kompetensi antara dosen Kristen dan dosen non-Kristen, dan tingkat jabatan fungsional yang paling dominan. Penelitian ini menggunakan metode penelitian kuantitatif. Dari hasil analisis data yang dilakukan dengan Confidence Interval pada taraf signifikansi 5% dihasilkan nilai lower Bound dan upper Bound pada kategori sedang sehingga sesuai dengan hipotesis pertama. Dari hasil analisis menggunakan regresi linier dimensi kompetensi kepribadian (D3) memiliki sebesar 42 %. Hasil tersebut menunjukkan bahwa kompetensi pedagogik sebagai dimensi yang paling dominan karena berkaitan erat sebagai tenaga pengajar yang kompeten pada perguruan tinggi keguruan. Tingkat implementasi dosen Kristen dan dosen non-Kristen pada kategori sedang. Tetapi dengan analisa perolehan skor, skor implementasi kompetensi dosen Kristen lebih tinggi yaitu 99,10%. Berdasarkan hasil analisis menggunakan Regresi linier dan Biner segmentation pada hipotesis keempat Lektor Kepala menjadi kategori latar belakang jabatan fungsional paling dominan, mampu memperbaiki sebesar 0,637 kali. Perlu dilakukan upaya atau kebijakan untuk meningkatkan kualitas dosen.

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Posterior lesser trochanter line should not be used as reference for assessing femoral version in CT scans: a retrospective reliability and agreement study

Acta Radiologica ◽

10.1177/0284185116682383 ◽

2016 ◽

Vol 58 (9) ◽

pp. 1101-1107

Author(s):

Michael Worlicek ◽

Markus Weber ◽

Benjamin Craiovan ◽

Florian Zeman ◽

Joachim Grifka ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Femoral Condyle ◽

Three Dimensional ◽

Ct Scans ◽

Lesser Trochanter ◽

Total Hip ◽

Femoral Version ◽

Posterior Femoral Condyle ◽

Significant Difference

Background The estimation of femoral version in preoperative planning of total hip arthroplasty and to assess complications after total hip arthroplasty is crucial. Recent studies have recommended the posterior lesser trochanter line as an intraoperative reference for estimating femoral version. We hypothesized, that if there is a correlation, the posterior lesser trochanter line could be used to assess femoral version in computed tomography (CT) scans. Purpose To evaluate the correlation between the posterior lesser trochanter line and the posterior femoral condyle axis. Material and Methods CT scans of 126 patients after unilateral total hip arthroplasty were analyzed by means of a newly developed digital planning software for CT scans. Both hips were measured, the angle between the posterior lesser trochanter line and the posterior femoral condyle axis was determined, and the relationship between both lines was evaluated. Results We found significant differences between male and female patients ( P < 0.001) and between left and right femora ( P = 0.001). There was no significant difference between healthy hips and hips with osteoarthritis after total hip arthroplasty ( P = 0.901). Conclusion There is no reliable correlation between posterior lesser trochanter line and posterior femoral condyle axis. Therefore, posterior lesser trochanter line should not be used to assess femoral version in CT scans. As a consequence, the gold standard for measuring femoral version should still be a three-dimensional CT scan of the whole femur.

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Comparison of Femoral Head Translation following Eccentric Rotational Acetabular Osteotomy and Rotational Acetabular Osteotomy

Hip International ◽

10.5301/hipint.5000422 ◽

2016 ◽

Vol 27 (1) ◽

pp. 49-54 ◽

Cited By ~ 3

Author(s):

Tohru Irie ◽

Daisuke Takahashi ◽

Tsuyoshi Asano ◽

Ryuta Arai ◽

Takuya Konno ◽

...

Keyword(s):

Femoral Head ◽

Confidence Interval ◽

Rotational Acetabular Osteotomy ◽

Acetabular Roof ◽

Significant Difference ◽

The Mean ◽

Radiological Methods ◽

Roof Angle ◽

Head Translation ◽

Eccentric Rotational Acetabular Osteotomy

Purpose Eccentric rotational acetabular osteotomy (ERAO) is a modification of rotational acetabular osteotomy (RAO); it has been reported that ERAO allows the femoral head to translate medially and distally. However, no study has compared femoral head translation following RAO or ERAO. The purpose of this study was to compare immediate postoperative translation of the femoral head after RAO and ERAO in comparison with the pre-operative position by radiological methods. Methods Patients treated by RAO or ERAO between 2006 and 2014 were retrospectively evaluated. 19 hips (17 patients) were treated with RAO, and 25 hips (22 patients) were treated with ERAO. The acetabular roof angle and the location of the femoral head were measured on anteroposterior pelvic radiographs. Results The mean pre-operative acetabular roof angle was 20.9° in the RAO group and 22.0° in the ERAO group, showing no significant difference. The mean acetabular roof angle immediately postoperatively was −0.5° in the RAO group and −0.4° in the ERAO group, again showing no significant difference. The mean femoral head translation immediately postoperatively was 3.1 mm (95% confidence interval (CI), 1.5-4.7 mm) laterally and 3.0 mm (95% CI, 1.3-4.7 mm) proximally in the RAO group and 0.8 mm (95% CI, −0.7-2.3 mm) medially and 2.8 mm (95% CI, 1.5-4.1 mm) distally in the ERAO group; this difference was very highly significant (p≤0.001). Conclusions In contrast with RAO, ERAO resulted in significant femoral head translation both medially and distally immediately postoperatively.

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Effect of Confidence Interval Construction on Judgment Accuracy

10.31234/osf.io/mktgj ◽

2020 ◽

Author(s):

David R. Mandel ◽

Robert N Collins ◽

Evan F. Risko ◽

Jonathan Albert Fugelsang

Keyword(s):

Lower Bound ◽

Confidence Interval ◽

Confidence Rating ◽

Upper Bound ◽

Expert Elicitation ◽

Elicitation Method ◽

Judgment Accuracy ◽

Construction Procedure ◽

One Step ◽

Elicitation Studies

Three experiments (N = 550) examined the effect of an interval construction elicitation method used in several expert elicitation studies on judgment accuracy. Participants made judgments about topics that were either searchable or unsearchable online using one of two order variations of the interval construction procedure. One group of participants provided their best judgment (one step) prior to constructing an interval (i.e., lower bound, upper bound, and a confidence rating that the correct value fell in the range provided), whereas another group of participants provided their best judgment last, after the three-step confidence interval was constructed. Theoverall effect of this elicitation method was not significant in 8 out of 9 univariate tests. Moreover, the calibration of confidence intervals also was not affected by elicitation order. The findings warrant skepticism regarding the benefit of prior confidence interval construction forimproving judgment accuracy.

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Influence of Femoral Version on the Outcomes of Hip Arthroscopic Surgery for Femoroacetabular Impingement or Labral Tears: A Systematic Review and Meta-analysis

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211009192 ◽

2021 ◽

Vol 9 (6) ◽

pp. 232596712110091

Author(s):

Chenghui Wang ◽

Yaying Sun ◽

Zheci Ding ◽

Jinrong Lin ◽

Zhiwen Luo ◽

...

Keyword(s):

Systematic Review ◽

Patient Satisfaction ◽

Femoroacetabular Impingement ◽

Arthroscopic Surgery ◽

Harris Hip Score ◽

Cochrane Library ◽

Femoral Version ◽

Labral Tears ◽

Significant Difference ◽

Secondary Outcomes

Background: It remains controversial whether abnormal femoral version (FV) affects the outcomes of hip arthroscopic surgery for femoroacetabular impingement (FAI) or labral tears. Purpose: To review the outcomes of hip arthroscopic surgery for FAI or labral tears in patients with normal versus abnormal FV. Study Design: Systematic review; Level of evidence, 4. Methods: Embase, PubMed, and the Cochrane Library were searched in July 2020 for studies reporting the outcomes after primary hip arthroscopic surgery for FAI or labral tears in patients with femoral retroversion (<5°), femoral anteversion (>20°), or normal FV (5°-20°). The primary outcome was the modified Harris Hip Score (mHHS), and secondary outcomes were the visual analog scale (VAS) for pain, Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), Non-Arthritic Hip Score (NAHS), failure rate, and patient satisfaction. The difference in preoperative and postoperative scores (Δ) was also calculated when applicable. Results: Included in this review were 5 studies with 822 patients who underwent hip arthroscopic surgery for FAI or labral tears; there were 166 patients with retroversion, 512 patients with normal version, and 144 patients with anteversion. Patients with retroversion and normal version had similar postoperative mHHS scores (mean difference [MD], 2.42 [95% confidence interval (CI), –3.42 to 8.26]; P = .42) and ΔmHHS scores (MD, –0.70 [96% CI, –8.56 to 7.15]; P = .86). Likewise, the patients with anteversion and normal version had similar postoperative mHHS scores (MD, –3.09 [95% CI, –7.66 to 1.48]; P = .18) and ΔmHHS scores (MD, –1.92 [95% CI, –6.18 to 2.34]; P = .38). Regarding secondary outcomes, patients with retroversion and anteversion had similar ΔNAHS scores, ΔHOS-SSS scores, ΔVAS scores, patient satisfaction, and failure rates to those with normal version, although a significant difference was found between the patients with retroversion and normal version regarding postoperative NAHS scores (MD, 5.96 [95% CI, 1.66-10.26]; P = .007) and postoperative HOS-SSS scores (MD, 7.32 [95% CI, 0.19-14.44]; P = .04). Conclusion: The results of this review indicated that abnormal FV did not significantly influence outcomes after hip arthroscopic surgery for FAI or labral tears.

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Association of interleukin-17A rs2275913 polymorphism with rheumatoid arthritis susceptibility in Sudanese population

SAGE Open Medicine ◽

10.1177/20503121211020207 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110202

Author(s):

Rgda Mohamed Osman ◽

Mounkaila Noma ◽

Abdallah Elssir Ahmed ◽

Hanadi Abdelbagi ◽

Rihab Ali Omer ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Confidence Interval ◽

Statistical Tests ◽

Demographic Data ◽

Control Group ◽

P Value ◽

Case Group ◽

Molecular Technique ◽

Interleukin 17A ◽

Significant Difference

Objectives: Rheumatoid arthritis is a chronic inflammatory autoimmune disease. This study aimed to determine the association of interleukin-17A-197G/A polymorphism with rheumatoid arthritis in Sudanese patients. Methods: A case–control study was conducted between March and December 2018. Clinical and demographic data of the study participants were collected and analyzed. Polymerase chain reaction restriction fragment length polymorphism molecular technique was done to investigate interleukin-17A-197G/A polymorphisms. All statistical tests were considered statistically significant when p < 0.05. Results: The study population included 266 participants aged between 1 and 85 years, with an average of 40 years, classified into 85 (31.2%) cases (mean age 48.5 ± 11.3 years), and 181 (68.8%) controls (mean age 35.3 ± 15.9 years). The interleukin-17A homozygote AA genotype was more frequent among the control group compared to the case group; 95 (52.5%) and 7 (8.2%), respectively. The homozygote GG and the heterozygote AG genotypes were proportionally not different among the cases and control groups; 13 (54.2%) and 11 (45.8%), and 65 (46.4%) and 75 (53.6%), respectively. According to the distribution of interleukin-17A genotypes, a statistically significant difference was observed among cases with the interleukin-17A AA and AG genotypes, p values 0.001 and 0.004, respectively. For the association interleukin-17A genotypes and family history a negatively significant association was reported (95% confidence interval, –0.219, p value = 0.001). There was also a negatively significant association of interleukin-17A genotypes and anti-cyclic citrullinated peptide (95% confidence interval, −0.141, p value = 0.002). Conclusion: This study is the first study in Sudan established the association between interleukin-17A-197G/A (rs2275913) polymorphisms and susceptibly to rheumatoid arthritis. These findings appeal for further research in Sudan to investigate the exact role of IL-17A in immunopathology and disease severity among Sudanese rheumatoid arthritis

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A Novel Measurement Using Digital Radiography to Minimize Fluoroscopy in Total Hip Arthroplasty

The Journal of Hip Surgery ◽

10.1055/s-0041-1728760 ◽

2021 ◽

Author(s):

Andrew G. Yun ◽

Marilena Qutami ◽

Kory B. Dylan Pasko

Keyword(s):

Femoral Head ◽

Total Hip Arthroplasty ◽

Radiation Exposure ◽

Hip Arthroplasty ◽

Fluoroscopy Time ◽

Lesser Trochanter ◽

Total Hip ◽

Preoperative Templating ◽

The Mean ◽

Templating Technique

AbstractPreoperative templating for total hip arthroplasty (THA) is fraught with uncertainty. Specifically, the conventional measurement of the lesser trochanter to the center (LTC) of the femoral head used in preoperative planning is easily measured on a template but not measurable intraoperatively. The purpose of this study was to examine the utility of a novel measurement that is reproducible both on templating and in surgery as a more accurate and practical guide. We retrospectively reviewed 201 patients with a history of osteoarthritis who underwent primary THA. For preoperative templating, the distance from the top of the lesser trochanter to the equator (LeTE) of the femoral head was measured on a calibrated digital radiograph with a neutral pelvis. This measurement was used intraoperatively to guide the choice of the trial neck and head. As with any templating technique, the goal was to construct a stable, impingement-free THA with equivalent leg lengths and hip offset. In evaluating this novel templating technique, the primary outcomes measured were the number of trial reductions and the amount of fluoroscopic time, exposures, and radiation required to obtain a balanced THA reconstruction. Using the LeTE measurement, the mean number of trial reductions was 1.21, the mean number of intraoperative fluoroscopy images taken was 2.63, the mean dose of radiation exposure from fluoroscopy was 0.02 mGy, and the mean fluoroscopy time per procedure was 0.6 seconds. In hips templated with the conventional LTC prior to the LeTE, the mean fluoroscopy time was 0.9 seconds. There was a statistically significant difference in fluoroscopy time (p < 0.001). The LeTE is a reproducible measurement that transfers reliably from digital templating to surgery. This novel preoperative templating metric reduces the fluoroscopy time and consequent radiation exposure to the surgical team and may minimize the number of trial reductions.

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Evaluating Endoscopic Ipsilateral Endonasal Corridor Approaches to the Anterolateral Wall of the Maxillary Sinus: A Computerized Tomography Study

International Archives of Otorhinolaryngology ◽

10.1055/s-0041-1724092 ◽

2021 ◽

Author(s):

Navarat Vatcharayothin ◽

Pornthep Kasemsiri ◽

Sanguansak Thanaviratananich ◽

Cattleya Thongrong

Keyword(s):

Confidence Interval ◽

Maxillary Sinus ◽

Inferior Turbinate ◽

Radial Access ◽

Sinus Wall ◽

Nasal Floor ◽

Significant Difference ◽

Anterolateral Wall ◽

The Mean ◽

Maxillary Sinuses

Abstract Introduction The endoscopic access to lesions in the anterolateral wall of the maxillary sinus is a challenging issue; therefore, the evaluation of access should be performed. Objective To assess the accessibility of three endoscopic ipsilateral endonasal corridors. Methods Three corridors were created in each of the 30 maxillary sinuses from 19 head cadavers. Accessing the anterolateral wall of the maxillary sinus was documented with a straight stereotactic navigator probe at the level of the nasal floor and of the axilla of the inferior turbinate. Results At level of the nasal floor, the prelacrimal approach, the modified endoscopic Denker approach, and the endoscopic Denker approach allowed mean radial access to the anterolateral maxillary sinus wall of 42.6 ± 7.3 (95% confidence interval [CI]: 39.9–45.3), 56.0 ± 6.1 (95%CI: 53.7–58.3), and 60.1 ± 6.2 (95%CI: 57.8–62.4), respectively. Furthermore, these approaches provided more lateral access to the maxillary sinus at the level of the axilla of the inferior turbinate, with mean radial access of 45.8 ± 6.9 (95%CI: 43.3–48.4) for the prelacrimal approach, 59.8 ± 4.7 (95% CI:58.1–61.6) for the modified endoscopic Denker approach, and 63.6 ± 5.5 (95%CI: 61.6–65.7) for the endoscopic Denker approach. The mean radial access in each corridor, either at the level of the nasal floor or the axilla of the inferior turbinate, showed a statistically significant difference in all comparison approaches (p < 0.05). Conclusions The prelacrimal approach provided a narrow radial access, which allows access to anteromedial lesions of the maxillary sinus, whereas the modified endoscopic Denker and the endoscopic Denker approaches provided more lateral radial access and improved operational feasibility on far anterolateral maxillary sinus lesions.

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