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1.
Melissa C. Soderquist Ryan Scully Anthony S. Unger 《The Journal of arthroplasty》2017,32(9):2748-2754
Background
Acetabular cup placement in total hip arthroplasty (THA) has been recognized as an important factor in operative success, and accurate cup placement has been the impetus for novel medical technologies.Methods
This article examines the cup placement in 955 THAs using a freehand Direct Anterior Approach on a standard operating table. Acetabular anteversion and inclination were determined using the circle theorem. Measurements were divided into safe zone placement determined by Callanan et al as 5°-25° for anteversion and 30°-45° for inclination, as well as by Lewinnek et al as 5°-25° for anteversion and 30°-50° for inclination. Dislocation rate was determined and correlated to safe zone placement.Results
Although technology has advanced for cup placement, this investigation shows that a freehand technique demonstrates 0.31% dislocation after THA with an accuracy of 85% for the Lewinnek safe zone and 61% for Callanan, potentially because of the sparing of the posterior hip capsule.Conclusion
The direct anterior approach to the hip on a regular operating table is safe and reliable. Our results demonstrate improvement in cup positioning compared with other freehand techniques. Surgeon awareness and control of the position of the pelvis within space optimizes acetabular component accuracy and precision without the need for special equipment, such as intraoperative fluoroscopy. 相似文献2.
Jean Y. Lazennec Frederic Thauront Christopher B. Robbins Aidin E. Pour 《The Journal of arthroplasty》2017,32(11):3550-3556
Background
Although most hip dislocations occur in either standing or sitting position, the safe zone for implant position is defined for the supine position. Our goal was to determine preoperative and postoperative pelvis and hip orientations and whether the safe zone defined in supine position can be used to assess standing radiographs.Methods
Preoperative and postoperative three-dimensional EOS images were assessed in 66 total hip arthroplasty patients. None of the patients had dislocation within the follow-up period (12-36 months). The acetabular anteversion (both anterior pelvic plane [APP] and patient functional plane) and the femoral anteversion were measured. The sacral slope, pelvic version, pelvic inclination, and pelvic incidence were also measured.Results
Acetabular anteversion increased postoperatively in both APP and patient functional plane (P <.001). Femoral neck anteversion decreased postoperatively (P =.0942). Sacral slope was 42.4° (?25.9° to 24°) preoperatively compared with 40.3° (?4.1° to 64.2°) postoperatively (P =.013). Pelvic version changed from 15.2° (?10.4° to 43.8°) to 17.2° (?6° to 46.7°; P = 0.008). Pelvic inclination was 1.12° (?25.9° to 24°) before total hip arthroplasty and ?1.2° (?40.7° to 23.4°) postoperatively (P =.005).Conclusion
The acetabular and femoral implant orientations in standing position reside out of the safe zone in most patients. The APP is not vertical in standing position in most patients due to anterior or posterior pelvic tilt. The proposed safe zone in supine position may not be a useful measure in the assessment of standing radiographs of patients with significant anterior or posterior pelvic tilt.Level of Evidence
Level IV, therapeutic case series study. 相似文献3.
Kentaro Iwakiri Akio Kobayashi Yoichi Ohta Yukihide Minoda Kunio Takaoka Hiroaki Nakamura 《The Journal of arthroplasty》2017,32(12):3659-3664
Background
The acetabular component orientation in total hip arthroplasty (THA) is of critical importance to the good clinical results. However, traditional widely used cup alignment guides for cup placement are reported to be relatively unreliable. The present study aims at comparing a novel cup alignment guide, which can be attached to our anatomical pelvic plane (APP) pelvic lateral positioner for reducing discrepancies in sagittal pelvic tilt and indicate a targeted cup angle based on the APP, with a conventional cup alignment guide.Methods
The subjects were 136 hips of 136 patients who underwent unilateral THA using the APP positioner. The procedure was performed with the conventional cup alignment guide (conventional group; 60 hips) and with the novel cup navigator (mechanical navigator group; 76 hips). Postoperative cup angles and discrepancies of postoperative cup angles (inclination and anteversion angles) from the targeted angles were compared between the 2 groups to evaluate the usefulness of these navigators.Results
The mean cup angles in the conventional group were 39.0° ± 5.3° for the inclination angle and 21.7° ± 6.4° for the anteversion angle, whereas those in the mechanical navigator group were 40.6° ± 3.2° and 18.3° ± 4.6°, respectively (P = .018, P < .0001). The discrepancies from the targeted angles were 3.5° ± 3.1° for the inclination angle and 4.6° ± 3.4° for the anteversion angle in the conventional group and 2.3° ± 2.3° and 3.2° ± 2.7°, respectively, in the mechanical navigator group (P = .020, P = .012).Conclusion
The mechanical cup navigator easily attachable to the APP positioner is a tool that can improve the accuracy of cup placement in a simple, economical, and noninvasive manner in THA via the lateral position. 相似文献4.
Naofumi Taniguchi Tetsuya Jinno Daisuke Koga Tetsuo Hagino Atsushi Okawa Hirotaka Haro 《The Journal of arthroplasty》2017,32(5):1547-1552
Background
Appropriate stem anteversion is important for achieving stability of the prosthetic joint in total hip arthroplasty. Anteversion of a cementless femoral stem is affected by the femoral canal morphology and varies according to stem geometry. We investigated the difference and variation of the increase in anteversion between 2 types of cementless stems, and the correlation between each stem and the preoperative femoral anteversion.Methods
We retrospectively compared 2 groups of hips that underwent total hip arthroplasty using a metaphyseal filling stem (78 hips) or a tapered wedge stem (83 hips). All the patients had osteoarthritis due to hip dysplasia. Computed tomography was used to measure preoperative femoral anteversion at 5 levels and postoperative stem anteversion.Results
The increase in anteversion of the tapered wedge stem group (22.7° ± 11.6°) was more than that of the metaphyseal filling stem group (17.2° ± 8.3°; P = .0007). The variation of the increase in the tapered wedge stem group was significantly larger than that in the metaphyseal filling stem group (P = .0016). The metaphyseal filling stem group was more highly and positively correlated with femoral anteversion than the tapered wedge stem group.Conclusion
Femoral anteversion affects stem anteversion differently according to stem geometry. The tapered wedge stems had greater variation of the increase in anteversion than did the metaphyseal filling stems. Based on the results of this study, it is difficult to preoperatively estimate the increase in stem anteversion for tapered wedge stems. 相似文献5.
Friedrich Boettner Matthieu Zingg Ahmed K. Emara Wenzel Waldstein Martin Faschingbauer Maximilian F. Kasparek 《The Journal of arthroplasty》2017,32(4):1180-1185
Background
This study compares the differences in acetabular component position, leg length discrepancy, and hip offset between the anterior and posterior approach. A novel method is applied to determine the acetabular anteversion using the C-arm tilt angle for the anterior approach.Methods
Hundred consecutive anterior total hip arthroplasties were matched according to gender, body mass index, and age to a cohort of 100 primary total hip arthroplasties operated on through a posterior approach. Postoperative radiographs were analyzed to determine cup inclination, cup anteversion, leg length discrepancy, and hip offset.Results
The mean inclination was 40.8° (range 33°-48°) and 45.1° (range 33°-55°) for the anterior and posterior approach, respectively. Using the new C-arm tilt plane technique, an average acetabular anteversion of 18.4° (range 11°-26°) was achieved with the anterior approach compared with 23.6° (range 8°-38°) with the posterior approach. Hundred percent cups in the anterior group and 81% in the posterior group fell within the safe zone (P < .001). There was no difference in the overall hip offset between the operated side and the contralateral side for the anterior (P = .074) and posterior (P = .919) group. There was no difference in leg length discrepancy between the 2 approaches (P = .259).Conclusion
Intraoperative fluoroscopy-assisted direct anterior approach was associated with improved acetabular component positioning. However, no benefit was shown with regards to restoration of hip offset or leg length. 相似文献6.
Jun-Dong Chang In-Sung Kim Sharad Prabhakar Sameer A. Mansukhani Sang-Soo Lee Je-Hyun Yoo 《The Journal of arthroplasty》2017,32(5):1576-1580
Background
The purpose of the study was to evaluate the implant positions and clinical results of revision total hip arthroplasty (THA) using an imageless navigation with the concept of combined anteversion.Methods
A total of 40 cementless revision THAs (24 men and 16 women) using an imageless navigation with the concept of combined anteversion were retrospectively evaluated. The concept of combined anteversion was applied in cup positioning based on Widmer's equation (cup anteversion + 0.7 × stem anteversion). The mean follow-up period was 80.7 months. Postoperatively, the inclination of the cup was evaluated on standard anteroposterior view of the radiograph, and the anteversion of the cup and femoral stem was evaluated using computed tomography scan. A cup inclination of 40° ± 10° and combined anteversion of the cup and femoral stem of 37° ± 10° based on Widmer's equation were regarded as the “safe zone.”Results
The average anteversion of the revised femoral stems was 15.3° ± 2.9° (range, 9.5°-21.5°), whereas that of the remained femoral stems was 17.4° ± 9.7° (range, 4.2°-29.8°). The inclination, anteversion of the cup, and combined anteversion after revision THA were 42.3° ± 3.1° (range, 32.1°-48.2°), 25.0° ± 2.9° (range, 16.9°-29.5°), and 36.1° ± 3.4° (range, 27.2°-42.9°), respectively. Therefore, the position of the implants, relative to the safe zone, showed no outliers after the revision surgery. Neither dislocation nor osteolysis was observed after the surgery.Conclusion
Favorable results of this study indicate that imageless navigation helps the surgeon in placing the components of revision THA in the safe zone. This study also shows that when this safe zone is consistently obtained, then no postoperative dislocations were observed in these patients over the 6-year follow-up period. 相似文献7.
Michael C. Worlicek Michael L. Wörner Benjamin S. Craiovan Florian Zeman Joachim Grifka Tobias F. Renkawitz Markus Weber 《The Journal of arthroplasty》2017,32(9):2892-2897
Background
Assessing femoral version in orthopedic surgery is important for preoperative planning of total hip arthroplasty, especially for recognizing excessive anteversion or retroversion. The present study addressed the following: (1) Is the position of the lesser trochanter correlated to the femoral neck axis? (2) If so, may femoral version be assessed by means of plain pelvic radiographs?Methods
Three-dimensional computed tomography scans of 60 patients undergoing minimally invasive cement-free total hip arthroplasty were retrospectively analyzed, particularly with regard to the relation between the femoral neck axis and the lesser trochanter, the femoral version, and the size of the projected lesser trochanter in different rotational positions. Based on linear regression, a biomathematical formula was developed to assess femoral anteversion on plain radiographs depending on the visible part of the lesser trochanter.Results
The mean difference between the location of the lesser trochanter axis and the femoral neck axis was 43.3° ± 6.2°. Eighty-seven percent of patients (52 of 60) had a deviation of <10° from the mean value of 43.3°. By virtual rotation of the femur in steps of 10°, the visible part of the lesser trochanter linearly increased with anteversion of the femur: femoral version = (lesser trochanter size ? 5.57) × 4.17. There was a high correlation between the visible part of the lesser trochanter and femoral version (R2 = 0.75; P < .001). The lesser trochanter was no longer visible with femoral retroversion in each of the 60 data sets.Conclusion
The projected size of the lesser trochanter as available on plain pelvic AP radiographs correlates with native femoral anteversion. 相似文献8.
Keisuke Uemura Masaki Takao Yoshito Otake Koki Koyama Futoshi Yokota Hidetoshi Hamada Takashi Sakai Yoshinobu Sato Nobuhiko Sugano 《The Journal of arthroplasty》2017,32(8):2568-2573
Background
Cup anteversion and inclination are important for avoiding implant impingement and dislocation in total hip arthroplasty. However, functional cup anteversion and cup inclination also change as the pelvic sagittal inclination (PSI) changes. Therefore, PSI in both supine and standing positions was measured in a large cohort in this study.Methods
A total of 422 patients (median age, 61; range, 15-87) who underwent total hip arthroplasty were the subjects of this study. There were 83 patients with primary osteoarthritis (OA), 274 patients with developmental dysplasia–derived secondary OA, 48 patients with osteonecrosis, and 17 patients with rapidly destructive coxopathy (RDC). Preoperative PSI in supine and standing positions was measured by automated computed topography segmentation and landmark localization of the pelvis followed by intensity-based 2D-3D registration, and the number of cases in which PSI changed more than 10° posteriorly was calculated. Hip disease, sex, and age were analyzed if they were related to a PSI change of more than 10°.Results
The median PSI was 5.1° (interquartile range, 0.4°-9.4°) in supine and ?1.3° (interquartile range, ?6.5° to 4.2°) in standing position. There were 79 cases (19%) in which the PSI changed more than 10° posteriorly from supine to standing. Elder age and patients with primary OA and RDC were revealed to be the related factors.Conclusion
PSI changed more than 10° posteriorly from supine to standing in 19% of cases. Age and diagnosis of primary OA and RDC were the significant factors for the posterior rotation. 相似文献9.
Steffen Brodt Dimitri Nowack Benjamin Jacob Linda Krakow Christoph Windisch Georg Matziolis 《The Journal of arthroplasty》2017,32(9):2762-2767
Background
Movement of the pelvis during implantation of total hip arthroplasty (THA) has a major influence on the positioning of the acetabular cup. Strong traction caused by retractors leads to iatrogenic pelvic lift and can thus be partly responsible for cup malpositioning. The objective of this study was to investigate such factors that influence pelvic lift.Methods
The dynamic movement of the pelvis was measured during implantation of THA in 67 patients. This was done by measuring the acceleration using the SensorLog app on a smartphone.Results
At its maximum, the pelvis was lifted by an average of 6.7°. When impacting the press-fit cup, the surgical side was raised by 4.4° compared with the time of skin incision. This lift at the time of cup implantation correlates significantly with the body mass index and the patient's abdominal and pelvic circumference.Conclusion
Every surgeon performing THA must be aware of the pelvic lift during an operation. Especially in patients with a high body mass index, a large abdominal circumference, or a large pelvic circumference, there is an increased risk of malpositioning of the acetabular cup. When impacting the cup, we recommend releasing the traction of the retractor, so that the pelvis can tilt back into its natural position, and thus, the anticipated cup positioning can be implemented as exactly as possible. 相似文献10.
Jonathan G. Haw Andrew K. Battenberg Der-Chen T. Huang Thomas P. Schmalzried 《The Journal of arthroplasty》2017,32(4):1381-1386
Background
Cross-linked polyethylene (XLPE) has demonstrated significantly reduced wear and osteolysis into the second decade for total hip arthroplasty. There is a relative paucity of data with ≥36-mm bearings. Issues include potential effects of reduced liner thickness and component position on wear, osteolysis, and mechanical failure of the bearing.Methods
Radiographs of 48 primary total hip arthroplasties with ≥36-mm modular XLPE bearings were analyzed at a minimum 5 years postoperative on serial radiographs using a validated, edge-detection-based algorithm. Subgroups were examined to assess the effect of bearing diameter, liner thickness, acetabular abduction angle, and acetabular anteversion on XLPE wear.Results
There was no significant difference in volumetric wear when subgroups were stratified by component factors: liner thickness (<6.5 mm vs ≥6.5 mm) 40.69 mm3/y vs 24.47 mm3/y, respectively (P = .315); acetabular component abduction angle (<45° vs ≥45°): 38.68 mm3/y vs 27.8 mm3/y, respectively (P = .522); acetabular anteversion (<20° vs ≥20°): 41.32 mm3/y vs 31.79 mm3/y, respectively (P = .521). There were no dislocations, mechanical failures, or revisions. There were 7 hips with volumetric wear rates ≥80 mm3/y; 1 had possible osteolysis.Conclusion
Larger-diameter XLPE wear was not measurably affected by liner thickness, acetabular abduction angle, or acetabular anteversion. However, there is a trend for increasing volumetric wear with increasing bearing size. Wear outliers do occur, and continued follow-up of larger-diameter XLPE bearings is warranted. 相似文献11.
Raul G. Gosthe Juan C. Suarez Colin A. McNamara Cecilia Calvo Preetesh D. Patel 《The Journal of arthroplasty》2017,32(10):3052-3055
Background
Obesity has been described as an independent risk factor for acetabular component malpositioning. The purpose of this study was to determine if this could be overcome by use of fluoroscopic navigation in total hip arthroplasty (THA).Methods
The first, postoperative, standing, anteroposterior pelvis radiographs from 1599 consecutive patients who underwent fluoroscopic-guided THAs via anterior approach during a six-year period were obtained. We retrospectively reviewed this prospectively collected data. Inclination and anteversion were measured as described by Barrack et al. Intraoperative target ranges for inclination and anteversion angles were 30°-50° and 5°-25°. Patients were divided into 3 cohorts by body mass index, nonobese (<30 kg/m2) obese (between 30 and 40 kg/m2) and morbidly obese (>40 kg/m2), looking for significant differences in acetabular component positioning.Results
Of the 1599 patients, 1065 were nonobese, 506 obese, and 28 morbidly obese. Overall, average inclination was 37.7° and anteversion was 16.3°. Regarding inclination, 95.0% of cups were positioned in the safe zone, 95.7% for anteversion, and 91.2% for both inclination and anteversion. Analysis of each cohort individually revealed an average inclination of 37.5° in the nonobese, 37.9° in the obese, and 39.9° in the morbidly obese patients. For anteversion, each group's averages were 16.1°, 16.5°, and 16.0°, respectively. There was no significant relationship between a patient's body mass index and cup position for inclination (P = .867), anteversion (P = .673), or both inclination and anteversion (P = .624).Conclusion
Fluoroscopy is a useful tool for achieving a targeted acetabular component orientation in direct anterior THA, irrespective of patient BMI. 相似文献12.
Kentaro Iwakiri Akio Kobayashi Yoichi Ohta Kunio Takaoka 《The Journal of arthroplasty》2017,32(5):1520-1524
Background
Total hip arthroplasty in the lateral position involves particularly large variance in the sagittal tilt of pelvis fixation, which affects the imprecision of the cup anteversion leading to poor outcomes. We have added an additional compression pad to an existing device, also to be used in the lateral position, but theoretically enabling fixation on the anatomical pelvic plane (APP) serving as the reference plane. The present study aims to evaluate the usefulness of this device in comparison with the conventional device.Methods
We have studied 141 patients who underwent total hip arthroplasty at our hospital. Two frontal plain x-rays of the pelvis were obtained preoperatively for each patient after pelvis fixation; one with the conventional lateral fixation device and the other with an APP lateral fixation device. The sagittal tilt of the pelvis in each position was measured with 3D templating software, and variance in the sagittal tilt was compared between the 2 devices.Results
The mean bias in sagittal tilt relative to the functional pelvic plane (FPP) in the conventional device was ?5.0° ± 4.8° (minus mean backward tilt) and was within 5° relative to the functional pelvic plane in 43%. The mean bias in the sagittal tilt relative to the APP in the APP lateral position device was 1.7° ± 3.1° (forward tilt) and was within 5° relative to the APP in 89%. The APP lateral device significantly reduced the variance in the sagittal tilt.Conclusion
This device holds promise as a means of reducing the sagittal tilt in a simple, minimally invasive, and highly cost-effective manner. 相似文献13.
Matthew J. Harris Jason Tam Steven J. Fineberg Paul A. Lucas Steven B. Zelicof 《The Journal of arthroplasty》2017,32(1):296-299
Background
The transverse acetabular ligament (TAL) has been described as an anatomic landmark to guide in the positioning of the acetabular component during total hip arthroplasty. On plain films, the radiographic teardrop (RT) has similarly been used as a measure of appropriate cup positioning. The goal of this study is to quantify the distance and location between the anatomic TAL and RT landmarks to aid in the positioning of acetabular component.Methods
Sixteen randomly selected cadaveric pelvises (eight males, eight females) underwent dissection. Radiographic markers were placed bilaterally at the anteromedial insertions of the TAL, and true anteroposterior pelvic radiographs of the cadavers were obtained. Distances between the markers and the lateral borders of the RT were measured.Results
The mean distance between the anteromedial insertion of the TAL and the lateral border of the RT in the male specimens was 11.8 (99% confidence interval, 11.4-12.2) mm. In the female specimens, the TAL to RT distance was shorter, with a mean of 8.4 (99% CI, 7.2-9.6) mm. There was a statistically significant difference between male and female cadavers (P < .01).Conclusion
The distance between the RT and TAL differs between males and females. Understanding the distance between these anatomic and radiographic landmarks should aid surgeons in obtaining a more accurate degree of acetabular component medialization and can serve as a guide to minimize overmedialization in order to achieve more accurate and reproducible placement of acetabular components during a total hip arthroplasty. 相似文献14.
Anita Sadhu Denis Nam Benjamin R. Coobs Toby N. Barrack Ryan M. Nunley Robert L. Barrack 《The Journal of arthroplasty》2017,32(3):987-991
Background
Recently, the importance of acetabular component positioning in the Lewinnek “safe zone” in preventing prosthetic dislocation following total hip arthroplasty (THA) has been questioned. The purpose of this study was to determine the proportion of acetabular components within the Lewinnek safe zone between primary and revision THAs that have sustained a dislocation vs matched controls without a dislocation event.Methods
This was a retrospective, institutional review board–approved investigation of THAs performed at our institution or referred to our institution between 1997 and 2013. Ninety-six primary THAs and 60 revision THAs that sustained a dislocation were included and matched 1:1 based on age, gender, and body mass index with nondislocated controls. Acetabular component inclination and anteversion were performed using Martell Hip Analysis Suite and compared between the 2 cohorts for both primary and revision THAs.Results
The proportion of acetabular components within the safe zone for both inclination and anteversion was 23 of 96 (24%) in primary THA dislocators vs 48 of 96 (50%, P < .001) in controls. The proportion of acetabular components within the safe zone for both inclination and anteversion was 28 of 60 (47%) in revision THA dislocators vs 40 of 60 (66%, P = .03) in controls.Conclusion
Patients sustaining a dislocation following a primary or revision THA had acetabular components less frequently positioned within the safe zone compared to control patients. This study suggests acetabular component positioning remains an important variable in decreasing the risk of dislocation following primary and revision THA. 相似文献15.
Min Chen Zhengliang Luo Xiaofeng Ji Peng Cheng Guolin Tang Xifu Shang 《The Journal of arthroplasty》2017,32(1):131-138
Background
The direct anterior approach (DAA) for total hip arthroplasty (THA) is typically performed in the supine position using a specially designed operating room table, which makes this approach more accessible to orthopedic surgeons. We attempted to perform this procedure in the lateral decubitus position on an ordinary operation table to avoid dependence on a special operating room table. There is an obvious absence of literature regarding this subject.Methods
A total of 248 patients (295 hips) were recruited for primary THAs from July 1, 2014 to December 31, 2014. In total, 126 hips (42.7%) underwent THAs using the DAA in the lateral decubitus position. The technical feasibility and early results were evaluated.Results
The orientation of the acetabular component was 16.5° ± 4.9° anteversion and 43.3° ± 3.5° abduction. Intraoperative proximal femoral fracture occurred in one hip. The superficial wound complications occurred in 2 hips and the hematoma in one hip while in hospital. The lateral femoral cutaneous nerve injury was noted in 43 hips. The early dislocation occurred in 2 hips. Heterotopic ossification was Brooker class I in 5 hips and class II in 1 hip. No aseptic loosening, postoperative periprosthetic fracture, and deep infection occurred in our series.Conclusion
The DAA for THA in the lateral decubitus position may be a valuable alternative if the DAA in the supine position is difficult to implement owing to absence of a special operating room table. This technique also seems to provide satisfactory clinical and radiographic outcomes with an acceptable complication in our early follow-up. 相似文献16.
Monther A. Gharaibeh Gandhi N. Solayar Ian A. Harris Darren B. Chen Samuel J. MacDessi 《The Journal of arthroplasty》2017,32(3):777-782
Background
Accelerometer-based, portable navigation devices have been introduced as a less invasive and simpler technique to perform navigated surgical implantation of knee prostheses. They have been postulated to have better accuracy than conventional instruments in restoration of alignment in total knee arthroplasty.Methods
A total of 190 patients were enrolled in this prospective, randomized controlled trial and underwent total knee arthroplasty using either the KneeAlign or conventional guides. Multiplanar alignment was evaluated with a CT imaging protocol.Results
A total of 86.5% of portable navigation device and 82.2% of conventional group had a postoperative hip–knee angle within 3° of neutral alignment (P = .54). There was no significant difference between the 2 groups for component coronal and sagittal plane alignment. Portable navigation device did not significantly increase the time to perform the surgery.Conclusion
Portable navigation device demonstrates accurate restoration of alignment; however, there was no statistically significant difference when compared with conventional guides. 相似文献17.
Satoru Tamura Shunsaku Nishihara Masaki Takao Takashi Sakai Hidenobu Miki Nobuhiko Sugano 《The Journal of arthroplasty》2017,32(3):877-882
Background
Functional anteversion and inclination of the cup change as the pelvic sagittal inclination (PSI) changes. The purposes of this study were to investigate the chronological changes of PSI during a 10-year follow-up period after total hip arthroplasty (THA) and to report the characteristics of patients who showed a greater than 10° change in the PSI from the supine to the standing position.Methods
The subjects were 70 patients who were followed up for 10 years after THA. PSI values in the supine and standing positions were measured by 2D-3D matching using computed tomography images and pelvic radiographs. PSI values before THA and 1, 5, and 10 years after THA were compared in both the supine and standing positions.Results
Supine PSI showed less than 5° of change, whereas standing PSI showed a significant decrease with time over the 10-year period. Although 43% of patients with less than 10° of difference in the PSI between the supine and standing positions before THA increased PSI posteriorly (reclining) more than 10° in standing from the supine position at 10 years, no late dislocation was observed.Conclusion
Supine PSI showed no significant change, but standing PSI showed a significant increase posteriorly with time over a 10-year period. However, this PSI change did not reach the level that it caused negative consequences such as late dislocation. The pelvic position in the supine position might still be a good functional reference position of the pelvis for aiming to achieve proper cup alignment at 10 years. 相似文献18.
Siddharth M. Shah Kamal Deep Chaiyaporn Siramanakul Vivek Mahajan Frederic Picard David J. Allen 《The Journal of arthroplasty》2017,32(9):2783-2787
Background
Noise after ceramic-on-ceramic (CoC) total hip arthroplasty (THA) is a well-recognized problem. Computer navigation has been shown to achieve desired implant orientation. Our aim was (1) to compare the incidence of noise between navigated and conventional CoC THAs and (2) to determine the factors associated with noise.Methods
All patients undergoing CoC THA between March 2009 and August 2012 were considered for this study. Information regarding hip noise was obtained via telephone or postal interview. A comparable cohort of patients in navigated and conventional groups was used to evaluate the incidence of noise.Results
A total of 375 CoC THAs using the same implant (202 navigated and 173 conventional) were evaluated. Patients <65 years of age had significantly greater incidence of noise (22.4% vs 6.1%; P < .001). To ensure similarity, a subgroup of cohort <65 years and a 32-mm head size was used to compare the incidence of noise between the navigated (68 THAs) and conventional (118 THAs) groups. Overall incidence of noise was significantly greater in the conventional group (28%) as compared with the navigated group (10%; P = .005). The relative risk of noise for the conventional vs the navigated group was 2.7 (P = .01), and for squeaking was 1.9 (P = .2). Squeaking THAs had significantly lower cup anteversion (13.4° ± 5.2°) as compared with the silent THAs (17.6° ± 6.9°; P = .01).Conclusion
Navigated CoC THAs were 2.7× less likely to have noise as compared with the conventional ones. Squeaking THAs had significantly lower cup anteversion as compared with the silent ones. Patients of age <65 years had significantly greater incidence of noise after CoC THA. 相似文献19.
Ran Schwarzkopf Jeffrey M. Muir Wayne G. Paprosky Scott Seymour Michael B. Cross Jonathan M. Vigdorchik 《The Journal of arthroplasty》2017,32(10):3056-3060
Background
Accurate cup positioning is one of the most challenging aspects of total hip arthroplasty (THA). Undetected movement of the patient during THA surgery can lead to inaccuracies in cup anteversion and inclination, increasing the potential for dislocation and revision surgery. Investigations into the magnitude of patient motion during THA are not well represented in the literature.Methods
We analyzed intraoperative pelvic motion using a novel navigation device used to assist surgeons with cup position, leg length, and offset during THA. This device uses an integrated accelerometer to measure motion in 2 orthogonal degrees of freedom. We reviewed the data from 99 cases completed between February and September 2016.Results
The mean amount of pitch recorded per patient was 2.7° (standard deviation, 2.2; range, 0.1°-9.9°), whereas mean roll per patient was 7.3° (standard deviation, 5.5; range, 0.3°-31.3°). Twenty-one percent (21 of 99) of patients demonstrated pitch of >4°. Sixty-nine percent (68 of 99) of patients demonstrated >4° of roll, and 25% (25 of 99) of patients demonstrated roll of ≥10°.Conclusion
Our findings indicate that while the majority of intraoperative motion is <4°, many patients experience significant roll, with a large proportion rolling >10°. This degree of movement has implications for acetabular cup position, as failure to compensate for this motion can result in placement of the cup outside the planned safe zone, thus, increasing the potential for dislocation. Further study is warranted to determine the effect of this motion on cup position, leg length, and offset. 相似文献20.
Vahit Emre Ozden Goksel Dikmen Burak Beksac Ismail Remzi Tozun 《Journal of orthopaedic science》2017,22(3):517-523