共查询到20条相似文献，搜索用时 31 毫秒
1.
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.
Jean Y. Lazennec Ian C. Clark Dominique Folinais Imen N. Tahar Aidin E. Pour 《The Journal of arthroplasty》2017,32(10):3184-3190
Background
This study used EOS imaging of primary total hip arthroplasty (THA) patients, with and without predating spinal fusion, to investigate (1) the impact of spinal fusion on acetabular implant anteversion and inclination, and (2) whether more extensive spinal fusion (fusion starting above the thoracolumbar junction or extension of fusion to the sacrum) affects acetabular implant orientation differently than lumbar only spinal fusion.Methods
Ninety-three patients had spinal fusion (case group), and 150 patients were without spinal fusion (controls). None of the patients experienced dislocation. The change in sacral slope (SS) and cup orientation from standing to sitting was measured.Results
Mean SS change from the standing to sitting positions was ?7.9°in the fusion group vs ?18.4°in controls (P = .0001). Mean change in cup inclination from the standing to sitting positions was 4.9°in the fusion group vs 10.2°in controls (P = .0001). Mean change in cup anteversion from standing to sitting positions was 7.1°in the fusion group vs 12.1°in controls (P = .0001). For each additional level of spinal fusion, the change in SS from standing to sitting positions decreased by 1.6(95% confidence interval [CI], 2.2073-1.0741), the change in cup inclination decreased by 0.8(95% CI, 0.380-1.203), and the change in cup anteversion decreased by 0.9(95% CI, 0.518-1.352; P < .001 in all cases).Conclusion
Patients with spinal fusion demonstrated less adaptability of the lumbosacral junction. Longer spinal fusion or inclusion of the pelvis in the fusion critically impacts hip-spine biomechanics and significantly affects the ability to compensate in the standing-to-sitting transition. 相似文献4.
Denis Nam Venessa Riegler John C. Clohisy Ryan M. Nunley Robert L. Barrack 《The Journal of arthroplasty》2017,32(4):1200-1205
Background
This study's purpose was to determine the impact of THA implantation on pelvic motion, and to assess motion in patients with a history of lumbar fusion or prosthetic dislocation.Methods
This was an IRB-approved, prospective investigation of 3 cohorts: (1) patients without a history of lumbar surgery undergoing THA (group A), (2) patients with a lumbar fusion (group B), and (3) patients with a THA prosthetic dislocation (group C). All patients received both standing and sitting lateral pelvis images to measure sacral slope and pelvic tilt in the sagittal plane.Results
Fifty-eight patients were enrolled (24 group A, 27 group B, and 7 group C), with no differences in age, gender, or body mass index (P = .1-.7). In group A, the mean change in sacral slope from standing to sitting was 22.1° ± 15.2° preoperatively and 19.5° ± 14.8° postoperatively. However, in 13 patients, the difference in pelvic motion from the standing to seated position, from preoperatively to postoperatively, was >5° and in 10 patients, this difference was >10°.The change in standing to sitting sacral slope was significantly less in patients with a lumbar fusion (9.8° ± 8.2°) and history of prosthetic dislocation (12.5° ± 4.7°) vs group A (P < .001 and P = .008).Conclusion
Implantation of a THA can increase or decrease sagittal plane pelvic motion from the standing to seated position with a high degree of variability. Thus, the ability to predict ideal component positioning from preoperative images may be challenging. 相似文献5.
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6.
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7.
Edward M. DelSole Jonathan M. Vigdorchik Ran Schwarzkopf Thomas J. Errico Aaron J. Buckland 《The Journal of arthroplasty》2017,32(6):1910-1917
Background
Changes in spinal alignment and pelvic tilt alter acetabular orientation in predictable ways, which may have implications on stability of total hip arthroplasty (THA). Patients with sagittal spinal deformity represent a subset of patients who may be at particularly high risk of THA instability because of postural compensation for abnormal spinal alignment.Methods
Using standing stereoradiography, we evaluated the spinopelvic parameters, acetabular cup anteversion, and inclination of 139 THAs in 107 patients with sagittal spinal deformity. Standing images were compared with supine pelvic radiographs to evaluate dynamic changes in acetabular cup position. Dislocation and revision rates were procured through retrospective chart review. The spinal parameters and acetabular cup positions among dislocators were compared with those who did not dislocate.Results
The rate of THA dislocation in this cohort was 8.0%, with a revision rate of 5.8% for instability. Patients who sustained dislocations had significantly higher spinopelvic tilt, T1-pelvic angle, and mismatch of lumbar lordosis and pelvic incidence. Among all patients, 78% had safe anteversion while supine, which decreased significantly to 58% when standing due to increases in spinopelvic tilt. Among dislocating THA, 80% had safe anteversion, 80% had safe inclination, and 60% had both parameters within the safe zone.Conclusion
In this cohort, patients with THA and concomitant spinal deformity have a particularly high rate of THA instability despite having an acetabular cup position traditionally thought of as within acceptable alignment. This dislocation risk may be driven by the degree of spinal deformity and by spinopelvic compensation. Surgeons should anticipate potential instability after hip arthroplasty and adjust their surgical plan accordingly. 相似文献8.
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9.
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10.
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11.
Taiki Murakami Makoto Enokida Kei Kawaguchi Ryoji Otsuki Hideki Nagashima 《Journal of orthopaedic science》2017,22(2):318-324
Objective
Medial radial displacement (MRD) of the medial meniscus is a feature proving a dysfunction in the medial meniscus in osteoarthritis (OA) of the knee. MRD was measured in radiographic pre-OA knee and early osteoarthritis of the knee (early-OA) longitudinally using ultrasound (US) to investigate the characteristics involved in the onset and progression of OA.Methods
Fifty-five patients with pain on the medial side of the knee participated in the present study. It was possible to follow-up 46 patients for 5 years, and, thus, they were divided into 32 pre-OA patients (female: 59%, mean age: 69.0 years) and 14 early-OA patients (female: 78%, mean age: 74.4 years) based on radiography at the baseline time-point. MRD was measured in standing and supine positions at baseline and after 1 and 5 years using US. MRD corrected with the skeletal size, i.e., the medial displacement index (MDI), was analyzed. The pre- and early-OA groups were divided into subgroups at 5 years: stable and OA progression groups, following the Kellgren/Lawrence classification, and ⊿MDI (gap of the MDI between the standing and supine positions) were retrospectively compared between the subgroups at baseline, 1 and 5 years.Results
In the overall pre-OA group, MDI increased by 7% and 10% at 5 years in the supine and standing position, showing a significant increase (P = 0.044, 0.0147). ⊿MDI was significantly greater in the subgroup with OA progression in the pre- and early-OA groups (P = 0.02 and 0.03, respectively), and was continuously 6–7% in the pre-OA progression group, showing that the displacement rate was 2-fold or higher than in the stable group.Conclusion
An increase in ⊿MDI on US may be an important risk factor for the disease stage progression of OA and useful as a feature predicting the onset of radiographic knee OA. 相似文献12.
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13.
Tuomas J.T. Tauriainen Tuukka T. Niinimäki Jaakko L. Niinimäki Tomi O.P. Nousiainen Juhana I. Leppilahti 《The Journal of arthroplasty》2017,32(7):2204-2207
Background
The rate of and the reasons for the failure of metal-on-metal (MoM) bearings have recently been discussed in literature. The aim of this study was to evaluate the influence of acetabular cup inclination and version angles on revision risk in patients with MoM hip arthroplasty.Methods
We retrospectively reviewed 825 patients (976 hips) who underwent a MoM hip arthroplasty between 2000 and 2013. There were 474 men and 351 women, with a mean age of 58 (19-86) years. Acceptable cup orientation was considered to be inside the Lewinnek's safe zone.Results
The mean acetabular inclination angle was 48.9° (standard deviation, 8.1°; range, 16°-76°) and version angle 20.6° (standard deviation, 9.9°; range, ?25 to 46°). The cup was found to be outside the Lewinnek's safe zone in 571 hips (58.5%). Acetabular cup revision surgery was performed in 157 hips (16.1%). The cup angles were outside Lewinnek's safe zone in 69.2% of the revised hips. The mean interobserver reliability and intraobserver repeatability of the measurements of cup inclination and version angles were excellent (intraclass correlation coefficients >0.90). The odds ratio for revision in hips outside vs inside the Lewinnek's safe zone was 1.82 (95% confidence interval, 1.26-2.62; P = .0014).Conclusion
Our findings provide compelling evidence that a cup position outside the Lewinnek's safe zone is associated with increased revision risk in patients with MoM arthroplasty. 相似文献14.
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15.
Michael T. Milone Ran Schwarzkopf Patrick A. Meere Kaitlin M. Carroll Seth A. Jerabek Jonathan Vigdorchik 《The Journal of arthroplasty》2017,32(6):1890-1893
Background
To our knowledge, no study has assessed the ability of rigid patient positioning devices to afford arthroplasty surgeons with ideal acetabular orientation throughout surgery. The purpose of this study is to use robotic arm–assisted computer navigation to assess the reliability of pelvic position in total hip arthroplasty performed on patients positioned with rigid positioning devices.Methods
A prospective cohort of 100 hips (94 patients) underwent robotic-guided total hip arthroplasty in the lateral decubitus position from the posterior approach, 77 stabilized by universal lateral positioner, and 23 by peg board. Before reaming, computed tomography–templated computer software generated true values of pelvic anteversion and inclination based on the position of the robot arm registered to the patient’s preoperative pelvic computed tomography.Results
Mean alteration in anteversion and inclination values was 1.7° (absolute value, 5.3°; range, ?20° to 20°) and 1.6° (absolute value, 2.6°; range, ?8° to 10°), respectively. And 22% of anteversion values were altered by >10° and 41% by >5°. There was no difference between hip positioners used (P = .36). Anteversion variability was correlated with body mass index (P = .02).Conclusion
Despite the use of rigid patient positioning devices—a lateral hip positioner or peg board—this study reveals clinically important malposition of the pelvis in many cases, especially with regard to anteversion. These results show a clear need to pay particular attention to anatomic landmarks or computer-assisted techniques to assure accurate acetabular cup positioning. Patient positioning should not be solely trusted. 相似文献16.
Eli Kamara Jonathon Robinson Marcel A. Bas Jose A. Rodriguez Matthew S. Hepinstall 《The Journal of arthroplasty》2017,32(1):125-130
Background
Acetabulum positioning affects dislocation rates, component impingement, bearing surface wear rates, and need for revision surgery. Novel techniques purport to improve the accuracy and precision of acetabular component position, but may have a significant learning curve. Our aim was to assess whether adopting robotic or fluoroscopic techniques improve acetabulum positioning compared to manual total hip arthroplasty (THA) during the learning curve.Methods
Three types of THAs were compared in this retrospective cohort: (1) the first 100 fluoroscopically guided direct anterior THAs (fluoroscopic anterior [FA]) done by a surgeon learning the anterior approach, (2) the first 100 robotic-assisted posterior THAs done by a surgeon learning robotic-assisted surgery (robotic posterior [RP]), and (3) the last 100 manual posterior (MP) THAs done by each surgeon (200 THAs) before adoption of novel techniques. Component position was measured on plain radiographs. Radiographic measurements were taken by 2 blinded observers. The percentage of hips within the surgeons’ “target zone” (inclination, 30°-50°; anteversion, 10°-30°) was calculated, along with the percentage within the “safe zone” of Lewinnek (inclination, 30°-50°; anteversion, 5°-25°) and Callanan (inclination, 30°-45°; anteversion, 5°-25°). Relative risk (RR) and absolute risk reduction (ARR) were calculated. Variances (square of the standard deviations) were used to describe the variability of cup position.Results
Seventy-six percentage of MP THAs were within the surgeons’ target zone compared with 84% of FA THAs and 97% of RP THAs. This difference was statistically significant, associated with a RR reduction of 87% (RR, 0.13 [0.04-0.40]; P < .01; ARR, 21%; number needed to treat, 5) for RP compared to MP THAs. Compared to FA THAs, RP THAs were associated with a RR reduction of 81% (RR, 0.19 [0.06-0.62]; P < .01; ARR, 13%; number needed to treat, 8). Variances were lower for acetabulum inclination and anteversion in RP THAs (14.0 and 19.5) as compared to the MP (37.5 and 56.3) and FA (24.5 and 54.6) groups. These differences were statistically significant (P < .01).Conclusion
Adoption of robotic techniques delivers significant and immediate improvement in the precision of acetabular component positioning during the learning curve. While fluoroscopy has been shown to be beneficial with experience, a learning curve exists before precision improves significantly. 相似文献17.
Jun-Il Yoo Javad Parvizi Ji-ung Song Yong-Chan Ha Young-Kyun Lee Kyung-Hoi Koo 《The Journal of arthroplasty》2017,32(7):2199-2203
Background
In total hip arthroplasty (THA) of hips with coxa vara, the femoral stems might be inserted in a varus alignment. To avoid varus insertion, we designed a technique, which we termed “trochantoplasty.” In this procedure, the medial half of the greater trochanter was removed during THA.Methods
We evaluated 30 patients (31 hips) who had coxa vara deformity and underwent THA using trochantoplasty at the mean follow-up of 5 years (range, 3-9 years).Results
All stems were inserted in the neutral position. One Vancouver type 1 periprosthetic femoral fracture occurred after a fall at postoperative 2 months. At the latest follow-up, the mean power of abductor was 4.3 (range, 3-5). Four patients had moderate limp whereas 26 patients had slight limp. The abduction at 90° flexion ranged from 15° to 45° (mean, 35°). There was no revision. All prostheses had bone-ingrown stability without any detectable wear or osteolysis. The mean Harris hip score was improved from 66.9 to 89.4 points.Conclusion
Trochantoplasty can be used to avoid varus insertion of the femoral stem while performing THA in patients with coxa vara deformity without compromising the abductor mechanism. 相似文献18.
Vincent V.G. An Brahman S. Sivakumar Kevin Phan Yadin David Levy Warwick J.M. Bruce 《Journal of orthopaedic science》2017,22(1):116-120
Introduction
The technical objective of total knee arthroplasty (TKA) is to restore normal mechanical parameters to the knee. Patient-specific instrumentation (PSI) was developed to streamline the operative process and improve accuracy. PSI produces individualized cutting guides based on three-dimensional models of the patient's anatomy acquired from computed-tomography (CT) or magnetic-resonance imaging (MRI). However, the superiority of one modality over the other remains unclear. Therefore, we aimed to compare the accuracy of patient-specific cutting guides produced from MRI or CT imaging methods in TKA.Methods
Electronic databases were systematically searched using relevant keywords and MeSH terms for original-data English-language publications comparing the accuracy of CT and MRI-based PSI cutting guides in TKA. Data was extracted from the text, tables and figures of studies and meta-analysed.Results
MRI-based PSI cutting guides produced a lower proportion of coronal plane outliers (>3°) with regard to overall limb mechanical axis (OR 2.75, p = 0.01). There were no significant differences between the two in terms of sagittal femoral and tibial component placement, or coronal femoral and tibial placement, or femoral component axial rotation. Tibial rotation was not analysed in the literature.Conclusions
MRI-based patient-specific cutting guides produced a lower proportion of outliers in the overall coronal alignment of the limb compared to CT, with no significant difference between the two in terms of femoral or tibial component placement. Future studies should investigate the differences in resource usage and operative time between the two to inform surgeons' decision making when choosing an ideal imaging modality for PSI TKA.Study design
Meta-analysis.Level of evidence
III, systematic review of cohort and comparative studies. 相似文献19.
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20.
Young-Kyun Lee Ki-Chul Kim Woo-Lam Jo Yong-Chan Ha Javad Parvizi Kyung-Hoi Koo 《The Journal of arthroplasty》2017,32(4):1360-1362