A custom-made guide-wire positioning device for Hip Surface Replacement Arthroplasty: description and first results

Abstract

BackgroundHip surface replacement arthroplasty (SRA) can be an alternative for total hip arthroplasty. The short and long-term outcome of hip surface replacement arthroplasty mainly relies on the optimal size and position of the femoral component. This can be defined before surgery with pre-operative templating. Reproducing the optimal, templated femoral implant position during surgery relies on guide wire positioning devices in combination with visual inspection and experience of the surgeon. Another method of transferring the templated position into surgery is by navigation or Computer Assisted Surgery (CAS). Though CAS is documented to increase accurate placement particularly in case of normal hip anatomy, it requires bulky equipment that is not readily available in each centre.MethodsA custom made neck jig device is presented as well as the results of a pilot study.The device is produced based on data pre-operatively acquired with CT-scan. The position of the guide wire is chosen as the anatomical axis of the femoral neck. Adjustments to the design of the jig are made based on the orthopedic surgeon's recommendations for the drill direction. The SRA jig is designed as a slightly more-than-hemispherical cage to fit the anterior part of the femoral head. The cage is connected to an anterior neck support. Four knifes are attached on the central arch of the cage. A drill guide cylinder is attached to the cage, thus allowing guide wire positioning as pre-operatively planned.Custom made devices were tested in 5 patients scheduled for total hip arthroplasty. The orthopedic surgeons reported the practical aspects of the use of the neck-jig device. The retrieved femoral heads were analyzed to assess the achieved drill place in mm deviation from the predefined location and orientation compared to the predefined orientation.ResultsThe orthopedic surgeons rated the passive stability, full contact with neck portion of the jig and knife contact with femoral head, positive. There were no guide failures. The jig unique position and the number of steps required to put the guide in place were rated 1, while the complexity to put the guide into place was rated 1-2. In all five cases the guide wire was accurately positioned. Maximum angular deviation was 2.9° and maximum distance between insertion points was 2.1 mm.ConclusionsPilot testing of a custom made jig for use during SRA indicated that the device was (1) successfully applied and user friendly and (2) allowed for accurate guide wire placement according to the preoperative plan.

Validation of patient specific surgical guides in total hip arthroplasty

“…The absolute error between the preoperative planning and the femoral guidewire insertion for RHA was significantly better using the wide contact type than the narrow contact type in the present study, and these results were comparable with other PSG reports, which showed errors of 0.6°–4.2° for the stem‐shaft angle and 0.4°–8.2° for anteversion in the clinical situation . The results for the wide‐base‐contact PSG are also comparable with reports from a previously published navigation study (Table ).…”

“…A PSG for implantation in total knee arthroplasty has been increasingly used , but the usefulness of PSGs in total hip arthroplasty (THA) has been only sporadically reported , including a PSG for guidewire insertion in resurfacing THA (RHA) and a cup implantation guide . The absolute error of the RHA femoral guidewire when comparing preoperative planning and the postoperative implantation using CT was 0.6°–4.2° for the stem‐shaft angle and 0.4°–8.2° for anteversion in clinical situations . The absolute error of the cup implantation guide was 0.7°–5.5° for the inclination angle and 0.8°–6.4° for anteversion in clinical situations .…”

Robotic motion compensation for bone movement, using ultrasound images

“…With smooth movements of the bone, the tracking error improves significantly. An accuracy in the order of Ϯ 2 mm/2 .. 4°is achieved, which is aligned with the accuracy of current systems (Raaijmaakers et al, 2010;McMinn, 2009). The root mean square error (RMSE) was used to obtain the errors of position and orientation.…”

Patient-Specific Modelling in Orthopedics: From Image to Surgery

“…Since then, the number of applications has grown drastically, both in academic and industrial environments. One can now find patient-specific guides for various surgical procedures such as total knee replacement (Hafez et al 2006, Lombardi et al 2008, total hip replacement (Hananouchi et al 2009), hip surface replacement , Raaijmaakers et a. 2010, Kunz et al 2010, intra-and extraarticular radius malunions (Leong et al 2010, Oka et al 2008, and distal femur osteotomy (Victor et al 2011), Fig.…”

“…For each application, a guide can provide different types of guidance. It can mechanically guide surgical gestures, such as drilling or cutting , Raaijmaakers et al 2010, Kunz et al 2010, Leong et al 2010, Oka et al 2008, Victor et al 2011 or indicate anatomical landmarks for positioning standard instruments (Blanz et al 2004). It can guide the placement of a plate by providing the drilling positions and orientations of plate fixations on preoperative bone (Leong et al 2010, Victor et al 2011.…”