Determining and Achieving Target Limb Length and Offset in Total Hip Arthroplasty Using Intraoperative Digital Radiography

Debbi, Eytan M.; Rajaee, Sean S.; Mayeda, Brian; Penenberg, Brad L.

doi:10.1016/j.arth.2019.10.003

Cited by 26 publications

(15 citation statements)

References 34 publications

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“…On the other hand, the proportion of rTHA procedures associated with instability increased from 17.7% in 2012 to 23.0% in 2018. This finding is of particular interest as there have been many advances to attempt to mitigate this complication: the focus on re-establishing hip length, offset, combined anteversion, the popularization of dual mobility liners, and the increased use of the direct anterior approach [ [39] , [40] , [41] ]. Robot-assisted THA, which has been shown to decrease component positioning outliers, has also been developed in part to decrease instability and dislocation risk [ [42] , [43] , [44] ].…”

Section: Discussionmentioning

confidence: 99%

Instability Is the Most Common Indication for Revision Hip Arthroplasty in the United States: National Trends From 2012 to 2018

et al. 2021

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Background As primary total hip arthroplasty volume continues to increase, so will the number of revision total hip arthroplasty (rTHA) procedures. These complex cases represent a significant clinical and financial burden to the health-care system. Methods This was a retrospective review using the National Inpatient Sample. International Classification of Diseases, 9th and 10 th revision codes were used to identify patients who underwent rTHA and create cohorts based on rTHA indications from 2012 to 2018. National and regional trends for length of stay (LOS), cost, and discharge location were evaluated. Results A total of 292,250 rTHA procedures were identified. The annual number of rTHA procedures increased by 28.1% from 2012 to 2018 (37,325 to 47,810). The top 3 indications for rTHA were instability (20.4%), aseptic loosening (17.8%), and infection (11.1%). Over the study period, the proportion of patients discharged to skilled nursing facility decreased from 44.2% to 38% ( P < .001). Hospital LOS decreased on average from 4.8 to 4.4 days ( P < .001). Infections had the highest average LOS (7.3 days) followed by periprosthetic fractures (6.5 days). Hospital costs decreased over the study period, from $25,794 to $24,555 ( P < .001). The proportion of rTHA cases performed at urban academic centers increased (58.0% to 75.3%, P < .001) while the proportion performed at urban nonacademic centers decreased (35.5% to 19.4%, P < .001). Conclusion Instability was the most common indication for rTHA between 2012 and 2018. The proportion of rTHA performed in urban academic centers has increased substantially, away from urban nonacademic centers. While cost and LOS have decreased, significant geographic variability exists.

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Section: Discussionmentioning

confidence: 99%

Instability Is the Most Common Indication for Revision Hip Arthroplasty in the United States: National Trends From 2012 to 2018

et al. 2021

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“…Debbi et al reported on a cohort of 102 hips, noting intraoperative radiography successfully reproduced limb length within 5 mm (100% of cases) and restored femoral offset within 5 mm in greater than 97% of cases. 14 In these studies, operative time was not reported, and comparative cohorts were not included. Hambright et al reported a retrospective case–control study of 100 primary THA patients performed by a single surgeon—50 with digital imaging and 50 treated without imaging—noting that adjustments in femoral length or offset were performed during 86% of cases performed with intraoperative imaging.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Imaging Improves Posterolateral THA Accuracy with Increased Time Cost

Ralston

Aggarwal

Keeney

2022

The Journal of Hip Surgery

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Intraoperative imaging may improve total hip arthroplasty (THA) component placement, but the time and cost associated with this approach have not been well described. We assessed component placement accuracy, operative time, and operating room (OR) charges for 270 patients undergoing posterolateral THA (PL-THA) with or without intraoperative imaging. This study retrospectively compared 135 PL-THA performed with intraoperative digital radiography (group PLxr) and a contemporary cohort of 135 PL-THA performed without imaging (group PL). Postoperative radiographs were evaluated to determine outlier rates for acetabular inclination of 55 degrees or higher, anteversion less than 15 or more than 40 degrees, and leg length or offset differences more than 10 mm. Surgical procedure time was extracted from hospital OR records, and procedural costs were estimated from facility charges associated with 30-minute OR time blocks and intraoperative imaging. Group PLxr had significantly fewer outliers for acetabular inclination more than 50 degrees (5.2 vs. 21.5%, p < 0.001), acetabular inclination of 55 degrees or higher (0.7 vs. 8.1%, p = 0.01), acetabular anteversion less than 15 or more than 40 degrees (14.8 vs. 28.9%, p < 0.01), leg length difference more than 10 mm (2.2 vs. 10.4%, p = 0.01), and femoral offset difference more than 10 mm (1.5 vs. 9.6%, p < 0.01). The difference in component inclination less than 30 degrees was not significant (0.0 vs. 2.2%, p = 0.24). Intraoperative component adjustment occurred in 26 cases (21.5%), was associated with a 19-minute mean increase in operative time (p < 0.001) and $1,504 mean increase in facility charges compared with nonimaged cases. Imaged cases without component adjustment increased mean operative time by 9.4 minutes (p < 0.001) and mean operative charges by $766. Intraoperative imaging improves component placement accuracy during PL-THA and significantly reduces component placement outliers, particularly with respect to acetabular component inclination, femoral length, and femoral offset. Level of Evidence Level III, case-control study.

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“…For LLD measurement, a reliable method is used to measure the vertical distance from the line connecting the lower edge of the two tear drops to the innermost edge of the small rotor. The difference between the measured values of the two sides is the LLD ( 10 ). OD is measured by the distance between the axis of femur and the center of the femoral head ( Figures 1 , 2 ) ( 1 , 12 ).…”

Section: Methodsmentioning

confidence: 99%

“…But studies have shown that in up to 60% of the cases, the preoperative template cannot accurately predict the correct size of the implant ( 9 ). Some studies have also reported the use of intraoperative radiography to assess limb length and offset, but the postural requirements are greatly high ( 10 , 11 ). Intraoperative navigation may yield satisfying results, but its application is limited by the difficulty of finding anatomical navigation points in obese patients and the high price ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Accuracy of the Horizontal Calibrator in Correcting Leg Length and Restoring Femoral Offset in Total Hip Arthroplasty

Xing

Zhu

et al. 2022

Front. Surg.

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BackgroundLimb length discrepancy (LLD) is one of the most common postoperative complications and can cause serious consequences. Poor recovery of femoral offset (OD) will result in weakness of the patient's external rotator muscles and affect the patient's postoperative function. The study is aimed to present a simple approach that compensates for the shortcomings of previous measuring devices and combines the advantages of different measuring devices to provide more accurate limb length and femoral offset restoration in total hip arthroplasty (THA).MethodsThis study was a prospective controlled trial involving 89 patients with THA. Group I (n = 44) was used for intraoperative measurement of THA with our self-designed horizontal calibrator. Group II (n = 45) was measured by a traditional freehand technique. The main outcome indicators were measured on the Neusoft PACS, including LLD, femoral offset deviation, and operative time. IBM SPSS 23.0 was used for data analysis.ResultsThe independent sample t-test was performed for all the data. The operative time, preoperative radiographic LLD, and OD of Group I and Group II had no statistical significance. Postoperative LLD of Group I and Group II were 2.5 ± 2.1 mm (range −5.7 to 8.3 mm) and 6.2 ± 4.3 mm (range −18.0 to 15.2 mm), and the independent sample t-test data of both (P < 0.001; 95%CI = −5.1, −2.2) showed statistical significance. In Group I, there were 38 THAs with LLD <5 mm, accounting for 86% and there were 44 THAs with LLD <10 mm, accounting for 100%. In Group II, there were 20 THAs with LLD <5 mm, accounting for 44%. There were 36 THAs with LLD <10 mm, covering for 80%. There was no significant difference in postoperative femoral offset and OD.ConclusionThe horizontal calibrator can provide more accurate limb length and femoral offset recovery in THA. It is a simple surgical technique that does not add additionally surgical costs and does not significantly increase operative time, providing a new solution for surgeons to resolve postoperative LLD and restore femoral offset.

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Determining and Achieving Target Limb Length and Offset in Total Hip Arthroplasty Using Intraoperative Digital Radiography

Cited by 26 publications

References 34 publications

Instability Is the Most Common Indication for Revision Hip Arthroplasty in the United States: National Trends From 2012 to 2018

Instability Is the Most Common Indication for Revision Hip Arthroplasty in the United States: National Trends From 2012 to 2018

Intraoperative Imaging Improves Posterolateral THA Accuracy with Increased Time Cost

Accuracy of the Horizontal Calibrator in Correcting Leg Length and Restoring Femoral Offset in Total Hip Arthroplasty

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