Efficacy of Computed Tomography-Based Navigation for Cup Placement in Revision Total Hip Arthroplasty

Kubota, Yuta; Kaku, Nobuhiro; Tabata, Toshihide; Tagomori, Hiroaki; Tsumura, Hiroshi

doi:10.4055/cios.2019.11.1.43

Cited by 13 publications

(13 citation statements)

References 24 publications

(25 reference statements)

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“…They found the center of rotation of the hip and length discrepancy was accurately recovered as preoperative plan without signs of loosening, subsidence, or osteolysis at final follow-up [25]. Compared with CT-based navigation, the 3D preoperative simulation technology and 3D model had lower accuracy [26–28]. Additionally, previous study reported there was a high accuracy by using imageless navigation-assisted cup positioning [29].…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional technology assisted trabecular metal cup and augments positioning in revision total hip arthroplasty with complex acetabular defects

Chen

Lin

et al. 2019

J Orthop Surg Res

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BackgroundRevision total hip arthroplasty (THA) with large acetabular defect remains a challenge. Though trabecular metal (TM) cup and augments have been introduced in defect reconstruction with good result, the accurate positioning of implant is important to avoid complications. Therefore, we aimed to evaluate the usefulness of three-dimensional (3D) simulation and 3D model in assisting implant positioning during complex revision THA.MethodsSixteen patients (18 hips) who underwent revision THA with a Paprosky type III acetabular defect were analyzed retrospectively. Placement of acetabular cup and TM augments was simulated with 3D simulation software and 3D model preoperatively. Cup anteversion, abduction angle, and hip center were measured in each case preoperatively and postoperatively. Primary outcome was the percentage of outliers according to Lewinnek safe zone and Harris hip score (HHS). Secondary outcome was the correlation between the 3D planned and the postoperative value.ResultsThe percentage of outliers was significantly corrected from 77.78% (14/18) preoperatively to 38.88% (7/18) postoperatively (p = 0.04). There was a significant correlation between mean planned cup anteversion and postoperative value (13.39 vs 11.99, r = 0.894; p < 0.001). There was a significant correlation between mean planned abduction and postoperative value (42.67 vs 44.91, r = 0.921, p < 0.001). The number of planned and used augments was the same in all the cases. In 15 cases (83.33%), the size of planned and used TM augments was the same. The HHS was significantly improved at final follow-up (80.94 vs 27.50, p < 0.001). No cases presented dislocation or radiological signs of loosening.ConclusionPreoperative 3D simulation and model were considered the useful method to assist implant positioning in revision THA with complex acetabular defect, with moderate to high accuracy and satisfied clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Three-dimensional technology assisted trabecular metal cup and augments positioning in revision total hip arthroplasty with complex acetabular defects

Chen

Lin

et al. 2019

J Orthop Surg Res

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“…Combined anteversion, which is defined as the sum of the anteversion of the cup and that of the femoral component, is used to further illustrate the ideal orientation for the stability of prostheses. Many studies have summarized the angle of combined anteversion in clinic practice 6,8,15 . However, the range of combined anteversion varies in different reports.…”

Section: Introductionmentioning

confidence: 99%

“…Dorr concluded that the combined anteversion was 37.6 AE 7 (range, 19 -50 ) 6 . Kubota reported that combined anteversion is 41.2 AE 8.9 with navigation and 33.6 AE 20.5 without navigation 15 . Although the ideal combined anteversion still needs to be investigated, numerous studies have used the combined anteversion technique to guide their operations and achieve good results [16][17][18][19] .…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, THA with the concept of combined anteversion decreases the dislocation rate and is widely used in clinical practice 19 . However, although the range of combined anteversion varies across reports 6,15 , no studies have investigated combined anteversion using the lateral approach. Moreover, because different approaches may require different implant orientations for hip stability, whether the required combined anteversion is similar to the angle used in the P-L approach remains unknown.…”

Section: Introductionmentioning

confidence: 99%

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A Specific Anteversion of Cup and Combined Anteversion for Total Hip Arthroplasty Using Lateral Approach

Zhang

Lin

et al. 2020

Orthopaedic Surgery

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Objective To determine the implant orientation, especially the combined anteversion measurements in total hip arthroplasty (THA) using lateral approach, and to compare with implant orientation using posterior‐lateral (P‐L) approach. The secondary goal was to identify the factors associated with implant orientation. Methods Five hundred and one patients (545 hips) who underwent primary THA with the modified Hardinge approach between January 2016 and November 2019 by one senior surgeon in our department in a retrospective study were followed up. A survey to inquire about the history of dislocation of the hip after THA was designed and responses were gathered by telephone, WeChat software, and outpatient follow‐up. The mean age of the patients was 61.97 ± 11.72 years, and there were 254 males and 247 females. The average follow‐up time was 25.2 ± 13.7 months (range, 3.2–49.7 months). Among the patients who were followed up, 97 patients (104 hips) underwent computed tomography (CT) scans from L4 to the tuberosity of the tibia. The implant orientation, including the anteversion and inclination of the cup, anteversion of the stem, combined anteversion, and pelvic tilt were measured based on CT scans of these patients. The results were compared with the implant orientation reported in previous reports measured by CT. Factors that may be associated with implant orientation were investigated, including the patient's age, sex, body mass index (BMI), and diagnosis; size of the cup; diameter of the femoral head component; and pelvic tilt. Data and statistical analyses were performed using SPSS 20.0. Results No cases of dislocation were found in the 501 patients (545 hips) who underwent primary THA during this period. The mean inclination and anteversion of the cups were 38.83° ± 5.04° (24.5°–53.1°) and 9.26° ± 11.19° (−15°–48°), respectively. The mean anteversion of the stem was 13.83° ± 10.7° (−10.2°–42.3°). The combined anteversion was 23.1° ± 13.4° (−7.4°–54.6°). Compared with the reported combined anteversion and anteversion of the cup, the mean anteversion of the cup and combined anteversion using the lateral approach were much lower than the reported values in the literature using the P‐L approach. Pelvic tilt was found to be the only independent factor for cup anteversion. Factors including age, sex, BMI, diagnosis, cup size, and diameter of the femoral head component were not associated with implant orientation. Conclusion THA using the lateral approach yields smaller cup anteversion and combined anteversion values than using the P‐L approach. Pelvic tilt is the only predictor for cup anteversion.

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“…[ 97 ] 2007 Journal of Arthroplasty 1, 2, 4 Kubota Y. et al. [ 98 ] 2019 Clinical Orthopaedics and Related Research 1, 2, 4 Kurosaka K et al. [ 99 ] 2016 Orthopedics 1, 2, 3, 4 Langlotz U. et al.…”

Section: Appendixmentioning

confidence: 99%

Lewinnek Safe Zone References are Frequently Misquoted

et al. 2020

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Background: Optimal acetabular component orientation in total hip arthroplasty (THA) is a necessity in achieving a stable implant. Although there has been considerable debate in the literature concerning the safe zone, to date, there has not been any review to determine if these references are consistent with the definition applied by Lewinnek et al. in 1978. Therefore, this article aims to examine the available literature in the PubMed database to determine how often a correct reference to the safe zone as defined by Lewinnek was applied to discussions regarding THA. Methods: A search for literature in the PubMed database was performed for articles from 1978 to 2019. Search criteria included terms 'Lewinnek,' 'safe zone,' and 'total hip arthroplasty.' Exclusions included abstract-only articles, non-English articles, articles unrelated to THA, and those lacking full content. Results: A review of literature yielded 147 articles for inclusion. Overall, only 11% (17) cited the Lewinnek article correctly. Forty-five percent (66) of articles referenced measurements in the supine position, 18% (26) referenced other positions, and 37% (55) did not specify. Nineteen percent (28) reported measurements of the acetabular cup orthogonal to the anterior pelvic plane, while 73% (108) did not, and 7% (11) did not specify. Twenty-three percent (34) measured from computed tomography scans instead of other methods. Conclusions: In the discussion of the safe zone regarding THA, only 11% of articles listed are consistent with the definition established by Lewinnek. This warrants further investigation into a consistent application of the term and its implications for THA implant stability and dislocation rates.

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Efficacy of Computed Tomography-Based Navigation for Cup Placement in Revision Total Hip Arthroplasty

Cited by 13 publications

References 24 publications

Three-dimensional technology assisted trabecular metal cup and augments positioning in revision total hip arthroplasty with complex acetabular defects

Three-dimensional technology assisted trabecular metal cup and augments positioning in revision total hip arthroplasty with complex acetabular defects

A Specific Anteversion of Cup and Combined Anteversion for Total Hip Arthroplasty Using Lateral Approach

Lewinnek Safe Zone References are Frequently Misquoted

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