A Multiplanar Radiography Method for Assessing Cup Orientation in Total Hip Arthroplasty

2012 ◽  
Vol 134 (10) ◽  
Author(s):  
Shahram Amiri ◽  
Bassam A. Masri ◽  
Donald Garbuz ◽  
Carolyn Anglin ◽  
David R. Wilson
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Pelvic Tilt ◽  
Patient Specific ◽  
Systematic Bias ◽  
Acetabular Cup ◽  
Cadaveric Specimen ◽  
Total Hip ◽  
Correct Orientation ◽  
Bony Landmarks

Correct orientation of the acetabular cup considering patient-specific functional pelvic angles is an important factor for improving outcomes and avoiding complications after total hip arthroplasty. This study introduces a new, noninvasive radiographic tool for accurately determining a patient’s specific pelvic tilt angle preoperatively, as well as accurately assessing acetabular cup orientation with respect to bony landmarks intraoperatively and postoperatively. The method was validated by imaging a bone replica model of the pelvis with implanted hip components, in comparison to digitized references, and verified with a cadaveric specimen. Pelvic tilt was measured with an accuracy of 0.1 deg and SD of 0.4 deg. Operative cup inclination and anteversion showed accuracies of 0.6 deg and 2.5 deg, with SD of 0.4 deg and 0.6 deg, respectively; these could be improved further by subtracting systematic bias. The method shows accuracy advantages over existing radiographic and fluoroscopic methods and exposes the subjects to a lower radiation dose compared to the similar computed tomography methods. These results suggest that the proposed method is feasible for assessing cup placement with reference to the functional and anatomical references. Furthermore, the ability to reference the same bony landmarks preoperatively, intraoperatively, and postoperatively has important research and clinical advantages.

scholarly journals Late Anterior Dislocation Due to Posterior Pelvic Tilt in Total Hip Arthroplasty

2016 ◽  
Vol 10 (1) ◽  
pp. 206-212 ◽  
Author(s):  
Hiroki Kobayashi ◽  
Yasuharu Nakashima ◽  
Takuaki Yamamoto ◽  
Goro Motomura ◽  
Masayuki Kanazawa ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Conservative Treatment ◽  
Hip Arthroplasty ◽  
Pelvic Tilt ◽  
Compression Fracture ◽  
Anterior Dislocation ◽  
Minor Trauma ◽  
Thoracolumbar Kyphosis ◽  
Acetabular Cup ◽  
Total Hip

Background: Excessive pelvic tilt may be one of the factors leading to instability in total hip arthroplasty (THA), even when the acetabular cup is placed properly. To our knowledge, only a few studies have described late anterior dislocation due to posterior pelvic tilt. We present 3 cases with late anterior dislocations possibly due to posterior pelvic tilt. Cases Presentations: Case-1: An 84-years-old woman fell and presented with an anterior dislocation 12-years after THA. Her pelvis had tilted to approximately 30° posteriorly in a supine position. After conservative treatment, she presented with 10 recurrent anterior dislocations. She had thoracolumbar kyphosis due to multiple compression fractures. Revision with anterior placement of an elevated liner and a 32-mm head corrected the dislocation, and no further dislocations occurred. Case-2: A 78-years-old woman fell and presented with an anterior dislocation 4-years after THA. Her posterior pelvic tilt had increased 23° due to a lumbar compression fracture. Revision by decreasing the cup anteversion was performed, but recurrent posterior dislocations occurred. Owing to her worsened general condition, further treatment was abandoned. Case-3: A 79-years-old woman twisted her body and presented an anterior dislocation 3-years after THA. After manual reduction and conservative treatment, the dislocation recurred. Her posterior pelvic tilt had increased 16°. Conclusion: Although minor trauma triggered the anterior instability in these patients, the underlying pathomechanism existed in the progressive pelvic posterior tilt due to thoracolumbar kyphosis. As longer life expectancy as well as implant survivorship is predicted, attention must be paid to the change of pelvic tilt in elderly patients.

scholarly journals Patient-Specific Safe Zone Based on Daily Positions and Range of Motion

10.29007/nw28 ◽  
2020 ◽  
Author(s):  
Wistan Marchadour ◽  
Guillaume Dardenne ◽  
Aziliz Guezou-Philippe ◽  
Christian Lefèvre ◽  
Eric Stindel
Keyword(s):  
Total Hip Arthroplasty ◽  
Range Of Motion ◽  
Hip Arthroplasty ◽  
Pelvic Tilt ◽  
Safe Zone ◽  
Patient Specific ◽  
Total Hip ◽  
Prosthetic Impingement ◽  
Param Eters

Cup orientation is a challenging step in total hip arthroplasty (THA), to ensure comfort of the patient and durability of the prosthesis. The safe zone defined by Lewinnek is commonly used for cup orientation, but it is nowadays being questioned because it is not patient-specific.We propose to define a new safe zone for cup orientation, that considers patient-specific parameters such as the pelvic tilt and the range of motion (ROM) of the leg.We developed a software that easily computes a unique safe zone from these param- eters in different daily positions, ensuring a cup orientation without risks of prosthetic impingement.

scholarly journals The impact of hip-spine relations on the results of total hip arthroplasty (literature review)

2021 ◽  
pp. 73-79
Author(s):  
Mykola Korzh ◽  
Volodymyr Radchenko ◽  
Volodymyr Filipenko ◽  
Kostiantyn Popsuishapka ◽  
Olga Pidgaiska
Keyword(s):  
Total Hip Arthroplasty ◽  
Literature Review ◽  
Hip Arthroplasty ◽  
Pelvic Tilt ◽  
Pelvic Incidence ◽  
Patient Specific ◽  
Spinal Diseases ◽  
Stable Range ◽  
Total Hip ◽  
The Impact

Spine balance can alter THA outcomes, but the exact mechanism is not yet well recognized. We aimed at bridging the gap between hip and spine surgeons with an up-to-date analysis of the best available literature review concerning to data as for total hip arthroplasty results of those patient with concomitant spine disorders. In total hip arthroplasty accurate acetabular cup placement is essential for impingement free and stable range of motion. For decades, hip surgeons have relied on traditional safe acetabular zones to reduce prosthetic instability. Nevertheless, hip dislocation is one of the most common complications following total hip arthroplasty. Numerous studies have shown that patients with abnormal spinopelvic mobility due to degene­rative spinal diseases and after spinal fusion surgery had an increased rate of dislocations after THA. In our review we described the main spine-pelvic parameters, such as pelvic tilt, sacral slope, pelvic incidence, lumbar lordosis etc. and spino-pelvic motions and how they can change in standing and sitting postures. Measurements of these parameters are necessary for presurgical planning before hip arthroplasty especially those patients who had previously made spine fusion. A review of lite­rature shows that sagittal pelvic kinematics, but not the pelvic incidence, influences the risk of prosthetic impingement or dislocation. Pelvic position is dynamic during gait and other daily living activities. Variations in anteroposterior pelvic tilt affects the resulting spatial orientation of the acetabulum. Recommendations for cup positioning are switching from a classic Lewinneck safe zone to a patient-specific approach, with the standing cup orientation giving way to a new parameter of interest: the functional orientation of the cup. Thus, functional cup anterversion should be taken into consideration. Abnormal spinopelvic mobility is a risk factor for THA dislocation. Thus patients with combined spine and hip pathology are at higher risk for further complications and they should be identified and screened more carefully. Key words. Spine-pelvic relations, sagittal alingement, hip arthroplasty, dislocation

CT-based automated planning of acetabular cup for total hip arthroplasty (THA) based on hybrid use of two statistical atlases

2016 ◽  
Vol 11 (12) ◽  
pp. 2253-2271 ◽  
Author(s):  
Yoshiyuki Kagiyama ◽  
Itaru Otomaru ◽  
Masaki Takao ◽  
Nobuhiko Sugano ◽  
Masahiko Nakamoto ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Automated Planning ◽  
Acetabular Cup ◽  
Total Hip

Assessment of an Orthopaedic Templating Software Package for Uncemented Total Hip Arthroplasty

2020 ◽  
Vol 4 (04) ◽  
pp. 155-157
Author(s):  
Michael Newman ◽  
David Hartwright
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Acetabular Cup ◽  
Total Hip ◽  
Pelvic Radiograph ◽  
Uncemented Total Hip Arthroplasty ◽  
Femoral Stems ◽  
Hip Arthroplasties ◽  
Acetabular Components ◽  
Insight Into

AbstractThe aim of this study was to assess a large, single-surgeon dataset of uncemented total hip arthroplasties that had been templated using software. This assessment compared preoperative templated predictions with what was implanted with regard to (1) femoral prosthesis size and (2) acetabular cup size. The operation notes for two types of uncemented total hip arthroplasty performed by a single surgeon between January 9, 2008, and March 21, 2019, were assessed. The data were refined so that only those that were fully templated on a correctly calibrated pelvic radiograph were included. This provided a total of 153 cases. The predicted software template was compared with actual implanted component sizes. With regard to the femoral stems, the templating software was exactly correct in 45.75% of cases and was accurate to within one size in 87.59% of cases. With regard to the acetabular component, the templating software was exactly correct in 52.94% of cases and was accurate to within one size (2 mm) in 86.94% of cases. Templating software offers an accurate prediction of the size of uncemented femoral and acetabular components. In addition, the benefits of templating include cognitive rehearsal, insight into potentially challenging aspects of surgery, and highlighting intraoperative issues where there is a large intraoperative deviation from what is templated. This study demonstrates the congruence and reproducibility of templating software when compared with other smaller studies performed in the literature.

scholarly journals Pelvic Tilt in Patients Undergoing Total Hip Arthroplasty: When Does it Matter?

2015 ◽  
Vol 30 (3) ◽  
pp. 387-391 ◽  
Author(s):  
Joseph D. Maratt ◽  
Christina I. Esposito ◽  
Alexander S. McLawhorn ◽  
Seth A. Jerabek ◽  
Douglas E. Padgett ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Pelvic Tilt ◽  
Total Hip

Effects of posterior pelvic tilt on anterior instability in total hip arthroplasty: A parametric experimental modeling evaluation

2013 ◽  
Vol 28 (2) ◽  
pp. 178-181 ◽  
Author(s):  
Taishi Sato ◽  
Yasuharu Nakashima ◽  
Akinobu Matsushita ◽  
Masanori Fujii ◽  
Yukihide Iwamoto
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Pelvic Tilt ◽  
Experimental Modeling ◽  
Anterior Instability ◽  
Total Hip

Redesign of the Femoral Stem for a Total Hip Arthroplasty for Additive Manufacturing

2018 ◽  
Author(s):  
Bradley Hanks ◽  
Shantanab Dinda ◽  
Sanjay Joshi
Keyword(s):  
Additive Manufacturing ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Lattice Structure ◽  
Stress Shielding ◽  
Patient Specific ◽  
Hip Implants ◽  
Hip Implant ◽  
Total Hip ◽  
Multiple Materials

Total hip arthroplasty (THA) is an increasingly common procedure that replaces all or part of the hip joint. The average age of patients is decreasing, which in turn increases the need for more durable implants. Revisions in hip implants are frequently caused by three primary issues: femoral loading, poor fixation, and stress shielding. First, as the age of hip implant patients decreases, the hip implants are seeing increased loading, beyond what they were traditionally designed for. Second, traditional implants may have roughened surfaces but are not fully porous which would allow bone to grow in and through the implant. Third, traditional implants are too stiff, causing more load to be carried by the implant and shielding the bone from stress. Ultimately this stress shielding leads to bone resorption and implant loosening. Additive manufacturing (AM) presents a unique opportunity for enhanced performance by allowing for personalized medicine and increased functionality through geometrically complex parts. Much research has been devoted to how AM can be used to improve surgical implants through lattice structures. To date, the authors have found no studies that have performed a complete 3D lattice structure optimization in patient specific anatomy. This paper discusses the general design of an AM hip implant that is personalized for patient specific anatomy and proposes a workflow for optimizing a lattice structure within the implant. Using this design workflow, several lattice structured AM hip implants of various unit cell types are optimized. A solid hip implant is compared against the optimized hip implants. It appears the AM hip implant with a tetra lattice outperforms the other implant by reducing stiffness and allowing for greater bone ingrowth. Ultimately it was found that AM software still has many limitations associated with attempting complex optimizations with multiple materials in patient specific anatomy. Though software limitations prevented a full 3D optimization in patient specific anatomy, the challenges associated such an approach and limitations of the current software are discussed.

Sign in / Sign up

Export Citation Format

Share Document