scholarly journals Fuzzy Support System for Total Hip Arthroplasty Stem by Ultrasonic Intraoperative Measurement

2012 ◽  
Vol 2012 ◽  
pp. 1-8
Author(s):  
Naomi Yagi ◽  
Yutaka Hata ◽  
Nao Shibanuma
Keyword(s):  
Total Hip Arthroplasty ◽  
Support System ◽  
Hip Arthroplasty ◽  
Fuzzy System ◽  
Fuzzy Inference ◽  
Center Frequency ◽  
Ultrasonic Probe ◽  
Stem Size ◽  
Total Hip ◽  
Difference Time

This paper describes a fuzzy system of stem implantation on total hip arthroplasty by an ultrasonic device. The system can perform automatic and accurate assessment in the surgery. In this system, we employ a single ultrasonic probe whose center frequency is 1,000 Hz. We detect the acoustic signals when knocking the inserted stem with a hammer. We then have a correlation between the degree of tightening and the attenuation time of acoustic signal. That is, the higher tightened degree implies shorter attenuation period. The support system selects the most suitable stem size by fuzzy inference with respect to the attenuation time and its difference time from correct stem to one larger size stem which dynamically adapts to each patient. As a result, we successfully determined the suitable stem in comparison to the results of the practical surgery.

scholarly journals Retrograde Cement Extrusion into Femoral Nutrient Vessels Following Uncomplicated Total Hip Arthroplasty

2017 ◽  
Vol 16 (1) ◽  
Author(s):  
Lim Chia Hua ◽  
V.A. Jacob ◽  
N. Premchandran
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Artery ◽  
Femoral Stem ◽  
Deep Femoral Artery ◽  
Neck Of Femur ◽  
Term Survival ◽  
Stem Size ◽  
Total Hip ◽  
Femoral Cortex

The present concepts in Total Hip Arthroplasty advocate mechanical cement interlock with trabecular bone utilising the third-generation cementing technique. However, the force generated can easily reach peak pressure of 122 kPa to 1500 kPa, leading to extrusion of cement through nutrient foramina into femoral cortex into nutrient vessels, henceforth the retrograde arteriovenogram. A 76 years old lady who premorbid ADLindependent had a fall and sustained a closed right neck of femur fracture. She underwent cemented right total hip arthroplasty. Acetabulum cup of 47mm and femoral stem size 1 was utilized. Femoral canal was prepared and medullary cavity plug inserted before retrograde cement was introduced using the cementing gun. Intraoperative no complications were noted. This case has been followed up to a year with no adverse effect. The post-operative radiograph demonstrated a linear radio-opacity communicating with the posterior aspect of the femoral shaft which continues proximally and medially for approximately 10cm. Its uniformity in shape and position corresponds to the vascular supply of proximal femur. In Farouk et al cadaveric study, nutrient vessel arises in 166 ± 10 mm from the greater trochanter and is a branch of the second perforating artery from the deep femoral artery. Knight et al infer that retrograde cement extrusion occurs in female patients with small stature and small endosteal canal. Cement extrusion unlikely will influence the long haul survival of prosthesis as shown in the radiograph that cement is well pressurized to interlock with the endosteal bone. Moreover, because of extensive anastomoses of perforating branches of the deep femoral artery, segmental obliteration of nutrient artery alone is unlikely to lead to vascularity issues. Cement extrusion into the nutrient foramen is a vital differential in presence of posterior medial cement in the diaphysis of the femur following total hip replacement. This is to differentiate from extra osseous extrusions due to the iatrogenic breach of the femoral cortex suggesting periprosthetic fracture which affects the long term survival of prosthesis.

scholarly journals Femoral stem size mismatch in women undergoing total hip arthroplasty

2018 ◽  
Vol 15 (2) ◽  
pp. 293-296 ◽  
Author(s):  
John M. Dundon ◽  
Dvorah Leah Felberbaum ◽  
William J. Long
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Size Mismatch ◽  
Stem Size ◽  
Total Hip

scholarly journals Value of preoperative three-dimensional planning software (AI-HIP) in primary total hip arthroplasty: a retrospective study

2021 ◽  
Vol 49 (11) ◽  
pp. 030006052110588
Author(s):  
Xuzhuang Ding ◽  
Bingshi Zhang ◽  
Wenao Li ◽  
Jia Huo ◽  
Sikai Liu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Preoperative Planning ◽  
Intraclass Correlation ◽  
Three Dimensional ◽  
Femoral Stem ◽  
Stem Size ◽  
Total Hip ◽  
Primary Total Hip Arthroplasty

Objective We performed a retrospective study to compare the accuracy of preoperative planning using three-dimensional AI-HIP software and traditional two-dimensional manual templating to predict the size and position of prostheses. The purpose of this study was to evaluate the accuracy of AI-HIP in preoperative planning for primary total hip arthroplasty. Methods In total, 316 hips treated from April 2019 to June 2020 were retrospectively reviewed. A typical preoperative planning process for patients was implemented to compare the accuracy of the two preoperative planning methods with respect to prosthetic size and position. Intraclass correlation coefficients (ICCs) were used to evaluate the homogeneity between the actual prosthetic size and position and the preoperative planning method. Results When AI-HIP software and manual templating were used for preoperative planning, the stem agreement was 87.7% and 58.9%, respectively, and the cup agreement was 94.0% and 65.2%, respectively. The results showed that when AI-HIP software was used, an extremely high level of consistency (ICC > 0.95) was achieved for the femoral stem size, cup size, and femoral osteotomy level (ICC = 0.972, 0.962, and 0.961, respectively). Conclusion AI-HIP software showed excellent reliability for predicting the component size and implant position in primary total hip arthroplasty.

scholarly journals Assessment of clinical and functional outcomes following uncemented total hip arthroplasty in failed primary hemiarthroplasty

2017 ◽  
Vol 3 (3) ◽  
pp. 551
Author(s):  
Pavankumar H. Patil ◽  
Srinivas Pamarathi
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Functional Outcomes ◽  
Operative Procedure ◽  
Walking Distance ◽  
Harris Hip Score ◽  
Loss Of Function ◽  
Stem Size ◽  
Total Hip ◽  
Uncemented Total Hip Arthroplasty

<p class="abstract"><strong>Background:</strong> Modern hip replacement has resulted in huge benefit for patients with arthritic hip disease, providing them with reduction of pain, return of function and consequently an improved quality of life. Evaluation of long term outcomes of an operative procedure is important to determine the durability of the procedures like uncemented total revision hip arthroplasty. In the present study, clinical and functional outcome and complications of uncemented total hip arthroplasty in failed primary hemiarthroplasty was assessed.</p><p class="abstract"><strong>Methods:</strong> Patients with failed primary hemiarthroplasty with Unipolar or Bipolar prosthesis (cemented and uncemented) due to aseptic loosening, protrusio causing groin pain, dislocation, breakage of implant leading to loss of function, periprosthetic fracture and acetabular osteolysis were included. During each visit, medical history was taken and physical examination was done. Range of movements (ROM) was recorded. The clinical and functional outcomes were evaluated by Harris Hip Score evaluation. Statistical analysis: Student’s paired t-test was used to find out the significance of difference between pre-operative and post-operative Harris Hip scores.<strong></strong></p><p class="abstract"><strong>Results:</strong> In 7 cases modular series was used for uncemented total hip arthroplasty, of which calcar replacement was done in 4 cases, and in one case constrained liner was placed. The maximum stem size used was 15mm and the minimum stem size 11mm. Stem size 11 was most frequently used. About 30% of the cases presented with pain postoperatively till the last follow-up, of which two cases reported mild pain with no effect on average activities and one case reported with moderate pain with some limitation of ordinary activity or work. The difference between the average pre-operative Harris Hip Score post-operative score was found to be highly significant (p=0.0001).</p><p><strong>Conclusions:</strong> This study has shown excellent results following the uncemented modular total hip arthroplasty in failed primary hemiarthroplasty in terms of pain relief, increased walking distance, and functional capabilities of the patients.</p>

scholarly journals The effect of the hip joint endoprosthesis length after a total hip arthroplasty: A biomechanical study

2019 ◽  
Vol 26 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Andreas-Foivos Smyris ◽  
Vassiliki T. Potsika ◽  
Ioannis-Ilias K. Farmakis ◽  
Nikolaos Tachos ◽  
Dimitrios I. Fotiadis ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Cost Effective ◽  
Normal Weight ◽  
Biomechanical Study ◽  
Stem Length ◽  
Fourth Generation ◽  
Stem Size ◽  
Total Hip ◽  
Hip Joint Endoprosthesis

Background/purpose: Total hip arthroplasty is a safe, cost-effective surgical intervention which restores mobility and alleviates pain from most kinds of hip arthritis. The proposed biomechanical study evaluates the effect of the stem size on the mechanical environment of the hip and its association with aseptic loosening. Methods: Medium left, fourth-generation, composite femoral models were used, and different prosthesis dimensions were examined. Fourteen strain gages were placed at specific positions on the femur. Load cycles were programmed to simulate single-leg stance of gait of a normal-weight subject. Results: Microstrains in the anterior and posterior region of the femur shaft were found to decrease with increasing the stem length, while no specific tendency was observed in the regions of the great and lesser trochanteric as well as in the medial and lateral femur. Conclusion: This study indicates that shorter implants are subjected to higher strains distally to the pertrochanteric area.

The Accuracy and Ability of Preoperative Templating to Restore Femoral Offset in Calcar-Guided Short-Stem Total Hip Prosthesis through Direct Anterior Approach

2021 ◽  
Author(s):  
Barbara Favier ◽  
Nathalie van Beek ◽  
Mike Tengrootenhuysen
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Short Stem ◽  
Size Difference ◽  
Femoral Offset ◽  
Stem Size ◽  
Total Hip ◽  
Preoperative Templating

AbstractThe aim of this study was to assess the applicability and ability of preoperative templating to restore femoral offset and hip length with a calcar-guided short-stem implant design in total hip arthroplasty through the direct anterior approach. Preoperative measurements were performed of femoral offset, hip length, and stem size and compared with the perioperative placed prosthesis in 100 patients undergoing primary total hip replacement through direct anterior approach. Additionally, the pre- and postoperative femoral offset and hip length were compared to evaluate the ability to restore the offset and hip length with this kind of femoral short stem. With an acceptance of 1 size difference pre- and postoperatively, a 94% accuracy of predicting the size of the calcar-guided short stem was achieved with templating. Femoral offset was within means of 5 mm in 82.2% of the patients. Postoperative hip length was within 6 mm in 90% of the patients compared with the preoperative length.The use of preoperative templating for total hip arthroplasty with calcar-guided short-stem implants was proven to be a useful tool to predict the definite implanted size of the femoral prosthesis. Our results show that this new stem design does not significantly differ from previous reported outcomes with other stem designs and is competent to restore the femoral offset and hip length within clinical acceptable range. Level of evidence Level 3 retrospective case study.

Definition and validation of a system for classifying the undersized Corail femoral stem in total hip arthroplasty

2021 ◽  
pp. 112070002199600
Author(s):  
Jamie S McConnell ◽  
Farhan A Syed ◽  
Paul Saunders ◽  
Raviprasad Kattimani ◽  
Anthony Ugwuoke ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Classification System ◽  
Femoral Stem ◽  
Observer Agreement ◽  
Stem Size ◽  
Total Hip ◽  
Initial Fixation ◽  
Uncemented Total Hip Arthroplasty ◽  
Hip Arthroplasties

Introduction: The uncemented total hip arthroplasty relies on a secure initial fixation of the femoral stem to achieve osseointegration. Undersizing of the femoral implant compromises this. Surgeons routinely review postoperative radiographs to assess appropriate sizing, but existing methods of assessment lack standardisation. We present a system of accurately and reliably classifying radiological undersizing, which will help us better understand the factors that might have led to undersizing. Aim: To describe and evaluate a classification system for assessing radiological undersizing of the uncemented stem in hip arthroplasty. Method: We conducted a retrospective review of 1,337 consecutive hip arthroplasties using the Corail stem. Two independent investigators reviewed post-operative radiographs and classified them as either appropriately sized or undersized. Undersized stems were sub-categorised into four subtypes: uniformly undersized, varus undersized, valgus undersized or ‘cocktail-glass’ undersized. Inter- and intra-observer agreement was determined. The accuracy of our classification system was validated by comparison with digital re-templating. We further assessed patient demographics and stem size in relation to sizing. Results: 1 in 5 cases (19.75%) were deemed radiologically undersized. The commonest subtypes of undersizing were uniformly (47%) and varus (39%) undersized. When assessing sizing and subtype categorisation, inter-observer agreement was 89–92% and intra-observer agreement 86%. Classification decisions showed 92% and 97% accuracy for uniformly undersizing and varus undersizing respectively when validated against digital re-templating. Age, gender and smaller stem size were significantly associated with radiological undersizing. The Corail KLA model (125° neck) was found to have a higher incidence of stems undersized in varus. Conclusions: This study describes and validates a classification system for the analysis of radiological undersizing.

scholarly journals The role of AIHIP in Preoperative Planning of Total Hip Arthroplasty to Different Surgeons.

2021 ◽  
Author(s):  
Wenao Li ◽  
Xiaowei Yao ◽  
Bingshi Zhang ◽  
Xuzhuang Ding ◽  
Jia Huo ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Preoperative Planning ◽  
Intraoperative Radiation ◽  
Stem Size ◽  
Neck Shaft Angle ◽  
Total Hip ◽  
Senior Surgeon ◽  
Significant Difference

Abstract BackgroundPreoperative planning with computed tomography (CT)-based three-dimensional templating has been achieved more precise placement of hip components. This study investigated the value of the software for preoperative planning (artificial intelligence hip system, AIHIP) in primary total hip arthroplasty (THA) for surgeons with different experience levels.MethodsWe performed a retrospective study of 240 hips in 240 patients who underwent cementless primary THA. The patients were divided into four groups: A1) senior surgeon without AIHIP, A2) senior surgeon with AIHIP, B1) junior surgeon without AIHIP, and B2) junior surgeon with AIHIP. All preoperative planning evaluations were completed using the AIHIP software. We analysed the accuracy of stem size prediction and cup size prediction, the absolute value of postoperative discrepancy in leg length, discrepancy of neck-shaft angle and femoral offset between the healthy side and the affected side from the anteroposterior radiographic view of the hip, intraoperative and postoperative complications, operative times, the reduction in the haemoglobin (Hb) level during the first 24 hours and the number of intraoperative radiations.ResultsThe sizes of 95% were accurately estimated to be within one stem size, and 97% of the cup size estimates were accurate to within one cup size in group A2. A total of 87% were accurately estimated to be within one stem size, and 85% were accurate to within one cup size in group B2. There was a significant difference in radiological indicators (P<0.050), postoperative complications (overall P=0.035), operation duration (P<0.001), decrease in Hb per 24 hours (P=0.046) and intraoperative radiation frequency (P<0.050) among the patients in group B. There was also a significant difference in postoperative complications (overall P=0.01) between groups A1 and B1.ConclusionOur results suggest that the AIHIP is a favourable tool for young surgeons, and the accuracy is good.

scholarly journals More than a feeling?—Overruling the preoperatively templated offset option leads to a minor offset increase in short stem total hip arthroplasty

2022 ◽  
Author(s):  
Matthias Luger ◽  
Christian Stadler ◽  
Rainer Hochgatterer ◽  
Jakob Allerstorfer ◽  
Tobias Gotterbarm ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Short Stem ◽  
Leg Length ◽  
Digital Templating ◽  
Stem Size ◽  
Total Hip ◽  
Press Fit ◽  
A Minor ◽  
Short Stems

Abstract Purpose Short stems are increasingly used in total hip arthroplasty (THA) because of advantages in bone and soft tissue preservation and reconstruction of hip geometry. Digital templating is essential in determining the correct offset option and stem size in THA. However, the preoperative template sizes might be intraoperatively overruled. Patients and methods We evaluated the effect of intraoperative overruling of the preoperatively templated offset option of a short curved stem on hip offset, leg length, implant positioning, and femoral canal fill index. The overruling was performed in case of intraoperative instability, telescoping, or both. A series of 1052 consecutive THAs with a cementless short curved stem and press-fit cup was retrospectively screened. One hundred patients with unilateral THA and a contralateral native and morphologically healthy hip as a reference met the inclusion criteria. Measurements were carried out on preoperative and 3 months anterior–posterior postoperative radiographs. Patients were divided according to the overruling by offset option or stem size. Results Hip offset was increased in all groups, but only with significant increase if an offset option + 1 was used intraoperatively (p = 0.025). LLD was restored without significance in all groups (p = 0.323; p = 0.157). Conclusion Intraoperative overruling of the preoperative digital template in cementless short stem total hip arthroplasty results in an increase of hip offset compared to a contralateral healthy hip. However, the increase is marginal and clearly under 5 mm compared to the contralateral healthy hip.

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