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 Multi-Dimensional Range-of-Motion-Based Safe Zone for Patient-Specific Total Hip Arthroplasty

10.29007/vk8v ◽  
2018 ◽  
Author(s):  
Juliana Hsu ◽  
Matias de La Fuente ◽  
Klaus Radermacher
Keyword(s):  
Total Hip Arthroplasty ◽  
Range Of Motion ◽  
Hip Arthroplasty ◽  
Spherical Surface ◽  
Safe Zone ◽  
Patient Specific ◽  
Femoral Antetorsion ◽  
Total Hip ◽  
Mathematical Formulas ◽  
Safe Zones

Proper component alignment is crucial for a successful total hip arthroplasty (THA). Some studies found safe cup orientations and corresponding stem antetorsions based on a defined desired range of motion (ROM) suitable for activities of daily living. These studies either used complex and time consuming 3D simulations or more simple mathematical formulas which cannot be extended to combined motions.With the method introduced in this work, any arbitrary motion can be applied. The ROM specified as the ROM of the femur relative to the pelvis is transformed into the ROM of the prosthesis neck relative to the cup for each cup orientation. For this transformation, the orientation and design of the stem are considered. The comparison of the neck and cup orientations is done using a 2D mapping of a 3D spherical surface which reduces the complexity of the calculation.We found that the femoral antetorsion as well as the neutral stem flexion and adduction have an influence on the resulting safe zone. The result is not just a combined anteversion but a combined orientation. For validating the plausibility of the algorithm, the resulting safe zones are compared to literature. Same results can be achieved using the same input data. Using this technique, a patient-specific safe zone based on the ROM can be derived and adjusted to the stem orientation.

scholarly journals Optimal combined anteversion pattern for obtaining a wider range of motion without prosthetic impingement after total hip arthroplasty: a three-dimensional analysis study

2021 ◽  
Author(s):  
Ryo Hidaka ◽  
Kenta Matsuda ◽  
Masaki Nakamura ◽  
Shigeru Nakamura ◽  
Hirotaka Kawano
Keyword(s):  
Total Hip Arthroplasty ◽  
Range Of Motion ◽  
Hip Arthroplasty ◽  
Three Dimensional ◽  
Target Range ◽  
Total Hip ◽  
Combined Anteversion ◽  
Significant Difference ◽  
The Absolute ◽  
Prosthetic Impingement

Abstract Background Obtaining a larger theoretical range of motion (ROM) is crucial to avoid prosthetic impingement after total hip arthroplasty (THA); however, no reports have examined the permissible range values of combined anteversion (CA) satisfying targeted ROM without prosthetic impingement. This retrospective study aimed to evaluate the possible postoperative CA extent that would allow meeting target ROM criteria according to Yoshimine’s theory using computed tomography (CT)-based three-dimensional motion analysis after THA. Methods This study included 114 patients (133 hips) who underwent cementless primary THA using a CT-based navigation system and implants (oscillation angle ≥ 135°). Implant positions were determined using Yoshimine's CA formula. Postoperative evaluation was conducted using a three-dimensional templating software for CT data. The postoperative Yoshimine’s and Widmer’s CA was calculated, and the difference between the target and postoperative values was defined as the error of Yoshimine’s CA and Widmer’s CA. Prosthetic ROM was assessed by Yoshimine’s stringent criteria for activities of daily living. Based on fulfilling these criteria, all patients were divided into the ROM (+) and ROM (-) groups. Evaluation items were compared between the two groups. Results There were 111 and 22 hips in the ROM (+) and ROM (-) groups, respectively. A significant difference was noted in the absolute error of Yoshimine’s and Widmer’s CA between the two groups. Using receiver operating characteristic analysis, threshold values of 6.0 (higher values indicate greater disability; sensitivity 90.9%, specificity 72.1%) for the absolute Yoshimine’s CA difference (area under the curve [AUC] 0.87, P < 0.01) and 6.9 (higher values indicate greater disability; sensitivity 68.2%, specificity 88.3%) for the absolute Widmer’s CA difference (AUC 0.83, P < 0.01) were predictors in the ROM (-) group. Conclusions The target range of Yoshimine’s CA (90.8°±6.0°) and Widmer’s CA values (37.3°±6.9°) was crucial in implant orientation for obtaining theoretical ROM without prosthetic impingement after THA.

scholarly journals The Patient-Specific Combined Target Zone for Morpho-Functional Planning of Total Hip Arthroplasty

2021 ◽  
Vol 11 (8) ◽  
pp. 817
Author(s):  
Juliana Habor ◽  
Maximilian Fischer ◽  
Kunihiko Tokunaga ◽  
Masashi Okamoto ◽  
Klaus Radermacher
Keyword(s):  
Total Hip Arthroplasty ◽  
Range Of Motion ◽  
Hip Arthroplasty ◽  
Implant Design ◽  
Patient Specific ◽  
Target Zones ◽  
Target Zone ◽  
Specific Patient ◽  
Total Hip ◽  
Safe Zones

Background Relevant criteria for total hip arthroplasty (THA) planning have been introduced in the literature which include the hip range of motion, bony coverage, anterior cup overhang, leg length discrepancy, edge loading risk, and wear. The optimal implant design and alignment depends on the patient’s anatomy and patient-specific functional parameters such as the pelvic tilt. The approaches proposed in literature often consider one or more criteria for THA planning. but to the best of our knowledge none of them follow an integrated approach including all criteria for the definition of a patient-specific combined target zone (PSCTZ). Questions/purposes (1) How can we calculate suitable THA implant and implantation parameters for a specific patient considering all relevant criteria? (2) Are the resulting target zones in the range of conventional safe zones? (3) Do patients who fulfil these combined criteria have a better outcome score? Methods A method is presented that calculates individual target zones based on the morphology, range of motion and load acting on the hip joint and merges them into the PSCTZ. In a retrospective analysis of 198 THA patients, it was calculated whether the patients were inside or outside the Lewinnek safe zone, Dorr combined anteversion range and PSCTZ. The postoperative Harris Hip Scores (HHS) between insiders and outsiders were compared. Results 11 patients were inside the PSCTZ. Patients inside and outside the PSCTZ showed no significant difference in the HHS. However, a significant higher HHS was observed for the insiders of two of the three sub-target zones incorporated in the PSCTZ. By combining the sub-target zones in the PSCTZ, all PSCTZ insiders except one had an HHS higher than 90. Conclusions The results might suggest that, for a prosthesis implanted in the PSCTZ a low outcome score of the patient is less likely than using the conventional safe zones by Lewinnek and Dorr. For future studies, a larger cohort of patients inside the PSCTZ is needed which can only be achieved if the cases are planned prospectively with the method introduced in this paper. Clinical Relevance The method presented in this paper could help the surgeon combining multiple different criteria during THA planning and find the suitable implant design and alignment for a specific patient.

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 Optimal Combined Anteversion Range for Obtaining a Wider Range of Motion without Prosthetic Impingement after Total Hip Arthroplasty: A Three-dimensional Analysis Study

2021 ◽  
Author(s):  
Ryo hidaka ◽  
Kenta Matsuda ◽  
Masaki Nakamura ◽  
Shigeru Nakamura ◽  
Hirotaka Kawano
Keyword(s):  
Total Hip Arthroplasty ◽  
Range Of Motion ◽  
Hip Arthroplasty ◽  
Three Dimensional ◽  
Target Range ◽  
Total Hip ◽  
Combined Anteversion ◽  
Significant Difference ◽  
The Absolute ◽  
Prosthetic Impingement

Abstract Background: Obtaining a larger theoretical range of motion (ROM) is crucial to avoid prosthetic impingement after total hip arthroplasty (THA); however, no reports have examined the permissible range values of combined anteversion (CA) satisfying targeted ROM without prosthetic impingement. This retrospective study aimed to evaluate the possible postoperative CA extent that would allow meeting target ROM criteria according to Yoshimine’s theory using computed tomography (CT)-based three-dimensional motion analysis after THA.Methods: This study included 114 patients (133 hips) who underwent cementless primary THA using a CT-based navigation system and implants (oscillation angle ≥135°). Implant positions were determined using Yoshimine's CA formula. Postoperative evaluation was conducted using a three-dimensional templating software for CT data. The postoperative Yoshimine’s and Widmer’s CA was calculated, and the difference between the target and postoperative values was defined as the error of Yoshimine’s CA and Widmer’s CA. Prosthetic ROM was assessed by Yoshimine’s stringent criteria for activities of daily living. Based on fulfilling these criteria, all patients were divided into the ROM (+) and ROM (-) groups. Evaluation items were compared between the two groups.Results: There were 111 and 22 hips in the ROM (+) and ROM (-) groups, respectively. A significant difference was noted in the absolute error of Yoshimine’s and Widmer’s CA between the two groups. Using receiver operating characteristic analysis, threshold values of 6.0 (higher values indicate greater disability; sensitivity 90.9%, specificity 72.1%) for the absolute Yoshimine’s CA difference (area under the curve [AUC] 0.87, P<0.01) and 6.9 (higher values indicate greater disability; sensitivity 68.2%, specificity 88.3%) for the absolute Widmer’s CA difference (AUC 0.83, P<0.01) were predictors in the ROM (-) group.Conclusions: The target range of Yoshimine’s CA (90.8°±6.0°) and Widmer’s CA values (37.3°±6.9°) was crucial in implant orientation for obtaining theoretical ROM without prosthetic impingement after THA.

scholarly journals A Preoperative Analytical Model for Patient-Specific Impingement Analysis in Total Hip Arthroplasty

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Yolanda Gu ◽  
Jim Pierrepont ◽  
Catherine Stambouzou ◽  
Qing Li ◽  
Jonathan Baré
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Computational Simulation ◽  
Target Range ◽  
Patient Specific ◽  
Component Alignment ◽  
Total Hip ◽  
Risk Zones ◽  
The Impact ◽  
Prosthetic Impingement

Prosthetic impingement is important to consider during total hip arthroplasty planning to minimise the risk of joint instability. Modelling impingement preoperatively can assist in defining the required component alignment for each individual. We developed an analytical impingement model utilising a combination of mathematical calculations and an automated computational simulation to determine the risk of prosthetic impingement. The model assesses cup inclination and anteversion angles that are associated with prosthetic impingement using patient-specific inputs, such as stem anteversion, planned implant types, and target Range of Motion (ROM). The analysed results are presented as a range of cup inclination and anteversion angles over which a colour map indicates an impingement-free safe zone in green and impingement risk zones in red. A validation of the model demonstrates accuracy within +/- 1.4° of cup inclination and anteversion. The study further investigated the impact of changes in stem anteversion, femoral head size, and head offset on prosthetic impingement, as an example of the application of the model.

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

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

scholarly journals Is the alignment guide technique in total hip arthroplasty sufficient for accurate cup positioning with a modified Watson Jones approach?

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880664 ◽  
Author(s):  
Junya Yoshitani ◽  
Takuya Nakamura ◽  
Yoshinobu Maruhashi ◽  
Noriyuki Hashimoto ◽  
Takeshi Sasagawa ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Safe Zone ◽  
Lateral Decubitus Position ◽  
Total Hip ◽  
Logistic Analysis ◽  
Final Sample ◽  
Lateral Decubitus ◽  
Cup Positioning ◽  
Alignment Guide

Purpose: Cup setting with only an alignment guide has been reported to be inaccurate in the lateral decubitus position in total hip arthroplasty (THA). We assessed the accuracy of cup positioning using only the alignment guide technique via a modified Watson Jones approach in the lateral decubitus position. Methods: Two hundred hips of 189 patients underwent THA from October 2014 to September 2016 via a modified Watson Jones approach. In the final sample, 181 hips of 171 patients (35 males, 136 females) were included in this investigation. The alignment of the cup was evaluated by an anteroposterior radiograph of the pelvis 1 week after surgery. Measurements were divided into safe zone determined by Callanan and Lewinnek. Results: There were 168 (92.8%) acetabular cups that were placed within the safe zone for both inclination and anteversion based on the safe zones defined by Lewinnek, and 134 (74%) acetabular cups that were placed within the safe zone defined by Callanan. Multiple logistic analysis showed that the laterality and the addition of the confirmation method were indicators for malpositioning of combined inclination and anteversion. Conclusion: Our data suggested that even if special tools were not used in the lateral decubitus position, using only the alignment guide enabled cup positioning to be achieved with 92.8% accuracy in the Lewinnek safe zone and 74% accuracy in the Callanan safe zone. Multiple logistic analysis showed that the laterality and the addition of a confirmation alignment guide influenced the accuracy of cup positioning.

Sign in / Sign up

Export Citation Format

Share Document