Influence of obesity and intra-operative imaging guidance technology on acetabular cup positioning in total hip arthroplasty.

Autor: Luu K; John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA., Nishioka ST; John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA., Lawton DRY; John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA., Unebasami E; Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96818, USA., Andrews SN; Department of Surgery, University of Hawai'I, John A Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA.; Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96818, USA., Nakasone CK; Department of Surgery, University of Hawai'I, John A Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA. onohunter@icloud.com.; Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96818, USA. onohunter@icloud.com.
Jazyk: angličtina
Zdroj: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2023 Nov; Vol. 143 (11), pp. 6857-6863. Date of Electronic Publication: 2023 Jun 04.
DOI: 10.1007/s00402-023-04922-x
Abstrakt: Background: Accuracy of acetabular cup positioning during total hip arthroplasty (THA) can be improved with intra-operative imaging but may be influenced by body mass index (BMI). This study assessed the influence of BMI (kg/m 2 ) on cup accuracy when using intra-operative fluoroscopy (IF) alone or supplemented with a commercial product.
Methods: This retrospective review included four consecutive cohorts of patients having undergone anterior approach THA with IF alone (2011-2015), IF and Overlay (2015-2016) (Radlink Inc., Los Angeles, CA), IF and Grid (2017-2018) (HipGrid Drone™, OrthoGrid Systems Inc., Salt Lake City, UT) and IF and Digital (2018-2020) (OrthoGrid Phantom®, OrthoGrid Systems, Inc., Salt Lake City, UT). Component placement accuracy was measured on 6-week post-operative weight bearing radiographs and compared between four BMI patient groups (BMI ≤ 25, 25 < BMI ≤ 30, 30 < BMI ≤ 35, and 35 < BMI). Total fluoroscopy times were also recorded directly from the fluoroscopy unit.
Results: Abduction angle significantly increased as BMI increased (p = 0.003) with IF alone but no difference was present in groups with guidance technology. Anteversion was significantly different between BMI groups for IF alone (p = 0.028) and Grid (p = 0.027) but was not different in Overlay (p = 0.107) or Digital (p = 0.210). Fluoroscopy time was significantly different between BMI categories for IF alone (p = 0.005) and Grid (p = 0.018) but was not different in Overlay (p = 0.444) or Digital (p = 0.170).
Conclusion: Morbid obesity (BMI > 35) increases risk for malpositioning of acetabular cups and increases surgical time with IF alone or the Grid. Additional IF guidance technology (Overlay or Digital) increased cup positioning accuracy without decreasing surgical efficiency.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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