New combined anteversion technique in hybrid THA: cup-first procedure with CT-based navigation
| Autor: | Shohei Okahisa, Yuki Fujihara, Tomokazu Fukui, Shinichi Yoshiya, Shoji Nishio, Shigeo Fukunishi, Taishi Okada, Yu Takeda, Ariha Goshi, Yoshinobu Masumoto, Makoto Kanto, Futoshi Morio |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Anterior protrusion Arthroplasty Replacement Hip Radiography Interventional 03 medical and health sciences 0302 clinical medicine Ct based navigation Medicine Humans Orthopedics and Sports Medicine Combined anteversion Aged Orthodontics Aged 80 and over 030222 orthopedics Preoperative planning business.industry Cup anteversion Acetabulum 030229 sport sciences Middle Aged Sagittal plane medicine.anatomical_structure Surgery Female Hip Prosthesis business Tomography X-Ray Computed Total hip arthroplasty |
| Zdroj: | European journal of orthopaedic surgerytraumatology : orthopedie traumatologie. 30(3) |
| ISSN: | 1432-1068 |
| Popis: | Combined anteversion (CA) technique (stem-first procedure) is generally accepted as the optimal technique to attain an appropriate CA value in total hip arthroplasty (THA). However, cup anteversion is strongly influenced by the native femoral anteversion. Accordingly, anterior protrusion of the cup in the acetabulum might occur. The purpose of the present study is to investigate the achievement of the optimal CA while avoiding anterior cup protrusion and examine the significance of our new CA technique with cup-first procedure in hybrid THA. Seventy-nine hybrid THAs with the cup-first procedure used a CT-based navigation system for cup positioning. In the preoperative planning, cup anteversion was aimed at approximately 20°. However, in actuality, sufficient cup coverage in the original acetabulum based on individual anatomy is given priority over cup placement based on CT-based planning to ensure adequate cup coverage. The target stem anteversion was determined following Widmer’s mathematical formula (37.3 = femoral stem anteversion × 0.7 + cup anteversion). Cemented stem was inserted according to the target stem anteversion angle. Regarding the assessment of overall alignment, the calculated Widmer’s CA values during surgery and postoperative CT evaluation were 34.1° ± 6.0° (range 20.7°–51.2°) and 35.1° ± 6.7° (range 21.6°–50.7°). There were 72 hips (91.1%) within 25°–50° of CA. Cup protrusion length averaged 2.0 mm ± 2.6 mm (0–8.8 mm) in the axial view and 0.4 mm ± 1.0 mm (0–3.6 mm) in the sagittal view. Cup protrusion length of more than 5 mm was indicated in 10 hips, and no hips observed more than 10 mm. Our new CA technique (cup-first procedure) with hybrid THA was able to achieve optimal CA value while avoiding anterior cup protrusion. |
| Databáze: | OpenAIRE |
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