Robotic Arm–Assisted System Improved Accuracy of Cup Position and Orientation in Cementless Total Hip Arthroplasty for Dysplastic Hips: A Comparison Among Groups With Manual Placement, Computed Tomography–Based Navigation, and Robotic Surgery
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PROVIDER: S-EPMC11295473 | biostudies-literature | 2024 Jul
REPOSITORIES: biostudies-literature
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Project description:Developmental dysplasia of the hip (DDH) is strongly associated with an increased risk for hip osteoarthritis. Skeletal deformities undeniably contribute to detrimental biomechanical loading in dysplastic hips, but cannot explain all types of damage and symptoms that patients with DDH experience. Characterizing the geometry and function of the muscles spanning the hip is a logical next step in our progression of knowledge about DDH pathomechanics. In this study, we compared skeletal geometry, muscle volumes, intramuscular fatty infiltration, moment arms, and isometric strength in patients with DDH (N = 20) to healthy controls (N = 15). Femoral coverage was significantly less in patients (p < 0.001, Cohen's d effect size = 2.2), femoral neck-shaft angles were larger (p = 0.001, d = 1.3), and hip joint centers (HJCs) were more lateral (p = 0.001, d = 1.3). These skeletal abnormalities were associated with smaller abductor muscle moment arms in patients with DDH (e.g., gluteus medius [GMED]: p = 0.001, d = 1.2). Patients with DDH also had larger GMED volumes (p = 0.02, d = 0.83), but no differences in fatty infiltration, compared to controls. Isometric strength of the hip abductors, extensors, and flexors was lower in patients, but not significantly different from controls. The abnormal skeletal geometry, lateralized HJC, and reduced muscle moment arms represent a chronic biomechanical disadvantage under which patients with DDH operate. This phenomenon causes increased demand on the abductor muscles and results in high medially and superiorly directed joint reaction forces, which can explain reports of superomedial femoral cartilage damage in patients. The abnormal muscle geometry and function, in context with abnormal skeletal structure, are likely strong, but underappreciated, contributors to damaging loads in DDH.
| S-EPMC8858333 | biostudies-literature
Project description:Background: The gold standard for percutaneous pedicle screw placement is 2-dimensional (2D) fluoroscopy. Data are sparse on the accuracy of 3-dimensional (3D) navigation percutaneous screw placement in minimally invasive spine procedures. Objective: We sought to compare a single surgeon's percutaneous pedicle screw placement accuracy using 2D fluoroscopy versus 3D navigation, as well as to investigate the effect of facet orientation on facet violation when using 2D fluoroscopy. Methods: We conducted a retrospective radiographic study of consecutive cohort of patients who underwent percutaneous lumbar instrumentation using either 2D fluoroscopy or 3D navigation. All procedures were performed by a single surgeon at 2 academic institutions between 2011 and 2018. Radiographic measurement of screw accuracy was assessed using a postoperative computed tomographic scan. The primary outcome was facet violation, and secondary outcomes were endplate/tip breaches, the Gertzbein-Robbins classification for cortical breaches, and the Simplified Screw Accuracy grade. Statistical comparisons were made between screws placed using 2D fluoroscopy versus 3D navigation. Axial facet angles were also measured to correlate with facet violation rates. Results: In the 138 patients included, 376 screws were placed with fluoroscopy and 193 with navigation. Superior (unfused) level facet violation was higher with 2D fluoroscopy than with 3D navigation (9% vs 0.5%), which comprises the main cause for poor screw placement. Axial facet angles exceeding 45° at L4 and 60° at L5 were correlated with facet violations. Conclusion: This retrospective study found that 3D navigation is associated with lower facet violation rates in percutaneous lumbar pedicle screw placement when compared with 2D fluoroscopy. These findings suggest that 3D navigation may be of particular value when facet joints are coronally oriented.
| S-EPMC8436351 | biostudies-literature
Project description:Developmental dysplasia of the hip (DDH) causes hip instability and early-onset osteoarthritis. The focus on pathomechanics in DDH has centered on the shallow acetabulum, however there is growing awareness of the role of femoral deformities in joint damage. The objective of this study was to determine the influence of femoral version (FV) on the muscle and joint reaction forces (JRFs) of dysplastic hips during gait. Magnetic resonance images, in-vivo gait data, and musculoskeletal models were used to calculate JRFs and simulate changes due to varying FV deformities. Rotation about the long axis of the femur was added in the musculoskeletal models to simulate FV values from -5° (relative retroversion) to + 35° (increased anteversion). In our simulations, FV deformities caused the largest changes to the anteroposterior and resultant JRFs. From a normal FV of 15°, a 15° increase in femoral anteversion caused JRFs to be less posterior in early stance (Δ = 0.43 ± 0.22 xbodyweight) and more anterior in late stance (Δ = 0.60 ± 14 xbodyweight). Relative retroversion caused anteroposterior changes that were similar to anteversion in early stance but opposite in late stance. Resultant JRFs experienced the largest changes during late stance where anteversion raised the peak by 0.48 ± 0.15 xbodyweight and relative retroversion lowered the peak by 0.32 ± 0.30 xbodyweight. Increasing anteversion increased hip flexor and abductor muscle forces, which caused the changes in JRFs. Identifying how FV deformities influence hip joint loading can elucidate their role in the mechanisms of hip degeneration in patients with DDH.
| S-EPMC9064981 | biostudies-literature
Project description:Computer-aided implant surgery has undergone continuous development in recent years. In this study, active and passive systems of dynamic navigation were divided into active dynamic navigation system group and passive dynamic navigation system group (ADG and PDG), respectively. Active, passive and semi-active implant robots were divided into active robot group, passive robot group and semi-active robot group (ARG, PRG and SRG), respectively. Each group placed two implants (FDI tooth positions 31 and 36) in a model 12 times. The accuracy of 216 implants in 108 models were analysed. The coronal deviations of ADG, PDG, ARG, PRG and SRG were 0.85 ± 0.17 mm, 1.05 ± 0.42 mm, 0.29 ± 0.15 mm, 0.40 ± 0.16 mm and 0.33 ± 0.14 mm, respectively. The apical deviations of the five groups were 1.11 ± 0.23 mm, 1.07 ± 0.38 mm, 0.29 ± 0.15 mm, 0.50 ± 0.19 mm and 0.36 ± 0.16 mm, respectively. The axial deviations of the five groups were 1.78 ± 0.73°, 1.99 ± 1.20°, 0.61 ± 0.25°, 1.04 ± 0.37° and 0.42 ± 0.18°, respectively. The coronal, apical and axial deviations of ADG were higher than those of ARG, PRG and SRG (all P < 0.001). Similarly, the coronal, apical and axial deviations of PDG were higher than those of ARG, PRG, and SRG (all P < 0.001). Dynamic and robotic computer-aided implant surgery may show good implant accuracy in vitro. However, the accuracy and stability of implant robots are higher than those of dynamic navigation systems.
| S-EPMC11227595 | biostudies-literature
Project description:BackgroundAccurate cup placement during total hip arthroplasty (THA) is difficult because the intraoperative pelvic position changes even in supine patient position. We developed a device known as HipPointer; it corrects pelvic rotation and creates a functional pelvic plane as a reference. The aim of this study was to determine the device placement accuracy and investigate causes of error.Material and methodsHipPointer was used for cup placement in 353 hips of 308 patients who underwent direct-anterior-approach THA in supine position. The mean age at surgery and body mass index were 63.9 (17-90) years and 24.9 (16.6-42.0) kg/m2, respectively. The mean observation period was 40.5 (12-73) months. To investigate the accuracy of HipPointer, preoperative planning and postoperative cup placement angles relative to the functional pelvic plane were evaluated using a three-dimensional analysis software, and absolute errors were determined.ResultsThe means ± standard deviations of radiographic inclination (RI) and radiographic anteversion (RA) were 40.2 ± 3.0° and 15.8 ± 3.6°, respectively. The absolute errors of RI and RA were 2.2 ± 2.0° and 2.7 ± 2.3°, respectively. The ratio of the cup placement angle for which both RI and RA are ≤10° in the target zone was 99% (350/353 hips), and the ratio of the absolute errors for which both RI and RA are ≤5° was 80.4% (284/353 hips).ConclusionsHipPointer is simple in structure, easy to use, and useful for direct-anterior-approach THA in supine position. It provides good cup placement accuracy.
| S-EPMC9133511 | biostudies-literature
Project description:By combining the anatomical-pelvic-plane (APP) positioner with a newly improved navigation system during total hip arthroplasty (THA), it is theoretically possible to determine cup orientation based on the APP while tracking pelvic movement. The purpose of this study was to determine the navigation accuracy and whether the error is related to the pelvic position fixed by the positioner. Fifty hips that underwent primary THA between 2018 and 2020 were analysed. The accuracy was 2.34° at radiographic inclination (RI) and - 5.01° at radiographic anteversion (RA), and the error was within 10° at both RI and RA in only 40 of 50 hips (80.0%). The discrepancy in pelvic sagittal tilt was correlated with the cup orientation error and especially strongly correlated with the RA error (r = - 0.751, p < 0.001). When RI and RA were calculated using a correction formula to determine the true cup orientation based on the pelvic tilt discrepancies, the error in both RI and RA was within 10° in all cases (100%). The navigation accuracy is related to the pelvic position fixed by the positioner, and the correction formula for the target angle that considers pelvic tilt discrepancies can lead to accurate cup placement in the future.
| S-EPMC8260668 | biostudies-literature
Project description:Hips with developmental dysplasia (DDH) are at a heightened risk of premature hip osteoarthritis, which is often expedited by mechanically induced articular tissue damage. A prevalent form of damage in DDH is labral tears caused by abnormal loading at the shallow acetabular edge. Although the majority of reported DDH-related labral tears occur in the antero-superior acetabulum, posterior labral tears are prevalent in individuals whose lifestyle involves frequent high hip flexion tasks such as squatting. To better understand region-specific risks for chondrolabral damage during high hip flexion, we used image-based musculoskeletal models to compare acetabular edge loading (AEL) during double-legged squat between hips with symptomatic DDH (n = 10) and healthy controls (n = 10). Compared to controls, hips with DDH had higher instantaneous posterior AEL at the lowest point of squat (2.6 vs. 1.8 ×BW, p ≤ 0.04), and higher accumulative loading across the duration of the squatting motion (2.6 vs. 1.9 ×BW*s, p ≤ 0.04). Elevated posterior AEL coincided with increased net hip extension moments and posterior joint reaction forces, and was correlated with the severity of DDH acetabular deformity. Our findings suggest that posterior AEL is elevated in hips with symptomatic DDH during double-legged squat, which may contribute to chondrolabral damage in individuals who often perform such high hip flexion tasks. Clinical evaluation of DDH should consider patient-specific anatomy and lifestyle factors when establishing diagnoses and planning personalized treatment.
| S-EPMC9271518 | biostudies-literature
Project description:Femoral version (FV) deformities are common in patients with developmental dysplasia of the hip (DDH) and may contribute to cartilage damage due to abnormal joint loading. Derotational femoral osteotomy (DFO) surgery corrects FV deformities. However there is little consensus about the femoral transection location for DFO, and its influence on joint loads is unknown. The purpose of this study was to compare the effects of two common DFO locations on muscle forces and hip joint reaction forces (JRFs) in patients with DDH. DFO was simulated in nine patients with DDH and abnormal FV using patient-specific musculoskeletal models. Femoral transection for DFO was separately simulated proximal and distal to the lesser trochanter and FV values were corrected to an idealized 15°. JRFs during early and late stance of gait were compared between the two simulated transection locations. Most changes to JRFs were similar between proximal and distal DFO, however, statistically significant differences were found for the medial JRF component during late stance among patients with femoral anteversion (p = 0.01). Force changes from five hip muscles were significantly different between DFO locations, however, changes were minimal. Most changes after DFO in patients with femoral retroversion were opposite of those with femoral anteversion, with anteroposterior and superior JRFs increasing after retroversion correction. After DFO correction, superior and medial JRFs in DDH patients remained elevated compared to controls. Understanding the influence of DFO location on muscle-generated hip forces can help surgeons justify decisions and potentially standardize surgical correction of FV deformities in patients with DDH.
| S-EPMC10505249 | biostudies-literature
Project description:BackgroundMany patients with developmental dysplasia of the hip (DDH) are young and highly active but often become limited by activity-induced pain. Characterizing how the abnormal bony geometry of DDH affects hip joint loading and multiplanar kinematics during sport-specific motions relevant to active patients may provide insight into injury mechanisms and inform optimal treatment options.Purpose/hypothesisThe purpose of this study was to determine how hip joint loading and kinematics are altered in DDH during 2 common sport activities: running and multidirectional hop-cutting. It was hypothesized that superior and medial joint-reaction forces (JRFs) would be elevated during running and that medial JRFs would be elevated during hop-cutting when compared with controls.Study designControlled laboratory study.MethodsUsing patient-specific musculoskeletal modeling, both running and hop-cutting motions were analyzed for female patients with symptomatic DDH (DDH group) and female controls without hip disorders who were enrolled from October 2017 to August 2022. Hip joint angles, JRFs, and muscle forces were compared between the groups using 1-dimensional statistical parametric mapping.ResultsOverall, 19 women in the DDH group and 19 female controls were included in the running analysis, and 13 women in the DDH group and 10 female controls were included in the hop-cutting analysis. During the running motion, medial hip JRFs and gluteal muscle forces were significantly elevated in the DDH group, while rectus femoris muscle forces were reduced. During the hop-cutting motion, medial hip JRFs, gluteus minimus, and gluteus medius muscle forces were elevated, while gluteus maximus forces were reduced in the DDH group. There were no significant group differences in hip joint angles for either activity.ConclusionThe lack of kinematic differences between women with symptomatic DDH and controls suggests that the JRF differences between groups stemmed from the abnormal joint geometry in the DDH group. These activities may have greater damaging potential than previously studied lower impact activities such as walking.Clinical relevanceBetter understanding of how loading varies from activity to activity can help patients with DDH, and clinicians understand the mechanistic causes of DDH-related hip pain and damage and plan appropriate intervention strategies.
| S-EPMC11909653 | biostudies-literature
Project description:Radiographic evaluation of preoperative joint space width is believed important to predict the long-term results of osteotomy. We asked whether joint space width differs in the supine and standing positions in patients with Crowe Type-1 osteoarthritis (OA) secondary to developmental dysplasia of the hip (DDH). Joint space width was measured in the supine and standing positions in 146 women and 16 men (231 hips) with OA. Subjects had a mean age of 46.7 years (range, 22-59 years). Differences were seen on radiographs in joint space width between supine (2.35 +/- 1.65 mm; range, 0.1-6.2 mm) and standing (2.04 +/- 1.78 mm; range, 0.0-5.9 mm). In 27 of 172 hips with greater than 1 mm joint space in the supine position, joint space width was decreased by greater than 1 mm in the standing position. To evaluate preoperative joint space width in patients scheduled for osteotomy, radiographs should be obtained with the patient in the standing position.Level IV, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
| S-EPMC2493015 | biostudies-other