Adrian K Schneider1,2, Jim W Pierrepont3,4, Gabrielle Hawdon1, Stephen McMahon1,5. 1. 1 Malabar Orthopaedic Clinic, Melbourne, VIC, Australia. 2. 2 Kantonspital St. Gallen, Klinik für Orthopädie und Traumatologie, St. Gallen, Switzerland. 3. 4 Optimized Ortho, Sydney, Sydney, NSW, Australia. 4. 5 University of Sydney, NSW, Australia. 5. 3 Department of Surgery (School of Clinical Sciences at Monash Health), Monash University, Melbourne, VIC, Australia.
Abstract
INTRODUCTION: Patient specific guides can be a valuable tool in improving the precision of planned femoral neck osteotomies, especially in minimally invasive hip surgery, where bony landmarks are often inaccessible. The aim of our study was to validate the accuracy of a novel patient specific femoral osteotomy guide for THR through a minimally invasive posterior approach, the direct superior approach (DSA). METHODS: As part of our routine preoperative planning 30 patients underwent low dose CT scans of their arthritic hip. 3D printed patient specific femoral neck osteotomy guides were then produced. Intraoperatively, having cleared all soft tissue from the postero-lateral neck of the enlocated hip, the guide was placed and pinned onto the posterolateral femoral neck. The osteotomy was performed using an oscillating saw and the uncemented hip components were implanted as per routine. Postoperatively, the achieved level of the osteotomy at the medial calcar was compared with the planned level of resection using a 3D/2D matching analysis (Mimics X-ray module, Materialise, Belgium). RESULTS: A total of 30 patients undergoing uncemented Trinity acetabular and TriFit TS femoral component arthroplasty (Corin, UK) were included in our analysis. All but one of our analysed osteotomies were found to be within 3 mm from the planned height of osteotomy. In one patient the level of osteotomy deviated 5 mm below the planned level of resection. CONCLUSION: Preoperative planning and the use of patient specific osteotomy guides provides an accurate method of performing femoral neck osteotomies in minimally invasive hip arthroplasty using the direct superior approach. LEVEL OF EVIDENCE: IV (Case series).
INTRODUCTION:Patient specific guides can be a valuable tool in improving the precision of planned femoral neck osteotomies, especially in minimally invasive hip surgery, where bony landmarks are often inaccessible. The aim of our study was to validate the accuracy of a novel patient specific femoral osteotomy guide for THR through a minimally invasive posterior approach, the direct superior approach (DSA). METHODS: As part of our routine preoperative planning 30 patients underwent low dose CT scans of their arthritic hip. 3D printed patient specific femoral neck osteotomy guides were then produced. Intraoperatively, having cleared all soft tissue from the postero-lateral neck of the enlocated hip, the guide was placed and pinned onto the posterolateral femoral neck. The osteotomy was performed using an oscillating saw and the uncemented hip components were implanted as per routine. Postoperatively, the achieved level of the osteotomy at the medial calcar was compared with the planned level of resection using a 3D/2D matching analysis (Mimics X-ray module, Materialise, Belgium). RESULTS: A total of 30 patients undergoing uncemented Trinity acetabular and TriFit TS femoral component arthroplasty (Corin, UK) were included in our analysis. All but one of our analysed osteotomies were found to be within 3 mm from the planned height of osteotomy. In one patient the level of osteotomy deviated 5 mm below the planned level of resection. CONCLUSION: Preoperative planning and the use of patient specific osteotomy guides provides an accurate method of performing femoral neck osteotomies in minimally invasive hip arthroplasty using the direct superior approach. LEVEL OF EVIDENCE: IV (Case series).
Entities:
Keywords:
Direct superior approach; hip replacement; minimally invasive; osteotomy guide; patient specific
Authors: Bouke J Duijnisveld; Joost A A M van den Hout; Robert Wagenmakers; Koen L M Koenraadt; Stefan B T Bolder Journal: Orthop Surg Date: 2020-05-18 Impact factor: 2.071