| Literature DB >> 36183111 |
Christopher Thomas1,2, Vatsal Gupta3, Helen Parsons4, Andrew Metcalfe3,4, Pedro Foguet3, Richard King3.
Abstract
AIMS: Debate continues as to the optimal orientation of the acetabular component in total hip arthroplasty (THA) and how to reliably achieve this. The primary objective of this study was to compare functional CT-based planning and patient-specific instruments with conventional THA using 2D templating.Entities:
Keywords: Functional templating; Navigation; Patient-specific instrumentation; Spine-pelvic; Total hip arthroplasty
Year: 2022 PMID: 36183111 PMCID: PMC9526907 DOI: 10.1186/s42836-022-00143-6
Source DB: PubMed Journal: Arthroplasty ISSN: 2524-7948
Fig. 1Femoral neck osteotomy cutting guide
Fig. 2Acetabular orientation guide in provided 3D model
Fig. 3Fixed pelvic pin in situ with laser alignment with acetabular guide
Fig. 4Acetabular component impactor with removable laser guide, matched to fixed pelvic target
Fig. 5Consort diagram of participant flow throughout the study
Patient descriptive statistics at baseline
| Group A Standard THA ( | Group B OPS THA ( | All ( | |
|---|---|---|---|
| Age at randomization (years, mean, SD) | 57.3 (9.8) | 58.8 (7.4) | 58.1 (8.6) |
| Sex:Female ( | 12 (44.4) | 18 (66.7) | 30 (55.6) |
| Ethnicity: White British ( | 24 (88.9) | 23 (85.2) | 47 (87) |
| BMI (kg/m2, mean, SD) | 29.7 (5.0) | 30.3 (4.8) | 30.0 (4.9) |
| Study Hip: Left ( | 9 (33.3) | 10 (37.0) | 19 (35.2) |
| Previous spinal surgery: Yes ( | * | * | 3 (5.7) |
| Known spinal deformity: Yes ( | 4 (15.4) | 4 (14.8) | 8 (15.1) |
| Neurological disorder: Yes ( | 2 (7.7) | 2 (7.4) | 4 (7.5) |
| Hip pathology: Osteoarthritis: Yes ( | * | * | 53 (98.1) |
| Length of legs: ( | |||
| About the same | 14 (51.9) | 15 (55.6) | 29 (53.7) |
| Left leg longer | 4 (14.8) | 8 (29.6) | 12 (22.2) |
| Right leg longer | 4 (14.8) | 2 (7.4) | 6 (11.1) |
| Unsure | 5 (18.5) | 2 (7.4) | 7 (13.0) |
| Walking aids: None ( | 17 (63.0) | 19 (70.4) | 36 (66.7) |
Fig. 6Box and Whisker plot of acetabular planned vs. achieved implant position in conventional and Corin OPS
Difference between planned or (intraoperative) estimated and achieved component position with reference to 10 degree outlier cut-off
| Implant position variable | Standard THA ( | OPS THA ( | Ratio (Std:OPS) |
|---|---|---|---|
| Difference between planned and achieved anteversion over 10° ( | 5 (20) | 1 (4) | 5 |
| Difference between planned and achieved abduction over 10° ( | 4 (16) | 2 (8) | 2 |
| Difference between planned and achieved femoral version over 10° ( | 8 (32) | 3 (12) | 2.7 |
| Difference between planned and achieved acetabular anteversion OR abduction over 10° ( | 7 (28) | 3 (12) | 2.3 |
| Difference between planned and achieved any angle of acetabular or femoral orientation over 10° ( | 11 (44) | 5 (19) | 2.3 |
| Difference between estimated and achieved anteversion over 10° ( | 6 (24) | 1 (4) | 6 |
| Difference between estimated and achieved abduction over 10° ( | 4 (16) | 1 (4) | 4 |
| Difference between estimated and achieved femoral anteversion over 10° ( | 7 (26) | 1 (4) | 7 |
| Difference between estimated and achieved acetabular anteversion OR abduction over 10° ( | 8 (32) | 2 (8) | 4 |
| Difference between estimated and achieved any angle of acetabular or femoral orientation over 10° ( | 12 (48) | 3 (12) | 4 |
Baseline, 6-week, 4- and 12-month follow-up HOOS, OHS and EQ-5D scores
| Outcome | Time point | Standard ( | OPS ( | All ( |
|---|---|---|---|---|
| | Baseline | 34.8 (14.1) | 33.0 (14.0) | 33.9 (13.9) |
| 6 weeks | 79.8 (22.5) | 83.7 (14.0) | 81.8 (18.6) | |
| 4 months | 87.9 (18.0) | 90.2 (12.0) | 89.1 (15.1) | |
| 12 Months | 89.9 (18.4) | 91.8 (15.3) | 90.9 (16.8) | |
| | Baseline | 39.4 (18.9) | 34.3 (15.1) | 36.9 (17.1) |
| 6 weeks | 77.4 (18.4) | 80.8 (11.7) | 79.1 (15.3) | |
| 4 months | 82.7 (16.9) | 84.6 (11.9) | 83.7 (14.5) | |
| 12 Months | 88.6 (16.4) | 86.2 (16.8) | 87.4 (16.5) | |
| | Baseline | 37.8 (19.0) | 34.9 (18.1) | 36.3 (18.4) |
| 6 weeks | 74.1 (21.8) | 79.5 (12.1) | 76.8 (17.6) | |
| 4 months | 83.9 (18.1) | 87.2 (14.2) | 85.6 (16.1) | |
| 12 Months | 90.4 (18.8) | 90.5 (17.7) | 90.5 (18.1) | |
| | Baseline | 18.5 (20.8) | 14.4 (15.9) | 16.4 (18.5) |
| 6 weeks | 47.5 (24.1) | 58.4 (21.0) | 53.1 (23.0) | |
| 4 months | 71.9 (27.1) | 72.8 (24.7) | 72.3 (25.6) | |
| 12 Months | 82.2 (25.2) | 82.0 (24.5) | 82.1 (24.6) | |
| | Baseline | 24.8 (16.9) | 19.9 (15.1) | 22.3 (16.1) |
| 6 weeks | 55.2 (26.3) | 57.7 (16.5) | 56.5 (21.7) | |
| 4 months | 76.0 (21.8) | 76.5 (24.5) | 76.3 (23.0) | |
| 12 Months | 82.8 (20.7) | 82.0 (20.0) | 82.4 (20.2) | |
| | Baseline | 16.3 (6.3) | 17.9 (7.9) | 17.1 (7.1) |
| 6 weeks | 30.9 (10.9) | 35.7 (6.6) | 33.4 (9.2) | |
| 4 months | 40.1 (9.3) | 41.0 (7.3) | 40.6 (8.3) | |
| 12 Months | 42.4 (9.8) | 43.1 (7.3) | 42.8 (8.5) | |
| | Baseline | 0.428 (0.235) | 0.420 (0.261) | 0.424 (0.246) |
| 6 weeks | 0.691 (0.243) | 0.748 (0.148) | 0.720 (0.200) | |
| 4 months | 0.802 (0.201) | 0.744 (0.289) | 0.772 (0.249) | |
| 12 Months | 0.823 (0.180) | 0.753 (0.232) | 0.787 (0.209) | |
Further secondary outcome measures
| Standard THA ( | OPS THA ( | All ( | ||
|---|---|---|---|---|
| Absolute postop leg length difference (mm, mean, SD) | Hip | 2.2 (1.8) | 3.0 (2.5) | 2.6 (2.2) |
| Global | 5.4 (3.8) | 5.4 (5.4) | 5.4 (4.6) | |
| Absolute difference in osteotomy height (mm, mean, SD) | Planned and actual | 2.9 (2.0) | 1.9 (1.5) | 2.4 (1.8) |
| Estimated and actual | 2.2 (1.9) | 1.7 (1.3) | 2.0 (1.6) | |
| Surgery length (mean, SD) | 1 h 29 m (12 m 44 secs) | 1 h 37 m (21 m 3secs) | 1 h 33 m (17 m 49 secs) | |