Computer-Assisted Navigation for Complex Revision of Unstable Total Hip Replacement in a Patient With Post-traumatic Arthritis.
Ontology highlight
ABSTRACT:
SUBMITTER: Rankin KA
PROVIDER: S-EPMC9108506 | biostudies-literature | 2022 Jun
REPOSITORIES: biostudies-literature
Publications
Computer-Assisted Navigation for Complex Revision of Unstable Total Hip Replacement in a Patient With Post-traumatic Arthritis.
Rankin Kelsey A KA Petit Logan L Nasreddine Adam A Minotti Phil P Leslie Michael M Wiznia Daniel H DH
Arthroplasty today 20220510
Imageless computer-assisted navigation (CAN) excels in the post-traumatic arthritis and complex revision case setting when altered anatomy and landmarks are inaccurate references for cup positioning. We describe the case of an adult male patient who suffered an acetabular fracture which was treated nonoperatively. He subsequently developed post-traumatic arthritis and underwent an anterior approach total hip arthroplasty 25 years later. Postoperatively, he developed recurrent hip instability due ...[more]
Similar Datasets
Project description:Computer assisted surgery was pioneered in early 1990s. The first computer assisted surgery (CAS) total knee replacement with an imageless system was carried out in 1997. In the past 25 years, CAS has progressed from experimental in vitro studies to established in vivo surgical procedures.A comprehensive body of evidence establishing the advantages of computer assisted surgery in knee and hip arthroplasty is available. Established benefits have been demonstrated including its role as an excellent research tool. Its advantages include dynamic pre-operative and per-operative assessment, increased accuracy in correction of deformities, kinematics and mechanical axis, a better alignment of components, better survival rates of prostheses and a better functional outcome. Adoption of computer navigation in the hip arthroplasty is still at an early stage compared to knee arthroplasty, though the results are well documented. Evidence suggests improved accuracy in acetabular orientation, positioning, hip offset and leg length correction.Among the orthopaedic surgeons, navigated knee arthroplasty is gaining popularity though slowly. The uptake rates vary from country to country. The Australian joint registry data shows increased navigated knee arthroplasty from 2.4% in 2003 to 28.6% in 2015 and decreased revision rates with navigated knee arthroplasty in comparison with traditional instrumented knee arthroplasty in patient cohort under the age of 55 years.Any new technology has a learning curve and with practice the navigation assisted knee and hip arthroplasty becomes easy. We have actively followed the evidence of CAS in orthopaedics and have successfully adopted it in our routine practice over the last decades. Despite the cautious inertia of orthopaedic surgeons to embrace CAS more readily; we are certain that computer technology has a pivotal role in lower limb arthroplasty. It will evolve to become a standard practice in the future in various forms like navigation or robotics.
| S-EPMC5532908 | biostudies-other
Project description:BackgroundTotal hip arthroplasty (THA) is an effective treatment for symptomatic hip osteoarthritis. The aim of this study was to determine the revision outcome of commercially available navigation technologies.MethodsData from the Australian Orthopaedic Association National Joint Replacement Registry from January 2016 to December 2020 included all primary THA procedures performed for osteoarthritis. Procedures using the Intellijoint HIP navigation system were identified and compared to procedures using "other" computer navigation systems and to nonnavigated procedures. The cumulative percent revision (CPR) was compared between the 3 groups using Kaplan-Meier estimates of survivorship and hazard ratios from Cox proportional hazards models, adjusted for age and gender.ResultsThere were 1911 procedures that used the Intellijoint system, 4081 used "other" computer navigation systems, and 160,661 were nonnavigated procedures. The all-cause 2-year CPR rate for the Intellijoint system was 1.8% (95% confidence interval [CI], 1.2-2.6), compared to 2.2% (95% CI, 1.8-2.8) for other navigated cases and 2.2% (95% CI, 2.1-2.3) for nonnavigated cases. A prosthesis analysis identified the Paragon/Acetabular Shell THAs combined with the Intellijoint system to have a higher (3.4%) rate of revision than nonnavigated THAs (hazard ratio = 2.00 [95% CI, 1.01-4.00], P = .048). When this combination was excluded, the Intellijoint group demonstrated a 2-year CPR of 1.3%. There was no statistical difference in the CPR between the 3 groups before or after excluding the Paragon/Acetabular Shell system.ConclusionsThe preliminary data presented demonstrate no statistical difference in all-cause revision rates when comparing the Intellijoint system with "other" navigation systems and "nonnavigated" approaches for primary THAs.Level of evidenceIII (National registry analysis).
| S-EPMC9633565 | biostudies-literature
Project description:BackgroundLittle is known about how often patients have revision total hip replacement in the same hospital in which they had the primary procedure.MethodsWe examined Medicare claims data to identify patients who had primary total hip replacement from July 1995 to June 1996 and subsequently had revision through December 31, 2006. We examined whether the revision was performed in the same or different hospital from the primary procedure, with different hospitals being categorized as being in a lower, a higher, or the same hospital volume stratum. Hospital strata included twenty-five or fewer cases of total hip replacement annually in the Medicare population, twenty-six to fifty cases, fifty-one to 100 cases, and >100 cases. We calculated the number of revisions generated (primary procedures eventuating in revision) by hospitals in each volume stratum and the number of revisions performed in these hospitals.ResultsOf 4448 revision procedures, 3306 (74%) were performed in hospitals in the same volume stratum as the hospital where the primary procedure was performed. Four hundred twenty-nine revisions (9.6%) were performed in a lower-volume hospital, and 713 (16%) were performed in a higher-volume hospital. Thirty-one (3%) of 960 patients who had revision within one year after the primary total hip replacement had the revision in a lower-volume center, compared with 204 (15%) of 1393 who had revision more than six years after the primary procedure (odds ratio = 4.6 ; 95% confidence interval, 3.0 to 6.8). The ratio of revisions performed to revisions generated was 1.21 for the highest-volume centers and 0.86 for the lowest-volume centers.ConclusionsOf 4448 revisions examined in this study, 429 (<10%) were performed in centers with a lower volume of total hip replacement than the center at which the initial hip replacement was performed, whereas 713 (16%) were performed in higher-volume centers. Higher-volume centers performed 21% more revisions than they generated (531 revisions performed, compared with 438 generated). These data will help to inform health-care policy with regard to the utilization of resources for revision total hip replacement.
| S-EPMC2991067 | biostudies-literature
Project description:IntroductionThe STRYKER ADAPT computer-assisted navigation system provides intraoperative feedback to the surgeon regarding implant placement of the Gamma3 nail. The usability of the ADAPT system has not been evaluated. The aim of the study was to investigate the perceived usability of the ADAPT system.Materials and methodsThis was a descriptive study with prospectively collected data. ADAPT was introduced at Aarhus University Hospital in February 2021. Prior to introduction, surgeons at the department attended a general introduction to the system. ADAPT was introduced to the surgical nurses and was on display at the surgical ward at more than one occasion, where personal introduction to the system was possible. After introduction, it was mandatory to use ADAPT when using the Gamma3 nail to treat intertrochanteric femur fractures. After each procedure, primary and an eventual supervisor answered a questionnaire, which encompassed the System Usability Scale (SUS) questionnaire. The SUS is a ten-item questionnaire regarding the perceived usability of a system. SUS scores were translated to adjectives, describing user experience on a 7-point adjective scale (worst imaginable, awful, poor, ok, good, excellent, best imaginable). User acceptability, defined as "not acceptable", "marginal" or "acceptable", was also used to interpret the SUS scores.ResultsADAPT was used in 50 procedures by 29 different surgeons, with varying skill-level. Median SUS-score after first-time use of ADAPT for all 29 surgeons was 43 (range: 5-60), which translated to "poor" or "not acceptable". For surgeons who performed ≥ 3 ADAPT-assisted procedures, there were no statistically significant difference in their first to latest SUS-score (median difference: 4.3, p = 0.5). In free text comments ADAPT was positively described as helpful in placement of K-wire and providing educational opportunities for inexperienced surgeons and negatively as inconsistent, slow, time consuming, and causing excessive fluoroscopy.ConclusionsUsability and acceptability of ADAPT was rated as "poor" or "not acceptable" by the majority of operating surgeons. ADAPT has not been used at our institution based on these findings. The System Usability Scale may be used in further research exploring usability and acceptability of novel computer-assisted navigation systems for orthopaedic surgery.
| S-EPMC10774189 | biostudies-literature
Project description:Several factors can cause bone loss and fixation failure following total hip arthroplasty (THA), including polyethylene wear debris, implant micromotion and stress shielding. Various techniques have been used in an effort to detect bone density loss in vivo, all with varying success. Quantitative computed tomography (qCT)-assisted osteodensitometry has been shown to be useful in assessing the in vivo structural bone changes after THA. It has a high resolution, accuracy and reproducibility, thereby making it a useful tool for research purposes, and it is able to differentiate between cortical and cancellous bone structures and assess the bone/implant interface. This technique also provides valuable information about the pattern of stress shielding which occurs around the prosthesis and can show early bony changes, which may prove informative about the quality of implant fixation and surrounding bone adaptation. In conjunction with finite-element analysis, qCT is able to generate accurate patient-specific meshes on which to model implants and their effect on bone remodelling. This technology can be useful to predict bone remodelling and the quality of implant fixation using prostheses with different design and/or biomaterials. In the future, this tool could be used for pre-clinical validation of new implants before their introduction in the market-place.
| S-EPMC2267633 | biostudies-other
Project description:Background This study sought to determine the accuracy in placing the acetabular component, estimation of leg length, offset, radiation time and dose, and operative time using a handheld navigation device compared to conventional anterior total hip arthroplasty (THA). It also examined the learning curve of the handheld navigation device. Methods Data were prospectively collected for a consecutive series of 159 THAs; 99 THAs with handheld navigation and 60 conventional THAs. Thresholds of <5°, ≥5° to <10°, and ≥10° for acetabular inclination and version and thresholds of <5 mm, ≥5 mm to <10 mm, and ≥10 mm for leg-length and combined offset discrepancy were used to assess accuracy. Fluoroscopy time and exposure, operative time, and complications were compared. Learning curve was determined using operative time. Statistical analysis was performed for the different accuracy thresholds with P values set a <0.05 for significance. Results The handheld navigation device demonstrated a mean accuracy of 3.2° and 1.8° for version and inclination, respectively. The handheld navigation group had significantly fewer outliers in version (P < .001), inclination (P < .001), leg-length discrepancy (P < .001), and offset discrepancy (P < .001). Fluoroscopic dose and time (P < .001) were lower in the handheld navigation cohort. The learning curve for handheld navigation was 31-35 cases. The mean operative time after the learning curve was similar to that in the conventional fluoroscopy group (P = .113). Conclusions Handheld navigation technology provided more accurate results while mitigating radiation exposure to the surgeon and patient. There were fewer outliers in the handheld navigation group. After the learning curve, all metrics improved in accuracy, and operative time was similar to that of the conventional technique.
| S-EPMC9399378 | biostudies-literature
Project description:BackgroundThe optimal management strategy for instability afte total hip arthroplasty remains unclear. Acetabular lip augmentation devices may offer an operative solution for recurrent instability. This systematic review reports the clinical outcomes of acetabular lip augmentation devices in comparison to other treatment options.MethodsA literature search strategy was performed of Medline, EMBASE, and CENTRAL on September 19, 2020, for all studies reporting outcomes of acetabular lip augmentation devices for recurrent dislocation after total hip arthroplasty. Non-English language articles were excluded. Clinical and survivorship data were collated and analyzed.ResultsThirteen studies describing acetabular augmentation were included for analysis. A total of 644 hips in 636 patients were augmented with a mean age of 75 years (39 to 103). Five different augmentation devices were used. The posterior lip augmentation device (PLAD, DePuy) was the most used (406 hips). Overall, acetabular lip augmentation devices had a 10% postoperative dislocation rate at a mean follow-up of 49 months (0.2 to 132). The PLAD had a 3.9% subsequent dislocation rate with a mean follow-up of 51 months (0.2 to 132). Only one study compared the PLAD to a dual-mobility cup, which demonstrated shorter operative times with the PLAD but higher rates of dislocation and revision surgery.ConclusionThe quality of literature on lip acetabular augmentation devices is poor. In these studies, the postoperative dislocation rate after lip acetabular augmentation was relatively high. The PLAD (DePuy) has the most evidence and may offer a therapeutic option for recurrent instability, in very specific clinical situations.
| S-EPMC8567156 | biostudies-literature
Project description:BackgroundSupercapsular Percutaneously Assisted total hip arthroplasty (SuperPATH approach) is a relatively new minimal invasive approach which has been associated with encouraging postoperative outcomes. The aim of this study is to compare the minimal invasive (MIS) SuperPATHapproach with the standard modified Hardinge approach at the base of muscle damage due to serum markers, functional results and other perioperative and postoperative data.Material and methodsForty eight (48) consecutive patients undergone primary total hip arthroplasty (THA) by the same surgeon (GD), were enrolled in our study. From this study population, the modified Hardinge approach was performed in 23 patients and the SuperPATH approach was performed in 25 patients. Soft tissue impairment was studied based on three representative markers, C-reactive-protein (CRP) and two enzymes, creatine kinase (CK) and lactate dehydrogenase (LDH). We measured these markers 10 min after surgery, on 1st and 2nd postoperative day. The levels of the perceived pain were evaluated according to the Visual Analog Scale/Numerical Rating Scale (VAS/NRS) score which was registered 6 h, 12 h, 1 day and 2 days postoperatively. The functional and clinical evaluation of the patients was achieved with Harris Hip Score (HHS), Charnley's Hip score, EuroQol (EQ-5D)-(EQ-100), Patient Health Questionnaire (PHQ-9) and neuropathic pain questionnaire (DN-4) 6 months and 1 year postoperatively. The rest of the collected data included patient's age, gender, body mass index (BMI), other comorbitities, the American Society of Anesthiologists score (ASA), Charlson Index score, the pre-operative diagnosis, implant positioning through radiographic evaluation, the type of anesthesia, the days of hospitalization, the operating time, incision length, blood loss and blood transfusion requirements and complication rates.ResultsSuperPATH approach was related with statistically considerable lower levels of CRP at 10 min (p = 0,001) and at 24 h (p = 0,047) postoperatively, as well as lower LDH levels in all time points postoperatively. It was also associated with shorter incision length (p < 0.001), longer operating time (p < 0.001), higher mean cup inclination p < 0.001, decreased postoperative pain levels the first 6 and 12 h (p < 0.001) and relatively better clinical and functional results 6 months after surgery, but not at 12 months.ConclusionOur study revealed some advantages in favor of the SuperPATH approach comparing with the standard modified Hardinge approach, mainly in terms of less muscle damage and less perceived pain postoperatively. More research is required in order to further elucidate its efficacy.
| S-EPMC7476237 | biostudies-literature
Project description:Opening-wedge high tibial osteotomy is an increasingly performed procedure for treatment of varus gonarthrosis and correction of malalignment during meniscal transplantation or cartilage restoration. Precise preoperative planning and meticulous surgical technique are required to achieve an appropriate mechanical axis correction. We describe our technique of arthroscopic and computer-assisted high tibial osteotomy using commonly available total knee arthroplasty navigation software as an intraoperative goniometer. We believe that our technique, by providing intraoperative real-time guidance of the degree of correction that is accurate and reliable, represents a useful tool for the surgeon who uncommonly performs high tibial osteotomy.
| S-EPMC3716232 | biostudies-literature
Project description:BackgroundAn aim of the use of computer navigation is to reduce rates of revisions of total knee replacements by improving the alignment achieved at the surgery. However, the decision to adopt this technology may be difficult for some centers, especially low-volume centers, where the cost of purchasing this equipment may be high. The purpose of this study was to examine the impact of hospital volume on the cost-effectiveness of this new technology in order to determine its feasibility and the level of evidence that should be sought prior to its adoption.MethodsA Markov decision model was used to evaluate the impact of hospital volume on the cost-effectiveness of computer-assisted knee arthroplasty in a theoretical cohort of sixty-five-year-old patients with end-stage arthritis of the knee to coincide with the peak incidence of knee arthroplasty in the United States.ResultsComputer-assisted surgery becomes less cost-effective as the annual hospital volume decreases, as the cost of the navigation increases, and as the impact on revision rates decreases. Centers at which 250, 150, and twenty-five computer-navigated total knee arthroplasties are performed per year will require a reduction of the annual revision rate of 2%, 2.5%, and 13%, respectively, per year over a twenty-year period for computer navigation to be cost-effective.ConclusionsComputer navigation is less likely to be a cost-effective investment in health-care improvement in centers with a low volume of joint replacements, where its benefit is most likely to be realized. However, it may be a cost-effective technology for centers with a higher volume of joint replacements, where the decrease in the rate of knee revision needed to make the investment cost-effective is modest, if improvements in revision rates with the use of this technology can be realized.
| S-EPMC2657305 | biostudies-literature