Intraperitoneal Loss of Pelvic Array Pin During Navigated Total Hip Arthroplasty.
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ABSTRACT:
SUBMITTER: Kan H
PROVIDER: S-EPMC9764167 | biostudies-literature | 2023 Feb
REPOSITORIES: biostudies-literature
Publications
Intraperitoneal Loss of Pelvic Array Pin During Navigated Total Hip Arthroplasty.
Arthroplasty today 20221212
Pelvic array pin placement during navigated total hip arthroplasty has been known to cause complications; however, most of them are minor. We report a 78-year-old female who underwent a routine computer-navigated total hip replacement which was subsequently complicated by complete loss of the pelvic array pin requiring retrieval via laparotomy. No structures were injured despite the surrounding urological, vascular, and visceral anatomy. The patient recovered and subsequently underwent a total h ...[more]
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Project description:BackgroundEvery degree of change in pelvic tilt (PT) leads to a 0.7° change in anteversion and a 0.3° change in inclination. This study aimed to determine the significance of contralateral hip arthritis on changes in PT using preoperative and postoperative anteroposterior radiographs.MethodsThere were 193 primary total hip arthroplasties done by 2 surgeons at a single academic tertiary referral center reviewed between September 2021 and January 2023. PT was calculated as Tilt = -(ln[(B/A) × (1/0.483)]) / 0.051. Value A is the distance from the base of the SI joint to the superior margin of the obturator foramen; value B is the height of the obturator foramen. After exclusions, contralateral hips were identified as being normal (n = 75), arthritic (n = 39) (Tönnis grade 3/4), replaced (n = 34), or having undergone simultaneous bilateral total hip arthroplasty (n = 5) on postoperative films. Difference in PT was measured between preoperative and postoperative films taken 1-3 months after surgery. Analyses for statistical significance were calculated using t-tests and one-way analysis of variance.ResultsAverage change in PT in patients with normal contralateral hips was -5.2° with an absolute mean difference of 7.6°, -1.5° for arthritic contralateral hips with an absolute mean difference of 5.0°, -1.6° for replaced contralateral hips with a mean absolute difference of 4.3°, and 2.2° for bilateral hips with a mean absolute difference of 2.6° (P < .01).ConclusionsDifferences in postoperative PT changes between healthy, arthritic, and replaced contralateral hip study groups were significant. Changes in preoperative to postoperative tilt may have implications for optimal cup placement.
| S-EPMC11347829 | biostudies-literature
Project description:BackgroundSymptomatic leg length discrepancies (LLDs) are a significant complication after total hip arthroplasty. Many surgeons incorporate an intraoperative anteroposterior pelvis radiograph, to help prevent LLD; however, obtaining a high-quality radiograph is often difficult. The purpose of this study is to evaluate the accuracy and reliability of estimating LLD using different radiographic reference landmarks on suboptimal anteroposterior pelvis radiographs.Material and methodsWe obtained 2 pelvis Sawbones models with attached femurs and created a true shortening of the left femur of the experimental model by 7 mm. We then obtained a series of radiographs manipulating each model in standardized increments for a total of 66 different permutations of suboptimal radiographs. Each radiograph was evaluated for LLD by 2 separate orthopedic surgeons using reference lines bisecting the following anatomic landmarks: ischial tuberosities, acetabular teardrops, obturator foramina, sacroiliac joints, and the femoral heads, to the lesser trochanters. The accuracy and reliability of each line were then analyzed.ResultsThe obturator foramina line yielded the most reliable LLD estimates with an intraclass correlation coefficient of 0.939. This reference line was also the most accurate, with an average difference of 1.5 mm from the true LLD (P < .001), with 95% confidence to be within 1.8 mm.ConclusionThe obturator foramen reference line on an intraoperative radiograph is an accurate and reliable tool that should be utilized by joint replacement surgeons to estimate LLD even if the radiograph is suboptimal. This estimate is reliably reproduced among multiple observers and puts the estimate within 1.8 mm of a true LLD.
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Project description:The successful outcome of total knee arthroplasty (TKA) is very much dependent on precise positioning of the components. Inaccuracy may result in complaints as well as in early mechanical failure. Between March 2003 and September 2005, 69 TKA procedures were performed by the computer navigated technique. The postoperative outcome of this cohort was compared with the same number of TKAs done by the traditional technique. The lower limb anatomical axis was determined in all cases pre- and postoperatively by weight-bearing anteroposterior (AP) and lateral full length X-rays. The positions of femoral and tibial components were recorded. Comparing the data in the navigation group on the AP view, 96.6% of femoral and 96.9% of tibial components and on the lateral view in 95.4% of femoral and in 95.4% of tibial components, the overall postoperative axis in 95.4% fell in the range considered in the literature as optimal. In the traditional group on the AP view, 75.7% of femoral and 68.1% of tibial components and on the lateral view 81.8% of femoral and 63.6% of tibial components, the overall postoperative axis in 60.6% fell between the values considered optimal in the literature. It seems to be proven that the computer navigated total knee arthroplasty technique ensures positioning of components significantly more precisely compared with the traditional surgical method. Accuracy of navigation depends on the software used, on the correct detection of anatomical reference points, and on a potentially uneven thickness of the cement layer during final insertion of the components. The computer navigated technique does not substitute professional skill and experience, since it merely transmits information for the surgeon. The decision is in the hands of the doctor during the entire procedure. The real benefits of the computer navigated technique require further research and can be determined only after long-term analyses.
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Project description:BackgroundThe purpose of our study was to assess the accuracy of a commercially available wearable sensor in replicating pelvic tilt movement in both the sitting and standing position in patients before total hip arthroplasty.MethodsThis prospective study evaluated patients undergoing a primary unilateral total hip arthroplasty by a single surgeon. Patients were excluded if they had a body mass index (BMI) greater than 40 kg/m2. Two sensors were adhered directly to patients' skin at S2 and T12. The S2 angle was recorded on the sensor at maximum flexion and extension angles and compared with pelvic tilt measurements on both sitting and standing radiographs. The primary outcomes recorded were patients' pelvic tilts measured using radiographs (PT-RAD) and sensors (PT-SEN), with Pearson correlation coefficients and intraclass correlation coefficients (ICCs) calculated.ResultsSixty-one patients (35 males and 26 females) with an average age of 61.5 ± 8.5 years and BMI of 26.9 ± 4.1 kg/m2 were analyzed. The mean prestanding PT-RAD and PT-SEN were 1.5 ± 8.3 and 1.0 ± 8.1, respectively, with an ICC of 0.98 (95% confidence interval, 0.96-0.99). The mean presitting PT-RAD and PT-SEN were -21.9 ± 12.5 and -20.9 ± 11.7, respectively, with an ICC of 0.97 (95% confidence interval, 0.95-0.98). The multiple R2 was 0.95 for the prestanding and presitting comparisons. The R2 for all comparisons between PT-RAD and PT-SEN was >0.85, regardless of BMI or sex.ConclusionsAlthough the use of wearable technology may have limitations, based on our results, a wearable sensor is accurate in replicating pelvic tilt movement.
| S-EPMC8784288 | biostudies-literature
Project description:Pelvic tilt (PT) affects the functional anteversion and inclination of acetabular components in total hip arthroplasty (THA). One-hundred and thirty-eight consecutive patients who underwent unilateral primary THA were reviewed. Most cases had some degree of pre-operative PT, with 17% having greater than 10° of PT on standing pre-operative radiographs. There was no significant change in PT following THA. A computer model of a hemispheric acetabular component implanted in a range of anatomic positions in a pelvis with varying PT was created to determine the effects of PT on functional anteversion and inclination. Based on the study results, tilt-adjustment of the acetabular component position based on standing pre-operative imaging will likely improve functional component position in most patients undergoing THA.
| S-EPMC4359644 | biostudies-literature
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Project description:BackgroundBoth minimally invasive surgery (MIS) and computer-assisted surgery (CAS) for total hip arthroplasty (THA) have gained popularity in recent years. We conducted a qualitative and systematic review to assess the effectiveness of MIS, CAS and computer-assisted MIS for THA.MethodsAn extensive computerised literature search of PubMed, Medline, Embase and OVIDSP was conducted. Both randomised clinical trials and controlled clinical trials on the effectiveness of MIS, CAS and computer-assisted MIS for THA were included. Methodological quality was independently assessed by two reviewers. Effect estimates were calculated and a best-evidence synthesis was performed.ResultsFour high-quality and 14 medium-quality studies with MIS THA as study contrast, and three high-quality and four medium-quality studies with CAS THA as study contrast were included. No studies with computer-assisted MIS for THA as study contrast were identified. Strong evidence was found for a decrease in operative time and intraoperative blood loss for MIS THA, with no difference in complication rates and risk for acetabular outliers. Strong evidence exists that there is no difference in physical functioning, measured either by questionnaires or by gait analysis. Moderate evidence was found for a shorter length of hospital stay after MIS THA. Conflicting evidence was found for a positive effect of MIS THA on pain in the early postoperative period, but that effect diminished after three months postoperatively. Strong evidence was found for an increase in operative time for CAS THA, and limited evidence was found for a decrease in intraoperative blood loss. Furthermore, strong evidence was found for no difference in complication rates, as well as for a significantly lower risk for acetabular outliers.ConclusionsThe results indicate that MIS THA is a safe surgical procedure, without increases in operative time, blood loss, operative complication rates and component malposition rates. However, the beneficial effect of MIS THA on functional recovery has to be proven. The results also indicate that CAS THA, though resulting in an increase in operative time, may have a positive effect on operative blood loss and operative complication rates. More importantly, the use of CAS results in better positioning of acetabular component of the prosthesis.
| S-EPMC2879237 | 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:We present a unique case of bladder perforation occurring intraoperatively during primary total hip arthroplasty. It is suspected that the patient's aberrant bladder anatomy, with idiopathic erosion of the quadrilateral space, predisposed the patient to bladder injury. Several preoperative risk factors for bladder injury were identified in the literature. These factors include cemented acetabular components, previous history of hip arthroplasty, history of pelvic trauma or intrapelvic surgery, and poor bone quality. Management of bladder injury, should it occur, includes bladder decompression with a Foley catheter, antibiotic administration, hemodynamic monitoring, and urology consult with close follow-up. This case reinforces the importance of urologic preoperative evaluation for anatomic variations of the bladder. In such cases, intraoperative Foley catheters to prevent distension may reduce the risk of perforation.
| S-EPMC5859462 | biostudies-literature