Abstract
Bone-to-bone impingement (BTBI) and implant-to-bone impingement (ITBI) risk assessment is generally performed intra-operatively by surgeons, which is entirely subjective and qualitative, and therefore, lead to sub-optimal results and recurrent dislocation in some cases. Therefore, a method was developed for identifying subject-specific BTBI and ITBI, and subsequently, visualising the impingement area on native bone anatomy to highlight where prominent bone should be resected. Activity definitions and subject-specific bone geometries, with planned implants were used as inputs for the method. The ITBI and BTBI boundary and area were automatically identified using ray intersection and region growing algorithm respectively to retain the same ‘conical clearance angle’ obtained to avoid prosthetic impingement (PI). The ITBI and BTBI area was then presented with different colours to highlight the risk of impingement, and importance of resection. A clinical study with five patients after 2 years of THA was performed to validate the method. The results supported the study hypothesis, in that the predicted highest risk area (red coloured zone) was completely/majorly resected during the surgery. Therefore, this method could potentially be used to examine the effect of different pre-operative plans and hip motions on BTBI, ITBI, and PI, and to guide bony resection during THA surgery.
Highlights
Total Hip Arthroplasty (THA) produces excellent intermediate to long-term results in accomplishing the primary objectives of enabling patients to reinstate their activities of daily living (ADLs) without pain or restriction.[2,5,7] there are still many post-operative complications associated with THA, with aseptic loosening and dislocation being two of the most common.[30,33] the overall dislocation rate has decreased over the past two decades,[15,26] a significant number of patients continue to experience recurrent episodes
It was observed that the implantto-bone impingement (ITBI) area was near to the acetabulum that was generally resected during surgery
The current practise of bony impingement (BI) risk assessment is performed intraoperatively by surgeons based on their expertise knowledge and experience, which sometimes lead to suboptimal surgical outcome
Summary
Total Hip Arthroplasty (THA) produces excellent intermediate to long-term results in accomplishing the primary objectives of enabling patients to reinstate their activities of daily living (ADLs) without pain or restriction.[2,5,7] there are still many post-operative complications associated with THA, with aseptic loosening and dislocation being two of the most common.[30,33] the overall dislocation rate has decreased over the past two decades,[15,26] a significant number of patients continue to experience recurrent episodes. The overall dislocation rate has decreased over the past two decades,[15,26] a significant number of patients continue to experience recurrent episodes Such recurrent dislocations, defined as two or more occurrences,[10] occurred in over 60% of patients at a minimum follow-up of 1 year after the first dislocation[10,26] and over 50% of these patients required revision surgery.[10,26] It was reported that impingement is the major cause of restricted range of motion (ROM) and post-THA dislocation.[16,28] The risk factors that are associated with impingement include design of implants, and their orientations and alignments, and the surgical approaches.[4,10,19,31,33] patient related factors such as gender, advanced age, history of previous hip surgery, pelvic tilt and bony structures around the hip increase the risk of impingement and subsequently recurrent dislocation.[8,10,11,33] Bartz et al.[1] classified dislocation mechanisms into three categories based on impingement type as follows: (a) prosthetic impingement (PI) which occurs when the prosthetic femoral neck comes in contact with the rim of the liner/cup, (b) bone-to-bone impingement (BTBI) which is the impingement between the osseous femur and the osseous pelvis, and
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