Component In Total Hip Arthroplasty Research Articles

Modular versus monobloc dual mobility components for primary cementless total hip arthroplasty: a systematic review and meta-analysis of implants' survival, complication rates, clinical and radiographic outcomes.

The dual mobility cup (DMC) reduces the dislocation rates in total hip arthroplasty (THA). DMC systems include anatomical (non-modular or monoblock) (ADM) and modular dual mobility (MDM) components (Stryker Orthopaedics, Mahwah, NJ, USA). This review aims to assess differences between these two types of DMC implants concerning dislocation and revision rates, as well as patient-reported outcomes. This systematic review and meta-analysis of studies reports data from patients undergoing primary THA using MDM and/or ADM implants. Following the PRISMA guidelines, we analyzed articles from Science Direct/Scopus, PubMed, and the Cochrane Database of Systematic Reviews. We compared dislocation rates, revisions for any reason, aseptic loosening, infections, fractures, and functional outcomes between ADM and MDM components. Eleven studies were considered eligible for further analysis. A total of 3369 patients (mean age = 65.4years) underwent primary THA, including 3386 DMC implants. The mean follow-up for the MDM and ADM groups was 2.9years and 3.9years, respectively. The study revealed one dislocation in the MDM and none in the ADM. By proportion metanalysis, the review did not show statistical differences in all-cause revisions (p = 0.93, [CI [0.01;0.02]) or periprosthetic fractures (p = 0.18, CI [0.01;0.02]). MDM and ADM systems, both, represent safe DM options regarding dislocation, all-causes revisions and functional outcomes.

Influence of hip prosthesis position on postoperative gait in symptomatic hip osteoarthritis secondary to hip dysplasia patients after primary total hip arthroplasty: a short-term follow-up study

BackgroundThe aim of this study was to analyze the influence of the positioning of the components of total hip arthroplasty (THA) evaluated by the acetabular anteversion (AA) and femoral anteversion (FA) angle on postoperative gait in patients with symptomatic hip osteoarthritis secondary to hip dysplasia undergoing THA.MethodsBetween May 2023 and May 2024, patients with symptomatic hip osteoarthritis secondary to hip dysplasia (Crowe Type I and IV) who underwent THA were enrolled in the study. The AA angle and FA angle were measured by computer tomography (CT). Gait data were determined by using the Dynamic Right Gait & Posture analysis system. The relationship between FA, AA and gait data was analyzed by Pearson correlation test, subgroup Pearson correlation test, multiple linear regression.ResultsA total of 40 patients (45hips) were included in the study. Compared with preoperative, the patient’s postoperative foot progression angle, foot contact angle, plantarflexion velocity, swing foot speed, gait velocity, cadence, stride length were significantly improved. Preoperative FA is significantly different from postoperative FA (P < 0.05), while the difference between preoperative and postoperative AA is not significant. BMI, Crowe Type, AA were related to change of cadence. The less the postoperative AA of patients, and the more the cadence in the postoperative gait of patients.ConclusionOur study showed that THA could improve the gait function of patients with symptomatic hip osteoarthritis secondary to hip dysplasia. Adjusting AA lower could obtain a much more postoperative cadence.

Long-term clinical results and patient satisfaction of a metaphyseal-engaging anatomic cementless femoral component in total hip arthroplasty.

There is relatively little information on the long-term clinical results of patients aged < 50 years with a contemporary total hip arthroplasty (THA), although a high rate of revision is projected for this group. Therefore, the purpose of this study was to evaluate the long-term results (a minimum of 21 years) of a metaphyseal-engaging anatomic cementless total hip prosthesis in patients aged < 50 years at the time of their THA. This study included 360 patients (498 hips), specifically 212 men and 148 women. The mean age of the patients at the time of their THA was 45.8 ± 8.1 years. The predominant diagnosis was osteonecrosis (56%). Demographic data, the Harris hip score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the University of California, Los Angeles (UCLA) activity score were recorded. Radiographic evaluation and dual-energy X-ray absorptiometry (DEXA) scanning were used to evaluate implant fixation, bone remodelling, and osteolysis. The mean follow-up was 25.2 year (range 21-28 years). At the latest follow-up, the mean Harris hip, WOMAC, and UCLA activity scores were 93, 10, and 6.7 points, respectively. No patients had thigh pain. All hips had osseous integration of the acetabular and femoral components. No patient had grade 3 stress shielding. The 28-year survival rate was 98.2% (95% confidence interval [CI] 95-100%) for the acetabular components and 98.8% (95% CI 95-100%) for the femoral components. Overall, 90% of the patients were satisfied with the THA results. The results suggest that a metaphyseal-engaging anatomic cementless femoral stem with alumina-on-alumina ceramic articulation provide outstanding long-term fixation and substantial pain relief well into the 3rd decade after surgery. Furthermore, there was no alumina ceramic fracture or osteolysis. Moreover, approximately 90% of the patients were satisfied with the results of their THA.

Polyethylene liner dissociation in total hip arthroplasty: a retrospective case–control study on a single implant design

BackgroundModular acetabular components for total hip arthroplasty (THA) provide intraoperative flexibility; however, polyethylene liner dissociation may occur. This study aimed to examine the incidence and causes of liner dissociation associated with a specific acetabular component design at a single centre.Materials and methodsA retrospective analysis of 7027 patients who underwent primary THA was performed to identify isolated liner dislocations. Patient demographics, clinical presentations, surgical and implant details, and both radiographic and computed tomography (CT) findings were analysed. Patients with liner dislocation were matched to a control group via 2:1 propensity score matching, and a logistic regression analysis was employed to identify associated risk factors.ResultsA total of 32 patients (0.45%) experienced liner dislocation at a mean 71.47 ± 60.10 months post surgery. Significant factors contributing to dislocations included the use of a conventional compared with a highly crosslinked polyethylene component (p = 0.049) and screw fixation (p = 0.028). Radiographic and CT analysis highlighted the importance of proper component orientation, revealing that patients experiencing dislocations demonstrated significantly lower acetabular cup anteversion angles (p = 0.001) compared with the control group. Impingement and malposition, identified in 41% and 47% of the cases, respectively, further underscored the multifactorial nature of dislocation risks.ConclusionsWhile the overall rate of polyethylene liner dislocation was low, the findings of this study highlight the importance of appropriate cup placement to decrease the risk of dissociation. It further substantiates the influence of impingement and malposition in liner displacement, with increased mechanical stress exerted on the locking mechanism under adverse conditions and the potential risk increase due to screw placement.

Determination of rotation center and diameter of femoral heads using off-the-shelf augmented reality hardware for navigation

In total hip arthroplasty (THA), determining the center of rotation (COR) and diameter of the hip joint (acetabulum and femoral head) is essential to restore patient biomechanics. This study investigates on-the-fly determination of hip COR and size, using off-the-shelf augmented reality (AR) hardware. An AR head-mounted device (HMD) was configured with inside-out infrared tracking enabling the determination of surface coordinates using a handheld stylus. Two investigators examined 10 prosthetic femoral heads and cups, and 10 human femurs. The HMD calculated the diameter and COR through sphere fitting. Results were compared to data obtained from either verified prosthetic geometry or post-hoc CT analysis. Repeated single-observer measurements showed a mean diameter error of 0.63 mm ± 0.48 mm for the prosthetic heads and 0.54 mm ± 0.39 mm for the cups. Inter-observer comparison yielded mean diameter errors of 0.28 mm ± 0.71 mm and 1.82 mm ± 1.42 mm for the heads and cups, respectively. Cadaver testing found a mean COR error of 3.09 mm ± 1.18 mm and a diameter error of 1.10 mm ± 0.90 mm. Intra- and inter-observer reliability averaged below 2 mm. AR-based surface mapping using HMD proved accurate and reliable in determining the diameter of THA components with promise in identifying COR and diameter of osteoarthritic femoral heads.

Decreased “Polar Axis Angle” is Associated With Instability After Total Hip Arthroplasty: A New Method to Assess Functional Component Position on Lateral-Seated Radiographs

BackgroundResearch on hip instability has focused on establishing “safe” ranges of combined component position in supine posture or functional placement of the acetabular component based on the hip-spine relationship. A new angle, the polar axis angle (PAA), of the total hip arthroplasty (THA) components describes the concentricity of both components and can be evaluated in functional positions that confer a greater risk of instability (ie, sitting). The goal of this study was to compare the PAA in functional positions between patients who experienced a postoperative dislocation and a matched control group who did not have a dislocation. MethodsAn institutional database was searched for patients experiencing a dislocation after primary THA. Patients who had postoperative full-length standing and lateral-seatedradiographs were included in the dislocator group. A control group of nondislocator patients was matched 2:1 by age, body mass index, sex, and hip-spine classification. Radiographic measurements of the neck angle, acetabular ante-inclination, and PAA were performed by 2 separate blinded, trained reviewers. ResultsThe lateral-seated neck angle and lateral-seated PAA measurements were significantly lower in the dislocator groups (n = 37) than the control group (n = 74) (23 versus 33 degrees, P < .001; 74 versus 83 degrees, P = .012, respectively). Significant differences were also observed in changes in the polar axes and neck angles between standing and seated positions (P < .001 and P < .001, respectively). When comparing patients who have mobile spines versus stiff spines within the dislocator group, there were no differences in the acetabular, neck, or PAAs. The effect of neck angle on the PAA showed a linear trend across cohorts. ConclusionsPatients who experience postoperative instability have a significantly lower PAA on lateral-seated radiographs when matched for age, sex, body mass index, and hip-spine classification. In addition, the lower seated PAA is driven more strongly by decreased functional femoral anteversion, which emphasizes the role of functional femoral version on stability in THA.

An Extended Trochanteric Osteotomy Is Necessary for the Removal of Broken Modular Metaphyseal Engaging Femoral Stems

BackgroundModular metaphyseal engaging (MME) femoral components in total hip arthroplasty (THA) allow optimized femoral length, offset, and anteversion and are useful in patients with unusual proximal femoral anatomy. Fretting, corrosion, and stem fractures above the modular sleeve are complications associated with these implants. The purpose of this study was to identify failure mechanisms of retrieved MME femoral components at our institution, identify all broken stem cases, and evaluate how often an extended trochanteric osteotomy (ETO) was required for removal. MethodsAll consecutively retrieved MME femoral components from September 2002 to May 2023 were reviewed. Patient demographics, procedure information, component specifications, indications for removal, and requirements for further revision surgery were reviewed. Descriptive statistics were calculated for variables of interest. ResultsThere were 131 retrieved MME components. The mean age at surgery was 59 years (range, 28 to 75), 49% were women, mean body mass index was 29.4 (range, 20.7 to 33.3), and mean American Society of Anesthesiologists score was 2.4 ± 0.5. There were 102 (78%) stems of 1 design (stem A), and 29 (22%) stems of a different design (stem B). Of 131 components, 10 (7.6%) failed secondary to stem fracture proximal to the modular sleeve. Four of 102 (4%) of stem A and 6 of 29 (21% of stem B) fractured. All broken stems required additional intervention for removal during revision THA, using an ETO (N = 9) or cortical window (N = 1) in which an intraoperative proximal femoral fracture occurred. ConclusionsBroken MME stems present a challenge for orthopaedic surgeons during revision THA. When a stem fracture occurs above the ingrown sleeve, the distal splines may have osseous interdigitation into the clothespin. Thus, when revising a broken MME stem, an ETO should be performed, and the segment should be long enough to allow distal access.

3D-printed Personalized Porous Acetabular Component to Reconstruct Extensive Acetabular Bone Defects in Primary Hip Arthroplasty.

Management of extensive acetabular bone defects in total hip arthroplasty (THA) remains challenging. This study aims to investigate the feasibility and preliminary outcomes of 3D-printed personalized porous acetabular components for the reconstruction of acetabular defects in primary THA. This retrospective study involved seven patients who received 3D-printed acetabular components in primary THA between July 2018 and March 2021. Preoperatively, acetabular bone defects were evaluated by referencing the Paprosky classification. There were two "Paprosky type IIIA" defects and five "Paprosky type IIIB" defects. The acetabular components were custom-made for each patient to reconstruct the extensive acetabular defects. The hip function was assessed according to the Harris hip score (HHS). Clinical and radiographic outcomes were assessed. The average follow-up period was 40 months, ranging from 26 to 57 months. There were no patients lost to follow-up. The HHS improved from 44 (range: 33-53) before the operation to 88 (range: 79-93) at the final follow-up. Postoperative X-rays showed that the 3D-printed personalized components were properly fitted with the acetabulum. The average center of rotation (COR) discrepancy was 2.3 mm horizontally and 2.1 mm vertically, respectively. Tomosynthesis-Shimadzu metal artifact reduction technology images showed that the implant was in close contact with the host bone. Moreover, no complications were observed during the follow-up period, including loosening, dislocation, or component protrusion. The implantation of 3D-printed personalized acetabular components showed accurate reconstruction, stable mechanical support, and favorable function at short-term follow-up. This may be a viable alternative method for reconstructing extensive acetabular defects in THA.

Are current rates of uncemented fixation in total hip arthroplasty supported by the literature? An update on the uncemented paradox.

The optimal fixation method in total hip arthroplasty (THA) remains controversial. Initial concerns related to the long-term performance of cement fixation as well as cement disease led to the development of cementless implants, and registry data has indicated that the use of this type of fixation has increased in recent years. However, data from these same registries has not shown any improvement in outcomes when compared to cement fixation. On the contrary, while similar outcomes are seen when comparing these fixation types in younger patients (<70 years of age), cementless fixation has shown increased implant failure and revision rates in elderly patients (>70 years of age). Given the increased projected volume of THA in the United States over the next decade, it is important to utilise available data to make clinical decisions that minimise not only individual patient harm, but also the burden on the healthcare system itself. This review provides an overview of currently available outcomes data comparing cement and cementless fixation, as well as an updated analysis of current trends in fixation use in THA. We furthermore provide a comprehensive technique guide to help surgeons optimise cement fixation of the femoral component for THA and hemiarthroplasty.

Factors affecting operating room scheduling accuracy for primary and revision total hip arthroplasty: a retrospective study.

Optimizing operating room (OR) scheduling accuracy is important for OR efficiency, meeting patient expectations, and maximizing value for health systems. However, limited data exist on factors influencing the precision of Total Hip Arthroplasty (THA) OR scheduling. This study aims to identify the factors influencing the accuracy of OR scheduling for THA. A retrospective review of 6,072 THA (5,579 primary THA and 493 revision THA) performed between January 2020 and May 2023 at an urban, academic institution was conducted. We collected baseline patient characteristics, surgeon years of experience, and compared actual wheels in to wheels out (WIWO) OR time against scheduled OR time. Significant scheduling inaccuracies were defined as actual OR times deviating by at least 15% from scheduled OR times. Logistic regression analyses were employed to assess the impact of patient, surgeon, and intraoperative factors on OR scheduling accuracy. Using adjusted odds ratios, primary THA patients who had a lower BMI and surgeons who had less than 10 years of experience were associated with overestimation of OR time. Whereas, higher BMI, younger age, general anesthesia, non-primary osteoarthritis indications, and afternoon procedure start times were linked to underestimation of OR time. For revision THA, lower BMI and fewer components revised correlated with overestimated OR time. Men, higher BMI, more components revised, septic indication for surgery, and morning procedure start times were associated with underestimation of OR time. This study highlights several critical patient, surgeon, and intraoperative factors influencing OR scheduling accuracy for THA. OR scheduling models should consider these factors to enhance OR efficiency.

Early Radiographic and Clinical Outcomes of an Additive-Manufactured Acetabular Component

BackgroundAdditive manufacturing has recently gained popularity and is widely adopted in the orthopaedic industry. However, there is a paucity of literature on the radiographic and clinical outcomes of these relatively novel components. The aim of this study was to assess the 2-year clinical and radiographic outcomes of a specific additive-manufactured acetabular component in primary total hip arthroplasty. MethodsWe performed a retrospective review of 60 patients who underwent primary total hip arthroplasty with the use of the Stryker’s TRIDENT II acetabular component. Evaluation of radiographs was performed at 6 weeks, 1 year, and 2 years postoperatively. Radiographs were evaluated for radiolucencies in Charnley and DeLee zones, signs of biologic fixation, and acetabular inclination and anteversion measurements. Patient-reported outcomes and complications were also obtained. ResultsThere were no cases of component loosening or changes in component position during follow-up, with an average follow-up time of 1.7 years. A radiolucent line was identified in one patient in zone 1 at 6 weeks; this was absent at 1 year. Radiographic signs of cup biologic fixation were present in 85% of cases by final follow-up. The average inclination was 45.1 (SD = 4.0), and the average anteversion was 26.9 (SD = 5.2). Patient-Reported Outcomes Measurement Information System scores significantly increased at the final follow-up, and there were no complications in this cohort. ConclusionsThis study demonstrated excellent radiographic and clinical outcomes with this novel additive-manufactured acetabular component at early follow-up. Although longer-term follow-up is warranted, this additively manufactured highly porous titanium acetabular component demonstrated excellent biologic fixation and reliable fixation at mid-term follow-up.

Functional Acetabular Component Positioning During Direct Anterior Approach Hip Arthroplasty Using a Novel Three-Dimensional Virtual Mesh Imaging System With Fluoroscopy

BackgroundOptimal position of total hip arthroplasty (THA) components is critical for joint mechanics and stability. Acetabular component positioning during supine surgery in direct anterior approach (DAA) THA may be different in the standing position postoperatively, which traditional fluoroscopy is unable to predict. A novel 3-dimensional (3D) image analysis technology (IAT) that uses artificial intelligence to measure the tilt and rotation of the pelvis has enabled prediction of component positioning from supine to standing. The purpose of this study was to compare intraoperative fluoroscopy, non–3D-IAT, and 3D-IAT with postoperative standing radiographs to assess the accuracy of component positioning. MethodsFrom 2022 to 2023, 30 consecutive patients (86.6% women, mean age 59 [range, 55 to 67]) undergoing primary DAA THA with the use of the 3D-IAT were identified. A separate cohort of 148 patients from 2020 to 2021 (85% women, mean age 65 [range, 55 to 69]) who underwent DAA THA with non–3D-IAT was used for comparison. Leg length discrepancy (LLD), cup anteversion, and inclination were manually measured on intraoperative fluoroscopic images and digitally measured using IAT. Follow-up evaluation occurred at 1 month with standing pelvis radiographs measured using Ein Bild Röntgen Analyze–Cup software. Measurements were compared via Wilcoxon signed rank tests where P ≤ .05 indicates significantly different measurements. ResultsMedian LLD, inclination, and anteversion measurements via non–3D-IAT and fluoroscopy were significantly different compared to postoperative standing radiographs (P < .001). The 3D-IAT more accurately predicted LLD, abduction, and anteversion, with values not significantly different from postoperative standing measurements (P = .23, P = .93, and P = .36, respectively). ConclusionsThe use of the 3D-IAT during DAA THA allowed for the more accurate prediction of acetabular component position in the standing position postoperatively.

Registry-based study of survivorship of cemented femoral components versus collared cementless femoral components in total hip arthroplasty in older patients with osteoarthritis.

In recent years, the use of a collared cementless femoral prosthesis has risen in popularity. The design intention of collared components is to transfer some load to the resected femoral calcar and prevent implant subsidence within the cancellous bone of the metaphysis. Conversely, the load transfer for a cemented femoral prosthesis depends on the cement-component and cement-bone interface interaction. The aim of our study was to compare the three most commonly used collared cementless components and the three most commonly used tapered polished cemented components in patients aged ≥ 75 years who have undergone a primary total hip arthroplasty (THA) for osteoarthritis (OA). Data from the Australian Orthopaedic Association National Joint Replacement Registry from 1 September 1999 to 31 December 2022 were analyzed. Collared cementless femoral components and cemented components were identified, and the three most commonly used components in each group were analyzed. We identified a total of 11,278 collared cementless components and 47,835 cemented components. Hazard ratios (HRs) from Cox proportional hazards models, adjusting for age and sex, were obtained to compare the revision rates between the groups. From six months postoperatively onwards, patients aged ≥ 75 years undergoing primary THA with primary diagnosis of OA have a lower risk of all-cause revision with collared cementless components than with a polished tapered cemented component (HR 0.78 (95% confidence interval 0.64 to 0.96); p = 0.018). There is no difference in revision rate prior to six months. Patients aged ≥ 75 years with a primary diagnosis of OA have a significantly lower rate of revision with the most common collared cementless femoral component, compared with the most common polished tapered cemented components from six months postoperatively onwards. The lower revision rate is largely due to a reduction in revisions for fracture and infection.

Changing practice to a new-generation triple-taper collared femoral component reduces periprosthetic fracture rates after primary total hip arthroplasty.

Periprosthetic femoral fracture (PPF) is a major complication following total hip arthroplasty (THA). Uncemented femoral components are widely preferred in primary THA, but are associated with higher PPF risk than cemented components. Collared components have reduced PPF rates following uncemented primary THA compared to collarless components, while maintaining similar prosthetic designs. The purpose of this study was to analyze PPF rate between collarless and collared component designs in a consecutive cohort of posterior approach THAs performed by two high-volume surgeons. This retrospective series included 1,888 uncemented primary THAs using the posterior approach performed by two surgeons (PKS, JMV) from January 2016 to December 2022. Both surgeons switched from collarless to collared components in mid-2020, which was the only change in surgical practice. Data related to component design, PPF rate, and requirement for revision surgery were collected. A total of 1,123 patients (59.5%) received a collarless femoral component and 765 (40.5%) received a collared component. PPFs were identified using medical records and radiological imaging. Fracture rates between collared and collarless components were analyzed. Power analysis confirmed 80% power of the sample to detect a significant difference in PPF rates, and a Fisher's exact test was performed to determine an association between collared and collarless component use on PPF rates. Overall, 17 PPFs occurred (0.9%). There were 16 fractures out of 1,123 collarless femoral components (1.42%) and one fracture out of 765 collared components (0.13%; p = 0.002). The majority of fractures (n = 14; 82.4%) occurred within 90 days of primary THA. There were ten reoperations for PPF with collarless components (0.89%) and one reoperation with a collared component (0.13%; p = 0.034). Collared femoral components were associated with significant decreases in PPF rate and reoperation rate for PPF compared to collarless components in uncemented primary THA. Future studies should investigate whether new-generation collared components reduce PPF rates with longer-term follow-up.

Survival of cemented short Exeter femoral components in primary total hip arthroplasty.

The aim of this study was to report the long-term follow-up of cemented short Exeter femoral components when used in primary total hip arthroplasty (THA). We included all primary 394 THAs with a cemented short Exeter femoral component (≤ 125 mm) used in our tertiary referral centre between October 1993 and December 2021. A total of 83 patients (21%) were male. The median age of the patients at the time of surgery was 42 years (interquartile range (IQR) 30 to 55). The main indication for THA was a childhood hip disease (202; 51%). The median follow-up was 6.7 years (IQR 3.1 to 11.0). Kaplan-Meier survival analyses were performed to determine the rates of survival with femoral revision for any indication, for septic loosening, for fracture of the femoral component and for aseptic loosening as endpoints. The indications for revision were evaluated. Fractures of the femoral component were described in detail. The 20-year rate of survival was 85.4% (95% confidence interval (CI) 73.9 to 92.0) with revision for any indication, 96.2% (95% CI 90.5 to 98.5) with revision for septic loosening and 92.7% (95% CI 78.5 to 97.6) with revision for fracture of the femoral component. No femoral components were revised for aseptic loosening. There were 21 revisions of the femoral component; most (seven) as part of a two-stage management of infection. Fracture of the femoral component occurred in four THAs (1.0%) at 6.6, 11.6, 16.5, and 18.2 years of follow-up, respectively. Three of these were transverse fractures and occurred at the level of the lesser trochanter. In one THA, there was a fracture of the neck of the component. THAs using cemented short Exeter femoral components showed acceptable rates of survival of the femoral component at long-term follow-up, in this young cohort of patients. Although fracture is a rare complication of these components, surgeons should be aware of their incidence and possible risk factors.

Endoscopic Arthroplasty via Mini-open Direct Anterior Approach Improves Postoperative Complications and Acetabular Components of Total Hip Arthroplasty in Obese Patients.

To overcome the high-risk complications and poor alignment of acetabular components in obese patients associated with direct anterior approach (DAA) for total hip arthroplasty (THA), we innovated an endoscopic arthroplasty via mini-open direct anterior approach technique (Endo-DAA). The purpose of this study was to compare the clinical and radiographic outcomes in obese patients subjected to THA between Endo-DAA, Bikini DAA, and conventional DAA. In this retrospective controlled study, a total of 360 consecutive primary THA on obese patients (body mass index greater than 28 kg/m2) via Endo-DAA, Bikini DAA, and conventional DAA performed from October 2017 to October 2022 by different surgeons and in a single center were included. Assessments including perioperative parameters, clinical outcomes, complications, and radiologic measurements were retrieved from patients before the surgery, perioperative period and the latest follow-up. A total of 360 consecutive THA (Endo-DAA = 108, Bikini DAA = 116, Conventional DAA = 136) with complete follow-up data were analyzed. Compared to Bikini DAA or conventional DAA, Endo-DAA significantly shortened the length of incision (5.46 ± 0.53), the duration of operation (64.47 ± 12.38), and postoperative hospital stay (2.15 ± 0.89). Endo-DAA significantly reduces wound related complications compared with conventional DAA. Besides, Endo-DAA achieved a significantly better alignment of acetabular components compared to Bikini DAA or conventional DAA. Furthermore, Endo-DAA improved postoperative pain at the activity at 24 h postoperatively and early functional scores. The Endo-DAA THA technique provides better short-term clinical and radiographic results in obese patients with a low rate of postoperative complications compared to Bikini DAA or conventional DAA.

The Effect Of Automated Component Impaction On The Surgeon’s Ergonomics, Fatigue And Stress Levels In Total Hip Arthroplasty

Background Total Hip Arthroplasty (THA) surgery is physically and cognitively challenging. Sub-optimal posture during component impaction may influence surgeon’s ergonomics and fatigue. Methods Thirty THA procedures were executed for 3 days. Only during the first day, manual impaction (MI) was performed. Postural risk was evaluated with Rapid Upper Limb Assessment (RULA) and Rapid Entire Body Assessment (REBA) score. Three cognitive tasks (Simon, pattern comparison and pursuit rotor test) and five physical tests (isometric wall-sit, plank-to-fatigue, handgrip, supra-postural task, and shoulder endurance) assessed surgeon’s psycho-physiological load in the morning, midday, and afternoon. Surgeon’s cortisol concentration and sound level of the broaching process was also recorded. Results RULA and REBA scores were 1.7 to 3 times lower with automated impaction (AI). Physical exhaustion was lower with AI: isometric wall-sit test (10.6% vs. 22.9%), plank-to-fatigue (2.2% vs. 43.8%), supra-postural task (-0.7% vs. -7.7%), handgrip force production (dominant hand -6.7% vs. -12.7%; contralateral +4.7% vs. +7.7%), and in shoulder endurance (-15s vs. -56s). After AI, the cognitive performance showed faster response times and lower error rates for all cognitive tests compared to MI. The salivary cortisol level decreased during the AI-days by 51% in comparison to a 38% increase following the MI-day. Mean broaching time with AI was 7’3’’ compared to 6’20’’ with MI. The mean sound level with the AI-device was 64.3 dBA compared to 68.2 dBA with manual impaction. Conclusions Automated THA component impaction improved the surgeon’s ergonomics which resulted in reduced hormonal stress levels and lower physical and cognitive exhaustion.

Intrawound navigation for custom-made acetabular component in revision total hip arthroplasty: Does it improve implant positioning?

BackgroundThe number of hip revisions makes up over 12 % of all hip arthroplasty cases. For large acetabular defects custom-made acetabular component (CMAC) are required. Rates of malposition of CMACs are highly variable. Our study aims to develop a readily available, reliable and easily reproducible method for positioning of the CMAC. We tried to answer the following questions: 1) how often does the postoperative position of the implant corresponds to the planned one; 2) is the use of intrawound navigation improve the precision of acetabular implant position. MethodsThis was a single-center observational cohort study and included two groups: the experimental group (use of 3D navigation for implant positioning) and the control group (no navigation use). All the patients were scheduled for acetabular revision surgery with custom-made 3D-printed acetabular components. All surgeries took place between 2016 and 2020. Results25 % freehand group, 85 % implants in the navigation group matched accuracy positioning criteria. The relative risk of malposition was significantly higher without the intraoperative navigation, with 5 times greater risk of malpositioning in the freehand group versus the navigation group. ConclusionNavigation method allows planning of the implant and reamer sizes for optimal bone preparation and preservation. It provides easier implantation of the complex implant with reliable, stable primary fixation in massive bone defects. It reliably decreases malposition rate, allowing for implant placement in a proper position with sufficient bone-implant contact. Further research is needed to determine the relationship between CMAC position accuracy and long-term clinical and radiographic outcomes.

Radiological evaluation of cemented acetabular component in primary total hip arthroplasty with or without interface bioactive bone cement technique

PurposeWe evaluated the medium-term radiological outcomes of the interface bioactive bone cement (IBBC) technique used in the acetabular component in primary cemented total hip arthroplasty (THA). MethodsIn total, 79 patients (88 hips) who underwent primary THA at our hospital between January 2004 and April 2009 were divided into the non-IBBC (NIBBC; n ​= ​39 patients, 44 hips) and IBBC (n ​= ​40 patients, 44 hips) groups. A clear zone (CZ) at the cement-bone interface around the cup was evaluated 5 and 10 years postoperatively. The CZ score, which indicates the spread of the CZ, and loosening of the cup (CZ ​> ​2 ​mm on all sides or movement of the cup >4°) were also evaluated. ResultsNo patient had loosening of the cup. The mean patient age at surgery was 66.5 ​± ​9.2 years in the NIBBC group and 61.9 ​± ​7.7 years in the IBBC group (p ​= ​0.012). At 5 years postoperatively, the incidence of CZ was 36.4 ​% in the NIBBC group and 18.2 ​% in the IBBC group (p ​= ​0.056). At 10 years postoperatively, the incidence of CZ was 36.4 ​% in the NIBBC group and 20.1 ​% in the IBBC group (p ​= ​0.098). Age at surgery (p ​= ​0.045) significantly affected the incidence of CZ at 5 years but not at 10 years. The IBBC technique (p ​= ​0.042) and age at surgery (p ​= ​0.028) significantly affected the CZ score at 5 years. The IBBC technique (p ​= ​0.036) significantly affected the CZ score at 10 years. ConclusionsThe IBBC technique resulted in a significantly lower CZ score than the NIBBC technique in patients undergoing THA.

Fluoroscopy-based robotic assistance for total hip arthroplasty improves acetabular cup placement accuracy for obese patients compared to the manual, fluoroscopic- assisted technique.

Patient obesity is a risk factor for poor acetabular cup positioning in total hip arthroplasty (THA). To assess the impact of using a novel, fluoroscopy-based robotic THA system on acetabular cup placement in obese versus non-obese patients. A review of 105 consecutive manual unassisted (mTHA) (47 Obese/58 Non-obese) and 102 robotic-assisted (RA-THA) (50 Obese/52 Non-obese) primary, direct anterior approach THA procedures was conducted. All cases were performed by a single surgeon, for a pre-operative diagnosis of osteoarthritis, avascular necrosis, or rheumatoid arthritis. Obesity was defined as a Body Mass Index (BMI) ⩾ 30 kg/m2. Outcomes included acetabular cup inclination and anteversion, and the proportion of cups within the Lewinnek safe-zone. Obese patients in the mTHA cohort had larger cup inclination angles on average compared to non-obese patients (44.82∘± 6.51 vs. 41.39∘± 6.75; p= 0.009). Obese mTHA patients were less likely to have cup placement within the Lewinnek zone compared to non-obese mTHA patients (0.48 vs. 0.67; p= 0.027). Obesity had no effect on the accuracy of RA-THA. Obesity affects the placement of the acetabular component in manual THA. The novel, fluoroscopy-based robotic THA system in this study demonstrated accurate cup placement regardless of obesity status.