Technique For Total Hip Arthroplasty Research Articles

Correction: A Radiological Comparison of Robotic-Assisted Versus Manual Techniques in Total Hip Arthroplasty

Correction: A Radiological Comparison of Robotic-Assisted Versus Manual Techniques in Total Hip Arthroplasty

Application of Intraoperative Individualized Cup Combination—Cup‐on‐Cup Technique in Severe Acetabular Defects

This study aimed to investigate the application of the cup‐on‐cup technique in revision total hip arthroplasty (THA) and report clinical and radiographic outcomes from a series of case follow‐ups. Retrospective analysis of 10 patients who underwent acetabular prosthesis revision with cup‐on‐cup technique. According to the Paprosky classification of acetabular bone defects, there were 2 cases of type II C, 3 cases of type III A, and 5 cases of type III B. The average follow‐up was 54.8 ± 5.1 months, and the Harris score of the hip joint increased from 37.0 ± 9.9 preoperatively to 80.5 ± 3.1 postoperatively at the final follow‐up (p < 0.001). Comparing the surgical side's hip center of rotation (COR) to the contralateral side, the preoperative average upward displacement was 33.8 ± 15.0 mm, while the postoperative average upward displacement was 0.2 ± 3.3 mm (p < 0.001). Similarly, the preoperative average inward displacement was 9.1 ± 5.1 mm, while the postoperative average outward displacement was 1.8 ± 1.6 mm (p < 0.001). There was no significant difference (p = 0.71) between the average density values of the contralateral and surgical sides at the final follow‐up, which were 127.4 ± 13.7 and 125.0 ± 14.8, respectively. During the follow‐up period, all patients achieved satisfactory radiographic outcomes, and no prosthetic loosening was observed. The cup‐on‐cup technique can reconstruct acetabular bone defects and restore hip COR in revision THA, with favorable clinical and radiographic outcomes.

Direct Anterior Total Hip Arthroplasty with VELYS™ Hip Navigation.

We describe the technique of total hip arthroplasty via a direct anterior approach using the Depuy Synthes (Raynham, MA) VELYS™ Hip Navigation system This technique allows one to accurately set the acetabular component position as well as recreate leg length and offset to meet the goals of hip reconstruction in a precise and efficient manner.

Use of a Novel Reverse Hip Replacement System to Address Dislocation and Instability.

While total hip arthroplasty (THA) is an enormously successful treatment for patients with end-stage degenerative arthritis of the hip, and surgeons have optimized existing hip implants and techniques, dislocation and instability persist as a leading cause of failure. Given the tremendous success of reverse total shoulder arthroplasty in enhancing the stability of shoulder reconstruction by reversing the anatomic seating of the ball and socket components, one manufacturer (Hip Innovation Technology, LLC, Woodstock, Georgia) has developed a novel Reverse Hip Replacement System (Reverse HRS) to address the need for greater stability in reconstruction of the arthritic hip joint. Rather than the traditional anatomic components that replace the head of the femur with a spherical ball and the acetabulum with a socket with polyethylene liner mounted into the pelvis, the Reverse HRS features a cup with polyethylene liner attached to the femoral stem and a spherical metal head attached to a central trunnion inside of the porous-coated acetabular shell fixed into the pelvis. This design provides dramatically enhanced stability and improved range of motion. This article reviews relevant published literature, including results from a Canadian clinical trial and case reports from a multicenter American clinical trial monitored by the U.S. Food and Drug Administration. It also describes the components and surgical technique of reverse THA.

Functional Outcome after Direct Anterior Approach Total Hip Arthroplasty (DAA-THA) for Coxa Profunda and Protrusio Acetabuli-A Retrospective Study.

Objective: The direct anterior approach (DAA) is a recognized technique for total hip arthroplasty (THA) that spares soft tissue. Functional and clinical outcomes following THA via the DAA in patients with complex acetabular deformities, specifically coxa profunda (CP) and protrusio acetabuli (PA), have yet to be determined. Methods: A retrospective analysis was conducted on 188 primary THA cases, including 100 CP hips and 88 PA hips, performed via the DAA. Functional and clinical outcomes were evaluated by means of the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Harris Hip Score (HHS) preoperatively and at a mean follow-up of 46 ± 14 months. Furthermore, potential complications were assessed. Results: From the preoperative to the latest postoperative visit, a significant improvement in the WOMAC total score was observed (CP: -34.89 ± 20.66; PA: -40.38 ± 21.11). The length of stay (LOS) was the only parameter predictive of the postoperative WOMAC total score, with each day of LOS increasing the postoperative WOMAC by a mean of 1.77 points (p < 0.01). The HHS improved by 38.37 ± 14.23 (PA-group) and 32.79 ± 14.89 points (CP-group). No significant difference in the patient-reported outcome measures (PROMs) between the CP- and PA-group was found. The survival rate for any revision was 97.70% (PA-group) and 92.80% (CP-group). Conclusion: The results of this study indicate that the minimally invasive DAA was not predictive of the functional and clinical outcome following DAA-THA in patients with CP and PA. Improvements in the mean WOMAC and HHS scores were above or within the reported MCID. Additionally, revision rates were well below those reported in the literature for short and intermediate follow-up periods.

Learning curve and initial outcomes of a novel percutaneously endoscopic-assisted total hip arthroplasty through mini bikini direct anterior approach: an observational cohort study

ObjectiveAlthough the direct anterior approach can reduce muscle damage and ensure accurate prosthesis placement, the steep learning curve and increased risk of complications associated with DAA necessitate careful consideration. Therefore, we describe a technique for a novel percutaneously endoscopic-assisted total hip arthroplasty through mini bikini direct anterior approach (mDAA) and report the learning curve and initial outcomes.MethodsThe first 125 THA performed by a single surgeon between September 2020 and February 2022 using the anterior approach were included, comprising the initial 41 cases of bikini DAA (bDAA) and the subsequent 84 cases of mDAA. Outcome measures included perioperative outcomes and postoperative complications. The cumulative sum analysis (CUSUM) was used to determine the learning curve of anterior approach THA for each patient’s ORT. Multivariable analysis was performed to determine risk correlation.ResultsA total of 125 anterior approach THA completed between 2020 and 2022 were identified. Among these, 41 were performed via bDAA and 84 via mDAA. No statistically significant differences were observed between the groups in terms of age, gender distribution, BMI or follow-up time. A significant reduction in ORT was noted, from 140 min for bDAA to 130 min for mDAA. Furthermore, there was a consistent decrease in LOI, LOS, and wound-healing problems. There was no statistically significant difference between groups with respect to Harris Hip Scores and other postoperative complications. The curve inflection points of the learning curve for the bDAA and mDAA group were located in the 22nd and 68th cases, respectively. The reduction of hemoglobin indicated a predicted increase in ORT.ConclusionsIn this study, ORT, LOI, LOS, and wound-healing problems decreased overall in mDAA group. After mastering the bDAA technique, approximately 27 mDAA cases are needed to acquire proficiency in this technique. Hence, mDAA is a valuable alternative for those seeking smaller incisions, resolving wound healing problems, and aiming for enhanced recovery after surgery.

Can Robotic-Arm Assistance Decrease Iatrogenic Soft-Tissue Damage During Direct Anterior Total Hip Arthroplasty?

Manual techniques for total hip arthroplasty (THA) have been widely utilized and proven to be clinically successful. However, the use of advanced computed tomography (CT) scan-based planning and haptically-bounded reamers in robotic-arm assisted total hip arthroplasty (RTHA) holds promise for potentially limiting surrounding soft-tissue damage. This cadaver-based study aimed to compare the extent of soft-tissue damage between a robotic-arm assisted, haptically-guided THA (RTHA) and a manual, fluoroscopic-guided THA (MTHA) direct anterior approach. There were six fresh-frozen torso-to-toe cadaver specimens included, with two surgeons each performing three RTHA and three MTHA procedures. One hip underwent an RTHA and the other hip received an MTHA in each cadaver. Postoperatively, one additional surgeon, blinded to the procedures, assessed and graded damage to nine key anatomical structures using a 1 to 4 grading scale: (1) complete soft-tissue preservation to <5% of damage; (2) 6 to 25% of damage; (3) 26 to 75% of damage; and (4) 76 to 100% of damage. Kruskal-Wallis hypothesis tests were used to compare soft-tissue damage between RTHA and MTHA cases and adjusted for ties. Pooled analysis of the gluteus minimus, sartorius, tensor fascia lata, and vastus lateralis muscle grades demonstrated that cadaver specimens who underwent RTHA underwent less damage to these structures than following MTHA (median, IQR: 1.0, 1.0 to 2.0 vs. 3.0, 2.0 to 3.0; p=0.003). Pooled analysis of the calculated volumetric damage (mm3) for the gluteus minimus, sartorius, tensor fascia lata, and vastus lateralis muscles demonstrated that the cadaver specimens that underwent RTHA underwent less damage to these structures than those that followed MTHA (median, IQR: 23, 2 to 586 vs. 216, 58 to 3,050; p=0.037). This cadaver-based study suggests that utilizing RTHA may lead to reduced soft-tissue damage compared with MTHA, likely due to enhanced preoperative planning with robotic-arm assisted software, real-time intraoperative feedback, haptically-bounded reamer usage, reduced surgical steps, as well as ease of use with reaming. These findings should be carefully considered when evaluating the utilization of robotic-arm assisted THA in practice.

Résultats à long terme de l’arthroplastie totale dans les luxations congénitales de la hanche. Étude rétrospective des résultats avec 10 à 20 ans de recul

Introduction: The impact of bone deformities, previous surgeries, and the surgical technique in total hip arthroplasty (THA) for congenital dislocation of the hip (CDH) at a long-term has not been clearly defined yet. In this single-centre observational study we sought to assess patients undergoing THA due to osteoarthritis secondary to severe CDH with low or high dislocation ten- to 20-years after surgery. To determine this purpose, we assessed: 1) THA-related complications and reoperations; 2) the clinical outcome, patients´ satisfaction and radiological results; and 3) the possible risk factors for reoperation with particular attention to the surgical technique and the influence of prior surgeries.Hypothesis: We hypothesized that an anatomical reconstruction of the hip would decrease the reoperations rates in patients undergoing THA with severe CDH.Methods: Seventy-five patients (85 hips) operated between 1999 and 2012 at our large tertiary hospital were analyzed. Fifty-six hips were diagnosed as low dislocation (group 1) and 29 hips as high dislocation (group 2). The existence of prior surgeries was frequent: group 1, pelvic osteotomies 6 hips, femoral osteotomies 7, tectoplasty (shelf) 6, resection arthroplasty 1 and lowering of the greater trochanter 1; group 2 included pelvic osteotomies 10 hips, femoral osteotomies 10, and a femoral lengthening 2. The number of additional procedures during THA was: group 1 (19/56 (34%)), acetabular roof bone autograft 8 hips, acetabular medial wall autograft 2, hardware removal 6, extended femoral osteotomy 2, and a femoral shortening 1; group 2 (20/29 (69%)), acetabular bone autograft 12 hips, medial autograft 1, hardware removal 1, extended femoral osteotomy 2, and a femoral shortening 4 hips The clinical and the radiological analysis were compared in both groups for a minimum follow-up of ten years. Cox regression models were used to detect risk factors for reoperation.Results: Nine patients (13.8%) required reoperation for the following reasons: cup loosening (5 hips), periprosthetic femoral fracture (3) and stem loosening (1); seven had prior surgeries. The 12-year survival rate for reoperation for any reason was 96.3% (95% Confidence Interval (CI) 91.2-100) in group 1 and 75.7% (95% CI, 65.8-90.8) in group 2 (p=0.003). Patients with high dislocation (p=0.02, Hazard Ratio (HR): 6.25, 95% CI, 1.26-30.9) and those with an acetabular component inclination placed out of the target zone between 35º and 50º (p=0.03, HR: 4,27, 95% CI, 1.13-16.1) had a higher risk of reoperation.Discussion: An optimal placement of the acetabular component decreased the reoperation rates in patients undergoing THA for severe CDH. Hips with high dislocation and the existence of prior surgery can affect THA implantation.Level of Evidence: III; retrospective; comparative

Differences in acoustic parameters of hammering sounds between successful and unsuccessful initial cementless cup press-fit fixation in total hip arthroplasty.

It is important to analyze objectively the hammering sound in cup press-fit technique in total hip arthroplasty (THA) in order to better understand the change of the sound during impaction. We hypothesized that a specific characteristic would present in a hammering sound with successful fixation. We designed the study to quantitatively investigate the acoustic characteristics during cementless cup impaction in THA. In 52 THAs performed between November 2018 and April 2022, the acoustic parameters of the hammering sound of 224 impacts of successful press-fit fixation, and 55 impacts of unsuccessful press-fit fixation, were analyzed. The successful fixation was defined if the following two criteria were met: 1) intraoperatively, the stability of the cup was retained after manual application of the torque test; and 2) at one month postoperatively, the cup showed no translation on radiograph. Each hammering sound was converted to sound pressures in 24 frequency bands by fast Fourier transform analysis. Basic patient characteristics were assessed as potential contributors to the hammering sound. The median sound pressure (SP) of successful fixation at 0.5 to 1.0 kHz was higher than that of unsuccessful fixation (0.0694 (interquartile range (IQR) 0.04721 to 0.09576) vs 0.05425 (IQR 0.03047 to 0.06803), p < 0.001). The median SP of successful fixation at 3.5 to 4.0 kHz and 4.0 to 4.5 kHz was lower than that of unsuccessful fixation (0.0812 (IQR 0.05631 to 0.01161) vs 0.1233 (IQR 0.0730 to 0.1449), p < 0.001; and 0.0891 (IQR 0.0526 to 0.0891) vs 0.0885 (IQR 0.0716 to 0.1048); p < 0.001, respectively). There was a statistically significant positive relationship between body weight and SP at 0.5 to 1.0 kHz (p < 0.001). Multivariate analyses indicated that the SP at 0.5 to 1.0 kHz and 3.5 to 4.0 kHz was independently associated with the successful fixation. The frequency bands of 0.5 to 1.0 and 3.5 to 4.0 kHz were the key to distinguish the sound characteristics between successful and unsuccessful press-fit cup fixation.

Total Hip Arthroplasty in Protrusio Acetabuli: A Systematic Review.

Protrusio acetabuli, or abnormal protrusion of the femoral head into the acetabulum, requires performance of a total hip arthroplasty (THA) for which various reconstruction techniques and outcomes have been described. The aim of this systematic review is to provide a comprehensive analysis of the current evidence, evaluate treatment efficacy, compare surgical techniques, and identify topics for future research along with improving evidence-based decision-making, improving patient outcomes in the management of this condition. A thorough systematic review of the PubMed, Embase, Cochrane Library databases, and Scopus library was conducted, and articles describing techniques of THA for treatment of protrusion acetabuli were extracted. The initial search generated 751 results. After exclusion, 18 articles were included. Of these, eight were prospective studies and 10 were retrospective. Surgery was performed on 783 hips with a mean age of 60 years; 80% of females who mostly had inflammatory arthritis were followed up for 8.86 years (range, 2-15.4 years). Good outcomes have been achieved with THA using uncemented cups with bone graft; however, no conclusion could be drawn with regard to the femoral side. It can be concluded that the concept of restoration of the anatomical hip center of rotation is paramount for good outcome and better survival of the implant is important when using uncemented cups with a bone graft. In addition, screw augmentation for fixation is not recommended unless absolutely necessary. The most common complications were aseptic loosening and heterotopic ossification. While the former required revision, conservative management was administered for the latter.

Application of high hip center technique in total hip arthroplasty in patients with Crowe typeⅡand Ⅲ developmental dysplasia of hip and severe hip osteoarthritis

To explore the clinical efficacy of high hip center technique total hip arthroplasty （THA） for Crowe Ⅱand Ⅲ developmental dysplasia of hip （DDH） and severe hip osteoarthritis （HOA）. From January 2018 to January 2020, 74 patients with Crowe typeⅡand Ⅲ DDH and severe HOA were admitted, and 37 cases of anatomical hip center reconstruction were taken as control group, including 7 males and 30 females, aged from 42 to 65 years old with an average of （58.40±4.98） years old, body mass index （BMI） ranged from 18 to 29 kg·m-2 with an average of （23.02±2.21） kg·m-2. Thirty-seven routine high hip center technical reconstruction were performed as study group, including 5 males and 32 females, aged from 41 to 65 years old with an average of （57.31±5.42） years old, BMI ranged from 18 to 29 kg·m-2 with an average of （23.14±2.07） kg·m-2. The patients presented with hip pain, limited function and range of motion, and gait instability before surgery. All patients underwent THA, the control group underwent intraoperative anatomical hip center reconstruction, and the study group underwent intraoperative high hip joint reconstruction. The perioperative indicators of the two groups were compared. The hip joint function, balance function and gait of the patients were evaluated before surgery, 3 months, 6 months, and 12 months after surgery. The length difference of both lower limbs, horizontal distance of rotation center, vertical distance of rotation center and femoral eccentricity were measured before operation and 1 year after operation. The incidence of complications in the two groups during the operation and postoperative follow-up was counted. The operation time of the study group was shorter than that of the control group, and the intraoperative blood loss was less than that of the control group （P<0.05）. After 12-months follow-up, 1 was lost to followvup in study group and 2 were lost to follow-up in control group. The Harris scores and Berg balance scale（BBS）, pace, stride frequency and single step length in the study group were higher than those in the control group at 3 months and 6 months after operation （P<0.05）；there was no statistically significant difference between the two groups in the indexes 12 months after operation （P>0.05）. The vertical distance of the center of rotation of the study group was greater than that of the control group 12 months after operation （P<0.05）, and there was no significant difference in the length difference of the lower limbs, the horizontal distance of the center of rotation, and the femoral eccentricity between two groups （P>0.05）. There were no complications in either group. The long-term effects of THA in patients with DDH and severe HOA were similar between the two central hip reconstruction methods, and the safety was good, and the high hip central reconstruction technique could shorten the operation time and reduce the amount of intraoperative blood loss.At the same time, it has certain advantages in early recovery of hip joint function, balance function and walking function of patients.

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.

Optimal retractor insertion point for nerve safety during total hip arthroplasty: an anatomical study on the femoral and sciatic nerves in relation to hip motion.

Nerve injury is one of the most serious complications of total hip arthroplasty (THA). It is suspected to be a result from nerve compression or direct injury caused by an acetabular retractor. The anatomical relationship between the acetabular rim and the femoral and sciatic nerves, including hip motion, has not been investigated. This study aimed to identify the optimal position for retractor insertion during THA to prevent nerve damage. A total of 28 hip joints from 14 freshly frozen cadavers were used. Using an anterolateral approach, each cadaver was immobilised in the lateral decubitus position and deployed to measure the distance between the nerves and the acetabular rim, while the hip joint was changed to the extension, neutral, and flexion positions. Three femoral nerves were closest to the anterior margin of the acetabulum at 90° and 120° of extension and farthest away at 30° of flexion. The sciatic nerve was closest to the posterior margin of the acetabulum at 90° and 120° of flexion and farthest away at 30° and 150° of extension compared with the other points. To prevent nerve damage during THA, we suggest that the retractor be inserted at the points where the nerves are the farthest away, such as at 30° and 150°. The femoral and sciatic nerves vary in their movements depending on the hip position. Therefore, the safe insertion of a retractor is recommended for hip flexion of the femoral nerve and extension of the sciatic nerve. Additionally, it is important to carefully insert the retractor along the acetabular margin without penetrating the joint capsule. Overall, this study provides valuable insights into the anatomical location and movement of the femoral and sciatic nerves in relation to hip motion and can help inform surgical techniques for safer THA.

Long-term results of total hip arthroplasty in severe congenital hip disease: A ten- to 20-year follow-up study

IntroductionThe impact of bone deformities, previous surgeries, and the surgical technique in total hip arthroplasty (THA) for congenital dislocation of the hip (CDH) at a long-term has not been clearly defined yet. In this single-centre observational study we sought to assess patients undergoing THA due to osteoarthritis secondary to severe CDH with low or high dislocation ten- to 20-years after surgery. To determine this purpose, we assessed: (1) THA-related complications and reoperations; (2) the clinical outcome, patients’ satisfaction and radiological results; and (3) the possible risk factors for reoperation with particular attention to the surgical technique and the influence of prior surgeries. HypothesisWe hypothesized that an anatomical reconstruction of the hip would decrease the reoperations rates in patients undergoing THA with severe CDH. MethodsSeventy-five patients (85 hips) operated between 1999 and 2012 at our large tertiary hospital were analyzed. Fifty-six hips were diagnosed as low dislocation (group 1) and 29 hips as high dislocation (group 2). The existence of prior surgeries was frequent: group 1, pelvic osteotomies 6 hips, femoral osteotomies 7, tectoplasty (shelf) 6, resection arthroplasty 1 and lowering of the greater trochanter 1; group 2 included pelvic osteotomies 10 hips, femoral osteotomies 10, and a femoral lengthening 2. The number of additional procedures during THA was: group 1 (19/56 [34%]), acetabular roof bone autograft 8 hips, acetabular medial wall autograft 2, hardware removal 6, extended femoral osteotomy 2, and a femoral shortening 1; group 2 (20/29 [69%]), acetabular bone autograft 12 hips, medial autograft 1, hardware removal 1, extended femoral osteotomy 2, and a femoral shortening 4 hips. The clinical and the radiological analysis were compared in both groups for a minimum follow-up of ten years. Cox regression models were used to detect risk factors for reoperation. ResultsNine patients (13.8%) required reoperation for the following reasons: cup loosening (5 hips), periprosthetic femoral fracture (3) and stem loosening (1); seven had prior surgeries. The 12-year survival rate for reoperation for any reason was 96.3% (95% confidence interval [CI] 91.2–100) in group 1 and 75.7% (95% CI, 65.8–90.8) in group 2 (p=0.003). Patients with high dislocation (p=0.02, hazard ratio [HR]: 6.25, 95% CI, 1.26–30.9) and those with an acetabular component inclination placed out of the target zone between 35° and 50° (p=0.03, HR: 4.27, 95% CI, 1.13–16.1) had a higher risk of reoperation. DiscussionAn optimal placement of the acetabular component decreased the reoperation rates in patients undergoing THA for severe CDH. Hips with high dislocation and the existence of prior surgery can affect THA implantation. Level of evidenceIII; retrospective; comparative.

Effectiveness of combined anteversion angle technique in total hip arthroplasty for treatment of ankylosing spondylitis affecting hip joint

To explore the effectiveness of the combined anteversion angle technique in total hip arthroplasty (THA) for treating ankylosing spondylitis (AS) affecting the hip joint. A retrospective analysis was conducted on the clinical data of 73 patients with AS affecting the hip joint who underwent THA between August 2018 and August 2021. According to whether the combined anteversion angle technique was used in THA, the patients were divided into study group (37 cases, combined anteversion angle technique was used in THA) and control group (36 cases, traditional THA). There was no significant difference in baseline data such as gender, age, body mass index, disease duration, preoperative Harris score, range of motion (ROM), acetabular anteversion angle, acetabular abduction angle, femoral anteversion angle, and combined anteversion angle between the two groups ( P>0.05). The operation time, hospital stay, and complications of the two groups were recorded and compared. The Harris score and hip ROM were compared between the two groups before operation, at 1, 3, 6, 12 months after operation, and at last follow-up. The acetabular component anteversion angle, femoral component anteversion angle, acetabular component abduction angle, and component combined anteversion angle were measured postoperatively. The operation time in the study group was significantly shorter than that in the control group ( P<0.05), and there was no significant difference in hospital stay between the two groups ( P>0.05). There was no intraoperative complication such as acetabular and proximal femoral fractures, neurovascular injuries in both groups, and the incisions healed by first intention. All patients were followed up 2-3 years, with an average of 2.4 years; there was no significant difference in the follow-up time between the two groups ( P>0.05). During the follow-up period, there was no complication such as hip dislocation, wound infection, delayed wound healing, deep venous thrombosis, and hip dislocation in both groups. The hip Harris score and ROM of the two groups gradually increased with time after operation, and the differences were significant when compared with those before operation ( P<0.05); the above two indicators of the study group were significantly better than those of the control group at each time point after operation ( P<0.05). Extensive bone ingrowth on the surface of the components could be observed in the anteroposterior X-ray films of the hip joint of the two groups at 12 months after operation, and the acetabular components was stable without femoral stem subsidence, osteolysis around the components, and heterotopic ossification. At last follow-up, the acetabular component anteversion angle, femoral component anteversion angle, and component combined anteversion angle in the study group were significantly superior to those in the control group ( P<0.05), except that there was no significant difference in the acetabular component abduction angle between the two groups ( P>0.05). For patients with AS affecting the hip joint, the use of the combined anteversion angle technique during THA effectively promotes the recovery of hip joint function and enhances the postoperative quality of life of patients when compared to traditional THA.

Automated digital templating of component sizing is accurate in robotic total hip arthroplasty when compared to predicate software

Accurate pre-operative templating of prosthesis components is an essential factor in successful total hip arthroplasty (THA), including robotically-assisted THA (RA-THA) techniques. We sought to validate the accuracy of a novel, robotic-optimized THA planning software compared to a predicate THA planner for component sizing. We analyzed a series of 199 patients who received manual THA (mTHA) and fluoroscopy-based RA-THA at a single institution. All cases were templated using a predicate pre-operative templating software. For RA-THA cases, the novel robotic-optimized pre-operative planner software was also used for templating. The differences between templated and implanted acetabular cup, femoral head, and stem component sizes were compared based on matching within 1, 2, and ≥3 sizes. Differences in templated and implanted femoral stem implant geometry were also compared. The robot-optimized pre-operative RA-THA plans demonstrated equivalent accuracy to that of predicate pre-operative plans for both RA-THA and mTHA cases. Templated acetabular cups (90.4 vs. 86.8 vs. 82.8; p = 0.421), femoral stems (76.0 vs. 65.1 vs. 67.7; p = 0.096), and femoral heads (91.3 vs. 96.2 vs. 88.2; p = 0.302) were within +/−1 size of implanted components. No significant differences were detected in the proportion of matching templated and implanted stem geometry across the study cohorts.

Mako® Robotic-Arm Assisted Total Hip Arthroplasty: Avoiding Impingement with Updated THA Software.

The use of robotic-assisted total hip arthroplasty and three-dimensional computed tomography scan-based templating has become increasingly popular over the last 10 years. However, proper planning and execution are vital to producing optimal patient outcomes. In order to achieve these outcomes, the robotic-assisted system requires training, familiarity, and experience. The goal of this article is to provide clear and condensed examples of preoperative planning, as well as adjustments that one can make to avoid impingement. The surgical technique for robotic-assisted total hip arthroplasty is also briefly discussed. Examples will be given using the latest computed tomography (CT) scan-based robotic platform for osteoarthritic hips, with specific examples of various cases of impingement that might be encountered by the surgeon and how to ultimately avoid this problem when performing the arthroplasty. This article, through case histories, will discuss the various principles and adjustments that can be made to place components in the ideal location based on individual anatomy.

A Systematic Review of Functional Outcome after Lateral Surgical Approach for Total Hip Arthroplasty

Introduction: Osteoarthritis affects 10% of the population, primarily affecting weight-bearing joints such the hips (5%) and other joints. A total hip arthroplasty (THA) is typically required (2.5% of persons between the ages of 40 and 84) as a result of worsening gait, rising pain, and stiffness. There have been many different surgical methods for the hip mentioned. The posterior and direct lateral approaches are currently the main THA techniques. The direct lateral method is said to have the advantage of allowing good acetabular exposure and simplifying cup alignment, which may lower hip dislocation rates. Additionally, it reduces the chance of damaging the sciatic nerve far from the surgical site. Materials and Methods: The prospective study on 25 patients with unilateral osteoarthritis, aged 25 to 60 years was carried out at Department of Orthopaedic surgery, Bangabandhu Sheikh Mujib Medical University and different private hospital at Dhaka, Bangladesh from September 2020 to March 2023 where outcome of uncemented THR by Direct Lateral approach was recorded. Evaluation of the results was done the day before the procedure as well as one month, three months, six months, and twelve months thereafter. Aim: The main objective was to find out functional outcome of patients after total hip arthroplasty by direct lateral approach. Results: Total 25 Patients with unilateral osteoarthritis have undergone uncemented total hip arthroplasty by Lateral approach, n= 25; 12(48%) were female and 13 (52%) were male. The mean age of patients was 42.5 years range from 25-60 years. Right Side was predominantly affected in all cases. VAS, HHS and WOMAC scores significantly improved at the follow-up after THA by the LA (all p &lt; 0.05). A VAS score preoperatively was 8.7 which was improved 2.5 at 12 months follow up with significant p value &lt;0.001. Conclusion: Patients who had Total Hip Arthroplasty performed with the Lateral Approach reported significiant improvement in functional outcomes with less postoperative muscle damage, stiffness, and pain during daily activities.

The periarticular vasoconstrictor infiltration technique (PVI) for total knee and hip arthroplasty. A brief description of a new technique complemented by audiovisual presentations

The periarticular vasoconstrictor infiltration technique (PVI) for total knee and hip arthroplasty. A brief description of a new technique complemented by audiovisual presentations

Combined Anteversion Technique for Total Hip Arthroplasty With Handheld Accelerometer-Based Navigation System.

IV (technical note).