Computed tomography-based navigation to determine the socket location in total hip arthroplasty of an osteoarthritis hip with a large leg length discrepancy due to severe acetabular dysplasia.
ABSTRACT For osteoarthritis hips due to severe acetabular dysplasia such as Crowe type 3 or 4, placement of the socket is a difficult procedure in total hip arthroplasty. Because the acetabular bone stock is poor, suitable location for the socket is very limited with respect to achieving good coverage with the host bone. A 51-year-old woman who had an osteoarthritis hip with a large leg length discrepancy due to severe acetabular dysplasia required total hip arthroplasty. The purpose of the total hip arthroplasty was to improve the hip disorder as well as to reduce the leg length discrepancy to achieve good gait function. We present technical solutions to aid the surgeons in placing the acetabular socket at the proper location by using computed tomography-based navigation system.
SourceAvailable from: Hiroyuki Tsuchiya[Show abstract] [Hide abstract]
ABSTRACT: Although some navigation systems have been used for improvement of component positioning, there have been few reports regarding cases of severe pelvic deformity. We performed a retrospective review of 25 cases of total hip arthroplasty with a computed tomography-based navigation system in patients with severe pelvic deformities and estimated acetabular component position and angle between severe deformity group and mild dysplastic group as a control. There were no significant differences in accuracy of navigation system between 2 groups in terms of 3-dimensional component position or angle. Accuracy of computed tomography-based hip navigation does not depend on the degree of pelvic deformity, and this system is also useful to identify acetabular orientation and for precise component implantation in cases of pelvic deformity.The Journal of arthroplasty 04/2012; 27(9):1651-7. DOI:10.1016/j.arth.2012.03.009 · 2.37 Impact Factor
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ABSTRACT: Purpose This study assessed the accuracy of cup and stem positioning and limb length adjustment for developmental dysplasia of the hip (DDH) using our new mechanical technique compared with imageless navigation or a computed tomography (CT)-based navigation system. Methods One hundred thirteen primary total hip arthroplasties (THAs) for DDH were evaluated. At pre-operative positioning, patients were placed in a precise lateral decubitus position by tilting the surgical table using simple ready-made devices (two shot pipe, metal chain, level gauge and goniometer). During surgery, cups were intentionally placed at 45° inclination and 15° anteversion on radiograph by using a level gauge and goniometer. Results Cup inclination was 44.2° ± 3.4° (range, 32.0–51.2°), cup anteversion was 19.6° ± 6.1° (range, 3.0–33.1°), stem alignment was 0.04° ± 0.8° valgus (range, 2.1° varus to 1.9° valgus), and leg length discrepancy was −0.37 ± 3.7 mm (range, −12.8 to 8.8 mm) in postoperative radiographs. Outliers (outside ±10° from intentional position) occurred in 15 cases (13.3 %) in inclination or anteversion. Postoperative dislocation did not occur in any cases. Conclusions Cup and stem positioning in THAs with our new mechanical technique yielded satisfactory results compared with previously reported imageless navigation or CT-based navigation. Our results were superior with regard to being non-invasive and low cost and involving minimum radiation exposure.International Orthopaedics 12/2014; DOI:10.1007/s00264-014-2613-6 · 2.02 Impact Factor
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ABSTRACT: In the conversion of an arthrodesed hip to a total hip arthroplasty, the osteotomy of the femoral neck and the placement of the acetabular socket are difficult procedures as anatomical abnormalities hamper identification of the femoral neck and of the original center of the acetabulum. A 59-year-old woman who had a hip arthrodesis for dysplastic osteoarthritis at 21 years of age underwent total hip arthroplasty for relief of back pain, achievement of good gait function, and improvement of activities of daily living. In this report, we introduce a technical solution, using a computed tomography-based navigation system to determine the site and direction of the femoral neck osteotomy and the positioning of the acetabular socket.The Journal of arthroplasty 03/2009; 24(8):1292.e1-4. DOI:10.1016/j.arth.2008.12.005 · 2.37 Impact Factor