Dynamic evaluation of THA components by Prosthesis Impingement Software (PIS)
Keywords:
total hip arthroplasty, tha, dislocation, software, revision surgery, range of motion, impingementAbstract
Background and aim of the work
Implant dislocation in total hip arthroplasties (THA) is a common concern amongst the orthopedic surgeons and represents the most frequent complication after primary implant. Several causes could be responsible for the dislocation, including the malpositioning of the components. Conventional imaging techniques frequently fail to detect the mechanical source of dislocation mainly because they could not reproduce a dynamic evaluation of the components. The purpose of this study was to elaborate a diagnostic tool capable to virtually assess if the range of movement (ROM) of a THA is free from anterior and/or superior mechanical impingement. The ultimate aim is to give the surgeon the possibility to weigh the mechanical contribution in a THA dislocation.
Methods
A group of patients who underwent THA revision for acute dislocation was compared to a group of non-dislocating THA. CT scans and a virtual model of each patient was obtained. A software called “Prosthesis Impingement Simulator (PIS)” was developed for simulating the (ROM) of the prosthetic hip. The ROM free of mechanical impingement was compared between the two groups.
Results
The PIS test could detect the dislocations with a sensitivity of 71,4%, and a specificity of 85,7%. The Fisher’s exact test showed a p-value of 0,02. The Chi-square test found a p-value of 0,009.
Conclusion
The PIS seems to be an effective tool for the determination of hip prosthetic impingement, as the main aid of the software is the exclusion of mechanical causes in the event of a dislocation.
References
2. Parvizi J, Picinic E, Sharkey P. Revision total hip arthroplasty for instability: surgical
techniques and principles. J Bone Joint Surg [Am] 2008;90-A:1134–1142.
3. Bolland BJ, Whitehouse SL, Timperley AJ. Indications for early hip revision surgery in the UK–a re-analysis of NJR data. Hip Int. 2012;22:145–152.
4. Bozic KJ, Ong K, Lau E, et al. Risk of complication and revision total hip arthroplasty among medicare patients with different bearing surfaces. Clin Orthop Relat Res. 2010;468:2357–2362.
5. Dargel J, Oppermann J, Brüggemann GP, Eysel P. Dislocation following total hip replacement. Dtsch Arztebl Int. 2014 Dec; 111(51-52): 884–890.
6. Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res 2002; 405: 46–53.
7. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978;60:217–220.
8. Amlie E, Hovik O, Reikeras O. Dislocation after total hip arthroplasty with 28 and 32-mm femoral head. J Orthop Traumatol. 2010;11:111–115.
9. Howie DW, Holubowycz OT, Middleton R. Large femoral heads decrease the incidence of dislocation after total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am. 2012;94:1095–1102.
10. Lawrence D. Dorr, John J. Callaghan. Death of the Lewinnek “Safe Zone”. Journal of Arthroplasty. 2019 Editorial volume 34, issue 1, p1-2,
11. Wines AP, McNicol D. Computed tomography measurement of the accuracy of component version in total hip arthroplasty. J Arthroplasty 2006; 21: 696–701.
12. Woerner M, Weber M, Sendtner E, et al. Soft tissue restricts impingement-free mobility in total hip arthroplasty. Int Orthop. 2017 Feb;41(2):277-282.
13. Fessy MH, Putman S, Viste A, et al. What are the risk factors for dislocation in primary total hip arthroplasty? A multicenter case-control study of 128 unstable and 438 stable hips. Orthop Traumatol Surg Res. 2017 Sep;103(5):663-668.
14. Ghaffari M, Nickmanesh R, Tamannaee N, Farahmand F. The impingement-dislocation risk of total hip replacement: effects of cup orientation and patient maneuvers. Conf Proc IEEE Eng Med Biol Soc. 2012;2012:6801-4.
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