Abstract
Introduction
Lesion location and volume are critical factors to select patients with osteonecrosis for whom resurfacing arthroplasty is appropriate. However, no reliable surgical planning system which can assess relationship between necrotic lesions and the femoral component has been established. We have developed a 3D-MRI-based planning system for resurfacing arthroplasty. The purpose of the present study was to evaluate its feasibility.
Methods
The subjects included five patients with osteonecrosis of ARCO stage 3 or 4 who had undergone resurfacing THA at our institute. All patients had an MRI before surgery using 3D-SPGR sequences and fat suppression 3D-SPGR sequencea. In cases where it was difficult to distinguish bone marrow edema and reparative zone on 3D-SPGR images, fat suppression 3D-SPGR sequences were used. Simulation of resurfacing arthroplasty was performed on image analysis software where multidirectional oblique views could be reconstructed. The femoral neck axis was determined by drawing line through centers of two spheres which were fitted to the normal portion of the femoral head and the mid-portion of femoral neck. A femoral component was virtually implanted to align the femoral neck axis and match the implant center and femoral head center.
Results
Planning could be performed within 10 minutes in every case. In all cases, size selection of acetabular and femoral component was within 1 size of actually implanted components. This 3D-MRI based planning system was useful to assess proportion and location of necrotic lesion in the preserved portion of femoral head in resurfacing THA.
Conclusion
This preliminary study demonstrated that a 3D-MRI based planning system was useful in surgical planning of resurfacing arthroplasty for patients with osteonecrosis.
