The application of digital radiography in orthopaedic settings has facilitated the improvement in the retention and utilization of these images in pre and post-operative assessments [1]. In addition to the cost-effectiveness of such technology the use of digital imaging combined with advanced computer image processing software such as TraumaCadTM software system (TraumaCad, BRAINLAB, Westchester, IL, USA) can provide more accurate details about patients in total hip replacement arthroplasty (THA), a process traditionally called preoperative templating [2] by which intraoperative complications are minimized and overall surgical time is reduced[3]. In a study of 486 patients we demonstrated that patients demographic had significant effect on the outcome of the measurement and utilizing them in a predictive model had helped with improving the results [4]. In this study, we aimed to improve and optimize the proposed algorithm by utilizing more patients’ information and improving the model by using a nonlinear relationship. Our main hypothesis in this study was that the model would significantly predict the actual implant size based on the preoperative assessments. We analyzed the outcome of digital radiographs of 1018 patients who were treated with THA. Digital radiographs were acquired in the anteroposterior view of the pelvis centered over the pubic symphysis. The hip was internally rotated 10° to 15°. We evaluated multiple interactions and nonlinear models and developed the most significant model based on the available clinical data.Introduction
Method
Minimum
Maximum
Mean
Std. Deviation
Templated Acetabulum Size
44.00
64.00
54.12
4.05
Height (m)
147.32
202.20
172.02
10.73
Weight (kg)
39.10
139.10
84.44
19.67
BMI
15.48
43.06
28.33
5.18
Acetabular Size
44.00
64.00
54.25
3.75
The concept of neck preserving stems, known as short femoral stems or metaphyseal stems has been utilized to improve the outcomes of standard cementless stems. The preservation of the proximal femoral bone stock results in decreasing the potential stress shielding and thigh pain. Additionally, these stems may be used in less invasive procedures and provide the option for easier revision procedures if implant failure occurs. In this study we aim to demonstrate the clinical outcome of direct anterior approach of total hip arthroplasty (THA) with short stem prosthesis. In this study, 390 total cases of THA in 345 patients who underwent an anterior approach of THA by using a new type of short-stem prosthesis (Minihip, Corin) between 2009 and 2013 were reviewed. There were 282 male and 62 female patients and Table 1 summarizes the demographics. In 48 cases avascular necrosis (AVN) was the diagnosis and 339 cases were reported to be due to osteoarthritis. Twenty eight patients were assessed to have American Society of Anesthesiologist (ASA) physical functional score of class I, 258 patients had class II, 103 had class III, and 1 had class IV. Table 2 shows the Charnley classification of the patients. In the current study we evaluated the outcomes of the surgery by utilizing Hip Disability and Osteoarthritis Outcome Score (HOOS) subscales (Pain, Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport) and hip related Quality of life (QOL)).Introduction
Methods
Cementless stems have been used in treatment of patients with osteoarthritis however, the new design concept of neck preserving stems also known as short femoral stems have been utilized to decrease the potentially adverse symptoms of the standard stems such as stress shielding and thigh pain. In this ongoing study we aim to demonstrate the clinical and radiographic outcome of direct anterior approach of total hip arthroplasty (THA) by using short stem prosthesis. In this study, 390 total cases of THA in 345 patients who underwent an anterior approach of THA by using a short-stem prosthesis (Minihip, Corin) between 2009 and 2013 were reviewed. This group included 282 male and 62 female patients. Table 1 summarizes the demographic information of the patients. In 48 cases avascular necrosis (AVN) was the diagnosis and 339 cases was reported to be due to osteoarthritis. Twenty eight patients were assessed to have American Society of Anesthesiologist (ASA) physical functional score of class I, 258 patients had class II, 103 had class III, and 1 had class IV. In the current study we evaluated the outcomes of the surgery by utilizing Hip Disability and Osteoarthritis Outcome Score (HOOS) subscales (Pain, Symptoms, Function in daily living (ADL), Function in sport and recreation (Sport/Rec) and Quality of life (QOL)).Introduction
Methods
The application of digital radiography in clinical settings has provided the opportunity to obtain high quality images while reducing the overall cost of imaging, thus this technology is gaining more popularity in clinical settings specifically in orthopaedic clinics 1. In addition, advanced computer software helps with quick and easy approach to perform preoperative measurements with high accuracy 2. Preoperative templating has become one of the standard of care procedures that prepares the surgical team to lower surgical time and more efficiently face intraoperative complications 3. Commonly, the acetabular cup size and femoral stem size are templated and used for estimation process 4. However, the goal of this study was to investigate whether patients' demographics would play a role in increasing the accuracy of templating. We hypothesized that preoperative implant templating (acetabular and femoral components), gender, weight, height, and body mass index (BMI) would contribute to higher accuracy of templating in total hip arthroplasty (THA). Digital radiographs of 468 patients treated with THA from August 2012 to December 2013 at a single institution were reviewed. They aged 59.96 ±12.50 years and 436 of them were diagnosed with osteoarthritis, 53 with avascular necrosis, 13 with failed THA, 2 with infection, 4 post trauma, and 13 with failed hemi arthroplasty. THA templating was conducted by assessing the anteroposterior view of the pelvis that was centered over the pubic symphysis, with the hips in 10° to 15° of internal rotation and we utilized a lateral frog-leg view of the affected hip. A backward stepwise multiple regression model was used to exclude the parameters that had no significant contribution to the accuracy of the measurement.Introduction
Method
Unicompartmental knee replacement (UKR) facilitates the use of smaller sized implants that require less bone resection and allows preservation of the anterior and posterior cruciate ligaments (ACL and PCL)[1]. Therefore, UKR preserves the intact kinematics and may improve the clinical outcomes especially compared to the outcomes of total knee replacement (TKA). Despite the known benefits of UKR in arthritis limited to one compartment, in multicompartment disease TKA remains the gold standard. Current TKA designs require the sacrifice of the ACL in all cases, whereas the surgeon can decide to use a cruciate sparing or substituting design altering normal knee kinematics. Performing bi-UKR or tri-UKR with traditional instruments is very challenging and rarely done due to the difficulty in establishing the correct spatial relationship of the separate components. Recent advances in robotic surgery have provided the opportunity to utilize partial knee replacements. The MAKO Rio platform is a surgeon-interactive robotic arm with haptic guidance that allows computer assisted planning and intraoperative accurate placement of multiple unicompartmental components including the bi-UKR. Currently there is a lack of understanding about the short-term and long-term clinical outcomes of the bi-UKR compared to the traditional TKA. The objective of the current study was to investigate the differences in the clinical outcomes of bi-UKR and TKA.INTRODUCTION:
OBJECTIVES:
The popularity of the direct anterior approach (DAA) for total hip arthroplasty (THA) is increasing as this approach causes less soft tissue damage and no muscular detachments and significantly shorter postoperative recovery time. Despite the promising early results the complication rate in the DAA cases has been concerning such as 9% rate in 247 DAA cases reported by Woolen et. al [1]. As DAA has not conventionally being used by surgeons these complications are expected to be reduced when the surgeons are more experienced. Therefore to better understand the issues that cause the postop complications in DAA we have conducted the present study. The objective of the current study is to investigate the postop complications in individuals with arthritic hips treated by DAA THA over a period of 3.5 years by a one surgeon.INTRODUCTION:
OBJECTIVES:
The current study was conducted to report the short-term clinical outcome of the THA by using Minihip neck preserving stem.INTRODUCTION:
OBJECTIVES:
