Use of a Digital Protractor and a Spirit Level to Determine the Intraoperative Anteversion of Femoral Component during Cemented Hip Hemiarthroplasty: a Prospective Clinical Trial | ||
The Archives of Bone and Joint Surgery | ||
مقاله 3، دوره 7، شماره 4، مهر 2019، صفحه 314-320 اصل مقاله (1.27 M) | ||
نوع مقاله: RESEARCH PAPER | ||
شناسه دیجیتال (DOI): 10.22038/abjs.2018.33936.1894 | ||
نویسندگان | ||
Anuwat Pongkunakorn* ؛ Patanapong Palawong؛ Swist Chatmaitri؛ Nawakun Phetpangnga | ||
Department of Orthopaedic Surgery, Lampang Hospital and Medical Educational Center, Mueang District, Lampang, Thailand | ||
چکیده | ||
Background: Femoral stem anteversion during hip arthroplasty is generally estimated by eye intraoperatively and has proven to be different from targeted values. This study aims to determine the accuracy of a novel technique using a digital protractor and a spirit level to improve surgeons’ estimation of stem anteversion. Methods: A prospective non-randomized study was conducted among 93 patients with femoral neck fracture who underwent cemented hemiarthroplasty via posterolateral approach. In the control group (N=62), five experienced surgeons assessed stem anteversion related to the posterior femoral condylar plane using visual estimation with a target angle of 15°-25°. In the study group (N=31), another two surgeons assessed stem anteversion with the same target angle by placing a digital protractor on the femoral stem inserter handle while the assistant held the leg in the truly vertical position, verified by a spirit level that was attached to the shin with cable ties. Stem anteversion was measured blind, postoperatively, on 2D-CT and compared with the intraoperative results. Results: The mean postoperative anteversion was 22.4° (-4.2° to 51.3°, SD 11.1°) in the control group and 23.0° (16.0° to 29.9°, SD 3.6°) in the study group (P=0.810). The study group had more stems positioned in 15°-25° anteversion (71.0% vs 32.3%, P=0.001) and the mean absolute value of surgeon error was -0.2° (-5.4° to 7.0°, SD 3.0°). Twentyeight stems of the study group (90.3%) had an error within 5°. Surgeon overestimation >5° was found in 1 hip (3.2%) and underestimation >5° was found in 2 hips (6.4%). Conclusion: Using a digital protractor and a spirit level was reliable with high accuracy and precision to improve the intraoperative estimation of cemented stem anteversion. Level of evidence: II | ||
کلیدواژهها | ||
Digital protractor؛ Femoral stem anteversion؛ Hip arthroplasty؛ Spirit level | ||
مراجع | ||
1. Kiernan S, Hermann KL, Wagner P, Ryd L, Flivik G. The importance of adequate stem anteversion for rotational stability in cemented total hip replacement: a radiostereometric study with ten-year follow-up. Bone Joint J. 2013; 95-B(1):23-30. 2. Gill HS, Alfaro-Adrián J, Alfaro-Adrián C, McLardy-Smith P, Murray DW. The effect of anteversion on femoral component stability assessed by radiostereometric analysis. J Arthroplasty. 2002; 17(8):997-1005. 3. Olofsson K, Digas G, Kärrholm J. Influence of design variations on early migration of a cemented stem in THA. Clin Orthop Relat Res. 2006; 448(1):67-72. 4. Flugsrud GB, Nordsletten L, Espehaug B, Havelin LI, Meyer HE. The effect of middle-age body weight and physical activity on the risk of early revision hip arthroplasty: a cohort study of 1,535 individuals. Acta Orthop. 2007; 78(1):99-107. 5. van Embden D, van Gijn W, van de Steenhoven T, Rhemrev S. The surgeon’s eye: a prospective analysis of the anteversion in the placement of hemiarthroplasties after a femoral neck fracture. Hip Int. 2015; 25(2):127-30. 6. Dorr LD, Wan Z, Malik A, Zhu J, Dastane M, Deshmane P. A comparison of surgeon estimation and computed tomographic measurement of femoral component anteversion in cementless total hip arthroplasty. J Bone Joint Surg Am. 2009; 91(11):2598-604. 7. Wines AP, McNicol D. Computed tomography measurement of the accuracy of component version in total hip arthroplasty. J Arthroplasty. 2006; 21(5):696-701. 8. Hirata M, Nakashima Y, Ohishi M, Hamai S, Hara D, Iwamoto Y. Surgeon error in performing intraoperative estimation of stem anteversion in cementless total hip arthroplasty. J Arthroplasty. 2013; 28(9):1648-53. 9. Dorr LD, Malik A, Dastane M, Wan Z. Combined anteversion technique for total hip arthroplasty. Clin Orthop Relat Res. 2009; 467(1):119-27. 10. Eingartner C. Current trends in total hip arthroplasty. Orthop Traumatol Rehabil. 2007; 9(1):8-14. 11. Meermans G, Goetheer-Smits I, Lim RF, Van Doorn WJ, Kats J. The difference between the radiographic and the operative angle of inclination of the acetabular component in total hip arthroplasty: use of a digital protractor and the circumference of the hip to improve orientation. Bone Joint J. 2015; 97-B(5):603-10. 12. Sykes AM, Hill JC, Beverland DE, Orr JF. A novel device to measure acetabular inclination with patients in lateral decubitus. Hip Int. 2012; 22(6):683-9. 13. Sugano N, Noble PC, Kamaric E. A comparison of alternative methods of measuring femoral anteversion. J Comput Assist Tomogr. 1998; 22(4): 610-4. 14. Hsu A, Blomberg J. Femoral neck fracture cemented bipolar hemiarthroplasty. Lineage Medical. Available at: URL: http://www.orthobullets.com/ approaches/12087/hip-cemented-hemiarthroplasty; 2018. 15. Turley GA, Ahmed SM, Williams MA, Griffin DR. Validation of the femoral anteversion measurement method used in imageless navigation. Comput Aided Surg. 2012; 17(4):187-97. 16. Siston RA, Daub AC, Giori NJ, Goodman SB, Delp SL. Evaluation of methods that locate the center of the ankle for computer-assisted total knee arthroplasty. Clin Orthop Relat Res. 2005; 439(1):129-35. 17. Howell SM, Chen J, Hull ML. Variability of the location of the tibial tubercle affects the rotational alignment of the tibial component in kinematically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2013; 21(10):2288-95. 18. Mukka S, Lindqvist J, Peyda S, Brodén C, Mahmood S, Hassany H, et al. Dislocation of bipolar hip hemiarthroplasty through a postero-lateral approach for femoral neck fractures: a cohort study. Int Orthop. 2015; 39(7):1277-82. 19. Emami M, Manafi A, Hashemi B, Nemati A, Safari S. Comparison of intertrochanteric fracture fixation with dynamic hip screw and bipolar hemiarthroplasty techniques. Arch Bone Jt Surg. 2013; 1(1):14-7. | ||
آمار تعداد مشاهده مقاله: 453 تعداد دریافت فایل اصل مقاله: 497 |