Accuracy of combined anteversion in image-free navigated total hip arthroplasty: stem-first or cup-first technique?
Accuracy of combined anteversion in image-free navigated total hip arthroplasty: stem-first or cup-first technique?
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DOI：
10.1007/s00264-015-2784-9
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发表时间：
2016-01-01
影响因子：
2.7
通讯作者：
Yoshiya, Shinichi
中科院分区：
文献类型：
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作者：
Fukunishi, Shigeo;Nishio, Shoji;Yoshiya, Shinichi
目的 在全髋关节置换术 (THA) 中，联合前倾角 (CA) 被用作评估整体假体对齐的参数。本研究的目的是比较检查使用无图像导航系统（采用杯优先或茎优先技术）进行初次 THA 的患者的 CA 值。 方法 本研究纳入了 83 个使用 OrthoPilotA (R) 无图像导航系统（B. Braun-Aesculap，图特林根，德国）进行初次 THA 的髋关节。根据所使用的程序，将患者群体分为两组：先杯技术和先茎技术。在先杯组中，倾斜和前倾 (AV) 角分别目标为 35-45 度和 15-25 度，而柄前倾 (AT) 则根据个体股骨天然 AT 角的大小确定。在先柄组中，首先以与天然股骨 AT 相对应的目标角度制备股骨，并考虑使用 Widmer 公式计算的 CA 来确定杯 AV（以最佳 Widmer 的 CA 为 37.3 度为目标）。结果 如较小的 SD 值所示，先柄组中 Widmer 的 CA 值具有更好的一致性。在整体对位评估中，杯优先组和柄优先组中分别有 41.9% 和 92.3% 的 Widmer CA 值在满意范围内（37 +/- 5 度）。 结论 采用无图像导航全髋关节置换术的柄优先技术可以有效实现对 CA 值的精确一致控制，从而有望改善手术效果。
Purpose In total hip arthroplasty (THA), combined anteversion (CA) is used as a parameter for assessment of overall prosthetic alignment. The purpose of this study was to comparatively examine the CA value in patients who underwent primary THA using the image-free navigation system either with a cup-first or stem-first technique.Methods Eighty-three hips undergoing primary THA using the OrthoPilotA (R) image-free navigation system (B. Braun-Aesculap, Tuttlingen, Germany) were included in this study. The patient population was divided into two groups depending on the procedure used: cup-first technique and stem-first technique. In the cup-first group, inclination and anteversion (AV) angles were targeted at 35-45 degrees and 15-25 degrees, respectively, while stem antetorsion (AT) was determined for each patient based on the amount of individual native femoral AT angle. In the stem-first group, the femur was prepared first with the target angle corresponding to the native femoral AT and the cup AV was decided considering the CA calculated with Widmer's formula (aiming at the optimal Widmer's CA of 37.3 degrees).Results Better consistency in Widmer's CA values was attained in the stem-first group as indicated by the smaller SD values. In the assessment of overall alignment, Widmer's CA values were within the satisfactory range (37 +/- 5 degrees) in 41.9 and 92.3 % of the subjects in the cup-first group and the stem-first group, respectively.Conclusions The stem-first technique with image-free navigated THA could effectively achieve accurate and consistent control of the CA value and thus is expected to improve the surgical outcome.