Objective: The present research aims to determine if adherence to the Lewinnek safe zone, when exclusively considered, constitutes a pivotal element for ensuring stability in the context of total hip arthroplasty. Thi...Objective: The present research aims to determine if adherence to the Lewinnek safe zone, when exclusively considered, constitutes a pivotal element for ensuring stability in the context of total hip arthroplasty. This is done by examining the acetabular placement in instances of hip dislocation after total hip arthroplasty (THA). Methodology: The authors searched 2653 patient records from 2015 to 2022 looking for patients who had total hip arthroplasty at our facility. For the analysis, 23 patients were culled from 64 individuals who exhibited post-THA dislocations, employing a stringent exclusion criterion, and the resultant acetabular angulation and anteversion were quantified utilizing PEEKMED software (Peek Health S.A., Portugal) upon radiographic evidence. Results: Within the operational timeframe, from the cohort of 2653 subjects, 64 presented with at least a singular incident of displacement. Post-exclusion criterion enforcement, 23 patients were eligible for inclusion. Of these, 10 patients conformed to the safe zone demarcated by Lewinnek for both inclination and anteversion angles, while 13 exhibited deviations from the prescribed anteversion and/or inclination benchmarks. Conclusion: Analysis of the 23 patients reveals that 13 did not confirm to be in the safe zone parameters for anteversion and/or inclination, whereas 10 were within the safe zone as per Lewinnek’s guidelines. This investigative review, corroborated by extant literature, suggests that the isolated consideration of the Lewinnek safe zone does not suffice as a solitary protective factor. It further posits that additional variables are equally critical as acetabular positioning and mandate individual assessment.展开更多
Background: Although abduction of the acetabular component is considered to predict factors for polyethylene wear attributable to osteolysis, other radiographic factors have yet to be elucidated. The purpose of the pr...Background: Although abduction of the acetabular component is considered to predict factors for polyethylene wear attributable to osteolysis, other radiographic factors have yet to be elucidated. The purpose of the present study was to evaluate whether anteversion or change in implantation angle of the acetabular component influences polyethylene linear wear by using standing and supine radiographs of the hip joint. Methods: Standing and supine plain anteroposterior radiographs of 62 hip joints in which cementless total hip arthroplasty was performed were examined for polyethylene linear wear rate (mm/year), pelvic inclination, and radiological inclination and anatomic anteversion of the acetabular component. Results: All correlation coefficients of measurements of polyethylene linear wear, pelvic inclination angle, anatomical anteversion angle and radiological inclination angle were calculated highly. And by the three-dimensional numerical analysis, anatomic anteversion of the acetabular component had at least some effect on the degree of polyethylene wear. Conclusion: This study suggests that increased anteversion of the acetabular component reduces polyethylene linear wear in metal-on-polyethylene total hiparthroplasty.展开更多
BACKGROUND Selecting the optimal size of components is crucial when performing a primary total hip arthroplasty.Implanting the accurate size of the acetabular component can occasionally be exacting,chiefly for surgeon...BACKGROUND Selecting the optimal size of components is crucial when performing a primary total hip arthroplasty.Implanting the accurate size of the acetabular component can occasionally be exacting,chiefly for surgeons with little experience,whilst the complications of imprecise acetabular sizing or over-reaming can be potentially devastating.AIM To assist clinicians intraoperatively with a simple and repeatable tip in elucidating the ambivalence when determining the proper acetabular component size is not straightforwardly achieved,specifically when surgeons are inexperienced or preoperative templating is unavailable.METHODS This method was employed in 263 operations in our department from June 2021 to December 2022.All operations were performed by the same team of joint reconstruction surgeons,employing a typical posterior hip approach technique.The types of acetabular shells implanted were:The Dynasty®acetabular cup system(MicroPort Orthopedics,Shanghai,China)and the R3®acetabular system(Smith&Nephew,Watford,United Kingdom),which both feature cementless press-fit design.RESULTS The mean value of all cases was calculated and collated with each other.We distinguished as oversized an implanted acetabular shell when its size was>2 mm larger than the size of the acetabular size indicator reamer(ASIR)or when the implanted shell was larger than 4 mm compared to the preoperative planned cup.The median size of the implanted acetabular shell was 52(48–54)mm,while the median size of the preoperatively planned cup was 50(48–56)mm,and the median size of the ASIR was 52(50–54)mm.The correlation coefficient between ASIR size and implanted acetabular component size exhibited a high positive correlation with r=0.719(P<0.001).Contrariwise,intraoperative ASIR measurements precisely predicted the implanted cups’size or differed by only one size(2 mm)in 245 cases.CONCLUSION In our study,we demonstrated that the size of the first acetabular reamer not entering freely in the acetabular rim corroborates the final acetabular component size to implant.This was also corresponding in the majority of the cases with conventional preoperative templating.It can be featured as a valid tool for avoiding the potentially pernicious complications of acetabular cup over-reaming and over-sizing in primary total hip arthroplasty.It is a simple and reproducible technical note useful for confirming the predicted acetabular cup size preoperatively;thus,its application could be considered routinely,even in cases where preoperative templating is unavailable.展开更多
文摘Objective: The present research aims to determine if adherence to the Lewinnek safe zone, when exclusively considered, constitutes a pivotal element for ensuring stability in the context of total hip arthroplasty. This is done by examining the acetabular placement in instances of hip dislocation after total hip arthroplasty (THA). Methodology: The authors searched 2653 patient records from 2015 to 2022 looking for patients who had total hip arthroplasty at our facility. For the analysis, 23 patients were culled from 64 individuals who exhibited post-THA dislocations, employing a stringent exclusion criterion, and the resultant acetabular angulation and anteversion were quantified utilizing PEEKMED software (Peek Health S.A., Portugal) upon radiographic evidence. Results: Within the operational timeframe, from the cohort of 2653 subjects, 64 presented with at least a singular incident of displacement. Post-exclusion criterion enforcement, 23 patients were eligible for inclusion. Of these, 10 patients conformed to the safe zone demarcated by Lewinnek for both inclination and anteversion angles, while 13 exhibited deviations from the prescribed anteversion and/or inclination benchmarks. Conclusion: Analysis of the 23 patients reveals that 13 did not confirm to be in the safe zone parameters for anteversion and/or inclination, whereas 10 were within the safe zone as per Lewinnek’s guidelines. This investigative review, corroborated by extant literature, suggests that the isolated consideration of the Lewinnek safe zone does not suffice as a solitary protective factor. It further posits that additional variables are equally critical as acetabular positioning and mandate individual assessment.
文摘Background: Although abduction of the acetabular component is considered to predict factors for polyethylene wear attributable to osteolysis, other radiographic factors have yet to be elucidated. The purpose of the present study was to evaluate whether anteversion or change in implantation angle of the acetabular component influences polyethylene linear wear by using standing and supine radiographs of the hip joint. Methods: Standing and supine plain anteroposterior radiographs of 62 hip joints in which cementless total hip arthroplasty was performed were examined for polyethylene linear wear rate (mm/year), pelvic inclination, and radiological inclination and anatomic anteversion of the acetabular component. Results: All correlation coefficients of measurements of polyethylene linear wear, pelvic inclination angle, anatomical anteversion angle and radiological inclination angle were calculated highly. And by the three-dimensional numerical analysis, anatomic anteversion of the acetabular component had at least some effect on the degree of polyethylene wear. Conclusion: This study suggests that increased anteversion of the acetabular component reduces polyethylene linear wear in metal-on-polyethylene total hiparthroplasty.
文摘BACKGROUND Selecting the optimal size of components is crucial when performing a primary total hip arthroplasty.Implanting the accurate size of the acetabular component can occasionally be exacting,chiefly for surgeons with little experience,whilst the complications of imprecise acetabular sizing or over-reaming can be potentially devastating.AIM To assist clinicians intraoperatively with a simple and repeatable tip in elucidating the ambivalence when determining the proper acetabular component size is not straightforwardly achieved,specifically when surgeons are inexperienced or preoperative templating is unavailable.METHODS This method was employed in 263 operations in our department from June 2021 to December 2022.All operations were performed by the same team of joint reconstruction surgeons,employing a typical posterior hip approach technique.The types of acetabular shells implanted were:The Dynasty®acetabular cup system(MicroPort Orthopedics,Shanghai,China)and the R3®acetabular system(Smith&Nephew,Watford,United Kingdom),which both feature cementless press-fit design.RESULTS The mean value of all cases was calculated and collated with each other.We distinguished as oversized an implanted acetabular shell when its size was>2 mm larger than the size of the acetabular size indicator reamer(ASIR)or when the implanted shell was larger than 4 mm compared to the preoperative planned cup.The median size of the implanted acetabular shell was 52(48–54)mm,while the median size of the preoperatively planned cup was 50(48–56)mm,and the median size of the ASIR was 52(50–54)mm.The correlation coefficient between ASIR size and implanted acetabular component size exhibited a high positive correlation with r=0.719(P<0.001).Contrariwise,intraoperative ASIR measurements precisely predicted the implanted cups’size or differed by only one size(2 mm)in 245 cases.CONCLUSION In our study,we demonstrated that the size of the first acetabular reamer not entering freely in the acetabular rim corroborates the final acetabular component size to implant.This was also corresponding in the majority of the cases with conventional preoperative templating.It can be featured as a valid tool for avoiding the potentially pernicious complications of acetabular cup over-reaming and over-sizing in primary total hip arthroplasty.It is a simple and reproducible technical note useful for confirming the predicted acetabular cup size preoperatively;thus,its application could be considered routinely,even in cases where preoperative templating is unavailable.
