Accuracy of Leg Length and Offset Restoration in Femoral Pinless Navigation Compared to Navigation Using a Fixed Pin during Total Hip Arthroplasty

Weber, Markus; Thieme, Max; Kaiser, Moritz; Völlner, Florian; Worlicek, Michael; Craiovan, Benjamin; Grifka, Joachim; Renkawitz, Tobias

doi:10.1155/2018/1639840

Cited by 7 publications

(10 citation statements)

References 30 publications

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“…There are several ways to avoid LLD after hip replacement: (1) fix Kirschner wires on bones to serve as references points, and measure the distance before and after installation of the prosthesis by a ruler or similar device,5,16,18 (2) use a navigation system during the operation,4,5,15,19 (3) direct manual comparison of the positions of bilateral patellas or heels in surgery,9,20 (4) similar to our method, measure the distance between the center of the femoral head and the top of lesser trochanter of the fractured side before femoral neck osteotomy and after the prosthesis implantation,21,22 (5) template measuring on X-ray film before operation to confirm the osteotomy position according to the lesser trochanter or the fracture line,14 and (6) compare the tip of the greater trochanter and the femoral head center during operation 14…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative navigation is more accurate, but its fixation markers may require additional skin incisions, could cause pin sit pain and irritation, even increase the risk of peri-pinhole fractures 23,25,26. Some pinless navigation systems4,27 do not require bone-fixation markers, but still need additional equipment that can increase both operation time and costs. The accuracy of the manual comparison of the position of bilateral patellas and heels is not high, which depends on the patient’s position and surgical drapes 9.…”

Section: Discussionmentioning

confidence: 99%

“…It is reported that the incidence of LLD after hip arthroplasty is as high as 62% 7. Unequal leg length can lead to lower back pain, poor gait, dislocation of hip, neurological impairment and patient dissatisfaction or even revision surgery,3,8–10 and 15–50% of the patients may require elevated shoes 4,11. A survey enrolled 1114 patients undergoing total hip arthroplasties shows that LLD occurs in 30% of the patients, of which 49% are unsatisfied with the effect of operation and 4% regret having had the operation 12.…”

Section: Introductionmentioning

confidence: 99%

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<p>A simple method to minimize leg length discrepancy in hip hemiarthroplasty</p>

Wang

et al. 2019

CIA

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PurposeWe developed a simple method to minimize leg length discrepancy (LLD) during hip arthroplasty. The purpose of this study is to evaluate the accuracy of the method.Patients and methodsA total of 47 patients who suffered from unilateral femoral neck fracture and underwent hip hemiarthroplasty between 2015 and 2018 were enrolled in this study. We measured the diameter of the contralateral femoral head (D) and the distance (L) between the center of the femoral head and the top of lesser trochanter in the antero-posterior pelvic X-ray view before the operation, the ratio (R) of D to L was calculated. During the operation, the diameter of the femoral head (d) was measured using a Vernier caliper. Then, the distance should be obtained from the center of the femoral head prosthesis to the lesser trochanter was calculated according to the contralateral ratio R.ResultsThe mean LLD was 4.4±3.2 mm (−4.0 to 11.1 mm), 80.9% of the patients had LLD <6 mm, 93.6% of the patients with LLD <10 mm, only 6.4% ≥10 mm LLD.ConclusionThis method is a simple, cost-effective, fast and accurate way to reduce the postoperative leg length discrepancy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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<p>A simple method to minimize leg length discrepancy in hip hemiarthroplasty</p>

Wang

et al. 2019

CIA

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“…Leg length discrepancy after THA is a common source of patient dissatisfaction and litigation [ 3 ]. Despite the plethora of intraoperative tests and technological advances made through navigation and robotics, no method is currently universally accepted [ 2 , 6 – 8 , 13 , 21 ]. Most surgeons, therefore, rely on a combination of preoperative templating, intraoperative landmarks, and an overall feel for leg length [ 10 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Anatomical Mapping of the External Obturator Footprint: A Study In Cadavers with Implications for Direct Anterior THA

Vles

Eemeren

Taylan

et al. 2020

Clin Orthop Relat Res

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Background The external obturator footprint in the trochanteric fossa has been suggested as a potential landmark for stem depth in direct anterior THA. Its upper border can be visualized during surgical exposure of the femur. A recent study reported that the height of the tendon has little variability (6.4 ± 1.4 mm) as measured on CT scans and that the trochanteric fossa is consistently visible on conventional pelvic radiographs. However, it is unclear where exactly the footprint of this tendon should be templated during preoperative planning so that it can be useful intraoperatively. Questions/purposes In this study, we sought: (1) to provide instructions on exactly where to template the external obturator footprint on a preoperative planning radiograph, and (2) to confirm the small variability in height of the external obturator footprint found on CT scans in a cadaver study. Methods Two-dimensional (2-D) and three-dimensional (3-D) imaging was used to map the anatomy of the external obturator footprint. This dual approach was chosen because of their complementarity; conventional 2-D radiographs translate to clinical practice but 3-D navigation-based digitalization combined with CT allows for a better understanding of the cortical lines that comprise the outline of the trochanteric fossa. In 12 (four males, mean age 80 years, range 69 to 88) formalin-treated cadaveric lower extremities including the pelvis, the external obturator tendon was dissected, and the top and bottom end of its footprint marked with two small needles, and calibrated radiographs were taken. For another five (three males, mean age 75.7 years, range 61 to 91) fresh-frozen cadaveric lower extremities, including femoral reflective marker frames, CT scans were obtained and the exact location of the external obturator footprint was recorded using 3-D navigation-based digitalization. Qualitative analysis of both imaging modalities was used to develop instructions on where the external obturator footprint should be templated on a preoperative planning radiograph. Quantitative analysis of the dimensions of the external obturator footprint was performed. Results The lowest point of the external obturator footprint was consistently found (± 1 mm) at the intersection of the vertical line comprised of the lateral wall of the trochanteric fossa and the oblique line formed by the intertrochanteric crest and therefore allows templating of this structure on the preoperative planning radiograph. The median (range) height of the footprint measured 6.4 mm and demonstrated small variability (4.7 to 7.6). Conclusions We suggest templating a 6.4-mm circle with its bottom on the intersection described above. Clinical Relevance The distance between the templated shoulder of the stem and the top of the circle can be used intraoperatively for guidance. Discrepancy should lead to re-evalu...

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“…1 , 5 The absence of these structures presents technical challenges to surgeons in accurately restoring biomechanics, which can result in limb length inequality, increased joint reactive forces, and altered gait kinematics, which may predispose to aseptic loosening and implant failure. 1 , 5 ‐ 7 Limb length inequality is an important driver of patient-reported outcome measures and is the third most common cause of successful malpractice litigation against orthopaedic surgeons. 2 , 6 , 8 ‐ 10 …”

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confidence: 99%

Gluteus Maximus Tendon Reference: A Novel Method to Restore Leg Length in Total Hip Arthroplasty With Femoral Bone Loss

et al. 2022

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Background: Accurate restoration of leg length and proximal femoral geometry is essential for achieving satisfactory outcomes in both primary and revision total hip arthroplasty. Although common landmarks such as the greater trochanter and the lesser trochanter (LT) may be used to measure limb length intraoperatively in primary cases, these landmarks may be absent or disrupted in fractures and revision procedures. We propose the distance between the gluteus maximus tendon gluteal sling (GS) and the center of the femoral head (FHC) as a novel anatomic landmark beyond the zone of injury, which can be used to restore limb length in the setting of proximal femoral bone loss or fracture. Methods: One hundred healthy hips were retrospectively reviewed using MRI to determine the distance between the proximal edge of the GS and the FHC. Additional measurements were collected including the distance between the GS and the greater trochanter and LT, as well as the FHC to the LT and greater trochanter. Results: The distance between the GS and the femoral head was consistent and measured 8.0 cm (61.88 cm, SD = 0.66). A moderate positive correlation (r = 0.37, P , 0.001) was observed between patient height and GS to FHC distance. Discussion: The distance between the GS and the center of the femoral head consistently measures 8 cm and can be used to set implant height to restore proximal femoral geometry and leg length in total hip arthroplasty with proximal femoral bone loss.A ccurately restoring proximal femoral geometry is essential for recreating a stable, functional total hip arthroplasty (THA) and achieving satisfactory patient outcomes. 1,2 Numerous methods exist for intraoperative measurement of leg length discrepancy (LLD) and offset in primary total hip arthroplasties with intact proximal femoral bony architecture. [2][3][4] Although common landmarks such as the greater and lesser

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Accuracy of Leg Length and Offset Restoration in Femoral Pinless Navigation Compared to Navigation Using a Fixed Pin during Total Hip Arthroplasty

Cited by 7 publications

References 30 publications

<p>A simple method to minimize leg length discrepancy in hip hemiarthroplasty</p>

<p>A simple method to minimize leg length discrepancy in hip hemiarthroplasty</p>

Anatomical Mapping of the External Obturator Footprint: A Study In Cadavers with Implications for Direct Anterior THA

Gluteus Maximus Tendon Reference: A Novel Method to Restore Leg Length in Total Hip Arthroplasty With Femoral Bone Loss

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