Effectiveness and Accuracy of a Patient‐Specific Instrumentation System for Total Hip Arthroplasty

Abstract

Objective Traditional total hip arthroplasty (THA) is often performed by visual inspection due to the lack of reliable reference, which results in inappropriate position of prosthesis and poor outcomes. This study attempts to introduce a novel patient‐specific instrumentation (PSI) system and assess its effectiveness and accuracy compared with freehand operation and robot system through bone model experiments. Methods Equally divide 30 sawbone models into the freehand group, PSI group, and robot group. Ten sets of prosthesis parameters were randomly generated as planning, and the three groups underwent simulated THA depending on these parameters. After the placement of the femoral prosthesis, the acetabular anteversion plan was adjusted in the PSI and robot groups so that the combined anteversion was maintained before and after adjustment. After the surgery, the actual prosthesis parameters of all bone models were measured and analyzed statistically. Results No statistically significant difference was found in femoral anteversion error among the three groups (p = 0.951). The errors of acetabular cup anteversion, acetabular cup abduction, and combined anteversion in PSI group were 3.92° (2.94°, 4.62°), 5.65° (4.63°, 6.70°), and 3.93° (2.94°, 4.62°), respectively, which were significantly smaller than those in the freehand group [11.84° (9.92°, 13.87°), 13.54° (9.81°, 15.21°), 16.04° (8.18°, 19.25°), respectively, p < 0.05], but significantly larger than those in the robot group [1.34° (0.98°, 1.70°), 1.80° (1°, 2.02°), 1.34° (0.98°, 1.70°), respectively, p < 0.05]. Conclusion Compared with the traditional freehand operation, the patient‐specific instrumentation system is feasible in total hip arthroplasty because it improves the accuracy of prosthesis placement. In addition, the rapid measurement of intraoperative femoral prosthesis parameters can help surgeons optimize preoperative planning.

Femoral Anteversion in Total Hip Arthroplasty: Retrospective Comparison of Short- and Straight-Stem Models Using CT Scans

“…Zhang et al [ 24 ] demonstrated that the use of a patient-specific instrumentation system promises advantages in the accuracy of implantation compared to freehand THA. Preoperatively acquired CT images are once again used, as in other procedures, and 3D models are molded afterward.…”

“…Preoperatively acquired CT images are once again used, as in other procedures, and 3D models are molded afterward. These models can be applied as a guide on the femoral neck or acetabulum to ensure accurate osteotomy and, consequently, accurate implantation [ 24 ]. Due to the fact that the exact positioning of the stem and the avoidance of unphysiological FA is a matter of multimodal influences, further research in this field will be necessary.…”

“…This can be accomplished by a patient-specific preoperative 3D simulation of range of motion (ROM), flexion, and internal rotation (IR) angle to establish the correct implantation zone of the implant components [ 23 ]. Another approach to achieve even better results with THA that are more similar to the naturally occurring physiology would be a patient-specific instrument system that can be individually manufactured for each configuration of the femur and acetabulum [ 24 ]. Furthermore, the correct choice of material and implantation site may be crucial when considering a patient’s body mass index (BMI) or the implementation of intraoperational fluoroscopy for the success of THA [ 25 , 26 ].…”

Safety and Effectiveness of Robotic‐Arm Assisted Total Knee Arthroplasty

“…With the rapid development of science and technology in the medical field, the concepts of precision medicine, including intelligent orthopaedics and digital orthopaedics, are gradually capturing the attention of orthopaedists. Computer navigation‐assisted surgery is a typical example of precision medicine 2,3 . It has been used to improve the accuracy of osteotomy as well ollected from patients in America and Europe, not Asia.…”

“…Computer navigation‐assisted surgery is a typical example of precision medicine. 2 , 3 It has been used to improve the accuracy of osteotomy as well ollected from patients in America and Europe, not Asia.…”