Surgical automation reduces operating time while maintaining accuracy for direct anterior total hip arthroplasty

Bhimani, Aamir; Rizkalla, James; Kitziger, Kurt J.; Peters, Paul C.; Schubert, Richard D.; Gladnick, Brian P.

doi:10.1016/j.jor.2020.03.057

Cited by 18 publications

(10 citation statements)

References 33 publications

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“…It should be noted that the assumption of constant energy consecutive impactions presented in this study does not re ect the clinical situation, in which the surgeon tends to increase the impaction energy with consecutive impactions. Increasing energy will increase introducer stresses and more constant energy impaction may be preferable, for example, using automated tools (24).…”

Section: Surgeonmentioning

confidence: 99%

WITHDRAWN: A Parametric Analysis of Femoral Stem Impaction

Bishop

Wright²,

Preutenborbeck³

2021

Preprint

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BackgroundPress-fitted implants are implanted by impaction to ensure adequate seating, but without overloading the components, the surgeon, or the patient. To understand this interrelationship a uniaxial discretised model of the hammer/introducer/implant/bone/soft-tissues was developed. A parametric analysis of applied energy, component materials and geometry, and interaction between implant-bone and bone-soft-tissue was performed, with implant seating and component stresses as outcome variables. ResultsTo reduce stresses without compromising seating, the following outcomes were observed: Less energy per hit with more hits / Increase hammer mass / Decrease introducer mass / Increase implant-bone resistance (eg stem roughness). Material stiffness and patient mechanics were found to be less important.ConclusionsThis simple model provides a basic understanding of how stress waves travel through the impacted system, and an understanding of their relevance to component design.

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Section: Surgeonmentioning

confidence: 99%

WITHDRAWN: A Parametric Analysis of Femoral Stem Impaction

Bishop

Wright²,

Preutenborbeck³

2021

Preprint

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“…It is noted that the hammer tip stiffness increases with tip material stiffnesses at the impaction interface, and with increasing radius or contact area of the interface surfaces. These things could be achieved by powered impaction tools [32,33] with a predefined impaction interface geometry. The maximum effective tip stiffness tends to the magnitude of the lower of the stiffness of the bulk hammer or introducer materials.…”

Section: Component Designmentioning

confidence: 99%

“…It should be noted that the assumption of constant energy consecutive impactions presented in this study does not reflect the clinical situation, in which the surgeon tends to increase the impaction energy with consecutive impactions. Increasing energy will increase introducer stresses and more constant energy impaction may be preferable, for example, using powered impaction tools [32,33].…”

Section: Surgeon Parametersmentioning

confidence: 99%

“…Of course, more complex models will be necessary to study load transfer in multiple degrees of freedom and detailed geometry will allow local stress concentrations and detailed failure modes of impaction devices to be studied. The current uni-axial model may be particularly relevant to contemporary linear implant insertion systems, and particularly those which employ an axially mounted impaction gun, offering optimal impaction [32,33].…”

Section: Plos Onementioning

confidence: 99%

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A parametric numerical analysis of femoral stem impaction

Bishop

Wright²,

Preutenborbeck³

2022

PLoS ONE

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Press-fitted implants are implanted by impaction to ensure adequate seating, but without overloading the components, the surgeon, or the patient. To understand this interrelationship a uniaxial discretised model of the hammer/introducer/implant/bone/soft-tissues was developed. A parametric analysis of applied energy, component materials and geometry, and interactions between implant and bone and between bone and soft-tissues was performed, with implant seating and component stresses as outcome variables. To reduce the impaction effort (energy) required by the surgeon for implant seating and also reduce stresses in the hardware the following outcomes were observed: Reduce energy per hit with more hits / Increase hammer mass / Decrease introducer mass / Increase implant-bone resistance (eg stem roughness). Hardware stiffness and patient mechanics were found to be less important and soft tissue forces, due to inertial protection by the bone mass, were so low that their damage would be unlikely. This simple model provides a basic understanding of how stress waves travel through the impacted system, and an understanding of their relevance to implantation technique and component design.

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“…Especially inexperienced surgeons would benefit from these devices. An additional benefit of the use of powered impaction tools is a positive effect on the duration of the surgery and fatigue of the surgeon [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Variability in Femoral Preparation and Implantation Between Surgeons Using Manual and Powered Impaction in Total Hip Arthroplasty

Konow

Bätz

Beverland³

et al. 2022

Arthroplasty Today

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Background The influence of the surgical process on implant loosening and periprosthetic fractures (PPF) as major complications in uncemented total hip arthroplasty (THA) has rarely been studied because of the difficulty in quantification. Meanwhile, registry analyses have clearly shown a decrease in complications with increasing experience. The goal of this study was to determine the extent of variability in THA stem implantation between highly experienced surgeons with respect to implant size, position, press-fit, contact area, primary stability, and the effect of using a powered impaction tool. Methods Primary hip stems were implanted in 16 cadaveric femur pairs by three experienced surgeons using manual and powered impaction. Quantitative CTs were taken before and after each process step, and stem tilt, canal-fill-ratio, press-fit, and contact determined. Eleven femur pairs were additionally tested for primary stability under cyclic loading conditions. Results Manual impactions led to higher variations in press-fit and contact area between the surgeons than powered impactions. Stem tilt and implant sizing varied between surgeons but not between impaction methods. Larger stems exhibited less micromotion than smaller stems. Conclusions Larger implants may increase PPF risk, while smaller implants reduce primary stability. The reduced variation for powered impactions indicates that appropriate measures may promote a more standardized process. The variations between these experienced surgeons may represent an acceptable range for this specific stem design. Variability in the implantation process warrants further investigations since certain deviations, for example, a stem tilt toward varus, might increase bone stresses and PPF risk.

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Surgical automation reduces operating time while maintaining accuracy for direct anterior total hip arthroplasty

Cited by 18 publications

References 33 publications

WITHDRAWN: A Parametric Analysis of Femoral Stem Impaction

WITHDRAWN: A Parametric Analysis of Femoral Stem Impaction

A parametric numerical analysis of femoral stem impaction

Variability in Femoral Preparation and Implantation Between Surgeons Using Manual and Powered Impaction in Total Hip Arthroplasty

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