Abnormal spinopelvic mobility as a risk factor for acetabular placement error in total hip arthroplasty using optical computer-assisted surgical navigation system
Aims: Navigation devices are designed to improve a surgeon’s accuracy in positioning the acetabular and femoral components in total hip arthroplasty (THA). The purpose of this study was to both evaluate the accuracy of an optical computer-assisted surgery (CAS) navigation system and determine whethe...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2022-06-01
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| Series: | Bone & Joint Open |
| Subjects: | |
| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.36.BJO-2022-0055 |
| _version_ | 1811318734240874496 |
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| author | Seong J. Jang Jonathan M. Vigdorchik Eric W. Windsor Ran Schwarzkopf David J. Mayman Peter K. Sculco |
| author_facet | Seong J. Jang Jonathan M. Vigdorchik Eric W. Windsor Ran Schwarzkopf David J. Mayman Peter K. Sculco |
| author_sort | Seong J. Jang |
| collection | DOAJ |
| description | Aims: Navigation devices are designed to improve a surgeon’s accuracy in positioning the acetabular and femoral components in total hip arthroplasty (THA). The purpose of this study was to both evaluate the accuracy of an optical computer-assisted surgery (CAS) navigation system and determine whether preoperative spinopelvic mobility (categorized as hypermobile, normal, or stiff) increased the risk of acetabular component placement error. Methods: A total of 356 patients undergoing primary THA were prospectively enrolled from November 2016 to March 2018. Clinically relevant error using the CAS system was defined as a difference of > 5° between CAS and 3D radiological reconstruction measurements for acetabular component inclination and anteversion. Univariate and multiple logistic regression analyses were conducted to determine whether hypermobile (Δsacral slope(SS)stand-sit > 30°), or stiff (ΔSSstand-sit < 10°) spinopelvic mobility contributed to increased error rates. Results: The paired absolute difference between CAS and postoperative imaging measurements was 2.3° (standard deviation (SD) 2.6°) for inclination and 3.1° (SD 4.2°) for anteversion. Using a target zone of 40° (± 10°) (inclination) and 20° (± 10°) (anteversion), postoperative standing radiographs measured 96% of acetabular components within the target zone for both inclination and anteversion. Multiple logistic regression analysis controlling for BMI and sex revealed that hypermobile spinopelvic mobility significantly increased error rates for anteversion (odds ratio (OR) 2.48, p = 0.009) and inclination (OR 2.44, p = 0.016), whereas stiff spinopelvic mobility increased error rates for anteversion (OR 1.97, p = 0.028). There were no dislocations at a minimum three-year follow-up. Conclusion: Despite high reliability in acetabular positioning for inclination in a large patient cohort using an optical CAS system, hypermobile and stiff spinopelvic mobility significantly increased the risk of clinically relevant errors. In patients with abnormal spinopelvic mobility, CAS systems should be adjusted for use to avoid acetabular component misalignment and subsequent risk for long-term dislocation. Cite this article: Bone Jt Open 2022;3(6):475–484. |
| first_indexed | 2024-04-13T12:30:42Z |
| format | Article |
| id | doaj.art-7bbd557c5b9548dc8cc31f208edb3ae3 |
| institution | Directory Open Access Journal |
| issn | 2633-1462 |
| language | English |
| last_indexed | 2024-04-13T12:30:42Z |
| publishDate | 2022-06-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Open |
| spelling | doaj.art-7bbd557c5b9548dc8cc31f208edb3ae32022-12-22T02:46:51ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622022-06-013647548410.1302/2633-1462.36.BJO-2022-0055Abnormal spinopelvic mobility as a risk factor for acetabular placement error in total hip arthroplasty using optical computer-assisted surgical navigation systemSeong J. Jang0Jonathan M. Vigdorchik1Eric W. Windsor2Ran Schwarzkopf3David J. Mayman4Peter K. Sculco5Weill Cornell Medical College, New York, New York, USAAdult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USAAdult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USANYU Langone Orthopedic Center, New York, New York, USAAdult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USAAdult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USAAims: Navigation devices are designed to improve a surgeon’s accuracy in positioning the acetabular and femoral components in total hip arthroplasty (THA). The purpose of this study was to both evaluate the accuracy of an optical computer-assisted surgery (CAS) navigation system and determine whether preoperative spinopelvic mobility (categorized as hypermobile, normal, or stiff) increased the risk of acetabular component placement error. Methods: A total of 356 patients undergoing primary THA were prospectively enrolled from November 2016 to March 2018. Clinically relevant error using the CAS system was defined as a difference of > 5° between CAS and 3D radiological reconstruction measurements for acetabular component inclination and anteversion. Univariate and multiple logistic regression analyses were conducted to determine whether hypermobile (Δsacral slope(SS)stand-sit > 30°), or stiff (ΔSSstand-sit < 10°) spinopelvic mobility contributed to increased error rates. Results: The paired absolute difference between CAS and postoperative imaging measurements was 2.3° (standard deviation (SD) 2.6°) for inclination and 3.1° (SD 4.2°) for anteversion. Using a target zone of 40° (± 10°) (inclination) and 20° (± 10°) (anteversion), postoperative standing radiographs measured 96% of acetabular components within the target zone for both inclination and anteversion. Multiple logistic regression analysis controlling for BMI and sex revealed that hypermobile spinopelvic mobility significantly increased error rates for anteversion (odds ratio (OR) 2.48, p = 0.009) and inclination (OR 2.44, p = 0.016), whereas stiff spinopelvic mobility increased error rates for anteversion (OR 1.97, p = 0.028). There were no dislocations at a minimum three-year follow-up. Conclusion: Despite high reliability in acetabular positioning for inclination in a large patient cohort using an optical CAS system, hypermobile and stiff spinopelvic mobility significantly increased the risk of clinically relevant errors. In patients with abnormal spinopelvic mobility, CAS systems should be adjusted for use to avoid acetabular component misalignment and subsequent risk for long-term dislocation. Cite this article: Bone Jt Open 2022;3(6):475–484.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.36.BJO-2022-0055total hip arthroplastycomputer assisted navigationacetabular cup positionaccuracyspinopelvic mobilityspinopelvic mobilitytotal hip arthroplasty (tha)acetabular componentsbmifemoral componentsradiographslogistic regression analysisprimary total hip arthroplastystandard deviationhips |
| spellingShingle | Seong J. Jang Jonathan M. Vigdorchik Eric W. Windsor Ran Schwarzkopf David J. Mayman Peter K. Sculco Abnormal spinopelvic mobility as a risk factor for acetabular placement error in total hip arthroplasty using optical computer-assisted surgical navigation system Bone & Joint Open total hip arthroplasty computer assisted navigation acetabular cup position accuracy spinopelvic mobility spinopelvic mobility total hip arthroplasty (tha) acetabular components bmi femoral components radiographs logistic regression analysis primary total hip arthroplasty standard deviation hips |
| title | Abnormal spinopelvic mobility as a risk factor for acetabular placement error in total hip arthroplasty using optical computer-assisted surgical navigation system |
| title_full | Abnormal spinopelvic mobility as a risk factor for acetabular placement error in total hip arthroplasty using optical computer-assisted surgical navigation system |
| title_fullStr | Abnormal spinopelvic mobility as a risk factor for acetabular placement error in total hip arthroplasty using optical computer-assisted surgical navigation system |
| title_full_unstemmed | Abnormal spinopelvic mobility as a risk factor for acetabular placement error in total hip arthroplasty using optical computer-assisted surgical navigation system |
| title_short | Abnormal spinopelvic mobility as a risk factor for acetabular placement error in total hip arthroplasty using optical computer-assisted surgical navigation system |
| title_sort | abnormal spinopelvic mobility as a risk factor for acetabular placement error in total hip arthroplasty using optical computer assisted surgical navigation system |
| topic | total hip arthroplasty computer assisted navigation acetabular cup position accuracy spinopelvic mobility spinopelvic mobility total hip arthroplasty (tha) acetabular components bmi femoral components radiographs logistic regression analysis primary total hip arthroplasty standard deviation hips |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.36.BJO-2022-0055 |
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