Jang Seong J, Vigdorchik Jonathan M, Windsor Eric W, Schwarzkopf Ran, Mayman David J, Sculco Peter K
Weill Cornell Medical College, New York, New York, USA.
Adult Reconstruction and Joint Replacement Service, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.
Bone Jt Open. 2022 Jun;3(6):475-484. doi: 10.1302/2633-1462.36.BJO-2022-0055.
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.
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 ([Formula: see text]sacral slope(SS) > 30°), or stiff ([Formula: see text]SS < 10°) spinopelvic mobility contributed to increased error rates.
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.
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: 2022;3(6):475-484.
导航设备旨在提高外科医生在全髋关节置换术（THA）中髋臼和股骨组件定位的准确性。本研究的目的是评估光学计算机辅助手术（CAS）导航系统的准确性，并确定术前脊柱骨盆活动度（分为活动过度、正常或僵硬）是否会增加髋臼组件放置错误的风险。
2016年11月至2018年3月前瞻性纳入了356例行初次THA的患者。使用CAS系统时，临床相关误差定义为CAS测量值与髋臼组件倾斜度和前倾角的三维放射学重建测量值之间相差>5°。进行单因素和多因素逻辑回归分析，以确定活动过度（[公式：见原文]骶骨斜率（SS）>30°）或僵硬（[公式：见原文]SS<10°）的脊柱骨盆活动度是否会导致错误率增加。
CAS测量值与术后影像测量值之间的配对绝对差值，倾斜度为2.3°（标准差（SD）2.6°），前倾角为3.1°（SD 4.2°）。使用40°（±10°）（倾斜度）和20°（±10°）（前倾角）的目标区域，术后站立位X线片显示，髋臼组件倾斜度和前倾角均有96%在目标区域内。控制体重指数和性别进行多因素逻辑回归分析显示，活动过度的脊柱骨盆活动度显著增加前倾角（优势比（OR）2.48，p = 0.009）和倾斜度（OR 2.44，p = 0.016）的错误率，而僵硬的脊柱骨盆活动度增加前倾角的错误率（OR 1.97，p = 0.028）。至少三年的随访中无脱位发生。
尽管在一大组患者中使用光学CAS系统进行髋臼倾斜度定位具有较高的可靠性，但活动过度和僵硬的脊柱骨盆活动度显著增加了临床相关误差的风险。对于脊柱骨盆活动度异常的患者，应调整CAS系统的使用，以避免髋臼组件排列不齐及随后的长期脱位风险。引用本文：2022；3（6）：475 - 484。
