Orthopedics. 2024 May-Jun;47(3):e139-e145. doi: 10.3928/01477447-20231220-04. Epub 2023 Dec 28.
Identification of the hip center of rotation (HCOR) before total hip arthroplasty (THA) is crucial for achieving optimal implant position and size, and for restoring native biomechanics around the hip joint. Current techniques for determining the HCOR in cases of abnormal hip anatomy are limited and unreliable. This study presents a novel technique using open-access software for preoperative THA templating for patients with significantly abnormal hip anatomy due to unilateral hip arthrosis. The aim is to reliably predict the HCOR and acetabular implant size compared with a traditional intraoperative method.
This retrospective study involved 20 patients with unilateral hip arthrosis who underwent THA. Preoperative templating was performed using the experimental technique, and the position of the HCOR was measured on preoperative and postoperative radiographs. The positions of the predicted and actual HCOR were compared, along with the inclination and size of the acetabular component.
The difference between the predicted and actual HCOR positions was insignificant (0.43±0.22 mm vertically and 0.18±0.20 mm horizontally), and there was a positive correlation between them (=0.78, <.005; =0.72, <.005). The agreement between the predicted and actual acetabular implant sizes was 85%, with near-perfect interobserver agreement (Cohen's kappa=0.827).
This novel technique provides a reliable method for predicting HCOR and acetabular implant size for THA in cases of unilateral hip arthrosis. This technique may help optimize biomechanics and improve outcomes in challenging cases. Further research and validation are warranted to establish its broader applicability. [. 2024;47(3):e139-e145.].
在全髋关节置换术 (THA) 之前确定髋关节旋转中心 (HCOR) 对于实现最佳的植入物位置和大小以及恢复髋关节周围的原生生物力学至关重要。目前，对于髋关节解剖异常病例确定 HCOR 的技术有限且不可靠。本研究提出了一种新的技术，使用开源软件为单侧髋关节骨关节炎导致髋关节解剖异常的患者进行术前 THA 模板设计。目的是与传统的术中方法相比，可靠地预测 HCOR 和髋臼植入物的大小。
这项回顾性研究涉及 20 例单侧髋关节骨关节炎患者，他们接受了 THA。使用实验技术进行术前模板设计，并在术前和术后 X 光片上测量 HCOR 的位置。比较了预测和实际 HCOR 位置、髋臼组件的倾斜度和大小。
预测和实际 HCOR 位置之间的差异无统计学意义（垂直方向为 0.43±0.22mm，水平方向为 0.18±0.20mm），且两者之间存在正相关（=0.78，<.005；=0.72，<.005）。预测和实际髋臼植入物大小之间的一致性为 85%，观察者间一致性接近完美（Cohen's kappa=0.827）。
对于单侧髋关节骨关节炎患者的 THA，该新技术提供了一种可靠的预测 HCOR 和髋臼植入物大小的方法。该技术可能有助于优化生物力学并改善挑战性病例的结果。需要进一步的研究和验证来确定其更广泛的适用性。
