Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York.
Icahn School of Medicine at Mount Sinai, New York, New York.
J Arthroplasty. 2024 Sep;39(9S1):S88-S96. doi: 10.1016/j.arth.2024.03.042. Epub 2024 Mar 24.
Optimal position of total hip arthroplasty (THA) components is critical for joint mechanics and stability. Acetabular component positioning during supine surgery in direct anterior approach (DAA) THA may be different in the standing position postoperatively, which traditional fluoroscopy is unable to predict. A novel 3-dimensional (3D) image analysis technology (IAT) that uses artificial intelligence to measure the tilt and rotation of the pelvis has enabled prediction of component positioning from supine to standing. The purpose of this study was to compare intraoperative fluoroscopy, non-3D-IAT, and 3D-IAT with postoperative standing radiographs to assess the accuracy of component positioning.
From 2022 to 2023, 30 consecutive patients (86.6% women, mean age 59 [range, 55 to 67]) undergoing primary DAA THA with the use of the 3D-IAT were identified. A separate cohort of 148 patients from 2020 to 2021 (85% women, mean age 65 [range, 55 to 69]) who underwent DAA THA with non-3D-IAT was used for comparison. Leg length discrepancy (LLD), cup anteversion, and inclination were manually measured on intraoperative fluoroscopic images and digitally measured using IAT. Follow-up evaluation occurred at 1 month with standing pelvis radiographs measured using Ein Bild Röntgen Analyze-Cup software. Measurements were compared via Wilcoxon signed rank tests where P ≤ .05 indicates significantly different measurements.
Median LLD, inclination, and anteversion measurements via non-3D-IAT and fluoroscopy were significantly different compared to postoperative standing radiographs (P < .001). The 3D-IAT more accurately predicted LLD, abduction, and anteversion, with values not significantly different from postoperative standing measurements (P = .23, P = .93, and P = .36, respectively).
The use of the 3D-IAT during DAA THA allowed for the more accurate prediction of acetabular component position in the standing position postoperatively.
全髋关节置换术（THA）组件的最佳位置对于关节力学和稳定性至关重要。在直接前入路（DAA）THA 中，仰卧位手术时髋臼组件的定位在术后可能与站立位不同，传统的透视术无法预测。一种新的 3 维（3D）图像分析技术（IAT），使用人工智能来测量骨盆的倾斜和旋转，能够从仰卧位预测到站立位的组件位置。本研究的目的是比较术中透视、非 3D-IAT 和 3D-IAT 与术后站立位 X 线片，以评估组件定位的准确性。
从 2022 年至 2023 年，我们确定了 30 例连续接受 3D-IAT 辅助下的初次 DAA THA 的患者（86.6%为女性，平均年龄 59 岁[范围 55 至 67 岁]）。还纳入了 2020 年至 2021 年期间接受非 3D-IAT 辅助下的 DAA THA 的 148 例患者作为对照（85%为女性，平均年龄 65 岁[范围 55 至 69 岁]）。术中透视图像上手动测量下肢长度差异（LLD）、杯前倾角和倾斜度，并使用 IAT 进行数字测量。术后 1 个月行站立位骨盆 X 线片随访，使用 Ein Bild Röntgen Analyze-Cup 软件进行测量。采用 Wilcoxon 符号秩检验比较测量值，P ≤.05 表示测量值有显著差异。
非 3D-IAT 和透视术中测量的 LLD、倾斜度和前倾角与术后站立位 X 线片测量值有显著差异（P<.001）。3D-IAT 更准确地预测了髋臼组件在术后站立位的位置，其 LLD、外展角和前倾角与术后站立位测量值无显著差异（P=.23、P=.93 和 P=.36）。
在 DAA THA 中使用 3D-IAT 可更准确地预测术后髋臼组件在站立位的位置。
