Zampogna Biagio, Parisi Francesco Rosario, Zampoli Andrea, Prezioso Anna, Vorini Ferruccio, Laudisio Alice, Papalia Matteo, Papapietro Nicola, Falez Francesco, Papalia Rocco
Department of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy.
Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
Int Orthop. 2024 Aug;48(8):1979-1985. doi: 10.1007/s00264-024-06172-x. Epub 2024 Apr 15.
In the last decades, there has been a refinement in total hip arthroplasty, which allowed surgeons to achieve the highest performance and better patient outcomes. Preoperative planning in primary hip arthroplasty is an essential step that guides the surgeon in restoring the anatomy and biomechanics of the joint. This study aims to evaluate the accuracy of the 2D digital planning, considering cup sizing, stem sizing, and limb length discrepancy. Additionally, we conducted a multivariable analysis of demographic data and comorbidities to find factors influencing preoperative planning.
This retrospective study analyzed the planning accuracy in 800 consecutive uncemented primary total hip arthroplasty. We compared the preoperatively planned total hip arthroplasty with postoperative results regarding the planned component size, the implanted size, and the lower limb length restoration. Therefore, we investigated factors influencing planning accuracy: overweight and obesity, sex, age, past medical history, comorbidities, and implant design. All the surgeries were performed in the posterolateral approach by one expert surgeon who did the preoperative planning. The preoperative planning was determined to be (a) exact if the planned and the implanted components were the same size and (b) accurate if exact ± one size. The restoration of postoperative limb length discrepancy was classified into three groups: ± 3 mm, ± 5 mm, and ± 10 mm. This assessment was performed through a digital method 2D based on a standard hip X-ray.
This court of 800 implants showed that planning was exact in 60% of the cups and 44% of the stems and was accurate in 94% of the cups and 80% of the stems. The postoperative limb length discrepancy was ± 3 mm in 91% and ± 5 mm in 97%.
This study showed preoperative 2D digital planning great precision and reliability, and we demonstrated that it was accurate in 94% of the cups and 80% of the stems. Therefore, the preoperative limb length discrepancy analysis was essential to guarantee the recovery of the operated limb's correct length.
在过去几十年中，全髋关节置换术不断完善，使外科医生能够实现最佳手术效果并改善患者预后。初次髋关节置换术的术前规划是指导外科医生恢复关节解剖结构和生物力学的关键步骤。本研究旨在评估二维数字规划在髋臼杯尺寸、股骨柄尺寸和肢体长度差异方面的准确性。此外，我们对人口统计学数据和合并症进行了多变量分析，以找出影响术前规划的因素。
这项回顾性研究分析了800例连续的非骨水泥型初次全髋关节置换术的规划准确性。我们将术前规划的全髋关节置换术与术后结果在计划组件尺寸、植入尺寸和下肢长度恢复方面进行了比较。因此，我们研究了影响规划准确性的因素：超重和肥胖、性别、年龄、既往病史、合并症和植入物设计。所有手术均由一位进行术前规划的专家外科医生采用后外侧入路完成。术前规划被确定为：（a）如果计划组件和植入组件尺寸相同，则为“精确”；（b）如果精确尺寸±一个尺寸，则为“准确”。术后肢体长度差异的恢复分为三组：±3毫米、±5毫米和±10毫米。这项评估是通过基于标准髋关节X线片的二维数字方法进行的。
这800例植入物的研究表明，60%的髋臼杯和44%的股骨柄规划精确，94%的髋臼杯和80%的股骨柄规划准确。术后肢体长度差异±3毫米的占91%，±5毫米的占97%。
本研究表明术前二维数字规划具有很高的精度和可靠性，我们证明其在94%的髋臼杯和80%的股骨柄规划中是准确的。因此，术前肢体长度差异分析对于保证患侧肢体正确长度的恢复至关重要。
