Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Arch Orthop Trauma Surg. 2024 May;144(5):2429-2435. doi: 10.1007/s00402-024-05338-x. Epub 2024 Apr 25.
Correct cup placement in total hip arthroplasty (THA) for patients with developmental dysplasia of the hip (DDH) is considerably difficult. This study aimed to analyze the orientation accuracy of cup insertion during THA using a portable navigation system in patients with DDH.
In this retrospective cohort study, we analyzed data from 64 patients who underwent THA using infrared stereo camera-matching portable navigation. Patients underwent THA via the anterolateral approach in the lateral decubitus position. Navigation records for intraoperative cup angles, postoperative cup angles measured on computed tomography (CT) images, and cup angle measurement differences were measured and compared between patients with non-DDH/mild DDH and severe DDH. Furthermore, the predictive factors for outliers of accurate acetabular cup placement were analyzed.
The average measurement absolute abduction differences (postoperative CT-navigation record) were 3.9 ± 3.5° (severe DDH) and 3.3 ± 2.6° (non-DDH/ mild DDH), and the anteversion differences were 4.7 ± 3.4° (severe DDH) and 2.3 ± 2.1° (non-DDH/ mild DDH). The anteversion difference was different between the two groups. Multivariate analysis showed that the navigation difference (absolute difference in anteversion between postoperative CT and navigation records of > 5°) was significantly associated with severe DDH (odds ratio [OR]: 3.3; p = 0.049, 95% confidence interval [CI]: 1.0-11.1) and posterior pelvic tilt (OR: 1.1; p = 0.042, 95% CI: 1.0-1.27).
In patients with severe DDH, it is important to pay close attention during THA using portable navigation. However, the average difference was < 5º even in patients with severe DDH, and the accuracy may be acceptable in a clinical setting when the cost is considered.
对于患有发育性髋关节发育不良（DDH）的患者，全髋关节置换术（THA）中正确的杯状放置位置相当困难。本研究旨在分析使用便携式导航系统在 DDH 患者中进行 THA 时的杯插入方向准确性。
在这项回顾性队列研究中，我们分析了 64 例使用红外立体相机匹配便携式导航进行 THA 的患者数据。患者在侧卧位的前外侧入路接受 THA。术中杯角度的导航记录、术后 CT 图像上测量的杯角度以及杯角度测量差异在非 DDH/轻度 DDH 和重度 DDH 患者之间进行了测量和比较。此外，还分析了髋臼杯准确放置的离群值的预测因素。
平均测量的外展差异绝对值（术后 CT-导航记录）分别为 3.9±3.5°（重度 DDH）和 3.3±2.6°（非 DDH/轻度 DDH），前倾角差异分别为 4.7±3.4°（重度 DDH）和 2.3±2.1°（非 DDH/轻度 DDH）。两组间前倾角差异有统计学意义。多变量分析显示，导航差异（术后 CT 和导航记录的前倾角绝对差值>5°）与重度 DDH（比值比[OR]：3.3；p=0.049，95%置信区间[CI]：1.0-11.1）和骨盆后倾（OR：1.1；p=0.042，95% CI：1.0-1.27）显著相关。
在使用便携式导航进行 THA 时，对于重度 DDH 患者，需要密切关注。然而，即使在重度 DDH 患者中，平均差异也<5°，在考虑成本的情况下，在临床环境中准确性可能是可以接受的。
