Chai Yuan, Boudali A Mounir, Jenkins Evan, Maes Vincent, Walter William L
The University of Sydney, Sydney Musculoskeletal Health and The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health and the Northern Sydney Local Health District, Level 10, 10 Westbourne St, St. Leonards, NSW, 2064, Australia; Institute of Future Health, South China University of Technology, 777 Xingyedadao Avenue, Panyu District, Guangzhou, Guangdong Province, 511442, China.
The University of Sydney, Sydney Musculoskeletal Health and The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health and the Northern Sydney Local Health District, Level 10, 10 Westbourne St, St. Leonards, NSW, 2064, Australia.
Orthop Traumatol Surg Res. 2024 Oct;110(6):103908. doi: 10.1016/j.otsr.2024.103908. Epub 2024 May 19.
Accurate preoperative templating is essential for the success of hip resurfacing arthroplasty (HRA). While digital radiograph is currently considered the gold standard, stereoradiograph and CT converted 3D methods have shown promising results. However, there is no consensus in the literature regarding the preferred modality for HRA templating, and angular measurements are often overlooked. Thus, this study aimed to: (1) compare the performances of different modality in implant sizing and angle measurements, (2) evaluate the measurement reproducibility, (3) assess the impact of severe osteoarthritis on femoral head sizing, and (4) based on the analysis above, explore the optimal imaging and planning strategy for HRA.
An optimal imaging modality exists for HRA planning regarding implant sizing and angular measurements.
Preoperative imaging data from seventy-seven HRA surgeries were collected. Three raters performed templating using digital radiograph, stereoradiograph, and CT converted 3D models. Measurements for femoral head size, neck-shaft angle, and calcar-shaft angle were obtained. The femoral head sizing was compared to the intraoperative clinical decision. The reproducibility of measurements was assessed using the intraclass correlation coefficient (ICC). Correlations were examined between sizing disagreement and osteoarthritis grade (Tonnis Classification).
Digital radiograph, stereoradiograph, and 3D techniques predicted one size off target in 27/77 (35%), 49/70 (70%), and 75/77 (97%) of cases, respectively, corresponding to 1.8±1.6 (0 to 5.67), 0.9±0.7 (0 to 2.67), and 0.4±0.4 (0 to 1.67) sizes off target, indicating statistically significant differences among all three modalities, with p-values all below 0.01. There were no statistically significant differences among the different modalities for angular measurements. Measurements showed moderate to excellent reproducibility (ICC=0.628-0.955). High-grade osteoarthritis did not impact image sizing in any modality (r=0.08-0.22, all p>0.05).
CT converted 3D models were more accurate for implant sizing in HRA, but did not significantly outperform other modalities in angular measurements. Given the high costs and increased radiation exposure associated with CT, the study recommended using CT scans selectively, particularly for precise femoral head sizing, while alternative imaging methods can be effectively used for angular measurements.
III; retrospective comparative diagnostic study.
精确的术前模板规划对于髋关节表面置换术（HRA）的成功至关重要。虽然数字X线摄影目前被认为是金标准，但立体X线摄影和CT转换3D方法已显示出有前景的结果。然而，关于HRA模板规划的首选方式，文献中尚无共识，并且角度测量常常被忽视。因此，本研究旨在：（1）比较不同方式在植入物尺寸测量和角度测量方面的性能；（2）评估测量的可重复性；（3）评估重度骨关节炎对股骨头尺寸的影响；（4）基于上述分析，探索HRA的最佳成像和规划策略。
对于HRA规划的植入物尺寸测量和角度测量存在一种最佳成像方式。
收集了77例HRA手术的术前成像数据。三名评估者使用数字X线摄影、立体X线摄影和CT转换3D模型进行模板规划。获得了股骨头尺寸、颈干角和小转子干角的测量值。将股骨头尺寸测量结果与术中临床决策进行比较。使用组内相关系数（ICC）评估测量的可重复性。检查尺寸测量差异与骨关节炎分级（Tonnis分类）之间的相关性。
数字X线摄影、立体X线摄影和3D技术分别在27/77（35%）、49/70（70%）和75/77（97%）的病例中预测的尺寸与目标尺寸相差一个型号，分别对应偏离目标尺寸1.8±1.6（0至5.67）、0.9±0.7（0至2.67）和0.4±0.4（0至1.67）个型号，表明所有三种方式之间存在统计学显著差异，p值均低于0.01。不同方式在角度测量方面无统计学显著差异。测量显示出中度至极好的可重复性（ICC = 0.628 - 0.955）。重度骨关节炎在任何方式下均未影响图像尺寸测量（r = 0.08 - 0.22，所有p>0.05）。
CT转换3D模型在HRA植入物尺寸测量方面更准确，但在角度测量方面并未显著优于其他方式。鉴于CT相关的高成本和辐射暴露增加，本研究建议选择性地使用CT扫描，特别是用于精确的股骨头尺寸测量，而其他成像方法可有效地用于角度测量。
III级；回顾性比较诊断研究。
