Orthopedic Department, Croix St Simon Hospital 125 rue d'Avron, 75020 Paris, France.
Orthopedic Department, Croix St Simon Hospital 125 rue d'Avron, 75020 Paris, France.
Orthop Traumatol Surg Res. 2024 Oct;110(6):103940. doi: 10.1016/j.otsr.2024.103940. Epub 2024 Jul 22.
Various computer-assisted surgical systems claim to improve the accuracy of cup placement in total hip arthroplasties after assessing spinopelvic mobility to prevent prosthetic impingement. However, no study has yet analyzed the extent of the patient-specific cup anteversion safe zones.
We hypothesized that most patients have a safe zone >10 °, except those with abnormal spinopelvic mobility, who have a much narrower safe zone.
We simulated the risks of prosthetic impingement using the planned cup anteversion. The consecutive cohort included 341 patients who underwent total hip arthroplasty. Our primary endpoint was the patient-specific impingement-free zone for cup anteversion, which was then divided into four subgroups: 0 °, 1 ° to 5 °, 6 ° to 10 °, and >10 °. This data was then secondarily analyzed for abnormal spinopelvic mobility (the difference in the spinopelvic tilt [ΔSPT] from a standing to a flexed seated position >20 °).
The mean anteversion safe zone was 22.8 ° with 82.4% (281/341) of patients with a zone strictly >10 °. The mean safe zone was 8.9 ° (+/- 9 °) in patients with an ΔSPT ≥20 ° (18.2%), with 37.1% of these patients having a zone of 0 °, 16.13% a zone between 1 ° and 5 °, 8.06% a zone between 6 ° and 10 ° and 38.71% a zone >10 °. The mean safe zone was 25.9 ° (+/- 9 °) in patients with an ΔSPT <20 ° (81.8%), and the proportion of cases in each zone was 2.51%, 1.08%, 4.3%, and 92.11%, respectively (p < 0.001).
The safe zone for anteversion appears to be fairly wide in most patients. However, identifying patients at risk of abnormal spinopelvic mobility seems necessary to identify the two-thirds of patients with a narrow safe zone.
IV; retrospective study.
各种计算机辅助手术系统声称通过评估脊柱骨盆活动度来预防假体撞击，从而提高全髋关节置换术后杯放置的准确性。然而，目前还没有研究分析患者特定杯前倾角安全区的范围。
我们假设大多数患者的安全区>10°，但脊柱骨盆活动度异常的患者除外，他们的安全区要窄得多。
我们使用计划的杯前倾角模拟了假体撞击的风险。连续队列纳入 341 例接受全髋关节置换术的患者。我们的主要终点是患者特定的杯前倾角无撞击区，然后将其分为四个亚组：0°、1°至 5°、6°至 10°和>10°。然后，我们对脊柱骨盆活动度异常（站立位到屈髋坐位时脊柱骨盆倾斜度的差值>20°）的患者进行了二次分析。
平均前倾角安全区为 22.8°，82.4%（281/341）的患者安全区严格>10°。ΔSPT≥20°（18.2%）的患者平均安全区为 8.9°（±9°），其中 37.1%的患者安全区为 0°，16.13%为 1°至 5°，8.06%为 6°至 10°，38.71%为>10°。ΔSPT<20°（81.8%）的患者平均安全区为 25.9°（±9°），每个区的病例比例分别为 2.51%、1.08%、4.3%和 92.11%（p<0.001）。
大多数患者的前倾角安全区似乎相当宽。然而，识别有异常脊柱骨盆活动度风险的患者似乎有必要确定三分之二的患者安全区较窄。
IV；回顾性研究。
