Pang Michael, Vigdorchik Jonathan M, Schwarzkopf Ran, Chen Antonia F, Iorio Richard, Lange Jeffrey K, Ramkumar Prem N
Harvard Medical School and Brigham & Women's Hospital, Department of Orthopaedic Surgery, Boston, MA, USA.
Hospital for Special Surgery, New York, NY, USA.
Arthroplast Today. 2024 Oct 16;30:101508. doi: 10.1016/j.artd.2024.101508. eCollection 2024 Dec.
Spinopelvic mechanics are critical in total hip arthroplasty; however, there is no established consensus for adjusting acetabular component positioning based on spinopelvic parameters. This study aimed to (1) validate a recently developed Patient-Specific acetabular safe-zone calculator that factors in spinopelvic parameters and (2) compare differences with hip-spine classification targets.
A total of 3750 patients underwent primary total hip arthroplasty across 3 academic referral centers, with 33 (0.88%) requiring revision for instability. Spinopelvic parameters were measured before initial total hip arthroplasty, and acetabular component position was measured following the index and revision procedures. Most operations employed either computer navigation or robotic assistance (94%). Surgical approaches included both anterior and posterior techniques. Utilizing our recently developed patient-specific safe-zone calculator, theoretical intraoperative positions were calculated and compared to true component positions before and after revision.
Among 33 patients who underwent revision, none dislocated at an average follow-up of 5.1 years. In the external validation cohort, the average absolute differences between the patient-specific safe-zone and the median hip-spine classification recommendation were 3.8° ± 2.1° inclination and 5.0° ± 3.2° version. For the pooled cohort, the absolute differences between the patient-specific safe-zone targets and the prerevision component positions were 7.9° ± 5.1° inclination and 11.4° ± 6.9° version. After revision, the mean absolute differences decreased to 3.6° ± 3.1° inclination and 5.8° ± 3.5° version ( < .001).
A patient-specific approach improved acetabular component positioning accuracy within 6° of version and 4° of inclination of stable, revised hips. Patient-specific safe zones provide quantitative targets for nuanced spinopelvic preoperative planning that may mitigate risk of instability and may indicate use of assisted technologies.
在全髋关节置换术中，脊柱骨盆力学至关重要；然而，对于基于脊柱骨盆参数调整髋臼组件位置，目前尚无既定的共识。本研究旨在：（1）验证一种最近开发的、考虑脊柱骨盆参数的患者特异性髋臼安全区计算器；（2）比较其与髋部 - 脊柱分类目标的差异。
3个学术转诊中心共有3750例患者接受了初次全髋关节置换术，其中33例（0.88%）因不稳定需要翻修。在初次全髋关节置换术前测量脊柱骨盆参数，并在初次手术和翻修手术后测量髋臼组件位置。大多数手术采用计算机导航或机器人辅助（94%）。手术入路包括前路和后路技术。利用我们最近开发的患者特异性安全区计算器，计算理论术中位置，并与翻修前后的真实组件位置进行比较。
在33例接受翻修的患者中，平均随访5.1年，无一例发生脱位。在外部验证队列中，患者特异性安全区与髋部 - 脊柱分类中位数推荐值之间的平均绝对差异为倾斜度3.8°±2.1°，旋转角度5.0°±3.2°。对于汇总队列，患者特异性安全区目标与翻修前组件位置之间的绝对差异为倾斜度7.9°±5.1°，旋转角度11.4°±6.9°。翻修后，平均绝对差异降至倾斜度3.6°±3.1°，旋转角度5.8°±3.5°（P <.001）。
患者特异性方法提高了稳定、翻修后髋关节旋转角度6°和倾斜度4°范围内髋臼组件的定位准确性。患者特异性安全区为细致的脊柱骨盆术前规划提供了定量目标，这可能降低不稳定风险，并可能提示使用辅助技术。
