Application of preoperative digital-template planning in total hip arthroplasty via direct anterior approach_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAO Zheng ^1,2 ,  YANG Wei ^2,3 , YANG Minzhi ^1,2 , KONG Xiangpeng ² , WANG Yi ² , GUO Renwen ² , CHEN Jiying ² ,  CHAI Wei ²

1. Medical School of Nankai University, Tianjing, 300071, P.R.China;
2. Department of Orthopedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China;
3. Department of Orthopedics, the First People Hospital of Linxiang, Linxiang Hunan, 414300, P.R.China;

Corresponding?author：

CHAI Wei, Email: chaiwei301@163.com

Keywords：

Digital-template planning; direct anterior approach; total hip arthroplasty; complication

DOI：

10.7507/1002-1892.201903108

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Objective To investigate the accuracy of preoperative digital-template planning in total hip arthroplasty (THA) via direct anterior approach (DAA) and its effect on the short-term effectiveness.Methods The clinical data of 77 patients (109 hips) with osteonecrosis of femoral head who underwent THA via DAA between January 2016 and May 2018 was retrospectively analyzed. According to the type of template, patients were divided into digital-template group (group A, 40 patients, 56 hips) and conventional-template group (group B, 37 patients, 53 hips). There was no significant difference in age, gender, body mass index, the stages of osteonecrosis of femoral head, and preoperative Harris hip score (HHS) (P>0.05). The operation time, intraoperative blood loss, frequencies of intraoperative fluoroscopy, and complications were recorded. Otherwise, the consistency rate of preoperative planning and practical prosthesis size was analyzed. Position of acetabular prosthesis and femoral prosthesis alignment were measured on anteroposterior X-ray film of the pelvis at 3 months after operation. HHS was used to evaluate clinical function.Results The consistency rate of preoperative planning and practical acetabular prosthesis size was significantly higher in group A (80.4%, 45/56) than that in group B (62.3%, 33/53), showing significant difference (χ²=4.38, P=0.04). But there was no significant difference in the consistency rate of preoperative planning and practical femoral prosthesis size between group A (83.9%, 47/56) and group B (79.2%, 42/53）(χ²=0.40, P=0.53). The prosthesis abductions were (40.7±6.4)° in group A and (38.8±7.3)° in group B; the femoral prosthesis alignment deviations were (0.1±1.8)° in group A and (0.3±1.7)° in group B. There was no significant difference in the prosthesis abduction and femoral prosthesis alignment deviation between 2 groups (P>0.05). No prosthesis sinking or loosening occurred during follow-up. The operation time and frequencies of intraoperative fluoroscopy were less in group A than those in group B (P<0.05). But there was no significant difference in intraoperative blood loss between 2 groups (t=1.92, P=0.06). The complication occurred in 1 hip of group A and 6 hips of group B, with no significant difference (P=0.06). All patients were followed up 6-22 months (mean 13.8 months) in group A and 6-24 months (mean, 14.6 months) in group B. At last follow-up, the HHS scores were 91.8±3.1 in group A and 92.6±4.2 in group B, and the difference was not significant (t=1.14, P=0.26).Conclusion Preoperative digital-template planning in THA via DAA is accurate, which can reduce the operation time and frequencies of intraoperative fluoroscopy without enhancing the risk of complication.

Citation： CAO Zheng, YANG Wei, YANG Minzhi, KONG Xiangpeng, WANG Yi, GUO Renwen, CHEN Jiying, CHAI Wei. Application of preoperative digital-template planning in total hip arthroplasty via direct anterior approach. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(11): 1374-1378. doi: 10.7507/1002-1892.201903108 Copy

1.	Meermans G, Konan S, Das R, et al. The direct anterior approach in total hip arthroplasty: a systematic review of the literature. Bone Joint J, 2017, 99-B(6): 732-740.
2.	Post ZD, Orozco F, Diaz-Ledezma C, et al. Direct anterior approach for total hip arthroplasty: indications, technique, and results. J Am Acad Orthop Surg, 2014, 22(9): 595-603.
3.	Lovell TP. Single-incision direct anterior approach for total hip arthroplasty using a standard operating table. J Arthroplasty, 2008, 23(7 Suppl): 64-68.
4.	Putananon C, Tuchinda H, Arirachakaran A, et al. Comparison of direct anterior, lateral, posterior and posterior-2 approaches in total hip arthroplasty: network meta-analysi. Eur J Orthop Surg Traumatol, 2018, 28(2): 255-267.
5.	倪喆, 尚希福, 吳科榮, 等. 直接前入路與后外側入路全髖關節置換術的近期臨床效果對比. 中華骨與關節外科雜志, 2018, 11(7): 518-521.
6.	Van Den Eeden Y, Van Den Eeden F. Learning curve of direct anterior total hip arthroplasty: a single surgeon experience. Acta Orthop Belg, 2018, 84(3): 321-330.
7.	劉宇, 桑偉林, 姜亞飛, 等. 直接前方入路與后外側入路行人工全髖關節置換術對髖臼假體位置影響的比較研究. 中國修復重建外科雜志, 2017, 31(7): 790-793.
8.	De Geest T, Fennema P, Lenaerts G, et al. Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis. Arch Orthop Trauma Surg, 2015, 135(8): 1183-1192.
9.	朱鏡, 陳剛, 蔣應華. 數字化模板術前測量在選擇人工髖關節假體尺寸中的準確性. 現代醫藥衛生, 2013, 29(23): 3530-3532.
10.	馬若凡, 許杰, 劉尚禮. 數字化模板與傳統膠片模板術前測量在髖假體精確性選擇上的比較研究. 中華關節外科雜志(電子版), 2008, 2(4): 420-426.
11.	許杰, 馬若凡, 劉尚禮. 數字化模板測量在髖假體精確性選擇上的應用價值及其應用改良. 中華關節外科雜志(電子版), 2007, 1(3): 165-171.
12.	Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg (Br), 1993, 75(2): 228-232.
13.	何金鵬, 郝運, 王小林, 等. 數字化模板聯合骨性參數測量輔助髖關節假體型號選擇的研究. 中國修復重建外科雜志, 2015, 29(6): 688-692.
14.	張學軍, 王宸. 數字化模板測量對全髖關節置換后下肢不等長的影響. 中國組織工程研究, 2013, 17(9): 1527-1534.
15.	Osmani FA, Thakkar S, Ramme A, et al. Variance in predicted cup size by 2-dimensional vs 3-dimensional computerized tomography-based templating in primary total hip arthroplasty. Arthroplast Today, 2017, 3(4): 289-293.
16.	Shaarani SR, McHugh G, Collins DA. Accuracy of digital preoperative templating in 100 consecutive uncemented total hip arthroplasties: a single surgeon series. J Arthroplasty, 2013, 28(2): 331-337.
17.	Ellapparadja P, Mahajan V, Deakin AH, et al. Reproduction of hip offset and leg length in navigated total hip arthroplasty: How accurate are we? J Arthroplasty, 2015, 30(3): 1002-1007.
18.	Heep H, Xu J, L?chteken C, et al. A simple and convenient method guide to determine the magnification of digital X-rays for preoperative planning in total hip arthroplasty. Orthop Rev (Pavia), 2012, 4(1): e12.
19.	Meneghini RM, Elston AS, Chen AF, et al. Direct anterior approach: Risk factor for early femoral failure of cementless total hip arthroplasty: a multicenter study. J Bone Joint Surg (Am), 2017, 99(2): 99-105.
20.	陳勤, 周政, 邵勇, 等. 影像監測術中控制人工全髖關節假體置入. 中國修復重建外科雜志, 2006, 20(12): 1172-1175.
21.	McNabb DC, Jennings JM, Levy DL, et al. Direct anterior hip replacement does not pose undue radiation exposure risk to the patient or surgeon. J Bone Joint Surg (Am), 2017, 99(23): 2020-2025.
22.	Peters PG, Laughlin RT, Markert RJ, et al. Timing of C-arm drape contamination. Surg Infect (Larchmt), 2012, 13(2): 110-113.

1. Meermans G, Konan S, Das R, et al. The direct anterior approach in total hip arthroplasty: a systematic review of the literature. Bone Joint J, 2017, 99-B(6): 732-740.
2. Post ZD, Orozco F, Diaz-Ledezma C, et al. Direct anterior approach for total hip arthroplasty: indications, technique, and results. J Am Acad Orthop Surg, 2014, 22(9): 595-603.
3. Lovell TP. Single-incision direct anterior approach for total hip arthroplasty using a standard operating table. J Arthroplasty, 2008, 23(7 Suppl): 64-68.
4. Putananon C, Tuchinda H, Arirachakaran A, et al. Comparison of direct anterior, lateral, posterior and posterior-2 approaches in total hip arthroplasty: network meta-analysi. Eur J Orthop Surg Traumatol, 2018, 28(2): 255-267.
5. 倪喆, 尚希福, 吳科榮, 等. 直接前入路與后外側入路全髖關節置換術的近期臨床效果對比. 中華骨與關節外科雜志, 2018, 11(7): 518-521.
6. Van Den Eeden Y, Van Den Eeden F. Learning curve of direct anterior total hip arthroplasty: a single surgeon experience. Acta Orthop Belg, 2018, 84(3): 321-330.
7. 劉宇, 桑偉林, 姜亞飛, 等. 直接前方入路與后外側入路行人工全髖關節置換術對髖臼假體位置影響的比較研究. 中國修復重建外科雜志, 2017, 31(7): 790-793.
8. De Geest T, Fennema P, Lenaerts G, et al. Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis. Arch Orthop Trauma Surg, 2015, 135(8): 1183-1192.
9. 朱鏡, 陳剛, 蔣應華. 數字化模板術前測量在選擇人工髖關節假體尺寸中的準確性. 現代醫藥衛生, 2013, 29(23): 3530-3532.
10. 馬若凡, 許杰, 劉尚禮. 數字化模板與傳統膠片模板術前測量在髖假體精確性選擇上的比較研究. 中華關節外科雜志(電子版), 2008, 2(4): 420-426.
11. 許杰, 馬若凡, 劉尚禮. 數字化模板測量在髖假體精確性選擇上的應用價值及其應用改良. 中華關節外科雜志(電子版), 2007, 1(3): 165-171.
12. Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg (Br), 1993, 75(2): 228-232.
13. 何金鵬, 郝運, 王小林, 等. 數字化模板聯合骨性參數測量輔助髖關節假體型號選擇的研究. 中國修復重建外科雜志, 2015, 29(6): 688-692.
14. 張學軍, 王宸. 數字化模板測量對全髖關節置換后下肢不等長的影響. 中國組織工程研究, 2013, 17(9): 1527-1534.
15. Osmani FA, Thakkar S, Ramme A, et al. Variance in predicted cup size by 2-dimensional vs 3-dimensional computerized tomography-based templating in primary total hip arthroplasty. Arthroplast Today, 2017, 3(4): 289-293.
16. Shaarani SR, McHugh G, Collins DA. Accuracy of digital preoperative templating in 100 consecutive uncemented total hip arthroplasties: a single surgeon series. J Arthroplasty, 2013, 28(2): 331-337.
17. Ellapparadja P, Mahajan V, Deakin AH, et al. Reproduction of hip offset and leg length in navigated total hip arthroplasty: How accurate are we? J Arthroplasty, 2015, 30(3): 1002-1007.
18. Heep H, Xu J, L?chteken C, et al. A simple and convenient method guide to determine the magnification of digital X-rays for preoperative planning in total hip arthroplasty. Orthop Rev (Pavia), 2012, 4(1): e12.
19. Meneghini RM, Elston AS, Chen AF, et al. Direct anterior approach: Risk factor for early femoral failure of cementless total hip arthroplasty: a multicenter study. J Bone Joint Surg (Am), 2017, 99(2): 99-105.
20. 陳勤, 周政, 邵勇, 等. 影像監測術中控制人工全髖關節假體置入. 中國修復重建外科雜志, 2006, 20(12): 1172-1175.
21. McNabb DC, Jennings JM, Levy DL, et al. Direct anterior hip replacement does not pose undue radiation exposure risk to the patient or surgeon. J Bone Joint Surg (Am), 2017, 99(23): 2020-2025.
22. Peters PG, Laughlin RT, Markert RJ, et al. Timing of C-arm drape contamination. Surg Infect (Larchmt), 2012, 13(2): 110-113.

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