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, 吴科荣, 等. 直接前入路与后外侧入路全髋关节置换术的近期临床效果对比. 中华骨与关节外科杂志, 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.	刘宇, 桑伟林, 姜亚飞, 等. 直接前方入路与后外侧入路行人工全髋关节置换术对髋臼假体位置影响的比较研究. 中国修复重建外科杂志, 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.	朱镜, 陈刚, 蒋应华. 数字化模板术前测量在选择人工髋关节假体尺寸中的准确性. 现代医药卫生, 2013, 29(23): 3530-3532.
10.	马若凡, 许杰, 刘尚礼. 数字化模板与传统胶片模板术前测量在髋假体精确性选择上的比较研究. 中华关节外科杂志(电子版), 2008, 2(4): 420-426.
11.	许杰, 马若凡, 刘尚礼. 数字化模板测量在髋假体精确性选择上的应用价值及其应用改良. 中华关节外科杂志(电子版), 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.	何金鹏, 郝运, 王小林, 等. 数字化模板联合骨性参数测量辅助髋关节假体型号选择的研究. 中国修复重建外科杂志, 2015, 29(6): 688-692.
14.	张学军, 王宸. 数字化模板测量对全髋关节置换后下肢不等长的影响. 中国组织工程研究, 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, Löchteken 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.	陈勤, 周政, 邵勇, 等. 影像监测术中控制人工全髋关节假体置入. 中国修复重建外科杂志, 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, 吴科荣, 等. 直接前入路与后外侧入路全髋关节置换术的近期临床效果对比. 中华骨与关节外科杂志, 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. 刘宇, 桑伟林, 姜亚飞, 等. 直接前方入路与后外侧入路行人工全髋关节置换术对髋臼假体位置影响的比较研究. 中国修复重建外科杂志, 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. 朱镜, 陈刚, 蒋应华. 数字化模板术前测量在选择人工髋关节假体尺寸中的准确性. 现代医药卫生, 2013, 29(23): 3530-3532.
10. 马若凡, 许杰, 刘尚礼. 数字化模板与传统胶片模板术前测量在髋假体精确性选择上的比较研究. 中华关节外科杂志(电子版), 2008, 2(4): 420-426.
11. 许杰, 马若凡, 刘尚礼. 数字化模板测量在髋假体精确性选择上的应用价值及其应用改良. 中华关节外科杂志(电子版), 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. 何金鹏, 郝运, 王小林, 等. 数字化模板联合骨性参数测量辅助髋关节假体型号选择的研究. 中国修复重建外科杂志, 2015, 29(6): 688-692.
14. 张学军, 王宸. 数字化模板测量对全髋关节置换后下肢不等长的影响. 中国组织工程研究, 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, Löchteken 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. 陈勤, 周政, 邵勇, 等. 影像监测术中控制人工全髋关节假体置入. 中国修复重建外科杂志, 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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