Treatment of Recurrent Dislocation after Total Hip Arthroplasty Using Advanced Imaging and Three-Dimensional Model
- PDF / 6,139,844 Bytes
- 11 Pages / 595.276 x 790.866 pts Page_size
- 51 Downloads / 179 Views
ORIGINAL ARTICLE
Treatment of Recurrent Dislocation after Total Hip Arthroplasty Using Advanced Imaging and Three-Dimensional Modeling Techniques: A Case Series Sean A. Sutphen, DO & Joseph D. Lipman, MS & Seth A. Jerabek, MD & David J. Mayman, MD & Christina I. Esposito, PhD
Received: 31 January 2019/Accepted: 1 July 2019 * The Author(s) 2019
Abstract Background: Surgical treatment options for addressing recurrent dislocation after total hip arthroplasty (THA) vary. Identifying impingement mechanisms in an unstable THA may be beneficial in determining appropriate treatment. Questions/Purposes: We sought to assess the effectiveness of developing pre-operative plans for treating hip instability after THA. We used advanced imaging and three-dimensional modeling techniques to perform impingement analyses in patients with unstable THA. Methods: We evaluated a series of eight patients who would require revision THA to treat recurrent dislocation. Using a preoperative algorithmic approach, we built patient-specific models and evaluated hip range of motion with computed tomographic scanning and biplanar radiography. This information was used to determine a surgical treatment plan that was then executed intra-operatively. Patients were followed for 2 years to determine whether they experienced another hip dislocation following treatment. Results: Pre-operative kinematic modeling showed four of the eight patients had limited hip range of motion during flexion and internal
Level of Evidence: Therapeutic Study Level IV Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11420-019-09704-z) contains supplementary material, which is available to authorized users. S. A. Sutphen, DO : J. D. Lipman, MS : S. A. Jerabek, MD : D. J. Mayman, MD : C. I. Esposito, PhD (*) Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA e-mail: [email protected]
rotation; a prominent anterior inferior iliac spine (AIIS) was found to limit hip range of motion in some of these cases. In the other four patients, range of motion was acceptable, suggesting soft-tissue causes of dislocation. No patients in this series experienced dislocation after undergoing revision THA. Conclusion: Advanced modeling techniques may be useful for identifying the impingement mechanisms responsible for instability after THA. Once variables contributing to limited hip range of motion are identified, surgeons can develop treatment plans to improve patient outcomes. Resecting a hypertrophic AIIS may improve hip range of motion and may be an important consideration for hip surgeons when revising unstable THAs. Keywords dislocation . impingement . instability . surgical planning . total hip arthroplasty Introduction Dislocation is one of the most common complications seen after total hip arthroplasty (THA). It can occur during the early or late post-operative period [6]. Reported rates of dislocation range from 0.1 to 9% after primary THA and 5 to 30% after revision THA [1, 16, 17, 24, 37, 39]. Single episo
Data Loading...
