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Simulating movements of daily living in robot-assisted total hip arthroplasty with 3D modelling: a feasibility study

AIMS: Computer-assisted 3D preoperative planning software has the potential to improve postoperative stability in total hip arthroplasty (THA). Commonly, preoperative protocols simulate two functional positions (standing and relaxed sitting) but do not consider other common positions that may increa...

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Autores principales: Tung, Wei S., Donnelley, Claire, Pour, Aidin E., Tommasini, Steven, Wiznia, Daniel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The British Editorial Society of Bone & Joint Surgery 2023
Materias:
Hip
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10234721/
https://www.ncbi.nlm.nih.gov/pubmed/37263587
http://dx.doi.org/10.1302/2633-1462.46.BJO-2023-0046.R1
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author Tung, Wei S.
Donnelley, Claire
Pour, Aidin E.
Tommasini, Steven
Wiznia, Daniel
author_facet Tung, Wei S.
Donnelley, Claire
Pour, Aidin E.
Tommasini, Steven
Wiznia, Daniel
author_sort Tung, Wei S.
collection PubMed
description AIMS: Computer-assisted 3D preoperative planning software has the potential to improve postoperative stability in total hip arthroplasty (THA). Commonly, preoperative protocols simulate two functional positions (standing and relaxed sitting) but do not consider other common positions that may increase postoperative impingement and possible dislocation. This study investigates the feasibility of simulating commonly encountered positions, and positions with an increased risk of impingement, to lower postoperative impingement risk in a CT-based 3D model. METHODS: A robotic arm-assisted arthroplasty planning platform was used to investigate 11 patient positions. Data from 43 primary THAs were used for simulation. Sacral slope was retrieved from patient preoperative imaging, while angles of hip flexion/extension, hip external/internal rotation, and hip abduction/adduction for tested positions were derived from literature or estimated with a biomechanical model. The hip was placed in the described positions, and if impingement was detected by the software, inspection of the impingement type was performed. RESULTS: In flexion, an overall impingement rate of 2.3% was detected for flexed-seated, squatting, forward-bending, and criss-cross-sitting positions, and 4.7% for the ankle-over-knee position. In extension, most hips (60.5%) were found to impinge at or prior to 50° of external rotation (pivoting). Many of these impingement events were due to a prominent ischium. The mean maximum external rotation prior to impingement was 45.9° (15° to 80°) and 57.9° (20° to 90°) prior to prosthetic impingement. No impingement was found in standing, sitting, crossing ankles, seiza, and downward dog. CONCLUSION: This study demonstrated that positions of daily living tested in a CT-based 3D model show high rates of impingement. Simulating additional positions through 3D modelling is a low-cost method of potentially improving outcomes without compromising patient safety. By incorporating CT-based 3D modelling of positions of daily living into routine preoperative protocols for THA, there is the potential to lower the risk of postoperative impingement events. Cite this article: Bone Jt Open 2023;4(6):416–423.
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spelling pubmed-102347212023-06-02 Simulating movements of daily living in robot-assisted total hip arthroplasty with 3D modelling: a feasibility study Tung, Wei S. Donnelley, Claire Pour, Aidin E. Tommasini, Steven Wiznia, Daniel Bone Jt Open Hip AIMS: Computer-assisted 3D preoperative planning software has the potential to improve postoperative stability in total hip arthroplasty (THA). Commonly, preoperative protocols simulate two functional positions (standing and relaxed sitting) but do not consider other common positions that may increase postoperative impingement and possible dislocation. This study investigates the feasibility of simulating commonly encountered positions, and positions with an increased risk of impingement, to lower postoperative impingement risk in a CT-based 3D model. METHODS: A robotic arm-assisted arthroplasty planning platform was used to investigate 11 patient positions. Data from 43 primary THAs were used for simulation. Sacral slope was retrieved from patient preoperative imaging, while angles of hip flexion/extension, hip external/internal rotation, and hip abduction/adduction for tested positions were derived from literature or estimated with a biomechanical model. The hip was placed in the described positions, and if impingement was detected by the software, inspection of the impingement type was performed. RESULTS: In flexion, an overall impingement rate of 2.3% was detected for flexed-seated, squatting, forward-bending, and criss-cross-sitting positions, and 4.7% for the ankle-over-knee position. In extension, most hips (60.5%) were found to impinge at or prior to 50° of external rotation (pivoting). Many of these impingement events were due to a prominent ischium. The mean maximum external rotation prior to impingement was 45.9° (15° to 80°) and 57.9° (20° to 90°) prior to prosthetic impingement. No impingement was found in standing, sitting, crossing ankles, seiza, and downward dog. CONCLUSION: This study demonstrated that positions of daily living tested in a CT-based 3D model show high rates of impingement. Simulating additional positions through 3D modelling is a low-cost method of potentially improving outcomes without compromising patient safety. By incorporating CT-based 3D modelling of positions of daily living into routine preoperative protocols for THA, there is the potential to lower the risk of postoperative impingement events. Cite this article: Bone Jt Open 2023;4(6):416–423. The British Editorial Society of Bone & Joint Surgery 2023-06-02 /pmc/articles/PMC10234721/ /pubmed/37263587 http://dx.doi.org/10.1302/2633-1462.46.BJO-2023-0046.R1 Text en © 2023 Author(s) et al. https://creativecommons.org/licenses/by-nc-nd/4.0/https://online.boneandjoint.org.uk/TDMThis is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Hip
Tung, Wei S.
Donnelley, Claire
Pour, Aidin E.
Tommasini, Steven
Wiznia, Daniel
Simulating movements of daily living in robot-assisted total hip arthroplasty with 3D modelling: a feasibility study
title Simulating movements of daily living in robot-assisted total hip arthroplasty with 3D modelling: a feasibility study
title_full Simulating movements of daily living in robot-assisted total hip arthroplasty with 3D modelling: a feasibility study
title_fullStr Simulating movements of daily living in robot-assisted total hip arthroplasty with 3D modelling: a feasibility study
title_full_unstemmed Simulating movements of daily living in robot-assisted total hip arthroplasty with 3D modelling: a feasibility study
title_short Simulating movements of daily living in robot-assisted total hip arthroplasty with 3D modelling: a feasibility study
title_sort simulating movements of daily living in robot-assisted total hip arthroplasty with 3d modelling: a feasibility study
topic Hip
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10234721/
https://www.ncbi.nlm.nih.gov/pubmed/37263587
http://dx.doi.org/10.1302/2633-1462.46.BJO-2023-0046.R1
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