Download PDF
Z Orthop Ihre Grenzgeb 2000; 138(6): 515-521
DOI: 10.1055/s-2000-9594
HÜFTENDOPROTHETIK

Georg Thieme Verlag Stuttgart · New York

Computerassistiert navigierte Pfannenplatzierung in der Hüftendoprothetik - Anwendungsstudie im klinischen Routinealltag

Computer Assisted Navigated Cup Placement in Hip Arthroplasty - Application Study in Clinical Routine.K.  Bernsmann1 , U.  Langlotz2 , B.  Ansari1 , M.  Wiese1
  • 1 Orthopädische Universitätsklinik im St. Josef-Hospital, Bochum
  • 2 M. E. Müller Institut für Biomechanik, Universität Bern, Bern, Schweiz
Further Information

Publication History

Publication Date:
31 December 2000 (online)

Also available at
    Permissions and Reprints

Zusammenfassung.

Studienziel: Routinetauglichkeit eines Navigationssystems für die Pfannenplatzierung in der Hüftendoprothetik. Methode: In einer prospektiven Studie wurden zwischen 03/1999 und 11/1999 70 computerassistierte (CAS) Hüfttotalendoprothesen (H-TFP) durch einen Operateur implantiert. Mit Hilfe eines CAS-Systems wurde die Implantation der künstlichen Hüftgelenkspfanne geplant und intraoperativ durchgeführt. Ergebnisse: Die mittlere Verlängerung der Operationszeit betrug 15-20 Min. Die durchschnittliche Op-Zeit lag insgesamt bei 70 Min. Der mittlere Blutverlust betrug 630 ml. Durch spezifische Arbeitsschritte, wie zum Beispiel die percutane Abtastung der Spina iliaca anterior superior oder die Fixierung der Referenzbasis, traten keine perioperativen Komplikationen auf. Schlussfolgerung: Die navigierte Pfannenpositionierung in der Hüftendoprothetik hat sich in der klinischen Applikation bewährt und zeigt durch sehr gute Ergebnisse einen effektiven Beitrag zur Qualitätssicherung in der Hüftendoprothetik.

Aim: This study serves to examine the feasibility of a CAS system in clinical routine use in the field of total hip replacement. Method: Within a prospective study 70 total hip replacements were performed by one surgeon (KB) between March and November, 1999 using a CAS system for preoperative planning and intraoperative cup placement. Results: The average operating time was 70 min. This means an average increase in total time of operation about 15 - 20 min. The average blood loss was 630 ml. No additional specific complications due to the use of the system were seen. There was no additional trauma created by percutaneous pointing at the spina or fixing a dynamic reference base (DRB) at the pelvis. Conclusion: The active application of this CAS system in clinical routine use showed very good results in feasibility and can be considered as reliable. The navigated cup placement shows the potential of improving the results in cup placement, thus improving the outcome of hip arthroplasty.

Schlüsselwörter:

Hüftendoprothetik - Navigation - Pfannenposition - CAS-Qualitätssicherung

Key words:

Hip arthroplasty - navigation - cup position - CAS - outcome management

Literatur

  • 01 Abraham  W D, Dimon III  J H. Leg length discrepancy in total hip arthroplasty.  Orthopedic Clinics of North America.. 1992;  23 (2) 201-209
    Google Scholar
  • 02 Ackland  M K, Bourne  W B, Uhthoff  H K. Anteversion of the acetabular cup. Measurement of angle after total hip replacement.  J Bone Joint Surg. 1986;  68-B 409-413
    Google Scholar
  • 03 Ali Khan  M A, Brakenbury  P H, Reynolds  I SR. Dislocation following total hip replacement.  J Bone Joint Surg. 1981;  63-B 214-218
    Google Scholar
  • 04 Amstutz  H C, Campbell  P, Kossovsky  N, Clanrke  I C. Mechanism and clinical significance of wear debris-induced osteolysis.  Clin Orthop. 1992;  276 7-18
    Google Scholar
  • 05 Callaghan  J J. Total hip arthroplasty.  Clin Orthop. 1992;  276 33-340
    Google Scholar
  • 06 Del Schutte  H Jr, Lipman  A J, Bannar  S M, Livermore  J T, Ilstrup  D, Morrey  B F. Effect of acetabular abduction on cup wear rates in total hip arthroplasty.  J Arthroplasty. 1998;  13 (6) 621-626
    Google Scholar
  • 07 DiGioia  A M, Jaramaz  B, Blackwell  M, Simon  D A, Morgan  F, Moody  J E, Nikou  C, Colgan  B D, Aston  C A, Labarca  R S, Kischell  E, Kanade  T. The Otto Aufranc Award. Image guided navigation system to measure intraoperatively acetabular implant alignment.  Clin Orthop. 1998;  355 8-22
    Google Scholar
  • 08 DiGioia  A M, Jaramaz  B, Moody  J E, Nikou  C, LaBarca  R S. Mechanical acetabular alignment guides: lnherent inaccuracy, 5th International Symposium on CAOS . Davos 17 - 19 Februar; 2000
    Google Scholar
  • 09 Eggli  S, Pisan  M, Müller  M E. The value of preoperative planning for total hip arthroplasty.  J Bone Joint Surg. 1998;  80-B 382-390
    Google Scholar
  • 10 Espehaug  B, Havelin  L I, Engesaeter  L B, Voliset  S E. The effect of hospital-type and operating volume on the survival of hip replacements. A review of 39,505 primary total hip replacements reported to the Norwegian Arthroplasty Register, 1988 - 1996.  Acta Orthop Scand. 1999;  70 (1) 12-18
    PubMedGoogle Scholar
  • 11 Fackler  C D, Poss  R. Dislocation in total hip arthroplasties.  Clin Orthop. 1980;  151 169-178
    PubMedGoogle Scholar
  • 12 Grossmann  P, Braun  M, Becker  W. Luxationen nach Hüft-TEP-Implantationen: Abhängigkeit vom Zugang und anderen Faktoren.  Z Orthop Ihre Grenzgeb. 1994;  132 (6) 521-526
    PubMedGoogle Scholar
  • 13 Han  C D, Choe  W S, Yoo  J H. Effect of polyethylene wear on osteolysis in cementless primary total hip arthroplasty: minimal 5-year follow-up study.  J Arthroplasty. 1999;  14 (6) 714-723
    CrossrefPubMedGoogle Scholar
  • 14 Hassan  D M, Johnston  G HF, Dust  W NC, Watson  G, Dolovich  A T. Accuracy of intraoperative assessment of acetabular prosthesis placement.  J Arthroplasty. 1998;  13 (1) 80-84
    CrossrefPubMedGoogle Scholar
  • 15 Hedlundh  U, Ahnfelt  L, Hybbinette  C-H, Weckström  J, Fredin  H. Surgical expedence related to dislocations after total hip arthroplasty.  J Bone Joint Surg. 1996;  78-B 206-209
    PubMedGoogle Scholar
  • 16 Hernandez  J R, Keating  E M, Faris  P M, Meding  J B, Ritter  M A. Poyethylene wear in uncemented acetabular components.  J Bone Joint Surg. 1994;  76-B (2) 263-266
    PubMedGoogle Scholar
  • 17 Ilchmann  T, Markovic  L, Joshi  A, Hardinge  K, Murphy  J, Wingstrand  H. Migration and wear of long-term successful Charnley total hip replacements.  J Bone Joint Surg. 1998;  80-B (3) 377-381
    PubMedGoogle Scholar
  • 18 Jaramaz  B, DiGioia  A M, Blackwell  M, Nikou  C. Computer assisted measurement of cup placement in total hip replacement.  Clin Orthop. 1998;  354 70-80
    PubMedGoogle Scholar
  • 19 Joshi  A, Lee  C M, Markovic  L, Vlatis  G, Murphy  C M. Prognosis of dislocation after total hip arthroplasty.  J Arthroplasty. 1998;  13 (1) 17-21
    CrossrefPubMedGoogle Scholar
  • 20 Kennedy  J G, Rogers  W B, Soffe  K E, Sullivan  R J, Griffen  D G, Sheehan  L J. Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration.  J Arthroplasty. 1998;  13 (5) 530-534
    CrossrefPubMedGoogle Scholar
  • 21 Kohn  D, Ruhmann  O, Wirth  C J. Die Verrenkung der Hüftendoprothese unter besonderer Beachtung verschiedener Zugangswege.  Z Orthop Ihre Grenzgeb. 1997;  135 (1) 40-44
    PubMedGoogle Scholar
  • 22 Kordelle  J, Starker  M. Migrationsanalyse zementierter Müller-Polyethylenpfannen versus zementfreier Zweymüller-Schraubpfannen.  Z Orthop Ihre Grenzegeb. 2000;  138 (1) 46-51
    PubMedGoogle Scholar
  • 23 Laine  T, Schlenzka  D, Mäkitalo  K, Tallroth  K, Nolte  L-P, Visarius  H. Improved accuracy of pedicle screw insertion with computer assisted surgery - A prospective clinical trial of 30 patients.  Spine. 1997;  22 (11) 1254-1258
    CrossrefPubMedGoogle Scholar
  • 24 Lewinnek  G E, Lewis  J L, Tarr  R, Compere  C L, Zimmerman  J R. Dislocation after total hip replacement arthroplastics.  J Bone Joint Surg. 1978;  60-A 217-220
    PubMedGoogle Scholar
  • 25 Malchau  H, Herberts  P, Ahnfehlt  L. Prognosis of total hip replacement in Sweden. Follow up of 92,675 operations performed 1978 - 1990.  Acta Orthop Scand. 1993;  64 (5) 497-506
    PubMedGoogle Scholar
  • 26 Mian  S W, Truchly  G, Pflum  F A. Computed tomography measurement of acetabular cup anteversion and retroversion in total hip arthroplasty.  Clin Orthop. 1992;  276 206-209
    PubMedGoogle Scholar
  • 27 Mirra  J M, Amstutz  H C, Matos  M, Gold  R. The pathology of the joint tissues and its Glinical relevance in prosthesis failure.  Clin Orthop. 1976;  117 221-240
    PubMedGoogle Scholar
  • 28 Moody  J E Jr, DiGioia  A M, Jaramaz  B, Blackwell  H, Colgan  B, Nikou  C. Gauging clinical practice: Surgical navigation for total hip replacement. Proceedings MICCAI '98 1998: 421-430
    Google Scholar
  • 29 Morrey  B F. Instability after total hip arthroplasty.  Orthopedic Clinics of North America. 1992;  23 (2) 237-248
    PubMedGoogle Scholar
  • 30 Murray  D W. The definition and measurement of acetabular orientation.  J Bone Joint Surg. 1993;  75-B 228-232
    PubMedGoogle Scholar
  • 31 Niethard  F U. Computer Assisted Orthopaedic surgery (CAOS) in der Hüftendoprothetik.  Z Orthop. 1999;  137 99-100
    PubMedGoogle Scholar
  • 32 Nolte  L-P, Zamorano  L, Visarius  H, Berlemann  U, Langlotz  F, Arm  E, Schwarzenbach  O. Clinical evaluation of a system for precision enhancement in spine surgery.  Clin Biomech. 1995;  10 (6) 293-303
    Google Scholar
  • 33 Persson  U, Persson  M, Malchau  H. The economics of preventing revisions in total hip replacement.  Acta Orthop Scand. 1999;  70 (2) 163-169
    PubMedGoogle Scholar
  • 34 Ritter  M A. Dislocation and subluxation of the total hip replacement.  Clin Orthop. 1976;  121 92-94
    PubMedGoogle Scholar
  • 35 Scheller  G, Schroeder-Boersch  H, Arnold  P, Jani  L. Die Gleitpaarung Polyethylene-PMMA als „Abriebmodell”.  Z Orthop Ihre Grenzgeb. 1998;  136 (6) 566-567
    PubMedGoogle Scholar
  • 36 Schmalzried  T P, Guttmann  D, Grecula  M, Amstutz  H C. The relationship between design, position, and articular wear of acetabular components inserted without cement and the development of pelvic osteolysis.  J Bone Joint Surg. 1994;  76-A 677-688
    PubMedGoogle Scholar
  • 37 Schulte  K R, Callaghan  J J, Kelley  S S, Johnston  R C. The outcome of Charnley total hip arthroplasty with cement after a minimum twenty year follow-up.  J Bone Joint Surg. 1993;  75-A 961-975
    PubMedGoogle Scholar
  • 38 Sochart  D H. Relationship of acetabular wear to osteolysis and loosening in total hip arthroplasty.  Clin Orthop. 1999;  363 135-150
    PubMedGoogle Scholar
  • 39 Thomas  W, Schug  M. Remarks on the biomechanical and clinical significance of the positioning of the acetabular cup - Proposal for a classification.  Biomed Technik. 1994;  39 (9) 222-226
    PubMedGoogle Scholar
  • 40 Visadus  H, Gong  J, Scheer  C, Haralamb  S, Nolte  L P. Men maschine interfaces in computerassistet Surgery.  Comput aides surgery. 1997;  2 102-107
    PubMedGoogle Scholar
  • 41 Willert  H G. Reactions of the articular rapsule to wear produrts of artificial joint prostheses.  J Biomed Mater Res. 1977;  11 (2) 157-164
    PubMedGoogle Scholar
  • 42 Yuan  L-J, Shih  C-H. Dislocation after total hip arthroplasty.  Arch Orthop Trauma Surg. 1999;  119 263-236
    PubMedGoogle Scholar

PD Dr. med. Kai Bernsmann

Giradet Clinic Essen Ltd. Arzt PD Dr. med. K. Bernsmann

Giradet Str. 2 - 38

45131 Essen

Phone: Tel. 0201/877880

Fax: Fax 0201/8778888

Email: E-mail: Kai.Bernsmann@ruhr-uni-bochum.de

      >