Preoperative planning of primary total hip arthroplasty using conventional radiographs

AbstractObjectivethe objective of this study was to present an analog method for preoperative planning of primary total hip arthroplasty procedures based on measuring the components by overlaying the transparencies of the prosthesis on the preoperative radiographs and checking the accuracy, both for predicting the size of the acetabular and femoral components used and for restoring the offset and correcting the dysmetria.Methodsbetween March 2005 and July 2009, 56 primary total hip arthroplasty procedures performed on 56 patients at the Mario Covas State Hospital in Santo André were analyzed. The measurements on the femoral and acetabular components obtained through planning were compared with those that were used in the surgery. The offsets measured through the preoperative planning were compared with those measured on the postoperative radiographs. Dysmetria was evaluated before and after the operation.Resultsaccuracy of 78.6% (p<0.001) in predicting the size of the acetabular component and 82.2% (p<0.001) in predicting the femoral nail was observed. The offsets measured through preoperative planning were statistically similar to the offsets measured on the postoperative radiographs. After the operation, we observed absolute equalization in 48.2% of the cases. In 87.5%, the dysmetria was less than or equal to 1cm and in 69.6%, it was less than or equal to 0.5cm.Conclusionsthe accuracy was 78.6% and 82.2%, respectively, for the acetabular and femoral components. The offsets that were planned preoperatively were statistically similar to those measured on postoperative radiographs. We found absolute equalization in 48.2% of the cases

Resultados preliminares da artroplastia do quadril metal-metal de superfície: análise dos primeiros 40 casos com seguimento médio de 3 anos Preliminary outcomes of hip metal-on-metal resurfacing arthroplasty: an analysis of the first 40 cases with mean follow-up time of 3 years

Quarenta quadris (39 pacientes) foram submetidos à artroplastia total metal-metal de superficie "resurfacing" entre 2002 e 2005. Todos foram estudados e analisados clinicamente e radiograficamente. Foram utilizados critérios clínicos, no pré e pós-operatório, pela avaliação de D'Aubigné e Postel. Radiograficamente, as áreas de radiolucência ao redor do acetábulo foram classificadas de acordo com DeLee e Charnley e, no fêmur nas zonas descritas por Amstutz et al. A idade média foi de 54,40 anos. O seguimento mínimo foi de 14 meses e o máximo de 51(média de 37,36 meses). 94,44% dos resultados clínicos foram satisfatórios no pós-operatório. Ocorreram 2 casos de soltura asséptica. Não houve fratura do fêmur durante o seguimento. Os autores consideraram esta opção técnica e de implante satisfatória e, com bons resultados no seguimento médio de 3 anos.Forty hips (39 patients) were submitted to metal-on-metal hip replacement (resurfacing) between 2002 and 2005. Evaluation was provided by clinical examination and X-ray tests. The authors performed clinical evaluations before and after surgery. The specific criterion applied was the D'Aubigné and Postel's classification. X-ray images showed radiolucent lines around the acetabular component on the zones described by DeLee and Charnley and around the femoral component on the zones described by Amstutz et al. The mean age was 54.40 years. The minimum follow-up period was 14 months (range:12 to 51 months). The outcomes of 94.44% of the patients in the study were postoperatively rated as satisfactory. There were 2 cases of aseptic loose and no neck-femoral fractures during the follow-up period. The authors concluded that this technique and implant alternative is satisfactory, with good early outcomes in a mean follow-up time of three years