Pilot research of custom-made navigational template of femoral head in total hip resurfacing arthroplasty
Liang Jinlong1, Zhao Yonghui1, Lu Di2, Sun Jun2, Lu Sheng3
1Department of Orthopedics, the 920 Hospital of Joint Logistic Support Force, Kunming 650031, China; 2Department of Anatomy, Kunming Medical University, Kunming 650500, China; 3 Department of Orthopedics, the First People's Hospital of Yunnan Province, Yunnan Provincial Key Laboratory of Digital Orthopedics, Kunming 650032, China
Abstract：Objective To explore the feasibility and safety of custom-made navigational template of femoral head in total hip resurfacing arthroplasty (THRA).Methods Seventeen adult pelvic specimens were selected from the Department of Anatomy at Kunming Medical University from January 2019 to May 2019, including 9 males and 8 females, with age range of 40-70 years and height of approximately 155-165 cm. Each pelvic specimen was divided into the guide plate group (left) and the control group (right). In the guide plate group, the CT data of the cadaver specimens were preprocessed and calculated to obtain the anatomical axis of the femoral neck. A navigational template consistent with the anatomical shape of the femoral neck was designed. The accuracy and validity were evaluated using a positioning needle, which was used to assist the cadaver implantation experiment. In the control group, the positioning needle was implanted using the traditional technique. Postoperative X-ray and CT images were used to observe the location (varus, valgus, forward, or backward) of the positioning needle at the center of the femoral head and the anatomical axis of the femoral neck. The preoperative femoral neck stem angle (NSA), the postoperative shaft stem angle (SSA), the lateral migration angle, and the horizontal migration angle were measured to evaluate the accuracy of the custom-made navigational template.Results (1) In the guide plate group, the navigational template was attached to the femoral neck of the specimen with good anastomosis; it could assist the needle implant to the desired position. Postoperative CT and X-ray images showed that all the positioning needles passed through the center of the femoral head and the anatomical center of the femoral neck. Compared with the axis of the femoral neck, 15 cases were inverted, one case was varus, and one case was parallel based on the anteroposterior X-ray. On the lateral X-ray, 14 cases were parallel, 2 cases of forward inclination, 1 case was backward inclination. (2) In the control group, 12 cases of the needles passed through the center of the femoral head and the femoral neck based on the postoperative CT scans and anteroposterior X-ray. In addition, 12, 2, and 3 cases were found to be inverted, varus, and parallel by the anteroposterior X-ray. Fifteen cases of the needle passed through the center of the femoral head and the anatomical axis of the femoral neck, and 10 cases were parallel, 5 cases were forward inclination, and 2 cases were backward inclination based on the lateral X-ray. (3) The preoperative NSA, postoperative SSA, lateral migration angle, and horizontal migration angle were 133.1° ± 3.52°, 138.0° ± 4.1°, 5.2° ± 2.1°, and 4.6° ± 2.3° in the guide plate group, respectively, and 133.7° ± 3.4°, 144.3° ± 5.6°, 13.0° ± 1.7°, and 8.2° ± 2.9° in the control group, respectively. No statistically significant difference was found in the preoperative NSA between the two groups (P>0.05). The postoperative SSA, lateral migration angle, and horizontal migration angle in the guide plate group were less than those in the control group, and a statistically significant difference was observed (t=4.307, 14.280, and 3.520, respectively, all P values<0.05).Conclusions Custom-made navigational template of the femoral head could provide accurate navigation for the position and orientation of the femoral head prosthesis in THRA.
梁金龙, 赵永辉, 陆地, 孙俊, 陆声. 个体化股骨头导板在髋关节表面置换术中应用的实验研究[J]. 中华解剖与临床杂志, 2020, 25(4): 359-364.
Liang Jinlong, Zhao Yonghui, Lu Di, Sun Jun, Lu Sheng. Pilot research of custom-made navigational template of femoral head in total hip resurfacing arthroplasty. Chinese Journal of Anatomy and Clinics, 2020, 25(4): 359-364.
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