Dislocation is one of the most important complications in THA. Dual mobility cup (DMC) inserts reduce the risk for dislocation after total hip arthroplasty by increasing the oscillation angle. A lower rate of dislocation with use of a DMC insert has been reported in different studies. But there is no available research that clearly delineates the stability advantages of DMC inserts in primary THA. The aim of our study was to evaluate the area of the safe zone for a DMC insert, compared to a fixed insert for different anteversion angles of the femoral component. A model of the pelvis and femur were developed from computed tomography images. We defined the coordinate system of the pelvis relative to the anterior pelvic plane and the coordinate system of the femur relative to the posterior condylar plane. In our model, we simulated a positive anteversion position of the acetabular cup. The lower border for cup inclination is 50°. The safe zone was evaluated for the following range of motion of the implant: 120° of flexion, 90° of flexion 30° of internal rotation, 30° of extension, 40° of abduction, 40° of adduction, and 30° of external rotation. (Fig.1) The safe zone was calculated for both a fixed insert and a DMC insert over a pre-determined range of three-dimensional motion, and the effect of increasing the anteversion position of the femoral component from 5° to 35° quantified. The ratio of the safe zone for a DMC insert to a fixed insert was calculated.INTRODUCTION
Material and Methods
Computer navigation systems are quite sophisticated intra-operative support systems for the precise placement of acetabular or femoral components in THA. However, few studies have addressed the clinical benefits derived from using a navigation system to achieve precise placement of the implants. The purpose of this study is to investigate the early dislocation rate of navigation-assisted primary THA through a posterior approach in order to clarify the short-term benefit of using a computer navigation system. We retrospectively reviewed the early dislocation rate (within 12 months after surgery) of 475 consecutive primary cementless or hybrid THAs with femoral head sizes ≦32mm performed via posterior approach. There were 85 men and 390 women, with a mean age of 60 years (17 to 88) at operation. Preoperative diagnoses included osteoarthritis in 384 hips, osteonecrosis in 45 hips, and others in 46 hips (ex. RA, trauma, infection, congenital disease). All THAs were planned using a 3D templating system based on the combined anteversion theory, performed by single surgeon through a posterior approach with repair of the posterior capsule, assisted by a CT-based surface matching type computer navigation system for cup implantation. All patients were directly followed up at least 1 year after surgery. We classified all 475 joints into four groups: normal or mildly deformed hips (Group A; 308 joints, ex. primary OA, Crowe group 1, osteonecrosis), moderately deformed hips (Group B; 97 joints, ex. Crowe group 2, protrusio acetabuli, Perthes like deformity), severely deformed hips (Group C; 53 joints, ex. Crowe group 3 or 4, ankylosis, fused hip), and neuromuscular and cognitive disorders (Group D; 17 joints), and examined the dislocation rate for each group.Introduction
Methods
The number of total hip arthroplasties has been increasing worldwide, and it is expected that revision surgeries will increase significantly in the near future. Although reconstructing normal hip biomechanics with extensive bone loss in the revision surgery remains challenging. The custom−made acetabular component produced by additive manufacturing, which can be fitted to a patient's anatomy and bone defect, is expected to be a predominant reconstruction material. However, there have been few reports on the setting precision and molding precision of this type of material. The purpose of this study was to validate the custom−made acetabular component regarding postoperative three−dimensional positioning and alignment. Severe bone defects (Paprosky type 3A and 3B) were made in both four fresh cadaveric hip joints using an acetabular reamer mimicking clinical cases of acetabular component loosening or osteolysis in total hip arthroplasty. On the basis of computed tomography (CT) after making the bone defect, two types of custom−made acetabular components (augmented type and tri−flanged type) that adapted to the bone defect substantially were produced by an additive manufacturing machine. A confirmative CT scan was taken after implantation of the component, and then the data were installed in an analysis workstation to compare the postoperative component position and angle to those in the preoperative planning.Introduction
Methods
Post cam structure, which is the main structure of posterior-stabilized design (PS), is useful to realize the intrinsic stability of a knee prosthesis replaced for a case with the severe degeneration. A large size post might, however, shorten the range of knee motion. On the other hand, retrieval studies sometimes reveal the ultrahigh molecular weight polyethylene (UHMWPE) deformation or severe failure of the tibial post of PS knee. Strength of a tibial post of available design is obviously insufficient to prevent the severe deformation. Therefore, minimally required size of the post should be clarified for polyethylene inserts. In the present study, we performed finite element (FE) analysis assumed the mechanical conditions of a tibial post in a PS knee and aimed to design criterion of a post of polyethylene insert of a knee prosthesis. The shape of one commercially available knee prosthesis was referred as a posterior-stabilized knee prosthesis. The contour of the metallic femoral component was traced and digitized by hand. The contour of the UHMWPE insert was digitized by a micro computed tomography apparatus. Three dimensional finite elements were generated by a modeling software (Simpleware, Ltd. UK) as total 83000 four-noded tetrahedral elements. The bottom of the tibial insert was fully constrained. Load on femoral component was assumed to realize the tibial post impingement under several kinds of knee motions. Posterior load 100 N or 500N at the 10 degree hyperextension, anterior load 500N or 1000N during 120 degree flexion were applied (Fig. 1). The software of FE analysis was LS-DYNA ver.971 (Livemore Software Technology Corp. USA). The hardware was Endeaver Pro-4500 (EPSON Corp. Japan). The distributed values of von Mises stress and plastic strain of the tibial post were shown as the results of the analysis.Introduction
Method
We report an artificial elbow joint with a novel type radial component that we have designed that is now at the stage of trial production. The humeral component is a trochlea capitulum replacement type with a stem. The ulnar component with a stem has an articular surface distributed not only on the trochlea surface but also on the capitulum surface of the humeral component, and has another concave articular surface toward the radial component. The radial component also has a stem and has a spherical convex articular surface. This surface of the radial component does not assume the conventional anatomical morphology, but the convexity is designed to fit the concave articular surface of the ulnar component. In other words, the new artificial elbow joint is a functionally dissociated type, in which flexion-extension is achieved by the humeroulnar joint while rotation is done via the radioulnar joint. The newly designed artificial joint was used to replace the cadaveric elbow joint. Radiographic studies were conducted to observe the compatibility of each component during extension-flexion and rotationmovements. By replacing the cadaveric elbow joint with the newly designed artificial elbow joint and performing manual extension-flexion simultaneous with pronation-supination, the flexion positions of the humeral component and ulnar component were not affected, and stable compatibility was obtained for the radial component and ulnar component. Artificial elbow joints with a radial component have been reported by various authors. However, since the humeroradial joint possesses two movement axes for both flexion-extension and rotation, good compatibility with the humeroulnar joint is necessary. Aradial component that simply adopts the anatomical morphology does no tachieve good humeroradial joint compatibility. The functionally dissociated artificial elbow joint that we have designed is expected to offer a clue to solve these problems.
