Humeral head subluxation in patients with cuff tear arthropathy (CTA) and in patients with primary arthrosis has been classified by Hamada and by Walch (type B). These classifications are based on 2D evaluation techniques (AP X-ray view, axial CT images). To our knowledge no 3D evaluation of the direction of humeral head subluxation has been described To describe a reproducible 3D measuring technique to evaluate the direction of the humeral head subluxation in shoulder arthropathyIntroduction
Aim
The contralateral femur is frequently used for preoperative templating of total hip arthroplasty assuming femoral symmetry. We aimed to define the degree of asymmetry between left and right proximal femurs and whether if affected by demographics parameters. A CT-scan based modeling and analytics system of 346 CT-scans was used for this study, including pelvis and bilateral femora from 211 men and 135 women (mean age 61 ±16 years, mean BMI 26± 5 kg/m2). The femoral neck shaft angle (NSA), femoral offset (FO), femoral neck version (FNV), femoral length (FL), canal flare index (CFI) and femoral head diameter (FHD) were calculated for each patient. We then, analyzed symmetry based on absolute differences(AD) and percentage of asymmetry(%AS). An asymmetry >2% was found for NSA (mean AD=2.9°; mean %AS=2.3; p=0.03), FO (AD=3.8mm; %AS=9.1; p=0.01), FNV (AD=5.1°; %AS=46.7; p=0.001) and CFI (AD=0.2mm; %AS=5.4; p=0.7). Percentage of asymmetry was <2% for FL (AD=3.6mm; %AS=0.8; p=0.7) and FHD (AD=0.3mm; %AS=1.2; p=0.8). No correlation and predictive value was found between either AD or %AS and age, ethnicity, gender, height, weight or BMI. Our data support assumptions of substantial asymmetry of the proximal femur which is not affected by demographics or proximal femoral size. Clinical relevance: Upper femurs are not symmetric. Preoperative planning on contralateral femur might be affected this geometrical bias.
There is no consensus on which glenoid plane should be used in total shoulder arthroplasty. Nevertheless, anatomical reconstruction of this plane is imperative for the success of a total shoulder arthroplasty. Three-dimensional reconstruction CT-scans were performed on 152 healthy shoulders. Four different glenoid planes, each determined by three surgical accessible bony reference points, are determined. The first two are triangular planes, defined by the most anterior and posterior point of the glenoid and respectively the most inferior point for the Saller's Inferior plane and the most superior point for the Saller's Superior plane. The third plane is formed by the best fitting circle of the superior tubercle and the most anterior and posterior point at the distal third of the glenoid (Circular Max). The fourth plane is formed by the best fitting circle of three points at the rim of the inferior quadrants of the glenoid (Circular Inferior). We hypothesized that the plane with normally distributed parameters, narrowest variability and best reproducibility would be the most suitable surgical glenoid plane.Background
Methods
Introduction: The accurate positioning of the cup implant is a relevant prognostic factor for both short- and long-term results after total hip replacement. Conventional, manual control has proved to be less than optimal. Navigation systems might improve the accuracy. We designed this study to validate the accuracy of a non image based navigation system for cup orientation during total hip replacement, with post-operative
Introduction. Total hip arthroplaty (THA) using direct anterior minimal invasive (AMI) surgery is an attractive option to achieve a quicker habilitation. However, high complication rates were reported and very often related to technical difficulties at the time of surgery. We hypothesized that 3D preoperative planning may allow to anticipate these difficulties and to decrease the complications rates when using an AMI approach. Material and methods. A prospective observational study included 191 consecutive patients who underwent a primary cementless THA using an AMI. A
Purpose: Classical instrument sets for implantation of total knee arthroplasty (TKA) can be perfected. Computer-assisted implantation appears to offer improved technical quality. The purpose of this study was to compare a matched series of TKA implanted with the conventional method and with a computer-assisted navigation system. Material and methods: Seventy-eight prostheses implanted with a computer-assisted system based on