Academic Journal
Redefining the 3D Topography of the Acetabular Safe Zone ; A Multivariable Study Evaluating Prosthetic Hip Stability
| العنوان: | Redefining the 3D Topography of the Acetabular Safe Zone ; A Multivariable Study Evaluating Prosthetic Hip Stability |
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| المؤلفون: | Hevesi, Mario, Wyles, Cody C., Rouzrokh, Pouria, Erickson, Bradley J., Maradit-Kremers, Hilal, Lewallen, David G., Taunton, Michael J., Trousdale, Robert T., Berry, Daniel J. |
| المصدر: | Journal of Bone and Joint Surgery ; volume 104, issue 3, page 239-245 ; ISSN 0021-9355 1535-1386 |
| بيانات النشر: | Ovid Technologies (Wolters Kluwer Health) |
| سنة النشر: | 2021 |
| الوصف: | Background: Dislocation is the most common reason for early revision following total hip arthroplasty (THA). More than 40 years ago, Lewinnek et al. proposed an acetabular “safe zone” to avoid dislocation. While novel at the time, their study was substantially limited according to modern standards. The purpose of this study was to determine optimal acetabular cup positioning during THA as well as the effect of surgical approach on the topography of the acetabular safe zone and the hazard of dislocation. Methods: Primary THAs that had been performed at a single institution from 2000 to 2017 were reviewed. Acetabular inclination and anteversion were measured using an artificial intelligence neural network; they were validated with performance testing and comparison with blinded grading by 2 orthopaedic surgeons. Patient demographics and dislocation were noted during follow-up. Multivariable Cox proportional-hazards regression, including multidimensional analysis, was performed to define the 3D topography of the acetabular safe zone and its association with surgical approach. Results: We followed 9,907 THAs in 8,081 patients (4,166 women and 3,915 men; 64 ± 13 years of age) for a mean of 5 ± 3 years (range: 2 to 16); 316 hips (3%) sustained a dislocation during follow-up. The mean acetabular inclination was 44° ± 7° and the mean anteversion was 32° ± 9°. Patients who did not sustain a dislocation had a mean anteversion of 32° ± 9° (median, 32°), with the historic ideal anteversion of 15° observed to be only in the third percentile among non-dislocating THAs (p < 0.001). Multivariable modeling demonstrated the lowest dislocation hazards at an inclination of 37° and an anteversion of 27°, with an ideal modern safe zone of 27° to 47° of inclination and 18° to 38° of anteversion. Three-dimensional analysis demonstrated a similar safe-zone location but significantly different safe-zone topography among surgical approaches (p = 0.03) and sexes (p = 0.02). Conclusions: Optimal acetabular positioning differs ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| DOI: | 10.2106/jbjs.21.00406 |
| DOI: | 10.2106/JBJS.21.00406 |
| الاتاحة: | https://doi.org/10.2106/jbjs.21.00406 https://journals.lww.com/10.2106/JBJS.21.00406 |
| رقم الانضمام: | edsbas.E3D28E17 |
| قاعدة البيانات: | BASE |
| DOI: | 10.2106/jbjs.21.00406 |
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