{"title":"髋关节置换术术前规划成像的进展。","authors":"","doi":"10.1016/j.otsr.2024.103908","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Accurate preoperative templating is essential for the success of hip resurfacing arthroplasty (HRA). While digital radiograph is currently considered the gold standard, stereoradiograph and CT converted 3D methods have shown promising results. However, there is no consensus in the literature regarding the preferred modality for HRA templating, and angular measurements are often overlooked. Thus, this study aimed to: (1) compare the performances of different modality in implant sizing and angle measurements, (2) evaluate the measurement reproducibility, (3) assess the impact of severe osteoarthritis on femoral head sizing, and (4) based on the analysis above, explore the optimal imaging and planning strategy for HRA.</p></div><div><h3>Hypothesis</h3><p>An optimal imaging modality exists for HRA planning regarding implant sizing and angular measurements.</p></div><div><h3>Materials and methods</h3><p>Preoperative imaging data from seventy-seven HRA surgeries were collected. Three raters performed templating using digital radiograph, stereoradiograph, and CT converted 3D models. Measurements for femoral head size, neck-shaft angle, and calcar-shaft angle were obtained. The femoral head sizing was compared to the intraoperative clinical decision. The reproducibility of measurements was assessed using the intraclass correlation coefficient (ICC). Correlations were examined between sizing disagreement and osteoarthritis grade (Tonnis Classification).</p></div><div><h3>Results</h3><p>Digital radiograph, stereoradiograph, and 3D techniques predicted one size off target in 27/77 (35%), 49/70 (70%), and 75/77 (97%) of cases, respectively, corresponding to 1.8<!--> <!-->±<!--> <!-->1.6 (0 to 5.67), 0.9<!--> <!-->±<!--> <!-->0.7 (0 to 2.67), and 0.4<!--> <!-->±<!--> <!-->0.4 (0 to 1.67) sizes off target, indicating statistically significant differences among all three modalities, with <em>p</em>-values all below 0.01. There were no statistically significant differences among the different modalities for angular measurements. Measurements showed moderate to excellent reproducibility (ICC<!--> <!-->=<!--> <!-->0.628–0.955). High-grade osteoarthritis did not impact image sizing in any modality (r<!--> <!-->=<!--> <!-->0.08–0.22, all <em>p</em> <!-->><!--> <!-->0.05).</p></div><div><h3>Discussion</h3><p>CT converted 3D models were more accurate for implant sizing in HRA, but did not significantly outperform other modalities in angular measurements. Given the high costs and increased radiation exposure associated with CT, the study recommended using CT scans selectively, particularly for precise femoral head sizing, while alternative imaging methods can be effectively used for angular measurements.</p></div><div><h3>Level of evidence</h3><p>III; retrospective comparative diagnostic study.</p></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S187705682400152X/pdfft?md5=0875c14e0c14f8ac54249ab5daabfa41&pid=1-s2.0-S187705682400152X-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Advances in imaging for pre-surgical planning in hip resurfacing arthroplasty\",\"authors\":\"\",\"doi\":\"10.1016/j.otsr.2024.103908\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Accurate preoperative templating is essential for the success of hip resurfacing arthroplasty (HRA). While digital radiograph is currently considered the gold standard, stereoradiograph and CT converted 3D methods have shown promising results. However, there is no consensus in the literature regarding the preferred modality for HRA templating, and angular measurements are often overlooked. Thus, this study aimed to: (1) compare the performances of different modality in implant sizing and angle measurements, (2) evaluate the measurement reproducibility, (3) assess the impact of severe osteoarthritis on femoral head sizing, and (4) based on the analysis above, explore the optimal imaging and planning strategy for HRA.</p></div><div><h3>Hypothesis</h3><p>An optimal imaging modality exists for HRA planning regarding implant sizing and angular measurements.</p></div><div><h3>Materials and methods</h3><p>Preoperative imaging data from seventy-seven HRA surgeries were collected. Three raters performed templating using digital radiograph, stereoradiograph, and CT converted 3D models. Measurements for femoral head size, neck-shaft angle, and calcar-shaft angle were obtained. The femoral head sizing was compared to the intraoperative clinical decision. The reproducibility of measurements was assessed using the intraclass correlation coefficient (ICC). Correlations were examined between sizing disagreement and osteoarthritis grade (Tonnis Classification).</p></div><div><h3>Results</h3><p>Digital radiograph, stereoradiograph, and 3D techniques predicted one size off target in 27/77 (35%), 49/70 (70%), and 75/77 (97%) of cases, respectively, corresponding to 1.8<!--> <!-->±<!--> <!-->1.6 (0 to 5.67), 0.9<!--> <!-->±<!--> <!-->0.7 (0 to 2.67), and 0.4<!--> <!-->±<!--> <!-->0.4 (0 to 1.67) sizes off target, indicating statistically significant differences among all three modalities, with <em>p</em>-values all below 0.01. There were no statistically significant differences among the different modalities for angular measurements. Measurements showed moderate to excellent reproducibility (ICC<!--> <!-->=<!--> <!-->0.628–0.955). High-grade osteoarthritis did not impact image sizing in any modality (r<!--> <!-->=<!--> <!-->0.08–0.22, all <em>p</em> <!-->><!--> <!-->0.05).</p></div><div><h3>Discussion</h3><p>CT converted 3D models were more accurate for implant sizing in HRA, but did not significantly outperform other modalities in angular measurements. Given the high costs and increased radiation exposure associated with CT, the study recommended using CT scans selectively, particularly for precise femoral head sizing, while alternative imaging methods can be effectively used for angular measurements.</p></div><div><h3>Level of evidence</h3><p>III; retrospective comparative diagnostic study.</p></div>\",\"PeriodicalId\":54664,\"journal\":{\"name\":\"Orthopaedics & Traumatology-Surgery & Research\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-05-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S187705682400152X/pdfft?md5=0875c14e0c14f8ac54249ab5daabfa41&pid=1-s2.0-S187705682400152X-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Orthopaedics & Traumatology-Surgery & Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S187705682400152X\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Orthopaedics & Traumatology-Surgery & Research","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S187705682400152X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
背景:准确的术前模板对髋关节置换术(HRA)的成功至关重要。虽然目前数字 X 光片被认为是黄金标准,但立体 X 光片和 CT 转换三维方法也显示出良好的效果。然而,关于 HRA 模板制作的首选模式,文献中尚未达成共识,角度测量也经常被忽视。因此,本研究旨在1)比较不同模式在植入物大小和角度测量中的表现;2)评估测量的可重复性;3)评估严重骨关节炎对股骨头大小的影响;4)基于上述分析,探索 HRA 的最佳成像和规划策略:假设:在植入物尺寸和角度测量方面,HRA规划存在最佳成像模式:收集了 77 例 HRA 手术的术前成像数据。三名评分员使用数字X光片、立体放射摄影和CT转换的三维模型进行模板制作。测量结果包括股骨头大小、颈轴角和腓骨轴角。将股骨头大小与术中临床决定进行比较。使用类内相关系数(ICC)评估测量的可重复性。结果显示:数字X光片、立体放射摄影和骨关节炎分级(Tonnis 分级)之间存在相关性:数字X光片、立体放射摄影和三维技术分别在27/77 (35%)、49/70 (70%)和75/77 (97%)的病例中预测了一个偏离目标的尺寸,分别对应1.8±1.6 (0至5.67)、0.9±0.7 (0至2.67)和0.4±0.4 (0至1.67)个偏离目标的尺寸,这表明所有三种模式之间存在显著的统计学差异,P值均低于0.01。在角度测量方面,不同模式之间没有明显的统计学差异。测量结果显示出中等到极好的重现性(ICC = 0.628-0.955)。高度骨关节炎对任何模式的图像尺寸都没有影响(r = 0.08-0.22,均 p>0.05):讨论:CT转换的三维模型对HRA植入物的尺寸更准确,但在角度测量方面并没有明显优于其他模式。鉴于CT的高成本和增加的辐射暴露,该研究建议有选择性地使用CT扫描,尤其是在精确确定股骨头大小时,而其他成像方法可有效用于角度测量:证据级别:III;回顾性比较诊断研究。
Advances in imaging for pre-surgical planning in hip resurfacing arthroplasty
Background
Accurate preoperative templating is essential for the success of hip resurfacing arthroplasty (HRA). While digital radiograph is currently considered the gold standard, stereoradiograph and CT converted 3D methods have shown promising results. However, there is no consensus in the literature regarding the preferred modality for HRA templating, and angular measurements are often overlooked. Thus, this study aimed to: (1) compare the performances of different modality in implant sizing and angle measurements, (2) evaluate the measurement reproducibility, (3) assess the impact of severe osteoarthritis on femoral head sizing, and (4) based on the analysis above, explore the optimal imaging and planning strategy for HRA.
Hypothesis
An optimal imaging modality exists for HRA planning regarding implant sizing and angular measurements.
Materials and methods
Preoperative imaging data from seventy-seven HRA surgeries were collected. Three raters performed templating using digital radiograph, stereoradiograph, and CT converted 3D models. Measurements for femoral head size, neck-shaft angle, and calcar-shaft angle were obtained. The femoral head sizing was compared to the intraoperative clinical decision. The reproducibility of measurements was assessed using the intraclass correlation coefficient (ICC). Correlations were examined between sizing disagreement and osteoarthritis grade (Tonnis Classification).
Results
Digital radiograph, stereoradiograph, and 3D techniques predicted one size off target in 27/77 (35%), 49/70 (70%), and 75/77 (97%) of cases, respectively, corresponding to 1.8 ± 1.6 (0 to 5.67), 0.9 ± 0.7 (0 to 2.67), and 0.4 ± 0.4 (0 to 1.67) sizes off target, indicating statistically significant differences among all three modalities, with p-values all below 0.01. There were no statistically significant differences among the different modalities for angular measurements. Measurements showed moderate to excellent reproducibility (ICC = 0.628–0.955). High-grade osteoarthritis did not impact image sizing in any modality (r = 0.08–0.22, all p > 0.05).
Discussion
CT converted 3D models were more accurate for implant sizing in HRA, but did not significantly outperform other modalities in angular measurements. Given the high costs and increased radiation exposure associated with CT, the study recommended using CT scans selectively, particularly for precise femoral head sizing, while alternative imaging methods can be effectively used for angular measurements.
期刊介绍:
Orthopaedics & Traumatology: Surgery & Research (OTSR) publishes original scientific work in English related to all domains of orthopaedics. Original articles, Reviews, Technical notes and Concise follow-up of a former OTSR study are published in English in electronic form only and indexed in the main international databases.