Stefan Kreuzer, MD Houston, Texas Disclosures/ Affiliations: - - PowerPoint PPT Presentation

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Stefan Kreuzer, MD Houston, Texas Disclosures/ Affiliations: - - PowerPoint PPT Presentation

Jun 11, 2023 535 likes •928 views

Evolving Techniques: Patient specific S pecific Targets for Cup Position in Total Hip Arthroplasty Stefan Kreuzer, MD Houston, Texas Disclosures/ Affiliations: Device companies Board Member/ Advisory Board Corin: Consult ing/ speaking,

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Stefan Kreuzer, MD Houston, Texas Evolving Techniques: Patient specific S pecific Targets for Cup Position in Total Hip Arthroplasty

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Disclosures/ Affiliations:

Device companies

  • Corin: Consult ing/ speaking, Research support , Royalt ies
  • S

mit h and Nephew: Consult ing/ speaking, Research support , Royalt ies (in t he past )

  • S

t ryker: Royalt ies

  • Zimmer/ Biomet: Consult ing, Royalt ies
  • Medt ronic: Consult ing/ speaking
  • Depuy: Research support t hrough MBJ-RF
  • Pacira: Consult ing/ S

peaking

  • Brain Lab: Consult ing/ speaking
  • Int elli-Joint S

urgical: Consult ing/ speaking

  • Think S

urgical: Consult ing, Research

  • Knee 360: Consult ing (none-compensates)
  • S

hukla: Consult ing

  • S

wift Pat h: Consult ing/ speaking

  • Pulse: Consult ing/ speaking, Royalt ies
  • Y
  • ur Pract ice on line: Consult ing (none compensat ed)

Board Member/ Advisory Board

  • IS

TA

  • ICJR
  • MBJ-RF
  • S

urgical Care Affiliates: Medical Advisory Board

  • Employers Direct : Medical Advisory Board

Investments/ ownership:

  • IOT
  • K and S

solut ions

  • Alpoza
  • Ort hosensor
  • Argent um Medical (silverlone)
  • Inov8 S

urgical

  • Invo8 Healt hcare
  • First S

t reet S urgical Hospit al

  • Texo-Venture
  • Employers Direct
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“The dogmas of the quiet past are inadequate to the stormy present… As our case is new, so we must think anew, and act anew.”

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Lewinnek1 defined safe zone as 30-50° inclination and 5-25° anteversion

 36 yr old analysis (JBJS

1978)

 9 dislocations (3 in the safe zone)  300 THRs - only 113 X-rays

analysed from the 291 non- dislocated patients

 Relative to the APP

The first ‘safe zone’

Angle (degrees) Angle (degrees)

Dislocated

anterior posterior unknown

Normal

1. Lewinnek, et el, 1978, JBJS

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Facts on Dislocation: HSS

  • The frequency of dislocation was 2.1%

(147 of 7040 patients).

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  • M. Abdel2- AAHKS

Nov 2014

 12,000 Hips implanted between

2003 and 2012 at the Mayo clinic

 Minimum 2 yr follow up  1.9%

(224 hips) dislocated

 58%

  • f dislocations were inside

the Lewinnek safe zone.

Is a safe zone really safe?

Angle (degrees) Angle (degrees)

1. Lewinnek, et el, 1978, JBJS 2. Abdel, AAHKS, 2014

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Introduction

The pelvis rotates in the sagittal plane, consequently in patients with THR, the functional cup orientation changes Posterior Tilt Anterior Tilt

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Consequences

Posterior Rotation Bad in hip extension Anterior Rotation Bad in hip flexion

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1517 patients

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Variation of functional pelvic tilt

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Variation of functional pelvic tilt

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Variation of functional pelvic tilt

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S ymptomatic THRs analysed in supine

40% in “ safe zone”

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S ymptomatic THRs analysed functionally

13% in “ safe zone”

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Functional Boundaries

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Take Home’s…

  • 40 - 60%
  • f dislocating/ squeaking hips are within

published safe-zones

  • However, when analysed functionally this number

falls to only 13%

  • Functional analysis is a significantly better predictor
  • f dislocating/ squeaking hips than static assessments
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Patient imaging

Low dose CT scan Functional X-Rays

Image processing

Segmentation, landmarking and 3D implant positioning

Functional analysis

Analysis using kinematic parameters

FHA report

Results presented in Functional Hip Analysis report

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1. Standing 2. Flexed Seated 3. Contralateral leg raise

Functional X-rays

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1. Standing 2. Flexed Seated 3. Contralateral leg raise

Functional X-rays

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1. Standing 2. Flexed Seated 3. Contralateral leg raise

Functional X-rays

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Edge loading

Dynamic motion

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Delivery tools

The guide

Cup orientation is ideal for a PSI type solution Not compromised by unknown pelvic position on the table

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Case Study 1

S upine Pelvic Tilt 1.7°

Flexion Risk

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Case Study 1

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S upine Pelvic Tilt 3.6°

Case Study 2

S upine Pelvic Tilt 3.6°

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S upine Pelvic Tilt 3.6°

Case Study 2

S upine Pelvic Tilt 3.6°

Extension Risk

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Case Study 2

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S ummary

  • Variations in sagittal pelvic rotation have a substantial effect on the

functional anteversion and inclination of the acetabular cup in flexion and extension.

  • Optimal cup orientation is likely patient-specific - previously defined static

‘ safe zones’ might not be appropriate for all patients.

  • Functional analysis may be a significantly better predictor of

dislocating/ squeaking hips than static assessments.

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Thank Y

  • u