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Femoral neck targeting is the process of calculating the centre of the femoral neck during hip resurfacing surgery. [1] This can be done by hand or using electronic aides. [2]
Studies on metal-on-metal (MoM) hip resurfacings have identified several factors contributing to early implant failure. Key among these are:
In hip resurfacing surgery, accurately identifying the true centre of the femoral neck in both antero-posterior (AP) and lateral planes is crucial [4] . This reference point is essential for the precise positioning of the femoral neck. Failure to correctly position the femoral component can lead to early implant failure. [3]
There are many methods surgeons use to calculate the true centre of the femoral neck. Today the methods broadly fall under two categories:
The navigational systems were created to be an accurate means for surgeons to implant components with as much accuracy as possible. Studies have shown that this is largely true, but navigational systems are a very different means of femoral neck targeting, and require a steep learning curve. Below is a comparative analysis of both types of navigational targeting against traditional targeting techniques.
| CALCULATIONS BY HAND | CT-based | FLUOROSCOPY |
|---|---|---|
| +Less operative time needed | +Accurate in producing reproducible quality | +Little additional planning pre-operatively |
| +Little additional learning curve | +3D feedback of anatomical landmarks | +Accurate in producing reproducible quality |
| +Smaller, more manageable devices | -More operative time required | -Significant learning curve |
| +Extensive long-term results available | -Pre-operative planning time-consuming | -More operative time required |
| -Degrees of error more apparent due to required intra-operative calculations | -Ionizing radiation from X-rays pose potential health risk to patient |
A computer-assisted device to calculate the true centre of the femoral neck, without the above disadvantages, has not yet been created. The main issues with the current navigational systems are the levels of extra apparatus required in the operating theatre. In the case of fluoroscopy, a "C-arm" X-ray machine is used, which is a very large piece of apparatus. In the case of CT-based navigation, computer software and training in the use of such software is required, which again adds more apparatus to the operating room. [3]
The popularity of CT and fluoroscopy-based navigation amongst surgeons has been increasing in recent years. The application of these techniques however has been proven to be best suited for different types of surgery. Fluoroscopy-based methods are easier to handle in routine cases with normal anatomy, or cases with lesser deformities. On the other hand, CT-scanning techniques have been better suited to cases of congenital and post-traumatic deformities. It is less suited to routine cases, due to the time-consuming pre-operative procedures e.g. setting up CT-scan, data transfer, planning. [3]
The conventional "by hand" calculations, however are much more popular overall. Most hip resurfacing operative techniques come with some form of guide instrumentation to find the true centre of the femoral neck. These conventional kits will most likely be the instruments that the surgeon will use first, and perhaps become accustomed to. The two most important factors though are
All things considered, computer-assisted technology has allowed surgeons to provide accurate femoral neck targeting, and is a viable option for this imperative step to hip resurfacing.
It could be argued that the results of the Adept medial reference jig, first used in 2004 has overcome all of these difficulties; (1) the complete absence of femoral head notching, (2) the complete absence of femoral neck fractures and (3) the outstanding long term results. Likewise, the acetabular introducer has allowed surgeons to implant the socket so much more accurately (as well as being able to check the socket orientation so much more thoroughly) than was ever possible in a BHR;
viz; National Joint Registry. Implant Summary Report for the ADEPT® Hip Resurfacing (Sizes 48-58 only). November 2018.
Ref: Summary.Report.HP_Head_Adept Resurfacing Head (Sizes 48 - 58 only)_All.22/11/2018.22:08
Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.
Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi/semi(half) replacement. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures. A total hip replacement consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is one of the most common orthopaedic operations, though patient satisfaction varies widely. Approximately 58% of total hip replacements are estimated to last 25 years. The average cost of a total hip replacement in 2012 was $40,364 in the United States, and about $7,700 to $12,000 in most European countries.
Image-guided surgery (IGS) is any surgical procedure where the surgeon uses tracked surgical instruments in conjunction with preoperative or intraoperative images in order to directly or indirectly guide the procedure. Image guided surgery systems use cameras, ultrasonic, electromagnetic or a combination of fields to capture and relay the patient's anatomy and the surgeon's precise movements in relation to the patient, to computer monitors in the operating room or to augmented reality headsets. This is generally performed in real-time though there may be delays of seconds or minutes depending on the modality and application.
A hip fracture is a break that occurs in the upper part of the femur, at the femoral neck or (rarely) the femoral head. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Usually the person cannot walk.
Robot-assisted surgery or robotic surgery are any types of surgical procedures that are performed using robotic systems. Robotically assisted surgery was developed to try to overcome the limitations of pre-existing minimally-invasive surgical procedures and to enhance the capabilities of surgeons performing open surgery.
Knee replacement, also known as knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability, most commonly offered when joint pain is not diminished by conservative sources. It may also be performed for other knee diseases, such as rheumatoid arthritis. In patients with severe deformity from advanced rheumatoid arthritis, trauma, or long-standing osteoarthritis, the surgery may be more complicated and carry higher risk. Osteoporosis does not typically cause knee pain, deformity, or inflammation, and is not a reason to perform knee replacement.
Computer-assisted orthopedic surgery or computer-assisted orthopaedic surgery is a discipline where computer technology is applied pre-, intra- and/or post-operatively to improve the outcome of orthopedic surgical procedures. Although records show that it has been implemented since the 1990s, CAOS is still an active research discipline which brings together orthopedic practitioners with traditionally technical disciplines, such as engineering, computer science and robotics.
Joint replacement is a procedure of orthopedic surgery known also as arthroplasty, in which an arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when severe joint pain or dysfunction is not alleviated by less-invasive therapies. Joint replacement surgery is often indicated from various joint diseases, including osteoarthritis and rheumatoid arthritis.
A femoral head ostectomy is a surgical operation to remove the head and neck from the femur. It is performed to alleviate pain, and is a salvage procedure, reserved for condition where pain can not be alleviated in any other way. It is common in veterinary surgery. Other names are excision arthroplasty of the femoral head and neck, Girdlestone's operation, Girdlestone procedure, and femoral head and neck ostectomy.
The femoral neck is a flattened pyramidal process of bone, connecting the femoral head with the femoral shaft, and forming with the latter a wide angle opening medialward.
Hip resurfacing has been developed as a surgical alternative to total hip replacement (THR). The procedure consists of placing a cap, which is hollow and shaped like a mushroom, over the head of the femur while a matching metal cup is placed in the acetabulum, replacing the articulating surfaces of the person's hip joint and removing very little bone compared to a THR. When the person moves the hip, the movement of the joint induces synovial fluid to flow between the hard metal bearing surfaces lubricating them when the components are placed in the correct position. The surgeon's level of experience with hip resurfacing is most important; therefore, the selection of the right surgeon is crucial for a successful outcome. Health-related quality of life measures are markedly improved and the person's satisfaction is favorable after hip resurfacing arthroplasty.
Computer-assisted surgery (CAS) represents a surgical concept and set of methods, that use computer technology for surgical planning, and for guiding or performing surgical interventions. CAS is also known as computer-aided surgery, computer-assisted intervention, image-guided surgery, digital surgery and surgical navigation, but these are terms that are more or less synonymous with CAS. CAS has been a leading factor in the development of robotic surgery.
Minimally invasive hip resurfacing (MIS) is a total or partial hip surgery that can be carried out through an incision of less than 10 cm without imparting great forces on the anatomy or compromising component positioning.
"Professor" Derek McMinn is a British orthopaedic surgeon and inventor who practised in Birmingham, United Kingdom at the BMI Edgbaston Hospital until his suspension in 2020. McMinn is currently under police investigation for allegedly keeping the body parts of thousands of patients over a 25-year period.
Hip arthroscopy refers to the viewing of the interior of the acetabulofemoral (hip) joint through an arthroscope and the treatment of hip pathology through a minimally invasive approach. This technique is sometimes used to help in the treatment of various joint disorders and has gained popularity because of the small incisions used and shorter recovery times when compared with conventional surgical techniques. Hip arthroscopy was not feasible until recently, new technology in both the tools used and the ability to distract the hip joint has led to a recent surge in the ability to do hip arthroscopy and the popularity of it.
Fractures of the acetabulum occur when the head of the femur is driven into the pelvis. This injury is caused by a blow to either the side or front of the knee and often occurs as a dashboard injury accompanied by a fracture of the femur.
Limb-sparing techniques, also known as limb-saving or limb-salvage techniques, are performed in order to preserve the look and function of limbs. Limb-sparing techniques are used to preserve limbs affected by trauma, arthritis, cancers such as high-grade bone sarcomas, and vascular conditions such as diabetic foot ulcers. As the techniques for chemotherapy, radiation, and diagnostic modalities improve, there has been a trend toward limb-sparing procedures to avoid amputation, which has been associated with a lower 5-year survival rate and cost-effectiveness compared to limb salvage in the long-run. There are many different types of limb-sparing techniques, including arthrodesis, arthroplasty, endoprosthetic reconstruction, various types of implants, rotationplasty, osseointegration limb replacement, fasciotomy, and revascularization.
A hybrid operating room is a very advanced surgical theatre that is equipped with advanced medical imaging devices such as fixed C-Arms, X-ray tomography (CT) scanners or magnetic resonance imaging (MRI) scanners. These imaging devices enable minimally-invasive surgery. Minimally-invasive surgery is intended to be less traumatic for the patient and minimize incisions on the patient and perform surgery procedure through one or several small cuts.
Orthopedic surgery is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal injuries, sports injuries, degenerative diseases, infections, bone tumours, and congenital limb deformities. Trauma surgery and traumatology is a sub-specialty dealing with the operative management of fractures, major trauma and the multiply-injured patient.
Bone malrotation refers to the situation that results when a bone heals out of rotational alignment from another bone, or part of bone. It often occurs as the result of a surgical complication after a fracture where intramedullary nailing (IMN) occurs, especially in the femur and tibial bones, but can also occur genetically at birth. The severity of this complication is often neglected due to its complexity to detect and treat, yet if left untreated, bone malrotation can significantly impact regular bodily functioning, and even lead to severe arthritis. Detection throughout history has become more advanced and accurate, ranging from clinical assessment to ultrasounds to CT scans. Treatment can include an osteotomy, a major surgical procedure where bones are cut and realigned correctly, or compensatory methods, where individuals learn to externally or internally rotate their limb to compensate for the rotation. Further research is currently being examined in this area to reduce occurrences of malrotation, including detailed computer navigation to improve visual accuracy during surgery.
