Moralidou, Maria;
(2023)
The use of 3D-CT Planning and Patient Specific Instrumentation in Total Hip Arthroplasty: Pre-, Intra- and Post-Operative Evaluation.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Optimal implant placement in Primary Total Hip Arthroplasty (THA) aims to restore physiological hip function. Three-Dimensional Computed-Tomography (3D-CT) and Patient-Specific Instrumentation (PSI) can guide implant positioning in THA. Despite growing evidence of preferable results compared to conventional templating, these tools remain underused in clinical practice. This thesis aimed to assess the role of 3D-CT planning and PSI in terms of femoral stem implantation through pre- and post-operative 3D-CT image analysis in primary THA. 3D-CT planning accurately predicted the femoral stem size (96% within one size) and femoral offsets in uncemented THA. Predicting Prosthetic Femoral Version (PFV) proved to be the unmet need given the limited surgical control of uncemented femoral stems to avoid an insufficient or retroverted PFV associated with THA instability. An insufficient PFV (<5°) was reported in 20% of the femoral stems. The malleable nature of cement in cemented fixation offers increased control and can avoid delivering an insufficient PFV. All cases in a cemented THA group were anteverted more than 5°. However, both uncemented and cemented THA reported high PFV variability, indicating the need to develop PSI to guide PFV. First, the accuracy of a PSI osteotomy guide was evaluated by aligning pre- and postoperative 3D-CT reconstructed osteotomy levels to quantify their relative discrepancy, proving that planned neck osteotomy was delivered within the clinically accepted 5mm in 96% of cases. Finally, a pilot study was conducted to evaluate whether a PSI guide, engineered to indicate the angle at which the stem was positioned intra-operatively, can achieve the target range of PFV. Post-operative CT measurements suggested its efficacy in achieving a lower variability of PFV, when compared to the non-guided THA. These findings will inform that planning software cannot predict PFV in uncemented THA and highlight the potential of PSI in delivering the intended PFV in cemented THA.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | The use of 3D-CT Planning and Patient Specific Instrumentation in Total Hip Arthroplasty: Pre-, Intra- and Post-Operative Evaluation |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2023. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10179517 |
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