Journal Article

Kinematic–kinetic compliant acetabular cup positioning based on preoperative motion tracking and musculoskeletal modeling for total hip arthroplasty

Li, Xinxin, Tian, Qiang, Wang, Yanbing, Zhou, Yixin, Guo, Shaoyi, Guo, Jianqiao, Tang, Hao

2024

Overview

The invention of the surgical robot enabled accurate component implantation during total hip arthroplasty (THA). However, a preoperative surgical planning methodology is still lacking to determine the acetabular cup alignment considering the patient-specific hip functions during daily activities such as walking. To simultaneously avoid implant edgeloading and impingement, this study established a kinematic–kinetic compliant (KKC) acetabular cup positioning method based on preoperative gait kinematics measurement and musculoskeletal modeling. Computed tomography images around the hip joint and their biomechanical data during gait, including motion tracking and foot–ground reaction forces, were collected. Using the reconstructed pelvic and femur geometries, the patient-specific hip muscle insertions were located in the lower limb musculoskeletal model via point cloud registration. The designed cup orientation has to be within the patient-specific safe zone to prevent implant impingement, and the optimized value selected based on the time-dependent hip joint reaction force to minimize the risk of edgeloading. As a validation of the proposed musculoskeletal model, the predicted lower limb muscle activations for seven patients were correlated with their surface electromyographic measurements, and the computed hip contact force was also in quantitative agreement with data from the literature. However, the designed cup orientations were not always within the well-known Lewinnek safe zone, highlighting the importance of KKC surgical planning based on patient-specific biomechanical evaluations.

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Acetabular components / Acetabulum / Acetabulum - diagnostic imaging / Acetabulum - surgery / Aged / Arthroplasty, Replacement, Hip - methods / Biomechanical Phenomena / Biomechanics / Biomedical materials / Computed tomography / Contact force / Electromyography / Female / Femur / Gait / Gait - physiology / Hip / Hip joint / Hip Joint - diagnostic imaging / Hip Joint - physiology / Hip Joint - physiopathology / Hip Joint - surgery / Hip Prosthesis / Humans / Image reconstruction / Image registration / Impingement / Joint replacement surgery / Joints (anatomy) / Kinematics / Kinematic–kinetic alignment (KKC) / Male / Middle Aged / Modelling / Models, Biological / Motion tracking / Muscle, Skeletal - diagnostic imaging / Muscle, Skeletal - physiology / Muscle, Skeletal - surgery / Muscles / Musculoskeletal diseases / Orthopaedic implants / Perioperative care / Robot dynamics / Safe zone / Subject-specific musculoskeletal model / Surgical implants / Surgical plan / Tomography / Total hip arthroplasty / Tracking