Morpho-functional modelling for preoperative planning in total hip arthroplasty

  • Morphofunktionelle Modellierung für die präoperative Planung in der totalen Hüftendoprothetik

Fischer, Maximilian C. M.; Radermacher, Klaus (Thesis advisor); Lüring, Christian (Thesis advisor)

Düren : Shaker Verlag (2022)
Book, Dissertation / PhD Thesis

In: Aachener Beiträge zur Medizintechnik 71
Page(s)/Article-Nr.: 1 Online-Ressource : Illustrationen, Diagramme

Dissertation, RWTH Aachen University, 2022

Abstract

Total hip arthroplasty (THA) is the most frequently performed joint replacement worldwide. Preoperative planning considering the patient-specific morphology based on medical images is an established process in clinical routine. Although the high importance of functional parameters, such as the sagittal orientation of the pelvis, known as the pelvic tilt, and the resulting hip joint force, for the optimal alignment of the prosthesis is well-known from literature, these parameters are not usually considered in the preoperative planning process. The reasons for the missing integration might be the lack of adequate technical means and additional time required for the functional analysis as a basis for a prediction of the patient-specific postoperative functional parameters. One approach is the consideration of the relationship between the individual morphology and function of the musculoskeletal system in the development of prediction models for postoperative functional parameters. However, very little attention has been paid to the accuracy of the prediction of the postoperative functional parameters. Therefore, the aim of the thesis was to quantify the prediction uncertainties of clinically applicable morpho-functional prediction models for postoperative functional parameters and reveal the implications for a patient-specific preoperative planning process. The prediction of the postoperative pelvic tilt in the standing position was evaluated using multiple linear regression models that included preoperative morphological, functional and biometric parameters of a cohort of 196 THA patients. Static musculoskeletal models for the prediction of the hip joint force during the peak force phase of level walking were adapted by the osseous morphology of the patient and validated using in vivo data of ten patients with instrumented hip implants. Selected prediction models of both functional parameters were integrated into the planning process and the necessary reduction of a patient-specific target zone by the prediction uncertainties was investigated. The results show that functional parameters can change significantly after THA and the postoperative values can be predicted preoperatively. The results suggest that preoperative osseous morphological parameters might help to improve the prediction. However, their predictive value seems to be of minor importance. A preoperative measurement of the functional parameter in question, whenever possible and clinically practicable, seems to be a plausible basis for a prediction model. The prediction uncertainty of each prediction model has to be considered in the preoperative planning process. The prediction uncertainties have a significant impact on the preoperative plan. This highlights the importance of accurate preoperative parameter measurements and further research to improve the prediction of postoperative functional parameters.

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