A custom-made guide-wire positioning device for hip surface replacement arthroplasty: description and first results.
BACKGROUND
Hip surface replacement arthroplasty (SRA) can be an alternative for total hip arthroplasty. The short and long-term outcome of hip surface replacement arthroplasty mainly relies on the optimal size and position of the femoral component. This can be defined before surgery with pre-operative templating. Reproducing the optimal, templated femoral implant position during surgery relies on guide wire positioning devices in combination with visual inspection and experience of the surgeon. Another method of transferring the templated position into surgery is by navigation or Computer Assisted Surgery (CAS). Though CAS is documented to increase accurate placement particularly in case of normal hip anatomy, it requires bulky equipment that is not readily available in each centre.


METHODS
A custom made neck jig device is presented as well as the results of a pilot study. The device is produced based on data pre-operatively acquired with CT-scan. The position of the guide wire is chosen as the anatomical axis of the femoral neck. Adjustments to the design of the jig are made based on the orthopedic surgeon's recommendations for the drill direction. The SRA jig is designed as a slightly more-than-hemispherical cage to fit the anterior part of the femoral head. The cage is connected to an anterior neck support. Four knifes are attached on the central arch of the cage. A drill guide cylinder is attached to the cage, thus allowing guide wire positioning as pre-operatively planned. Custom made devices were tested in 5 patients scheduled for total hip arthroplasty. The orthopedic surgeons reported the practical aspects of the use of the neck-jig device. The retrieved femoral heads were analyzed to assess the achieved drill place in mm deviation from the predefined location and orientation compared to the predefined orientation.


RESULTS
The orthopedic surgeons rated the passive stability, full contact with neck portion of the jig and knife contact with femoral head, positive. There were no guide failures. The jig unique position and the number of steps required to put the guide in place were rated 1, while the complexity to put the guide into place was rated 1-2. In all five cases the guide wire was accurately positioned. Maximum angular deviation was 2.9 degrees and maximum distance between insertion points was 2.1 mm.


CONCLUSIONS
Pilot testing of a custom made jig for use during SRA indicated that the device was (1) successfully applied and user friendly and (2) allowed for accurate guide wire placement according to the preoperative plan.
Raaijmaakers
Martijn
M
Department of Reconstructive Hip Surgery, UZ Pellenberg, Katholieke Universiteit Leuven, Belgium. martijn.raaijmaakers@gmail.com
Gelaude
Frederik
F
De Smedt
Karla
K
Clijmans
Tim
T
Dille
Jeroen
J
Mulier
Michiel
M
D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation* / Q000379:methods / Q000592:standards; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000592:standards*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods; D056888:Patient Positioning / Q000295:instrumentation* / Q000379:methods / Q000592:standards; D011300:Preoperative Care / Q000295:instrumentation* / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods / Q000592:standards; D013525:Surgical Instruments / Q000592:standards; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome