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Custom made total hip replacement--necessary or not?
Andrzej Pozowski1, Małgorzata Paprocka-Borowicz, Sławomir Jarzab
1Zakład Biomechaniki Klinicznej, Katedra Fizjoterapii, Akademia Medyczna we Wrocławiu.
Insights
Custom total hip replacement (THR) offers unique solutions but presents challenges. Further research is needed to optimize indications and biomechanical considerations for better patient outcomes.
Area of Science:
- Orthopedic surgery
- Biomechanical engineering
- Medical device design
Background:
- Analysis of indications and technical requirements for custom-made total hip replacement (THR).
- Comparison of custom THR outcomes with standard THR based on available literature.
- Assessment of clinical reports focusing on custom THR production and implantation.
Observation:
- Significant divergence noted in indications, long-term results, and production costs between custom and standard THR.
- Clinical focus often on technical aspects (materials, shape, implantation) rather than comprehensive biomechanical analysis.
- Challenges in predicting biomechanical outcomes due to unpredictable soft tissue quality and altered joint mechanics.
Findings:
- Custom THR indications, late results, and costs differ substantially from standard THR.
- Biomechanical analyses, including range of motion and load transfer, remain largely hypothetical.
- Preoperative planning for complex cases is difficult due to factors like soft tissue quality and altered muscle function.
Implications:
- Need for refined indications and improved biomechanical understanding for custom THR.
- Potential for custom THR in complex cases, but challenges in planning and execution require further investigation.
- Importance of addressing soft tissue variability and dynamic joint changes in custom implant design and surgical strategy.
Abstract:
Indication and technical requirements analyses for custom made THR have been made. Indications for the use of custom made THR and the results achieved have been assessed according to the available literature and compared to the results of standard THR. There is a significant divergence in indications, late results and production costs. Clinical reports focus mostly on individual project metric data preparation method, technical aspects (such as shape or used material) or implantation method. Biomechanical analysis of achievable range of motion, ways of load transportation and equalization of frequently substantial discrepancy in leg length, is more hypothetical. The difficulty stems from the soft tissue quality which cannot be determined precisely, the cause of contracture or dynamic dysfunction triggered by the change of muscle action axis and muscle force over the joint, after changes of offset and joint axis of motion. In complicated cases, preoperative planning of a single approach/solution strategy can pose severe difficulties which would be hard to overcome during operation. Analysis was based on 2 cases.
