Title:
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Determination of femoral head centre during total hip arthroplasty
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Total hip arthroplasty (THA) is a successful operation with predictable results in
patients with end-stage hip arthritis. Poor component placement, orientation or sizing
on either the acetabular or femoral side increases the risk of a poor outcome. In
particular on the femoral side, not restoring offset or introducing a leg length
discrepancy are issues that can be avoided with good surgical technique and planning.
A Calliper has been used since 1992 in Musgrave Park Hospital, Belfast as a method
of intraoperative simple hip navigation to help determine the position of femoral head
centre and aid femoral side reconstruction. The Calliper system has certain limitations
and so a new system, the Femoral Head Navigation System (FHNS) is being
developed. The aim of this thesis was to compare the FHNS to the current Calliper
system in terms of the ability to determine the position of femoral head centre during
THA. The further subject of this thesis was to research alternative methods and to
validate the underlying assumptions made by the proposed method of the FHNS.
These included, that femoral head diameter can be measured accurately, that the Head
Centre Location Device (HCLD) part of the FHNS is accurate, that the femoral head
is grossly spherical, that the posterior femoral head surface is less affected than the
superior or anterior surface by osteoarthritis and fmally that the Trochanteric Fossa is
a reliable entry point for the proximal femoral axis.
The results showed that the mean accuracy in determining the position of femoral
head centre for the FHNS (1. 1 mrn, range 0.0 to 3.3 mm) was statistically more
accurate than the original Calliper system (4.0mm, range 0.5 to 11.0mm) (p=O.003).
These findings along with the results of the validation experiments suggest that the
FHNS has a potential role in THA in improving the surgical technique for
determining the position of femoral head centre and inserting the femoral component.
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