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1. Special orthopaedic geriatrics (SOG) - a new multiprofessional care model for elderly patients in elective orthopaedic surgery: a study protocol for a prospective randomized controlled trial of a multimodal intervention in frail patients with hip and knee replacement

Author

Tobias Kappenschneider, Günther Maderbacher, Markus Weber, Felix Greimel, Dominik Holzapfel, Lukas Parik, Timo Schwarz, Franziska Leiss, Michael Knebl, Jan Reinhard, Amadeus Dominik Schraag, Max Thieme, Agathe Turn, Julia Götz, Magdalena Zborilova, Loreto C. Pulido, Fady Azar, Jan-Frederik Spörrer, Britta Oblinger, Frederik Pfalzgraf, Leonie Sundmacher, Iryna Iashchenko, Sebastian Franke, Benedikt Trabold, Katrin Michalk, Joachim Grifka, and Matthias Meyer

Subjects
Orthogeriatric, Orthogeriatric co-management (OGC), Geriatric, Total hip arthroplasty (THA), Total knee arthroplasty (TKA), Elderly patients, Diseases of the musculoskeletal system, RC925-935
Abstract

Abstract Background Due to demographic change, the number of older people in Germany and worldwide will continue to rise in the coming decades. As a result, the number of elderly and frail patients undergoing total hip and knee arthroplasty is projected to increase significantly in the coming years. In order to reduce risk of complications and improve postoperative outcome, it can be beneficial to optimally prepare geriatric patients before orthopaedic surgery and to provide perioperative care by a multiprofessional orthogeriatric team. The aim of this comprehensive interventional study is to assess wether multimorbid patients can benefit from the new care model of special orthopaedic geriatrics (SOG) in elective total hip and knee arthroplasty. Methods The SOG study is a registered, monocentric, prospective, randomized controlled trial (RCT) funded by the German Federal Joint Committee (GBA). This parallel group RCT with a total of 310 patients is intended to investigate the specially developed multimodal care model for orthogeriatric patients with total hip and knee arthroplasty (intervention group), which already begins preoperatively, in comparison to the usual orthopaedic care without orthogeriatric co-management (control group). Patients ≥70 years of age with multimorbidity or generally patients ≥80 years of age due to increased vulnerability with indication for elective primary total hip and knee arthroplasty can be included in the study. Exclusion criteria are age

Published
2022
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2. Pelvic tilt impacts cup orientation on CT: how accurate is the gold standard?

Author

Max Thieme, Moritz Kaiser, Achim Benditz, Markus Weber, Matthias König, and Tobias Renkawitz

Subjects
Pelvic tilt, Cup orientation, Arthroplasty, Replacement, Hip, Computed tomography, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Medicine, Humans, Radiology, Nuclear Medicine and imaging, Prospective Studies, 030222 orthopedics, Radiological and Ultrasound Technology, medicine.diagnostic_test, business.industry, Acetabulum, General Medicine, Anterior pelvic plane, Gold standard (test), Cup position, Tomography, Hip Prosthesis, business, Nuclear medicine, Tomography, X-Ray Computed, Total hip arthroplasty
Abstract

Background Computed tomography (CT) is the gold standard for the accurate measurement of cup inclination and anteversion in total hip arthroplasty (THA). However, functional cup position strongly depends on the tilt of the pelvis and thus pelvic tilt in the supine position on the CT table harbors the risk of misinterpretation. Purpose To evaluate the influence of pelvic tilt on cup measurements in postoperative CT scans. Material and Methods This is a secondary outcome analysis of a prospective study. In 123 patients undergoing THA, anatomic cup inclination and anteversion as measured on postoperative 3D-CT scans were compared between: (i) the anterior pelvic plane (APP) resembling neutral pelvic tilt; and (ii) the coronal plane representing the standard planes on CT. Furthermore, the effect of the variation on cup positions within Lewinnek’s safe zone in relation to the applied reference plane was assessed. Results Mean pelvic tilt in supine position was –3.5° ± 5.6°. This resulted in a mean difference for anteversion between APP und coronal plane of 2.1° ± 3.7° and of 2.1° ± 1.9° for cup inclination, respectively. The change varied up to 20.2° for cup inclination and up 12.2° for cup anteversion. The overall conversion rate for inclination and/or anteversion regarding Lewinnek’s safe zone was high at 23.6% (29/123). Conclusion Pelvic tilt affects cup orientation on CT scans depending on the applied reference plane. Standard CT planes should be corrected regarding pelvic tilt before measurements to avoid errors in measurement.

Published
2021

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