Results of Femoral Offset and Leg Length in Bipolar Hip Hemiarthroplasty Pre-operatively Planned Using Digital Templating in the Keynote Program: a Retrospective Study
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Abstract
Background: When performing bipolar hemiarthroplasty (BHA) for femoral neck fractures (FNF), it is crucial to restore the femoral offset (FO) and leg length to match those of the normal contralateral leg. This is achieved through preoperative templating. A technique using a digital template, incorporating computer systems and the Keynote program on an iPhone, has been developed. However, the outcomes of using this digital template in BHA patients have not yet been studied.
Objective: To compare FO and leg length between the operated leg and the contralateral normal leg in FNF patients who underwent BHA surgery, using a digital template in the Keynote program for preoperative planning.
Material and methods: A retrospective cohort study among 101 elderly patients with FNF who underwent BHA at Lampang Hospital from January 2019 to March 2024. Preoperative templating was performed using the Keynote program on an iPhone or iPad, which included digital images of femoral prosthesis templates in the background of each slide. Postoperative leg length discrepancy (LLD) and FO difference were measured on X-ray images. Data were analyzed using descriptive statistics. Comparisons were made between the group with LLD within the range of -6 mm to 6 mm and the group with LLD outside this range, as well as between the group with FO difference within the range of -5 mm to 5 mm and the group with FO difference outside this range. The consistency of measurements was analyzed for both intra-rater and inter-rater reliability.
Results: The mean age of the patients was 77.9 years (SD 6.4, range 63−92), with the majority being female (86 patients, 84.2%). The direct lateral approach was used in 53 patients (52.5%), and the posterolateral approach was used in 48 patients (47.5%). Most of the femoral prostheses used were cemented (63.4%) and standard offset (75.3%). Radiographic measurements showed a median LLD of 0.0 mm (IQR -0.2, 3.6). Ninety-two patients (91.1%) had an LLD within the range of -6 mm to 6 mm. The mean FO difference was 0.9 mm (SD 2.5), with 94 patients (93.1%) having an FO difference within the range of -5 mm to 5 mm. Comparative analysis between groups revealed no factors associated with having an LLD within the range of -6 mm to 6 mm or an FO difference within the range of -5 mm to 5 mm. The intra-rater and inter-rater reliability had ICC values of 0.93 and 0.90, respectively
Conclusion: Using digital templates in the Keynote program for preoperative planning of BHA was highly effective in ensuring equal leg length and femoral offset. About 91−93% of patients achieve acceptable differences in these measurements.
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บทความที่ส่งมาลงพิมพ์ต้องไม่เคยพิมพ์หรือกำลังได้รับการพิจารณาตีพิมพ์ในวารสารอื่น เนื้อหาในบทความต้องเป็นผลงานของผู้นิพนธ์เอง ไม่ได้ลอกเลียนหรือตัดทอนจากบทความอื่น โดยไม่ได้รับอนุญาตหรือไม่ได้อ้างอิงอย่างเหมาะสม การแก้ไขหรือให้ข้อมูลเพิ่มเติมแก่กองบรรณาธิการ จะต้องเสร็จสิ้นเป็นที่เรียบร้อยก่อนจะได้รับพิจารณาตีพิมพ์ และบทความที่ตีพิมพ์แล้วเป็นสมบัติ ของลำปางเวชสาร
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