Multimodal Quantitative Assessment for Pre-Operative Prosthesis Selection in Total Hip Arthroplasty

摘要

Total Hip Arthroplasty (THA) is one of the most utilized and successful orthopedic surgical procedures, and with increasing life expectancies in many populations worldwide, THA rates are projected to continue to rise accordingly. Despite the procedure's rising prevalence, many periprosthetic fracture and unloading events are still reported. While many investigations have recently focused on potential assessment modalities and metrics to observe and characterize periprosthetic pathophysiology in THA patients, there is no extant, reliable method for the quantitative assessment of patients prior to THA. In most cases, respective opinions of the physicians involved dictate this decision, and procedures are therefore founded upon both the surgeon's own experiences and qualitative generalizations based on suggested indicators of bone quality (gender, age, and qualitative assessment of CT images). There is therefore a great need for a quantitative, multimodal gold standard to securely choose the appropriate implant on a patient-specific basis. The objective of the research presented herein was to describe a novel assembly of such data from a 72-patient cohort as a first step towards eventually creating a patient-specific, presurgical application that orthopedic surgeons can utilize for determining the optimal THA prosthesis procedure. Here, we report the use of 3D soft tissue segmentation of the Rectus femoris, Vastus lateralis, and the Vastus medialis muscles, the use of 3D FEA to compute Fracture Risk Indices (FRI), the pre-operative measurement and user-friendly assembly of 11 gait parameters, and the measurement and analyses of EMG activation data - all of which are presented herein as a comprehensive patient report for a representative 60 year-old female patient.