OPS (Optimised Positioning System)
Hip replacement is often considered the ‘operation of the century’ in that it is historically the most successful procedure in orthopedics. Yet, modern hip replacement still has a small but unacceptable percentage of patient dissatisfaction and failure.
In many cases, the failures are related to a lack of understanding, or disregard, for the hip/spine relationship at the time of the operation. The relationship between spine and hip, also known as spinopelvic balance, is specific for each individual. Failing to grasp the importance of hip/ spine relationship when performing a hip replacement can lead to complications such as dislocation and accelerated wear of the bearing parts of the new joint that can result in premature loosening of the components, ultimately requiring a revision.
Despite the growing appreciation of the importance of hip/spine relationship to improve the outcomes of hip replacement over the last decade, currently, most hip replacements are still being performed in the traditional way, with no adjuvants, using approaches and principles described decades ago when the importance of the hip/spine relationship was not known. Furthermore, even hip replacements performed using navigation and robots fail to consider the hip/spine relationship.
Both traditionally done and technology assisted hip replacements, the latter being those done with either navigation or robots, aim to implant the socket component of the hip replacement in one the so called “safe zones” described 40 years ago on the basis of rather rudimentary studies based in comparing the orientation of the socket component on the hip x-rays of patients that experienced a post-operative dislocation with those of patients that did not.
Over the last few years there has been a proliferation in the number of studies coming from illustrious institutions, from all over the world, that showed that more than half of the dislocations happened in patients where the socket component had been implanted within the “safe zone”.
Although the importance of considering the hip/spine relationship to improve outcomes in hip replacement has been known for a long time, this has only gained momentum during the last decade once the technology required to implement this theoretical knowledge to clinical practice became available. This technology is OPS which stands for Optimized Positioning System.
With OPS a team of highly specialized engineers analyze the preoperative radiographs and CT scan and deliver a personalized plan to the surgeon based on the patient’s unique spinopelvic mobility that will dictate the orientation of the socket and femoral components at the time of the surgery to minimize the risk of the above-mentioned complications.
To help implant the components in the planned orientation, as per the pre-operative analysis, the system does also provide the operating surgeon with 3D printed guides for both the femoral and the socket components.
A modern hip replacement, whether it is performed in the traditional way or whether the surgeon uses the assistance of technologies such as navigation or robots, is expected to have a survivorship greater than 95% at 15 years. However, there are specific groups of patients such as those who are very young and therefore likely to live for many decades with their new hip, those involved in high demand sporting/ artistic activities, and the much greater group of generally older patients with a stiff or hypermobile spine, that should greatly benefit from OPS in order to minimize the risk of post-operative complications and extend the survivorship of their hip replacement.
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