Preoperative radiographs to predict component malposition in direct anterior approach total hip arthroplasty

Abstract

Introduction:

There is conflicting evidence as to whether or not patients undergoing total hip arthroplasty (THA) via the direct anterior approach (DAA) have increased risk of component malposition. The aim of this study was to investigate whether specific preoperative radiographic features were predictive of postoperative component malposition in DAA THA.

Patients and methods:

We examined 204 THA operations performed for osteoarthritis via the DAA at a single institution. Preoperative radiographs were analysed with numerous pre-specified measurements and classifications being recorded. Postoperative radiographs were analysed to determine if any of these preoperative radiographic factors correlated with component malposition in regard to cup inclination, cup version, femoral stem coronal alignment, leg-length discrepancy (LLD) and femoral offset discrepancy.

Results:

Numerous preoperative factors were associated with component malposition. Coxa profunda was found to be a significant predictor of cup anteversion being outside of the target range (p = 0.0089) and an increased centre-edge angle was a significant predictor for a postoperative LLD (p = 0.0134). A decreased neck-shaft angle (p = 0.0007) and a lower preoperative LLD (p = 0.0019) were both predictive of femoral stem coronal malalignment.

Conclusions:

Preoperative radiographs can be a valuable tool for surgeons in predicting patients at risk of component malposition in DAA THA.

Keywords

Component position direct anterior approach radiographic prediction total hip arthroplasty

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References

Lewinnek

Lewis

Tarr

, et al. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 1978; 60: 217–220.

Wan

Boutary

Dorr

LD.

The influence of acetabular component position on wear in total hip arthroplasty. J Arthroplasty 2008; 23: 51–56.

Callanan

Jarrett

Bragdon

, et al. The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res 2011; 469: 319–329.

Kennedy

Rogers

Soffe

, et al. Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration. J Arthroplasty 1998; 13: 530–534.

Biedermann

Tonin

Krismer

, et al. Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component. J Bone Joint Surg Br 2005; 87: 762–769.

Free

Owen

Agius

, et al. Direct anterior approach total hip arthroplasty: an adjunct to an enhanced recovery pathway: outcomes and learning curve effects in surgeons transitioning from other surgical approaches. J Arthroplasty 2018; 33: 3490–3495.

Martin

Pugely

Gao

, et al. A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. J Arthroplasty 2013; 28: 849–854.

Zawadsky

Paulus

Murray

, et al. Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. J Arthroplasty 2014; 29: 1256–1260.

Woolson

Pouliot

Huddleston

JI.

Primary total hip arthroplasty using an anterior approach and a fracture table: short-term results from a community hospital. J Arthroplasty 2009; 24: 999–1005.

10.

Wayne

Stoewe

Primary total hip arthroplasty: a comparison of the lateral Hardinge approach to an anterior mini-invasive approach. Orthop Rev (Pavia) 2009; 1: e27.

11.

Spaans

Hout

Bolder

SB.

High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach. Acta Orthop 2012; 83: 342–346.

12.

Busse

Gasteiger

Tönnis

A new method for roentgenologic evaluation of the hip joint—the hip factor. Arch Orthop Unfallchir 1972; 72: 1–9.

13.

Dorr

Faugere

Mackel

, et al. Structural and cellular assessment of bone quality of proximal femur. Bone 1993; 14: 231–242.

14.

Meermans

Malik

Witt

, et al. Preoperative radiographic assessment of limb-length discrepancy in total hip arthroplasty. Clin Orthop Relat Res 2011; 469: 1677–1682.

15.

Wiberg

Shelf operation in congenital dysplasia of the acetabulum and in subluxation and dislocation of the hip. J Bone Joint Surg Am 1953; 35: 65–80.

16.

Reynolds

Lucas

Klaue

Retroversion of the acetabulum: a cause of hip pain. J Bone Joint Surg Br 1999; 81: 281–288.

17.

Clohisy

Carlisle

Beaulé

, et al. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am 2008; 90(Suppl. 4): 47–66.

18.

Lin

Bendich

, et al. A comparison of radiographic outcomes after total hip arthroplasty between the posterior approach and direct anterior approach with intraoperative fluoroscopy. J Arthroplasty 2017; 32: 616–623.

19.

Jasty

Webster

Harris

Management of limb length inequality during total hip replacement. Clin Orthop Relat Res 1996; (333): 165–171.

20.

Sykes

Hill

Orr

, et al. Patients’ perception of leg length discrepancy post total hip arthroplasty. Hip Int 2015; 25: 452–456.

21.

Lecerf

Fessy

Philippot

, et al. Femoral offset: anatomical concept, definition, assessment, implications for preoperative templating and hip arthroplasty. Orthop Traumatol Surg Res 2009; 95: 210–219.

22.

Nakata

Nishikawa

Yamamoto

, et al. A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty 2009; 24: 698–704.

23.

Bono

JV.

Digital templating in total hip arthroplasty. J Bone Joint Surg Am 2004; 86-A(Suppl. 2): 118–122.

24.

Bourne

Rorabeck

CH.

Soft tissue balancing: the hip. J Arthroplasty 2002; 17(Suppl. 1): 17–22.

25.

Suh

Cheon

Kim

DW.

Comparison of preoperative templating with postoperative assessment in cementless total hip arthroplasty. Acta Orthop Scand 2004; 75: 40–44.

26.

Jennings

Iorio

Kleiner

, et al. Intraoperative fluoroscopy improves component position during anterior hip arthroplasty. Orthopedics 2015; 38: e970–e975.

27.

Nomura

Naito

Nakamura

, et al. An analysis of the best method for evaluating anteversion of the acetabular component after total hip replacement on plain radiographs. Bone Joint J 2014; 96-B: 597–603.

28.

Park

Shin

Lee

, et al. The best method for evaluating anteversion of the acetabular component after total hip arthroplasty on plain radiographs. J Orthop Surg Res 2018; 13: 66.

29.

Nho

Lee

Kim

, et al. Reliability and validity of measuring version of the acetabular component. J Bone Joint Surg Br 2012; 94: 32–36.

30.

Kjellberg

Al-Amiry

Englund

, et al. Measurement of leg length discrepancy after total hip arthroplasty. The reliability of a plain radiographic method compared to CT-scanogram. Skeletal Radiol 2012; 41: 187–191.

31.

Mahmood

Al-Amiry

Mukka

, et al. Validity, reliability and reproducibility of plain radiographic measurements after total hip arthroplasty. Skeletal Radiol 2015; 44: 345–351.