Contemporary,non-navigation,cup orientation techniques improve accuracy and eliminate differences seen between the anterior and posterior approach in THA

Abstract

Background:

This study aimed to: (1) Determine the ability to achieve the surgeons’ desired cup orientation, without navigation, using contemporary measures with the anterior- (AA) and posterior- approaches (PA); and (2) assess whether surgical approach is associated with cup orientation accuracy, as previously reported, when contemporary measures are used.

Methods:

A prospective, 2-centre, multi-surgeon study of 400 THAs (200 AA; 200 PA) was performed. Intraoperative radiographs were obtained with the AA. A digital inclinometer and 3-point pelvic support were used with the PA. With the PA, intraoperative cup inclination at impaction was recorded. Radiographic inclination/anteversion (RI/RA) was measured from intraoperative radiographs (AA-only) and from postoperative radiographs for all cases. Optimum inclination/anteversion was defined as 40°/20° (±10°). The difference between intra- and postoperative orientations allowed for determination of the difference in pelvic position at impaction.

Results:

Optimum RI and RA were achieved in 91.3% (n = 365) and 92% (n = 368) of cases respectively. Optimum cup orientation was detected in 84% of cases (n = 336). There was equivalent ability to achieve cup orientation between approaches (AA: 82.5% vs. PA: 85.5%; p = 0.41). The use of an inclinometer in the PA was associated with a smaller variability of inclination at implantation (10° vs. 14°) and counteracted the greater difference in pelvic position (4.4° vs. 2.1°) seen with the PA.

Conclusions:

Over 80% of cases can have optimum orientation without navigation, using simple, cheap contemporary measures. Such measures eliminate differences between approaches, related to patient position. Narrower implantation angles will further reduce variability in cup orientation achieved.

Keywords

Anteversion cup orientation inclination inclinometer total hip arthroplasty

Get full access to this article

View all access options for this article.

References

Grammatopoulos

Thomas

Pandit

, et al. The effect of orientation of the acetabular component on outcome following total hip arthroplasty with small diameter hard-on-soft bearings. Bone Joint J 2015; 97-B: 164–172.

Grammatopoulos

Pandit

Glyn-Jones

, et al. Optimal acetabular orientation for hip resurfacing. J Bone Joint Surg Br 2010; 92: 1072–1078.

Langton

Joyce

Jameson

, et al. Adverse reaction to metal debris following hip resurfacing: the influence of component type, orientation and volumetric wear. J Bone Joint Surg Br 2011; 93: 164–171.

Lewinnek

Lewis

Tarr

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

Barrack

. Dislocation after total hip arthroplasty: implant design and orientation. J Am Acad Orthop Surg 2003; 11: 89–99.

Abdel

von Roth

Jennings

, et al. What safe zone? The vast majority of dislocated THAs are within the Lewinnek safe zone for acetabular component position. Clin Orthop Relat Res 2016; 474: 386–391.

Grammatopoulos

Pandit

da Assunção

, et al. The relationship between operative and radiographic acetabular component orientation: which factors influence resultant cup orientation? Bone Joint J 2014; 96-B: 1290–1297.

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.

Esposito

Walter

Roques

, et al. Wear in alumina-on-alumina ceramic total hip replacements: a retrieval analysis of edge loading. J Bone Joint Surg Br 2012; 94: 901–907.

10.

Grammatopoulos

Pandit

da Assunção

, et al. Pelvic position and movement during hip replacement. Bone Joint J 2014; 96-B: 876–883.

11.

Grammatopoulos

Gofton

Cochran

, et al. Pelvic positioning in the supine position leads to more consistent orientation of the acetabular component after total hip arthroplasty. Bone Joint J 2018; 100-B: 1280–1288.

12.

Ezoe

Naito

Asayama

, et al. Pelvic motion during total hip arthroplasty with translateral and posterolateral approaches. J Orthop Sci 2005; 10: 167–172.

13.

Hamilton

Parks

Huynh

. Comparison of cup alignment, jump distance, and complications in consecutive series of anterior approach and posterior approach total hip arthroplasty. J Arthroplasty 2015; 30: 1959–1962.

14.

Slotkin

Patel

Suarez

. Accuracy of fluoroscopic guided acetabular component positioning during direct anterior total hip arthroplasty. J Arthroplasty 2015; 30(Suppl): 102–106.

15.

Soderquist

Scully

Unger

. Acetabular placement accuracy with the direct anterior approach freehand technique. J Arthroplasty 2017; 32: 2748–2754.

16.

Asayama

Akiyoshi

Naito

, et al. Intraoperative pelvic motion in total hip arthroplasty. J Arthroplasty 2004; 19: 992–997.

17.

Beverland

O’Neill

Rutherford

, et al. Placement of the acetabular component. Bone Joint J 2016; 98-B(Suppl. A): 37–43.

18.

Rutherford

O’Connor

Hill

, et al. Patient positioning and cup orientation during total hip arthroplasty: assessment of current UK practice. Hip Int 2019; 29: 89–95.

19.

Darrith

Bell

Culvern

, et al. Can the use of an inclinometer improve the positioning of the acetabular component in total hip arthroplasty? Bone Joint J 2018; 100-B: 862–866.

20.

Meermans

Goetheer-Smits

Lim

, et al. The difference between the radiographic and the operative angle of inclination of the acetabular component in total hip arthroplasty: use of a digital protractor and the circumference of the hip to improve orientation. Bone Joint J 2015; 97-B: 603–610.

21.

O’Neill

Hill

Patterson

, et al. Reducing variability in apparent operative inclination during total hip arthroplasty: findings of a randomised controlled trial. Hip Int 2018; 28: 234–239.

22.

Dorr

Malik

Wan

, et al. Precision and bias of imageless computer navigation and surgeon estimates for acetabular component position. Clin Orthop Relat Res 2007; 465: 92–99.

23.

Grammatopoulos

Alvand

Monk

, et al. Surgeons’ accuracy in achieving their desired acetabular component orientation. J Bone Joint Surg Am 2016; 98: e72.

24.

DeChenne

Jayaram

Lovell

, et al. A novel acetabular alignment guide for THR using selective anatomic landmarks on the pelvis. J Biomech 2005; 38: 1902–1908.

25.

Padgett

Hendrix

Mologne

, et al. Effectiveness of an acetabular positioning device in primary total hip arthroplasty. HSS J 2005; 1: 64–67.

26.

Vendittoli

Duval

Stitson

, et al. Vertical acetabular positioning with an inclinometer in total hip arthroplasty. J Arthroplasty 2002; 17: 936–941.

27.

Hartofilakidis

Stamos

Ioannidis

. Low friction arthroplasty for old untreated congenital dislocation of the hip. J Bone Joint Surg Br 1988; 70: 182–186.

28.

Eilander

Harris

Henkus

, et al. Functional acetabular component position with supine total hip replacement. Bone Joint J 2013; 95-B: 1326–1331.

29.

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.

30.

Murray

. The definition and measurement of acetabular orientation. J Bone Joint Surg Br 1993; 75: 228–232.

31.

Langton

Sprowson

Mahadeva

, et al. Cup anteversion in hip resurfacing: validation of EBRA and the presentation of a simple clinical grading system. J Arthroplasty 2010; 25: 607–613.

32.

Wilkinson

Hamer

Elson

, et al. Precision of EBRA-Digital software for monitoring implant migration after total hip arthroplasty. J Arthroplasty 2002; 17: 910–916.

33.

Danoff

Bobman

Cunn

, et al. Redefining the acetabular component safe zone for posterior approach total hip arthroplasty. J Arthroplasty 2016; 31: 506–511.

34.

Beamer

Morgan

Barr

, et al. Does fluoroscopy improve acetabular component placement in total hip arthroplasty? Clin Orthop Relat Res 2014; 472: 3953–3962.

35.

van Duren

Royeca

Cunningham

, et al. Can the use of an inclinometer improve acetabular cup inclination in total hip arthroplasty? A review of the literature. Hip Int 2021; 31: 609–617.

36.

Takada

Jinno

Miyatake

, et al. Supine versus lateral position for accurate positioning of acetabular cup in total hip arthroplasty using the modified Watson-Jones approach: a randomized single-blind controlled trial. Orthop Traumatol Surg Res 2019; 105: 915–922.