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Chai Y, Boudali AM, Khadra S, Dasgupta A, Maes V, Walter WL. Evaluating Pelvic Tilt Using the Pelvic Antero-Posterior Projection Images: A Systematic Review. J Arthroplasty 2024; 39:1108-1116.e2. [PMID: 37871860 DOI: 10.1016/j.arth.2023.10.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Pelvic tilt (PT) is a routinely evaluated parameter in hip and spine surgeries, and is usually measured on a sagittal pelvic radiograph. This may not always be feasible due to limitations such as landmark visibility, pelvic anomaly, and hardware presence. Tremendous efforts have been dedicated to using pelvic antero-posterior (AP) radiographs for assessing sagittal PT. Thus, this systematic review aimed to collect these methods and evaluate their performances. METHODS Two independent reviewers searched the PubMed, Ovid, Cochrane, and Web of Science databases in June 2023 with backward reference trailing (Google Scholar archive). There were 30 studies recruited. Risk of bias was assessed using the prediction model risk of bias assessment tool. The relevant data were tabulated in a standardized form for evaluating either the absolute PT or relative PT. Disagreement was resolved by discussing with the senior author. RESULTS There were 19 parameters from pelvic AP projection images involved, with 4 studies which used artificial intelligence, eyeball, or statistical shape method not involving a specific parameter. In comparing the PT values from pelvic sagittal images with those extrapolated from antero-posterior projection images, the highest correlation coefficient was found to be 0.91. The mean absolute difference (error) was 2.6°, with a maximum error reaching 10.9°. Most studies supported the feasibility of using AP parameters to calculate changes in PT. CONCLUSIONS No individual AP parameter was found to precisely estimate absolute PT. However, relative PT can be derived by evaluating serial AP radiographs of a patient in varying postures, employing any AP parameters.
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Affiliation(s)
- Yuan Chai
- Sydney Musculoskeletal Health and The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health and the Northern Sydney Local Health District, The University of Sydney, Sydney, New South Wales, Australia
| | - A Mounir Boudali
- Sydney Musculoskeletal Health and The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health and the Northern Sydney Local Health District, The University of Sydney, Sydney, New South Wales, Australia
| | - Sam Khadra
- Faculty of Medicine and Health, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Amrita Dasgupta
- Faculty of Medicine and Health, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Vincent Maes
- Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia; Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - William L Walter
- Sydney Musculoskeletal Health and The Kolling Institute, Northern Clinical School, Faculty of Medicine and Health and the Northern Sydney Local Health District, The University of Sydney, Sydney, New South Wales, Australia; Department of Orthopaedics and Traumatic Surgery, Royal North Shore Hospital, St. Leonards, New South Wales, Australia
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2
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Zhang W, Xu J, Li D, Sun H, Cai Z, Chen M, Ma R. Reliability and Validity of Standing Lateral Radiograph Method for Measuring Acetabular Component Version: A Modified Cross-table Lateral Radiograph Method. Orthop Surg 2022; 14:1622-1629. [PMID: 35711111 PMCID: PMC9363715 DOI: 10.1111/os.13373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To investigate the effect of the X-ray incidence angle on cup version measurements and the reliability and validity of standing lateral (SL) radiography for measuring cup versions. METHODS Cup versions under different X-ray incidence angles were investigated by the 3D simulation analysis. Ninety-three patients, who underwent primary total hip arthroplasty (THA) with postoperative SL radiographs and CT scans between April 2020 and December 2021, were retrospectively analyzed. SL radiography was taken under naturally standing position, correcting for the measurement error of pelvic tilt in cross-table lateral (CL) radiography. Cup versions were measured on SL radiographs and CT images by two qualified orthopedic physicians. The intra- and inter-observer reliabilities were assessed by intra-class correlation coefficient. The consistency between radiographic and CT measurements was evaluated using Pearson correlation coefficient. RESULTS No significant differences in cup version measurements were observed between groups of different X-ray incidence angles (P = 0.663) in the 3D simulation analysis. All measurements had excellent intra- and inter-observer reliabilities, with an intraclass correlation coefficient of >0.95. Mean cup version measurements from SL radiographs correlated well with those from CT scans (r = 0.853, P < 0.001). The mean difference between radiographic and CT measurements was -0.49° (range -12.62° to 10.37°, SD 3.95°), and the majority of differences were within the 95% limits of agreement. CONCLUSION The cup versions measured with SL radiography were close to the CT measurements. SL radiograph method is reliable and valid for measuring acetabular component version after THA.
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Affiliation(s)
- Wenhui Zhang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Xu
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Deng Li
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao Sun
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiqing Cai
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Meiyi Chen
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruofan Ma
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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3
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Kivistö S, Kotiaho A, Henner A, Nevala T, Niinimäki J, Nieminen MT, Hanni M. Air gap technique is recommended in axiolateral hip radiographs. J Appl Clin Med Phys 2020; 21:210-217. [PMID: 32959511 PMCID: PMC7592970 DOI: 10.1002/acm2.13021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 07/14/2020] [Accepted: 07/21/2020] [Indexed: 11/12/2022] Open
Abstract
Purpose To investigate the replacement of conventional grid by air gap in axiolateral hip radiographs. The optimal air gap distance was studied with respect to radiation dose and image quality using phantom images, as well as 26 patient axiolateral hip radiographs. Methods The CDRAD phantom, along with polymethylmethacrylate slabs with thicknesses of 10.0, 14.6, and 20.0 cm was employed. The inverse image quality index and dose area product (DAP), as well as their combination, so called figure‐of‐merit (FOM) parameter, were evaluated for these images, with air gaps from 20 to 50 cm in increments of 10 cm. Images were compared to those acquired using a conventional grid utilized in hip radiography. Radiation dose was measured and kept constant at the surface of the detector by using a reference dosimeter. Verbal consent was asked from 26 patients to participate to the study. Air gap distances from 20 to 50 cm and tube current‐time products from 8 to 50 mAs were employed. Exposure index, DAP, as well as patient height and weight were recorded. Two radiologists evaluated the image quality of 26 hip axiolateral projection images on a 3‐point nondiagnostic — good/sufficiently good — too good scale. Source‐to‐image distance of 200 cm and peak tube voltage of 90 kVp were used in both studies. Results and conclusion Based on the phantom study, it is possible to reduce radiation dose by replacing conventional grid with air gap without compromising image quality. The optimal air gap distance appears to be 30 cm, based on the FOM analysis. Patient study corroborates this observation, as sufficiently good image quality was found in 24 of 26 patient radiographs, with 7 of 26 images obtained with 30 cm air gap. Thus, air gap method, with an air gap distance of 30 cm, is recommended in axiolateral hip radiography.
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Affiliation(s)
- Susanne Kivistö
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Antti Kotiaho
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Anja Henner
- Oulu University of Applied Sciences, Oulu, Finland
| | - Terhi Nevala
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Jaakko Niinimäki
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Miika T Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Matti Hanni
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
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4
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Gao YY, Zhang R, Che XD, Wang CF, Shi DP, Liang B, Li PH, Liang SF, Li PC. WITHDRAWN: Comparison of the accuracy between imageless navigation and manual freehand approaches for total hip arthroplasty: a systematic review and meta-analysis. Chin J Traumatol 2020:S1008-1275(20)30180-2. [PMID: 33008740 DOI: 10.1016/j.cjtee.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/07/2020] [Accepted: 06/06/2020] [Indexed: 02/04/2023] Open
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Yang-Yang Gao
- Department of Orthopaedic Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Rong Zhang
- Department of Oncology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, 046000, Shanxi, China
| | - Xian-Da Che
- Department of Orthopaedic Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
| | - Chun-Fang Wang
- Department of Experimental Animal Center, Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Dong-Ping Shi
- Department of Nephrology, Fenyang Hospital of Shanxi Province, Fenyang, 032200, Shanxi, China
| | - Bin Liang
- Department of Orthopaedic Surgery, Fenyang Hospital of Shanxi Province, Fenyang, 032200, Shanxi, China
| | - Peng-Hua Li
- Department of Laboratory, Fenyang Hospital of Shanxi Province, Fenyang, 032200, Shanxi, China
| | - Shu-Fen Liang
- Department of Laboratory, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Peng-Cui Li
- Department of Orthopaedic Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, 030001, China
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5
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Blevins JL, Shen TS, Morgenstern R, DeNova TA, Su EP. Conversion of Hip Resurfacing With Retention of Monoblock Acetabular Shell Using Dual-Mobility Components. J Arthroplasty 2019; 34:2037-2044. [PMID: 31178386 DOI: 10.1016/j.arth.2019.04.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Retention of the acetabular component is an option during conversion from hip resurfacing arthroplasty (HRA) to total hip arthroplasty (THA). The purpose of this study was to compare clinical outcomes of conversion of the femoral resurfacing component with retained acetabular components (RAC) and use of dual-mobility femoral heads to outcomes of patients treated with both component (BC) revisions. METHODS A retrospective review was performed of the clinical outcomes of HRA to THA conversions performed at a single institution between 2008 and 2017. RESULTS Seventy-one conversions were included (27 RAC and 44 BC). Average age at time of conversion was 54.4 years (range, 30-68 years). Median time to conversion was 5.14 (2.77-7.41) years and median follow-up post-conversion was 1.7 (0.33-4.0) years. There were no significant differences in indications for conversion between the 2 groups with the majority performed for complications related to elevated metal ions and aseptic loosening. Harris Hip Scores improved from pre-conversion to post-conversion in both cohorts (P < .01). There were no significant differences in pre-conversion and post-conversion metal ion levels between the RAC and BC groups. Serum metal ion levels decreased significantly in both cohorts (P < .01). There were 6 additional revisions in the cohort (4 in BC, 2 in RAC) at a median 2.94 (1.99-3.85) years post-conversion. Two RAC patients had intraprosthetic dislocations with extensive polyethylene wear requiring acetabular revision at median 3.92 (3.85-3.98) years post-conversion. Overall, there were a higher number of complications in the BC group related to acetabular fracture, failure of osseointegration, and periprosthetic joint infection; however, this did not reach statistical significance (P = .27). CONCLUSION Salvage of an appropriately positioned, well-fixed HRA acetabular component is a reasonable option in the setting of conversion to THA using dual-mobility components. This technique avoids the morbidity of acetabular revision and was associated with a decrease in metal ion levels and improvements in short-term functional outcomes comparable to a BC revision.
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Affiliation(s)
- Jason L Blevins
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Tony S Shen
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Rachelle Morgenstern
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Thomas A DeNova
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Edwin P Su
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
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6
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Buller LT, McLawhorn AS, Romero JA, Sculco PK, Mayman DJ. Accuracy and Precision of Acetabular Component Placement With Imageless Navigation in Obese Patients. J Arthroplasty 2019; 34:693-699. [PMID: 30616976 DOI: 10.1016/j.arth.2018.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Obesity is a risk factor for acetabular component malposition when total hip arthroplasty is performed with manual techniques. The utility of imageless navigation in obese patients remains unknown. This study compared the accuracy and precision of imageless navigation for component orientation between obese and nonobese patients. METHODS A total of 459 total hip arthroplasties performed for osteoarthritis using imageless navigation were reviewed from a single surgeon's institutional review board-approved database. Einzel-Bild-Roentgen Analyse determined component orientation on 6-week postoperative anteroposterior radiographs. Mean orientation error (accuracy) and precision were compared between obese (body mass index ≥ 30 kg/m2) and nonobese patients. Regression analysis evaluated the influence of obesity on component position. RESULTS The difference in mean inclination and anteversion between obese and nonobese groups was 1.1° (43.0° ± 3.5°; range, 35.8°-57.8° vs 41.9° ± 4.4°; range, 33.0°-57.1° and 24.9° ± 6.3°; range, 14.2°-44.3° vs 23.8° ± 6.6°; range, 7.0°-38.6°, respectively). Inclination precision was better for nonobese patients. No difference in inclination accuracy or anteversion accuracy or precision was detected between groups. And 83% of components were placed within the target range. There was no relationship between obesity (dichotomized) and component placement outside the target ranges for inclination, anteversion, or both. As a continuous variable, increased body mass index correlated with higher odds of inclination outside the target zone (odds ratio, 1.06; P = .001). CONCLUSION Using imageless navigation, inclination orientation was less precise for obese patients, but the observed difference is likely not clinically relevant. Accurate superficial registration of landmarks in obese patients is achievable, and the use of imageless navigation similarly improves acetabular component positioning in obese and nonobese patients. LEVEL OF EVIDENCE Therapeutic Level IV.
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Affiliation(s)
- Leonard T Buller
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | | | - Jose A Romero
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - David J Mayman
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
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7
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Saka G, Altun G, Burc H, Aydogan M. A new radiographic acetabular cup anteversion measurement method in total hip arthroplasty: a clinical study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:813-818. [PMID: 30656431 DOI: 10.1007/s00590-019-02384-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/11/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The acetabular cup positioning is one of the most crucial steps affecting stability and wear rates in total hip arthroplasty. Different methods have been described for determining the anteversion of the acetabular cup in the literature. But there is still not a widely accepted method to assess the acetabular anteversion radiography. The aim of this study is to measure the acetabular anteversion angle on a single pelvis AP radiography with our method which was proven with an experimental study before. MATERIALS AND METHODS A total of 15 patients (8 males, 7 females) who underwent total hip arthroplasty and have had a pelvis computed tomography scans in our outpatient clinic were evaluated retrospectively. The anteversion angle was calculated in all of pelvis CT scans. For radiological measurement, the formula defined by the authors in an experimental model previously was used. RESULTS Statistically significant difference was not determined between radiographic and CT-based measurements (p = 0.207; p > 0.05). A statistically significant agreement was observed at a level of 98.8% between radiographic and CT-based measurements (ICC = 0.988; 95% CI 0.966-0.996; p < 0.01). CONCLUSION Assessment of the acetabular cup anteversion is very important to predict the possible complications after total hip arthroplasty. Although many methods have been defined for this purpose, each of these has advantages and disadvantages. In particular, with computed tomography method, the patient is exposed to excessive radiation, whereas we think that our method is a preferred method due to features not requiring additional equipment, low radiation exposure, being simple, cost-effectiveness, easily applicable and almost 100% accurate.
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Affiliation(s)
- G Saka
- Department of Orthopaedics and Traumatology, Hisar İntercontinental Hospital, Istanbul, Turkey
| | - G Altun
- Department of Orthopedics and Traumatology, Ümraniye Research and Education Hospital, Istanbul, Turkey.
| | - H Burc
- Department of Orthopedics and Traumatology, Beykent University Faculty of Medicine, Istanbul, Turkey
| | - M Aydogan
- Department of Orthopedics and Traumatology, Bosphorus Spine Center, Istanbul, Turkey
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8
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Snijders TE, Willemsen K, van Gaalen SM, Castelein RM, Weinans H, de Gast A. Lack of consensus on optimal acetabular cup orientation because of variation in assessment methods in total hip arthroplasty: a systematic review. Hip Int 2019; 29:41-50. [PMID: 29772949 DOI: 10.1177/1120700018759306] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION: Dislocation is 1 of the main reasons for revision of total hip arthroplasty but dislocation rates have not changed in the past decades, compromising patients' well-being. Acetabular cup orientation plays a key role in implant stability and has been widely studied. This article investigates whether there is a consensus on optimal cup orientation, which is necessary when using a navigation system. METHODS: A systematic search of the literature in the PubMed, Embase and Cochrane databases was performed (March 2017) to identify articles that investigated the direct relationship between cup orientation and dislocation, including a thorough evaluation of postoperative cup orientation assessment methods. RESULTS: 28 relevant articles evaluating a direct relation between dislocation and cup orientation could not come to a consensus. The key reason is a lack of uniformity in the assessment of cup orientation. Cup orientation is assessed with different imaging modalities, different methodologies, different definitions for inclination and anteversion, several reference planes and distinct patient positions. CONCLUSIONS: All available studies lack uniformity in cup orientation assessment; therefore it is impossible to reach consensus on optimal cup orientation. Using navigation systems for placement of the cup is inevitably flawed when using different definitions in the preoperative planning, peroperative placement and postoperative evaluation. Further methodological development is required to assess cup orientation. Consequently, the postoperative assessment should be uniform, thus differentiating between anterior and posterior dislocation, use the same definitions for inclination and anteversion with the same reference plane and with the patient in the same position.
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Affiliation(s)
- Thom E Snijders
- 1 Clinical Orthopedic Research Centre - mN, Zeist, Utrecht, The Netherlands
| | - Koen Willemsen
- 1 Clinical Orthopedic Research Centre - mN, Zeist, Utrecht, The Netherlands
| | | | - Rene M Castelein
- 2 Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, The Netherlands.,3 Department of Rheumatology, University Medical Center Utrecht, Utrecht, The Netherlands.,4 Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Harrie Weinans
- 2 Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, The Netherlands.,3 Department of Rheumatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arthur de Gast
- 1 Clinical Orthopedic Research Centre - mN, Zeist, Utrecht, The Netherlands
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Muir JM, Vincent J, Schipper J, Govindarajan M, Paprosky WG. Evaluation of Tilt-correction of Anteversion on Anteroposterior Pelvic Radiographs in Total Hip Arthroplasty. Cureus 2018; 10:e2647. [PMID: 30034969 PMCID: PMC6051556 DOI: 10.7759/cureus.2647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Despite inaccuracies due to artifact and variations in patient positioning, anteroposterior (AP) radiographs remain the clinical standard for post-operative evaluation of component placement following total hip arthroplasty (THA). However, cup position, specifically anteversion, can be significantly affected by variations in patient positioning on an X-ray. A major cause of such artifact is unaccounted for pelvic tilt. Several methods for correcting the effects of pelvic tilt on radiographic anteversion have been proposed, with varying degrees of accuracy. The purpose of this study was to evaluate the accuracy and reliability of a commonly referenced method for correcting acetabular cup anteversion in a cohort undergoing total hip arthroplasty and determine its appropriateness for use in this population of patients. Radiographs from patients who underwent primary or revision hip arthroplasty between February 2016 and February 2017 were retrospectively reviewed. Corrected anteversion was calculated by measuring the vertical distance between the symphysis pubis and the sacrococcygeal joint, per the method outlined by Tannast et al. This symphococcygeal distance was then applied to Tannast’s nomograms to calculate the magnitude of pelvic tilt. Corrected and uncorrected anteversion values were compared to anteversion values collected intraoperatively using an imageless computer-assisted navigation device. A total of 71 cases were initially eligible for inclusion in the study. The correction method could not be applied in 44% (31/71) of the cases, chiefly due to difficulties in visualizing the required landmarks. In cases where it could be applied, corrected values correlated very poorly with navigation measurements (r = -0.07). Mean corrected anteversion (36.9°, SD: 7.4°) differed from uncorrected anteversion (25.2°, SD: 7.6°) by an average of 13.5° (p<0.001). Mean navigated anteversion (27.4°, SD: 5.7°) differed from corrected values by an average of 10.8° (p=0.16). The evaluated correction method could not be consistently applied to radiographs and did not reliably correct anteversion due to pelvic tilt in this population of patients undergoing hip arthroplasty. This correction method does not appear to be appropriate for use in this patient population.
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Affiliation(s)
| | - John Vincent
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo
| | | | - Meinusha Govindarajan
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo
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10
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Seagrave KG, Troelsen A, Malchau H, Husted H, Gromov K. Acetabular cup position and risk of dislocation in primary total hip arthroplasty. Acta Orthop 2017; 88:10-17. [PMID: 27879150 PMCID: PMC5251254 DOI: 10.1080/17453674.2016.1251255] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Hip dislocation is one of the most common complications following total hip arthroplasty (THA). Several factors that affect dislocation have been identified, including acetabular cup positioning. Optimal values for cup inclination and anteversion are debatable. We performed a systematic review to describe the different methods for measuring cup placement, target zones for cup positioning, and the association between cup positioning and dislocation following primary THA. Methods - A systematic search of literature in the PubMed database was performed (January and February 2016) to identify articles that compared acetabular cup positioning and the risk of dislocation. Surgical approach and methods for measurement of cup angles were also considered. Results - 28 articles were determined to be relevant to our research question. Some articles demonstrated that cup positioning influenced postoperative dislocation whereas others did not. The majority of articles could not identify a statistically significant difference between dislocating and non-dislocating THA with regard to mean angles of cup anteversion and inclination. Most of the articles that assessed cup placement within the Lewinnek safe zone did not show a statistically significant reduction in dislocation rate. Alternative target ranges have been proposed by several authors. Interpretation - The Lewinnek safe zone could not be justified. It is difficult to draw broad conclusions regarding a definitive target zone for cup positioning in THA, due to variability between studies and the likely multifactorial nature of THA dislocation. Future studies comparing cup positioning and dislocation rate should investigate surgical approach separately. Standardized tools for measurement of cup positioning should be implemented to allow comparison between studies.
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Affiliation(s)
- Kurt G Seagrave
- Faculty of Medicine, University of New South Wales, Sydney, Australia,Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre. Copenhagen, Denmark
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre. Copenhagen, Denmark
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Henrik Husted
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre. Copenhagen, Denmark
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre. Copenhagen, Denmark,Correspondence:
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