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Schwarz TJ, Maderbacher G, Leiss F, Grifka J, Kappenschneider T, Knebl M. Three-dimensional acetabular reorientation during periacetabular osteotomy: an intraoperative navigation method using an external fixator for periacetabular osteotomy. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05590-1. [PMID: 39313642 DOI: 10.1007/s00402-024-05590-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 09/16/2024] [Indexed: 09/25/2024]
Abstract
INTRODUCTION Bernese periacetabular osteotomy (PAO) is an effective procedure for treating acetabular dysplasia. However, limited visual control of the acetabular position during surgery may result in under- or overcorrection or changes in acetabular version resulting in residual dysplasia or femoroacetabular impingement. Thus, we wanted to develop a simple and straightforward navigation method that provides information about acetabular correction in all three planes during surgery. METHOD Intraoperatively, acetabular coordinates are shown in coronal, sagittal, and transverse plane by two perpendicular tubes of an external fixator mounted onto a third tube that is fixed to the mobilized acetabular fragment with two Schanz screws. The application and fixation of the external fixator on the pelvis are demonstrated in this article. We used this analog navigation method on 27 PAOs, where we mainly performed a lateral rotational correction. The pre- and postoperative radiographs of these 27 hips were analyzed regarding the radiological hip parameters, taking into account the pelvic tilt. RESULTS The mean preoperative lateral center edge angle (LCEA) of the 27 PAOs improved from 16° (+-6) to a mean of 34° (+-6°) and the mean acetabular index (AI) was corrected from 15° (+-4) to 2° (+-4). This implements highly physiologic postoperative values for lateral coverage in this population. In this case series, no postoperative acetabular retroversion was measured in any of the 27 PAOs. CONCLUSION Three-dimensional control of the acetabular orientation during periacetabular osteotomy is important to avoid over- and undercorrection. Using a fixateur externe as an analog navigation method this three-dimensional control can be implemented intraoperatively for PAOs.
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Affiliation(s)
- Timo J Schwarz
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany.
| | - Günther Maderbacher
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Franziska Leiss
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Tobias Kappenschneider
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - M Knebl
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
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Coxe FR, Jordan LA, Wong ZP, Spaan JC, Ren R, Su EP. Functional Acetabular Component Positioning During Direct Anterior Approach Hip Arthroplasty Using a Novel Three-Dimensional Virtual Mesh Imaging System With Fluoroscopy. J Arthroplasty 2024; 39:S88-S96. [PMID: 38522804 DOI: 10.1016/j.arth.2024.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Optimal position of total hip arthroplasty (THA) components is critical for joint mechanics and stability. Acetabular component positioning during supine surgery in direct anterior approach (DAA) THA may be different in the standing position postoperatively, which traditional fluoroscopy is unable to predict. A novel 3-dimensional (3D) image analysis technology (IAT) that uses artificial intelligence to measure the tilt and rotation of the pelvis has enabled prediction of component positioning from supine to standing. The purpose of this study was to compare intraoperative fluoroscopy, non-3D-IAT, and 3D-IAT with postoperative standing radiographs to assess the accuracy of component positioning. METHODS From 2022 to 2023, 30 consecutive patients (86.6% women, mean age 59 [range, 55 to 67]) undergoing primary DAA THA with the use of the 3D-IAT were identified. A separate cohort of 148 patients from 2020 to 2021 (85% women, mean age 65 [range, 55 to 69]) who underwent DAA THA with non-3D-IAT was used for comparison. Leg length discrepancy (LLD), cup anteversion, and inclination were manually measured on intraoperative fluoroscopic images and digitally measured using IAT. Follow-up evaluation occurred at 1 month with standing pelvis radiographs measured using Ein Bild Röntgen Analyze-Cup software. Measurements were compared via Wilcoxon signed rank tests where P ≤ .05 indicates significantly different measurements. RESULTS Median LLD, inclination, and anteversion measurements via non-3D-IAT and fluoroscopy were significantly different compared to postoperative standing radiographs (P < .001). The 3D-IAT more accurately predicted LLD, abduction, and anteversion, with values not significantly different from postoperative standing measurements (P = .23, P = .93, and P = .36, respectively). CONCLUSIONS The use of the 3D-IAT during DAA THA allowed for the more accurate prediction of acetabular component position in the standing position postoperatively.
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Affiliation(s)
- Francesca R Coxe
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - L Andrew Jordan
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Zachary P Wong
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Jonathan C Spaan
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
| | - Renee Ren
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Edwin P Su
- Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York
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Pagano S, Plate JF, Kappenschneider T, Reinhard J, Scharf M, Maderbacher G. Polyethylene liner dissociation in total hip arthroplasty: a retrospective case-control study on a single implant design. J Orthop Traumatol 2024; 25:38. [PMID: 39143399 PMCID: PMC11324622 DOI: 10.1186/s10195-024-00785-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 08/01/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Modular acetabular components for total hip arthroplasty (THA) provide intraoperative flexibility; however, polyethylene liner dissociation may occur. This study aimed to examine the incidence and causes of liner dissociation associated with a specific acetabular component design at a single centre. MATERIALS AND METHODS A retrospective analysis of 7027 patients who underwent primary THA was performed to identify isolated liner dislocations. Patient demographics, clinical presentations, surgical and implant details, and both radiographic and computed tomography (CT) findings were analysed. Patients with liner dislocation were matched to a control group via 2:1 propensity score matching, and a logistic regression analysis was employed to identify associated risk factors. RESULTS A total of 32 patients (0.45%) experienced liner dislocation at a mean 71.47 ± 60.10 months post surgery. Significant factors contributing to dislocations included the use of a conventional compared with a highly crosslinked polyethylene component (p = 0.049) and screw fixation (p = 0.028). Radiographic and CT analysis highlighted the importance of proper component orientation, revealing that patients experiencing dislocations demonstrated significantly lower acetabular cup anteversion angles (p = 0.001) compared with the control group. Impingement and malposition, identified in 41% and 47% of the cases, respectively, further underscored the multifactorial nature of dislocation risks. CONCLUSIONS While the overall rate of polyethylene liner dislocation was low, the findings of this study highlight the importance of appropriate cup placement to decrease the risk of dissociation. It further substantiates the influence of impingement and malposition in liner displacement, with increased mechanical stress exerted on the locking mechanism under adverse conditions and the potential risk increase due to screw placement.
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Affiliation(s)
- S Pagano
- Department of Orthopaedic Surgery, University of Regensburg, Asklepios Klinikum, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany.
| | - J F Plate
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - T Kappenschneider
- Department of Orthopaedic Surgery, University of Regensburg, Asklepios Klinikum, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - J Reinhard
- Department of Orthopaedic Surgery, University of Regensburg, Asklepios Klinikum, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - M Scharf
- Department of Orthopaedic Surgery, University of Regensburg, Asklepios Klinikum, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - G Maderbacher
- Department of Orthopaedic Surgery, University of Regensburg, Asklepios Klinikum, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
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Li W, Huang Y, Zou Z, Liu X, Li X. Reliability and accuracy of intraoperative fluoroscopy assessment of acetabular cup anteversion in supine direct anterior approach total hip arthroplasty. Sci Rep 2024; 14:12469. [PMID: 38816424 PMCID: PMC11139957 DOI: 10.1038/s41598-024-62964-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 05/23/2024] [Indexed: 06/01/2024] Open
Abstract
Poor implantation positioning of hip prostheses is considered the primary factor affecting postoperative joint wear. Cup anteversion in direct anterior approach (DAA) total hip arthroplasty (THA) is often excessive. Intraoperative fluoroscopy (IF) are effective for improving implant placement accuracy. This study aimed to analyze IF's reliability and accuracy in assessing intraoperative anteversion. Sixty-two consecutive hips underwent primary THA utilizing DAA alongside IF for cup placement. Intraoperative anteversion was measured using IF images, while postoperative CT and standard anteroposterior (AP) radiographs were used to calculate true anteversion component angles. Differences and correlations between intraoperative and true anteversions were analyzed, and intraclass correlation coefficients (ICC) determined the inter- and intra-observer reliabilities. Excellent intra- and inter-observer reliabilities were observed for all radiographic and CT methods (ICC > 0.9). Strong correlations (PCC > 0.6) existed between anteversion measured on IF image and postoperative CT and AP pelvic measurements. Intraoperative anteversion measured on IF images (16.8 ± 3.2°) was smaller than anteversion measured postoperatively on AP X-rays (21.3 ± 4.7°, P < 0.001) and CT (22.0 ± 4.9°, P < 0.001), with average differences of 4.5°and 5.3°, respectively. Under several influencing factors, the accuracy of IF in assessing cup anteversion in DAA-THA may be limited. However, this still requires large-sample experiments for verification.
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Affiliation(s)
- Weihua Li
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yan Huang
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Zehui Zou
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xuqiang Liu
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
| | - Xiaofeng Li
- Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
- Artificial Joints Engineering and Technology Research Center of Jiangxi Province, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
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Weber M, Meyer M, Von Kunow F, Füchtmeier B, Hillmann A, Wulbrand C. How Relevant Is the Parallax Effect on Low Centered Pelvic Radiographs in Total Hip Arthroplasty. J Pers Med 2023; 13:881. [PMID: 37373870 DOI: 10.3390/jpm13060881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 06/29/2023] Open
Abstract
The correct cup position in total hip arthroplasty (THA) is usually assessed on anteroposterior low centered pelvic radiographs, harboring the risk of misinterpretation due to projection of a three-dimensional geometry on a two-dimensional plane. In the current study, we evaluate the effect of this parallax effect on the cup inclination and anteversion in THA. In the course of a prospective clinical trial, 116 standardized low centered pelvic radiographs, as routinely obtained after THA, were evaluated regarding the impact of central beam deviation on the cup inclination and anteversion angles. Measurements of the horizontal and vertical beam offset with two different methods of parallax correction were compared with each other. Furthermore, the effect of parallax correction on the accuracy ofmeasuring the cup position was investigated. The mean difference between the two parallax correction methods was 0.2° ± 0.1° (from 0° to 0.4°) for the cup inclination and 0.1° ± 0.1° (from -0.1° to 0.2°) for the anteversion. For a typically intended cup position of a 45° inclination and 15° anteversion, the parallax effect led to a mean error of -1.5° ± 0.3° for the inclination and 0.6° ± 1.0° for the anteversion. Central beam deviation resulted in a projected higher cup inclination up to 3.7°, and this effect was more prominent in cups with higher anteversion. In contrast, the projected inclination decreased due to the parallax effect up to 3.2°, especially in cups with high inclination. The parallax effect on routinely obtained low centered pelvic radiographs is low and not clinically relevant due to the compensating effect of simultaneous medial and caudal central beam deviation.
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Affiliation(s)
- Markus Weber
- Faculty of Medicine, University of Regensburg, 93053 Regensburg, Germany
- Department of Orthopedic and Trauma Surgery, Barmherzige Brueder Regensburg Medical Center, 93047 Regensburg, Germany
| | - Matthias Meyer
- Department of Orthopedic Surgery, Regensburg University Medical Center, 93077 Bad Abbach, Germany
| | - Frederik Von Kunow
- Department of Orthopedic and Trauma Surgery, Barmherzige Brueder Regensburg Medical Center, 93047 Regensburg, Germany
| | - Bernd Füchtmeier
- Department of Orthopedic and Trauma Surgery, Barmherzige Brueder Regensburg Medical Center, 93047 Regensburg, Germany
| | - Axel Hillmann
- Department of Orthopedic and Trauma Surgery, Barmherzige Brueder Regensburg Medical Center, 93047 Regensburg, Germany
| | - Christian Wulbrand
- Department of Orthopedic and Trauma Surgery, Barmherzige Brueder Regensburg Medical Center, 93047 Regensburg, Germany
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Achieving Precise Cup Positioning in Direct Anterior Total Hip Arthroplasty: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020271. [PMID: 36837472 PMCID: PMC9959722 DOI: 10.3390/medicina59020271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/16/2023] [Accepted: 01/22/2023] [Indexed: 02/01/2023]
Abstract
Malpositioned implants in total hip arthroplasty are associated with impingement, increased wear, and dislocations, thus precise cup positioning is crucial. However, significant deviations between targeted and actually achieved cup positions have been found even in patients operated by experienced surgeons. When aiming for higher accuracy, various methods based on freehand positioning lead by anatomic landmarks, C-arm fluoroscopy, imageless navigation, or robotic-assisted-surgery have been described. There is a constant development of new products aiming to simplify and improve intraoperative guidance. Both the literature and expert opinions on this topic are often quite controversial. This article aims to give an overview of the different methods and systems with their specific advantages and potential pitfalls while also taking a look into the future of cup positioning in anterior hip replacements.
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Three-dimensional acetabular orientation during periacetabular osteotomy: a video analysis of acetabular rim position using an external fixator as navigation tool during reorientation procedure. Arch Orthop Trauma Surg 2022; 142:381-386. [PMID: 33098458 PMCID: PMC8843857 DOI: 10.1007/s00402-020-03632-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Bernese periacetabular osteotomy is an effective procedure for treating acetabular dysplasia. However, limited visual control of the acetabular position during surgery may result in under- or overcorrection with residual dysplasia or femoroacetabular impingement. Thus, we wanted to find a simple method to control the effect of correction in the sagittal and coronal plane. METHOD The acetabular coordinates are shown by two perpendicular tubes of an external fixator mounted onto a third tube that is fixed to the acetabular fragment with two Schanz screws. This method enables the isolated acetabular reorientation in the coronal, sagittal, and transverse plane. In a sawbone pelvis model, the acetabular rim is marked with a copper wire and a silicon adherent. To show the radiographic effect on acetabular parameters and the rim position, we visualized correction in the coronal and sagittal plane under fluoroscopic control. RESULTS Lateral rotation of the acetabular fragment had the highest impact on radiographic lateral coverage of the femoral head. But also ventral coverage increased during isolated lateral rotation. Anterior rotation showed almost no effect on lateral coverage and just a little effect on ventral coverage but caused severe total acetabular retroversion. CONCLUSION Three-dimensional control of the acetabular orientation during periacetabular osteotomy is important to avoid over- and under-correction. Isolated lateral rotation of the acetabular fragment should be the predominant direction of correction during periacetabular osteotomy. Ambitious anterior correction may be the main source for severe acetabular retroversion following periacetabular osteotomy.
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Burapachaisri A, Elbuluk A, Abotsi E, Pierrepont J, Jerabek SA, Buckland AJ, Vigdorchik JM. Lewinnek Safe Zone References are Frequently Misquoted. Arthroplast Today 2020; 6:945-953. [PMID: 33299915 PMCID: PMC7701843 DOI: 10.1016/j.artd.2020.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/13/2020] [Accepted: 09/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Optimal acetabular component orientation in total hip arthroplasty (THA) is a necessity in achieving a stable implant. Although there has been considerable debate in the literature concerning the safe zone, to date, there has not been any review to determine if these references are consistent with the definition applied by Lewinnek et al. in 1978. Therefore, this article aims to examine the available literature in the PubMed database to determine how often a correct reference to the safe zone as defined by Lewinnek was applied to discussions regarding THA. METHODS A search for literature in the PubMed database was performed for articles from 1978 to 2019. Search criteria included terms 'Lewinnek,' 'safe zone,' and 'total hip arthroplasty.' Exclusions included abstract-only articles, non-English articles, articles unrelated to THA, and those lacking full content. RESULTS A review of literature yielded 147 articles for inclusion. Overall, only 11% (17) cited the Lewinnek article correctly. Forty-five percent (66) of articles referenced measurements in the supine position, 18% (26) referenced other positions, and 37% (55) did not specify. Nineteen percent (28) reported measurements of the acetabular cup orthogonal to the anterior pelvic plane, while 73% (108) did not, and 7% (11) did not specify. Twenty-three percent (34) measured from computed tomography scans instead of other methods. CONCLUSIONS In the discussion of the safe zone regarding THA, only 11% of articles listed are consistent with the definition established by Lewinnek. This warrants further investigation into a consistent application of the term and its implications for THA implant stability and dislocation rates.
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Affiliation(s)
- Aonnicha Burapachaisri
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Ameer Elbuluk
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Edem Abotsi
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Jim Pierrepont
- Chief Innovation Officer, Corin Group, New South Wales, Australia
| | - Seth A. Jerabek
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
| | - Aaron J. Buckland
- Division of Spine Surgery, Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Jonathan M. Vigdorchik
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, USA
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9
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Thorne TJ, Nishioka ST, Andrews SN, Mathews KA, Nakasone CK. Comparison of Component Placement Accuracy Using Two Intraoperative Fluoroscopic Grid Technologies During Direct Anterior Total Hip Arthroplasty. J Arthroplasty 2020; 35:3601-3606. [PMID: 32680756 DOI: 10.1016/j.arth.2020.06.053] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Intraoperative fluoroscopy is beneficial when performing total hip arthroplasty (THA) via the direct anterior approach; however, image distortion may influence component placement. A manual gridding system (MGS) and a digital gridding system (DGS) are commercially available, aimed at visually representing or correcting image distortion. Therefore, the purpose of this study is to compare component placement accuracy following direct anterior approach THA when intraoperative fluoroscopy was supplemented with MGS or DGS. METHODS A retrospective evaluation of acetabular cup abduction (ABD), leg length discrepancy (LLD) and global hip offset difference (GHO) was completed for consecutive patients from 6 week post-THA weight-bearing radiographs. The predefined target LLD and GHO was <10 mm and ABD target was 45° ± 10°. Differences between MGS and DGS were determined by independent t-tests. RESULTS The MGS (250 patients, 315 hips) and DGS (183 patients, 218 hips) achieved targeted ABD in 98.7% and 96.8% of cases, respectively, and ABD was significantly lower in the MGS group (45.14 ± 4.03° and 47.01 ± 4.39°, respectively) (P < .001). Compared to MGS, the DGS group averaged significantly higher GHO (3.64 ± 2.44 and 4.45 ± 2.73 mm, respectively, P = .002) but was not significantly different regarding LLD (2.92 ± 2.55 and 3.19 ± 2.46 mm, respectively, P = .275). No significant group difference was noted for percentage within the targeted LLD and GHO; however, 93.5% of DGS and 97.6% of MGS achieved all three (P = .031). CONCLUSION The use of both the MGS and DGS resulted in consistent component placement within the predefined target zone. Although the MGS appeared to be slightly more consistent, these differences are unlikely to be clinically significant.
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Affiliation(s)
| | | | - Samantha N Andrews
- Bone and Joint Center, Straub Medical Center, Honolulu, HI; Department of Surgery, University of Hawai'i, Honolulu, HI
| | | | - Cass K Nakasone
- Bone and Joint Center, Straub Medical Center, Honolulu, HI; Department of Surgery, University of Hawai'i, Honolulu, HI
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10
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[Both measurement parameters are needed to assess cup orientation: cup inclination and cup anteversion]. DER ORTHOPADE 2020; 49:818-820. [PMID: 32757032 DOI: 10.1007/s00132-020-03960-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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Zhao JX, Su XY, Zhao Z, Xiao RX, Zhang LC, Tang PF. Radiographic assessment of the cup orientation after total hip arthroplasty: a literature review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:130. [PMID: 32175423 DOI: 10.21037/atm.2019.12.150] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Optimal acetabular cup orientation is of substantial importance to good long-term function and low complication rates after total hip arthroplasty (THA). The radiographic anteversion (RA) and inclination (RI) angles of the cup are typically studied due to the practicability, simplicity, and ease of interpretation of their measurements. A great number of methods have been developed to date, most of which have been performed on pelvic or hip anteroposterior radiographs. However, there are primarily two influencing factors for these methods: X-ray offset and pelvic rotation. In addition, there are three types of pelvic rotations about the transverse, longitudinal, and anteroposterior axes of the body. Their effects on the RA and RI angles of the cup are interactively correlated with the position and true orientation of the cup. To date, various fitted or analytical models have been established to disclose the correlations between the X-ray offset and pelvic rotation and the RA and RI angles of the cup. Most of these models do not incorporate all the potential influencing parameters. Advanced methods for performing X-ray offset and pelvic rotation corrections are mainly performed on a single pelvic AP radiograph, two synchronized radiographs, or a two-dimensional/three-dimensional (2D-3D) registration system. Some measurement systems, originally developed for evaluating implant migration or wear, could also be used for correcting the X-ray offset and pelvic rotation simultaneously, but some drawbacks still exist with these systems. Above all, the 2D-3D registration technique might be an alternative and powerful tool for accurately measuring cup orientation. In addition to the current methods used for postoperative assessment, navigation systems and augmented reality are also used for the preoperative planning and intraoperative guidance of cup placement. With the continuing development of artificial intelligence and machine learning, these techniques could be incorporated into robot-assisted orthopaedic surgery in the future.
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Affiliation(s)
- Jing-Xin Zhao
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Xiu-Yun Su
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,Intelligent and Digital Surgery Innovation Center, Southern University of Science and Technology Hospital, Shenzhen, Guangdong 518055, China
| | - Zhe Zhao
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Ruo-Xiu Xiao
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Li-Cheng Zhang
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
| | - Pei-Fu Tang
- Department of Orthopaedics, the First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing 100853, China
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12
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Schwarz TJ, Weber M, Renkawitz T, Greimel F, Leiss F, Grifka J, Schaumburger J. [Discrepancy between radiographic and true cup position after total hip arthroplasty : Are we interpreting our radiographic quality indicators correctly? Video article]. DER ORTHOPADE 2019; 49:226-229. [PMID: 31784797 DOI: 10.1007/s00132-019-03838-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND After total hip arthroplasty (THA), objective postoperative quality control is done via X‑rays by as component position assessment. The cup position is defined by its version and inclination. However, there is a discrepancy between radiographically measured and true (anatomic) cup position, which may lead to misinterpretation. METHODS To visualize the discrepancy between true and radiographically measured cup position, in this video, a cup holder was used to set the angular cup version and inclination. Hereby, the cup position (anteversion and inclination) can be characterized in its radiographic and anatomic definition in greater detail. The viewer of this video should receive an impression as to when radiographically measured cup angles must be considered with caution. RESULTS In a simultaneous X‑ray and image sequence, this video shows decreased radiographic inclination measurement with increasing anterior rotation of the cup exceeding 20° of anteversion, yet with unchanged true inclination on the cup holder. Isolated consideration of the radiographic angles of anteversion and inclination may cause misinterpretation of true cup position. In pectoral illustration we show that variations in cup version and inclination may remain undetected when considering isolated the radiographic cup parameters. CONCLUSION True cup position in its anatomical definition can be calculated from the radiographically measured position. For this purpose, both cup parameters (radiographic anteversion and radiographic inclination) have to be taken into account.
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Affiliation(s)
- T J Schwarz
- Klinik und Poliklinik für Orthopädie, Lehrstuhl für Orthopädie der Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - M Weber
- Klinik und Poliklinik für Orthopädie, Lehrstuhl für Orthopädie der Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - T Renkawitz
- Klinik und Poliklinik für Orthopädie, Lehrstuhl für Orthopädie der Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - F Greimel
- Klinik und Poliklinik für Orthopädie, Lehrstuhl für Orthopädie der Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - F Leiss
- Klinik und Poliklinik für Orthopädie, Lehrstuhl für Orthopädie der Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Klinik und Poliklinik für Orthopädie, Lehrstuhl für Orthopädie der Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - J Schaumburger
- Klinik und Poliklinik für Orthopädie, Lehrstuhl für Orthopädie der Universität Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
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13
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Rueckl K, Alcaide DJ, Springer B, Rueckl S, Kasparek MF, Boettner F. Intraoperative measurement of cup inclination using fluoroscopy requires a correction factor. Arch Orthop Trauma Surg 2019; 139:1511-1517. [PMID: 30937525 DOI: 10.1007/s00402-019-03168-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Malpositioning of the cup in total hip arthroplasty (THA) is associated with dislocation, early polyethylene wear, and impingement. The direct anterior approach (DAA) THA allows for intraoperative fluoroscopy imaging (IF). The current study investigates the following research hypotheses: (1) intraoperative measurements of radiographic cup inclination (RI) are reliable and reproducible. (2) A correction factor can compensate for the complex parallax effects when using IF. METHODS In 2016, 100 consecutive hips underwent primary THA utilizing DAA and IF for cup placement. RI was measured on intraoperative fluoroscopy images and postoperative AP pelvis radiographs. RESULTS Determination of RI on IF images is reliable and reproducible (ICC 0.851-0.950). RI measurement on IF images had a good correlation with the corresponding postoperative RI on AP pelvis radiographs (r = 0.538, p < 0.001). However, intraoperative RI measurements are on average 4.9° lower compared to postoperative measurements (SD 2.5°). CONCLUSION Intraoperative fluoroscopy is a reliable tool to measure RI during DAA THA. The surgeon needs to apply a 5°. correction factor to the intraoperative measurements to adjust for parallax.
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Affiliation(s)
- Kilian Rueckl
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Diego J Alcaide
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Bernhard Springer
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Stefan Rueckl
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Maximilian F Kasparek
- Department of Orthopaedics and Trauma Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Friedrich Boettner
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
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14
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Gebre RK, Hirvasniemi J, Lantto I, Saarakkala S, Leppilahti J, Jämsä T. Structural risk factors for low-energy acetabular fractures. Bone 2019; 127:334-342. [PMID: 31283995 DOI: 10.1016/j.bone.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/28/2019] [Accepted: 07/04/2019] [Indexed: 10/26/2022]
Abstract
In this study, we aimed to clarify proximal femur and acetabular structural risk factors associated with low-energy acetabular fractures in the elderly using three-dimensional (3D) computed tomography (CT). Pelvic bones and femurs were segmented and modeled in 3D from abdominopelvic CT images of 121 acetabular fracture patients (mean age 72 ± 12 years, range 50-98 years, 31 females and 90 males) and 121 age-gender matched controls with no fracture. A set of geometric parameters of the proximal femur and the acetabulum was measured. An independent-samples t-test or a Mann-Whitney U test was used for statistical analyses. The fractured side was used for proximal femur geometry, while the contralateral side was used for acetabular geometry. The neck shaft angle (NSA) was significantly smaller (mean 122.1° [95% CI 121.1°-123.2°] vs. 124.6° [123.6°-125.6°], p = 0.001) and the femoral neck axis length (FNALb) was significantly longer (78.1 mm [77.0-79.2 mm] vs. 76.0 mm [74.8-77.2 mm], p = 0.026) in the fracture group than in the controls when genders were combined. The NSA was significantly smaller both for females (120.2° [117.8°-122.6°] vs. 124.7° [122.5°-127.0°], p = 0.007) and for males (122.7° [121.5°-123.8°] vs. 124.6° [123.4°-125.7°], p = 0.006) in the fracture group. However, only males showed a significantly longer FNALb (80.0 mm [78.9-81.1 mm] vs. 77.8 mm [76.6-79.0 mm], p = 0.025). No statistically significant associations of acetabular geometry with fractures were found. However, the mean values of the acetabular angle of Sharp (34°), the lateral center-edge angle (40°), the anterior center-edge angle (62°), and the posterior center-edge angle (105°) indicated possible over-coverage. In conclusion, our findings suggest that proximal femur geometry is associated with low-energy acetabular fractures. Especially elderly subjects with an NSA smaller than normal have an increased risk of acetabular fractures.
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Affiliation(s)
- Robel K Gebre
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.
| | - Jukka Hirvasniemi
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Iikka Lantto
- Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Simo Saarakkala
- 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; Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Juhana Leppilahti
- Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Timo Jämsä
- 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; Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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15
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Murphy MP, Killen CJ, Ralles SJ, Brown NM, Hopkinson WJ, Wu K. A precise method for determining acetabular component anteversion after total hip arthroplasty. Bone Joint J 2019; 101-B:1042-1049. [PMID: 31474147 DOI: 10.1302/0301-620x.101b9.bjj-2019-0085.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Several radiological methods of measuring anteversion of the acetabular component after total hip arthroplasty (THA) have been described. These are limited by low reproducibility, are less accurate than CT 3D reconstruction, and are cumbersome to use. These methods also partly rely on the identification of obscured radiological borders of the component. We propose two novel methods, the Area and Orthogonal methods, which have been designed to maximize use of readily identifiable points while maintaining the same trigonometric principles. PATIENTS AND METHODS A retrospective study of plain radiographs was conducted on 160 hips of 141 patients who had undergone primary THA. We compared the reliability and accuracy of the Area and Orthogonal methods with two of the current leading methods: those of Widmer and Lewinnek, respectively. RESULTS The 160 anteroposterior pelvis films revealed that the proposed Area method was statistically different from those described by Widmer and Lewinnek (p < 0.001 and p = 0.004, respectively). They gave the highest inter- and intraobserver reliability (0.992 and 0.998, respectively), and took less time (27.50 seconds (sd 3.19); p < 0.001) to complete. In addition, 21 available CT 3D reconstructions revealed the Area method achieved the highest Pearson's correlation coefficient (r = 0.956; p < 0.001) and least statistical difference (p = 0.704) from CT with a mean within 1° of CT-3D reconstruction between ranges of 1° to 30° of measured radiological anteversion. CONCLUSION Our results support the proposed Area method to be the most reliable, accurate, and speedy. They did not support any statistical superiority of the proposed Orthogonal method to that of the Widmer or Lewinnek method. Cite this article: Bone Joint J 2019;101-B:1042-1049.
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Affiliation(s)
- Michael P Murphy
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA
| | - Cameron J Killen
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA
| | - Steven J Ralles
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA
| | - Nicholas M Brown
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA
| | - William J Hopkinson
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA
| | - Karen Wu
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA
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16
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Zhao JX, Su XY, Zhao Z, Xiao RX, Sun GF, Zhang LC, Tang PF. The synergetic effect of pelvic rotation and X-ray offset on radiographic angles of the acetabular cup. Med Biol Eng Comput 2019; 57:2359-2371. [PMID: 31502181 DOI: 10.1007/s11517-019-02041-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/24/2019] [Indexed: 01/08/2023]
Abstract
The objective of this study is to investigate the synergetic effect of the pelvic rotation and X-ray offset on the radiographic anteversion/inclination (RA/RI) angles of the acetabular cup using a mathematical model. A cone model for establishing the spatial relationship between a three-dimensional (3D) circle and its two-dimensional (2D) elliptical projection is utilized to quantify the relationship between the 3D RA/RI angles of the cup and their 2D counterparts with different types of pelvic rotations in pelvic/hip anteroposterior radiographs. The results reveal that the effect of inlet/outlet views on the 2D RA angle is similar to that of iliac/obturator views. The permissible ranges of pelvic rotation for the 2D RA angle with an acceptable bias are the 3D space formed by the limits of triple axial rotations. For a specified acceptable bias of the 2D RA angle, these ranges are almost equal between pelvic and hip radiographs. The combined inlet/obturator or outlet/iliac views can maintain the 2D RA angle of a pelvic radiograph within the same range of acceptable bias as that of a hip radiograph. For a 2D RA angle with an acceptable bias, the permissible range of pelvic rotation needs to be evaluated with equal attention in both radiographs. Graphical abstract The traditional methods for calculating the radiographic angles of the acetabular cup are based on the ellipse projection of the opening circle of the cup on radiographs. However, with varying locations of the X-ray source and pelvis rotations about different axes, the outline of this ellipse projection will change, and accordingly, the traditional method and calculating results will be inaccurate. In this study, a cone model for three-dimensional circle-to-two-dimensional ellipse projection is utilized to incorporate the effect of X-ray offset and quantify the relationships of the radiographic angles of the cup with the true orientation of the cup and pelvic rotations in either pelvic or hip anteroposterior radiographic situation.
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Affiliation(s)
- Jing-Xin Zhao
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiu-Yun Su
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhe Zhao
- Department of Orthopaedics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Ruo-Xiu Xiao
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Guo-Fei Sun
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Li-Cheng Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Pei-Fu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China.
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17
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Schwarz T, Benditz A, Springorum HR, Matussek J, Heers G, Weber M, Renkawitz T, Grifka J, Craiovan B. Assessment of pelvic tilt in anteroposterior radiographs by means of tilt ratios. Arch Orthop Trauma Surg 2018; 138:1045-1052. [PMID: 29651575 DOI: 10.1007/s00402-018-2931-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In anteposterior (AP) radiographs, cup position in total hip arthroplasty and acetabular anatomy in hip-preserving surgery are highly influenced by pelvic tilt. The sagittal rotation of the anterior pelvic plane is an important measurement of pelvic tilt during hip surgery. Thus, correct evaluation of cup position and acetabular parameters requires the assessment of pelvic tilt in AP radiographs. METHODS Changes in pelvic tilt inversely change the height of the lesser pelvis and the obturator foramen in AP radiographs. Tilt ratios were calculated by means of these two parameters in simulated radiographs for ten male and ten female pelvises in defined tilt positions. A tilt formula obtained by exponential regression analysis was evaluated by two blinded investigators by means of 14 simulated AP radiographs of the pelvis with pelvic tilts ranging from + 15° to - 15°. RESULTS No differences were found between male and female tilt ratios for each 5° step of simulated pelvic tilt. Pelvic tilt and tilt ratios correlated exponentially. Using the tilt formula, the two blinded investigators were able to assess pelvic tilt with high conformity, a mean relative error of + 0.4° (SD ± 4.6°), and a mean absolute error of 3.9° (SD ± 2.3°). Neutral pelvic tilt is indicated by a tilt ratio of 0.5 when the height of the lesser pelvis is twice the height of the obturator foramen. CONCLUSION The analysis and interpretation of cup position and acetabular parameters may be improved by our method for assessing pelvic tilt in AP radiographs.
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Affiliation(s)
- T Schwarz
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany.
| | - A Benditz
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - H-R Springorum
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - J Matussek
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - G Heers
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - M Weber
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - T Renkawitz
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - J Grifka
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - B Craiovan
- Department of Orthopedic Surgery, University Medical Center Regensburg, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
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18
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Zhao JX, Su XY, Zhao Z, Xiao RX, Zhang LC, Tang PF. Three-dimensional orientation and location-dependent varying rules of radiographic angles of the acetabular cup. INTERNATIONAL ORTHOPAEDICS 2018; 42:1819-1825. [PMID: 29453586 DOI: 10.1007/s00264-018-3809-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 01/23/2018] [Indexed: 10/18/2022]
Abstract
AIM The aim of this study is to demonstrate the varying rules of radiographic angles following varying three-dimensional (3D) orientations and locations of cup using an accurate mathematical model. METHODS A cone model is established to address the quantitative relationship between the opening circle of cup and its ellipse projection on radiograph. The varying rules of two-dimensional (2D) radiographic anteversion (RA) and inclination (RI) angles can be analyzed. RESULTS When the centre of cup is located above X-ray source, with proper 3D RI/RA angles, 2D RA angle can be equal to its 3D counterpart, and 2D RI angle is usually greater than its 3D counterpart. Except for the original point on hip-centered anterior-posterior radiograph, there is no area on radiograph where both 2D RA and RI angles are equal to their 3D counterparts simultaneously. DISCUSSION This study proposes an innovative model for accurately explaining how 2D RA/RI angles of cup are varying following different 3D RA/RI angles and location of cup. The analysis results provide clinicians an intuitive grasp of knowledge about 2D RA/RI angles greater or smaller than their 3D counterparts post-operatively. The established model may allow determining the effects of pelvic rotations on 2D radiographic angles of cup.
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Affiliation(s)
- Jing-Xin Zhao
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiu-Yun Su
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhe Zhao
- Department of Orthopaedics, Beijing Tsinghua Chang Gung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Ruo-Xiu Xiao
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, 100083, China
| | - Li-Cheng Zhang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Pei-Fu Tang
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, China.
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