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Kurmis AP, Lourens EC. Quantifying anterior pelvic roll during total hip arthroplasty in the lateral decubitus position. J Orthop Surg Res 2023; 18:863. [PMID: 37957756 PMCID: PMC10644623 DOI: 10.1186/s13018-023-04350-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/29/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Unintended pelvic positional change is an acknowledged intra-operative problem for hip arthroplasty, seen commonly with procedures performed in the lateral position. If unrecognised, such changes can dramatically alter final acetabular component anteversion potentially resulting in suboptimal construct performance. It has previously been suggested that pelvic roll of just 13° may be enough to place an otherwise perfectly orientated cup outside of conventional ± 10° safe zones. Using the real-time tracking capacity of a commercially available optical navigation system, we aimed to accurately quantify pelvic roll occurring during total hip arthroplasties (THAs) performed in the decubitus position. METHODS Prospectively collected data for 107 consecutive, unilateral, THAs were interrogated to determine the magnitude of pelvic movement around a central longitudinal axis (i.e. AP roll). Correlation statistics with patient age and body mass index (BMI) were also calculated. RESULTS A mean pelvic roll of 9.5° was observed, being anterior in 96% of cases. Of these, 18.3% of hips had a magnitude of roll greater than 13°. There were no statistically significant independent correlations observed between age (p = 0.87) or BMI (p = 0.59) and mean roll. CONCLUSIONS Errors in achieving acetabular target version may result in numerous post-operative concerns including instability/dislocation, bearing wear, squeaking, range-of-movement limitation and increased revision rate. In a general cohort, our findings suggest a mean anterior pelvic roll during THA of nearly 10°. Without purposeful correction, this may cause substantial deviation from intended target positions. Future work is indicated to map changing pelvic roll during THA which is likely to follow a nonlinear trajectory. Level of evidence: IV. .
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Affiliation(s)
- Andrew P Kurmis
- Discipline of Medical Specialties, University of Adelaide, Adelaide, SA, Australia.
- Department of Orthopaedic Surgery, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA, 5112, Australia.
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
| | - Ernest C Lourens
- Department of Orthopaedic Surgery, Lyell McEwin Hospital, Haydown Road, Elizabeth Vale, SA, 5112, Australia
- Department of Orthopaedic Surgery, Mount Gambier Hospital, Mount Gambier, SA, Australia
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Jia CQ, Wu YJ, Cao SQ, Hu FQ, Zheng ZR, Xu C, Zhang XS. Mid-term low back pain improvement after total hip arthroplasty in 306 patients with developmental dysplasia of the hip. J Orthop Surg Res 2023; 18:212. [PMID: 36932447 PMCID: PMC10022041 DOI: 10.1186/s13018-023-03701-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 03/12/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Low back pain (LBP) from hip and spinal disorders has been one of the main reasons for visiting physicians in patients with developmental dysplasia of the hip (DDH). It is essential to identify the LBP improvement among all grades of DDH patients treated with total hip arthroplasty (THA) at 5-year follow-up. METHODS The study included 407 hips of 306 patients (38 males, 268 females) who underwent THA between July 2007 and December 2016. There were 65 hips in Crowe I, 61 hips in Crowe II, 69 hips in Crowe III, and 212 hips in Crowe IV. One hundred and fourteen hips received subtrochanteric shortening. Patients included 101 bilateral THA (BTHA) and 205 unilateral THA (UTHA). The evaluation was performed through Back Pain Function Scale (BPFS), Harris hip score, Visual Analogue Scale (VAS), operative data and radiographic examinations. RESULTS The BPFS in patients of unilateral Crowe III and IV relieved significantly more (p < 0.05). However, the BPFS in patients with bilateral symmetry DDH hips relieved significantly less than other groups of DDH hips (p < 0.05). Harris in hips of Crowe II improved significantly more (p < 0.05). The VAS in hips of Crowe II and III improved significantly more (p < 0.05). The unilateral THA surgical time, blood loss, blood transfusion, and osteotomy number and length in Crowe IV were significantly more (p < 0.05). CONCLUSION THA is reliable to relieve LBP in DDH patients of unilateral Crowe III and IV; however, in patients with unilateral Crowe I, Crowe II, and bilateral DDH hips, the LBP improvements were limited. This should assist shared decision-making between orthopedic surgeons and patients. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Cheng-Qi Jia
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
- grid.488137.10000 0001 2267 2324Medical School of Chinese PLA, Beijing, China
- grid.414360.40000 0004 0605 7104Present Address: Department of Orthopedics, Beijing Jishuitan Hospital, Beijing, 100035 China
| | - Yu-Jie Wu
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
- Department of Nursing, The Third People’s Hospital of Datong, Datong, Shanxi China
- grid.414360.40000 0004 0605 7104Present Address: Department of Orthopedics, Beijing Jishuitan Hospital, Beijing, 100035 China
| | - Shi-Qi Cao
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
- grid.414252.40000 0004 1761 8894Department of Orthopedics of TCM Clinical Unit, 6th Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fan-Qi Hu
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Zhi-Rong Zheng
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Chi Xu
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
| | - Xue-Song Zhang
- grid.414252.40000 0004 1761 8894Department of Orthopedics, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853 China
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Wojcik JJ, Lyons ST. Digital Radiography During Total Hip Arthroplasty: Early Results With a Combined Anteversion Technique. Orthopedics 2022; 45:221-226. [PMID: 35245135 DOI: 10.3928/01477447-20220225-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ideal component positioning is critical to outcomes in total hip arthroplasty. We describe our early results using digital radiographs with a combined ante-version technique. We report the incidence of component adjustments made based on digital radiographs and show how this technology can be used during patient positioning to achieve appropriate starting pelvic alignment. We reviewed 176 cases of primary total hip arthroplasty performed by a single arthroplasty surgeon using a posterior approach. Mean follow-up was 1 year (range, 3 months to 2.7 years). Digital radiographs (Surgeon's Checklist Hip; Radlink) and a combined anteversion technique were used for component positioning. For a subset of 100 patients, we recorded the incidence of pelvic mal-positioning found on digital radiographs obtained during initial positioning of the patient. For this same subset we also detail the component changes made as a result of intraoperative radiographs during trialing. Among 176 cases we have had 2 (1.1%) postoperative dislocations. Both underwent closed reduction with no further dislocation. We have had no revisions and 1 intraoperative calcar fracture. For our 100-case subset, digital radiographs during patient positioning identified pelvic malpositioning greater than 5° (coronal or axial plane) among 17% of cases. During trialing, we made component adjustments 71% of the time because of findings on intraoperative imaging. Digital radiography can be a valuable tool for component positioning during total hip arthroplasty. We experienced favorable early outcomes and show the utility of digital radiographs for proper pelvic positioning and making intraoperative adjustments to achieve optimal component placement. [Orthopedics. 2022;45(4):221-226.].
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Wilson JM, Schwartz AM, Farley KX, Anastasio AT, Bradbury TL, Guild GN. Postoperative acetabular component position in revision hip arthroplasty: a comparison of the anterior and posterior approaches. Hip Int 2022; 32:466-474. [PMID: 32678714 DOI: 10.1177/1120700020942451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND While previously considered unsuitable for revision total hip arthroplasty (rTHA), the direct anterior approach (DAA) can be extended to allow for safe acetabular component revision. In primary hip arthroplasty, the DAA and its associated fluoroscopy, has been shown to produce more acceptable component positioning. However, there is little data comparing the DAA to the posterior approach (PA) for rTHA. We hypothesised that, the DAA with intraoperative fluoroscopy would allow for more precise acetabular component positioning when compared to those performed using a PA. METHODS 50 consecutive patients (25 DAA and 25 PA) undergoing rTHA were included. Radiographic analysis of postoperative acetabular component position was then performed. Univariate and multivariate analyses was performed to assess the contribution of approach on cup positioning inside classically defined "safe zones". RESULTS Baseline patient characteristics were similar. The PA was associated with more cups placed outside the Lewinnek (48% vs. 12%, p = 0.005) and the Danoff (52% vs. 28%, p = 0.083) "safe zones" when compared to the DAA. Multivariate analysis revealed that operative approach was the only patient or surgical factor associated with component position outside of the "safe zones" (Lewinnek [OR = 13.6; 95% CI, 2.12-87.9, p = 0.006] and Danoff [OR = 7.7; 95% CI, 1.48-40.1, p = 0.015]). CONCLUSION Our results suggest that the DAA allows for more reproducible and precise cup placement in RTHA. The safe-zone paradigm remains a useful index of accurate cup positioning and the DAA, with use of intraoperative fluoroscopy, offers more consistent acetabular component positioning when compared to the PA.
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Affiliation(s)
- Jacob M Wilson
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Andrew M Schwartz
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Kevin X Farley
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | | | - Thomas L Bradbury
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - George N Guild
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
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Hoehmann CL, DiVella M, Osborn NS, Giordano J, Fogel J, Taylor BC, Galos DK. Excessively long interfragmentary screws for posterior wall acetabular fractures can predict intra-articular penetration. Orthop Traumatol Surg Res 2022; 108:103202. [PMID: 35041993 DOI: 10.1016/j.otsr.2022.103202] [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: 04/03/2021] [Revised: 08/10/2021] [Accepted: 09/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The fixation of posterior wall acetabular fractures often utilizes interfragmentary screws with varying length. Intricate pelvic anatomy and overhanging greater trochanter make obtaining proper screw trajectory difficult. A large measurement may represent aberrant trajectory and breach of the articular surface. This study aims to identify a preferred maximum screw length that avoids intra-articular penetration. HYPOTHESIS We hypothesized that a screw measured 40 millimeters or longer has a high likelihood of being intra-articular. PATIENTS AND METHODS A retrospective review included CT scans of 151 consecutive patients collected at a level-1 trauma center was analyzed by two observers. On axial imaging, a straight line was measured at the largest extraarticular portion of the posterior wall simulating ideal screw placement. Another line was measured tangent to the articular surface simulating longest possible extraarticular screw. Measurements were taken at 2-millimeter increments. RESULTS The intra-class correlation coefficient between both observers was excellent (0.75-1.00) for most recorded values. The maximum mean length for straight line measured (m=32.18mm, SD=3.74) which was smaller than the mean length for tangent line (m=38.44, SD=4.29). Exploratory multivariate logistic regression analyses demonstrated increased height, age, and acetabular version were associated with larger measurements greater than 40mm (p<0.05). DISCUSSION This study demonstrates that most acetabular posterior walls cannot accommodate a 40 millimeter lag screw. If the measured drill hole is greater than this length, then careful reconsideration of the screw trajectory is warranted to ensure the screw is not intra-articular. Older and taller patients may be able to accommodate longer screws. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Christopher L Hoehmann
- Nassau University Medical Center, Department of Orthopaedic Surgery, East Meadow, NY, USA
| | - Michael DiVella
- Nassau University Medical Center, Department of Orthopaedic Surgery, East Meadow, NY, USA
| | - Nathan S Osborn
- Nassau University Medical Center, Department of Orthopaedic Surgery, East Meadow, NY, USA
| | - Joshua Giordano
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Joshua Fogel
- Nassau University Medical Center, Department of Orthopaedic Surgery, East Meadow, NY, USA; Brooklyn College, Department of Business Management, Brooklyn, NY, USA
| | - Benjamin C Taylor
- Orthopaedic Trauma and Reconstructive Surgeons 285 E State St. Suite 500, Columbus OH, 43215, USA
| | - David K Galos
- Nassau University Medical Center, Department of Orthopaedic Surgery, East Meadow, NY, USA.
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Does accelerometer-based portable navigation provide more accurate and precise cup orientation without prosthetic impingement than conventional total hip arthroplasty? A randomized controlled study. Int J Comput Assist Radiol Surg 2022; 17:1007-1015. [DOI: 10.1007/s11548-022-02592-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/04/2022] [Indexed: 11/05/2022]
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Siebenmorgen JP, Stronach BM, Mears SC, Stambough JB. The Use of Intraoperative Digital Radiography Alignment Software to Assess Implant Placement in Total Hip Arthroplasty. Curr Rev Musculoskelet Med 2021; 14:369-377. [PMID: 34694562 DOI: 10.1007/s12178-021-09722-7] [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] [Accepted: 09/17/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Total hip arthroplasty (THA) is a highly successful surgery with growing rates of utilization in the USA, but surgical outliers leading to postoperative complications remain a concern. There is need for a standard system of accurate, predictable intraoperative evaluation to decrease component positioning outliers. Many current intraoperative imaging systems have shown promise, but there are drawbacks that have led to slow adoption. Digital radiography, in conjunction with Radlink™ technology, is a potential solution to this problem. This review summarizes the clinical application and scientific literature regarding the use of Radlink™ in THA. RECENT FINDINGS Traditional surgeon-directed component placement can result in surgical outliers. This is especially true not only among low-volume arthroplasty surgeons, but can also occur with experienced, high-volume surgeons. Digital radiography allows for more precise and accurate placement of the acetabular cup in a targeted range in an effort to improve THA outcomes. Intraoperative images are obtained quickly, and they are accurate when compared to postoperative images. Additionally, the use of Radlink™ results in a significant decrease in leg length and femoral offset outliers. The adoption of Radlink™ technology in THA can significantly decrease surgical outliers, especially errors in acetabular cup placement, leg length, and femoral offset. Digital radiography avoids many of the previous aversions to intraoperative imaging as it produces a fast, reliable image with little radiation exposure and minimal interruption to workflow. There is the potential for Radlink™ use to provide superior patient outcomes, as a decrease in surgical outliers can minimize implant malpositioning with resultant need for revision THAs. Radlink™ may also provide benefit in analyzing other parameters, such as component sizing.
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Affiliation(s)
- Jacob P Siebenmorgen
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 531, Little Rock, AR, 72205, USA
| | - Benjamin M Stronach
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 531, Little Rock, AR, 72205, USA
| | - Simon C Mears
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 531, Little Rock, AR, 72205, USA
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 531, Little Rock, AR, 72205, USA.
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Tetsunaga T, Yamada K, Tetsunaga T, Furumatsu T, Sanki T, Kawamura Y, Ozaki T. Comparison of the accuracy of CT- and accelerometer-based navigation systems for cup orientation in total hip arthroplasty. Hip Int 2021; 31:603-608. [PMID: 32019376 DOI: 10.1177/1120700020904940] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The accuracies of various navigation systems in total hip arthroplasty (THA) have been described; however, the accuracy of cup orientation with an accelerometer-based navigation system has not been reported. The purpose of this study was to compare the accuracies of computed tomography (CT)- and accelerometer-based navigation systems for cup orientation in THA. METHODS In this prospective study, 30 patients who underwent cementless THA via anterolateral approach in the lateral decubitus position were analysed. A CT-based navigation system (30 hips) and an accelerometer-based navigation system (30 hips) were used simultaneously. The accuracy of cup orientation (absolute difference between intraoperative vs. postoperative measurements) was compared between the navigation systems using postoperative CT. RESULTS The accuracy of cup inclination was 3.2 ± 2.4° in the CT-based navigation group and 4.1 ± 3.7° in the accelerometer-based navigation group (p = 0.3035). The accuracy of cup anteversion was 3.0° ± 2.5° in the CT-based navigation group and 6.8° ± 4.8° in the accelerometer-based navigation group. Cup anteversion was significantly more accurate with the CT-based navigation system than with accelerometer-based navigation (p = 0.0009). Multiple regression analysis demonstrated that the malposition in cup anteversion was positively correlated with the change in pelvic tilt and loosening of the reference antenna. CONCLUSIONS Although, these results are only true for this specific accelerometer system, cup positioning was significantly more accurate with the CT-based navigation system than an accelerometer-based navigation in the lateral decubitus position. This is because of considerable discrepancies in the sagittal pelvic tilt, resulting in variability in cup anteversion angle with the use of an accelerometer-based navigation system.
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Affiliation(s)
| | - Kazuki Yamada
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
| | - Tomoko Tetsunaga
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
| | | | - Tomoaki Sanki
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
| | - Yoshi Kawamura
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Orthopaedics, Okayama University Hospital, Okayama, Japan
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Braswell MJ, Fehring KA, Barry JJ, Patel SP, Martin J Ryan J, Curtin BM, Fehring TK. Radiologist Overreads of Intraoperative Radiographs-Value or Waste? J Arthroplasty 2021; 36:830-832. [PMID: 33051120 DOI: 10.1016/j.arth.2020.09.013] [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: 07/09/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND All aspects of the arthroplasty pathway must be scrutinized to maximize value and eliminate unnecessary cost. Radiology providers' contracts with hospitals often call for readings of all radiographs. This policy has little effect on patient care when intraoperative radiographs are taken and used to make real-time decisions. In order to determine the value of radiologist overreads, we asked 3 questions: what was the delay between the time an intraoperative radiograph was taken and time the report was generated, were the overreads accurate, and what is the associated cost? METHODS Two hundred hip and knee radiograph reports generated over 6 months during 391 cases were reviewed. The time the report was dictated was compared to the time taken and time of surgery completion. To determine accuracy, each overread was rated as accurate or inaccurate. The cost of the overread was determined by multiplying the number of radiographs times the radiology fee less the technical fee. RESULTS Median delay between taking the radiograph and filing the report was 45 minutes (range, 0-9778 minutes). Only 31.5% were filed before completion of the procedure. And 18.0% (36/200) were considered inaccurate despite lenient criteria. The reading fee for hip radiographs was $52.00, and for knee radiographs was $38.00, representing a total cost of $10,182 in our select series. This cost projects to $43,614 annually at our facility. CONCLUSION Radiology overreads of intraoperative radiographs have no effect on real-time decision-making. In the era of value-based care, payors should stop paying for overreads and reimburse providers who actually read the films intraoperatively.
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Affiliation(s)
- Matthew J Braswell
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC
| | - Keith A Fehring
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC
| | - Jeff J Barry
- Hip & Knee Center, OrthoCarolina, Charlotte, NC; University of California at San Francisco Department of Orthopaedic Surgery, San Francisco, CA
| | - Shaun P Patel
- Hip & Knee Center, OrthoCarolina, Charlotte, NC; Adult Hip & Knee Reconstruction, Department of Orthopedic SurgeryKaiser Permanente - Orange County, Irvine, CA
| | | | | | - Thomas K Fehring
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC; Hip & Knee Center, OrthoCarolina, Charlotte, NC
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Deep K, Prabhakara A, Mohan D, Mahajan V, Sameer M. Orientation of Transverse Acetabular Ligament With Reference to Anterior Pelvic Plane. Arthroplast Today 2021; 7:1-6. [PMID: 33521189 PMCID: PMC7818603 DOI: 10.1016/j.artd.2020.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/22/2020] [Accepted: 11/22/2020] [Indexed: 11/21/2022] Open
Abstract
Background Transverse acetabular ligament (TAL) is a 3-dimensional structure which cannot be defined by a single plane. Therefore, we aimed at describing the orientation of different parts of TAL with respect to anterior pelvic plane (APP) and correlate it with gender, body mass index (BMI), and Lewinnek’s safe zone. Methods A total of 109 consecutive patients undergoing imageless navigated THA were prospectively studied. Computer navigation was used as the measurement tool. APP was registered for navigation. After excision of osteophytes, a trial component matching the size of unreamed acetabular cavity was aligned with acetabular rim, outer and inner margins, and middle of TAL to record cup orientation with computer tracker. Results Ninety-nine patients (41 males and 58 females, mean BMI of 28.8kg/m2) were studied after applying exclusion criteria. Mean acetabular inclination was 55.15°, 53.00°, 47.70°, and 42.60° respectively, for acetabular rim, outer, middle, and inner margins of the TAL. Corresponding mean acetabular anteversion was 6.63°, 7.41°, 11.23° and 14.90°respectively. Overall, 17.17%, 28.28%, 47.47% and 71.71% of cup orientation corresponding to acetabular rim, outer, middle, and inner margin of TAL respectively, were within Lewinnek’s safe zone. No association was established between BMI and acetabular orientation. Males had overall lesser anteversion than females. Conclusion We describe orientation of outer, middle, and inner margins of TAL, as reference planes for TAL, in relation to APP. The anteversion differs significantly with gender. A knowledge about these will assist surgeon in component placement during THA, with inner margin of TAL providing the best chance of orientation out of the studied landmarks.
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Affiliation(s)
- Kamal Deep
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Glasgow, UK
| | - Anjan Prabhakara
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Glasgow, UK
- Corresponding author. Golden Jubilee National Hospital, Agamemnon Street, G81 4DY, Glasgow, UK. Tel.: +44 7311195584.
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vivek Mahajan
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Glasgow, UK
| | - Mohamed Sameer
- Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, Glasgow, UK
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Reichert B. Bestimmung einer Beckenasymmetrie – Sinn oder Unsinn. MANUELLE MEDIZIN 2021. [DOI: 10.1007/s00337-020-00703-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ZusammenfassungPathologien des tiefen Rückens, der Becken- sowie Knie- und Hüftgelenke werden immer wieder mit einer Messung der Beinlänge und Feststellung einer Beckenasymmetrie in Verbindung gebracht. Aufgrund dieser Messungen werden therapeutische Wege eingeschlagen. Zu diesem Thema wurden auf der Basis einer systematischen Literatursuche in zwei maßgeblichen Datenbanken 28 Artikel ermittelt. Die inhaltliche Analyse beschäftigt sich v. a. mit der Variationsanatomie des Beckens sowie der Reliabilität palpatorischer und apparativer Bestimmungen von knöchernen Referenzpunkten am Becken. Hieraus ergeben sich maßgebliche Erkenntnisse: Eine Variationsanatomie des Beckens ist häufig und kommt auch bei nichtsymptomatischen Personen vor. Die palpatorische und apparative Bestimmungen der knöchernen Referenzpunkte sind gering bis moderat reliabel. Der Rückschluss von einer festgestellten Beckenasymmetrie auf den Einfluss bestehender oder noch zu erwartender Rücken‑, Hüft- oder Beckengelenkbeschwerden ist nach derzeitiger Studienlage zumindest umstritten und daher nicht empfehlenswert.
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Comparison of component positioning in robot-assisted and conventional total hip arthroplasty. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.656702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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