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Zhang H, Zhou J, Ling X, Chen H, Du M, Zhao J. Determining the orientation of acetabular prosthesis in total hip arthroplasty by refering to the anatomical landmarker of acetabular notches. Sci Rep 2023; 13:6185. [PMID: 37061581 PMCID: PMC10105719 DOI: 10.1038/s41598-023-33501-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/13/2023] [Indexed: 04/17/2023] Open
Abstract
The aim of this study was to explore a novel method to determine the orientation of acetabular prosthesis in total hip arthroplasty (THA) by refering to the anatomical landmarker of acetabular notches. Forty-one normal developmental hips were included in the present study. The acetabulums were reamed according to standard surgical procedures of THA on life-size 3D printing pelvis models. The inferior edge of acetabular cup were placed (1-5) mm proximal and distal to the proximal line of the anterior and posterior acetabular notches (PLAPAN) respectively to determine cup inclination. The inferior edge of acetabular cup were placed (1-5) mm pronating and supinating around the proximal point of acetabular posterior notch (PPAPN) respectively to determine cup anteversion. The pelvis plain radiographs were took and the inclination and anteversion of the acetabular cup at 22 positions were calculated. In the normal developmental hip, the mean inclination of acetabular prothesis were (35.10 ± 3.22)° and (45.90 ± 2.68)° when the inferior edge of the acetabular cup was 3 mm proximal and 1 mm distal to the PLAPAN. The optimal cup inclination could be obtained when the inferior edge of the acetabular cup was 1 mm proximal to the PLAPAN (the mean inclination was (40.71 ± 2.80)°). The mean anteversion of acetabular prothesis were (10.67 ± 4.55)° and (20.86 ± 4.44)° when the inferior edge of the acetabular cup was 1 mm pronating and 1 mm supinating around the PPAPN. The optimal cup anteversion could be obtained when the inferior edge of the acetabular cup was parallel to the PLAPAN (the mean anteversion was (18.00 ± 1.64)°). The inclination and anteversion of acetabular prosthesis could be determined by refering the anatomical landmarks of acetabular notches, which could help orthopedists to install the acetabular prosthesis quickly and safely in THA.
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Affiliation(s)
- Heng Zhang
- Department of Orthopedics, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, Jiangsu, China.
- Laboratory of Tissue and Transplant in Anhui Province, Department of Orthopedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu Medical College, Bengbu, Anhui, China.
| | - Jiansheng Zhou
- Laboratory of Tissue and Transplant in Anhui Province, Department of Orthopedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu Medical College, Bengbu, Anhui, China
| | - Xiao Ling
- Clinical Medical School, Bengbu Medical College, Bengbu, China
| | - Haonan Chen
- Medical Imaging School, Bengbu Medical College, Bengbu, China
| | - Mingqiu Du
- Clinical Medical School, Bengbu Medical College, Bengbu, China
| | - Jianning Zhao
- Department of Orthopedics, School of Medicine, Jinling Hospital, Nanjing University, Nanjing, Jiangsu, China.
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Gheewala RA, Young JR, Villacres Mori B, Lakra A, DiCaprio MR. Perioperative management of leg-length discrepancy in total hip arthroplasty: a review. Arch Orthop Trauma Surg 2023:10.1007/s00402-022-04759-w. [PMID: 36629905 DOI: 10.1007/s00402-022-04759-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023]
Abstract
Leg-length discrepancy (LLD) presents a significant management challenge to orthopedic surgeons and remains a leading cause of patient dissatisfaction and litigation after total hip arthroplasty (THA). Over or under-lengthening of the operative extremity has been shown to have inferior outcomes, such as dislocation, exacerbation of back pain and sciatica, and general dissatisfaction postoperatively. The management of LLD in the setting of THA is multifactorial, and must be taken into consideration in the pre-operative, intra-operative, and post-operative settings. In our review, we aim to summarize the best available practices and techniques for minimizing LLD through each of these phases of care. Pre-operatively, we provide an overview of the appropriate radiographic studies to be obtained and their interpretation, as well as considerations to be made when templating. Intra-operatively, we discuss several techniques for the assessment of limb length in real time, and post-operatively, we discuss both operative and non-operative management of LLD. By providing a summary of the best available practices and strategies for mitigating the impact of a perceived LLD in the setting of THA, we hope to maximize the potential for an excellent surgical and clinical outcome.
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Affiliation(s)
- Rohan A Gheewala
- Department of Orthopedic Surgery, Albany Medical Center, 43 New Scotland Ave, MC-184, Albany, NY, 12208, USA.
| | - Joseph R Young
- Department of Orthopedic Surgery, Albany Medical Center, 43 New Scotland Ave, MC-184, Albany, NY, 12208, USA
| | - Benjamin Villacres Mori
- Department of Orthopedic Surgery, Albany Medical Center, 43 New Scotland Ave, MC-184, Albany, NY, 12208, USA
| | - Akshay Lakra
- Department of Orthopedic Surgery, Albany Medical Center, 43 New Scotland Ave, MC-184, Albany, NY, 12208, USA
| | - Matthew R DiCaprio
- Department of Orthopedic Surgery, Albany Medical Center, 43 New Scotland Ave, MC-184, Albany, NY, 12208, USA
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Yeh KL, Wu TY, Fuh CS, Chen CS, Hou SM, Chiang CH, Liaw CK. Degree of Pelvic Rotation in the Coronal Plane on Postoperative Radiographs Obtained after Total Hip Arthroplasty. J Clin Med 2022; 11:jcm11216353. [PMID: 36362581 PMCID: PMC9656062 DOI: 10.3390/jcm11216353] [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: 07/31/2022] [Revised: 10/11/2022] [Accepted: 10/25/2022] [Indexed: 11/21/2022] Open
Abstract
There are many published cup anteversion measurements for postoperative total hip arthroplasty (THA), including Liaw’s, Lewinnek’s, and Murray’s methods. However, most measurements ignore the potential pelvic rotation on radiographs except in Liaw’s method. Without considering pelvic rotation, clinicians can miscalculate cup anteversion. Therefore, we aimed to quantify the mean degree of pelvic rotation. Herein, we collected 388 radiographs of 98 postoperative THA hips of 77 patients and measured pelvic rotation by measuring h, the horizontal displacement of the sacrococcygeal junction associated with the upper pole of the symphysis pubis, and ssd, the distance between the sacrococcygeal junction and pubic symphysis. The angle θ of pelvic rotation was defined as θ = arc sin (h/ssd) × (180°/π). The mean degree of pelvic rotation was then calculated. The standard deviation of h was 7.84 mm, and the mean ssd was 158 mm. The potential pelvic rotation was 2.50°. The p-values from the paired t-test were all >0.05 when interobserver and intraobserver errors were assessed. This is the first study to quantify the potential pelvic rotation in the coronal plane on postoperative plain radiographs. The potential pelvic rotation was too large to be neglected during the measurement of cup anteversion.
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Affiliation(s)
- Kuei-Lin Yeh
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600, Taiwan
- Institute of Computer Science and Information Engineering, National Taiwan University, Taipei City 106, Taiwan
- Department of Long-Term Care and Management, Wu Feng University, Chiayi County 621303, Taiwan
| | - Tai-Yin Wu
- Department of Family Medicine, Zhongxing Branch, Taipei City Hospital, Taipei City 103, Taiwan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei City 100, Taiwan
- General Education Center, University of Taipei, Taipei City 100, Taiwan
| | - Chiou-Shann Fuh
- Institute of Computer Science and Information Engineering, National Taiwan University, Taipei City 106, Taiwan
| | - Chu-Song Chen
- Institute of Computer Science and Information Engineering, National Taiwan University, Taipei City 106, Taiwan
| | - Sheng-Mou Hou
- Department of Orthopaedics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City 111, Taiwan
| | - Chen-Hao Chiang
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 600, Taiwan
| | - Chen-Kun Liaw
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235, Taiwan
- Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering, Research Center of Biomedical Device, Taipei Medical University, Taipei City 113, Taiwan
- TMU Biodesign Center, Taipei Medical University, Taipei City 11031, Taiwan
- Correspondence: ; Tel.: +886-938308072
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Dion CA, Schmidt-Braekling T, Falsetto A, Kreviazuk C, Beaulé PE, Grammatopoulos G. Does Surgical Approach Influence the Natural History of the Unstable Total Hip Arthroplasty? J Arthroplasty 2022; 37:787-794. [PMID: 34923093 DOI: 10.1016/j.arth.2021.12.012] [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: 08/03/2021] [Revised: 11/19/2021] [Accepted: 12/10/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Dislocation following total hip arthroplasty (THA) is a significant complication that occurs in 0.3%-10% of cases with 13%-42% of patients requiring revision surgery. The literature has primarily focused on the dislocation risk associated with different surgical approaches. However, little is known about the natural history of the dislocated hip and whether surgical approach of the index THA is associated with further instability and revision surgery. METHODS This is a retrospective, single-center, multi-surgeon consecutive case series of all patients who experienced THA dislocation from 2002 to 2020. Patients were excluded if the initial dislocation was secondary to infection or fracture. The natural history of the cohort as per approach was determined. Outcome measurements of interest were the number of dislocations; the treatment surrounding each dislocation; the necessity and type of revision; and the complications encountered. RESULTS Of the 75 patients, 58 (77%) dislocated within 6 months following primary THA. The anterior group had greater odds of dislocation within 2 weeks post-THA compared to the lateral and posterior groups (P = .04). The mean number of dislocations per patient was significantly lower in the anterior (1.5 ± 0.7) compared to the lateral (2.4 ± 1.2) and posterior (2.1 ± 1.0) groups (P = .02). Revision surgery was needed in 30% (6/20) of patients in the anterior, 69% (25/36) of the posterior, and 68% (13/19) of the lateral groups (P = .01). CONCLUSION This study illustrates that while primary THA dislocations happen earlier with the anterior approach, they are typically less complicated and have a lower risk of recurrent instability and revision surgery.
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Affiliation(s)
- Charles-Antoine Dion
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Tom Schmidt-Braekling
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amedeo Falsetto
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Cheryl Kreviazuk
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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