Anatomic Referencing of Cup Orientation in Total Hip Arthroplasty

Tannast, Moritz; Langlotz, Ulrich; Siebenrock, Klaus A.; Wiese, M.; Bernsmann, K.; Langlotz, Frank

doi:10.1097/01.blo.0000157657.22894.29

Cited by 154 publications

(99 citation statements)

References 30 publications

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“…The pelvis was then virtually rotated in 3°increments from À24°to 24°of pelvic tilt and from À12°to 12°of pelvic rotation. These ranges for tilt and rotation were chosen to cover the maximum deviations that had been detected in both the clinical series of this study (Table 1) and the literature [2,13,17]. The calculated values for each of the evaluated 11 radiographic hip parameters were compared between nine positions of pelvic rotation and 17 positions of pelvic tilt.…”

Section: Methodsmentioning

confidence: 99%

Which Radiographic Hip Parameters Do Not Have to Be Corrected for Pelvic Rotation and Tilt?

Tannast

Fritsch

Zheng

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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129

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Background Acetabular anatomy on AP pelvic radiographs depends on pelvic orientation during radiograph acquisition. However, not all parameters may change to a clinically relevant degree with differences in pelvic orientation. This issue may influence the diagnosis of acetabular pathologies and planning of corrective acetabular surgery (reorientation or rim trimming). However, to this point, it has not been well characterized. Questions/purposes We asked (1) which radiographic parameters change in a clinical setting when normalized to neutral pelvic orientation; (2) which parameters do not change in an experimental setting when the pelvis is experimentally rotated/tilted; and (3) which of these changes are ''ultimately'' relevant based on a prespecified definition of relevance. Methods In a clinical setup, 11 hip parameters were evaluated in 101 patients (126 hips) by two observers and the interobserver difference was calculated. All parameters were normalized to an anatomically defined neutral pelvic orientation with the help of a lateral pelvic radiograph and specific software. Differences between nonnormalized and normalized values were calculated (effect of normalization). In an experimental setup involving 20 cadaver pelves (40 hips), the maximum range for each parameter was computed with the pelvis rotated (range, À12°to 12°) and tilted (range, À24°to 24°). ''Ultimately'' relevant changes existed if the effect of normalization exceeded the interobserver difference (eg, 37% versus 6% for prevalence of a positive crossover sign) and/or the maximum experimental range exceeded 1 SD of interobserver difference (eg, 27% versus 6% for anterior acetabular coverage). Results In the clinical setup, all parameters except the ACM angle and craniocaudal acetabular coverage changed when being normalized, eg, effect of normalization for lateral center-edge angle, acetabular index, and sharp angle ranged from À5°to 4°(p values \ 0.029). In the experimental setup, five parameters showed no major changes, whereas six parameters did change (all p values \ 0.001). Ultimately relevant changes were found for anteroposterior acetabular coverage, retroversion index, and prevalence of a positive crossover or posterior wall sign. Conclusions Lateral center-edge angle, ACM angle, Sharp angle, acetabular and extrusion index, and craniocaudal acetabular coverage showed no relevant changes with varying pelvic orientation and can therefore be acquired independent from individual pelvic tilt and

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Section: Methodsmentioning

confidence: 99%

Which Radiographic Hip Parameters Do Not Have to Be Corrected for Pelvic Rotation and Tilt?

Tannast

Fritsch

Zheng

et al. 2015

Clinical Orthopaedics &Amp; Related Research

Self Cite

129

112

View full text Add to dashboard Cite

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“…We used a pelvic and a femoral coordinate system to define the neutral orientation of the hip. The pelvic coordinate system was the anterior pelvic plane, which was defined by the anterosuperior iliac spines and the pubic tubercles [29]. The femoral coordinate system was defined by the center of the femoral head, the knee center, and both femoral condyles.…”

Section: Methodsmentioning

confidence: 99%

LCPD: Reduced Range of Motion Resulting From Extra- and Intraarticular Impingement

Tannast

Hanke

Ecker

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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104

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Background Legg-Calvé-Perthes disease (LCPD) often results in a deformity that can be considered as a complex form of femoroacetabular impingement (FAI). Improved preoperative characterization of the FAI problem based on a noninvasive three-dimensional computer analysis may help to plan the appropriate operative treatment. Questions/purposes We asked whether the location of impingement zones, the presence of additional extraarticular impingement, and the resulting ROM differ between hips with LCPD and normal hips or hips with FAI. Methods We used a CT-based virtual dynamic motion analysis based on a motion algorithm to simulate the individual motion for 13 hips with LCPD, 22 hips with FAI, and 27 normal hips. We then determined the motion and impingement pattern of each hip for the anterior (flexion, adduction, internal rotation) and the posterior impingement tests (extension, adduction, external rotation). Results The location of impingement zones in hips with LCPD differed compared with the FAI/normal groups. Intra-and extraarticular impingement was more frequent in LCPD (79% and 86%, respectively) compared with normal (15%, 15%) and FAI hips (36%, 14%). Hips with LCPD had decreased amplitude for all hip motions (flexion, extension, abduction, adduction, internal and external rotation) compared with FAI or normal. Conclusions Hips with LCPD show a decreased ROM as a result of a higher prevalence of intra-and extraarticular FAI. Noninvasive assessment of impingement characteristics in hips with LCPD may be helpful in the future for establishment of a surgical plan.

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“…2C) [22]. Anatomic references for the calculation of the amplitude of hip motion were the anterior pelvic plane for the pelvis [5,23] and the axis through the hip and knee center for the femur [17]. Based on the motion pattern of conventional manual examination (impingement test [8,9]), we evaluated the hips in 5°i ncrements between 70°and 110°of flexion and in 10°i ncrements between -20°to 20°of adduction.…”

Section: Methodsmentioning

confidence: 99%