Can the use of an inclinometer improve acetabular cup inclination in total hip arthroplasty? A review of the literature

Duren, Bernard H van; Royeca, Joseph M; Cunningham, Conor M.; Lamb, Jonathan; Brew, Chris J.; Pandit, Hemant

doi:10.1177/1120700020946716

Cited by 11 publications

(20 citation statements)

References 60 publications

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“…Beacuse the relation between the RI and operative inclination (OI) is determined by the cosine of the operative anteversion and when operating in the lateral decubitus position the operated hemipelvis is commonly adducted and internally rotated, surgeons should aim for an angle of 30–35° of the cup introducer relative to the floor ( 20 , 76 ). Overall, the use of an inclinometer resulted in a mean radiographic inclination angle closer to the target angle with less variation and outliers when compared with freehand and mechanical alignment techniques ( 81 ).…”

Section: Cup Orientationmentioning

confidence: 98%

Cup placement in primary total hip arthroplasty: how to get it right without navigation or robotics

et al. 2022

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Acetabular component orientation and position are important factors in the short- and long-term outcomes of total hip arthroplasty. Different definitions of inclination and anteversion are used in the orthopaedic literature and surgeons should be aware of these differences and understand their relationships. There is no universal safe zone. Preoperative planning should be used to determine the optimum position and orientation of the cup and assess spinopelvic characteristics to adjust cup orientation accordingly. A peripheral reaming technique leads to a more accurate restoration of the centre of rotation with less variability compared with a standard reaming technique. Several intraoperative landmarks can be used to control the version of the cup, the most commonly used and studied is the transverse acetabular ligament. The use of an inclinometer reduces the variability associated with the use of freehand or mechanical alignment guides.

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Section: Cup Orientationmentioning

confidence: 98%

Cup placement in primary total hip arthroplasty: how to get it right without navigation or robotics

et al. 2022

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“…Optimal cup orientation within the safe zone relies on the surgeon's performance. However, accurate cup orientation is not always accomplished by experienced surgeons (2,12,21,22). In the present study, the surgeon had about nineteen years of experience in THA and encountered 17 of 73 outline cups.…”

Section: Discussionmentioning

confidence: 88%

“…Although surgeons attempt to accomplish accurate component position during the procedure, obtaining the targeted cup orientation remains a significant challenge for surgeons who have found high variability in the angle of acetabular cup radiographic inclination and anteversion (2). The inclination angle of the acetabular component may be related to implant failure due to suboptimal implant positioning and impingement, especially in the posterior approach that may lead to the increased risk of dislocation (31,32).…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have found that BMI had a significant impact on the optimal cup position, whereas some have reported no significant impact (23,24,35). Therefore, accurate placement of the acetabular cup is a crucial factor in preventing postoperative complications following THA, which is still difficult to accomplish the ideally intended component positioning owing to the difficulty in verifying the position during the procedure (2,21,22,33). These difficulties experienced during THA positioned using the posterolateral approach arose from the short distal portion of the skin incision in the current study.…”

Section: Discussionmentioning

confidence: 99%

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The length of distal skin incision of the postero-lateral approach affects the cup inclination during the total hip arthroplasty

Çataltepe

2022

Journal of Health Sciences and Medicine

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Aim: The primary aim of the study was to determine whether the length of the distal skin incision of the posterolateral approach affects the cup inclination during total hip arthroplasty (THA). Material and Method: In this study, a cohort of 71 consecutive patients who performed between January 2017 and December 2021 with unilateral THA using a posterolateral approach was retrospectively assessed. Two groups were formed according to acetabular cup inclination with normal anteversion angle. There were 56 hips in the inside group and 17 in the outside group. A curvilinear skin incision of around 13 cm was performed. Component position evaluation was carried out through a radiographic assessment of the acetabular component on an anteroposterior pelvis radiograph. The rate of an outlier was compared between groups according to the safe zone defined as 30° to 50° of inclination and 5° to 25° of anteversion, which was described by Lewinnek et al. Results: No significant difference in the average total incision length was found between the two groups (p=0.207). While the average distal incision length was 7.91±0.62 cm (range, 6.8-9 cm) in the inside group and 6.37±0.21 cm (range, 6-6.7 cm) in the outside group. According to ROC analysis, a patient with ≤6.7 cm of the distal length of incision (DLI) was 5.71 times more likely to be outside than a patient with >6.7 cm of DLI. Seventeen hips (23.3%) were found outside the safe range. Substantial differences were observed regarding radiographic cup inclination between the two groups (p=0.0001). In the inside group, the average cup inclination was 44.11°±3.44° (range, 37°-50°), whereas, in the outside group, it was 55.41°±2.5° (range, 52°-59°). However, there were no significant differences in the average radiographic cup anteversion between the two groups (p=0.960). Although 11 of 17 (64.5%) patients were classified as obese (BMI ≥30) in the outside group experienced higher rates of inaccurate cup orientation, logistic regression analysis showed that the individual effects of obesity on the occurrence of the inaccurate cup position were not observed (p=0.884). One posterior hip dislocation occurred after one month postoperative in the outside group. Conclusions: Longer distal portion of the skin incision of the posterolateral approach should be performed to achieve optimal operative inclination angles of the acetabular cup during THA. The surgeon must have no hesitation in extending the distal skin incision when adopting the posterolateral approach.

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“…To aid surgeons, the use of mechanical aids has been advocated. However, these aids vary by implant and may lead to high inclination values [11]. As such many have advocated the use of an inclinometer to better quantify intra-operative inclination and improve radiographic cup inclinations [7,12,13].…”

Section: Introductionmentioning

confidence: 99%

Cup orientation following posterior approach THA – the effect of different visual aids and pelvic supports

Innmann

Verhaegen

Merle

et al. 2022

BMC Musculoskelet Disord

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Introduction This study aims to compare cup inclination achieved (1) Using two orientation guides, whilst using the same 3-point pelvic positioner and (2) Using two types of pelvic positioners, whilst measuring intra-operative cup inclination with an inclinometer. Materials and methods This is a prospective, diagnostic cohort study of a consecutive series of 150 THAs performed through a posterior approach. Two types of 3-point pelvic positioners were used (Stulberg and modified Capello Hip Positioners) and the cup was positioned freehand using one of two orientation guides (mechanical guide or digital inclinometer). Intra-operative inclination was recorded, radiographic cup inclination and anteversion were measured from radiographs. The differences in inclination due to pelvic position (ΔPelvicPosition) and orientation definitions (ΔDefinition) were calculated. Target radiographic inclination and anteversion was 40/20° ± 10°. Results There was no difference in radiographic cup inclination/ (p = 0.63) using a mechanical guide or digital inclinometer. However, differences were seen in ΔPelvicPosition between the positioners ((Stulberg: 0° ± 5 vs. Capello: 3° ± 6); p = 0.011). Intra-operative inclination at implantation was different between positioners and this led to equivalent cases within inclination/anteversion targets (Stulberg:84%, Capello:80%; p = 0.48). Conclusions With the pelvis securely positioned with 3-point supports, optimum cup orientation can be achieved with both alignment guides and inclinometer. Non-optimal cup inclinations were seen when intra-operative inclinations were above 40° and below 32°, or the ΔPelvicPosition was excessive (> 15°; n = 2). We would thus recommend that the intra-operative cup inclination should be centered strictly between 30° and 35° relative to the floor. Small differences exist between different type of pelvic positioners that surgeons need to be aware off and account for.

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Can the use of an inclinometer improve acetabular cup inclination in total hip arthroplasty? A review of the literature

Cited by 11 publications

References 60 publications

Cup placement in primary total hip arthroplasty: how to get it right without navigation or robotics

Cup placement in primary total hip arthroplasty: how to get it right without navigation or robotics

The length of distal skin incision of the postero-lateral approach affects the cup inclination during the total hip arthroplasty

Cup orientation following posterior approach THA – the effect of different visual aids and pelvic supports

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