Photographic measurement of the inclination of the acetabular component in total hip replacement using the posterior approach

Hill, Janet; Gibson, Desmond; Pagoti, R.; Beverland, David

doi:10.1302/0301-620x.92b9.24476

Cited by 29 publications

(33 citation statements)

References 22 publications

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“…Any undetected pelvic movement, particularly about the antero-posterior axis will affect the angle achieved using the new device (23). This movement may be due to rotation about the lumbar spine whilst lying in lateral decubitus as suggested in previous work from this unit (21). Di Gioia et al measured a range of pelvic movements in the lateral decubitus position intra-operatively.…”

Section: Discussionmentioning

confidence: 98%

“…The surgeon must be aware that operative is not the same as radiographic inclination. Hill et al (21) found, on average, radiographic inclination was 13° greater than operative inclination in the lateral decubitus position and advised surgeons to chose a maximum of 35° of operative inclination to avoid excessive radiographic inclination. This study aimed to minimise inter and intra-user variability when positioning the acetabular cup during THA with a low cost technique that did not add to the overall procedure time or increase the complexity of implantation but that also allowed the surgeon to chose and record what angle of inclination was selected.…”

Section: Discussionmentioning

confidence: 99%

“…The MAG also incurred more error but did not differ significantly from the CTI at 45° (P>0.05), an expected result since this is what the MAG is designed to achieve. The issue with MAGs is that historically jigs were designed to provide 45° of operative inclination which if achieved in lateral decubitus will place the majority of cups beyond 55° of radiographic inclination, outside the traditional safe zone (21). Even if a MAG was designed to achieve a lower operative inclination, they are inflexible, not allowing any deviation from the specified angle, a problem if the surgeon decides that an individual patient's anatomy requires a different cup angle.…”

Section: Discussionmentioning

confidence: 99%

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A Novel Device to Measure Acetabular Inclination with Patients in Lateral Decubitus

et al. 2012

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The ability to measure acetabular cup orientation accurately during total hip arthroplasty represents a significant challenge. The aim of this research was to develop and evaluate a novel low cost mechanical device for measuring operative acetabular inclination. Cup implantation was simulated in two trials using the novel device: firstly involving surgeons and engineers orientating acetabular cups with sawbone pelves at a range of inclination angles (20°-55° in 5° increments); secondly in a simulated intra-operative scenario with surgeons. Target angles were compared with achieved angles and deviations from desired angles were recorded. In addition, all participants orientated cups under the same conditions using two other techniques: freehand and with a propriatory Mechanical Alignment Guide. In the first trial, the mean errors (deviations) using freehand technique, the mechanical alignment guide and the new device were 5.2° +/- 4.3° (range 0.1-22.0), 3.6° +/- 3.9° (range 0.1°-33.6°) and 0.5° +/- 0.4° (range 0.0-1.9) respectively. In the second trial, the mean error for freehand technique, mechanical alignment guide and the new device were 6.2° +/- 4.2° (range 0.2-18.2), 3.8° +/- 3.3° (range 0.0-19.1) and 0.6° +/- 0.5° (range 0.0-1.8) respectively. The new device has the potential to allow the surgeon to choose and record operative inclination accurately during total hip arthroplasty in the lateral decubitus position.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Novel Device to Measure Acetabular Inclination with Patients in Lateral Decubitus

et al. 2012

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“…31,32 Further, variability of patient positioning in the lateral decubitus restricts correct identification of the coronal plane. Supine patient positioning for THR with a stable pelvic position and the coronal plane positioned parallel to the operating table and the floor reduces these problems.…”

Section: Discussionmentioning

confidence: 99%

Functional acetabular component position with supine total hip replacement

Eilander

Harris

Henkus

et al. 2013

The Bone & Joint Journal

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Orientation of the acetabular component influences wear, range of movement and the incidence of dislocation after total hip replacement (THR). During surgery, such orientation is often referenced to the anterior pelvic plane (APP), but APP inclination relative to the coronal plane (pelvic tilt) varies substantially between individuals. In contrast, the change in pelvic tilt from supine to standing (dPT) is small for nearly all individuals. Therefore, in THR performed with the patient supine and the patient's coronal plane parallel to the operating table, we propose that freehand placement of the acetabular component placement is reliable and reflects standing (functional) cup position. We examined this hypothesis in 56 hips in 56 patients (19 men) with a mean age of 61 years (29 to 80) using three-dimensional CT pelvic reconstructions and standing lateral pelvic radiographs. We found a low variability of acetabular component placement, with 46 implants (82%) placed within a combined range of 30° to 50° inclination and 5° to 25° anteversion. Changing from the supine to the standing position (analysed in 47 patients) was associated with an anteversion change < 10° in 45 patients (96%). dPT was < 10° in 41 patients (87%). In conclusion, supine THR appears to provide reliable freehand acetabular component placement. In most patients a small reclination of the pelvis going from supine to standing causes a small increase in anteversion of the acetabular component.

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“…Hill et al 71. reported a 12.7° variation between implanted inclination angle and final position on radiographs despite careful implantation.…”

Section: How To Achieve Target Angular Positionmentioning

confidence: 99%

Current Concepts in Acetabular Positioning in Total Hip Arthroplasty

Bhaskar

Rajpura

Board

2017

IJOO

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Being one of the most successful surgeries in the history of medicine, the indications for total hip arthroplasty have widened and are increasingly being offered to younger and fitter patients. This has also led to high expectations for longevity and outcomes. Acetabular cup position has a significant impact on the results of hip arthroplasty as it affects dislocation, abductor muscle strength, gait, limb lengths, impingement, noise generation, range of motion (ROM), wear, loosening, and cup failure. The variables in cup position are depth, height, and angular position (anteversion and inclination). The implications of change in depth of center of rotation (COR) are medialized versus anatomical positioning. As opposed to traditional medialization with beneficial effects on joint reaction force, the advantages of an anatomical position are increasingly recognized. The maintained acetabular offset offers advantages in terms of ROM, impingement, cortical rim press fit, and maintaining medial bone stock. The height of COR influences muscle activity and limb lengths and available bone stock for cup support. On the other hand, ideal angular position remains a matter of much debate and reliably achieving a target angular position remains elusive. This is not helped by variations in the way we describe angular position, with operative, radiologic, or anatomic definitions being used variably to describe anteversion and inclination. Furthermore, pelvic tilt plays a major role in functional positions of the acetabulum. In addition, commonly used techniques of positioning often do not inform us of the real orientation of the pelvis on operating table, with possibility of significant adduction, flexion, and external rotation of the pelvis being possibilities. This review article brings together the evidence on cup positioning and aims to provide a systematic and pragmatic approach in achieving the best position in individual cases.

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Photographic measurement of the inclination of the acetabular component in total hip replacement using the posterior approach

Cited by 29 publications

References 22 publications

A Novel Device to Measure Acetabular Inclination with Patients in Lateral Decubitus

A Novel Device to Measure Acetabular Inclination with Patients in Lateral Decubitus

Functional acetabular component position with supine total hip replacement

Current Concepts in Acetabular Positioning in Total Hip Arthroplasty

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