Research Synthesis of Recommended Acetabular Cup Orientations for Total Hip Arthroplasty

Harrison, Claire L.; Thomson, Avril; Cutts, Steven; Rowe, Peter; Riches, Philip

doi:10.1016/j.arth.2013.06.026

Cited by 50 publications

(38 citation statements)

References 23 publications

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“…The effect of cup angle on the likelihood of dislocation has been reported by Lewinnek et al and Harrison et al [6,7]. Placing the cup too vertically, or too anteverted or retroverted reduces the distance that the femoral head has to go to dislocate [6][7][8][9]. Lewinnek established the "safe zones" for cup placement to minimize dislocation risk as 30-50 degrees of abduction and 5-25 degrees of anteversion [7].…”

mentioning

confidence: 93%

Comparison of Cup Alignment, Jump Distance, and Complications in Consecutive Series of Anterior Approach and Posterior Approach Total Hip Arthroplasty

Hamilton

Parks

Huynh

2015

The Journal of Arthroplasty

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mentioning

confidence: 93%

Comparison of Cup Alignment, Jump Distance, and Complications in Consecutive Series of Anterior Approach and Posterior Approach Total Hip Arthroplasty

Hamilton

Parks

Huynh

2015

The Journal of Arthroplasty

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“…The positioning of implants, restoration of joint biomechanics, and appropriate soft tissue preservation and tensioning are known to play a role in obtaining a stable THA [13,15,16]. In addition, head size, cup diameter, and the surgical approach itself may influence hip stability [16,17,34].…”

Section: Introductionmentioning

confidence: 99%

What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position

Abdel

Roth

Jennings

et al. 2016

Clinical Orthopaedics &Amp; Related Research

500

301

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Background Numerous factors influence total hip arthroplasty (THA) stability including surgical approach and soft tissue tension, patient compliance, and component position. One long-held tenet regarding component position is that cup inclination and anteversion of 40°± 10°a nd 15°± 10°, respectively, represent a ''safe zone'' as defined by Lewinnek that minimizes dislocation after primary THA; however, it is clear that components positioned in this zone can and do dislocate. Questions/purposes We sought to determine if these classic radiographic targets for cup inclination and anteversion accurately predicted a safe zone limiting dislocation in a contemporary THA practice.Methods From a cohort of 9784 primary THAs performed between 2003 and 2012 at one institution, we retrospectively identified 206 THAs (2%) that subsequently dislocated. Radiographic parameters including inclination, anteversion, center of rotation, and limb length discrepancy were analyzed. Mean followup was 27 months (range, 0-133 months). Results The majority (58% [120 of 206]) of dislocated THAs had a socket within the Lewinnek safe zone. Mean cup inclination was 44°± 8°with 84% within the safe zone for inclination. Mean anteversion was 15°± 9°with 69% within the safe zone for anteversion. Sixty-five percent of dislocated THAs that were performed through a posterior approach had an acetabular component within the combined acetabular safe zones, whereas this was true for only 33% performed through an anterolateral approach. An acetabular component performed through a posterior approach was three times as likely to be within the combined acetabular safe zones (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.6) than after an anterolateral approach (OR, 0.4; 95% CI, 0.2-0.7; p \ 0.0001). In contrast, acetabular components performed through a posterior approach (OR, 1.6; 95% CI, 1.2-1.9) had an increased risk of dislocation compared with those performed through an anterolateral approach (OR, 0.8; 95% CI, 0.7-0.

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“…11 To achieve interference rim fit in reamed acetabulum, we positioned the inferior edge of the cup at the level of the bottom of teardrop line together with cup constraining in both anterior and posterior columns in the transverse plane.…”

Section: Methodsmentioning

confidence: 99%

Possible Vascular Injury Due to Screw Eccentricity in Minimally Invasive Total Hip Arthroplasty

Singh

Kumar

Rastogi

2017

IJOO

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Background:Vascular injury during minimally invasive total hip arthroplasty (THA) is uncommon, yet a well-recognized and serious issue. It emerges because of non-visibility of vascular structures proximal to the pelvic bone during reaming, drilling holes, and fixing of screws. Numerous studies have found that screw fixation during cementless THA is beneficial for the initial stability of cup; yet, no anatomical guidelines support angular eccentric screw fixation.Materials and Methods:In this study, we obtained the pelvic arterial-phase computed tomographic data of thirty eight humans and reconstructed the three-dimensional models of osseous and vessel structures. We performed the surgical simulation to fix these structures with cementless cups and screws with angular eccentricities.Results:The effect of screw eccentricities (angular eccentricities of ±17° and ±34°) on the vascular injury was determined. Measurement between screw and adjoining vessels was performed and analyzed statistically to ascertain a comparative risk study for blood vessels that are not visible during surgery.Conclusion:Authors similarly discussed the significant absence of appreciation of quadrant systems proposed by Wasielewski et al. on eccentric screws. Adjustment of quadrant systems provided by Wasielewski et al. is required for acetabular implants with eccentric holes for fixation of acetabular screws.

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Research Synthesis of Recommended Acetabular Cup Orientations for Total Hip Arthroplasty

Cited by 50 publications

References 23 publications

Comparison of Cup Alignment, Jump Distance, and Complications in Consecutive Series of Anterior Approach and Posterior Approach Total Hip Arthroplasty

Comparison of Cup Alignment, Jump Distance, and Complications in Consecutive Series of Anterior Approach and Posterior Approach Total Hip Arthroplasty

What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position

Possible Vascular Injury Due to Screw Eccentricity in Minimally Invasive Total Hip Arthroplasty

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