Surgeon Estimations of Acetabular Cup Orientation Using Intraoperative Fluoroscopic Imagining Are Unreliable

Brush, Parker; Santana, Adrian; Toci, Gregory R.; Slotkin, Eric M.; Solomon, Michael; Jones, Tristan; Saxena, Arjun

doi:10.1016/j.artd.2023.101109

Cited by 5 publications

(4 citation statements)

References 42 publications

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“…The study protocol was approved by the Ethics Committee of the First Affiliated Hospital of Nanchang University, and all methods were performed in accordance with relevant guidelines and regulations, with written informed consent obtained from all participants. Exclusion criteria comprised: (1) patients undergoing hip revision surgery; (2) patients with ankylosing spondylitis; (3) patients who had undergone lumbosacral fusion; (4) patients with a severe spinal degenerative disease or pelvic tilt; (5) patients with congenital hip dysplasia (Crowe III-IV type); (6) patients with a history of a hip joint infection or osteotomy on the affected side; (7) patients with residual internal fixation in the hip joint and the acetabular prosthesis not clearly displayed on a CT scan; (8) patients with incomplete clinical data.…”

Section: Patient Recruitmentmentioning

confidence: 99%

Reliability and accuracy of intraoperative fluoroscopy assessment of acetabular cup anteversion in supine direct anterior approach total hip arthroplasty

Li,

Huang,

Zou

et al. 2024

Sci Rep

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Poor implantation positioning of hip prostheses is considered the primary factor affecting postoperative joint wear. Cup anteversion in direct anterior approach (DAA) total hip arthroplasty (THA) is often excessive. Intraoperative fluoroscopy (IF) are effective for improving implant placement accuracy. This study aimed to analyze IF’s reliability and accuracy in assessing intraoperative anteversion. Sixty-two consecutive hips underwent primary THA utilizing DAA alongside IF for cup placement. Intraoperative anteversion was measured using IF images, while postoperative CT and standard anteroposterior (AP) radiographs were used to calculate true anteversion component angles. Differences and correlations between intraoperative and true anteversions were analyzed, and intraclass correlation coefficients (ICC) determined the inter- and intra-observer reliabilities. Excellent intra- and inter-observer reliabilities were observed for all radiographic and CT methods (ICC > 0.9). Strong correlations (PCC > 0.6) existed between anteversion measured on IF image and postoperative CT and AP pelvic measurements. Intraoperative anteversion measured on IF images (16.8 ± 3.2°) was smaller than anteversion measured postoperatively on AP X-rays (21.3 ± 4.7°, P < 0.001) and CT (22.0 ± 4.9°, P < 0.001), with average differences of 4.5°and 5.3°, respectively. Under several influencing factors, the accuracy of IF in assessing cup anteversion in DAA-THA may be limited. However, this still requires large-sample experiments for verification.

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Section: Patient Recruitmentmentioning

confidence: 99%

Reliability and accuracy of intraoperative fluoroscopy assessment of acetabular cup anteversion in supine direct anterior approach total hip arthroplasty

Li,

Huang,

Zou

et al. 2024

Sci Rep

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“…Manual instrumentation of the acetabular component does not reliably enable such accurate positioning by the surgeon 25 ) . Some surgeons elect to use fluoroscopy for cup positioning; however, a lack of reliability for adjusting anteversion has been demonstrated 9 ) . In addition to restoring length and offset, some surgeons have considered the use of other techniques in the effort to improve stability, such as high offset stems or dual mobility bearings that allow for use of a head with a larger diameter 12 ) .…”

Section: Clinical Implications Of Spinopelvic Parametersmentioning

confidence: 99%

“…Different methods, including fluoroscopy and navigation, have been utilized intraoperatively to confirm implant position. Despite these efforts, anteversion of the acetabular component cannot be reliably reproduced with use of fluoroscopy 9 ) . In addition, Abdel et al 10 ) previously reported that the majority of unstable hips had components located within the Lewinnek safe zones.…”

Section: Introductionmentioning

confidence: 99%

Robotic-assisted Total Hip Arthroplasty and Spinopelvic Parameters: A Review

Rice,

D’Abarno,

Luu

2024

Hip & Pelvis

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“…9 However, cup anteversion and inclination cannot be reliably measured with fluoroscopy alone. 10,11 Fluoroscopy is susceptible to the limitations of 2-dimensional imaging, including parallax and distortion, which can result in misleading information. 12 In addition, fluoroscopy has not been demonstrated to be superior to nonfluoroscopic methods of assessing LLD.…”

mentioning

confidence: 99%

Fluoroscopy Versus Imageless Optical Navigation in Direct Anterior Approach Total Hip Arthroplasty

Manzo,

Lex,

Rodriguez-Elizalde

et al. 2023

J Am Acad Orthop Surg

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Background: Utilization of the direct anterior approach (DAA) for total hip arthroplasty (THA) has risen in popularity. Accurate implant placement is a critical factor that influences patient outcomes. The goal of this study was to compare the accuracy and precision of fluoroscopy with imageless optical navigation in DAA THA. Methods: This was a cohort study of 640 consecutive primary DAA THAs performed with intraoperative fluoroscopy (n = 300 patients) or imageless optical navigation (n = 304 patients). Accuracy was compared by measuring acetabular cup inclination, anteversion, and leg-length discrepancy (LLD). The proportion of implants placed within the Lewinnek safe zone and those placed within a more precise target of 40 ± 5° inclination and 20 ± 5° anteversion was evaluated. Results: According to the Lewinnek criteria, there was no difference in the percentage of implants placed within both inclination and anteversion targets (fluoroscopy: 90.3%; navigation: 88.8%, P = 0.519). Using the more precise targets, navigation increased the implants positioned correctly for both inclination and anteversion (fluoroscopy: 50.3%; navigation: 65.6%, P < 0.001). Navigation increased the proportion of implants positioned within the target anteversion zone (fluoroscopy: 71.3%; navigation: 83.8%, P < 0.001) but not inclination (fluoroscopy: 71.9%; navigation: 76.9%, P = 0.147). The mean LLD was higher with the use of fluoroscopy compared with navigation (5.5 mm, standard deviation: 4.1; 4.6 mm, SD: 3.4, P < 0.005). No difference in dislocation rate was observed (P = 0.643). Conclusion: Both fluoroscopy and imageless optical navigation demonstrated accurate acetabular implant positioning during DAA THA. Navigation was more precise and associated with improved acetabular anteversion placement and restoration of LLD. Navigation is an accurate alternative to fluoroscopy with decreased radiation exposure.

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Surgeon Estimations of Acetabular Cup Orientation Using Intraoperative Fluoroscopic Imagining Are Unreliable

Cited by 5 publications

References 42 publications

Reliability and accuracy of intraoperative fluoroscopy assessment of acetabular cup anteversion in supine direct anterior approach total hip arthroplasty

Reliability and accuracy of intraoperative fluoroscopy assessment of acetabular cup anteversion in supine direct anterior approach total hip arthroplasty

Robotic-assisted Total Hip Arthroplasty and Spinopelvic Parameters: A Review

Fluoroscopy Versus Imageless Optical Navigation in Direct Anterior Approach Total Hip Arthroplasty

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