The John Charnley Award: Risk Factors for Cup Malpositioning: Quality Improvement Through a Joint Registry at a Tertiary Hospital

Callanan, Mark C.; Jarrett, Bryan; Bragdon, Charles R.; Zurakowski, David; Rubash, Harry E.; Freiberg, Andrew A.; Malchau, Henrik

doi:10.1007/s11999-010-1487-1

Cited by 500 publications

(459 citation statements)

References 48 publications

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“…This is consistent with a recent report in the literature that shows a much higher variability in cup position than previously reported [5]. Two patients required early revision in our series and one patient sustained an intraoperative fracture.…”

Section: Discussionsupporting

confidence: 93%

Minimally Invasive Total Hip Arthroplasty Using a Transpiriformis Approach: A Preliminary Report

Roger

Hill

2012

Clinical Orthopaedics &Amp; Related Research

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Background Continuing efforts have been made to develop minimally invasive surgery techniques for THA. One of the most commonly performed of these techniques is the mini-posterior approach. All reported series using this approach describe surgical detachment of the short external rotators of the hip. In 2008, Penenberg et al. described an innovative surgical technique that preserves the short external rotators. We present the results of a singleincision modification of this technique in 135 patients. Description of TechniqueThis technique is based on preservation of all of the short external rotators of the hip with the exception of the piriformis or conjoined tendon. This single-incision technique required the development of specialized instrumentation for exposure and reaming of the acetabulum. The specialized retractors also successfully minimized trauma to the skin and subcutaneous tissue. Methods For the 135 patients undergoing THA with this technique, we analyzed demographic and operative data. We recorded complications, evaluated postoperative clinical function using the Harris hip score, and assessed cup abduction angle, cup anteversion, and stem alignment on radiographs. Minimum followup was 14 months (mean, 22 months; range, 14-33 months). Results There were no dislocations, no sciatic nerve palsies, no wound complications, and low transfusion rates (8%). The postoperative Harris hip score averaged 96.5 (range, 87-100). Overall acetabular cup abduction angle averaged 41°(range, 21°-49°) and anteversion averaged 21°(range, 15°-27°). Four percent and 2% of femoral components were inserted into more than 2°varus and 2°v algus alignment, respectively.

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Section: Discussionsupporting

confidence: 93%

Minimally Invasive Total Hip Arthroplasty Using a Transpiriformis Approach: A Preliminary Report

Roger

Hill

2012

Clinical Orthopaedics &Amp; Related Research

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“…A reduced risk of dislocation with increased risk of aseptic revision was observed in the anterolateral transgluteal approach as compared with the posterior approach with a specific implant type [32]. The authors attributed this to possible acetabular cup malpositioning (inclination angle of greater than 50°), which was more common with the anterolateral approach [9].…”

Section: Discussionmentioning

confidence: 99%

“…29 (6) 29 (6) 30 (6) 290 (6) 28 (5) 29 (6) Number ( 8002 (19) 758 (18) 77 (12) 6438 (20) 63 (3) 666 (17) \ 0.001 32 14,418 (34) 1485 (35) 201 (30) 11,034 (35) 423 (23) 1275 (32) 36 15,441 (36) 1502 (36) 264 (40) 11,119 (35) 1166 (63) 1390 (35) [ 36 3882 (9) 412 (10) 112 (17) 2678 (8) 159 (9) 521 (13) Missing 695 (2) 69 (2) 13 (2) 478 (2) 40 (2) 95 (2) BMI = body mass index; ASA = American Society of Anesthesiologists.…”

Section: Discussionmentioning

confidence: 99%

Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk

Sheth

Cafri

Inacio

et al. 2015

Clinical Orthopaedics &Amp; Related Research

199

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Background Lack of consensus continues regarding the benefit of anteriorly based surgical approaches for primary total hip arthroplasty (THA). The purpose of this study was to evaluate the risk of aseptic revision, septic revision, and dislocations for various approaches used in primary THAs from a community-based healthcare organization. Questions/purposes (1) What is the incidence of aseptic revision, septic revision, and dislocation for primary THA in a large community-based healthcare organization? (2) Does the risk of aseptic revision, septic revision, and dislocation vary by THA surgical approach? Methods The Kaiser Permanente Total Joint Replacement Registry was used to identify primary THAs performed between April 1, 2001 and December 31, 2011. Endpoints were septic revisions, aseptic revisions, and dislocations. The exposure of interest was surgical approach (posterior, anterolateral, direct lateral, direct anterior). Patient, implant, surgeon, and hospital factors were evaluated as possible confounders. Survival analysis was performed with marginal multivariate Cox models. Hazard ratios (HRs) and 95% confidence intervals (CIs) are reported. A total of 42,438 primary THAs were available for analysis of revision outcomes and 22,237 for dislocation. Median followup was 3 years (interquartile range, 1-5 years). The registry's voluntary participation is 95%. The most commonly used approach was posterior (75%, N = 31,747) followed by anterolateral (10%, N = 4226), direct anterior (4%, N = 1851), and direct lateral (2%, N = 667). Results During the study period 785 hips (2%) were revised for aseptic reasons, 213 (0.5%) for septic reasons, and 276 (1%) experienced a dislocation. The revision rate per 100 years of observation was 0.54 for aseptic revisions, 0.15 for septic revisions, and 0.58 for dislocations. There were no differences in adjusted risk of revision (either septic or aseptic) across the different THA approaches. However, the anterolateral approach (adjusted HR, 0.29; 95% CI, 0.13-0.63, p = 0.002) and direct anterior approach (adjusted HR, 0.44; 95% CI, 0.22-0.87, p = 0.017) had a lower risk of dislocation relative to the posterior approach. There were no differences in any of the outcomes when comparing the direct anterior approach with the anterolateral approach. Conclusions Anterior and anterolateral surgical approaches had the advantage of a lower risk of dislocation without increasing the risk of early revision. Level of Evidence Level III, therapeutic study.

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“…Recently, the prevalence of 'optimal' acetabular cup positioning in primary THA in a tertiary teaching hospital was reported to be 49 % [6]. The study reported that surgical approach, surgeon case numbers and obesity independently predicted malpositioned cups.…”

Section: Introductionmentioning

confidence: 99%

“…The study reported that surgical approach, surgeon case numbers and obesity independently predicted malpositioned cups. While there are a number of papers describing clinical results of acetabular revision with large bone defect [7,8], there is paucity of data regarding cup position in the setting of revision THA [6]. The purpose of this study was to evaluate the cup position in the setting of revision THA for Paprosky type III acetabular defect using the Martell digital image analysis technique.…”

Section: Introductionmentioning

confidence: 99%

Acetabular cup positioning in revision total hip arthroplasty with Paprosky type III acetabular defects: Martell radiographic analysis

Choi

Anderson

Foster

et al. 2013

International Orthopaedics (SICOT)

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Purpose This study evaluates acetabular cup position in the setting of revision total hip arthroplasty (THA) with severe acetabular bone defects. Methods With a definition of safe zone of abduction (30-50°) and anteversion (5-25°), acetabular cup position was measured by a digital image analysis program for 34 patients with Paprosky type III acetabular bone defects. Results There were 24 cups (71 %) for abduction and 26 cups (76 %) for anteversion located in the safe zone. Nineteen cups (56 %) were within the safe zone for both abduction and anteversion. There was no dislocation, however one cup out of the safe zone resulted in early cup failure due to aseptic loosening. Conclusions The acetabular cup positioning in patients with Paprosky type III defects was 'optimal' in half of the cases. The prevalence of optimal acetabular cup position was similar to those reported in primary THA, suggesting that the presence of a large acetabular bone defect may not be a significant risk factor for suboptimal acetabular cup positioning in the setting of revision THA.

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The John Charnley Award: Risk Factors for Cup Malpositioning: Quality Improvement Through a Joint Registry at a Tertiary Hospital

Cited by 500 publications

References 48 publications

Minimally Invasive Total Hip Arthroplasty Using a Transpiriformis Approach: A Preliminary Report

Minimally Invasive Total Hip Arthroplasty Using a Transpiriformis Approach: A Preliminary Report

Anterior and Anterolateral Approaches for THA Are Associated With Lower Dislocation Risk Without Higher Revision Risk

Acetabular cup positioning in revision total hip arthroplasty with Paprosky type III acetabular defects: Martell radiographic analysis

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