Which Safe Zone Is Safe in Total Hip Arthroplasty? The Effect of Bony Impingement

Weber, Markus; Kunow, Frederik von; Innmann, Moritz M.; Meyer, M.; Thieme, Max; Jerabek, Seth A.; Renkawitz, Tobias

doi:10.3390/jpm12050812

Cited by 9 publications

(4 citation statements)

References 26 publications

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“…In 2011, Callanan et al suggested to target an inclination of 30–45° [ 68 ]. Weber et al suggested even smaller zones, ideally within 40–50° inclination and 20–30° anteversion [ 14 ]. The recent development tends towards concepts of patient-specific combined target zones, including the femoral positioning, the patient’s individual anatomy, and the spinopelvic alignment with pelvic tilt and spinal deformities [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Over the years, multiple slight variations of the safe zones have been described [ 13 ]. Weber et al criticized that most methods could not prevent bony impingement and suggested smaller safe zones with best results between 40–50° inclination and 20–30° anteversion [ 6 , 14 ]. Other authors propagated concepts of a combined anteversion, including the positioning of the stem [ 15 ], or patient-specific target zones [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Achieving Precise Cup Positioning in Direct Anterior Total Hip Arthroplasty: A Narrative Review

Streck

Boettner

2023

Medicina

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Malpositioned implants in total hip arthroplasty are associated with impingement, increased wear, and dislocations, thus precise cup positioning is crucial. However, significant deviations between targeted and actually achieved cup positions have been found even in patients operated by experienced surgeons. When aiming for higher accuracy, various methods based on freehand positioning lead by anatomic landmarks, C-arm fluoroscopy, imageless navigation, or robotic-assisted-surgery have been described. There is a constant development of new products aiming to simplify and improve intraoperative guidance. Both the literature and expert opinions on this topic are often quite controversial. This article aims to give an overview of the different methods and systems with their specific advantages and potential pitfalls while also taking a look into the future of cup positioning in anterior hip replacements.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Achieving Precise Cup Positioning in Direct Anterior Total Hip Arthroplasty: A Narrative Review

Streck

Boettner

2023

Medicina

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“…It seems certain that the use of more precise navigation systems is making it increasingly necessary to reach a consensus regarding what should be considered optimal cup orientation [ 21 , 51 ]. Moreover, once such values are defined, orthopedic surgeons ought to receive the required training or be given the necessary tools to reproduce them intraoperatively.…”

Section: Discussionmentioning

confidence: 99%

Orthopedic Surgeons’ Accuracy When Orienting an Acetabular Cup. A Comparison with Untrained Individuals

et al. 2022

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Background and Objectives: Previous studies demonstrated a huge variability among surgeons when it comes to reproducing the position of an acetabular cup in total hip arthroplasty. Our main objective is to determine if orthopedic surgeons can replicate a given orientation on a pelvic model better than untrained individuals. Our secondary objective is to determine if experience has any influence on their ability for this task. Materials and Methods: A group of specialist orthopedic hip surgeons and a group of volunteers with no medical training were asked to reproduce three given (randomly generated) acetabular cup orientations (inclination and anteversion) on a pelvic model. Error was measured by means of a hip navigation system and comparisons between groups were made using the appropriate statistical methods. Results: The study included 107 individuals, 36 orthopedic surgeons and 71 untrained volunteers. The mean error among surgeons was slightly greater as regards both inclination (7.84 ± 5.53 vs. 6.70 ± 4.03) and anteversion (5.85 ± 4.52 vs. 5.48 ± 3.44), although statistical significance was not reached (p = 0.226 and p = 0.639, respectively). Similarly, although surgeons with more than 100 procedures a year obtained better results than those with less surgical experience (8.01 vs. 7.67 degrees of error in inclination and 5.83 vs. 5.87 in anteversion), this difference was not statistically significant, either (p = 0.852 and p = 0.981). Conclusions: No differences were found in the average error made by orthopedic surgeons and untrained individuals. Furthermore, the surgeons’ cup orientation accuracy was not seen to improve significantly with experience.

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“…Correct positioning of the acetabular cup is crucial for short- and long-term outcomes after total hip arthroplasty (THA) [ 1 ]. Failure can result in impingement, instability and polyethylene wear [ 2 , 3 , 4 ]. In clinical practice, the inclination and anteversion of the acetabular component are usually assessed on anteroposterior low centered pelvic radiographs.…”

Section: Introductionmentioning

confidence: 99%

How Relevant Is the Parallax Effect on Low Centered Pelvic Radiographs in Total Hip Arthroplasty

Weber

Meyer²,

Kunow

et al. 2023

JPM

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The correct cup position in total hip arthroplasty (THA) is usually assessed on anteroposterior low centered pelvic radiographs, harboring the risk of misinterpretation due to projection of a three-dimensional geometry on a two-dimensional plane. In the current study, we evaluate the effect of this parallax effect on the cup inclination and anteversion in THA. In the course of a prospective clinical trial, 116 standardized low centered pelvic radiographs, as routinely obtained after THA, were evaluated regarding the impact of central beam deviation on the cup inclination and anteversion angles. Measurements of the horizontal and vertical beam offset with two different methods of parallax correction were compared with each other. Furthermore, the effect of parallax correction on the accuracy ofmeasuring the cup position was investigated. The mean difference between the two parallax correction methods was 0.2° ± 0.1° (from 0° to 0.4°) for the cup inclination and 0.1° ± 0.1° (from −0.1° to 0.2°) for the anteversion. For a typically intended cup position of a 45° inclination and 15° anteversion, the parallax effect led to a mean error of −1.5° ± 0.3° for the inclination and 0.6° ± 1.0° for the anteversion. Central beam deviation resulted in a projected higher cup inclination up to 3.7°, and this effect was more prominent in cups with higher anteversion. In contrast, the projected inclination decreased due to the parallax effect up to 3.2°, especially in cups with high inclination. The parallax effect on routinely obtained low centered pelvic radiographs is low and not clinically relevant due to the compensating effect of simultaneous medial and caudal central beam deviation.

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Which Safe Zone Is Safe in Total Hip Arthroplasty? The Effect of Bony Impingement

Cited by 9 publications

References 26 publications

Achieving Precise Cup Positioning in Direct Anterior Total Hip Arthroplasty: A Narrative Review

Achieving Precise Cup Positioning in Direct Anterior Total Hip Arthroplasty: A Narrative Review

Orthopedic Surgeons’ Accuracy When Orienting an Acetabular Cup. A Comparison with Untrained Individuals

How Relevant Is the Parallax Effect on Low Centered Pelvic Radiographs in Total Hip Arthroplasty

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