Undetected Intraoperative Pelvic Movement Can Lead to Inaccurate Acetabular Cup Component Placement during Total Hip Arthroplasty: A Mathematical Simulation Estimating Change in Cup Position

2017 ◽  
Vol 01 (04) ◽  
pp. 186-193 ◽  
Author(s):  
Jonathan Vigdorchik ◽  
Aaron Buckland ◽  
Ameer Elbuluk ◽  
Alex Alguire ◽  
Joseph Schipper ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Pelvic Obliquity ◽  
Acetabular Cup ◽  
Total Hip ◽  
Increased Risk ◽  
Pelvic Movement ◽  
Induced Changes ◽  
Intraoperative Movement ◽  
Cup Position

AbstractIntraoperative patient movement is a common but underappreciated phenomenon in total hip arthroplasty (THA). Such movement can significantly affect the accuracy with which the acetabular cup component is implanted. To evaluate the effect of intraoperative movement on cup position, we performed a study using mathematical modeling to simulate intraoperative movement. Mathematical simulations were used to simulate pelvic movements during THA. Pelvic axial rotation, tilt, and obliquity were simulated, and the resulting changes in intended cup position were calculated. The rate of change of inclination and anteversion per degree of pelvic movement was calculated, establishing a ratio relating cup angle sensitivity to pelvic movement. These sensitivities were used to construct nomograms showing the per-degree effect of pelvic movement on cup position. The effect of pelvic movement on cup position was multifactorial and dependent on the intended cup orientation. For a cup intended to be inserted at 15° anteversion and 40° inclination, each degree of pelvic rotation induced changes of 0.64° and –0.20°, respectively. For this same cup orientation, each degree of pelvic tilt induced changes of 0.77° for anteversion and 0.17° for inclination. Pelvic obliquity was associated with a 1:1 ratio with inclination, with each degree of obliquity inducing 1° of change in inclination. Anteversion was unaffected by changes in pelvic obliquity. This study demonstrates the consequences of undetected pelvic movement on cup position, including the increased risk of the acetabular component being placed in an orientation that could increase wear or the likelihood of impingement and dislocation.

Randomised Controlled Trial Comparing two Methods of Acetabular Cup Positioning during Total Hip Arthroplasty

2007 ◽  
Vol 17 (3) ◽  
pp. 137-142 ◽  
Author(s):  
P.-A. Vendittoli ◽  
M. Ganapathi ◽  
N. Duval ◽  
P. Lavoie ◽  
A. Roy ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Reference Points ◽  
Abduction Angle ◽  
Anatomical Landmarks ◽  
Acetabular Cup ◽  
Total Hip ◽  
Increased Risk ◽  
Visuospatial Perception ◽  
Cup Positioning

Background Acetabular cup positioning is an important technical aspect in total hip arthroplasty. Most surgeons estimate cup abduction angle during surgery with the insertion rod position according to the patient's body anatomical landmarks or other reference points in the operating room. High acetabular component abduction angle is associated with an increased risk of dislocation, premature polyethylene wear and osteolysis. Method To evaluate the potential benefits of a new technique for vertical acetabular cup positioning, 100 acetabular cups were randomised to be inserted with or without an inclinometer. Abduction angles were measured on postoperative radiographs by 2 evaluators blind to the treatment group. Results Of the cups, 57% (27/47) were positioned within the desirable abduction angle range of 40°–49° with the inclinometer, compared with 50% (27/53) by visuospatial perception (p=0.454). The proportion of cups positioned outside a safe angle range of 30°–55° was low in both groups: 6% (3/47) for the inclinometer group versus 4% (2/53) for the visuospatial perception group (p=0.536). Conclusion The use of an inclinometer did not significantly improve the acetabular cup abduction angle obtained by our group of surgeons when compared with visuospatial perception. Newer techniques such as navigation may be useful in further optimising cup positioning and reducing the outliers.

scholarly journals Acetabular cup position and risk of dislocation in primary total hip arthroplasty

2016 ◽  
Vol 88 (1) ◽  
pp. 10-17 ◽  
Author(s):  
Kurt G Seagrave ◽  
Anders Troelsen ◽  
Henrik Malchau ◽  
Henrik Husted ◽  
Kirill Gromov
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Acetabular Cup ◽  
Total Hip ◽  
Cup Position ◽  
Acetabular Cup Position ◽  
Primary Total Hip Arthroplasty

scholarly journals Effects of Acetabular Cup Orientation and Implant Design on Psoas Impingement in Total Hip Arthroplasty

2019 ◽  
Vol 9 ◽  
Author(s):  
Michael Ries ◽  
Ahmad Faizan ◽  
Jingwei Zhang ◽  
Laura Scholl
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Psoas Muscle ◽  
Tendon Sheath ◽  
Implant Design ◽  
Acetabular Cup ◽  
Steel Cable ◽  
Total Hip ◽  
Solid Models ◽  
Cup Position

Background:  Durable fixation has been demonstrated with use of large (jumbo) cementless cups in revision total hip arthroplasty (THA).    However, anterior protrusion of the cup rim may impinge on the iliopsoas tendon and cause groin pain.  The purpose of this study was to assess the effect of cup position and implant design on iliopsoas impingement.Methods:  THA was performed on six cadaver hips using oversized (jumbo) acetabular components, 60 to 66mm. A stainless steel cable was inserted into the psoas tendon sheath to identify the location of the psoas muscle.  CT scans were performed on each cadaver and imported in an imaging software. The acetabular shells, cables, and pelvi were segmented to create separate solid models of each. The shortest distance between each shell and cable was measured. To determine the influence of cup inclination and anteversion, the inclination (30°/40°/50°) and anteversion (10°/20°/30°) angles were varied in the virtual model for both a hemispheric and offset head center shell design. Results:  The shell to wire distance increased linearly with greater cup anteversion (R2>0.99) while inclination had less effect.  The distance was greater for the offset head center cup in comparison to the hemispheric cup.  Our results indicate that psoas impingement is related to both cup position and implant geometry. Conclusions:  For an oversized jumbo cup, psoas impingement is reduced by greater anteversion while cup inclination has little effect.   An offset head center cup with an anterior recess was helpful in reducing psoas impingement in comparison to a conventional hemispherical geometry. 

scholarly journals Computer Navigated Total Hip Arthroplasty Via The Direct Superior Approach: A Retrospective Study of The First 30 Consecutive Cases

2021 ◽  
Author(s):  
HIROSHI Watanabe ◽  
Takuya Uematsu ◽  
Yusuke Tabata ◽  
Yoshihiro Mizuno ◽  
Yuki Akashi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Total Hip Arthroplasty ◽  
Minimally Invasive ◽  
Hip Arthroplasty ◽  
Acetabular Cup ◽  
Total Hip ◽  
Positive Effects ◽  
Increased Risk ◽  
Superior Approach ◽  
Cup Positioning

Abstract Background The direct superior approach (DSA), which is one of the muscle-sparing approaches for total hip arthroplasty (THA), has been recently reported with positive outcomes. However, in minimally invasive THA, it has been reported that the visual intraoperative estimation of the cup position is not reliable. Therefore, those minimally invasive approaches are associated with the increased risk of acetabular cup malposition due to the limited exposure. Although the positive effects of computer navigation system on the accuracy of cup positioning have been reported in many studies, those are not unknown in THA via the DSA. In the current study, we investigated the accuracy of acetabular cup positioning in navigated THA via the DSA in the first 30 consecutive cases.Methods We have retroactively included the first 30 consecutive cases of navigated DSA, and the consecutive control cases using conventional posterior approach (PA) were included retroactively up to 30 cases. This retrospective study divided the cases of navigated DSA into 15 initial and 15 recent cases. The postoperative data were assessed on plain computed tomography to measure the radiographic inclination and anteversion of the acetabular component. Statistical analyses were performed using Mann-Whiteney U test for comparison of the mean, and Levene's tests for equality of standard deviations (SD). Results We found no significant differences in the means between navigated DSA and conventional PA for anteversion and inclination. For anteversion, the accuracy of acetabular cup positioning in navigated DSA (SD, 6.9°), including the recent 15 cases (SD, 4.1°), was significantly improved than in conventional PA (SD, 11.7°). For inclination, there were no significant differences in the accuracy of the acetabular cup positioning between navigated DSA (SD, 5.3°) and conventional PA (SD, 6.5°).Conclusions The increased variances of cup anteversion would be due to the frequency of pelvic malposition and the wide variation in pelvic orientation with the patient in the lateral decubitus position. Navigated THA via the DSA could be performed with good accuracy of cup placement in the first 30 cases. The results suggest that computer navigated THA via the DSA as a suitable option for hip replacement.

scholarly journals Acetabular cup position differs in spinopelvic mobility types: a prospective observational study of primary total hip arthroplasty patients

2021 ◽  
Author(s):  
Henryk Haffer ◽  
Zhen Wang ◽  
Zhouyang Hu ◽  
Christian Hipfl ◽  
Matthias Pumberger
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Sacral Slope ◽  
Acetabular Cup ◽  
Sagittal Vertical Axis ◽  
Total Hip ◽  
Spinal Segments ◽  
Cup Positioning ◽  
Cup Position ◽  
Acetabular Cup Position

Abstract Introduction Spinopelvic mobility was identified as a contributing factor for total hip arthroplasty (THA) instability. The influence of spinopelvic function on acetabular cup positioning has not yet been sufficiently investigated in a prospective setting. Therefore, our study aimed (1) to assess cup inclination and anteversion in standing and sitting based on spinopelvic mobility, (2) to identify correlations between cup position and spinopelvic function, (3) and to determine the influence of the individual spinal segments, spinal sagittal balance, and spinopelvic characteristics on the mobility groups. Materials and methods A prospective study assessing 197 THA patients was conducted with stereoradiography in standing and sitting position postoperatively. Two independent investigators determined cup anteversion and inclination, C7-Sagittal vertical axis, cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope, pelvic tilt (PT), anteinclination (AI), and pelvic femoral angle (PFA). Spinopelvic mobility is defined based on ∆PT = PTstanding − PTsitting as ∆PT < 10° stiff, ∆PT ≥ 10–30° normal, and ∆PT > 30° hypermobile. Pearson coefficient represented correlations between the cup position and spinopelvic parameters. Results Significant differences were demonstrated for cup anteversion (stiff/hypermobile 29.3°/40.1°; p < 0.000) and inclination (stiff/hypermobile 43.5°/60.2°; p < 0.000) in sitting, but not in standing position. ∆ (standing/sitting) of the cup anteversion (stiff/neutral/hypermobile 5.8°/12.4°/19.9°; p < 0.000) and inclination (stiff/neutral/hypermobile 2.3°/11.2°/18.8°; p < 0.000) revealed significant differences between the mobility groups. The acetabular cup position in sitting, was correlated with lumbar flexibility (∆LL) and spinopelvic mobility. Significant differences were detected between the mobility types and acetabular orientation (AI sit:stiff/hypermobile 47.6°/65.4°; p < 0.000) and hip motion (∆PFA:stiff/hypermobile 65.8°/37.3°; p < 0.000). Assessment of the spinal segments highlighted the role of lumbar flexibility (∆LL:stiff/hypermobile 9.9°/36.2°; p < 0.000) in the spinopelvic complex. Conclusion The significantly different acetabular cup positions in sitting and in the ∆ between standing and sitting and the significantly altered spinopelvic characteristics in terms of stiff and hypermobile spinopelvic mobility underlined the consideration for preoperative functional radiological assessment. Identifying the patients with altered spinopelvic mechanics due to a standardized screening algorithm is necessary to provide safe acetabular cup positioning. The proximal spinal segments appeared not to be involved in the spinopelvic function.

scholarly journals Trends In Cup Position Utilizing Computer-Assisted Navigation During Total Hip Arthroplasty

10.29007/jn8x ◽  
2019 ◽  
Author(s):  
Rachel Mays ◽  
Jessica Benson ◽  
Jeffrey Muir ◽  
Peter White ◽  
Morteza Meftah
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Lateral Approach ◽  
Computer Assisted ◽  
Acetabular Cup ◽  
Assisted Navigation ◽  
Total Hip ◽  
Current Mass ◽  
The Mean ◽  
Cup Position

Proper positioning of the acetabular cup deters dislocation after total hip arthroplasty (THA). The concept of a safe zone (SZ) for acetabular component placement was first characterized by Lewinnek et al. and furthered by Callanan et al. The SZ concept remains widely utilized and accepted in contemporary THA practice; however, components positioned in this SZ still dislocate. This study sought to characterize current mass trends in cup position identified across a large study sample of THA procedures completed by multiple surgeons. This retrospective, observational study reviewed acetabular cup position in 1,236 patients who underwent THA using computer-assisted navigation between July 2015 and November 2017. The overall mean cup position of all recorded cases was 21.8° (±7.7°, 95% CI = 6.7°, 36.9°) of anteversion and 40.9° (±6.5°, 95% CI = 28.1°, 53.7°) of inclination. For both anteversion and inclination, 65.5% (809/1236) of acetabular cup components were within the Lewinnek SZ and 58.4% (722/1236) were within the Callanan SZ. Acetabular cups were placed a mean of 6.8° of anteversion (posterior/lateral approach: 7.0°, anterior approach: 5.6°) higher than the Lewinnek and Callanan SZs whereas inclination was positioned 0.9° higher than the reported Lewinnek SZ and 3.4° higher than the Callanan SZ. Our data shows that while the majority of acetabular cups were placed within the traditional SZs, the mean anteversion orientation is considerably higher than those suggested by the Lewinnek and Callanan SZs. The implications of this observation warrant further investigation.

Effect of Acetabular Cup Position and Orientation in Cemented Total Hip Arthroplasty

2001 ◽  
Vol 388 ◽  
pp. 135-142 ◽  
Author(s):  
Kazuo Hirakawa ◽  
Naoto Mitsugi ◽  
Tomihisa Koshino ◽  
Tomoyuki Saito ◽  
Yasusuku Hirasawa ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Acetabular Cup ◽  
Total Hip ◽  
Position And Orientation ◽  
Cemented Total Hip Arthroplasty ◽  
Cup Position ◽  
Acetabular Cup Position
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