Landmarks for Identifying the Suprascapular Foramen Anteriorly: Application to Anterior Neurotization and Decompressive Procedures

2017 ◽  
Vol 14 (2) ◽  
pp. 166-170
Author(s):  
Olga V Manouvakhova ◽  
Veronica Macchi ◽  
Fabian N Fries ◽  
Marios Loukas ◽  
Raffaele De Caro ◽  
...  
Keyword(s):  
Anterior Approach ◽  
Skin Surface ◽  
Suprascapular Nerve ◽  
Coracoid Process ◽  
Average Depth ◽  
Suprascapular Foramen ◽  
The Mean

Abstract BACKGROUND Additional landmarks for identifying the suprascapular nerve at its entrance into the suprascapular foramen from an anterior approach would be useful to the surgeon. OBJECTIVE To identify landmarks for the identification of this hidden site within an anterior approach. METHODS In 8 adult cadavers (16 sides), lines were used to connect the superior angle of the scapula, the acromion, and the coracoid process tip thus creating an anatomic triangle. The suprascapular nerve's entrance into the suprascapular foramen was documented regarding its position within this anatomical triangle. Depths from the skin surface and specifically from the medial-most point of the clavicular attachment of the trapezius to the suprascapular nerve's entrance into the suprascapular foramen were measured using calipers and a ruler. The clavicle was then fractured and retracted superiorly to verify the position of the nerve's entrance into the suprascapular foramen. RESULTS From the trapezius, the nerve's entrance into the foramen was 3 to 4.2 cm deep (mean, 3.5 cm). The mean distance from the tip of the corocoid process to the suprascapular foramen was 3.8 cm. The angle best used to approach the suprascapular foramen from the surface was 15° to 20°. CONCLUSION Based on our study, an anterior suprascapular approach to the suprascapular nerve as it enters the suprascapular foramen can identify the most medial fibers of the trapezius attachment onto the clavicle and insert a finger at an angle of 15° to 20° laterally and advanced to an average depth of 3.5 cm.

The Difference in Facial Movement Between the Medial and the Lateral Midface: A 3D Skin Surface Vector Analysis

2021 ◽  
Author(s):  
David L Freytag ◽  
Michael G Alfertshofer ◽  
Konstantin Frank ◽  
Dmitry V Melnikov ◽  
Nicholas Moellhoff ◽  
...  
Keyword(s):  
3D Imaging ◽  
Functional Anatomy ◽  
Skin Surface ◽  
Facial Movements ◽  
Anatomic Location ◽  
Objective Evidence ◽  
The Face ◽  
Functional Boundary ◽  
The Mean ◽  
The Difference

Abstract Background Our understanding of the functional anatomy of the face is constantly improving. To date, it is unclear whether the anatomic location of the line of ligaments has any functional importance during normal facial movements such as smiling. Objectives It is the objective of the present study to identify differences in facial movements between the medial and lateral midface by means of skin vector displacement analyses derived from 3D imaging and to further ascertain whether the line of ligaments has both a structural and functional significance in these movements. Methods The study sample consisted of 21 healthy volunteers (9 females & 12 males) of Caucasian ethnic background with a mean age of 30.6 (8.3) years and a mean BMI of 22.57 (2.5) kg/m 2. 3D images of the volunteers’ faces in repose and during smiling (Duchenne type) were taken. 3D imaging-based skin vector displacement analyses were conducted. Results The mean horizontal skin displacement was 0.08 (2.0) mm in the medial midface (lateral movement) and was -0.08 (1.96) mm in the lateral midface (medial movement) (p = 0.711). The mean vertical skin displacement (cranial movement of skin toward the forehead/temple) was 6.68 (2.4) mm in the medial midface whereas it was 5.20 (2.07) mm in the lateral midface (p = 0.003). Conclusions The results of this study provide objective evidence for an antagonistic skin movement between the medial and the lateral midface. The functional boundary identified by 3D imaging corresponds to the anatomic location of the line of ligaments.

Distance of the Posterior Interosseous Nerve From the Bicipital (Radial) Tuberosity at Varying Positions of Forearm Rotation: A Magnetic Resonance Imaging Study With Clinical Implications

2021 ◽  
Vol 49 (5) ◽  
pp. 1152-1159
Author(s):  
Tyler A. Luthringer ◽  
David A. Bloom ◽  
David S. Klein ◽  
Samuel L. Baron ◽  
Erin F. Alaia ◽  
...  
Keyword(s):  
Anterior Approach ◽  
Single Incision ◽  
Biceps Tendon ◽  
Tendon Repair ◽  
Resonance Imaging ◽  
Forearm Rotation ◽  
Mri Scans ◽  
Biceps Tendon Repair ◽  
The Mean ◽  
Bicipital Tuberosity

Background: The proximity of the posterior interosseous nerve (PIN) to the bicipital tuberosity is clinically important in the increasingly popular anterior single-incision technique for distal biceps tendon repair. Maximal forearm supination is recommended during tendon reinsertion from the anterior approach to ensure the maximum protective distance of the PIN from the bicipital tuberosity. Purpose: To compare the location of the PIN on magnetic resonance imaging (MRI) relative to bicortical drill pin instrumentation for suspensory button fixation via the anterior single-incision approach in varying positions of forearm rotation. Study Design: Descriptive laboratory study. Methods: Axial, non–fat suppressed, T1-weighted MRI scans of the elbow were obtained in positions of maximal supination, neutral, and maximal pronation in 13 skeletally mature individuals. Distances were measured from the PIN to (1) the simulated path of an entering guidewire (GWE-PIN) and (2) the cortical starting point of the guidewire on the bicipital tuberosity (CSP-PIN) achievable from the single-incision approach. To radiographically define the location of the nerve relative to constant landmarks, measurements were also made from the PIN to (3) the prominent-most point on the bicipital tuberosity (BTP-PIN) and (4) a perpendicular plane trajectory from the bicipital tuberosity exiting the opposing radial cortex (PPT-PIN). All measurements were subsequently compared between positions of pronation, neutral, and supination. In supination only, BTP-PIN and PPT-PIN measurements were made and compared at 3 sequential axial levels to evaluate the longitudinal course of the nerve relative to the bicipital tuberosity. Results: Of the 13 study participants, mean age was 38.77 years, and mean body mass index was 25.58. Five participants were female, and 5 left and 8 right elbow MRI scans were reviewed. The GWE-PIN was significantly greater in supination (mean ± SD, 16.01 ± 2.9 mm) compared with pronation (13.66 ± 2.5 mm) ( P < .005). The mean CSP-PIN was significantly greater in supination (16.20 ± 2.8 mm) compared with pronation (14.18 ± 2.4 mm) ( P < .013).The mean PPT-PIN was significantly greater in supination (9.00 ± 3.0 mm) compared with both pronation (1.96 ± 1.2 mm; P < .001) and neutral (4.73 ± 2.6 mm; P < .001). The mean BTP-PIN was 20.54 ± 3.0, 20.81 ± 2.7, and 20.35 ± 2.9 mm in pronation, neutral, and supination, respectively, which did not significantly differ between positions. In supination, the proximal, midportion, and distal measurements of BTP-PIN did not significantly differ. The proximal PPT-PIN distance (9.08 ± 2.9 mm) was significantly greater than midportion PPT-PIN (5.85 ± 2.4 mm; P < .001) and distal BTP-PIN (2.27 ± 1.8 mm; P < .001). Conclusion: This MRI study supports existing evidence that supination protects the PIN from the entering guidewire instrumentation during anterior, single-incision biceps tendon repair using cortical button fixation. The distances between the entering guidewire trajectory and PIN show that guidewire-inflicted injury to the nerve is unlikely during the anterior single-incision approach. Clinical Relevance: When a safe technique is used, PIN injuries during anterior repair are likely the result of aberrant retractor placement, and we recommend against the use of retractors deep to the radial neck. Guidewire placement as close as possible to the anatomic footprint of the biceps tendon is safe from the anterior approach. MRI evaluation confirms that ulnar and proximal guidewire trajectory is the safest technique when using single-incision bicortical suspensory button fixation.

scholarly journals Promising medium-term results of anterior approach with an anatomical short stem in primary hip arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Fabrizio Rivera ◽  
Alessandro Bardelli ◽  
Andrea Giolitti
Keyword(s):  
Operating Room ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Short Stem ◽  
Medium Term ◽  
Operating Room Table ◽  
Sf 36 ◽  
Standard Operating ◽  
The Mean

Abstract Background In the last decade, the increase in the use of the direct anterior approach to the hip has contributed to the diffusion of the use of short stems in orthopedic surgery. The aim of the study is to verify the medium-term clinical and radiographic results of a cementless anatomic short stem in the anterior approach to the hip. We also want to verify whether the use of the standard operating room table or the leg positioner can affect the incidence of pre- and postoperative complications. Materials and methods All total hip arthroplasty patients with a 1-year minimum follow-up who were operated using the MiniMAX stem between January 2010 and December 2019 were included in this study. Clinical evaluation included the Harris Hip Score (HHS), Western Ontario and McMaster Universities Hip Outcome Assessment (WOMAC) Score, and Short Form-36 (SF-36) questionnaires. Bone resorption and remodeling, radiolucency, osteolysis, and cortical hypertrophy were analyzed in the postoperative radiograph and were related to the final follow-up radiographic results. Complications due to the use of the standard operating room table or the leg positioner were evaluated. Results A total of 227 patients (238 hips) were included in the study. Average age at time of surgery was 62 years (range 38–77 years). Mean follow-up time was 67.7 months (range 12–120 months). Kaplan–Meier survivorship analysis after 10 years revealed 98.2% survival rate with revision for loosening as endpoint. The mean preoperative and postoperative HHS were 38.35 and 94.2, respectively. The mean preoperative and postoperative WOMAC Scores were 82.4 and 16.8, respectively. SF-36 physical and mental scores averaged 36.8 and 42.4, respectively, before surgery and 72.4 and 76.2, respectively, at final follow-up. The radiographic change around the stem showed bone hypertrophy in 55 cases (23%) at zone 3. In total, 183 surgeries were performed via the direct anterior approach (DAA) on a standard operating room table, and 44 surgeries were performed on the AMIS mobile leg positioner. Comparison between the two patient groups did not reveal significant differences. Conclusion In conclusion, a short, anatomic, cementless femoral stem provided stable metaphyseal fixation in younger patients. Our clinical and radiographic results support the use of this short stem in the direct anterior approach. Level of evidence IV.

scholarly journals BREED AND SEX EFFECTS ON THE RELATIONSHIP BETWEEN WEIGHT AND FATNESS IN LACOMBE AND YORKSHIRE SWINE AND THEIR RECIPROCAL CROSSES

1965 ◽  
Vol 45 (1) ◽  
pp. 33-36
Author(s):  
G. W. Rahnefeld
Keyword(s):  
Body Weight ◽  
Sex Differences ◽  
Regression Coefficients ◽  
Average Depth ◽  
Constant Weight ◽  
Reciprocal Crosses ◽  
Sex Effects ◽  
Female Mating ◽  
The Mean ◽  
The Relationship

The relationship between thickness of fat measured at the shoulder, last rib, and loin of live pigs and market weight (86.2 to 95.2 kg) was studied in 1596 pigs from the Lacombe and Yorkshire breeds and their reciprocal crosses. No significant breed or sex differences were found in the proportion of fat at the three sites. Breed and sex differences were evident in the average depth of fat. The regression coefficients for the mean of three fat measurements on market weight were.016 ±.003,.019 ±.007, and.017 ±.004 for Lacombe males, barrows, and females respectively;.039 ±.002,.036 ±.005, and.041 ±.001 for Yorkshire males, barrows and females respectively;.027 ±.005 and.029 ±.004 for barrows and females from the Lacombe male × Yorkshire female mating; and.023 ±.007 and.021 ±.009 for barrows and females from the Yorkshire male × Lacombe female mating. Comparisons between animals measured at a relatively constant weight should be made after the fat measurement is adjusted for variations in body weight. The results of this study indicate that separate corrections should be applied for each breed. Separate corrections for sexes within breeds do not appear warranted.

scholarly journals Geometric Morphology of the Coracoacromial Ligament: A Cadaveric Study

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Mehmet Demir ◽  
Bülent Güneri
Keyword(s):  
Statistical Analysis ◽  
Shoulder Pain ◽  
Humeral Head ◽  
Common Knowledge ◽  
Coracoid Process ◽  
Coracoacromial Ligament ◽  
Death Time ◽  
The Mean ◽  
Geometric Morphology ◽  
Digital Caliper

The coracoacromial ligament (CAL), which restrains superior displacement of humeral head, connects the acromion and coracoid process. Due to the ligament’s variations and its role in shoulder pain, CAL was investigated in this study. Sixty shoulders of 34 cadavers, from persons aged 61-98 (80.95 ± 8.81) years at death time, were dissected. The lengths of lateral (LBL) and medial borders (MBL), widths of acromial (AIW) and coracoid insertions (CIW), and thicknesses of lateral (LSTAI) and medial (MSTAI) sides of acromial insertions were measured by digital caliper. The data were subjected to statistical analysis. 24 (40%) V-shaped, 12 (20%) broad-banded, 9 (15%) quadrangular, 9 (15%) Y-shaped, and 6 (10%) multiple-banded types were identified. The mean total LBL, MBL, AIW, CIW, LSTAI, and MSTAI were 34.94 ± 4.59 mm, 33.58 ± 5.31 mm, 29.82 ± 9.48 mm, 12.62 ± 3.95 mm, 1.29 ± 0.17 mm, and 0.90 ± 0.22 mm, respectively. The mean LBL (39.12 ± 4.29 mm), MBL (36.48 ± 3.9 mm), and CIW (37.01 ± 3.39 mm) were significantly greatest in quadrangular type (p<0.001). The mean AIW was slightly greatest in quadrangular type (p=0.069). The mean LSTAI was significantly greatest in multiple-banded type (1.45 ± 0.10 mm, p<0.001) whereas the mean MSTAI was significantly greatest in quadrangular type (1.23 ± 0.23 mm, p<0.001). CAL is quite variable regarding morphology, dimensions, and insertion features. Despite common knowledge, MSTAI and MBL of CAL can be greater than lateral counterparts in some types. To obtain complete release of CAL at acromion, the clearance of ligament fibers in an area with the dimensions of around 16 mm in mediolateral and 15 mm in anteroposterior direction, beginning from the lateral edge of acromial insertion, is recommended.

scholarly journals 5-Year Clinical and Radiographic Results of the Direct Anterior Approach for Total Hip Arthroplasty Using a Collared Cementless Femoral Short-Stem Prosthesis

2022 ◽  
Vol 11 (2) ◽  
pp. 346
Author(s):  
Ali Darwich ◽  
Kim Pankert ◽  
Andreas Ottersbach ◽  
Marcel Betsch ◽  
Sascha Gravius ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcome ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Hip Osteoarthritis ◽  
Direct Anterior Approach ◽  
Short Stem ◽  
Total Hip ◽  
The Mean

The aim of this study was to investigate the radiological and clinical outcome of the direct anterior approach (DAA) in total hip arthroplasty (THA) using a collared cementless femoral short-stem. This retrospective study included 124 patients with 135 THAs operated from 2014 to 2016 using a collared cementless triple tapered hydroxyapatite-coated femoral short-stem (AMIStem H Collared®, Medacta International, Castel San Pietro, Switzerland) implanted with a DAA. Follow-up was performed at three months, 12 months, and five years. Clinical outcome was assessed using the hip osteoarthritis outcome score (HOOS) and radiological analysis was done using conventional radiographs, which included evaluation of the femur morphology based on Dorr classification, of radiolucencies based on the Gruen zone classification and of stem subsidence. The mean age was 67.7 ± 11.3 years and the mean body mass index (BMI) was 27.4 ± 4.4 kg/m2. The stem survival rate at five years was 99.1% with one revision due to recurrent dislocations. Mean HOOS score improved from 40.9 ± 18.3 preoperatively to 81.5 ± 19.7 at three months, 89.3 ± 10.9 at 12 months, and 89.0 ± 14.0 at five years (all with p < 0.001). No significant correlations were found between age, femoral bone morphology, BMI and HOOS, and the appearance of relevant radiolucencies.

scholarly journals Anatomic Study of Subcoracoid Morphology in 418 Shoulders: Potential Implications for Subcoracoid Impingement

2017 ◽  
Vol 5 (10) ◽  
pp. 232596711773199 ◽  
Author(s):  
Anthony J. Dugarte ◽  
Rocklend J. Davis ◽  
T. Sean Lynch ◽  
Mark S. Schickendantz ◽  
Lutul D. Farrow
Keyword(s):  
Internal Rotation ◽  
Shoulder Pain ◽  
Older Patients ◽  
Morphological Changes ◽  
Young Female ◽  
Coracoid Process ◽  
Subscapularis Tendon ◽  
The Mean ◽  
Tendon Tears ◽  
Anterior Shoulder Pain

Background: Subcoracoid impingement has been implicated as a cause of anterior shoulder pain and subscapularis tendon tears. Purpose/Hypothesis: The purpose of this study was to evaluate the bony anatomy of the coracoid process and the subcoracoid space. We hypothesized that age-related changes that may contribute to subcoracoid impingement occur in the subcoracoid space. Study Design: Descriptive laboratory study. Methods: In total, 418 skeletal shoulder specimens were included in this study. We utilized 214 shoulders from a young cohort (25-35 years of age) and 204 shoulders from an older cohort (>55 years of age) for comparison. We evaluated several morphological characteristics of the coracoid process and the subcoracoid space: coracoid width, coracoid shape, coracoid thickness, and subcoracoid distance. Each coracoid was observed for the presence of spurring or other morphological changes. Results: The mean anteroposterior (AP) thickness of the coracoid tip was 7.9 and 9.4 mm in our young female and male cohorts, respectively, while the mean AP thickness was 8.1 and 9.7 mm in our older female and male cohorts, respectively. The coracoid tip was hooked in 31 of 108 young female shoulders compared with 55 of 102 older female shoulders, and the coracoid tip was hooked in 25 of 106 young male shoulders compared with 45 of 102 older male shoulders. The mean subcoracoid distance in neutral rotation was 14.8 and 12.5 mm in young and older female shoulders, respectively, while the mean subcoracoid distance in internal rotation in these same cohorts was 8.7 and 7.0 mm, respectively. The mean subcoracoid distance in neutral rotation was 14.8 and 13.3 mm in young and older male shoulders, respectively, while the mean subcoracoid distance in internal rotation was 8.6 and 8.1 mm in young and older male shoulders, respectively. Conclusion: The principal findings of our study demonstrate that anatomic changes implicated in subcoracoid impingement may be developmental and worsen with age. The subcoracoid space was narrower in our older cohort of shoulders. Additionally, these older shoulders also had a greater AP width and a more hooked coracoid compared with young shoulders. Clinical Relevance: Narrowing of the subcoracoid space has been shown to be implicated as a cause of anterior shoulder pain and subscapularis tendon tears. This is the first study to show that the morphological changes implicated in subcoracoid impingement become more prevalent with age. This may help to explain the increasing prevalence of subscapularis tendon tears in older patients. Furthermore, subcoracoid decompression may be seen as an option for older patients with anterior shoulder pain and subscapularis tendon tears.

Abstract WP389: Anatomical Trajectory for Focused Ultrasound Stimulation of Fastigial Nucleus for Neuroprotection in Human Cerebral Ischemia

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Mersedeh Bahr Hosseini ◽  
Norman Spivak ◽  
Martin Monti ◽  
Alex Korb ◽  
Jeffrey L Saver
Keyword(s):  
Ischemic Stroke ◽  
Focused Ultrasound ◽  
Brain Mri ◽  
Skin Surface ◽  
Fastigial Nucleus ◽  
Neutral Position ◽  
Neck Flexion ◽  
Ultrasound Stimulation ◽  
The Mean ◽  
Stimulation Of

Introduction: In multiple animal models of ischemic stroke, cerebellar fastigial nucleus stimulation (FNS) via implanted electrode has been shown to exert strong neuroprotective and collateral enhancement effects. Translational studies of FNS have been precluded due to the invasive nature of direct electrical stimulation. Recently, low-intensity focused ultrasound pulsation (LIFUP) has been used to stimulate deep hemispheric targets. Identifying achievable anatomic trajectories for LIFUP delivery is required for human trials. Method: Sagittal brain MRI T1 from 10 patients were analyzed. Potential pathways from the suboccipital (SO) region (transducer placement site) to the roof of the 4 th ventricle (location of FN) were traced, evaluating paths both via the thinnest portion of the occipital bone (OB) and via the transforaminal window (TFW). Interindividual variations in trajectory distances (cm), thickness of the OB through which the beam passes (cm), and the projected neck flexion degree from neutral position required to achieve a TFW path were measured. Results: An achievable anatomic pathway for stimulation of the FN via LIFUP was identified in 100% of patients (Fig 1). In standard MR positioning, 90% had an available path through thin portions of the OB and 10% had a projected path through TFW. The mean distance from the skin at the SO region to the roof of 4 th ventricle/FN was 7.2 cm (± 0.64cm). The mean OB thickness traversed by the beam was 0.3cm (±0.1). The projected required neck flexion to enable a TFW in all subjects was mean 9.3° (±5°). Conclusions: The distance for the LIFUP beam to travel from skin surface to FN via a suboccipital approach is well within the LIFUP penetration depth and all individuals had an accessible trajectory via the TFW through attainable degrees of head flexion, affording minimal ultrasonic energy dispersion and maximal focality. Ultrasound stimulation of fastigial nucleus is a feasible treatment strategy in human acute ischemic stroke.

scholarly journals Radiographic parameters and a novel fluoroscopic control view for posterior screw fixation of coracoid base fractures

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 9
Author(s):  
Hatem Galal Said ◽  
Tarek Nabil Fetih ◽  
Hosam Elsayed Abd-Elzaher ◽  
Simon Martin Lambert
Keyword(s):  
Sagittal Plane ◽  
Coracoid Process ◽  
Entry Point ◽  
Coronal Plane ◽  
Screw Placement ◽  
Posterior Fixation ◽  
Screw Insertion ◽  
Screw Length ◽  
Scapular Spine ◽  
The Mean

Introduction: Coracoid fractures have the potential to lead to inadequate shoulder function. Most coracoid base fractures occur with scapular fractures and the posterior approaches would be utilized for surgical treatment. We investigated the possibility of fixing the coracoid through the same approach without an additional anterior approach. Materials and methods: Multi-slice CT scans of 30 shoulders were examined and the following measurements were performed by an independent specialized radiologist: posterior coracoid screw entry point measured form infraglenoid tubercle, screw trajectory in coronal plane in relation to scapular spine and lateral scapular border, screw trajectory in sagittal plane in relation to glenoid face bisector line and screw length. We used the results from the CT study to guide postero-anterior coracoid screw insertion under fluoroscopic guidance on two fresh frozen cadaveric specimens to assess the reproducibility of accurate screw placement based on these parameters. We also developed a novel fluoroscopic projection, the anteroposterior (AP) coracoid view, to guide screw placement in the para-coronal plane. Results: The mean distance between entry point and the infraglenoid tubercle was 10.8 mm (range: 9.2–13.9, SD 1.36). The mean screw length was 52 mm (range: 46.7–58.5, SD 3.3). The mean sagittal inclination angle between was 44.7 degrees (range: 25–59, SD 5.8). The mean angle between screw line and lateral scapular border was 47.9 degrees (range: 34–58, SD 4.3). The mean angle between screw line and scapular spine was 86.2 degrees (range: 75–95, SD 4.9). It was easy to reproduce the screw trajectory in the para-coronal plane; however, multiple attempts were needed to reach the correct angle in the parasagittal plane, requiring several C-arm corrections. Conclusion: This study facilitates posterior fixation of coracoid process fractures and will inform the “virtual visualization” of coracoid process orientation.

Intraoperative Fluoroscopy with a Direct Anterior Approach Reduces Variation in Acetabular cup Abduction Angle

2017 ◽  
Vol 27 (6) ◽  
pp. 573-577 ◽  
Author(s):  
Gens P. Goodman ◽  
Nitin Goyal ◽  
Nancy L. Parks ◽  
Robert H. Hopper ◽  
William G. Hamilton
Keyword(s):  
Anterior Approach ◽  
Group Versus ◽  
Direct Anterior Approach ◽  
Abduction Angle ◽  
Analysis Software ◽  
Acetabular Cup ◽  
Intraoperative Fluoroscopy ◽  
The Mean ◽  
Cup Positioning ◽  
Cup Position

Introduction The purpose of this study was to compare acetabular cup position for 2 cohorts of total hip arthroplasty (THA) patients who had a direct anterior approach. Methods 100 THA cases were performed with an anterior approach using intraoperative fluoroscopy (IF) to aid in cup positioning. Another group of 100 cases underwent THA with an anterior approach without the use of any fluoroscopy. Postoperative abduction and anteversion angles were measured using Martell's hip analysis software. Results Mean abduction angle was 43.2° (standard deviation (SD) = 4.5°) for the IF group versus 37.5°(SD = 7.4°) for cases without IF (p<0.001). 18% more cases with IF fell within the Lewinnek safe zone (p<0.001); however, a similar number of cases had over 50° of abduction. The mean anteversion angles of the two groups were also significantly different (IF 21.8° vs. 24.9°) (p<0.01). Conclusions There was significantly less variation in cup position among the cases using IF with regards to abduction.

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