Alternative Anatomical Landmarks for Anterior Pelvic Plane Determination

The anterior pelvic plane (APP) defined by both anterior superior iliac spines (ASIS) and the pubic symphysis (PS), is used as reference for cup orientation during total hip arthroplasty (THA). However, acquiring the PS and the contralateral ASIS during the intervention with the patient in lateral decubitus position, can be challenging due to the medical devices and the patient abdominal apron. The goal of this study is to find more easily accessible anatomical landmarks, useful for the APP acquisition. Thus we propose to study the variability of the pelvis anatomy in order to identify which landmarks vary with the APP. We built a statistical shape model (SSM) of the pelvis and studied the variability of APP orientation when deforming the SSM along its variation modes. We computed the APP inclination for each deformation and modeled linear relations between the APP inclination and the deformation along the variation modes. We found that the variability in APP inclination is mainly due to 3 variation modes that deform the iliac crest (IC), the posterior superior and anterior inferior iliac spines (PSIS, AIIS). Acquiring those three anatomical landmarks (IC, PSIS and AIIS) with the ipsilateral ASIS, could be a solution to determine more easily the APP for THA in lateral decubitus.