J Korean Med Sci.  2009 Apr;24(2):315-319. 10.3346/jkms.2009.24.2.315.

Are Portable Imaging Intraoperative Radiographs Helpful for Assessing Adequate Acetabular Cup Positioning in Total Hip Arthroplasty?

• Park SW
• Park JH
• Han SB
• Choi GW
• Song DI
• An ES

• KMID: 1779137
• DOI: http://doi.org/10.3346/jkms.2009.24.2.315

Abstract

Despite advances in surgical techniques and instrumentation, current intra-operative estimations of acetabular version in total hip arthroplasty are of limited accuracy. In the present study, two experienced orthopedic surgeons compared intra-operatively measured (using portable imaging) anteversions and vertical inclinations of acetabular components with those measured using standardized radiographs post-operatively in 40 patients. Of the all vertical inclinations measured from intra-operative radiographs, 72.5% (n=29) were within +/-2degrees, and 97.5% (n=39) were within +/-5degrees of those determined using post-operative radiographs, and for anteversion, 52.5% (n=21) were within +/-2degrees, and 97.5% (n=39) were within +/-5degrees. Post-operative radiographs demonstrated that 90.0% (n=36) of vertical inclinations and anteversions were within the adequate zone. Obviously, our method has its limitations, but the authors conclude that the method described in this article better allows surgeons to verify acetabular version intra-operatively. In particular, the described method is suitable in cases with a deformed acetabular anatomy and difficult revision surgery.

Keyword

Arthroplasty, Replacement, Hip; Acetabular Cup; Vertical Inclination; Anteversion

MeSH Terms

Acetabulum/radiography/*surgery
Adult
Aged
Aged, 80 and over
*Arthroplasty, Replacement, Hip
Female
Hip Joint/*radiography/surgery
Hip Prosthesis
Humans
Imaging, Three-Dimensional/methods
Intraoperative Care/*instrumentation/methods
Male
Middle Aged
Prosthesis Fitting

Figure

• 

  Fig. 1 The angle between the line passing through the long axis of the imaginary elliptical orbit and a vertical line from the bottom was defined as the angle of anteversion in intra-operative portable Lat view.

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  Fig. 2 The angle between the line joining the ischial tuberosities and the line through the long axis of the acetabular cup was defined as the angle of vertical inclination in a portable pelvic AP view.

• 

  Fig. 3 Points represent vertical inclination differences between final post-operative standard radiographs and confirmed portable radiographs for each cup. F.I, Final Inclination; C.P.I, Confirmed Portable Inclination.

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  Fig. 4 Points represent anteversion differences between final post-operative and confirmed portable radiographs for each cup. F.A, Final Anteversion; C.P.A, Confirmed Portable Anteversion.

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  Fig. 5 (A) The acetabular cup was 9° retroverted in the initial portable radiograph. (B) The reinserted cup was 18.5° anteverted in the confirmed portable radiograph. (C) The cup position was 16° anteverted in the post-operative standard radiograph.

Reference

1. Garcia-Cimbrelo E, Munuera L. Dislocation in low-friction arthroplasty. J Arthroplasty. 1992. 7:149–155.

2. Ha YC, Kim SY, Kim HJ, Yoo JJ, Koo KH. Ceramic liner fracture after cementless alumina-on-alumina total hip arthroplasty. Clin Orthop Relat Res. 2007. 458:106–110.

3. Lewinnek GE, Lewis JL, Tarr R, compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978. 60:217–220.

4. Carlsson AS, Gentz CF. Postoperative dislocation in the Charnley and Brunswik total hip arthroplasty. Clin Orthop Relat Res. 1977. 125:177–182.

5. D'Lima DD, Urquhart AG, Buehler KO, Walker RH, Colwell CW Jr. The effect of the orientation of the acetabular and femoral components on the range of motion of the hip at different head-neck ratios. J Bone Joint Surg Am. 2000. 82:315–321.

6. Eftekhar NS. Dislocation and instability complicating low friction arthroplasty of the hip joint. Clin Orthop Relat Res. 1976. 121:120–125.

7. Hassan DM, Johnston GH, Dust WN, Watson G, Dolovich AT. Accuracy of intraoperative assessment of acetabular prosthesis placement. J Arthroplasty. 1998. 13:80–84.

8. Kummer FJ, Shah S, Iyer S, DiCesare PE. The effect of acetabular cup orientations on limiting hip rotation. J Arthroplasty. 1999. 14:509–513.

9. McLaren RH. Prosthetic hip angulation. Radiology. 1973. 107:705–706.

10. Wines AP, McNicol D. Computed tomography measurement of the accuracy of component version in total hip arthroplasty. J Arthroplasty. 2006. 21:696–701.

11. Cohn BT, Katz MM, Krackow KA, Lennox DW, Loeb P. A new technique for the intraoperative determination of acetabular anteversion. Orthopedics. 1987. 10:1565–1566.