Accuracy of Acetabular Cup Placement During Total Hip Arthroplasty in Supine Position Using a Pelvic Rotation Correction Device

Overview

Journal Arthroplast Today

Publisher Elsevier

Date 2022 Jun 1

PMID 35647246

Authors

Satoshi Nakasone

Mika Takaesu

Masato Ishihara

Masamichi Onaga

Takahiro Igei

Yoshihide Miyata

Kotaro Nishida

Affiliations

Soon will be listed here.

Abstract

Background: Accurate cup placement during total hip arthroplasty (THA) is difficult because the intraoperative pelvic position changes even in supine patient position. We developed a device known as HipPointer; it corrects pelvic rotation and creates a functional pelvic plane as a reference. The aim of this study was to determine the device placement accuracy and investigate causes of error.

Material And Methods: HipPointer was used for cup placement in 353 hips of 308 patients who underwent direct-anterior-approach THA in supine position. The mean age at surgery and body mass index were 63.9 (17-90) years and 24.9 (16.6-42.0) kg/m, respectively. The mean observation period was 40.5 (12-73) months. To investigate the accuracy of HipPointer, preoperative planning and postoperative cup placement angles relative to the functional pelvic plane were evaluated using a three-dimensional analysis software, and absolute errors were determined.

Results: The means ± standard deviations of radiographic inclination (RI) and radiographic anteversion (RA) were 40.2 ± 3.0° and 15.8 ± 3.6°, respectively. The absolute errors of RI and RA were 2.2 ± 2.0° and 2.7 ± 2.3°, respectively. The ratio of the cup placement angle for which both RI and RA are ≤10° in the target zone was 99% (350/353 hips), and the ratio of the absolute errors for which both RI and RA are ≤5° was 80.4% (284/353 hips).

Conclusions: HipPointer is simple in structure, easy to use, and useful for direct-anterior-approach THA in supine position. It provides good cup placement accuracy.

Citing Articles

Secure paediatric pelvic fracture external fixation using an intraoperative support device.

Igei T, Nakasone S, Onaga M, Nishida K BMJ Case Rep. 2023; 16(4).

PMID: 37011998 PMC: 10083815. DOI: 10.1136/bcr-2022-252365.

References

Nishihara S, Sugano N, Nishii T, Ohzono K, Yoshikawa H . Measurements of pelvic flexion angle using three-dimensional computed tomography. Clin Orthop Relat Res. 2003; (411):140-51. DOI: 10.1097/01.blo.0000069891.31220.fd. View

Ando W, Takao M, Hamada H, Uemura K, Sugano N . Comparison of the accuracy of the cup position and orientation in total hip arthroplasty for osteoarthritis secondary to developmental dysplasia of the hip between the Mako robotic arm-assisted system and computed tomography-based navigation. Int Orthop. 2021; 45(7):1719-1725. DOI: 10.1007/s00264-021-05015-3. View

Barrett W, Turner S, Leopold J . Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty. 2013; 28(9):1634-8. DOI: 10.1016/j.arth.2013.01.034. View

Sugano N, Takao M, Sakai T, Nishii T, Miki H . Does CT-based navigation improve the long-term survival in ceramic-on-ceramic THA?. Clin Orthop Relat Res. 2012; 470(11):3054-9. PMC: 3462880. DOI: 10.1007/s11999-012-2378-4. View

Hayashi S, Hashimoto S, Kuroda Y, Nakano N, Matsumoto T, Ishida K . Accuracy of cup position following robot-assisted total hip arthroplasty may be associated with surgical approach and pelvic tilt. Sci Rep. 2021; 11(1):7578. PMC: 8027591. DOI: 10.1038/s41598-021-86849-0. View

Okamoto M, Kawasaki M, Okura T, Seki T, Imagama S . Effects of body mass index and range of motion on intraoperative change in pelvic tilt during total hip arthroplasty using the direct anterior approach. BMC Musculoskelet Disord. 2021; 22(1):240. PMC: 7927233. DOI: 10.1186/s12891-021-04087-x. View

Wroblewski B, Siney P, Fleming P . Effect of reduced diameter neck stem on incidence of radiographic cup loosening and revisions in Charnley low-frictional torque arthroplasty. J Arthroplasty. 2008; 24(1):10-4. DOI: 10.1016/j.arth.2008.01.312. View

Berger R . Mini-incision total hip replacement using an anterolateral approach: technique and results. Orthop Clin North Am. 2004; 35(2):143-51. DOI: 10.1016/S0030-5898(03)00111-1. View

SMITH-PETERSEN M . Approach to and exposure of the hip joint for mold arthroplasty. J Bone Joint Surg Am. 1949; 31A(1):40-6. View

10.

Restrepo C, Parvizi J, Eslam Pour A, Hozack W . Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty. 2010; 25(5):671-9.e1. DOI: 10.1016/j.arth.2010.02.002. View

11.

Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H . A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty. 2008; 24(5):698-704. DOI: 10.1016/j.arth.2008.04.012. View

12.

Bertin K, Rottinger H . Anterolateral mini-incision hip replacement surgery: a modified Watson-Jones approach. Clin Orthop Relat Res. 2004; (429):248-55. View

13.

Learmonth I, Young C, Rorabeck C . The operation of the century: total hip replacement. Lancet. 2007; 370(9597):1508-19. DOI: 10.1016/S0140-6736(07)60457-7. View

14.

Suda K, Ito T, Miyasaka D, Imai N, Minato I, Endo N . Cup implantation accuracy using the HipCOMPASS mechanical intraoperative support device. Springerplus. 2016; 5(1):784. PMC: 4912536. DOI: 10.1186/s40064-016-2503-z. View

15.

Nishii T, Sugano N, Miki H, Koyama T, Takao M, Yoshikawa H . Influence of component positions on dislocation: computed tomographic evaluations in a consecutive series of total hip arthroplasty. J Arthroplasty. 2004; 19(2):162-6. DOI: 10.1016/j.arth.2003.09.005. View

16.

Wroblewski B, Siney P, Fleming P . Charnley low-frictional torque arthroplasty: follow-up for 30 to 40 years. J Bone Joint Surg Br. 2009; 91(4):447-50. DOI: 10.1302/0301-620X.91B4.21933. View

17.

Wenz J, Gurkan I, Jibodh S . Mini-incision total hip arthroplasty: a comparative assessment of perioperative outcomes. Orthopedics. 2002; 25(10):1031-43. DOI: 10.3928/0147-7447-20021001-14. View

18.

Gibson A . Posterior exposure of the hip joint. J Bone Joint Surg Br. 1950; 32-B(2):183-6. DOI: 10.1302/0301-620X.32B2.183. View

19.

Nakamura N, Sugano N, Nishii T, Kakimoto A, Miki H . A comparison between robotic-assisted and manual implantation of cementless total hip arthroplasty. Clin Orthop Relat Res. 2009; 468(4):1072-81. PMC: 2835605. DOI: 10.1007/s11999-009-1158-2. View

20.

Steppacher S, Kowal J, Murphy S . Improving cup positioning using a mechanical navigation instrument. Clin Orthop Relat Res. 2010; 469(2):423-8. PMC: 3018200. DOI: 10.1007/s11999-010-1553-8. View