Acetabular Component Orientation in Total Hip Arthroplasty: The Role of Acetabular Transverse Ligament

Idrissi, Mohammed El; Elibrahimi, Abdelhalim; Shimi, Mohammed; Elmrini, Abdelmajid

doi:10.1590/1413-785220162405158405

Cited by 11 publications

(19 citation statements)

References 27 publications

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“…We think that the following several reasons may help to explain this. First, surgeons in studies above position patients lying on X-ray radiographic table and adjust APP parallel with the horizontal plane to take standard postoperative anteroposterior radiographs of the pelvis to measure the anatomical cup orientation [ 4 , 12 , 14 , 15 , 17 ]. However, radiographs of the pelvis were taken in the standing position to measure the functional cup position in current study.…”

Section: Discussionmentioning

confidence: 99%

The influence of sagittal pelvic malrotation on transverse acetabular ligament guided cup orientation: a retrospective cohort study

Ling

Ding

Yuan

et al. 2021

BMC Musculoskelet Disord

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Background Total hip arthroplasty (THA) candidates frequently present pelvic malrotation. The aim of this study is to analyze how pelvic malrotation influence transverse acetabular ligament (TAL) guided cup orientation and investigate whether pelvic malrotation produce different clinical outcomes after THA. Methods We retrospectively reviewed a consecutive series of THA patients (144 hips) who use TAL as a guidance for cup positioning from March 2017 to January 2020. The patients were divided into normal pelvis (NP) group and backward pelvis (BP) group by sagittal pelvic malrotation assessed by APPA, the angle between the vertical and the APP on standing lateral pelvic radiographs preoperatively. Cup anteversion and inclination and that out of the safe zones were measured and compared in two groups. The demographic data, clinical results, and complications of patients were also compared. Results Backward pelvic malrotation were found in 60.6 % of this cohort of THA candidates. The mean angle of both inclination and anteversion in BP group were significantly larger than that in NP group. The rate of cup for anteversion and inclination above the safe zone in BP group was significantly larger than that in NP group. There were 4 patients in BP group recording anterior hip dislocation after surgery. Other complications were not observed at last follow-up. Conclusions Backward pelvis malrotation may increase TAL guided cup inclination and anteversion, which were inclined to became outlier above the safe zone. This likely increase the rates of dislocation after THA. For the patients with pelvis malrotation, cup positioning should be performed individually instead of guided by TAL.

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Section: Discussionmentioning

confidence: 99%

The influence of sagittal pelvic malrotation on transverse acetabular ligament guided cup orientation: a retrospective cohort study

Ling

Ding

Yuan

et al. 2021

BMC Musculoskelet Disord

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show abstract

“…Li junwei et al [14] observed that the accuracy of acetabular prosthesis installation, especially the inclination, could be improved by referring to the vertex of Harris fossa, however, which failed to explain how to locate acetabular center. Idrissi ME et al [15] believed that the transverse acetabular ligament is obvious and constant, which is not affected by factors such as pelvic position change or acetabular dysplasia. It is a reliable anatomical marker.…”

Section: Discussionmentioning

confidence: 99%

Mid-term and long-term results of restoring rotation center in revision hip arthroplasty

et al. 2020

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Background: To restore rotation center exactly in revision hip arthroplasty is technically challenging, especially in Paprosky type III. The technical difficulty is attributable to the complicated acetabular bone defect. In this study, we discussed the method of restoring rotation center in revision hip arthroplasty and reported the clinical and radiological outcome of mid-term and long-term follow-up. Methods: This study retrospectively reviewed 45 patients (48 hips) who underwent revision hip arthroplasty, in which 35 cases (35 hips) were available for complete follow-up data. During the operation, the acetabular bone defect was reconstructed by impaction morselized bone graft, and the hip rotation center was restored by using remnant Harris fossa and acetabular notches as the marks. The clinical outcome was assessed using the Harris hip score. Pelvis plain x-ray was used to assess implant migration, stability of implants, and incorporation of the bone graft to host bone. Result: The average follow-up duration was 97.60 months (range 72-168 months). The average Harris hip score improved from 29.54 ± 10.87 preoperatively to 83.77 ± 5.78 at the last follow-up. The vertical distance of hip rotation center measured on pelvis x-ray was restored to normal, with the mean distance (15.24 ± 1.31) mm (range 12.4~17.3 mm). The mean loss of vertical distance of hip rotation center was (2.21 ± 0.72) mm (range 1.1~5.3 mm) at the last follow-up. Conclusion: Satisfactory clinical and radiological outcome can be obtained through restoring hip rotation center by using remnant Harris fossa and acetabular notches as the anatomical marks in revision hip arthroplasty.

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“…This method helped to get an accurate abduction angle, but was unhelpful in determining anteversion angle and position of intraoperative grinding point. Archbold et al [24] and Idrissi et al [25] hold the opinion that transverse acetabular ligament is a reference to the position and anteversion angle of the cup, which is used as traditional method currently. However, acetabular reamers should be done carefully to avoid excessive reaming that may potentially result in transforming a grade 3 ligament into a grade 4 by destroying it.…”

Section: Discussionmentioning

confidence: 99%

A novel positioner for accurately sitting the acetabular component: a retrospective comparative study

et al. 2019

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Introduction In this study, we described a positioner which allows a combination of preoperative plan and intraoperative insertion of the cup to improve the reconstruction of the rotation center of the hip. Materials and methods A retrospective study was conducted on 32 consecutive patients (group A) using this positioner and 40 consecutive patients (group B) using conventional method; radiological parameters and clinical measurements before operation and at last follow-up were collected and evaluated. Results Group A had a reconstructed center of rotation (COR) that was 0.19 mm closer to the anatomic COR in height ( P < 0.005), compared with group B with 3.45 mm vertical dislocation. There were no statistically significant differences in the horizontal displacement between the two groups. The accuracy of cup inclination was 42.14 ± 3.57 in the group A and 38.73 ± 7.65 in the group B ( P = 0.015). The accuracy of cup anteversion was 14.82 ± 1.44 in the group A and 13.08 ± 5.95 in the group B ( P = 0.082). All cups in the group A were radiologically stable, while one cup in the group B was radiologically unstable and was successfully treated with second-stage revision. Both of the groups obtained a higher mean postoperative Harris Hip Score. Conclusions Utilizing this positioner helps to restore the COR position more precisely and provides satisfactory radiological and clinical outcomes in the short term, and more studies are required before its widespread adoption for complicated cases.

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Acetabular Component Orientation in Total Hip Arthroplasty: The Role of Acetabular Transverse Ligament

Cited by 11 publications

References 27 publications

The influence of sagittal pelvic malrotation on transverse acetabular ligament guided cup orientation: a retrospective cohort study

The influence of sagittal pelvic malrotation on transverse acetabular ligament guided cup orientation: a retrospective cohort study

Mid-term and long-term results of restoring rotation center in revision hip arthroplasty

A novel positioner for accurately sitting the acetabular component: a retrospective comparative study

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