A critical analysis of radiographic factors in patients who develop dislocation after elective primary total hip arthroplasty

Opperer, Marion; Lee, Yuo-yu; Nally, Francisco; Perez, Alvaro Blanes; Goudarz-Mehdikhani, Kaveh; Valle, Alejandro González Della

doi:10.1007/s00264-015-3022-1

Cited by 23 publications

(21 citation statements)

References 35 publications

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“…2015, Opperer et al. 2016). The other articles listed in Table 8 did not verify the differences between dislocators and non-dislocators in the Lewinnek safe zone with statistical analysis.…”

Section: Resultsmentioning

confidence: 99%

Acetabular cup position and risk of dislocation in primary total hip arthroplasty

et al. 2016

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Background and purpose — Hip dislocation is one of the most common complications following total hip arthroplasty (THA). Several factors that affect dislocation have been identified, including acetabular cup positioning. Optimal values for cup inclination and anteversion are debatable. We performed a systematic review to describe the different methods for measuring cup placement, target zones for cup positioning, and the association between cup positioning and dislocation following primary THA.Methods — A systematic search of literature in the PubMed database was performed (January and February 2016) to identify articles that compared acetabular cup positioning and the risk of dislocation. Surgical approach and methods for measurement of cup angles were also considered.Results— 28 articles were determined to be relevant to our research question. Some articles demonstrated that cup positioning influenced postoperative dislocation whereas others did not. The majority of articles could not identify a statistically significant difference between dislocating and non-dislocating THA with regard to mean angles of cup anteversion and inclination. Most of the articles that assessed cup placement within the Lewinnek safe zone did not show a statistically significant reduction in dislocation rate. Alternative target ranges have been proposed by several authors.Interpretation— The Lewinnek safe zone could not be justified. It is difficult to draw broad conclusions regarding a definitive target zone for cup positioning in THA, due to variability between studies and the likely multifactorial nature of THA dislocation. Future studies comparing cup positioning and dislocation rate should investigate surgical approach separately. Standardized tools for measurement of cup positioning should be implemented to allow comparison between studies.

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Section: Resultsmentioning

confidence: 99%

Acetabular cup position and risk of dislocation in primary total hip arthroplasty

et al. 2016

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“…24 Opperer et al reported that dislocations occurred when acetabular components were well positioned in 88.7% of their cases. 3 Seagrave et al recently performed a systematic review of 28 published articles on prosthetic joint dislocation and were unable to successfully identify a safe zone for acetabular component position based on the literature. 25 The results of our study suggest that dislocation risk is increased for hips reconstructed with increased acetabular inclination or reduced acetabular anteversion < 15 degrees.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of dislocation following primary THA has been reported between 2 and 5%. [1][2][3][4][5] The risk of THA dislocation may be influenced by patient sex, diagnosis, surgical approach, implant selection, component position, and soft tissue balance. [6][7][8][9][10][11][12] Improvements in femoral stem design that allow more consistent femoral offset restoration, improvements in polyethylene materials that enable use of larger femoral head sizes, and the inclusion of capsular closure with posterior hip approaches may contribute to lower early dislocation risk.…”

mentioning

confidence: 99%

“…1,22,23 But the importance of the traditional Lewinnek acetabular safe zone has been challenged by other studies that have not associated primary THA dislocation events with acetabular component malposition. 3,4,11,24,25 The ability to define specific surgical factors contributing to dislocation risk has been limited by relatively small and heterogeneous patient cohorts, and the relative role of insufficient femoral length or offset on THA instability has not been confirmed in the literature. Seagrave et al recently suggested that surgeons performing THA using a posterolateral approach should avoid shortening of the operative hip by 5 mm or more to avoid primary THA instability when a posterolateral approach is used.…”

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confidence: 99%

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Relative Contribution of Acetabular and Femoral Reconstruction to Prosthetic Joint Instability Risk after Primary Total Hip Arthroplasty

et al. 2019

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Prosthetic joint instability is a challenging concern for a minority of total hip arthroplasty (THA) patients. Placement of the acetabular component within the traditional safe zone does not eliminate dislocation, and the relative contribution of femoral length and offset to instability risk has not been well defined. The authors compared 53 dislocated primary THAs treated against an age- and gender-matched cohort of 134 stable primary THAs. Anteroposterior and cross-table lateral radiographs were used to determine whether reconstructions met targets for acetabular inclination (30–50 degrees), acetabular anteversion (5–30 degrees), femoral length (0–9.9 mm) and femoral offset (0–9.9 mm). Statistical analysis was performed to assess univariate and multivariate relationships with an instability event; statistical significance was set using a two-sided p-value < 0.05. Forty-seven (88.7%) of the dislocating hips had nonoptimal acetabular or femoral reconstructions. While a similar proportion of patients in the study and control groups had acetabular reconstruction within the safe zone (51.5 vs. 47.2%, p = 0.63) patients with unstable hips were more likely to have acetabular component inclination outside of the target zone (30.2 vs. 7.5%, p < 0.01), acetabular anteversion < 15 degrees (30.2 vs. 3.7%, p < 0.0001), reduced femoral length (35.9 vs. 3.7%, p < 0.0001), and reduced femoral offset (41.5 vs. 7.46%, p < 0.0001). Stepwise multivariate logistic regression was performed and identified femoral head size less than 32 mm (OR 2.9, 95% CI 1.4–6.2) and higher inclination angle (OR 1.1, 95% CI 1.04–1.2) as significant independent risk factors for hip instability. The authors' study findings suggest that insufficient acetabular anteversion, femoral length, and femoral offset reconstruction contribute significantly to instability risk following THA. Using a larger femoral head is protective, but should be balanced against long-term volumetric wear risk.

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“…17 studies reported on mean anteversion between the control groups and the groups with dislocation. 18,19,24,[27][28][29][30]32,[34][35][36]38,41,42 3 studies (from Ezquerra-Herrando et al, 25 Opperer et al 37 and Sadhu et al 39 ), showed a statistically significant difference between the control group and the group with dislocations, (mean anteversion of 14.19 vs. 11.54 [p = 0.043], 16.62 vs. 17.73 [p = 0.06], 17.6 vs. 20.5 [p = 0.04] respectively). 4 of the 28 included studies differentiated between anterior and posterior dislocations (Table 2).…”

Section: Acetabular Cup Orientationmentioning

confidence: 99%

Lack of consensus on optimal acetabular cup orientation because of variation in assessment methods in total hip arthroplasty: a systematic review

Snijders¹,

Willemsen²,

Gaalen³

et al. 2018

HIP International

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All available studies lack uniformity in cup orientation assessment; therefore it is impossible to reach consensus on optimal cup orientation. Using navigation systems for placement of the cup is inevitably flawed when using different definitions in the preoperative planning, peroperative placement and postoperative evaluation. Further methodological development is required to assess cup orientation. Consequently, the postoperative assessment should be uniform, thus differentiating between anterior and posterior dislocation, use the same definitions for inclination and anteversion with the same reference plane and with the patient in the same position.

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A critical analysis of radiographic factors in patients who develop dislocation after elective primary total hip arthroplasty

Cited by 23 publications

References 35 publications

Acetabular cup position and risk of dislocation in primary total hip arthroplasty

Acetabular cup position and risk of dislocation in primary total hip arthroplasty

Relative Contribution of Acetabular and Femoral Reconstruction to Prosthetic Joint Instability Risk after Primary Total Hip Arthroplasty

Lack of consensus on optimal acetabular cup orientation because of variation in assessment methods in total hip arthroplasty: a systematic review

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