Accuracy of acetabular cup placement during anterolateral supine total hip arthroplasty using intraoperative fluoroscopy: a retrospective study

Abstract

Background In our institution, total hip arthroplasty (THA) is performed using the anterolateral supine (ALS) approach with intraoperative fluoroscopy. This study aimed to investigate and review the accuracy of acetabular cup placement in ALS-THA using intraoperative fluoroscopy. Methods A total of 142 patients with 154 joints (mean age 64.3 years, 30 males and 112 females) underwent ALS-THA with intraoperative fluoroscopy at the same institution. The target angle of the cup position was set at 40° for radiographic inclination (RI) and 5°–25° for radiographic anteversion (RA) based on the functional pelvic plane according to the pelvic motion during individual postural changes. The cup position angle was measured using postoperative computed tomography, and the error in the target angle was investigated. Results The target angle of RI was 40°, and the postoperative RI was 39.3° ± 4.3°. The target angle of the RA was 17° ± 2.6°, and the postoperative RA was 20.6° ± 3.7°. The absolute values of the error from the target angle were 3.6° ± 2.5° for RI and 4.2° ± 3.3° for RA. For RI and RA, 67.5% (104/154 joints) were within ± 5° of the target and 96.1% (148/154 joints) were within ± 10°. Conclusions The accuracy of cup positioning in ALS-THA using intraoperative fluoroscopy was good and appeared comparable to that of various navigation systems.

Assessment of 3D acetabular offset in total hip arthroplasty using conventional reaming technique

“…Intraoperative uoroscopy is useful not only for con rming cup depth but also for determining cup abduction angle and anteversion. Cho et al reported that the accuracy of cup placement in ALS THA using uoroscopy is good and compares favorably with other navigation systems [14]. The use of uoroscopy in supine surgery not only con rms the position of the cup but also con rms the placement of the stem on the femoral side.…”

The Sum of the Leg Length Discrepancy and the Difference in Global Femoral Offset Is Equal to That of the Contralateral Intact Side and Improves Postoperative Outcomes after Total Hip Arthroplasty: A Three-Dimensional Analysis

“…We performed all THAs using the acetabular component-first technique, and subsequently, the femoral component was placed; however, broaching the femur before preparing the acetabulum, also known as the “combined anteversion technique”, was reported to contribute to reducing dislocation [ 21 , 29 , 30 ]. To the best of our knowledge, we considered that if the acetabular component was placed accurately, the dislocation rate did not markedly increase even when THA was performed using the acetabular component-first technique [ 14 , 15 , 16 , 19 ]. No dislocations occurred during our study period.…”

“…Even without a navigation or robotic system, the use of fluoroscopy may improve postoperative outcomes by reproducing GFO and LLD close to those of the pre-operative plan [ 34 , 35 ]. Therefore, we considered that adopting our findings to perform THA in the supine position, such as the anterolateral supine or direct anterior approach, is more reasonable to confirm GFO, LLD, and SGL using intra-operative fluoroscopy [ 16 ]. Despite these limitations, to our knowledge, this is the first report to use the 3D method to measure these parameters and obtain optimal GFO and SGL.…”

“…In total, 172 patients (131 females and 41 males) were enrolled in this survey. Notably, all THAs were performed by seven experienced orthopedic surgeons using the anterolateral supine approach [ 12 , 13 , 14 , 15 , 16 ]. The acetabular component was used to restore the original hip center and was planned relative to the functional pelvic plane (FPP), the sagittal tilt of the anterior pelvic plane (APP), and the plane, which included the most anterior part of the pubic symphysis and the anterior superior iliac spines of both sides, with 40° radiographic inclination and 15° radiographic anteversion [ 17 ].…”