Can simple radiographs be predictive of total hip dislocation?

Pollard, James; Daum, Wayne J.; Uchida, Tatsuo

doi:10.1016/s0883-5403(05)80078-6

Cited by 38 publications

(22 citation statements)

References 9 publications

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“…The mean SD of this method in our study was 3.7°. Using the same method, Pollard et al [15] found a mean SD of 4°. In this study, the ischiolateral method, using an internal skeletal landmark, had a mean SD of 2.2°.…”

Section: Discussionmentioning

confidence: 96%

A More Reliable Method to Assess Acetabular Component Position

Tiberi

Pulos

Kertzner

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Acetabular component position is associated with joint function and bearing wear. Current techniques for determining acetabular component version on standard radiographs lack reliability. Other, more consistent techniques are time-consuming and require additional equipment or software. Questions/purposes We compared three methods of acetabular component position assessment: (1) Einzel-BildRoentgen-Analyse (EBRA), (2) Woo and Morrey, and (3) the new ischiolateral method. Patients and MethodsWe assessed axial component position for 52 hips, with at least three radiographic series, using EBRA, and on true lateral radiographs using the Woo and Morrey method and a new method that uses the ischium as a skeletal landmark, the ischiolateral method.Results The mean SDs of the ischiolateral (2.15°) and EBRA (2.06°) methods were lower than that of the Woo and Morrey method (3.65°) but were not different from one another. We observed a SD of greater than 4°in 19 (36.5%) hip series using the Woo and Morrey method, compared to six series (11.5%) for both the ischiolateral and EBRA methods. Twenty-four (12.6%) Woo and Morrey measurements were greater than 4°from the mean for the hip series, compared to seven (3.8%) for ischiolateral and nine (4.7%) for EBRA. The intraclass correlation coefficients for intra-and interobserver reliability for the ischiolateral method and EBRA were the same (0.9). Conclusions Referencing the ischium standardizes pelvic position on each lateral radiograph and provides a simple and reliable means to assess axial component position, which is a surrogate for the planar anteversion measured by EBRA.

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Section: Discussionmentioning

confidence: 96%

A More Reliable Method to Assess Acetabular Component Position

Tiberi

Pulos

Kertzner

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…2010) to 7.21% (Pollard et al. 1995). This information is summarized in Tables 4 and 5 (see Supplementary data).…”

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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“…The influence of the angle of inclination on the direction of the dislocation is even more unclear. Our results, as well as those of others do not support the view that this is a factor of major importance [5,6,28,29]. One strength of our study is that the patients were included from a cohort treated at one hospital during a defined period of time where the selection of the surgical approach was determined by the individual surgeon's preference.…”

Section: Discussionmentioning

confidence: 48%

“…This is in line with the results of Biederman et al [6] and Masaoka et al [27] who reported an increased risk for anterior dislocation as anteversion of the acetabular component increased and vice versa for posterior dislocation. However, other authors have not been able to demonstrate any correlation between socket anteversion and the risk for dislocations [5,28,29]. The influence of the angle of inclination on the direction of the dislocation is even more unclear.…”

Section: Discussionmentioning

confidence: 96%

“…However, this may be difficult to achieve in routine health care since many of the reductions are performed by junior surgeons outside office hours who may be reluctant to redislocate the hip after having successfully reduced it. Furthermore, our method for assessing the position of the acetabular component has limitations even though it has been used by several previous authors [4,21,22,[28][29][30]. Measuring the anteversion of the socket may be especially difficult since no true reference line is available in the pelvis.…”

Section: Discussionmentioning

confidence: 99%

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Direction of hip arthroplasty dislocation in patients with femoral neck fractures

Enocson

Lapidus

Törnkvist

et al. 2010

International Orthopaedics (SICOT)

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In order to prevent hip arthroplasty dislocations, information regarding the direction of the dislocation is important for accurate implant positioning and for optimising the postoperative regimens in relation to the surgical approach used. The aim of this study was to analyse the influence of the surgical approach on the direction of the dislocation in patients treated by a hemiarthroplasty (HA) or total hip arthroplasty (THA) after a femoral neck fracture. Fracture patients have a high risk for dislocations, and this issue has not been previously studied in a selected group of patients with a femoral neck fracture. We analysed the radiographs of the primary dislocation in 74 patients who had sustained a dislocation of their HA (n=42) or THA (n=32). In 42 patients an anterolateral (AL) surgical approach was used and in 32 a posterolateral (PL). The surgical approach significantly influenced the direction of dislocation in patients treated with HA (p<0.001), while no such correlation was found after THA (p=0.388). For THA patients there was a correlation between the mean angle of anteversion of the acetabular component and the direction of dislocation when comparing patients with anterior and posterior dislocations (p=0.027). These results suggest that the surgical approach of a HA has an influence on the direction of dislocation, in contrast to THA where the position of the acetabular component seems to be of importance for the direction of dislocation in patients with femoral neck fractures.

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Can simple radiographs be predictive of total hip dislocation?

Cited by 38 publications

References 9 publications

A More Reliable Method to Assess Acetabular Component Position

A More Reliable Method to Assess Acetabular Component Position

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

Direction of hip arthroplasty dislocation in patients with femoral neck fractures

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