Clinical Impact of Pelvic Malrotation on Radiograph-Based Preoperative Planning for Total Hip Arthroplasty: A Proof-of-Concept and Prudent Prediction of Acceptable Rotation

Lourens, E.C.; Kurmis, Andrew P.; Lim, Wan Yin

doi:10.1007/s43465-022-00626-3

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…On the other hand, deviation from the standard anterior-posterior pelvic position could impact the measurement of leg length discrepancy (LLD). One study showed that when the pelvis was rotated more than 20 degrees, it affected the measurement of pelvis-related parameters [ 28 ]. In addition, it was reported that a 5-degree femoral abduction/adduction misalignment could significantly change leg length by 8 mm [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Does the use of intraoperative measurement reduce limb length discrepancies after total hip arthroplasty?

Wu,

Zhuang,

Lin

et al. 2023

BMC Musculoskelet Disord

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Purpose Postoperative limb length discrepancy (LLD) is a common complication of total hip arthroplasty, and several methods exist to prevent LLD, but each has its benefits and drawbacks. The study investigates the application of intraoperative lower limb length measurement in preventing postoperative LLD. Methods This study retrospectively analyzed 70 patients who underwent total hip arthroplasty from October 2018 to July 2022. The length of the lower limb on the operated side was measured intraoperatively using a sterilized paper ruler after the fitting of the trial mould and compared with the healthy side. Then the prosthesis size, depth and neck length were adjusted accordingly. Results The absolute value of postoperative LLD was found to be 6.68 ± 4.48 mm, of which 53 cases (75.7%) were less than or equal to 10 mm, while 30 patients (42.9%) were less than or equal to 5 mm. Conclusion The use of intraoperative measurement is effective in reducing LLD after total hip arthroplasty.

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Section: Discussionmentioning

confidence: 99%

Does the use of intraoperative measurement reduce limb length discrepancies after total hip arthroplasty?

Wu,

Zhuang,

Lin

et al. 2023

BMC Musculoskelet Disord

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“…In contrast, until recently there has been a lack of literature describing the isolated effects of radiographic pelvic rotation (PR) on preoperative acetabular planning angulation of acetabular prostheses. The recent work of Lourens et al used high resolution 3D CT pelvis models generated from healthy controls and arthroplasty patients to quantify the effects of pelvic rotation on acetabular cup position in various static planes simulating radiographic errors in basic imaging used for component templating [2]. They concluded that pelvic rotation can also significantly impact on the perceived acetabular angles observed on an AP pelvic radiograph used for pre-operative planning, which can in turn result in poor prosthetic placement and subsequent poorer long-term clinical outcomes.…”

Section: Understanding the Relationship Between Pelvic Movement And R...mentioning

confidence: 99%

“…As discussed later herein, inaccurate patient set up, loss of pelvic position during the procedure (i.e. patient movement) and errors in intended implantation angles can all undermine the achieved outcome [2,43]. Langston et al [57] suggested that a change in pelvic tilt of 13° or more on pre-operative assessment may be deemed unfavourable as this will result in a change in the functional anteversion of the acetabulum of 10°.…”

Section: Pre-operative Assessment: Setting a Target Positionmentioning

confidence: 99%

“…Total hip replacement remains a tried-and-true method for managing hip pain and dysfunction resultant from end-stage degenerative disease and a number of other medical conditions [1][2][3]. It has a long-standing proven clinical track record with strong evidence to support consistent improvements in patient function and satisfaction-indeed primary total hip arthroplasty (THA) has been claimed as one of the most significant surgical advances of the 20th century [4].…”

Section: Introductionmentioning

confidence: 99%

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Advanced, Imageless Navigation in Contemporary THA: Optimising Acetabular Component Placement

Kurmis¹

2023

Arthroplasty - Advanced Techniques and Future Perspectives

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Total hip arthroplasty (THA) stands as a reliable and effective way to manage end-stage hip disease secondary to a number of aetiologic conditions. While target ‘safe zones’ are widely quoted and endorsed, an increasingly robust body of evidence suggests that such idealised implantation goals have limited utility in patient-to-patient considerations and that even with a precise goal in mind, surgeons perform inconsistently in achieving these targets intra-operatively. Inter-patient variability, the concept of ‘functional’ safe zones and the largely under-appreciated impact of poor patient positioning (and progressive loss of position during the case) are all recognised and evidence-supported opponents of conventional ‘40/15’ approaches. In an environment whereby accountable cost utility, maximised surgical consistency (i.e., outlier minimisation), improved attainment of target position, and awareness of the radiation exposure burden of many pre-operative templating regimes are all paramount, there appears to be an increasing role for the application of imageless ‘mini’ intra-operative navigation systems for primary (and revision) THA procedures. This chapter reviews the evolution of THA navigation and discusses contemporary applications, defines the challenges associated with unanticipated pelvic movement, and explores potential future directions in the use of this exciting technology.

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Quantifying anterior pelvic roll during total hip arthroplasty in the lateral decubitus position

Kurmis,

Lourens

2023

J Orthop Surg Res

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Background Unintended pelvic positional change is an acknowledged intra-operative problem for hip arthroplasty, seen commonly with procedures performed in the lateral position. If unrecognised, such changes can dramatically alter final acetabular component anteversion potentially resulting in suboptimal construct performance. It has previously been suggested that pelvic roll of just 13° may be enough to place an otherwise perfectly orientated cup outside of conventional ± 10° safe zones. Using the real-time tracking capacity of a commercially available optical navigation system, we aimed to accurately quantify pelvic roll occurring during total hip arthroplasties (THAs) performed in the decubitus position. Methods Prospectively collected data for 107 consecutive, unilateral, THAs were interrogated to determine the magnitude of pelvic movement around a central longitudinal axis (i.e. AP roll). Correlation statistics with patient age and body mass index (BMI) were also calculated. Results A mean pelvic roll of 9.5° was observed, being anterior in 96% of cases. Of these, 18.3% of hips had a magnitude of roll greater than 13°. There were no statistically significant independent correlations observed between age (p = 0.87) or BMI (p = 0.59) and mean roll. Conclusions Errors in achieving acetabular target version may result in numerous post-operative concerns including instability/dislocation, bearing wear, squeaking, range-of-movement limitation and increased revision rate. In a general cohort, our findings suggest a mean anterior pelvic roll during THA of nearly 10°. Without purposeful correction, this may cause substantial deviation from intended target positions. Future work is indicated to map changing pelvic roll during THA which is likely to follow a nonlinear trajectory. Level of evidence: IV. .

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Clinical Impact of Pelvic Malrotation on Radiograph-Based Preoperative Planning for Total Hip Arthroplasty: A Proof-of-Concept and Prudent Prediction of Acceptable Rotation

Cited by 4 publications

References 27 publications

Does the use of intraoperative measurement reduce limb length discrepancies after total hip arthroplasty?

Does the use of intraoperative measurement reduce limb length discrepancies after total hip arthroplasty?

Advanced, Imageless Navigation in Contemporary THA: Optimising Acetabular Component Placement

Quantifying anterior pelvic roll during total hip arthroplasty in the lateral decubitus position

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