Cup Position Alone Does Not Predict Risk of Dislocation After Hip Arthroplasty

Esposito, Christina; Gladnick, Brian P.; Lee, Yuo Yu; Lyman, Stephen; Wright, Timothy M.; Mayman, David J.; Padgett, Douglas E.

doi:10.1016/j.arth.2014.07.009

Cited by 203 publications

(141 citation statements)

References 42 publications

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“…However, they did not report on the proportion of patients who dislocated. Esposito et al [13] also noted that 57% of their cups were within both safe zones for those who dislocated. The mean cup inclination (44°) and anteversion (15°) of dislocated hips reported in the current study reflect the standard values noted for the native hip [35].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Esposito et al [13] described their frequency of dislocation to be 2% as well. However, their study period was only the first 6 months from the surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of our THAs that dislocated were, in fact, within those target values. Although multiple authors proposed to keep the safe zones described by Lewinnek [33,37], Esposito et al [13] found no distinct safe zone. It is likely that the ideal cup position for some patients lies outside the Lewinnek zone and that more-advanced analysis is required to identify the right target in that subgroup.…”

Section: Discussionmentioning

confidence: 99%

“…This is important because the frequency of dislocation varies based on length of followup [4,10]. In addition, Esposito et al [13] identified dislocations through patient self-reporting and mailed surveys as opposed to confirmation through clinical followup. Finally, the posterior approach was used in 98% of their patients, limiting analysis with other approaches such as anterolateral.…”

Section: Discussionmentioning

confidence: 99%

“…The positioning of implants, restoration of joint biomechanics, and appropriate soft tissue preservation and tensioning are known to play a role in obtaining a stable THA [13,15,16]. In addition, head size, cup diameter, and the surgical approach itself may influence hip stability [16,17,34].…”

Section: Introductionmentioning

confidence: 99%

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What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position

Abdel

Roth

Jennings

et al. 2016

Clinical Orthopaedics &Amp; Related Research

453

287

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Background Numerous factors influence total hip arthroplasty (THA) stability including surgical approach and soft tissue tension, patient compliance, and component position. One long-held tenet regarding component position is that cup inclination and anteversion of 40°± 10°a nd 15°± 10°, respectively, represent a ''safe zone'' as defined by Lewinnek that minimizes dislocation after primary THA; however, it is clear that components positioned in this zone can and do dislocate. Questions/purposes We sought to determine if these classic radiographic targets for cup inclination and anteversion accurately predicted a safe zone limiting dislocation in a contemporary THA practice.Methods From a cohort of 9784 primary THAs performed between 2003 and 2012 at one institution, we retrospectively identified 206 THAs (2%) that subsequently dislocated. Radiographic parameters including inclination, anteversion, center of rotation, and limb length discrepancy were analyzed. Mean followup was 27 months (range, 0-133 months). Results The majority (58% [120 of 206]) of dislocated THAs had a socket within the Lewinnek safe zone. Mean cup inclination was 44°± 8°with 84% within the safe zone for inclination. Mean anteversion was 15°± 9°with 69% within the safe zone for anteversion. Sixty-five percent of dislocated THAs that were performed through a posterior approach had an acetabular component within the combined acetabular safe zones, whereas this was true for only 33% performed through an anterolateral approach. An acetabular component performed through a posterior approach was three times as likely to be within the combined acetabular safe zones (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.6) than after an anterolateral approach (OR, 0.4; 95% CI, 0.2-0.7; p \ 0.0001). In contrast, acetabular components performed through a posterior approach (OR, 1.6; 95% CI, 1.2-1.9) had an increased risk of dislocation compared with those performed through an anterolateral approach (OR, 0.8; 95% CI, 0.7-0.

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Section: Discussionmentioning

confidence: 99%

“…Recently, Esposito et al [13] described their frequency of dislocation to be 2% as well. However, their study period was only the first 6 months from the surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position

Abdel

Roth

Jennings

et al. 2016

Clinical Orthopaedics &Amp; Related Research

453

287

View full text Add to dashboard Cite

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Computer Navigation in Total Hip Arthroplasty

Malik

Dorr

2021

Evidence‐Based Orthopedics

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Standardized fluoroscopy‐based technique to measure intraoperative cup anteversion

Zingg¹,

Boudabbous²,

Hannouche³

et al. 2017

Journal Orthopaedic Research

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Direct anterior approach (DAA) with the patient lying supine has facilitated the use of intraoperative fluoroscopy and allows for standardized positioning of the patient. The current study presents a new technique to measure acetabular component anteversion using intraoperative fluoroscopy. The current paper describes a mathematical formula to calculate true acetabular component anteversion based on the acetabular component abduction angle and the c-arm tilt angle (CaT). The CaT is determined by tilting the c-arm until an external pelvic oblique radiograph with the equatorial plane of the acetabular component perpendicular to the fluoroscopy receptor is obtained. CaT is determined by direct reading on the C-arm device. The technique was validated using a radiopaque synbone model comparing the described technique to computed tomography anteversion measurement. The experiment was repeated 25 times. The difference in anteversion between the two measuring techniques was on average 0.2° (range -3.0-3.1). The linear regression coefficients evaluating the agreement between the experimental and control methods were 0.99 (95%CI 0.88-1.10, p < 0.001) and 0.33 (95%CI -1.53-2.20, p = 0.713) for the slope and intercept, respectively. The current study confirms that the described three-step c-arm acetabular cup measuring technique can reproducibly and reliably assess acetabular component anteversion in the supine position, as compared to CT-imaging. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2307-2312, 2017.

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Cup Position Alone Does Not Predict Risk of Dislocation After Hip Arthroplasty

Cited by 203 publications

References 42 publications

What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position

What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position

Computer Navigation in Total Hip Arthroplasty

Standardized fluoroscopy‐based technique to measure intraoperative cup anteversion

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