Effect of screw fixation on acetabular component alignment change in total hip arthroplasty

Fujishiro, Takaaki; Hayashi, Shinya; Kanzaki, Noriyuki; Hashimoto, Shingo; Shibanuma, Nao; Kurosaka, Masahiro

doi:10.1007/s00264-013-2271-0

Cited by 21 publications

(18 citation statements)

References 15 publications

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“…Fujishiro et al 10 studied the effect of screw fixation on acetabular component alignment change using CT-based fluoroscopic matched navigation system in 144 THAs. They demonstrated that the mean intraoperative change of cup position was 1.78° +1.6° (0°–5°) for inclination and 1.81° +1.6° (0°–8°) for anteversion.…”

Section: Discussionmentioning

confidence: 99%

Cup Alignment Change after Screw Fixation in Total Hip Arthroplasty

Suksathien

Piyapromdee

Tippimanchai

2019

IJOO

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Background: Cup malalignment increase impingement, dislocation, cup migration, and polyethylene wear. Screw fixation for enhanced stability is the preferred option in cases of doubtful primary cup stability. There have been few studies about alignment changes after screw fixation, which may be another cause of cup malalignment. This study aimed to evaluate cup alignment change after screw fixation. Materials and Methods: Patients undergoing imageless navigation total hip arthroplasty using screws fixation for acetabular cup were corrected. After the press-fit cup was fully seated, the cup orientation was recorded. After screws were inserted, the cup orientation was recorded again to calculate the alignment change. Results: There were 99 cases with a mean age 63.7 years (25–93). Alignment change after screw fixation was found in 73 cases (73.7%). There were 56 cases (56.6%) with inclination angle change and the mean change was 2.21° (0°–8°). The inclination angle increased in 47 cases (47.5%) with 9 cases (9.1%) increased by 5° or more and decreased in 9 cases (9.1%). There was statistically significant difference between patients using one screw and patients using two or more screws in inclination angle change, 1.56° (0°–5°) and 3.4° (0°–8°), respectively ( P = 0.0039). There was statistically significant correlation between inclination angle change and number of screws ( r = 0.5401, P < 0.01). There were 49 cases (49.5%) with anteversion angle change and the mean change was 1.67° (0°–5°). The anteversion angle increased in 31 cases (31.3%), decreased in 18 cases (18.2%) with two cases (2%) decreased by 5° or more. There was significant difference between patients using one screw and patients using two or more screws in anteversion angle change, 1.46° (0°–5°) and 2.21° (0°–5°), respectively ( P = 0.009). There was significant correlation between anteversion angle change and number of screws ( r = 0.284, P = 0.048). Conclusions: Changes in cup alignment after screw fixation were detected in most cases. It is one possible cause of cup malalignment.

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Section: Discussionmentioning

confidence: 99%

Cup Alignment Change after Screw Fixation in Total Hip Arthroplasty

Suksathien

Piyapromdee

Tippimanchai

2019

IJOO

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“…[4][5][6] However, screw fixation may cause changes in cup alignment, particularly when multiple screws are used. 7 Intraoperative positioning of the acetabular component influences the THA periprosthetic dislocation rates and material wear characteristics. 8 Therefore, implanting the acetabular component in the optimal position and at the optimal angle is crucial to avoid dislocation after a THA.…”

Section: Introductionmentioning

confidence: 99%

“…4–6 However, screw fixation may cause changes in cup alignment, particularly when multiple screws are used. 7…”

Section: Introductionmentioning

confidence: 99%

Changes in acetabular component alignment due to screw fixation in patients with hip dysplasia

et al. 2019

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Introduction: Adequate initial stability of the acetabular cup is essential for total hip arthroplasty (THA). However, changes in the alignment of the acetabular component caused by screw fixation are concerning in patients with inadequate bone stock. This study aimed to investigate the effects of screw fixation on the alignment of the acetabular component in THA patients with hip dysplasia. Methods: We retrospectively examined 256 hips (range 28–87 years) that underwent THA using a navigation system. Patients were divided into 2 groups based on the presence or absence of changes in the alignment of the intraoperative acetabular cup, and univariate and multivariate analyses were performed to identify factors that were predictive of changes in acetabular component alignment after screw fixation in 2 dimensions: inclination and anteversion. Results: Screw fixation led to a mean change in inclination of 1.6° (range 0–10°) and a mean change in anteversion of 1.4° (range 0–14°). The Crowe classification, the presence of bone cysts, and the use of an inferior quadrant screw were identified as factors that correlated with acetabular cup alignment changes in inclination (odds ratios, 6.01, 5.94 and 0.03, respectively). Only the Crowe classification was identified as a factor that correlated with intraoperative alignment changes in anteversion (odds ratio, 2.08). Conclusions: Screw fixation altered the acetabular cup alignment. The inclination changes were related to the extent of the dysplasia, and the risk was reduced when the inferior quadrant screw was used. Surgeons should use caution during screw fixation in THAs performed on severely dysplastic hips.

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“…Acetabular cup malalignment has been linked to increased dislocation, impingement, pelvic osteolysis, cup migration, polyethylene wear and decreased longevity of the prosthesis in patients undergoing total hip arthroplasty (THA) [1,2]. Several factors leading to cup malalignment including preoperative pelvic tilt [3], inaccurate pelvic position on the operating table [4], pelvic movement during the operation [5] and alignment change after screws fixation of the cup [6]. At present, there are few studies about deviation of cup alignment from target angle during press-fit insertion as it may be the other cause of cup malalignment.…”

Section: Introductionmentioning

confidence: 99%

“…They found that mean absolute errors were 2et al[5] studied pelvic movement during hip replacement and found that the mean angular movement was 9 (SD 6 ), factors influencing pelvic movement included surgeon, approach (posterior > lateral), procedure (hip resurfacing > THA) and type of support.The other cause of cup malalignment was a change of alignment after screw fixation of the cup. Fujishiro et al[6] studied the effect of screw fixation on acetabular component alignment change. They reported that the mean intraoperative change of cup position was 1.78 þ1.6…”

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confidence: 99%

Deviation of cup alignment from target angle during press-fit insertion

Suksathien

Sueajui

Piyapromdee

2018

Computer Assisted Surgery

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Background: Several factors lead to cup malalignment including preoperative pelvic tilt, inaccurate pelvic position on the operating table, pelvic movement during the operation and alignment change after screw fixation of the cup. There are few studies about the deviation of cup alignment from target angle during press-fit insertion, which may be the other cause of cup malalignment. The purpose of this study was to evaluate the deviation of cup alignment from target angle during press-fit insertion by using imageless navigation and to define any influential factors, including gender, age and side of operation. Methods: Between February 2016 and March 2017, patients undergoing total hip arthroplasty (THA) with imageless navigation were included in the present single-center study. Cup inclination angle was set at 40 degrees in all cases but the anteversion angle varied depending on the stem anteversion in each case using a combined anteversion technique. The final cup was aligned at target angles in both inclination and anteversion, the tracker was detached from the insertion handle and the surgeon inserted the cup until it was seated completely. The tracker was attached again to display both inclination and anteversion angles and these angles were recorded. Deviated Inclination Angles (DIA) and Deviated Anteversion Angles (DAA) in each case were calculated. Results: There were 124 cases in the present study. The mean age of the patients was 60.2 years (25-93). There were equal numbers of right-sided and left-sided operations, 62 cases each. There were 114 cases (91.9%) with DIA. The mean DIA was 2.65 (0 -8, SD 1.66). The DIA decreased in 107 cases (86.3%) with 12 cases (9.7%) showing a decrease of 5 or more. The DIA increased in 7 cases (5.6%) with 2 cases (1.6%) showing an increase of 5 or more. There were 103 cases (83.1%) with DAA. The mean DAA was 2.3 (0 -14 , SD 2.3). The DAA increased in 78 cases (62.9%) with 11 cases (8.3%) increasing by 5 or more. The DAA decreased in 25 cases (20.2%) with 4 cases (3.2%) decreasing by 5 or more. The DIA was significantly higher in males than in females (p ¼ .012). There was significant correlation between DAA and patient's age (p ¼ .037). There was no significant difference between DIA or DAA and side of operation. Conclusion: Changes in cup orientation were observed in most cases during cup insertion with hammer blows detected by imageless navigation. Deviation of cup alignment from target angle during press-fit insertion was a possible cause of cup malalignment, male gender and patient's age were influential factors.

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Effect of screw fixation on acetabular component alignment change in total hip arthroplasty

Cited by 21 publications

References 15 publications

Cup Alignment Change after Screw Fixation in Total Hip Arthroplasty

Cup Alignment Change after Screw Fixation in Total Hip Arthroplasty

Changes in acetabular component alignment due to screw fixation in patients with hip dysplasia

Deviation of cup alignment from target angle during press-fit insertion

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