Fluoroscopically Guided Acetabular Component Positioning: Does It Reduce the Risk of Malpositioning in Obese Patients?

Gösthe, Raúl G.; Suárez, Juan C.; McNamara, Colin A.; Calvo, Cecilia; Patel, Preetesh D.

doi:10.1016/j.arth.2017.04.045

Cited by 13 publications

(9 citation statements)

References 19 publications

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“…2 Although their results demonstrated that the odds for malpositioning increased by 0.2 for each 5 kg/ m 2 , we did not find any statistically significant associations between a patient's BMI and the incidence of acetabular component malpositioning for either inclination or anteversion when performing DAA THA. Our findings are aligned with the findings of Gosthe et al 5 Potential weaknesses of this study include that lack of comparison of surgical time. Without this data, we cannot definitively conclude that intraoperative referencing decreases surgical time or is more efficient than intraoperative fluoroscopy.…”

Section: Discussionsupporting

confidence: 89%

Intra-operative referencing technique is non-inferior to use of fluoroscopy for acetabular component positioning in anterior hip arthroplasty

Summers

Ocksrider

Lezak

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Background: Intra-operative fluoroscopy has been shown to improve the accuracy of acetabular component positioning when compared to no fluoroscopy in direct anterior approach (DAA) total hip arthroplasty (THA). Due to logistical reasons, our senior author has been performing DAA THA at one institution without the use of fluoroscopy and has created an intraoperative referencing technique to aid in acetabular component positioning. The purpose of this study is to evaluate the accuracy of acetabular component positioning using fluoroscopy when compared to an intra-operative referencing technique without fluoroscopy. Methods: A total of 214 consecutive primary DAA THA were performed by one surgeon at two institutions and were retrospectively reviewed over a 3-year period. Intra-operative fluoroscopy was used with all patients at Institution A (N ¼ 154). At institution B (N ¼ 60), no fluoroscopy was used, and an intra-operative referencing technique was employed to assist in placement of the acetabular component. Results: In the fluoroscopy group, 91% of components met our abduction target, 90% met our anteversion target, and 82.5% simultaneously met both targets. In the non-fluoroscopy group, 98% of components met our abduction target, 92% met our anteversion target, and 90% simultaneously met both targets. There was no difference between groups for placement of the component within both targets simultaneously (p ¼ .171). Conclusion: Use of our intra-operative referencing technique is non-inferior in placing acetabular components within a pre-defined safe zone when compared to use of intraoperative fluoroscopy. The intraoperative reference technique can be a helpful adjunct for ensuring accurate acetabular component positioning while simultaneously reducing cost and limiting radiation exposure.

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Section: Discussionsupporting

confidence: 89%

Intra-operative referencing technique is non-inferior to use of fluoroscopy for acetabular component positioning in anterior hip arthroplasty

Summers

Ocksrider

Lezak

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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“…Precise acetabular component placement mitigates the risk of hip instability, while avoiding impingement and restriction of the range of motion [ 23 , 24 ], but achieving accurate placement can be technically challenging. Surgeons with variable experience must account for potentially distorted or obscured bony landmarks, variation of intraoperative pelvic tilt and positioning, the limited accuracy of conventional alignment guides [ 25 , 26 ], and body habitus factors like obesity [ 27 ]. The RA-THA system in this report offers the ability to reduce outliers in acetabular component orientation.…”

Section: Discussionmentioning

confidence: 99%

Improved accuracy and fewer outliers with a novel CT-free robotic THA system in matched-pair analysis with manual THA

Kamath

Durbhakula²,

Pickering

et al. 2021

J Robotic Surg

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Accurate component orientation and restoration of hip biomechanics remains a continuing challenge in total hip arthroplasty (THA). The goal of this study was to analyze the accuracy/reproducibility of a novel CT-free and pin-less robotic-assisted THA (RA-THA) platform compared to manual THA (mTHA). This matched-pair cadaveric study compared this RA-THA system to mTHA (n = 33/arm), both using the assistance of fluoroscopic imaging, in a group of 14 high-volume arthroplasty surgeons. In both groups, surgeons were asked to aim for 40°/15° for cup inclination/version, and 0 mm of leg length discrepancy (LLD). A validated and accurate method using radio-opaque markers measured cup inclination/version and LLD. The accuracy and reproducibility (fewer outliers) of cup inclination was significantly improved in the robotic group (1.8° ± 1.3° vs 6.4° ± 4.9°, respectively, robotic vs manual; p < 0.001), with no significant difference between groups for version. The reproducibility of LLD was significantly improved in the robotic group (p = 0.003). For all parameters studied, the robotic group had an improved accuracy and lower variance (fewer outliers). The percentage of cases within the more restrictive Callanan safe zone was 100% for RA-THA vs 73% for mTHA (p = 0.002). The CT-free RA-THA platform, using only fluoroscopic imaging, demonstrated more accurate acetabular cup positioning, when compared to the mTHA procedures performed by high-volume hip surgeons (naive to this RA-THA platform), with respect to cup inclination and placement within the Lewinnek/Callanan safe zones. Future study must incorporate economic factors, lower volume surgeons, clinical and patient-centric outcomes, and other radiographic parameters in controlled studies in large sample sizes.

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“…Die Abweichung der tatsächlich erzielten von der geplanten Pfannenposition hängt vom BMI ab. Es erscheint vernünftig und wurde auch in einer Studie gezeigt, dass eine intraoperative Bildverstärkerkontrolle (BV-Kontrolle) der Pfanne diesen Fehler eliminiert, sodass die Implantatpositionierung genauso präzise wie bei schlanken Patienten möglich ist [37]. Insbesondere bei der bei adipösen Patienten vorteilhaften Seitlage wird in vielen Fällen jedoch die intraoperative Röntgenkontrolle durch im Strahlengang befindliche Seitstützen erschwert.…”

Section: Zugang Und Lagerungunclassified

Total Hip Arthroplasty in Young and Obese Patients

Matziolis

Brodt

2019

Z Orthop Unfall

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Special attention should be drawn on endoprosthetic hip replacement in young and obese patients because of an increased risk of perioperative complications and early implant failure. Gain of function and reduction of pain are not compromised in these patients, so that the indication criteria remain unchanged. Implant survival is reduced in very young patients and mainly influenced by the bearing materials. The risk of implant malalignment, specifically of the cup, can be minimized by an intraoperative X-ray control. The effect of bariatric surgery on perioperative complications remains unclear. But a preoperatively uncontrolled diabetes increases the risk of infection. Known specific risk factors of young and obese patients should be considered during the perioperative management and be included in the individual operation planning and informed consent.

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Fluoroscopically Guided Acetabular Component Positioning: Does It Reduce the Risk of Malpositioning in Obese Patients?

Cited by 13 publications

References 19 publications

Intra-operative referencing technique is non-inferior to use of fluoroscopy for acetabular component positioning in anterior hip arthroplasty

Intra-operative referencing technique is non-inferior to use of fluoroscopy for acetabular component positioning in anterior hip arthroplasty

Improved accuracy and fewer outliers with a novel CT-free robotic THA system in matched-pair analysis with manual THA

Total Hip Arthroplasty in Young and Obese Patients

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