Functional acetabular component position with supine total hip replacement

Eilander, Wouter; Harris, Simon; Henkus, Hans-Erik; Cobb, Justin P.; Hogervorst, Tom

doi:10.1302/0301-620x.95b10.31446

Cited by 53 publications

(48 citation statements)

References 36 publications

(51 reference statements)

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“…Meanwhile, McCollum and Gray 8 suggested the cup to be placed between 20° and 40° of anteversion based on 5 dislocations. Although Lewinnek's "safe zone" is considered obsolete by many surgeons, 17,18 it is often used in the literature to allow consistent comparison of outcomes.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of the modified Hardinge approach in acetabular positioning

Goyal

Lau

McCalden

et al. 2016

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Background:The surgical approach chosen for total hip arthroplasty (THA) may affect the positioning of the acetabular component. The purpose of this study was to examine the accuracy in orienting the acetabular component using the modified Hardinge approach. Methods:We used our institutional arthroplasty database to identify patients with primary, press-fit, hemispherical acetabular components of a metal-on-polyethylene THA performed between 2003 and 2011. Patients with radiographs obtained 1-3 years after the index procedure were included for measurement of anteversion and inclination angles. Acceptable values of anteversion and abduction angles were defined as 15° ± 10° and 40° ± 10°, respectively. Results:We identified 1241 patients from the database, and the modified Hardinge approach was used in 1010 of the patients included in our analysis. The acetabular component was anteverted in the acceptable zone in 54.1% of patients. The abduction angle was within the defined range in 79.2% of patients. Combined anteversion and abduction angles within the defined zone were present in 43.6% of patients. Conclusion:Consistent with studies examining accuracy from other approaches, our study reveals that the modified Hardinge approach was only moderately accurate in positioning the acetabular component in the acceptable zone.

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Section: Discussionmentioning

confidence: 99%

Accuracy of the modified Hardinge approach in acetabular positioning

Goyal

Lau

McCalden

et al. 2016

cjs

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“…Although the omega zone addresses all hip morphology parameters relevant for FAI, postural factors such as pelvic tilt and lumbosacral lordosis also influence femoral head position in the acetabulum. Nevertheless, for persons positioned supine in a CT scanner, there is a fairly robust correlation with their standing posture [6,7]. Finally, the analysis of the omega zone was performed with steps of 30°of flexion.…”

Section: Discussionmentioning

confidence: 99%

Can Combining Femoral and Acetabular Morphology Parameters Improve the Characterization of Femoroacetabular Impingement?

Bouma

Hogervorst

Audenaert

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Femoroacetabular impingement (FAI) presupposes a dynamic interaction of the proximal femur and acetabulum producing clinical symptoms and chondrolabral damage. Currently, FAI classification is based on alpha angle and center-edge angle measurements in a single plane. However, acetabular and femoral version and neck-shaft angle also influence FAI. Furthermore, each of these parameters has a reciprocal interaction with the others; for example, a shallow acetabulum delays impingement of the femoral head with the acetabular rim. Questions/purposes We introduce the new parameter ''omega zone,'' which combines five parameters into one: the alpha and center-edge angles, acetabular and femoral version, and neck-shaft angle. We sought to determine whether the omega zone could differentiate patients with FAI from (1) normal control subjects (alpha \ 55°), but also from (2) control subjects with elevated alpha angles (C 55°). Methods We evaluated CT data of 20 hips of male patients with symptomatic cam-type FAI and of 35 male hips extracted from 110 anonymized CT scans for vascular diagnosis. We excluded hips with osteoarthritis, developmental dysplasia, or coxa profunda (center-edge angle 20°-45°on AP pelvic view or corresponding coronal CT views). With dedicated software, femoral and pelvic orientation was standardized; we tested the omega zone in four hip positions in three distinct groups: patients with cam-type FAI (alpha [ 60°) and control subjects with normal (\ 55°) and high alpha angles (C 55°). Results The omega zone was smaller in patients with cam-type FAI than normal control subjects (alpha angle \ 55°) at 60°and 90°of flexion (mean, 12%; 95% confidence interval [CI], 7-17; p = 0.008; Cohen's d = 9%; 95% CI, 4-13; p = 0.003). Furthermore, the omega zone was smaller in all positions in patients with cam-type FAI than control subjects with high alpha angles (0°p = 0.017, 30°p = 0.004, 60°p = 0.004, 90°p = 0.007). In contrast, the omega zone did not differ between control subjects with normal or high alpha angles. In all hips, the omega zone decreased with flexion, corresponding to a decrease in remaining impingement-free motion with flexion.

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“…Acetabular anteversion of 20-30°could be adopted for cup placement based on the total excursion of the pelvis from standing to sitting. Supine on table positioning has been advocated to achieve accurate cup positioning but is subject to surgeon preference [25].…”

Section: Discussionmentioning

confidence: 99%