How does pelvic rotation or tilt affect radiographic measurement of acetabular component inclination angle during THA?

Mellano, C; Spitzer, Andrew I.

doi:10.1016/j.jor.2015.05.009

Cited by 18 publications

(14 citation statements)

References 9 publications

(4 reference statements)

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“…Despite their ongoing use, radiographs are subject to artifacts and are limited by an inability to adequately account for the distortion caused by 3D variations of pelvic orientation such as pelvic tilt, obliquity, and rotation [3,6]. By some estimates, the likelihood of an AP pelvic view being free of artifact or distortion is only 30% [7], a point that illustrates the existing limitations of radiographs, which provide significantly less accurate cup position measurements when compared to other modalities such as CT imaging. The impact of this potential error can have a significant impact on post-THA image analysis, increasing the likelihood of errors in cup placement and leading to postoperative complications such as accelerated component wear, component loosening, reduced range of motion, pain, and a greater risk of impingement or dislocation [4,6,8].…”

Section: Discussionmentioning

confidence: 99%

A Novel Method for Correcting Pelvic Tilt on Anteroposterior Pelvic Radiographs

Muir¹,

Vincent²,

Schipper³

et al. 2019

Cureus

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Section: Discussionmentioning

confidence: 99%

A Novel Method for Correcting Pelvic Tilt on Anteroposterior Pelvic Radiographs

Muir¹,

Vincent²,

Schipper³

et al. 2019

Cureus

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“…Forward or anteriorpelvic tilt causes a decrease in inclination and vice versa 37. Although the mean change is not significant (mean 2°),39 as the change in inclination happens in a nonlinear manner, patients with larger posterior tilts have a larger change in inclination (mean change 0.29° per degree of posterior pelvic tilt as opposed to 0.47° per degree when patient has 15° posterior tilt) 40…”

Section: Section I – Defining Cup Positionmentioning

confidence: 99%

Current Concepts in Acetabular Positioning in Total Hip Arthroplasty

Bhaskar

Rajpura

Board

2017

IJOO

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Being one of the most successful surgeries in the history of medicine, the indications for total hip arthroplasty have widened and are increasingly being offered to younger and fitter patients. This has also led to high expectations for longevity and outcomes. Acetabular cup position has a significant impact on the results of hip arthroplasty as it affects dislocation, abductor muscle strength, gait, limb lengths, impingement, noise generation, range of motion (ROM), wear, loosening, and cup failure. The variables in cup position are depth, height, and angular position (anteversion and inclination). The implications of change in depth of center of rotation (COR) are medialized versus anatomical positioning. As opposed to traditional medialization with beneficial effects on joint reaction force, the advantages of an anatomical position are increasingly recognized. The maintained acetabular offset offers advantages in terms of ROM, impingement, cortical rim press fit, and maintaining medial bone stock. The height of COR influences muscle activity and limb lengths and available bone stock for cup support. On the other hand, ideal angular position remains a matter of much debate and reliably achieving a target angular position remains elusive. This is not helped by variations in the way we describe angular position, with operative, radiologic, or anatomic definitions being used variably to describe anteversion and inclination. Furthermore, pelvic tilt plays a major role in functional positions of the acetabulum. In addition, commonly used techniques of positioning often do not inform us of the real orientation of the pelvis on operating table, with possibility of significant adduction, flexion, and external rotation of the pelvis being possibilities. This review article brings together the evidence on cup positioning and aims to provide a systematic and pragmatic approach in achieving the best position in individual cases.

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“…7 However, the lower point of sacroiliac joint, which was used as a reference point by Fessy et al and Pierchon et al, may also be affected by developmental abnormality of pelvis as in case of DDH, in addition to abnormal pelvic positioning during radiographic examination. 8 , 22 , 26 The method, which is presented in this study and takes the upper end of the iliac bone as a reference point, is more reliable from this point of view ( Fig. 2 ).…”

Section: Discussionmentioning

confidence: 89%

Determination of the hip rotation centre from landmarks in pelvic radiograph

Bombacı¹,

Simsek²,

Soyarslan³

et al. 2017

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThe hip rotation centre (HRC) is an important reference point in cases of total hip arthroplasty (THA). The aim of this study is to investigate the reference points in the Turkish population that enable the identification of the HRC in standard pelvic radiographs.MethodsThe pelvic radiographs of 50 women and 50 men were examined. The mean age was 46.2 (range; 18–91). Patients with deformity of the hip joint and non-standard pelvic radiograph due to hip flexion contracture were excluded from the study. The pelvic height (PH), the distance between the HRC and teardrop (HRC-Td), and the HRC and the line tangent tuber ischiadicums (HRC-TI) were measured. The ratio of HRC-Td and HRC-TI to PH were calculated. The first is called “the horizontal-HRC ratio” and the second, “the vertical-HRC ratio”.ResultsMean PH was 239 (±13.58) mm in males and 225 (±12.52) in females (p < 0.0001). The distances of HRC-TI were 71 (±6.35) and 65 (±6.72) mm (p < 0.0001) and the distance of HRC-Td were 34 (±3.73) and 30 (±4.05) mm (p = 0.0007), respectively. The vertical-HRC ratios were 30.01% (±2.05) for males, 29.10% (±2.35) for females, the horizontal-HRC ratio, 14.25% (±1.42) and 13.69% (±1.38), respectively (p > 0.05).ConclusionAlthough the quantitative values obtained in the present study differ between the genders, the ratios (“vertical-HRC” and “horizontal-HRC”) are comparable in both sexes. The results show that these proposed ratios can be used in THA planning, regardless of gender in the Turkish populationLevel of evidenceLevel IV, diagnostic study.

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How does pelvic rotation or tilt affect radiographic measurement of acetabular component inclination angle during THA?

Abstract: A trend exists toward slight underestimation of cup abduction angle measurement using intraoperative radiographs. Pelvic tilt or obliquity alters the measured cup abduction angle in known directions.

Cited by 18 publications

References 9 publications

A Novel Method for Correcting Pelvic Tilt on Anteroposterior Pelvic Radiographs

A Novel Method for Correcting Pelvic Tilt on Anteroposterior Pelvic Radiographs

Current Concepts in Acetabular Positioning in Total Hip Arthroplasty

Determination of the hip rotation centre from landmarks in pelvic radiograph

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