Intraoperative pelvic motion in total hip arthroplasty

Asayama, Isao; Akiyoshi, Yuichiro; Naito, Masatoshi; Ezoe, Masamitsu

doi:10.1016/j.arth.2004.03.013

Cited by 67 publications

(46 citation statements)

References 7 publications

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“…A considerable change in pelvic position intra-operatively was detected, similar to previous findings of Asayama et al, 14 who reported that internal rotation is the primary movement that takes place during THR. Although patient factors did not influence pelvic movement, surgical factors did, in particular pelvic support, approach and type of procedure.…”

Section: Discussionsupporting

confidence: 89%

Pelvic position and movement during hip replacement

Grammatopoulos

Pandit

Assuncao³

et al. 2014

The Bone & Joint Journal

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The orientation of the acetabular component is influenced not only by the orientation at which the surgeon implants the component, but also the orientation of the pelvis at the time of implantation. Hence, the orientation of the pelvis at set-up and its movement during the operation, are important. During 67 hip replacements, using a validated photogrammetric technique, we measured how three surgeons orientated the patient's pelvis, how much the pelvis moved during surgery, and what effect these had on the final orientation of the acetabular component. Pelvic orientation at set-up, varied widely (mean (± 2, standard deviation (sd))): tilt 8° (2sd ± 32), obliquity -4° (2sd ± 12), rotation -8° (2sd ± 14). Significant differences in pelvic positioning were detected between surgeons (p < 0.001). The mean angular movement of the pelvis between set-up and component implantation was 9° (sd 6). Factors influencing pelvic movement included surgeon, approach (posterior > lateral), procedure (hip resurfacing > total hip replacement) and type of support (p < 0.001). Although, on average, surgeons achieved their desired acetabular component orientation, there was considerable variability (2sd ± 16) in component orientation. We conclude that inconsistency in positioning the patient at set-up and movement of the pelvis during the operation account for much of the variation in acetabular component orientation. Improved methods of positioning and holding the pelvis are required.

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Section: Discussionsupporting

confidence: 89%

Pelvic position and movement during hip replacement

Grammatopoulos

Pandit

Assuncao³

et al. 2014

The Bone & Joint Journal

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“…The more common surgical approaches require that the patient be positioned in the lateral decubitus position which may result in tilting of the pelvis anteriorly during surgery [11, 12]. This anterior pelvic tilt if unrecognized intraoperatively may result in placement of the acetabular cup with inadequate anteversion, thus predisposing to posterior dislocation.…”

Section: Discussionmentioning

confidence: 99%

Early Clinical and Radiographic Results of Minimally Invasive Anterior Approach Hip Arthroplasty

Alexandrov

Ahlmann

Menendez

2014

Advances in Orthopedics

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We present a retrospective review of the early results and complications in a series of 35 consecutive patients with 43 total hip arthroplasties performed through an anterior muscle sparing minimally invasive approach. We found the early complication rates and radiographic outcomes comparable to those reported from arthroplasties performed via traditional approaches. Complications included dislocation (2%), femur fracture (2%), greater trochanteric fracture (12%), postoperative periprosthetic intertrochanteric fracture (2%), femoral nerve palsy (5%), hematoma (2%), and postoperative iliopsoas avulsion (2%). Radiographic analysis revealed average cup anteversion of 19.6° ± 6.6, average cup abduction angle of 48.4° ± 7, stem varus of 0.9° ± 2, and a mean leg length discrepancy of 0.7 mm. The anterior approach to the hip is an attractive alternative to the more traditional approaches. Acceptable component placement with comparable complication rates is possible using a muscle sparing technique which may lead to faster overall recovery.

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“…31,32 Further, variability of patient positioning in the lateral decubitus restricts correct identification of the coronal plane. Supine patient positioning for THR with a stable pelvic position and the coronal plane positioned parallel to the operating table and the floor reduces these problems.…”

Section: Discussionmentioning

confidence: 99%

Functional acetabular component position with supine total hip replacement

Eilander

Harris

Henkus

et al. 2013

The Bone & Joint Journal

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Orientation of the acetabular component influences wear, range of movement and the incidence of dislocation after total hip replacement (THR). During surgery, such orientation is often referenced to the anterior pelvic plane (APP), but APP inclination relative to the coronal plane (pelvic tilt) varies substantially between individuals. In contrast, the change in pelvic tilt from supine to standing (dPT) is small for nearly all individuals. Therefore, in THR performed with the patient supine and the patient's coronal plane parallel to the operating table, we propose that freehand placement of the acetabular component placement is reliable and reflects standing (functional) cup position. We examined this hypothesis in 56 hips in 56 patients (19 men) with a mean age of 61 years (29 to 80) using three-dimensional CT pelvic reconstructions and standing lateral pelvic radiographs. We found a low variability of acetabular component placement, with 46 implants (82%) placed within a combined range of 30° to 50° inclination and 5° to 25° anteversion. Changing from the supine to the standing position (analysed in 47 patients) was associated with an anteversion change < 10° in 45 patients (96%). dPT was < 10° in 41 patients (87%). In conclusion, supine THR appears to provide reliable freehand acetabular component placement. In most patients a small reclination of the pelvis going from supine to standing causes a small increase in anteversion of the acetabular component.

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Intraoperative pelvic motion in total hip arthroplasty

Cited by 67 publications

References 7 publications

Pelvic position and movement during hip replacement

Pelvic position and movement during hip replacement

Early Clinical and Radiographic Results of Minimally Invasive Anterior Approach Hip Arthroplasty

Functional acetabular component position with supine total hip replacement

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