New Cross-Table Lateral Radiography Method for Measuring Acetabular Component Anteversion in Total Hip Arthroplasty: A Prospective Study of 93 Primary THA

Seo, Hajime; Naito, Masatoshi; Nakamura, Yoshinari; Kinoshita, Koichi; Nomura, Taishin; Minokawa, So; Minamikawa, Tomohiko; Yamamoto, Takuya

doi:10.5301/hipint.5000456

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…While the most common historical methods for determining implantation parameters for acetabular components have included mechanical alignment guides and reference against the TAL [77], both methods have been shown to be unreliable [103] and hinge on precise judgement 'as per the surgeons eye' [114]. Accurate determination of anteversion during conventional hip replacement surgery can be difficult [90], even in experienced hands. Technology-assisted surgical options-such as computer-navigation-however may provide a solution to the limitations of visual human assessment.…”

Section: Discussionmentioning

confidence: 99%

“…accurately perpendicular to the long axis of the pelvis), concerns regarding radiation exposure and fundamental problems with the interpretation of an image captured in a decubitus position (as compared to the 'routine' AP supine or standing states) are all noteworthy considerations. While some authors advocate the use of imaging routinely [89,90] (most often fluoroscopy [80]) as an intra-operative aid-especially in the setting of a high BMI patient [80]-others have suggested limited utility through such means citing mismatch between apparent 'during surgery' and post-operative radiographic cup inclination and anteversion perception using intra-operative radiographs versus the post-operative gold standard [91] concluding that in-theatre determinations may not reflect post-operative targets.…”

Section: Intra-operative Execution Of the Surgical Planmentioning

confidence: 99%

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Advanced, Imageless Navigation in Contemporary THA: Optimising Acetabular Component Placement

Kurmis¹

2023

Arthroplasty - Advanced Techniques and Future Perspectives

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Total hip arthroplasty (THA) stands as a reliable and effective way to manage end-stage hip disease secondary to a number of aetiologic conditions. While target ‘safe zones’ are widely quoted and endorsed, an increasingly robust body of evidence suggests that such idealised implantation goals have limited utility in patient-to-patient considerations and that even with a precise goal in mind, surgeons perform inconsistently in achieving these targets intra-operatively. Inter-patient variability, the concept of ‘functional’ safe zones and the largely under-appreciated impact of poor patient positioning (and progressive loss of position during the case) are all recognised and evidence-supported opponents of conventional ‘40/15’ approaches. In an environment whereby accountable cost utility, maximised surgical consistency (i.e., outlier minimisation), improved attainment of target position, and awareness of the radiation exposure burden of many pre-operative templating regimes are all paramount, there appears to be an increasing role for the application of imageless ‘mini’ intra-operative navigation systems for primary (and revision) THA procedures. This chapter reviews the evolution of THA navigation and discusses contemporary applications, defines the challenges associated with unanticipated pelvic movement, and explores potential future directions in the use of this exciting technology.

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Section: Discussionmentioning

confidence: 99%

Section: Intra-operative Execution Of the Surgical Planmentioning

confidence: 99%

Advanced, Imageless Navigation in Contemporary THA: Optimising Acetabular Component Placement

Kurmis¹

2023

Arthroplasty - Advanced Techniques and Future Perspectives

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A new radiographic acetabular cup anteversion measurement method in total hip arthroplasty: a clinical study

Saka¹,

Altun

Burç

et al. 2019

Eur J Orthop Surg Traumatol

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Spinopelvic mobility affects accuracy of acetabular anteversion measurements on cross-table lateral radiographs

Bracey

Hegde

Shimmin

et al. 2021

The Bone & Joint Journal

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Aims Cross-table lateral (CTL) radiographs are commonly used to measure acetabular component anteversion after total hip arthroplasty (THA). The CTL measurements may differ by > 10° from CT scan measurements but the reasons for this discrepancy are poorly understood. Anteversion measurements from CTL radiographs and CT scans are compared to identify spinopelvic parameters predictive of inaccuracy. Methods THA patients (n = 47; 27 males, 20 females; mean age 62.9 years (SD 6.95)) with preoperative spinopelvic mobility, radiological analysis, and postoperative CT scans were retrospectively reviewed. Acetabular component anteversion was measured on postoperative CTL radiographs and CT scans using 3D reconstructions of the pelvis. Two cohorts were identified based on a CTL-CT error of ≥ 10° (n = 11) or < 10° (n = 36). Spinopelvic mobility parameters were compared using independent-samples t-tests. Correlation between error and mobility parameters were assessed with Pearson’s coefficient. Results Patients with CTL error > 10° (10° to 14°) had stiffer lumbar spines with less mean lumbar flexion (38.9°(SD 11.6°) vs 47.4° (SD 13.1°); p = 0.030), different sagittal balance measured by pelvic incidence-lumbar lordosis mismatch (5.9° (SD 18.8°) vs -1.7° (SD 9.8°); p = 0.042), more pelvic extension when seated (pelvic tilt -9.7° (SD 14.1°) vs -2.2° (SD 13.2°); p = 0.050), and greater change in pelvic tilt between supine and seated positions (12.6° (SD 12.1°) vs 4.7° (SD 12.5°); p = 0.036). The CTL measurement error showed a positive correlation with increased CTL anteversion ( r = 0.5; p = 0.001), standing lordosis ( r = 0.23; p = 0.050), seated lordosis ( r = 0.4; p = 0.009), and pelvic tilt change between supine and step-up positions ( r = 0.34; p = 0.010). Conclusion Differences in spinopelvic mobility may explain the variability of acetabular anteversion measurements made on CTL radiographs. Patients with stiff spines and increased compensatory pelvic movement have less accurate measurements on CTL radiographs. Flexion of the contralateral hip is required to obtain clear CTL radiographs. In patients with lumbar stiffness, this movement may extend the pelvis and increase anteversion of the acetabulum on CTL views. Reliable analysis of acetabular component anteversion in this patient population may require advanced imaging with a CT scan. Cite this article: Bone Joint J 2021;103-B(7 Supple B):59–65.

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New Cross-Table Lateral Radiography Method for Measuring Acetabular Component Anteversion in Total Hip Arthroplasty: A Prospective Study of 93 Primary THA

Abstract: The anteversion values measured with our new method were closer to the CT values used as a reference standard than those with standard CL radiographs. Our new method appears to be reliable and valid for measuring acetabular component anteversion.

Cited by 3 publications

References 22 publications

Advanced, Imageless Navigation in Contemporary THA: Optimising Acetabular Component Placement

Advanced, Imageless Navigation in Contemporary THA: Optimising Acetabular Component Placement

A new radiographic acetabular cup anteversion measurement method in total hip arthroplasty: a clinical study

Spinopelvic mobility affects accuracy of acetabular anteversion measurements on cross-table lateral radiographs

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