Pelvic pitch and roll during total hip arthroplasty performed through a posterolateral approach. A potential source of error in free-hand cup positioning

Valle, A. Gonzalez Della; Shanaghan, Kate; Benson, Jessica R; Carroll, Kaitlin M.; Cross, Michael B.; McLawhorn, Alexander S.; Sculco, Peter K.

doi:10.1007/s00264-018-4141-2

Cited by 14 publications

(7 citation statements)

References 25 publications

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“…The known risk factors for malpositioning consist of obesity, low experience of the surgeon and the use of minimally invasive approaches [18]. In addition, it was reported that intraoperative changes in pelvic position could lead to malpositioning of the acetabular cup [11]. In this study, we showed that more successful outcomes could be obtained by using our novel lateral support system that rapidly provides a more stable lateral decubitus position and appears to enable better acetabular cup positioning.…”

Section: Discussionmentioning

confidence: 66%

“…However, bone and soft tissue landmarks used for acetabular cup orientation are based on the assumption that the pelvis is maintained in a firm and fixed lateral position during surgery. Therefore, intraoperative changes in patient position or other changes that would disrupt the position during preoperative preparation would directly have a negative impact on acetabular cup orientation [11].…”

Section: Introductionmentioning

confidence: 99%

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Novel lateral support system increases stability and reduces angular error in total hip arthroplasty: A case control study

Dağtaş

Ünal²,

NACEFOV³

et al. 2022

Journal of Surgery and Medicine

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Background/Aim: Intraoperative changes in patient position or other changes that would disrupt the decisive position during preoperative preparation would directly have a negative impact on acetabular cup orientation in patients undergoing total hip arthroplasty. This study aimed to compare the standard support system and a novel lateral support system (Maltepe), which ensures stable lateral decubitus positioning during the perioperative period, in patients undergoing total hip arthroplasty with the posterolateral approach. Methods: Patients operated in our department for osteoarthritis of the hip between 2012 -2019 were included in this case-control study retrospectively. 46 and 41 patients were prepared for surgery in lateral decubitus position using the classical (Group 1) and novel (Group 2) lateral support systems, respectively. The groups were compared in terms of demographic characteristics, duration of preparation, anteversion and inclination, and Harris Hip scores. Results: Mean patient age was 66.89 (7.53). There was no significant difference between the two groups in terms of age (P=0.546), gender (P=1.00), body mass index (P=0.302) and the operative side (P=0.724). Duration of preparation and absolute deviation values from 15 degrees and 45 degrees were significantly better in group 2 compared to group 1 (P<0.01). There was no significant difference between the Harris Hip Scores of two groups. Conclusion:We demonstrated that the novel support system we developed provided more successful outcomes than the classical system in terms of acetabular cup orientation.

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Section: Discussionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Novel lateral support system increases stability and reduces angular error in total hip arthroplasty: A case control study

Dağtaş

Ünal²,

NACEFOV³

et al. 2022

Journal of Surgery and Medicine

View full text Add to dashboard Cite

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“…[5][6][7][8][9][10][11] A lack of defined anatomical landmarks and deceptive intraoperative positioning of the patient tend to cause cup malpositioning, which would increase the risk of dislocation and accelerating polyethylene wear after THA. [12][13][14][15] In recent years, the use of robot-assisted technology in executing THA for many complex cases has increased, and many studies have reported that robots can improve the accuracy of prosthetic positioning in THA. 14,[16][17][18] Therefore, we conducted a retrospective cohort study to evaluate the safety and efficacy of robot-assisted THA for arthrodesed hips.…”

Section: Introductionmentioning

confidence: 99%

<p>Robot-Assisted Total Hip Arthroplasty for Arthrodesed Hips</p>

Chai¹,

Kong²,

Yang³

et al. 2020

TCRM

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Background: Conversion of arthrodesed hips to total hip arthroplasty (THA) remains technically demanding. This study aims to evaluate the safety and efficacy of robotassisted THA in arthrodesed hips. Methods: We retrospectively analyzed 45 ankylosing spondylitis patients with hip arthrodesis in the Chinese PLA General Hospital between August 2018 and August 2019. All surgeries were carried out by one single surgeon. The patients were followed at 3 months after surgery. Gender, body mass index, angle of hip arthrodesis, operating time, intraoperative fluoroscopic times, postoperative length of hospitalization, cup positioning, postoperative leg length discrepancy, offset discrepancy, intraoperative and postoperative complications, and postoperative Harris Hip Score were collected for all patients. Results: Twenty-two patients (35 hips) who underwent robot-assisted THA and 23 patients (37 hips) who underwent manual THA were enrolled in this study. There were no significant differences in demographics and arthrodesed angles between the two groups. The fluoroscopic times during manual THA were significantly higher than those during robot-assisted THA (2.16±1.61 vs 0.47±0.61, respectively, p=0.000). In the robotic group, the percentage of acetabular cups within the safe zone was significantly greater than in the manual group (94.29% vs 67.56%, respectively, p=0.042). For manual THA, the anteversions were significantly different between the left and right sides (21.14±7.86 vs 16.00±6.32, respectively, p=0.042); however, no such significant difference was found in robot-assisted THA. Conclusion: Compared with manual THA for arthrodesed hips, robot-assisted THA had significant advantages in improving the frequency of achieving cup positioning within the target zone with diminished radiation dose and no increase in operating time.

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“…We hypothesize that these small discrepancies in acetabular orientation are the result of several factors. Rodriguez et al 24 described that in DAA cups were intentionally positioned with less anteversion because of concerns about anterior instability, and Gonzalez Della Valle et al 46 demonstrated that in PA the surgeon tends to overestimate intraoperative cup anteversion because of a progressive anterior pelvic roll. Further studies are required to determine whether the surgical approach is an independent factor for implant positioning.…”

Section: Discussionmentioning

confidence: 99%

Use of Surgical Approach Is Not Associated With Instability After Primary Total Hip Arthroplasty: A Meta-analysis Comparing Direct Anterior and Posterolateral Approaches

Huerfano

Bautista

Huérfano

et al. 2020

J Am Acad Orthop Surg

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Introduction: Posterolateral approach (PA) has been historically associated with an increased risk of dislocation after primary total hip arthroplasty (THA), especially when compared with the direct anterior approach (DAA). However, current evidence is inconsistent regarding the risk of dislocation with either approach. The purpose of this study is to determine whether surgical approach influences joint stability. Methods: A systematic search in PubMed, MEDLINE, and Embase databases was performed. Randomized controlled trials (RCTs) and non-RCTs comparing DAA with PA in primary THA were included. Pooled effect measure of risk differences, relative risk and mean differences for postoperative dislocation, acetabular implant positioning, and leg length discrepancy were calculated. Results: Twenty-five studies (5 RCTs and 20 non-RCTs) of 7,172 THAs were assessed. There were no significant differences in dislocation rates between approaches (risk difference = −0.00, 95% confidence interval: −0.01 to 0.00; P = 0.92; I2 = 0%). Results were similar in the subgroup analysis of RCTs (P = 0.98), posterior soft-tissue repair (P = 0.50), and learning curve (P = 0.77). The acetabular implant was better positioned within the safe zone in the DAA group (relative risk = 1.17; 95% confidence interval: 1.03 to 1.33; P = 0.01), but no significant differences were found in cup inclination (P = 0.8), anteversion (P = 0.10), and leg length discrepancy (P = 0.54). Conclusion: Dislocation rates after THA are not different between DAA and PA. Furthermore, no differences in the rate of dislocation were associated with cup positioning or surgical factors related with hip instability. Therefore, the surgical approach has little influence in prosthesis instability after primary THA. Level of Evidence: Level III

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Pelvic pitch and roll during total hip arthroplasty performed through a posterolateral approach. A potential source of error in free-hand cup positioning

Cited by 14 publications

References 25 publications

Novel lateral support system increases stability and reduces angular error in total hip arthroplasty: A case control study

Novel lateral support system increases stability and reduces angular error in total hip arthroplasty: A case control study

<p>Robot-Assisted Total Hip Arthroplasty for Arthrodesed Hips</p>

Use of Surgical Approach Is Not Associated With Instability After Primary Total Hip Arthroplasty: A Meta-analysis Comparing Direct Anterior and Posterolateral Approaches

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