Proposal of accurate cup placement procedure during total hip arthroplasty based on pelvic tilt discrepancies in the lateral position

Abstract

By combining the anatomical-pelvic-plane (APP) positioner with a newly improved navigation system during total hip arthroplasty (THA), it is theoretically possible to determine cup orientation based on the APP while tracking pelvic movement. The purpose of this study was to determine the navigation accuracy and whether the error is related to the pelvic position fixed by the positioner. Fifty hips that underwent primary THA between 2018 and 2020 were analysed. The accuracy was 2.34° at radiographic inclination (RI) and − 5.01° at radiographic anteversion (RA), and the error was within 10° at both RI and RA in only 40 of 50 hips (80.0%). The discrepancy in pelvic sagittal tilt was correlated with the cup orientation error and especially strongly correlated with the RA error (r = − 0.751, p < 0.001). When RI and RA were calculated using a correction formula to determine the true cup orientation based on the pelvic tilt discrepancies, the error in both RI and RA was within 10° in all cases (100%). The navigation accuracy is related to the pelvic position fixed by the positioner, and the correction formula for the target angle that considers pelvic tilt discrepancies can lead to accurate cup placement in the future.

Logistic Regression Analysis of Risk Factors and Improvement of Clinical Treatment of Traumatic Arthritis after Total Hip Arthroplasty (THA) in the Treatment of Acetabular Fractures

“…With the increase of high energy injury, the incidence of acetabular fracture is increasing year by year [ 8 ]. Because the acetabular fracture involves the important weight-bearing joint of the lower limb and is an intra-articular fracture, anatomical reduction is of great significance to maintain the function of the hip joint [ 9 ]. According to the detailed discussion of scholars on acetabular fracture, the concept of surgical treatment has been gradually established [ 10 ].…”

Accuracy of a novel accelerometer-based navigation (Naviswiss) for total hip arthroplasty in the supine position

“…The absolute deviations of the postoperative measured angle from the target position were ranged from 2.6° to 3.8° in inclination, and the values in anteversion were ranged from 2.7° to 3.8° [ 6 – 10 ]. The absolute value of navigation error in inclination was reported as 3.2° and navigation error in anteversion was 6.0° in the lateral decubitus position [ 13 ]. The absolute deviation of the postoperative measured angle from the target position was 3.7°in inclination, and the values in anteversion were ranged from 5.9° to 6.0° [ 11 , 12 ].…”

“…When used HipAlign in the lateral decubitus position, the longitudinal plane of body is registered by holding the registration probe parallel to long axis of body [ 11 ]. Pelvic position fixed by the positioner could be the major factor affecting the anteversion accuracy in the lateral decubitus position [ 13 ].…”

“…Pelvic position fixed by the positioner could be the major factor affecting the anteversion accuracy in the lateral decubitus position [ 13 ].…”

“…The costs are much lower for portable navigation systems than for large console navigation systems. An accelerometer-based portable navigation system (HipAlign; OrthAlign, Aliso Viejo, CA) has been used in THA, comprising accelerometers, gyroscopes, and inertial detectors to communicate between a reference sensor and the display unit [ 6 – 13 ]. Several studies have reported that HipAlign has significantly improved the accuracy of cup inclination and anteversion [ 6 – 13 ].…”