Rigid Patient Positioning is Unreliable in Total Hip Arthroplasty

Milone, Michael T.; Schwarzkopf, Ran; Meere, Patrick; Carroll, Kaitlin M.; Jerabek, Seth A.; Vigdorchik, Jonathan M.

doi:10.1016/j.arth.2016.12.038

Cited by 20 publications

(33 citation statements)

References 17 publications

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“…The application of exertion of external forces, such as pressure hemostasis, and utilization of a restraint strap were reported as risk factors for ulcers [7]. Pelvic positioners, which are devices that apply external forces, are widely used in hip surgeries to stabilize the patient in the lateral decubitus position throughout surgery [26][27][28]. This study found a higher frequency of ulcers in surgeries that used pelvic positioners compared to those that did not (Table 1).…”

Section: Discussionmentioning

confidence: 83%

“…It is reasonable for surgeons to prefer to firmly stabilize the patient's pelvis with a pelvic positioner; however, this may put great pressure on the contact area between the patient and the positioner (pubis, ASIS, or sacrum), especially in THA, because a large degree of pelvic movement during hip arthroplasty leads to great variability in pelvic orientation at implantation. This causes wide variability in the final orientation of the acetabular component and can increase risk of acetabular component malalignment [26,27,29]. Additionally, if the pressure from the pelvic positioner exceeds the capillary interface pressure (23-32 mmHg), [30] it will cause direct capillary blood occlusion and tissue ischemia, which may lead to pressure ulcers.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for pressure ulcers from the use of a pelvic positioner in hip surgery: a retrospective observational cohort study in 229 patients

et al. 2020

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Background: Intraoperatively acquired pressure ulcers are serious postsurgical complications requiring additional treatment, reoperation, and extended hospitalization. No study has investigated the frequency of the ulcers caused by compression with a pelvic positioner, which is used in hip surgeries to stabilize patients in the lateral decubitus position. Methods: This retrospective study investigated the risk factors and the frequency of the ulcers caused by the use of pelvic positioners in hip surgeries. The records of patients who underwent surgical procedures under general anesthesia at our institution between January 1, 2016 and March 31, 2018 were reviewed. The inclusion criterion for the assessment of risk factors was hip surgery in the lateral decubitus position stabilized by a pelvic positioner. The exclusion criteria were patients with trauma, missing data, or a pre-existing pressure ulcer. Finally,.the study included 229 patients (265 hip surgeries). All the patients were positioned in the lateral decubitus position with the assistance of either a pelvic positioner, which had a single support fixture located over the pubic symphysis or a double support fixture located over the bilateral anterior superior iliac spine. Intraoperatively acquired pressure ulcers were diagnosed when ulcers were absent on admission and the redness that was observed immediately after surgery remained after 24 h. Multivariate analysis was used to identify factors associated with an increased risk for ulcers. Results: Ulcers developed in 8 of 1810 (0.44%) patients who underwent orthopedic surgery. Seven of the 265 (2.64%) patients who underwent hip surgery in the lateral decubitus position stabilized by a pelvic positioner developed ulcers. All ulcers were located on areas of the body that were compressed by the pelvic positioner. After identifying controls for patient height (less than 154 cm), surgery duration (longer than 180 min), blood loss (more than 355 ml), and type of pelvic positioner used, we identified the independent risk factors for ulcers to be patient height < 154 cm (adjusted odds ratio, 12.8; p-value, 0.032) and the use of pelvic positioners with pubic bone support (adjusted odds ratio, 10.53; p-value, 0.047). Conclusion: The use of pelvic positioners with pubic bone support should be avoided in patients with a height of < 154 cm to decrease the risk of ulcers.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Risk factors for pressure ulcers from the use of a pelvic positioner in hip surgery: a retrospective observational cohort study in 229 patients

et al. 2020

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“…Because the safe zone for cup anteversion is narrower than that for inclination [4], the angle of anteversion must be carefully determined. Despite the use of rigid patient-positioning devices, clinically relevant malposition of the pelvis occurs in the lateral decubitus position, especially with regard to anteversion [16,17]. When THA is performed in the supine position, cup alignment can be monitored with the use of intraoperative fluoroscopy or Xray.…”

Section: Discussionmentioning

confidence: 99%

An accelerometer-based navigation system provides acetabular cup orientation accuracy comparable to that of computed tomography-based navigation during total hip arthroplasty in the supine position

Tetsunaga

Yamada

Tetsunaga

et al. 2019

Preprint

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Background: Inadequate acetabular component orientation is associated with postoperative impingement, dislocation, and accelerated polyethylene wear. Computed tomography (CT)-based navigation systems provide accuracy for total hip arthroplasty (THA) but are not available in all facilities. Accelerometer-based navigation systems are inexpensive, but their accuracy remains undetermined. This study compares the accuracy of cup orientation in THA using CT-based and accelerometer-based navigation systems. Methods: This retrospective study included 35 consecutive patients (11 males, 24 females; mean age, 65 years) who underwent primary cementless THA via an anterolateral approach in the supine position. Both CT-based and accelerometer-based navigation systems were used simultaneously. The accuracy of cup orientation was compared between the two systems using postoperative CT. Results: The accuracy of cup inclination was 2.7° ± 2.0° in the CT-based group and 3.3° ± 2.4° in the accelerometer-based group. The accuracy of cup anteversion was 2.8° ± 2.6° in the CT-based group and 3.4° ± 2.2° in the accelerometer-based group. No significant difference was observed in cup inclination ( p = 0.29) or cup anteversion ( p = 0.34) between CT-based and accelerometer-based navigation. Conclusions: The accuracy of cup positioning did not differ significantly between CT-based and accelerometer-based navigation systems.

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“…5 Current methods to assess acetabular component position intraoperatively involve identifying bone landmarks intraoperatively, relying on the preoperative patient position with the pelvis in a true lateral position and intraoperative alignment guides. 16 Quantitative measurement of acetabular component alignment is obtained on postoperative radiographs; acetabular component position can be evaluated using several methods. For the non-cemented BFX acetabular component (BioMedtrix; Whippany, New Jersey, United States), the methods for ALO measurement include; the ellipse method, the femoral head offset method and visual estimate using the truncated portion of the component to a reference chart.…”

Section: Introductionmentioning

confidence: 99%

“…Previous reports have evaluated postoperative methods of assessing acetabular component position, with the accuracy of these methods being within 10 degrees of the actual ALO in clinically relevant acetabular component positions. 16,17 As mentioned, positioning and maintaining the patient in true lateral recumbency are crucial for purposeful placement of the acetabular component. Without maintenance of correct position, or knowledge of the degree of deviation from true lateral recumbency adjustment to intraoperative acetabular component position could result in an ALO or version different than expected.…”

Section: Introductionmentioning

confidence: 99%

Measurement of Acetabular Component Position in Total Hip Arthroplasty in Dogs: Comparison of a Radio-Opaque Cup Position Assessment Device Using Fluoroscopy with CT Assessment and Direct Measurement

Dalbeth

Karlin

Lirtzman³

et al. 2020

Vet Comp Orthop Traumatol

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Objectives The aim of this study was to compare measurements of angle of lateral opening (ALO) and version determined using a radioopaque cup position assessment device imaged with fluoroscopy to measurements obtained by CT and direct measurement in a cadaveric model. Our null hypothesis was that there would not be any difference in the angles measured by the techniques. Methods Six cadavers were implanted with BFX acetabular components. The CPAD was placed and images were obtained with fluoroscopy. Measurements were obtained from the radiopaque marker bars on the CPAD device, and version and ALO were calculated. The ALO and version were determined by CT and DM. Comparisons were made using a two-way analysis of variance and a generalized linear model procedure analysis. Results There were no significant differences between the measurements for ALO (p = 0.275) or version (p = 0.226). Correlation between methods was 0.948 and 0.951 for ALO and version, respectively. The mean difference (standard deviation [SD], and 95% confidence interval [CI]) for ALO were: CT versus CPAD 1.85 degrees (± 2.32 degrees [-2.99–3.31]), CT versus DM 1.96 degrees (± 1.99 degrees [−2.2–4.27]), CPAD versus DM1.74 degrees (±2.21 degrees [−1.13 and 5.24]). The mean difference (SD [CI]) for version was CT versus CPAD 2.86 degrees (±1.56 degrees [ −2.63–1.69]), CT versus DM 1.10 degrees (±1.42 degrees [−1.57–2.09]), CPAD versus DM 1.07 degrees (±0.76 degrees [0.13–2.09]). Clinical Relevance The results demonstrate that intraoperative imaging in cadaveric specimens with the CPAD is an accurate method to determine ALO and version of the acetabular component.

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Rigid Patient Positioning is Unreliable in Total Hip Arthroplasty

Cited by 20 publications

References 17 publications

Risk factors for pressure ulcers from the use of a pelvic positioner in hip surgery: a retrospective observational cohort study in 229 patients

Risk factors for pressure ulcers from the use of a pelvic positioner in hip surgery: a retrospective observational cohort study in 229 patients

An accelerometer-based navigation system provides acetabular cup orientation accuracy comparable to that of computed tomography-based navigation during total hip arthroplasty in the supine position

Measurement of Acetabular Component Position in Total Hip Arthroplasty in Dogs: Comparison of a Radio-Opaque Cup Position Assessment Device Using Fluoroscopy with CT Assessment and Direct Measurement

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