The Safe Zone Range for Cup Anteversion Is Narrower Than for Inclination in THA

Murphy, William S.; Yun, Ho Hyun; Hayden, Brett L.; Kowal, Jens; Murphy, Stephen

doi:10.1007/s11999.0000000000000051

Cited by 110 publications

(92 citation statements)

References 39 publications

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“…Cup malposition, with respect to the Lewinnek safe zone, is an independent risk factor for postoperative dislocation (odds ratio 1.88) [17]. Because the safe zone for cup anteversion is narrower than that for inclination [4], the angle of anteversion must be carefully determined. When THA is performed in the supine position, cup alignment can be monitored with the use of intraoperative fluoroscopy or X-ray.…”

Section: Discussionmentioning

confidence: 99%

“…Correct implant positioning is important for good longterm results in total hip arthroplasty (THA). Inadequate orientation of the acetabular component is associated with postoperative impingement [1], dislocation [2], accelerated polyethylene wear [3], liner damage, and restricted range of motion [4]. Surgeons use intraoperative navigation systems to improve the accuracy of implant orientation [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2020

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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

et al. 2020

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“…It was previously proved, that proper prosthesis implants placement might be crucial for lowering the possibility of postoperative hip dislocations. (11,12) Still, to our knowledge there are no systematic reviews covering this subject, and while there is still unsatisfactory evidence concerning long-term outcomes of DAA, such review may prove useful in the debate. There has been recently published meta-analysis of 13…”

Section: Introductionmentioning

confidence: 99%

Systematic Review of Radiological Analysis of Total Hip Replacement Via Direct Anterior Approach in Comparison to Other Approaches – Study Protocol

Maciąg¹,

Radzimowski²,

Stępiński³

et al. 2020

Preprint

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Abstract BackgroundTotal hip arthroplasty (THR) is considered as the most effective available method of treatment of end-stage hip osteoarthritis (OA). This surgery can be performed via many different approaches. One of the newly developed technique is called direct anterior approach (DAA). It gains popularity and recognition as the least traumatic to the soft tissues, thus quickening rehabilitation and improving joint stability in the early postoperative period. There are no systematic reviews covering this subject in terms of potential differences in radiological prosthesis placement, and while there is still unsatisfactory evidence concerning long-term outcomes of DAA, such review may prove useful in the debate. The objective of our study was to systematically collect and review available data from randomized-controlled trials (RCTs) regarding radiographic assessment of prosthesis placement after total hip arthroplasty using direct anterior approach compared to other common approaches.MethodsA systematic review of randomized controlled trials (RCTs) will be conducted. SciFinder, Scopus, ScienceDirect, PubMed, Embase, Clinical Key and The Cochrane Library databases will be searched without restriction to date up to June 2020. Primary outcomes will include measurements related with the radiological analysis of trials comparing use of DAA to other approaches used for THR, containing at least two of the following: femoral stem alignment, mean radiographic cup inclination, mean radiographic cup anteversion, mean radiographic cup abduction, position in Lewinnek's safe zone. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological appraisal of the studies will be assessed by the Cochrane Risk-of-Bias Tool for RCTs. DiscussionThis systematic review will provide missing information regarding influence of differences between DAA and other surgical approaches in total hip replacement on prosthesis implants placement in case of femoral stem and cup. This may result in improving knowledge and awareness of surgeons, improving patients satisfaction and functional outcome and lowering the risk of hip dislocations and other complications. Trial registrationInternational Registration of Systematic reviews (PROSPERO) numberCRD42019122675

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“…Previous studies have attempted to improve the predictive efficacy of coronal safe zones. [14][15][16] Originally, Elkins and colleagues 14 proposed narrowing the coronal safe zone inclination and anteversion from 37 o -46 0 and 12 o -22 0 , respectively. Tezuka et al 16 reported that using this method resulted in fewer hips implanted into the narrow safe zone but no change in the number of hips in the functional safe zone.…”

Section: Discussionmentioning

confidence: 99%

Patient-Specific “Safe Zones” Reduce the Rate of Dislocation after Total Hip Arthroplasty

Vigdorchik¹,

Cizmic²,

Novikov³

et al.

EPiC Series in Health Sciences

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INTRODUCTION: Most dislocations have been shown to occur within Lewinnek’s proposed safe zone (LSZ) for cup inclination (40°±10°) and anteversion (15°±10°). Using a functional and dynamic simulation that accounts for individual patient anatomy and variations in pelvic tilt, we created a patient-specific target orientation for the acetabular cup. The purposes of this study were to: (1) compare pre-operative acetabular cup parameters using this novel dynamic imaging sequence to the LSZ, and (2) describe rates of dislocation in patients whose pre-operative acetabular cup parameters were determined using dynamic imaging sequences.METHODS: We retrospectively reviewed 1,500 consecutive, primary THAs that underwent dynamic sitting and standing pre-operative acetabular cup planning. Using these inputs, we modeled an optimal cup position for each patient. Inclination, anteversion, pelvic tilt, pelvic incidence, lumbar flexion angles, and rates of dislocation were analyzed.RESULTS: Mean age of patients was 63 years. Mean pelvic tilt was 4.7o when supine, -0.3o when standing, and -0.7o when flex-seated. Mean pelvic incidence was 54o and mean lumbar flexion was 43o. Mean inclination was 40° and mean anteversion was 24°. Only 56% of the dynamically planned cups were within the LSZ (p<0.05). Mean inclination and anteversion difference between dynamic and LSZ was 1.3o and 8.9o, respectively. Only 0.5% of dynamically planned cups dislocated post-operatively, all were within LSZ.DISCUSSION: Acetabular cup positioning in patient-specific safe zones reduces the rate of dislocation after THA. Historical target parameters for cup inclination and anteversion significantly differ to target values obtained with the use of functional imaging.

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The Safe Zone Range for Cup Anteversion Is Narrower Than for Inclination in THA

Abstract: Level III, diagnostic study.

Cited by 110 publications

References 39 publications

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

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

Systematic Review of Radiological Analysis of Total Hip Replacement Via Direct Anterior Approach in Comparison to Other Approaches – Study Protocol

Patient-Specific “Safe Zones” Reduce the Rate of Dislocation after Total Hip Arthroplasty

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