Elsevier

The Journal of Arthroplasty

Volume 21, Issue 6, September 2006, Pages 832-840
The Journal of Arthroplasty

Original Article
Using Intraoperative Pelvic Landmarks for Acetabular Component Placement in Total Hip Arthroplasty

https://doi.org/10.1016/j.arth.2005.12.001Get rights and content

Abstract

Dislocation after total hip arthroplasty is frequently due to acetabular malpositioning. Positioning of the acetabular component using anatomical landmarks may reduce the incidence of dislocation from improper acetabular orientation. The pelvis provides 3 bony landmarks (ilium, superior pubic ramus, and superior acetabulum), which, when used to define a plane, allows cup orientation in abduction and version. Landmarks evaluated in 24 cadaveric acetabuli allowed slightly increased abduction and anteversion of the cup, compared with native acetabuli. Six hundred seventeen primary total hip arthroplasties were performed between 1996 and 2003 using this technique. Mean cup abduction was 44.4° with 13.2° of anteversion. This technique allows satisfactory reproducible cup orientation based on individual pelvic morphology. Review of patient outcome data suggest high patient satisfaction and lower dislocation rate without additional equipment, time, or cost.

Section snippets

Use of Landmarks in Cup Placement: Geometric Details

Adequate placement of the acetabular component demands orienting the prosthesis within the confines of the acetabulum after reaming. The position must approximate the pelvic and femoral anatomical relationships to provide coverage of the femoral head. The relationship avoids dislocation by maintaining stability within the physiological arc of motion. The orientation of the acetabular component is based upon the prosthetic rim guiding planes of reference. The outer rim of the component forms a

Clinical Investigation

In 150 hips, we measured the cup abduction and version postoperatively. The measured mean cup abduction angle, using the method described by Widmer [13], was 44.4° (range, 24° to 58°). Components were defined as outliers when the cup abduction angle was out of the range of 30° to 50°. In only 4 (2.7%) of 150 procedures were the measured cup abduction angles greater than 50°. In 2 (1.3%) of 150 the measured cup abduction angle was lower than 30° (Table 1). The measured mean cup anteversion,

Discussion

Dislocations are disturbing for both the patient and physician and involve a significant expense. Preventive strategies are the appropriate remedy and can be divided into 3 broad categories: preoperative, intraoperative, and postoperative. Preoperatively, important steps include a thorough history, a complete physical exam, radiographic evaluation, and templating.

Intraoperatively, the surgical approach, implant orientation, soft tissue tension, and implant selection affect rates of dislocation 2

References (16)

  • K.H. Widmer

    A simplified method to determine acetabular cup anteversion from plain radiographs

    J Arthroplasty

    (2004)
  • L.D. Dorr et al.

    Classification and treatment of dislocations of total hip arthroplasty

    Clin Orthop

    (1983)
  • U. Hedlundh et al.

    The prognosis and treatment of dislocated total hip arthroplasties with a 22 mm head

    J Bone Joint Surg Br

    (1997)
  • R.S. Turner

    Postoperative total hip prosthetic femoral head dislocations. Incidence, etiologic factors, and management

    Clin Orthop

    (1994)
  • P.J. Daly et al.

    Operative correction of an unstable total hip arthroplasty

    J Bone Joint Surg Am

    (1992)
  • K. Herrlin et al.

    Space orientation of total hip prosthesis. A method for three-dimensional determination

    Acta Radiol Diagn (Stockh)

    (1986)
  • Zimmer, Inc.

    Trilogy Acetabular System Surgical Technique, in 97-6200-02 rev1

    (1998)
  • K. Herrlin et al.

    Position, orientation and component interaction in dislocation of the total hip prosthesis

    Acta Radiol

    (1988)
There are more references available in the full text version of this article.

Cited by (62)

  • ALDI (Anterior Lateral Decubitus Intermuscular) approach to the hip: Comprehensive description of the surgical technique with operative video

    2019, Orthopaedics and Traumatology: Surgery and Research
    Citation Excerpt :

    In normal acetabula, the cup inclination should follow the line between the acetabular superior edge and the acetabular notch. The correct cup anteversion is reached when the cup is parallel to the acetabular notch line, and to the line that joins the origin of the ischiopubic and ileopubic branches [17,18]. During the femoral preparation, the surgeon moves in front of the patient and the assistant goes to the back to hold the leg in extension, adduction and external rotation (Fig. 10A).

  • Primary total hip arthroplasty: Staying out of trouble intraoperatively

    2018, Annals of Medicine and Surgery
    Citation Excerpt :

    Intraoperative landmarks are patient-specific, reproducible, independent of patient position and have been reported for use as intraoperative orientation guides [6]. In this respect, the transverse acetabular ligament (TAL) has been shown to be one of the potential landmarks that has been used by several investigators [7–13]. Hiddema WB et al. [6] have shown that when the acetabulum's inferior rim is aligned flush with the TAL, the socket inclination will be ideally located within the accepted safe zone of Lewinnek.

  • Quantifying the Relationship Between the Transverse Acetabular Ligament and the Radiographic Teardrop

    2017, Journal of Arthroplasty
    Citation Excerpt :

    Because it is located at the inferior border of the native acetabulum, the TAL may also be used as an anatomic landmark for cup placement in the superior/inferior plane, but is not helpful in guiding the degree of cup abduction. The TAL is a consistent structure in the pelvis that can readily be identified at the time of surgery, even in patients with more complex pathology [3,4,8,9]. Osteophyte formation can sometimes obscure the boundaries of the native acetabulum.

View all citing articles on Scopus

No benefits or funds were received in support of the study.

View full text