Original ArticleUsing Intraoperative Pelvic Landmarks for Acetabular Component Placement in Total Hip Arthroplasty
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)
A simplified method to determine acetabular cup anteversion from plain radiographs
J Arthroplasty
(2004)- et al.
Classification and treatment of dislocations of total hip arthroplasty
Clin Orthop
(1983) - et al.
The prognosis and treatment of dislocated total hip arthroplasties with a 22 mm head
J Bone Joint Surg Br
(1997) Postoperative total hip prosthetic femoral head dislocations. Incidence, etiologic factors, and management
Clin Orthop
(1994)- et al.
Operative correction of an unstable total hip arthroplasty
J Bone Joint Surg Am
(1992) - et al.
Space orientation of total hip prosthesis. A method for three-dimensional determination
Acta Radiol Diagn (Stockh)
(1986) Trilogy Acetabular System Surgical Technique, in 97-6200-02 rev1
(1998)- et al.
Position, orientation and component interaction in dislocation of the total hip prosthesis
Acta Radiol
(1988)
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 ResearchCitation 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).
Variability of Pelvic Orientation in the Lateral Decubitus Position: Are External Alignment Guides Trustworthy?
2018, Journal of ArthroplastyPrimary total hip arthroplasty: Staying out of trouble intraoperatively
2018, Annals of Medicine and SurgeryCitation 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.
The Impact of Spino-Pelvic Alignment on Total Hip Arthroplasty Outcomes: A Critical Analysis of Current Evidence
2018, Journal of ArthroplastyQuantifying the Relationship Between the Transverse Acetabular Ligament and the Radiographic Teardrop
2017, Journal of ArthroplastyCitation 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.
No benefits or funds were received in support of the study.