The purpose of this study was to compare acetabular cup position for 2 cohorts of total hip arthroplasty (THA) patients who had a direct anterior approach.
Methods
100 THA cases were performed with an anterior approach using intraoperative fluoroscopy (IF) to aid in cup positioning. Another group of 100 cases underwent THA with an anterior approach without the use of any fluoroscopy. Postoperative abduction and anteversion angles were measured using Martell's hip analysis software.
Results
Mean abduction angle was 43.2° (standard deviation (SD) = 4.5°) for the IF group versus 37.5°(SD = 7.4°) for cases without IF (p<0.001). 18% more cases with IF fell within the Lewinnek safe zone (p<0.001); however, a similar number of cases had over 50° of abduction. The mean anteversion angles of the two groups were also significantly different (IF 21.8° vs. 24.9°) (p<0.01).
Conclusions
There was significantly less variation in cup position among the cases using IF with regards to abduction.
BarrettWPTurnerSELeopoldJPProspective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty.J Arthroplasty2013;28(9):1634–1638
2.
PostZDOrozcoFDiaz-LedezmaCHozackWJOngADirect anterior approach for total hip arthroplasty: indications, technique, and results.J Am Acad Orthop Surg2014;22(9):595–603
3.
RestrepoCMortazaviSMBrothersJParviziJRothmanRHHip dislocation: are hip precautions necessary in anterior approaches?Clin Orthop Relat Res2011;469(2):417–422
4.
TauntonMJMasonJBOdumSMSpringerBDDirect anterior total hip arthroplasty yields more rapid voluntary cessation of all walking aids: a prospective, randomized clinical trial.J Arthroplasty2014299 Suppl169–172
5.
BhandariMMattaJMDodginDAnterior Total Hip Arthroplasty Collaborative Investigators.Outcomes following the single-incision anterior approach to total hip arthroplasty: a multicenter observational study. Orthop Clin North Am2009;40(3):329–342
6.
JewettBACollisDKHigh complication rate with anterior total hip arthroplasties on a fracture table.Clin Orthop Relat Res2011;469(2):503–507
7.
LantingBAOdumSMCopeRPPattersonAHMasonisJLIncidence of perioperative events in single setting bilateral direct anterior approach total hip arthroplasty.J Arthroplasty2015;30(3):465–467
8.
MirzaAJLombardiAVJrMorrisMJBerendKRA mini-anterior approach to the hip for total joint replacement: optimising results: improving hip joint replacement outcomes.Bone Joint J201496-B11 Supple A32–35
9.
MasonisJThompsonCOdumSSafe and accurate: learning the direct anterior total hip arthroplasty.Orthopedics20083112 Suppl 2orthosupersite.com/view.asp?rID=37187.
10.
MattaJMShahrdarCFergusonTSingle-incision anterior approach for total hip arthroplasty on an orthopaedic table.Clin Orthop Relat Res2005;441(441):115–124
11.
GoytiaRNJonesLCHungerfordMWLearning curve for the anterior approach total hip arthroplasty.J Surg Orthop Adv2012;21(2):78–83
12.
MüllerDAZinggPODoraCAnterior minimally invasive approach for total hip replacement: five-year survivorship and learning curve.Hip Int2014;24(3):277–283
13.
HamiltonWGParksNLHuynhCComparison of cup alignment, jump distance, and complications in consecutive series of anterior approach and posterior approach total hip arthroplasty.J Arthroplasty2015;30(11):1959–1962
14.
RathodPABhallaSDeshmukhAJRodriguezJADoes fluoroscopy with anterior hip arthroplasty decrease acetabular cup variability compared with a nonguided posterior approach?Clin Orthop Relat Res2014;472(6):1877–1885
15.
RachbauerFKainMSLeunigMThe history of the anterior approach to the hip.Orthop Clin North Am2009;40(3):311–320
16.
HarrisonCLThomsonAICuttsSRowePJRichesPEResearch synthesis of recommended acetabular cup orientations for total hip arthroplasty.J Arthroplasty2014;29(2):377–382
17.
LewinnekGELewisJLTarrRCompereCLZimmermanJRDislocations after total hip-replacement arthroplasties.J Bone Joint Surg Am1978;60(2):217–220
18.
BarrackRLKrempecJAClohisyJCAccuracy of acetabular component position in hip arthroplasty.J Bone Joint Surg Am2013;95(19):1760–1768
19.
CallananMCJarrettBBragdonCRThe John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital.Clin Orthop Relat Res2011;469(2):319–329
20.
BlumenfeldTJMcKellopHASchmalzriedTPBilliFFracture of a cross-linked polyethylene liner: a multifactorial issue.J Arthroplasty2011;26(4):666 e5-666.e8.
21.
EbramzadehECampbellPATakamuraKMFailure modes of 433 metal-on-metal hip implants: how, why, and wear.Orthop Clin North Am2011;42(2):241–250 ix.
22.
SextonSAYeungEJacksonMPThe role of patient factors and implant position in squeaking of ceramic-on-ceramic total hip replacements.J Bone Joint Surg Br2011;93(4):439–442
23.
TakamuraKMAmstutzHCLuZCampbellPAEbramzadehEWear analysis of 39 conserve plus metal-on-metal hip resurfacing retrievals.J Arthroplasty2014;29(2):410–415
24.
HuiAJMcCaldenRWMartellJMMacDonaldSJBourneRBRorabeckCHValidation of two and three-dimensional radiographic techniques for measuring polyethylene wear after total hip arthroplasty.J Bone Joint Surg Am200385-A3505–511
25.
ElsonLCBarrCJChandranSEHansenVJMalchauHKwonYMAre morbidly obese patients undergoing total hip arthroplasty at an increased risk for component malpositioning?J Arthroplasty2013288 Suppl41–44
26.
DainesBKDennisDAThe importance of acetabular component position in total hip arthroplasty.Orthop Clin North Am2012;43(5):e23–e34
27.
KummerFJShahSIyerSDiCesarePEThe effect of acetabular cup orientations on limiting hip rotation.J Arthroplasty1999;14(4):509–513
28.
DigioiaAMIIIJaramazBPlakseychukAYComparison of a mechanical acetabular alignment guide with computer placement of the socket.J Arthroplasty2002;17(3):359–364
29.
DiGioiaAMJaramazBBlackwellMThe Otto Aufranc Award.Image guided navigation system to measure intraoperatively acetabular implant alignment. Clin Orthop Relat Res1998;(355):8–22
30.
HassanDMJohnstonGHDustWNWatsonGDolovichATAccuracy of intraoperative assessment of acetabular prosthesis placement.J Arthroplasty1998;13(1):80–84
31.
SotereanosNGMillerMCSmithBHubeRSeweckeJJWohlrabDUsing intraoperative pelvic landmarks for acetabular component placement in total hip arthroplasty.J Arthroplasty2006;21(6):832–840
32.
SarmientoAEbramzadehEGoganWJMcKellopHACup containment and orientation in cemented total hip arthroplasties.J Bone Joint Surg Br1990;72(6):996–1002
33.
WidmerKHContainment versus impingement: finding a compromise for cup placement in total hip arthroplasty.Int Orthop200731S1 Suppl 1S29–S33
34.
KanawadeVDorrLDWanZPredictability of acetabular component angular change with postural shift from standing to sitting position.J Bone Joint Surg Am2014;96(12):978–986
35.
MarattJDEspositoCIMcLawhornASJerabekSAPadgettDEMaymanDJPelvic tilt in patients undergoing total hip arthroplasty: when does it matter?J Arthroplasty2015;30(3):387–391
36.
TiberiJVIIIAntociVMalchauHRubashHEFreibergAAKwonYMWhat is the fate of the acetabular component orientation when evaluated in the standing position?J Arthroplasty2015;30(9):1555–1560
