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ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2024, Number 4

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Acta Ortop Mex 2024; 38 (4)

Radiographic measurements of acetabular component orientation with Widmer´s method in total hip arthroplasty. Descriptive case series

Macías-González E, Pérez-Alavez J, Contreras-Blancas H, Guadalupe-Rojas L

Language: Spanish
References: 33
Page: 226-233
PDF size: 207.06 Kb.


ABSTRACT

Introduction: total hip arthroplasty (THA) is one of the most performed surgeries worldwide, with high satisfaction rates. The orientation of the acetabular component has a direct impact on the risk of dislocation, recently with the support of robotic surgery the margin of error in implant placement has decreased; however, the conventional technique even without fluoroscopic support continues to have satisfactory results within the safety zone. Material and methods: retrospective, cross-sectional, descriptive case series of patients treated with THA at Hospital General Xoco between 2022 and 2024. Degrees of anteversion and inclination were measured with Widmer's method on postoperative radiographs. Results: the radiographs of 113 patients were studied, 80 female and 33 male, with a mean age of 63.2 ± 13.01 years (95% CI: 60.6-65.4), a mean inclination of 42.2° ± 8.1° (95% CI: 40.7-43.2) and anteversion of 14.3° ± 8.5° (95% CI: 12.5-15.4); 76% of the population was within Lewinnek safe zone; by etiology: osteoarthrosis 74%, sequelae of dysplasia 68% and intracapsular fracture 82%; difference between the values of the affected side: left 65%, right 83%, of 3.9° and 4.7°/6.4o and 9° in relation to the overall values of the population. Conclusion: in our population undergoing THA, without the use of robotic technique or support of imaging studies, anteversion and inclination figures were recorded within the Lewinnek safety parameters with a conventional method.


REFERENCES

  1. Lee JM. The current concepts of total hip arthroplasty. Hip Pelvis. 2016; 28(4): 191. Available in: http://dx.doi.org/10.5371/hp.2016.28.4.191

  2. Okafor L, Chen AF. Patient satisfaction and total hip arthroplasty: a review. Arthroplasty. 2019; 1(1): 6. Available in: http://dx.doi.org/10.1186/s42836-019-0007-3

  3. Walker RP, Gee M, Wong F, Shah Z, George M, Bankes MJK, et al. Functional outcomes of total hip arthroplasty in patients aged 30 years or less: a systematic review and meta-analysis. Hip Int. 2016; 26(5): 424-31. Available in: http://dx.doi.org/10.5301/hipint.5000376

  4. Evans JT, Evans JP, Walker RW, Blom AW, Whitehouse MR, Sayers A. How long does a hip replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up. Lancet. 2019; 393(10172): 647-54. Available in: http://dx.doi.org/10.1016/s0140-6736(18)31665-9

  5. Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am. 2018; 100(17): 1455-60. Available in: http://dx.doi.org/10.2106/JBJS.17.01617

  6. Tannast M, Langlotz U, Siebenrock KA, Wiese M, Bernsmann K, Langlotz F. Anatomic referencing of cup orientation in total hip arthroplasty. Clin Orthop Relat Res. 2005; (436): 144-50. Available in: http://dx.doi.org/10.1097/01.blo.0000157657.22894.29

  7. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, et al. The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014; 73(7): 1323-30. Available in: http://dx.doi.org/10.1136/annrheumdis-2013-204763

  8. Yao L, Yao J, Gold RH. Measurement of acetabular version on the axiolateral radiograph. Clin Orthop Relat Res. 1995; (316): 106-11. Available in: http://dx.doi.org/10.1097/00003086-199507000-00015

  9. Di Maro A, Creaco S, Albini M, Latiff M, Merlo M. Radiographic results on acetabular cup placement with the SuperPath technique: a retrospective study of 756 cases. BMC Musculoskelet Disord. 2021. Available in: http://dx.doi.org/10.21203/rs.3.rs-952471/v1

  10. Burgo FJ, Mengelle DE, Autorino CM. Anteversión del componente acetabular: Evaluación de dos métodos radiológicos actuales de medición. Estudio in vitro. Rev Asoc Argent Ortop Traumatol. 2009; 74: 79-84.

  11. Widmer KH. A simplified method to determine acetabular cup anteversion from plain radiographs. J Arthroplasty. 2004; 19(3): 387-90. Available in: http://dx.doi.org/10.1016/j.arth.2003.10.016

  12. Budzi?ska MB, Maciag BM, Zarnovsky K, Kordyaczny T, Kowalczyk IM, Adamska O, et al. How to analyze postoperative radiographs after total hip replacement. Jpn J Radiol. 2023; 41(1): 14-8. Available in: http://dx.doi.org/10.1007/s11604-022-01332-8

  13. Burapachaisri A, Elbuluk A, Abotsi E, Pierrepont J, Jerabek SA, Buckland AJ, et al. Lewinnek safe zone references are frequently misquoted. Arthroplast Today. 2020; 6(4): 945-53. Available in: http://dx.doi.org/10.1016/j.artd.2020.09.011

  14. Park J, Kim GL, Yang KH. Anatomical landmarks for acetabular abduction in adult hips: the teardrop vs. the inferior acetabular rim. Surg Radiol Anat. 2019; 41(12): 1505-11. Available in: http://dx.doi.org/10.1007/s00276-019-02329-1

  15. Biedermann R, Tonin A, Krismer M, Rachbauer F, Eibl G, Stockl B. Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component: the effect of orientation of the acetabular component. J Bone Joint Surg Br. 2005; 87(6): 762-9. Available in: http://dx.doi.org/10.1302/0301-620X.87B6.14745

  16. Callanan MC, Jarrett B, Bragdon CR, Zurakowski D, Rubash HE, Freiberg AA, et al. The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res. 2011; 469(2): 319-29. Available in: http://dx.doi.org/10.1007/s11999-010-1487-1

  17. Murphy MP, Schneider AM, LeDuc RC, Killen CJ, Adams WH, Brown NM. A multivariate analysis to predict total hip arthroplasty dislocation with preoperative diagnosis, surgical approach, spinal pathology, cup orientation, and head size. J Arthroplasty. 2022; 37(1): 168-75. Available in: http://dx.doi.org/10.1016/j.arth.2021.08.031

  18. Gosthe RG, Suarez JC, McNamara CA, Calvo C, Patel PD. Fluoroscopically guided acetabular component positioning: does it reduce the risk of malpositioning in obese patients? J Arthroplasty. 2017; 32(10): 3052-5. Available in: http://dx.doi.org/10.1016/j.arth.2017.04.045

  19. Deep K, Prabhakara A, Mohan D, Mahajan V, Sameer M. Orientation of transverse acetabular ligament with reference to anterior pelvic plane. Arthroplast Today. 2020; 7: 1-6. Available in: http://dx.doi.org/10.1016/j.artd.2020.11.018

  20. Rubalcava J, Gómez-García F, Ríos-Reina JL. Ángulo de anteversión acetabular de la cadera en población adulta mexicana medida por tomografía computada. Acta Ortop Mex. 2012; 26(3): 155-61.

  21. Nishii T, Sakai T, Takao M, Sugano N. Fluctuation of cup orientation during press-fit insertion: a possible cause of malpositioning. J Arthroplasty. 2015; 30(10): 1847-51. Available in: http://dx.doi.org/10.1016/j.arth.2015.04.037

  22. Scorcelletti M, Reeves ND, Rittweger J, Ireland A. Femoral anteversion: significance and measurement. J Anat. 2020; 237(5): 811-26. Available in: http://dx.doi.org/10.1111/joa.13249

  23. Murphy WS, Yun HH, Hayden B, Kowal JH, Murphy SB. The safe zone range for cup anteversion is narrower than for inclination in THA. Clin Orthop Relat Res. 2018; 476(2): 325-35. Available in: http://dx.doi.org/10.1007/s11999.0000000000000051

  24. Hernández A, Lakhani K, Núñez JH, Mimendia I, Pons A, Barro V. Can we trust combined anteversion and Lewinnek safe zone to avoid hip prosthesis dislocation? J Clin Orthop Trauma. 2021; 21(101562): 101562. Available in: http://dx.doi.org/10.1016/j.jcot.2021.101562

  25. Dorr LD, Malik A, Dastane M, Wan Z. Combined anteversion technique for total hip arthroplasty. Clin Orthop Relat Res. 2009; 467(1): 119-27. Available in: http://dx.doi.org/10.1007/s11999-008-0598-4

  26. Pour AE, Schwarzkopf R, Patel KP, Anjaria M, Lazennec JY, Dorr LD. Is combined anteversion equally affected by acetabular cup and femoral stem anteversion? J Arthroplasty. 2021; 36(7): 2393-401. Available in: http://dx.doi.org/10.1016/j.arth.2021.02.017

  27. Ueno T, Kabata T, Kajino Y, Ohmori T, Yoshitani J, Ueoka K, et al. Tilt-adjusted cup anteversion in patients with severe backward pelvic tilt is associated with the risk of iliopsoas impingement: a three-dimensional implantation simulation. Clin Orthop Relat Res. 2019; 477(10): 2243-54. Available in: http://dx.doi.org/10.1097/corr.0000000000000830

  28. Yang G, Li Y, Zhang H. The influence of pelvic tilt on the anteversion angle of the acetabular prosthesis. Orthop Surg. 2019; 11(5): 762-9. Available in: http://dx.doi.org/10.1111/os.12543

  29. Stem ES, O'Connor MI, Kransdorf MJ, Crook J. Computed tomography analysis of acetabular anteversion and abduction. Skeletal Radiol. 2006; 35(6): 385-9. Available in: http://dx.doi.org/10.1007/s00256-006-0086-4

  30. Lubovsky O, Wright D, Hardisty M, Kiss A, Kreder H, Whyne C. Acetabular orientation: anatomical and functional measurement. Int J Comput Assist Radiol Surg. 2012; 7(2): 233-40. Available in: http://dx.doi.org/10.1007/s11548-011-0648-3

  31. Kamara E, Robinson J, Bas MA, Rodriguez JA, Hepinstall MS. Adoption of robotic vs fluoroscopic guidance in total hip arthroplasty: is acetabular positioning improved in the learning curve? J Arthroplasty. 2017; 32(1): 125-30. Available in: http://dx.doi.org/10.1016/j.arth.2016.06.039

  32. Stewart NJ, Stewart JL, Brisbin A. A comparison of component positioning between fluoroscopy-assisted and robotic-assisted total hip arthroplasty. J Arthroplasty. 2022; 37(8): 1602-5.e3. Available in: http://dx.doi.org/10.1016/j.arth.2022.03.056

  33. Migliorini F, Cuozzo F, Oliva F, Eschweiler J, Hildebrand F, Maffulli N. CT-based navigation for total hip arthroplasty: a meta-analysis. Eur J Med Res. 2023; 28(1): 443. Available in: https://doi.org/10.1186/s40001-023-01437-4



EVIDENCE LEVEL

IV




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