The Effect of Intraoperative Radiographs on Component Position and Leg Length during Routine Posterior Approach Total Hip Arthroplasty
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Purpose: Accurate component placement and restoration of patient anatomy are critical in total hip arthroplasty (THA) surgery. Although intraoperative radiographs are sometimes utilized, it is unclear whether this practice can improve accuracy. Materials and Methods: This study evaluated acetabular cup abduction, anteversion, leg length, and offset among 100 posterior approach THAs performed without imaging (No X-ray group) and compared them to a subsequent series of 100 THAs where an intraoperative radiograph was taken with the trial components in place (X-ray group). THAs were performed using a posterior approach by a single, experienced surgeon whose goal was to place the cup at 45。of abduction and 30。of anteversion. Supine anteroposterior pelvic digital radiographs taken at the first (nominal 4-week) postoperative visit were used for measurements. Results: Slight differences in cup abduction (47。±6。vs 44。±6。, respectively, P=0.003) and anteversion angle (35。±6。vs 31。±6。, respectively, P<0.001) were observed between the X-ray and No X-ray groups; however, a similar proportion of cups within 10。of the target angles was observed (76% vs 83%, respectively, P=0.22). No difference in offset measurements (1.1±6.6 mm vs 0.3±6.9 mm, respectively, P=0.42) or leg lengths (0.3±3.8 mm vs 0.3±4.8 mm, respectively, P=0.94) was observed between the X-ray and No X-ray groups; however, the X-ray group showed less leg length variation (P=0.05). Conclusion: In this study, the routine use of intraoperative radiographs was not associated with improved implant positioning for uncomplicated primary THA.
Abstract
Purpose: Accurate component placement and restoration of patient anatomy are critical in total hip arthroplasty (THA) surgery. Although intraoperative radiographs are sometimes utilized, it is unclear whether this practice can improve accuracy. Materials and Methods: This study evaluated acetabular cup abduction, anteversion, leg length, and offset among 100 posterior approach THAs performed without imaging (No X-ray group) and compared them to a subsequent series of 100 THAs where an intraoperative radiograph was taken with the trial components in place (X-ray group). THAs were performed using a posterior approach by a single, experienced surgeon whose goal was to place the cup at 45。of abduction and 30。of anteversion. Supine anteroposterior pelvic digital radiographs taken at the first (nominal 4-week) postoperative visit were used for measurements. Results: Slight differences in cup abduction (47。±6。vs 44。±6。, respectively, P=0.003) and anteversion angle (35。±6。vs 31。±6。, respectively, P<0.001) were observed between the X-ray and No X-ray groups; however, a similar proportion of cups within 10。of the target angles was observed (76% vs 83%, respectively, P=0.22). No difference in offset measurements (1.1±6.6 mm vs 0.3±6.9 mm, respectively, P=0.42) or leg lengths (0.3±3.8 mm vs 0.3±4.8 mm, respectively, P=0.94) was observed between the X-ray and No X-ray groups; however, the X-ray group showed less leg length variation (P=0.05). Conclusion: In this study, the routine use of intraoperative radiographs was not associated with improved implant positioning for uncomplicated primary THA.
참고문헌 (32)
- Abdel MP, "What safe zone? The vast majority of dislocated THAs are within the Lewinnek safe zone for acetabular component position", Clin Orthop Relat Res, 474, pp.386~391 (2016)
- Sadhu A, "Acetabular component position and the risk of dislocation following primary and revision total hip arthroplasty : a matched cohort analysis", J Arthroplasty, 32, pp.987~991 (2017)
- Danoff JR, "Redefining the acetabular component safe zone for posterior approach total hip arthroplasty", J Arthroplasty, 31, pp.506~511 (2016)
- DelSole EM, "Total hip arthroplasty in the spinal deformity population : does degree of sagittal deformity affect rates of safe zone placement, instability, or revision", J Arthroplasty, 32, pp.1910~1917 (2017)
- Lewinnek GE, "Dislocations after total hip-replacement arthroplasties", J Bone Joint Surg Am, 60, pp.217~220 (1978)
- Penenberg BL, "Digital radiography in total hip arthroplasty : technique and radiographic results", J Bone Joint Surg Am, 100, pp.226~235 (2018)
- Merle C, "Comparison of native anatomy with recommended safe component orientation in total hip arthroplasty for primary osteoarthritis", J Bone Joint Surg Am, 95, pp.e172~ (2013)
- Kalteis T, "The role of the transverse acetabular ligament for acetabular component orientation in total hip replacement : an analysis of acetabular component position and range of movement using navigation software", J Bone Joint Surg Br, 93, pp.1021~1026 (2011)
- Domb BG, "Comparison of robotic-assisted and conventional acetabular cup placement in THA : a matched-pair controlled study", Clin Orthop Relat Res, 472, pp.329~336 (2014)
- Xu K, "Computer navigation in total hip arthroplasty : a meta-analysis of randomized controlled trials", Int J Surg, 12, pp.528~533 (2014)
- Rathod PA, "Does fluoroscopy with anterior hip arthroplasty decrease acetabular cup variability compared with a nonguided posterior approach", Clin Orthop Relat Res, 472, pp.1877~1885 (2014)
- Ezzet KA, "Use of intraoperative X-rays to optimize component position and leg length during total hip arthroplasty", J Arthroplasty, 29, pp.580~585 (2014)
- Leucht P, "Does intraoperative fluoroscopy optimize limb length and the precision of acetabular positioning in primary THA?", Orthopedics, 38, pp.e380~e386 (2015)
- Hamilton WG, "Comparison of cup alignment, jump distance, and complications in consecutive series of anterior approach and posterior approach total hip arthroplasty", J Arthroplasty, 30, pp.1959~1962 (2015)
- Goodman GP, "Intraoperative fluoroscopy with a direct anterior approach reduces variation in acetabular cup abduction angle", Hip Int, 27, pp.573~577 (2017)
- Lin TJ, "A comparison of radiographic outcomes after total hip arthroplasty between the posterior approach and direct anterior approach with intraoperative fluoroscopy", J Arthroplasty, 32, pp.616~623 (2017)
- Bingham JS, "Does intraoperative fluoroscopy improve limb-length discrepancy and acetabular component positioning during direct anterior total hip arthroplasty", J Arthroplasty, 33, pp.2927~2931 (2018)
- Gililland JM, "A fluoroscopic grid in supine total hip arthroplasty : improving cup position, limb length, and hip offset", J Arthroplasty, 27(8 Suppl), pp.111~116 (2012)
- Weber M, "Fluoroscopy and imageless navigation enable an equivalent reconstruction of leg length and global and femoral offset in THA", Clin Orthop Relat Res, 472, pp.3150~3158 (2014)
- Domb BG, "Accuracy of component positioning in 1980 total hip arthroplasties : a comparative analysis by surgical technique and mode of guidance", J Arthroplasty, 30, pp.2208~2218 (2015)
- Hamilton WG, "A prospective, randomized study of surgical positioning software shows improved cup placement in total hip arthroplasty", Orthopedics, 42, pp.42~47 (2019)
- McGee HM, "A simple method of obtaining equal leg length in total hip arthroplasty", Clin Orthop Relat Res, (194), pp.269~270 (1985)
- Matta JM, "Single-incision anterior approach for total hip arthroplasty on an orthopaedic table", Clin Orthop Relat Res, 441, pp.115~124 (2005)
- Sariali E, "Comparison of three-dimensional planning-assisted and conventional acetabular cup positioning in total hip arthroplas ty : a randomized controlled trial", J Bone Joint Surg Am, 98, pp.108~116 (2016)
- Lass R, "Total hip arthroplasty using imageless computer-assisted hip navigation : a prospective randomized study", J Arthroplasty, 29, pp.786~791 (2014)
- Redmond JM, "Accuracy of component placement in robotic-assisted total hip arthroplasty", Orthopedics, 39, pp.193~199 (2016)
- Kalteis T, "Imageless navigation for insertion of the acetabular component in total hip arthroplasty : is it as accurate as CT-based navigation", J Bone Joint Surg Br, 88, pp.163~167 (2006)
- Chen E, "Implant position calculation for acetabular cup placement considering pelvic lateral tilt and inclination", Comput Aided Surg, 11, pp.309~316 (2006)
- Kanawade V, "Predictability of acetabular component angular change with postural shift from standing to sitting position", J Bone Joint Surg Am, 96, pp.978~986 (2014)
- Kanazawa M, "Pelvic tilt and movement during total hip arthroplasty in the lateral decubitus position", Mod Rheumatol, 26, pp.435~440 (2016)
- Mellano CR, "How does pelvic rotation or tilt affect radiographic measurement of acetabular component inclination angle during THA", J Orthop, 12, pp.222~227 (2015)
- Herisson O, "Validity and reliability of intraoperative radiographs to assess leg length during total hip arthroplasty : correlation and reproducibility of anatomic distances", J Arthroplasty, 31, pp.2784~2788 (2016)