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Standardized fluoroscopy-based technique to measure intraoperative cup anteversion
Matthieu Zingg1, Sana Boudabbous2, Didier Hannouche1
1Division of Orthopaedics and Trauma Surgery, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva 14, Switzerland.
Summary
This study introduces a new fluoroscopy technique to accurately measure acetabular component anteversion during direct anterior approach hip surgery. The method provides reliable and reproducible results comparable to CT scans.
Area of Science:
- Orthopaedic Surgery
- Medical Imaging
- Biomechanical Engineering
Background:
- The direct anterior approach (DAA) for hip arthroplasty allows for supine positioning, facilitating intraoperative fluoroscopy.
- Accurate measurement of acetabular component anteversion is crucial for optimal surgical outcomes.
- Existing methods for measuring anteversion may be less precise or require different patient positioning.
Purpose of the Study:
- To present and validate a novel technique for measuring acetabular component anteversion using intraoperative fluoroscopy in the supine position.
- To establish a mathematical formula for calculating true acetabular component anteversion.
- To compare the accuracy and reliability of this new technique against computed tomography (CT) measurements.
Main Methods:
- A mathematical formula was developed to calculate acetabular component anteversion using the abduction angle and c-arm tilt angle (CaT).
- The CaT was determined by adjusting the c-arm to achieve a specific pelvic oblique radiograph.
- The technique was validated on a radiopaque synbone model, with 25 repetitions, comparing fluoroscopy measurements to CT anteversion measurements.
Main Results:
- The new fluoroscopy technique demonstrated high accuracy, with an average difference of only 0.2° compared to CT measurements.
- Linear regression analysis showed excellent agreement between the fluoroscopy technique and CT, with a slope of 0.99 (p < 0.001).
- The technique proved to be reproducible and reliable in assessing acetabular component anteversion.
Conclusions:
- The described three-step c-arm technique reliably and reproducibly measures acetabular component anteversion in supine patients undergoing DAA hip surgery.
- This fluoroscopic method offers a valuable alternative to CT imaging for intraoperative assessment of acetabular component positioning.
- The findings support the integration of this technique into standard surgical practice for improved accuracy in hip arthroplasty.
