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Changes in acetabular orientation during total hip arthroplasty.

D T Schloemann1, A I Edelstein2, R L Barrack1

  • 1Department of Orthopedic Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St. Louis, Missouri, USA.

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|June 1, 2019
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Summary

Pelvic alignment changes during total hip arthroplasty (THA) can affect acetabular component placement. Intraoperative imaging may help ensure accurate positioning of the acetabular component during THA.

Keywords:
ComponentpositionIntraoperative imagingPelvic inletSagittal pelvic rotation

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Area of Science:

  • Orthopedic Surgery
  • Radiology
  • Biomedical Engineering

Background:

  • Pelvic sagittal alignment is crucial for accurate acetabular component placement in total hip arthroplasty (THA).
  • Variations in patient positioning during THA can alter pelvic alignment, potentially leading to component malpositioning.
  • Understanding these dynamic changes is essential for optimizing surgical outcomes.

Purpose of the Study:

  • To quantify changes in pelvic sagittal alignment during and after THA performed in the lateral decubitus position.
  • To assess the impact of these alignment shifts on the perceived position of the acetabular component.
  • To evaluate the clinical significance of altered pelvic alignment on acetabular component version.

Main Methods:

  • Retrospective analysis of 91 patients undergoing THA.
  • Radiographic assessment of pelvic ratio in standing (pre- and post-op), lateral decubitus (intra-op), and supine (post-anesthesia) positions.
  • Calculation of pelvic ratio and determination of changes in apparent acetabular component version (>5° considered significant).

Main Results:

  • Increased pelvic ratio (anterior tilt) observed intraoperatively in 69.4% of cases during lateral decubitus positioning.
  • Postoperative comparison revealed decreased pelvic ratio (posterior tilt) in 44.9% of cases.
  • Significant changes (>5°) in apparent acetabular component version occurred in 79.6% of cases intraoperatively and 57.7% postoperatively.

Conclusions:

  • Dynamic changes in pelvic sagittal alignment occur throughout the THA procedure.
  • Unaccounted pelvic positional shifts can introduce errors in acetabular component placement.
  • Intraoperative imaging may be beneficial for achieving appropriate acetabular component positioning.