Top

Clinical Orthopaedics and Related Research®

Published in:

01-01-2009 | Symposium: Papers Presented at the Hip Society Meetings 2008

Combined Anteversion Technique for Total Hip Arthroplasty

Authors: Lawrence D. Dorr, MD, Aamer Malik, MD, Manish Dastane, MD, Zhinian Wan, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 1/2009

Abstract

Combined cup and stem anteversion in THA based on femoral anteversion has been suggested as a method to compensate for abnormal femoral anteversion. We investigated the combined anteversion technique using computer navigation. In 47 THAs, the surgeon first estimated the femoral broach anteversion and validated the position by computer navigation. The broach was then measured with navigation. The navigation screen was blocked while the surgeon estimated the anteversion of the broach. This provided two estimates of stem anteversion. The navigated stem anteversion was validated by postoperative CT scans. All cups were implanted using navigation alone. We determined precision (the reproducibility) and bias (how close the average test number is to the true value) of the stem position. Comparing the surgeon estimate to navigation anteversion, the precision of the surgeon was 16.8° and bias was 0.2°; comparing the navigation of the stem to postoperative CT anteversion, the precision was 4.8° and bias was 0.2°, meaning navigation is accurate. Combined anteversion by postoperative CT scan was 37.6° ± 7° (standard deviation) (range, 19°–50°). The combined anteversion with computer navigation was within the safe zone of 25° to 50° for 45 of 47 (96%) hips. Femoral stem anteversion had a wide variability.

Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Available only for authorised users

ASTM. Standard Practice for Use of the Terms Precision and Bias in ASTM Test Methods. In: Annual Book of ASTM Standards ed. Philadelphia, PA: American Society for Testing and Materials; 2002:E177–E190a.

Barrack RL, Lavernia C, Ries M, Thornberry R, Tozakoglou E. Virtual reality computer animation of the effect of component position and design on stability after total hip arthroplasty. Orthop Clin North Am. 2001;32:569–577.PubMedCrossRef

Best DE, Horii SC, Bennett W, Thomson B, Snavely D. Review of the American College of Radiology–National Electrical Manufacturers’ Association standards activity. Comput Methods Programs Biomed. 1992;37:305–309.PubMedCrossRef

Bidgood WD Jr, Horii SC. Introduction to the ACR-NEMA DICOM standard. Radiographics. 1992;12:345–355.PubMed

DiGioia AM, Jaramaz B, Blackwell M, Simon DA, Morgan F, Moody JE, Nikou C, Colgan BD, Aston CA, Labarca RS, Kischell E, Kanade T. The Otto Aufranc Award. Image guided navigation system to measure intraoperatively acetabular implant alignment. Clin Orthop Relat Res. 1998;355:8–22.PubMedCrossRef

DiGioia AM 3rd, Jaramaz B, Plakseychuk AY, Moody JE Jr, Nikou C, Labarca RS, Levison TJ, Picard F. Comparison of a mechanical acetabular alignment guide with computer placement of the socket. J Arthroplasty. 2002;17:359–364.PubMedCrossRef

D’Lima DD, Chen PC, Colwell CW Jr. Optimizing acetabular component position to minimize impingement and reduce contact stress. J Bone Joint Surg Am. 2001;83(Suppl 2 Pt 2):87–91.PubMed

D’Lima DD, Urquhart AG, Buehler KO, Walker RH, Colwell CW Jr. The effect of the orientation of the acetabular and femoral components on the range of motion of the hip at different head-neck ratios. J Bone Joint Surg Am. 2000;82:315–321.PubMed

Dobzyniak M, Fehring TK, Odum S. Early failure in total hip arthroplasty. Clin Orthop Relat Res. 2006;447:76–78.PubMedCrossRef

10.

Dorr LD. Hip Arthroplasty, Minimally Invasive Techniques and Computer Navigation. Philadelphia, PA: Saunders, Elsevier; 2006.

11.

Dorr LD, Faugere MC, Mackel AM, Gruen TA, Bognar B, Malluche HH. Structural and cellular assessment of bone quality of proximal femur. Bone. 1993;14:231–242.PubMedCrossRef

12.

Dorr LD, Hishiki Y, Wan Z, Newton D, Yun A. Development of imageless computer navigation for acetabular component position in total hip replacement. Iowa Orthop J. 2005;25:1–9.PubMed

13.

Dorr LD, Malik A, Wan Z, Long WT, Harris M. Precision and bias of imageless computer navigation and surgeon estimates for acetabular component position. Clin Orthop Relat Res. 2007;465:92–99.PubMed

14.

Dorr LD, Wan Z. Ten years of experience with porous acetabular components for revision surgery. Clin Orthop Relat Res. 1995;319:191–200.PubMed

15.

Harris M, Dorr LD, Wan Z, Sirianni L, Boutary M. Total hip arthroplasty with the APR stem and cup follow-up of a previous report. J Arthroplasty. 2005;20:828–831.PubMedCrossRef

16.

Hassan DM, Johnston GH, Dust WN, Watson G, Dolovich AT. Accuracy of intraoperative assessment of acetabular prosthesis placement. J Arthroplasty. 1998;13:80–84.PubMedCrossRef

17.

Inaba Y, Dorr LD, Wan Z, Sirianni L, Boutary M. Operative and patient care techniques for posterior mini-incision total hip arthroplasty. Clin Orthop Relat Res. 2005;441:104–114.PubMedCrossRef

18.

Jolles BM, Genoud P, Hoffmeyer P. Computer-assisted cup placement techniques in total hip arthroplasty improve accuracy of placement. Clin Orthop Relat Res. 2004;426:174–179.PubMedCrossRef

19.

Kalteis T, Handel M, Bathis H, Perlick L, Tingart M, Grifka J. 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. 2006;88:163–167.PubMedCrossRef

20.

Kang JS, Dorr LD, Wan Z. The effect of diaphyseal biologic fixation on clinical results and fixation of the APR-II stem. J Arthroplasty. 2000;15:730–735.PubMedCrossRef

21.

Komeno M, Hasegawa M, Sudo A, Uchida A. Computed tomographic evaluation of component position on dislocation after total hip arthroplasty. Orthopedics. 2006;29:1104–1108.PubMed

22.

Malik A, Maheshwari A, Dorr LD. Impingement with total hip replacement. J Bone Joint Surg Am. 2007;89:1832–1842.PubMedCrossRef

23.

Maruyama M, Feinberg JR, Capello WN, D’Antonio JA. The Frank Stinchfield Award: Morphologic features of the acetabulum and femur: anteversion angle and implant positioning. Clin Orthop Relat Res. 2001;393:52–65.PubMedCrossRef

24.

McKibbin B. Anatomical factors in the stability of the hip joint in the newborn. J Bone Joint Surg Br. 1970;52:148–159.PubMed

25.

Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg Br. 1993;75:228–232.PubMed

26.

Nishii T, Sugano N, Miki H, Koyama T, Takao M, Yoshikawa H. Influence of component positions on dislocation: computed tomographic evaluations in a consecutive series of total hip arthroplasty. J Arthroplasty. 2004;19:162–166.PubMedCrossRef

27.

Patil S, Bergula A, Chen PC, Colwell CW Jr, D’Lima DD. Polyethylene wear and acetabular component orientation. J Bone Joint Surg Am. 2003;85(Suppl 4):56–63.PubMed

28.

Pierchon F, Pasquier G, Cotten A, Fontaine C, Clarisse J, Duquennoy A. Causes of dislocation of total hip arthroplasty. CT study of component alignment. J Bone Joint Surg Br. 1994;76:45–48.PubMed

29.

Ranawat CS, Maynard MJ. Modern Techniques of Cemented Total Hip Arthroplasty. Tech Orthopedics. 1991;6:17–25.CrossRef

30.

Wan Z, Boutary M, Dorr LD. The influence of acetabular component position on wear in total hip arthroplasty. J Arthroplasty. 2008;23:51–56.PubMedCrossRef

31.

Widmer KH, Zurfluh B. Compliant positioning of total hip components for optimal range of motion. J Orthop Res. 2004;22:815–821.PubMedCrossRef

32.

Wines AP, McNicol D. Computed tomography measurement of the accuracy of component version in total hip arthroplasty. J Arthroplasty. 2006;21:696–701.PubMedCrossRef

33.

Yoshimine F. The safe-zones for combined cup and neck anteversions that fulfill the essential range of motion and their optimum combination in total hip replacements. J Biomech. 2006;39:1315–1323.PubMedCrossRef

Title: Combined Anteversion Technique for Total Hip Arthroplasty
Authors: Lawrence D. Dorr, MD
Aamer Malik, MD
Manish Dastane, MD
Zhinian Wan, MD
Publication date: 01-01-2009
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 1/2009
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-008-0598-4

At a glance: The STEP trials

Springer Medicine

Combined Anteversion Technique for Total Hip Arthroplasty

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2009

Initial American Experience with Hip Resurfacing Following FDA Approval

Case Reports: Symptomatic Bilateral Talonavicular Coalition

Papers Presented at the Hip Society Meetings 2008: Editorial Comment

Imaging and Navigation Measurement of Acetabular Component Position in THA

Reply to Letter to the Editor: Early Outcome of TKA with a Medial Pivot Fixed-bearing Prosthesis Is Worse Than With a PFC Mobile-bearing Prosthesis

Why Revision Total Hip Arthroplasty Fails