International Orthopaedics

, Volume 43, Issue 11, pp 2477–2483 | Cite as

Cup alignment in total hip arthroplasty using the muscle-sparing modified Watson-Jones approach—comparison between lateral and supine positions

  • Yuichi Kishimura
  • Yukihide MinodaEmail author
  • Shigekazu Mizokawa
  • Ryo Sugama
  • Yoichi Ohta
  • Hiroaki Nakamura
Original Paper



The present study aimed to compare the cup alignment outliers in total hip arthroplasty (THA) using the same surgical approach with the patient in the supine position versus the lateral position.


THA using the muscle-sparing modified Watson-Jones approach was performed in 142 consecutive hips. THA was performed with the patient in the lateral position in 84 hips (lateral group) and in the supine position in 58 hips (supine group). The cup alignment was aimed at 40° inclination and 20° anteversion by referring to the mechanical alignment guide. Cup alignment and outliers (10° > aimed alignment) were assessed using post-operative 3D-CT.


The absolute error from the aimed inclination was 6.0 ± 4.7° in the supine group and 4.2 ± 3.6° in the lateral group (p = 0.01). The absolute error from the aimed anteversion was 4.1 ± 3.2° in the supine group and 5.1 ± 3.7° in the lateral group (p = 0.12). The supine group showed a higher rate of outliers than the lateral group for the cup inclination (22% vs 5%; p < 0.01). Inclination and BMI were positively correlated in the spine position group (p < 0.01, R = 0.48), but were not correlated in the lateral position group.


THA performed with the patient in the supine position has a higher risk of outliers of cup alignment compared with the lateral position, even when the same surgical approach is used. BMI affected the cup inclination in the supine position.


Total hip arthroplasty Cup alignment Supine position Lateral position Muscle-sparing modified Watson-Jones approach 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the institutional review boards of our hospital.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Brooks PJ (2013) Dislocation following total hip replacement: causes and cures. Bone Joint J 95-B(11 Suppl A):67–69CrossRefGoogle Scholar
  2. 2.
    Biedermann R, Tonin A, Krismer M, Rachbauer F, Eibl G, Stockl B (2005) Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component. J Bone Joint Surg Br 87(6):762–769CrossRefGoogle Scholar
  3. 3.
    Jolles B, Zangger P, Leyvraz P (2002) Factors predisposing to dislocation after primary total hip arthroplasty: a multivariate analysis. J Arthroplasty 17(3):282–288CrossRefGoogle Scholar
  4. 4.
    Kennedy J, Rogers W, Soffe K, Sullivan R, Griffen D, Sheehan L (1998) Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration. J Arthroplast 13(5):530–534CrossRefGoogle Scholar
  5. 5.
    Rojas J, Bautista M, Bonilla G, Amado O, Huerfano E, Monsalvo D, Llinás A, Navas J (2018) A retrospective study on the relationship between altered native acetabular angle and vertical implant malpositioning. Int Orthop 42(4):769–775CrossRefGoogle Scholar
  6. 6.
    Kawarai Y, Iida S, Nakamura J, Shinada Y, Suzuki C, Ohtori S (2017) Does the surgical approach influence the implant alignment in total hip arthroplasty? Comparative study between the direct anterior and the anterolateral approaches in the supine position. Int Orthop 41(12):2487–2493CrossRefGoogle Scholar
  7. 7.
    Kanazawa M, Nakashima Y, Ohishi M, Hamai S, Motomura G, Yamamoto T, Fukushi J, Ushijima T, Hara D, Iwamoto Y (2016) Pelvic tilt and movement during total hip arthroplasty in the lateral decubitus position. Mod Rheumatol 26(3):435–440CrossRefGoogle Scholar
  8. 8.
    Hayakawa K, Minoda Y, Aihara M, Sakawa A, Ohzono K, Tada K (2009) Acetabular component orientation in intra- and postoperative positions in total hip arthroplasty. Arch Orthop Trauma Surg 129(9):1151–1156CrossRefGoogle Scholar
  9. 9.
    Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H (2009) A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty 24(5):698–704CrossRefGoogle Scholar
  10. 10.
    Bertin KC, Röttinger H (2004) Anterolateral mini-incision hip replacement surgery: a modified Watson-Jones approach. Orthop Relat Res 429:248–255CrossRefGoogle Scholar
  11. 11.
    Austin MS, Rothman RH (2009) Acetabular orientation: anterolateral approach in the supine position. Clin Orthop Relat Res 467(1):112–118CrossRefGoogle Scholar
  12. 12.
    Pflüger G, Junk-Jantsch S, Schöll V (2007) Minimally invasive total hip replacement via the anterolateral approach in the supine position. Int Orthop 31(Suppl 1):7–11CrossRefGoogle Scholar
  13. 13.
    Miki H, Yamanashi W, Nishii T, Sato Y, Yoshikawa H, Sugano N (2007) Anatomic hip range of motion after implantation during total hip arthroplasty as measured by a navigation system. J Arthroplast 22(7):946–952CrossRefGoogle Scholar
  14. 14.
    Murray DW (1993) The definition and measurement of acetabular orientation. J Bone Joint Surg Br 75(2):228–232CrossRefGoogle Scholar
  15. 15.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174CrossRefGoogle Scholar
  16. 16.
    Walter SD, Eliasziw M, Donner A (1998) Sample size and optimal designs for reliability studies. Stat Med 17(1):101–110CrossRefGoogle Scholar
  17. 17.
    Kanda Y (2013) Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 48(3):452–458CrossRefGoogle Scholar
  18. 18.
    Suda K, Ito T, Miyasaka D, Imai N, Minato I, Endo N (2016) Cup implantation accuracy using the HipCOMPASS mechanical intraoperative support device. Springerplus 5(1):784CrossRefGoogle Scholar
  19. 19.
    Iwakiri K, Kobayashi A, Ohta Y, Minoda Y, Takaoka K, Nakamura H (2017) Efficacy of a pelvic lateral positioner with a mechanical cup navigator based on the anatomical pelvic plane in total hip arthroplasty. J Arthroplast 32(12):3659–3664CrossRefGoogle Scholar
  20. 20.
    Sato R, Takao M, Hamada H, Sakai T, Marumo K, Sugano N (2018) Clinical accuracy and precision of hip resurfacing arthroplasty using computed tomography-based navigation. Int Orthop 2018. CrossRefGoogle Scholar
  21. 21.
    Minoda Y, Ohzono K, Aihara M, Umeda N, Tomita M, Hayakawa K (2010) Are acetabular component alignment guides for total hip arthroplasty accurate? J Arthroplast 25(6):986–989CrossRefGoogle Scholar
  22. 22.
    Maeda Y, Sugano N, Nakamura N, Hamawaki M (2015) The accuracy of a mechanical cup alignment guide in total hip arthroplasty (THA) through direct anterior and posterior approaches measured with CT-based navigation. J Arthroplast 30(9):561–564CrossRefGoogle Scholar
  23. 23.
    Bayraktar V, Weber M, von Kunow F, Zeman F, Craiovan B, Renkawitz T, Grifka J, Woerner M (2017) Accuracy of measuring acetabular cup position after total hip arthroplasty: comparison between a radiographic planning software and three-dimensional computed tomography. Int Orthop 41(4):731–738CrossRefGoogle Scholar
  24. 24.
    Kalteis T, Handel M, Herold T, Perlick L, Paetzel C, Grifka J (2006) Position of the acetabular cup -- accuracy of radiographic calculation compared to CT-based measurement. Eur J Radiol 58(2):294–300CrossRefGoogle Scholar
  25. 25.
    Ghelman B, Kepler CK, Lyman S, Della Valle AG (2009) CT outperforms radiography for determination of acetabular cup version after THA. Clin Orthop Relat Res 467(9):2362–2370CrossRefGoogle Scholar
  26. 26.
    Olivecrona H, Weidenhielm L, Olivecrona L, Beckman MO, Stark A, Noz ME, Maguire GQ Jr, Zeleznik MP, Svensson L, Jonson T (2004) A new CT method for measuring cup orientation after total hip arthroplasty: a study of 10 patients. Acta Orthop Scand 75(3):252–260CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  • Yuichi Kishimura
    • 1
    • 2
  • Yukihide Minoda
    • 1
    Email author
  • Shigekazu Mizokawa
    • 1
    • 2
  • Ryo Sugama
    • 1
  • Yoichi Ohta
    • 1
  • Hiroaki Nakamura
    • 1
  1. 1.Department of Orthopaedic SurgeryOsaka City University Graduate School of MedicineOsakaJapan
  2. 2.Department of Orthopaedic SurgeryIzumi Municipal HospitalOsakaJapan

Personalised recommendations