Clinical Orthopaedics and Related Research

, Volume 467, Issue 1, pp 119–127 | Cite as

Combined Anteversion Technique for Total Hip Arthroplasty

  • Lawrence D. DorrEmail author
  • Aamer Malik
  • Manish Dastane
  • Zhinian Wan
Symposium: Papers Presented at the Hip Society Meetings 2008


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.


Pelvic Tilt Safe Zone Computer Navigation Femoral Anteversion Combine Anteversion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Patricia Paul for her help in preparing this manuscript.


  1. 1.
    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.Google Scholar
  2. 2.
    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.PubMedCrossRefGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    Bidgood WD Jr, Horii SC. Introduction to the ACR-NEMA DICOM standard. Radiographics. 1992;12:345–355.PubMedGoogle Scholar
  5. 5.
    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.PubMedCrossRefGoogle Scholar
  6. 6.
    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.PubMedCrossRefGoogle Scholar
  7. 7.
    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.PubMedGoogle Scholar
  8. 8.
    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.PubMedGoogle Scholar
  9. 9.
    Dobzyniak M, Fehring TK, Odum S. Early failure in total hip arthroplasty. Clin Orthop Relat Res. 2006;447:76–78.PubMedCrossRefGoogle Scholar
  10. 10.
    Dorr LD. Hip Arthroplasty, Minimally Invasive Techniques and Computer Navigation. Philadelphia, PA: Saunders, Elsevier; 2006.Google Scholar
  11. 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.PubMedCrossRefGoogle Scholar
  12. 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.PubMedGoogle Scholar
  13. 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.PubMedGoogle Scholar
  14. 14.
    Dorr LD, Wan Z. Ten years of experience with porous acetabular components for revision surgery. Clin Orthop Relat Res. 1995;319:191–200.PubMedGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. 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.PubMedCrossRefGoogle Scholar
  17. 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.PubMedCrossRefGoogle Scholar
  18. 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.PubMedCrossRefGoogle Scholar
  19. 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.PubMedCrossRefGoogle Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. 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.PubMedGoogle Scholar
  22. 22.
    Malik A, Maheshwari A, Dorr LD. Impingement with total hip replacement. J Bone Joint Surg Am. 2007;89:1832–1842.PubMedCrossRefGoogle Scholar
  23. 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.PubMedCrossRefGoogle Scholar
  24. 24.
    McKibbin B. Anatomical factors in the stability of the hip joint in the newborn. J Bone Joint Surg Br. 1970;52:148–159.PubMedGoogle Scholar
  25. 25.
    Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg Br. 1993;75:228–232.PubMedGoogle Scholar
  26. 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.PubMedCrossRefGoogle Scholar
  27. 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.PubMedGoogle Scholar
  28. 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.PubMedGoogle Scholar
  29. 29.
    Ranawat CS, Maynard MJ. Modern Techniques of Cemented Total Hip Arthroplasty. Tech Orthopedics. 1991;6:17–25.CrossRefGoogle Scholar
  30. 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.PubMedCrossRefGoogle Scholar
  31. 31.
    Widmer KH, Zurfluh B. Compliant positioning of total hip components for optimal range of motion. J Orthop Res. 2004;22:815–821.PubMedCrossRefGoogle Scholar
  32. 32.
    Wines AP, McNicol D. Computed tomography measurement of the accuracy of component version in total hip arthroplasty. J Arthroplasty. 2006;21:696–701.PubMedCrossRefGoogle Scholar
  33. 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.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2008

Authors and Affiliations

  • Lawrence D. Dorr
    • 1
    Email author
  • Aamer Malik
    • 1
  • Manish Dastane
    • 1
  • Zhinian Wan
    • 1
  1. 1.The Arthritis Institute at Good Samaritan HospitalLos AngelesUSA

Personalised recommendations