International Orthopaedics

, Volume 42, Issue 4, pp 769–775 | Cite as

A retrospective study on the relationship between altered native acetabular angle and vertical implant malpositioning

  • Jorge Rojas
  • Maria Bautista
  • Guillermo Bonilla
  • Omar Amado
  • Elina Huerfano
  • Daniel Monsalvo
  • Adolfo Llinás
  • José Navas
Original Paper

Abstract

Purpose

Acetabular cup positioning in extreme angles of vertical position affects both stability and long-term survivorship of total hip arthroplasty. The purpose of this study is to determine whether native Sharp’s angle is associated with an increased abduction angle of the acetabular component.

Methods

Consecutive patients who underwent primary total hip replacement between February 2012 and August 2015 were included. Vertical positioning of acetabular implant in the antero-posterior post-operative radiographs were measured. The proportion of implants positioned outside the safe zone (40° ± 10°) was calculated and through a multivariate analysis, Sharp’s angle and other factors possibly associated with cup malpositioning were evaluated.

Results

Five hundred twenty-eight hip arthroplasties were analyzed. Prevalence of cup malpositioning was 7.6% and 25 patients had an altered native acetabular angle. An altered pre-operative Sharp’s angle was associated with a higher risk of vertical malpositioning of the acetabular component (OR 2.51 IC 95%: 1.17–5.39) (p = 0.02). Body mass index, surgeon’s volume, size of the implant, gender, pre-operative diagnose and age, were not associated with the position of the cup.

Conclusions

The alteration of the Sharp’s angle as an indicator of hip dysplasia in native hips increases the odds of acetabular cup malpositioning. Other factors explored did not correlate with the position of the acetabular prosthesis. Systematic assessment of Sharp’s angle should be included in the pre-operative planning of primary hip arthroplasty.

Keywords

Acetabulum Artrhoplasty, replacement, hip Hip prosthesis implantation Acetabular cup positioning 

Notes

Compliance with ethical standards

Conflict of interest

Dr. Bautista has received other financial support from DePuy Synthes (Orthopedics) and Grunenthal, outside this work. Dr. Bonilla has participated as a paid speaker for Boehringer-Ingelheim, Pfizer, Bristol-Myers-Squibb, DePuy Synthes (Orthopedics) and Stryker; has received other financial support from DePuy Synthes (Orthopedics) and Grunenthal, outside this work. Dr. Llinás has received royalties from Innomed; has participated as a paid speaker for Zimmer, Bayer, Covidien, Ethicon, Pfizer, Novonordisk, Baxter, 3 M, Biotest and Procaps; has participated as a paid consultant for Ethicon, Zimmer and Bayer, outside this work. Dr. Rojas has nothing to disclose. Dr. Amado has nothing to disclose. Dr. Huerfano has nothing to disclose. Dr. Monsalvo has nothing to disclose. Dr. Navas has nothing to disclose.

Ethical approval

The Institutional Review Board approved the development of this research study. For this type of study formal consent is not required. This article does not contain any experimental intervention with human participants or animals performed by any of the authors.

References

  1. 1.
    Meftah M, Yadav A, Wong AC et al (2013) A novel method for accurate and reproducible functional cup positioning in total hip arthroplasty. J Arthroplast 28:1200–1205. doi: 10.1016/j.arth.2012.09.018 CrossRefGoogle Scholar
  2. 2.
    Ng VY, McShane M (2011) Understanding acetabular cup orientation: the importance of convention and defining the safe zone. HIP Int 21:646–652. doi: 10.5301/HIP.2011.8858 CrossRefPubMedGoogle Scholar
  3. 3.
    Merle C, Grammatopoulos G, Waldstein W et al (2013) Comparison of native anatomy with recommended safe component orientation in total hip arthroplasty for primary osteoarthritis. J Bone Joint Surg Am 95–A:e172–e179Google Scholar
  4. 4.
    Mcbride A, Flynn J, Miller G et al (2013) Body mass index and acetabular component position in total hip arthroplasty. ANZ J Surg 83:171–174. doi: 10.1111/j.1445-2197.2012.06176.x CrossRefPubMedGoogle Scholar
  5. 5.
    Grammatopoulos G, Thomas G, Pandit H et al (2015) The effect of orientation of the acetabular component on outcome following total hip arthroplasty with small diameter hard-on-soft bearings. Bone Joint J 97–B:164–172. doi: 10.1302/0301-620X.97B2.34294 CrossRefPubMedGoogle Scholar
  6. 6.
    Antoniades J, Pellegrini VD (2012) Cross-sectionalanatomy of the ilium: implications for acetabular component placement in total hip arthroplasty. Clin Orthop Relat Res 470:3537–3541. doi: 10.1007/s11999-012-2574- CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Legaye J, Duval-Beaupere G, Barrau A et al (2011) Relationship between sacral pelvic incidence and acetabular orientation. HIP Int 21:87–97. doi: 10.5301/HIP.2011.6283 CrossRefPubMedGoogle Scholar
  8. 8.
    Miettinen SSA, Mäkinen TJ, Laaksonen I et al (2016) Early aseptic loosening of cementless monoblock acetabular components. Int Orthop 41:1–8. doi: 10.1007/s00264-016-3254-8 Google Scholar
  9. 9.
    Murayama T, Ohnishi H, Mori T et al (2015) A novel non-invasive mechanical technique of cup and stem placement and leg length adjustment in total hip arthroplasty for dysplastic hips. Int Orthop 39:1057–1064. doi: 10.1007/s00264-014-2613-6 CrossRefPubMedGoogle Scholar
  10. 10.
    Barrack R, Krempec J, Clohisy J et al (2013) Accuracy of acetabular component position in hip arthroplasty. J Bone Joint Surg Am 95:1760–1768. doi: 10.2106/JBJS.L.01704 CrossRefPubMedGoogle Scholar
  11. 11.
    Domb B, El Bitar Y, Sadik A et al (2014) Comparison of robotic-assisted and conventional acetabular cup placement in THA: a matched-pair controlled study hip. Clin Orthop Relat Res 472:329–336. doi: 10.1007/s11999-013-3253-7 CrossRefPubMedGoogle Scholar
  12. 12.
    Korduba L, Essner A, Pivec R et al (2014) Effect of acetabular cup abduction angle on wear of ultrahigh-molecular-weight polyethylene in hip simulator testing. Am J Orthop 43:466–471PubMedGoogle Scholar
  13. 13.
    Lewinnek G, Lewis J, Tarr R et al (1978) Dislocations after total hip-replacement arthroplasties. J Bone Jt Surg Am 60:217–220CrossRefGoogle Scholar
  14. 14.
    Barrack R (2003) Dislocation after total hip arthroplasty: implant design and orientation. J Am Acad Orthop Surg 11:89–99CrossRefPubMedGoogle Scholar
  15. 15.
    Callanan M, Jarrett B, Bragdon C et al (2011) The john charnley award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res 469:319–329. doi: 10.1007/s11999-010-1487-1 CrossRefPubMedGoogle Scholar
  16. 16.
    Harrison C, Thomson A, Cutts S et al (2014) Research synthesis of recommended acetabular cup orientations for total hip arthroplasty. J Arthroplast 29:377–382. doi: 10.1016/j.arth.2013.06.026
  17. 17.
    Seagrave KG, Troelsen A, Malchau H et al (2016) Acetabular cup position and risk of dislocation in primary total hip arthroplasty a systematic review of the literature. Acta Orthop 87:10–17. doi: 10.1080/17453674.2016.1251255 Google Scholar
  18. 18.
    Gromov K, Greene ME, Huddleston JI et al (2015) Acetabular dysplasia and surgical approaches other than direct anterior increases risk for Malpositioning of the acetabular component in total hip arthroplasty. J Arthroplast. doi: 10.1016/j.arth.2015.10.045
  19. 19.
    Sharp I (1961) Acetabular dysplasia. J Bone Jt Surg 43B:268–272. doi: 10.1017/CBO9781107415324.004 CrossRefGoogle Scholar
  20. 20.
    Sotereanos NG, Miller MC, Smith B et al (2006) Using intraoperative pelvic landmarks for acetabular component placement in total hip arthroplasty. J Arthroplast 21:832–840. doi: 10.1016/j.arth.2005.12.001
  21. 21.
    Archbold H, Mockford B, Molloy D et al (2006) The transverse acetabular ligament: an aid to orientation of the acetabular component during primary total hip replacement: a preliminary study of 1000 cases investigating postoperative stability. J Bone Joint Surg Br 88:883–886. doi: 10.1302/0301-620X.88B7.17577 CrossRefPubMedGoogle Scholar
  22. 22.
    Jawad M, Scully S (2011) In brief: Crowe’s classification: arthroplasty in developmental dysplasia of the hip. Clin Orthop Relat Res 469:306–308. doi: 10.1007/s11999-010-1316-6 CrossRefPubMedGoogle Scholar
  23. 23.
    Lee YK, Biau DJ, Yoon BH et al (2014) Learning curve of acetabular cup positioning in total hip arthroplasty using a cumulative summation test for learning curve (LC-CUSUM). J Arthroplast 29:586–589. doi: 10.1016/j.arth.2013.07.023 CrossRefGoogle Scholar
  24. 24.
    Tripuraneni KR, Archibeck MJ, Junick DW et al (2010) Common errors in the execution of preoperative templating for primary total hip arthroplasty. J Arthroplast 25:1235–1239. doi: 10.1016/j.arth.2009.10.004
  25. 25.
    McArthur B, Cross M, Geatrakas C et al (2012) Measuring acetabular component version after THA: CT or plain radiograph? Hip Clin Orthop Relat Res 470:2810–2818. doi: 10.1007/s11999-012-2292-9 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Maratt J, Esposito C, McLawhor A et al (2015) Pelvic tilt in patients undergoing Total hip arthroplasty: when does it matter? J Arthroplast 30:387–391. doi: 10.1007/978-1-4614-5915-6 CrossRefGoogle Scholar
  27. 27.
    Bayraktar V, Weber M, von Kunow F et al (2016) Accuracy of measuring acetabular cup position after total hip arthroplasty: comparison between a radiographic planning software and three-dimensional computed tomography. Int Orthop. doi: 10.1007/s00264-016-3240-1
  28. 28.
    Tang W, Chiu K, Kwan M, Ng T (2007) Sagittal pelvic mal-rotation and positioning of the acetabular component in total hip arthroplasty: three-dimensional computer model analysis. J Orthop Res 25:766–771. doi: 10.1002/jor
  29. 29.
    Buckland AJ, Vigdorchik J, Schwab FJ et al (2015) Acetabular anteversion changes due to spinal deformity correction: bridging the gap between hip and spine surgeons. J Bone Joint Surg Am 97:1913–1920. doi: 10.2106/JBJS.O.00276
  30. 30.
    Goyal P, Howard JL, Yuan X et al (2016) Effect of acetabular position on polyethylene liner wear measured using simultaneous Biplanar acquisition. J Arthroplast. doi: 10.1016/j.arth.2016.11.057
  31. 31.
    El Bitar Y, Jackson T, Lindner D et al (2015) Predictive value of robotic-assisted total hip arthroplasty. Orthopedics 38:e31–e37. doi: 10.3928/01477447-20150105-57
  32. 32.
    Wassilew GI, Perka C, Janz V et al (2012) Use of an ultrasound-based navigation system for an accurate acetabular positioning in total hip arthroplasty. A prospective, randomized, controlled study. J Arthroplast 27:687–694. doi: 10.1016/j.arth.2011.06.038
  33. 33.
    Elson L, Barr C, Chandran S et al (2013) Are morbidly obese patients undergoing total hip arthroplasty at an increased risk for component malpositioning? J Arthroplast 28:41–44. doi: 10.1016/j.arth.2013.05.035 CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2017

Authors and Affiliations

  • Jorge Rojas
    • 1
  • Maria Bautista
    • 2
  • Guillermo Bonilla
    • 3
  • Omar Amado
    • 1
  • Elina Huerfano
    • 1
  • Daniel Monsalvo
    • 1
  • Adolfo Llinás
    • 3
  • José Navas
    • 1
  1. 1.Department of Orthopedics and TraumatologyHospital Universitario Fundación Santa Fe de BogotáBogotáColombia
  2. 2.Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, School of MedicineUniversidad del RosarioBogotáColombia
  3. 3.Department of Orthopedics and Traumatology, Hospital Universitario Fundación Santa Fe de Bogotá, School of Medicine, Universidad de los Andes. School of MedicineUniversidad del RosarioBogotáColombia

Personalised recommendations