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Pelvic pitch and roll during total hip arthroplasty performed through a posterolateral approach. A potential source of error in free-hand cup positioning

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Abstract

Purpose

Intraoperative pelvic motion can alter the perceived cup inclination and version during non-navigated THA. We quantified pelvic motion during different phases of primary THA performed in the lateral decubitus through a posterolateral approach.

Methods

Pelvic roll (rotation of the coronal plane) and pitch angles (rotation parallel to the coronal plane) were studied in 75 patients undergoing THA for osteoarthritis by four arthroplasty surgeons. Ten steps of surgery were defined. Angular motion was recorded with a miniature surgical device that utilizes inertial sensors.

Results

The mean absolute roll ranged from 0.03° detected at the end of surgery to 4.13° detected during acetabular exposure. The mean absolute pitch ranged from 0.05° detected at the end of surgery to 2.54° detected during hip dislocation. The maximum pelvic roll and pitch detected during surgery averaged 17.62° (SD: 5.08) and 9.3° (SD: 3.39) respectively. Absolute roll and pitch angles were not affected by patient’s BMI, sex, pre-operative hip motion, or surgeon. Before cup insertion, the greatest mean change in roll was observed during acetabular exposure (10.02° anteriorly), and for pitch was observed during dislocation (1.88° caudally).

Conclusion

During THA performed through a posterolateral approach, there is a progressive anterior pelvic roll that peaks before cup insertion. This can lead to underestimation of cup anteversion during non-navigated THA. The anterior roll does not completely correct, even when all retractors and external forces acting on the pelvis are removed. Pelvic pitch that could affect the perceived cup inclination occurs to a lesser extent than pelvic roll.

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Acknowledgments

We are grateful to Jeffrey M. Muir, MSc, DC, MSc (Clin Epi) and Luke Becker, BASc from Intellijoint Surgical, Inc. for their assistance in data extraction and graphic preparation.

Funding

This study was partially funded by Intellijoint Surgical, Glenn Bergenfiend and The Sidney Milton and Leoma Simon Foundation.

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Authors and Affiliations

  1. From the Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Alejando Gonzalez Della Valle, Kate Shanaghan, Kaitlin Carroll, Michael Cross, Alexander McLawhorn & Peter K. Sculco

  2. Weill Medical College of Cornell University, New York, NY, USA

    Alejando Gonzalez Della Valle, Kate Shanaghan, Kaitlin Carroll, Michael Cross, Alexander McLawhorn & Peter K. Sculco

  3. Department of Clinical Research, Intellijoint Surgical, Inc., Waterloo, Canada

    Jessica R. Benson

Authors
  1. Alejando Gonzalez Della Valle
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  2. Kate Shanaghan
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  3. Jessica R. Benson
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  4. Kaitlin Carroll
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  5. Michael Cross
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  6. Alexander McLawhorn
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  7. Peter K. Sculco
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Corresponding author

Correspondence to Alejando Gonzalez Della Valle.

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Conflict of interest statement

Funding for this study has been received by Intellijoint Surgical, Inc.

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Gonzalez Della Valle, A., Shanaghan, K., Benson, J.R. et al. Pelvic pitch and roll during total hip arthroplasty performed through a posterolateral approach. A potential source of error in free-hand cup positioning. International Orthopaedics (SICOT) 43, 1823–1829 (2019). https://doi.org/10.1007/s00264-018-4141-2

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  • DOI: https://doi.org/10.1007/s00264-018-4141-2

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