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Influence of obesity and intra-operative imaging guidance technology on acetabular cup positioning in total hip arthroplasty

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Accuracy of acetabular cup positioning during total hip arthroplasty (THA) can be improved with intra-operative imaging but may be influenced by body mass index (BMI). This study assessed the influence of BMI (kg/m2) on cup accuracy when using intra-operative fluoroscopy (IF) alone or supplemented with a commercial product.

Methods

This retrospective review included four consecutive cohorts of patients having undergone anterior approach THA with IF alone (2011–2015), IF and Overlay (2015–2016) (Radlink Inc., Los Angeles, CA), IF and Grid (2017–2018) (HipGrid Drone™, OrthoGrid Systems Inc., Salt Lake City, UT) and IF and Digital (2018–2020) (OrthoGrid Phantom®, OrthoGrid Systems, Inc., Salt Lake City, UT). Component placement accuracy was measured on 6-week post-operative weight bearing radiographs and compared between four BMI patient groups (BMI ≤ 25, 25 < BMI ≤ 30, 30 < BMI ≤ 35, and 35 < BMI). Total fluoroscopy times were also recorded directly from the fluoroscopy unit.

Results

Abduction angle significantly increased as BMI increased (p = 0.003) with IF alone but no difference was present in groups with guidance technology. Anteversion was significantly different between BMI groups for IF alone (p = 0.028) and Grid (p = 0.027) but was not different in Overlay (p = 0.107) or Digital (p = 0.210). Fluoroscopy time was significantly different between BMI categories for IF alone (p = 0.005) and Grid (p = 0.018) but was not different in Overlay (p = 0.444) or Digital (p = 0.170).

Conclusion

Morbid obesity (BMI > 35) increases risk for malpositioning of acetabular cups and increases surgical time with IF alone or the Grid. Additional IF guidance technology (Overlay or Digital) increased cup positioning accuracy without decreasing surgical efficiency.

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Funding

This research received no specific grant from any funding agency in the public, commercial or non-for-profit sectors.

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Authors and Affiliations

  1. John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA

    Kayti Luu, Scott T. Nishioka & Dylan R. Y. Lawton

  2. Department of Surgery, University of Hawai’I, John A Burns School of Medicine, 1356 Lusitana Street, Honolulu, HI, 96813, USA

    Samantha N. Andrews & Cass K. Nakasone

  3. Department of Orthopedic Surgery, Straub Medical Center, 888 South King Street, Honolulu, HI, 96818, USA

    Emily Unebasami, Samantha N. Andrews & Cass K. Nakasone

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  1. Kayti Luu
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Correspondence to Cass K. Nakasone.

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Conflict of interest

Author Cass Nakasone receives royalties as a design surgeon and consulting fees from Ortho Development Corporation and is a consultant for OrthoGrid Systems. Cass Nakasone has no other relevant financial or non-financial interests to disclose. All other authors certify that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Ethical approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Hawai’i Pacific Health Research Institute (local Western Institutional Review Board) approved this study.

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This was a retrospective chart review and data collected were deidentified and presented as large-scale, aggregate data. Therefore, no informed consent was obtained or required by the IRB.

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Luu, K., Nishioka, S.T., Lawton, D.R.Y. et al. Influence of obesity and intra-operative imaging guidance technology on acetabular cup positioning in total hip arthroplasty. Arch Orthop Trauma Surg 143, 6857–6863 (2023). https://doi.org/10.1007/s00402-023-04922-x

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