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Higher Acetabular Anteversion in Direct Anterior Total Hip Arthroplasty: A Retrospective Case-Control Study

  • Original Article
  • Published:
HSS Journal ®

Abstract

Background

Surgical approach is known as a risk factor that influences cup malposition while performing total hip arthroplasty (THA). However, no study has been conducted comparing cup positioning between the supine direct anterior (DA) and supine direct lateral (DL) THA approaches.

Questions/Purposes

(1) Is there a difference in acetabular cup positioning between supine DA and supine DL THA approaches?

(2) Are there differences in complications based on acetabular cup positioning between the two approaches?

Methods

From 2012 to 2014, 186 patients who underwent primary THAs using DA approach were matched with 186 patients using DL approach by body mass index, age, and gender. Cup anteversion and abduction angles were measured from standing anteroposterior pelvis radiographs by two blinded observers. The Lewinnek safe zone was used as the standard for cup positioning. Cup anteversion, abduction angles, and complications were recorded and compared.

Results

Cup anteversion was on average 3° higher in the DA approach compared to the DL approach. The abduction angle for the DA approach was equivalent to the DL approach both averaging 46° to 47°. There were more DA hips outside of the safe zone (10%) for anteversion than DL (3%) hips. There were no differences in complications between DA and DL approaches.

Conclusion

There is a tendency to antevert the acetabular cup when performing THAs using the DA approach, and one must be mindful of this when implanting the acetabular component.

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Authors and Affiliations

  1. Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Antonia F. Chen MD, MBA, Sara Low MD, Karthikeyan Chinnakkannu MBBS, MS, Fabio R. Orozco MD, Alvin C. Ong MD & Zachary D. Post MD

  2. Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan

    Chi-Lung Chen MD

  3. Department of Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan

    Wei-Ming Lin MD

  4. 2500 English Creek Avenue, Building 1300, Egg Harbor Township, NJ, 08234, USA

    Fabio R. Orozco MD, Alvin C. Ong MD & Zachary D. Post MD

Authors
  1. Antonia F. Chen MD, MBA
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  2. Chi-Lung Chen MD
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  3. Sara Low MD
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  4. Wei-Ming Lin MD
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  5. Karthikeyan Chinnakkannu MBBS, MS
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  6. Fabio R. Orozco MD
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  8. Zachary D. Post MD
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Corresponding author

Correspondence to Zachary D. Post MD.

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Conflict of Interest

Chi-Lung Chen, MD; Sara Low, MD; Wei-Ming Lin, MD; and Karthikeyan Chinnakkannu, MBBS, MS, have declared that they have no conflict of interest. Zachary D. Post, MD, reports personal fees from Smith and Nephew, Stryker, DePuy, and OrthoDevelopment, outside the work. Alvin C. Ong, MD, reports personal fees from Stryker and Smith & Nephew, outside the work. Fabio R. Orozco, MD, reports personal fees from Stryker, outside the work. Antonia F. Chen, MD, MBA, reports other support from SLACK publishing, research support from 3M and Myoscience, non-financial support from Joint Purification Systems, and personal fees from ACI, outside the work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent

Informed consent was waived from all patients for being included in the study.

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Additional information

Level of Evidence: Therapeutic study, Level III

This work was performed at The Rothman Institute.

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Chen, A.F., Chen, CL., Low, S. et al. Higher Acetabular Anteversion in Direct Anterior Total Hip Arthroplasty: A Retrospective Case-Control Study. HSS Jrnl 12, 240–244 (2016). https://doi.org/10.1007/s11420-016-9488-6

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  • DOI: https://doi.org/10.1007/s11420-016-9488-6

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