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The John Charnley Award: Risk Factors for Cup Malpositioning: Quality Improvement Through a Joint Registry at a Tertiary Hospital

  • Symposium: Papers Presented at the Hip Society Meetings 2010
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Few studies have examined factors that affect acetabular cup positioning. Since cup positioning has been linked to dislocation and increased bearing surface wear, these factors affecting cup position are important considerations.

Question/purposes

We determined the percent of optimally positioned acetabular cups and whether patient and surgical factors affected acetabular component position.

Methods

We obtained postoperative AP pelvis and cross-table lateral radiographs on 2061 consecutive patients who received a THA or hip resurfacing from 2004 to 2008. One thousand nine hundred and fifty-two hips had AP pelvic radiographs with correct position of the hip center, and 1823 had both version and abduction angles measured. The AP radiograph was measured using Hip Analysis Suite™ to calculate the cup inclination and version angles, using the lateral film to determine version direction. Acceptable ranges were defined for abduction (30°–45°) and version (5°–25°).

Results

From the 1823 hips, 1144 (63%) acetabular cups were within the abduction range, 1441 (79%) were within the version range, and 917 (50%) were within the range for both. Surgical approach, surgeon volume, and obesity (body mass index > 30) independently predicted malpositioned cups. Comparison of low versus high volume surgeons, minimally invasive surgical versus posterolateral approach, and obesity versus all other body mass index groups showed a twofold (1.5–2.8), sixfold (3.5–10.7), and 1.3-fold (1.1–1.7) increased risk for malpositioned cups, respectively.

Conclusions

Factors correlated to malpositioned cups included surgical approach, surgeon volume, and body mass index with increased risk of malpositioning for minimally invasive surgical approach, low volume surgeons, and obese patients. Further analyses on patient and surgical factors’ influence on cup position at a lower volume medical center would provide a valuable comparison.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ 1206, Boston, MA, 02114, USA

    Mark C. Callanan MA, Bryan Jarrett BS, Charles R. Bragdon PhD, Harry E. Rubash MD, Andrew A. Freiberg MD & Henrik Malchau MD, PhD

  2. Departments of Anesthesiology and Surgery, Children’s Hospital Boston, Harvard Medical School, Boston, MA, USA

    David Zurakowski PhD

Authors
  1. Mark C. Callanan MA
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  2. Bryan Jarrett BS
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  3. Charles R. Bragdon PhD
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  4. David Zurakowski PhD
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  5. Harry E. Rubash MD
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  6. Andrew A. Freiberg MD
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  7. Henrik Malchau MD, PhD
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Corresponding author

Correspondence to Henrik Malchau MD, PhD.

Additional information

This project was funded by the Harris Orthopaedic Laboratory.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Harris Orthopaedic Laboratory.

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Callanan, M.C., Jarrett, B., Bragdon, C.R. et al. 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 (2011). https://doi.org/10.1007/s11999-010-1487-1

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