Coverage of the acetabular cup under different perspective angles: assessing the position of the total hip arthroplasty prosthesis for complex types of hip dysplasia

doi:10.12307/2022.057

Abstract

Abstract: BACKGROUND: The coverage of acetabular cup is used to evaluate the inclusiveness and stability of the acetabular cup after total hip arthroplasty. Plain radiograph examination of the hip is a common method to detect acetabular cup coverage during or after total hip arthroplasty. Different perspective angles may affect the measurement and evaluation of acetabular cup coverage.
OBJECTIVE: To explore the relationship between the coverage of the acetabular cup under different perspectives after total hip arthroplasty.
METHODS: Five three-dimensional printed synthetic pelvic specimens were taken, and 52 mm diameter acetabular cup prosthesis was placed by polishing the right acetabulum to prepare different acetabular cup coverage models. The prepared pelvis model was fixed with the right acetabulum as the center under the C-arm machine for fluoroscopy. By rotating the C-arm machine, the right hip joint was seen through the front view, 15°, 30°, and 45° axial position films and left 15°, 30°, and 45° oblique films. The coverage of the acetabular cup under different perspective angles was calculated by Photoshop2019 software to compare the difference between the acetabular cup coverage under the different angles of the axial and oblique films and the orthographic film.
RESULTS AND CONCLUSION: (1) In the test of the acetabular cup coverage of the axial film, as the axial perspective angle was tilted upward; the coverage of the acetabular cup gradually increased, and was significantly higher in the upper 45° axial film group than that in the hip orthographic film group [increased (6.72±1.57)%, P=0.009]. (2) In the oblique film acetabular cup coverage test, as the perspective angle tilted to the left, the coverage rate showed a downward trend. The coverage was significantly lower in the left 45° oblique film group than that in the hip joint orthographic film group [decreased (5.56±1.91)%, P=0.021]. (3) Results confirm that there are differences in the coverage of the acetabular cup under different oblique perspective angles. The greater the upward axial tilt angle, the greater the cup coverage, and the greater the contralateral tilt angle, the less cup coverage. It is indicated that for patients undergoing total hip arthroplasty, attention should be paid to the intraoperative fluoroscopy angle. For complicated types of total hip arthroplasty patients, 45° oblique films can be shown during or after the operation to further evaluate the position and coverage of the cup.

Key words: arthroplasty, hip, replacement, coverage, pelvis, acetabular cup, fluoroscopy, axial

CLC Number:

Wang Jinzi, Ding Hai, Zhang Heng, Chang Wenju, Liu Fendou. Coverage of the acetabular cup under different perspective angles: assessing the position of the total hip arthroplasty prosthesis for complex types of hip dysplasia[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(3): 350-353.

Figures/Tables 2

References

[1] Schmitz MR, Murtha AS, Clohisy JC, et al. Developmental Dysplasia of the Hip in Adolescents and Young Adults. J Am Acad Orthop Surg. 2020;28(3):91-101.
[2] Goiano EO, Akkari M, Pupin JP, et al. The epidemiology of developmental dysplasia of the hip in males. Acta Ortop Bras. 2020;28(1):26-30.
[3] Gómez Alcaraz J, Pardo García JM, Sevilla Fernández J, et al. Primary total hip arthroplasty in elderly patients over 85 years old: risks, complications and medium-long term results. Rev Esp Cir Ortop Traumatol. 2021;65(1):13-23.
[4] Malik AT, Jain N, Scharschmidt TJ, et al. Primary hip arthroscopy and conversion to total hip arthroplasty: trends and survival analysis in the Medicare population. Hip Int. 2020:1120700020951171.
[5] Sherman AE, Plantz MA, Hardt KD. Outcomes of Elective Total Hip Arthroplasty in Nonagenarians and Centenarians. J Arthroplasty. 2020;35(8):2149-2154.
[6] Agarwal N, To K, Khan W. Cost effectiveness analyses of total hip arthroplasty for hip osteoarthritis: A PRISMA systematic review. Int J Clin Pract. 2021;75(2):e13806.
[7] Nowakowski AM. Developments in hip arthroplasty. Ther Umsch. 2020;77(10): 499-503.
[8] Dezateux C, Rosendahl K. Developmental dysplasia of the hip. Lancet. 2007; 369(9572):1541-1552.
[9] Alp NB, AkdaĞ G, ErdoĞan F. Long-term results of total hip arthroplasty in developmental dysplasia of hip patients. Jt Dis Relat Surg. 2020;31(2):298-305.
[10] Sodhi N, Khlopas A, Berliner Z, et al. Survivorship and Radiographic Analysis of Highly Porous Acetabular Cups Designed for Improved Osseointegration Potential. Surg Technol Int. 2019;34:425-429.
[11] Seo LJ, Gabor J, Novikov D, et al. Outcomes in 385 developmental dysplastic hips requiring total hip arthroplasty. Arch Orthop Trauma Surg. 2019;139(5): 723-728.
[12] Philippot R, Baulot E, Vermorel PH, et al. Outcomes of Augmented Dual Mobility Acetabular Cups. Surg Technol Int. 2019;35:274-279.
[13] Nugent M, Campbell DG, Lewis PL, et al. Acetabular screws do not improve early revision rates in primary total hip arthroplasty. An instrumented registry analysis. Int Orthop. 2021;45(3):593-604.
[14] Du Y, Fu J, Sun J, et al. Acetabular Bone Defect in Total Hip Arthroplasty for Crowe II or III Developmental Dysplasia of the Hip: A Finite Element Study. Biomed Res Int. 2020;2020:4809013.
[15] Mou P, Liao K, Chen HL, et al. Controlled fracture of the medial wall versus structural autograft with bulk femoral head to increase cup coverage by host bone for total hip arthroplasty in osteoarthritis secondary to developmental dysplasia of the hip: a retrospective cohort study. J Orthop Surg Res. 2020;15(1):561.
[16] 查国春,冯硕,马桥桥,等.髋关节发育不良全髋关节置换术中髋臼覆盖率对臼杯初始稳定性的影响[J].中华骨科杂志,2019(19):1215-1221.
[17] Ueno T, Kabata T, Kajino Y, et al. Three-Dimensional Host Bone Coverage Required in Total Hip Arthroplasty for Developmental Dysplasia of the Hip and Its Relationship With 2-Dimensional Coverage. J Arthroplasty. 2019;34(1):93-101.
[18] Tachibana T, Fujii M, Kitamura K, et al.Does Acetabular Coverage Vary Between the Supine and Standing Positions in Patients with Hip Dysplasia? Clin Orthop Relat Res. 2019;477(11):2455-2466.
[19] Fritz B, Agten CA, Boldt FK, et al. Acetabular coverage differs between standing and supine positions: model-based assessment of low-dose biplanar radiographs and comparison with CT. Eur Radiol. 2019;29(10):5691-5699.
[20] Uemura K, Atkins PR, Peters CL, et al. The effect of pelvic tilt on three-dimensional coverage of the femoral head: A computational simulation study using patient-specific anatomy. Anat Rec (Hoboken). 2021;304(2):258-265.
[21] Li RT, Hu E, Gould H, et al. Does Pelvic Rotation Alter Radiologic Measurement of Anterior and Lateral Acetabular Coverage? Arthroscopy. 2019;35(4):1111-1116.e1.
[22] Masui T, Iwase T, Kouyama A, et al. Autogenous bulk structural bone grafting for reconstruction of the acetabulum in primary total hip arthroplasty: average 12-year follow-up. Nagoya J Med Sci. 2009;71(3-4):145-150.
[23] Zheng LL, Lin YY, Zhang XY, et al. Best bone of acetabulum for cup component placement in Crowe types I to III dysplastic hips: a computer simulation study.Chin Med J (Engl). 2019;132(23):2820-2826.
[24] Takada R, Jinno T, Miyatake K, et al. Longitudinal morphological change of acetabular subchondral bone cyst after total hip arthroplasty in developmental dysplasia of the hip. Eur J Orthop Surg Traumatol. 2018;28(4):621-625.
[25] Sakemi Y, Komiyama K, Yoshimoto K, et al. How does anteroposterior cup placement affect bone coverage and range of motion in primary total hip arthroplasty for hip dysplasia? J Orthop Sci. 2019;24(2):269-274.
[26] Ma Y, Luo D, Cheng H, et al. Is cup positioning easier in DDH patients previously treated with Bernese periacetabular osteotomy? J Orthop Surg Res. 2020;15(1):501.
[27] Shi XT, Li CF, Han Y, et al. Total Hip Arthroplasty for Crowe Type IV Hip Dysplasia: Surgical Techniques and Postoperative Complications. Orthop Surg. 2019;11(6): 966-973.
[28] Zhang H, Zhou J, Guan J, et al. How to restore rotation center in total hip arthroplasty for developmental dysplasia of the hip by recognizing the pathomorphology of acetabulum and Harris fossa? J Orthop Surg Res. 2019;14(1): 339.
[29] Geng X, Li Y, Li F, et al. A new 3D printing porous trabecular titanium metal acetabular cup for primary total hip arthroplasty: a minimum 2-year follow-up of 92 consecutive patients. J Orthop Surg Res. 2020;15(1):383.
[30] Xu J, Qu X, Li H, et al. Three-Dimensional Host Bone Coverage in Total Hip Arthroplasty for Crowe Types II and III Developmental Dysplasia of the Hip. J Arthroplasty. 2017;32(4):1374-1380.
[31] Nie Y, Wang H, Huang Z, et al. Radiographic Underestimation of In Vivo Cup Coverage Provided by Total Hip Arthroplasty for Dysplasia. Orthopedics. 2018;41(1):e46-46e51.
[32] 郭宇,冯德宏,王凌,等.3D打印技术在髋关节置换中的应用及价值[J].中国组织工程研究,2020,24(12):1962-1968.
[33] Liu K, Li Z, Ma Y, et al. 3D-printed pelvis model is an efficient method of osteotomy simulation for the treatment of developmental dysplasia of the hip.Exp Ther Med. 2020;19(2):1155-1160.
[34] Fang C, Cai H, Kuong E, et al. Surgical applications of three-dimensional printing in the pelvis and acetabulum: from models and tools to implants. Unfallchirurg. 2019;122(4):278-285.