Variability in Acetabular Component Position in Patients Undergoing Direct Anterior Approach Total hip Arthroplasty with Concomitant Spine Pathology
Byeongho
1 Jung ,
Cesar
2 Iturriaga ,
Sreevathsa
2 Boraiah
1Donald
and Barbara Zucker School of Medicine at Hofstra/Northwell 1Department of Orthopedic Surgery, Northwell Health
Background
Discussion
Results Table 1. Anteversion and Vertical Version of Acetabular Component in Standing and Supine Positioning Stratified by Lane Grade Anteversion Supine
(Foran, 2020)
Abnormal spinopelvic motion increases instability, but there is lack of literature guiding THA with concomitant spinopelvic pathology
Anteversion Standing
Vertical Version
Vertical Version Supine
Standing
Mean
SD
Mean
SD
Mean
SD
Mean
SD
Lane
0 (n=125)
19.88
4.90
19.90
5.67
38.42
6.63
40.46
7.05
Grading
1 (n=201)
18.48
4.78
20.69
5.25
38.54
5.79
41.12
6.16
2 (n=209)
16.83
5.34
22.90
5.34
38.35
6.19
42.03
6.43
p-value*
<0.001
<0.001
0.952
0.088
Our study has extensive implications to clinical practice, because the intraoperative and perioperative assessment of anteversion in patients with spine pathology may be even less accurate than previously reported This is due to anterior dissection of soft tissues leading to greater instability anteriorly than posteriorly
SD=Standard Deviation; *=Assessed by One-way ANOVA
Determining optimum placement is difficult as cup positioning changes due to patient positioning and lumbar pathology
Table 2. Change in Cup Anteversion and Vertical Version from Supine to Standing Patient Positioning Stratified by Lane Grade
In patients with high Lane Grade spine pathology, increasing the anteversion intraoperatively amplifies the standing anteversion, possibly leading to an increased incidence of anterior instability
Lane Grading
Hypothesis
0 (n=125)
We assessed: 1) Acetabular cup positioning between standing and supine 2) Cup orientation stratified by degree of spine pathology
1 (n=201)
2 (n=209)
Mean
SD
Mean
SD
Mean
SD
p-value*
Change in Anteversion
0.03
4.65
2.20
4.08
6.07
5.50
<0.001
Change in Vertical Version
2.04
4.15
2.58
3.77
3.68
4.67
0.001
SD=Standard Deviation; *=Assessed by One-way ANOVA
Change in Cup Anteversion from Supine to Standing Stratified by Lane Grade
Anteversion of Acetabular Component in Standing and Supine
Methods
**** ****
***
***
40
***
30
Anteversion ()
Anteversion ()
*
****
20
10 1
2
0
Supine
More importantly, patients with high Lane Grade spine pathology, who have a stiffer spine, have increased anteversion on standing when compared to those with no spine pathology. The surgeon must be mindful not to over antevert the cup, which can lead to anterior instability
****
20
0
1
2
0
1
2
Lane Grade
Standing Lane Grade
Table 3. Post-Hoc Tests Evaluating Change in Anteversion and Vertical Version between Supine and Standing Positioning among Lane Groups 95% Confidence Interval Lane Grading* Mean Difference Std. Error Lower Bound Upper Bound p-value*
Acetabular anteversion was determined by method described by Widmer et al, utilizing ratio of short axis to length of cup implant Vertical version was evaluated with reference to parallel line through pelvic teardrops
Since the supine anteversion tends to be slightly lower in more rigid spines, surgeons have to account for this finding and be mindful not to retrovert the cup
-20 0
Lumbar spine arthritis was determined by Lane classification for degenerative disk disease (joint space narrowing, osteophyte formation, and subchondral sclerosis)
Conclusion
Change in Anteversion
1
2.17
0.50
0.96
3.39
<0.001
2
6.04
0.56
4.69
7.39
<0.001
Change in Vertical Version 1
0.54
0.45
-0.56
1.63
0.562
2
1.64
0.49
0.45
2.82
0.003
*=Comparing groups to control group (Lane Grade 0) using Dunnett’s T3 test.
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