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European Journal of Orthopaedic Surgery & Traumatology

Erschienen in:

08.11.2019 | Original Article • HIP - ARTHROPLASTY

New combined anteversion technique in hybrid THA: cup-first procedure with CT-based navigation

verfasst von: Yoshinobu Masumoto, Shigeo Fukunishi, Tomokazu Fukui, Shinichi Yoshiya, Shoji Nishio, Yuki Fujihara, Shohei Okahisa, Taishi Okada, Makoto Kanto, Ariha Goshi, Futoshi Morio, Yu Takeda

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 3/2020

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Abstract

Purpose

Combined anteversion (CA) technique (stem-first procedure) is generally accepted as the optimal technique to attain an appropriate CA value in total hip arthroplasty (THA). However, cup anteversion is strongly influenced by the native femoral anteversion. Accordingly, anterior protrusion of the cup in the acetabulum might occur. The purpose of the present study is to investigate the achievement of the optimal CA while avoiding anterior cup protrusion and examine the significance of our new CA technique with cup-first procedure in hybrid THA.

Methods

Seventy-nine hybrid THAs with the cup-first procedure used a CT-based navigation system for cup positioning. In the preoperative planning, cup anteversion was aimed at approximately 20°. However, in actuality, sufficient cup coverage in the original acetabulum based on individual anatomy is given priority over cup placement based on CT-based planning to ensure adequate cup coverage. The target stem anteversion was determined following Widmer’s mathematical formula (37.3 = femoral stem anteversion × 0.7 + cup anteversion). Cemented stem was inserted according to the target stem anteversion angle.

Results

Regarding the assessment of overall alignment, the calculated Widmer’s CA values during surgery and postoperative CT evaluation were 34.1° ± 6.0° (range 20.7°–51.2°) and 35.1° ± 6.7° (range 21.6°–50.7°). There were 72 hips (91.1%) within 25°–50° of CA. Cup protrusion length averaged 2.0 mm ± 2.6 mm (0–8.8 mm) in the axial view and 0.4 mm ± 1.0 mm (0–3.6 mm) in the sagittal view. Cup protrusion length of more than 5 mm was indicated in 10 hips, and no hips observed more than 10 mm.

Conclusion

Our new CA technique (cup-first procedure) with hybrid THA was able to achieve optimal CA value while avoiding anterior cup protrusion.

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Titel: New combined anteversion technique in hybrid THA: cup-first procedure with CT-based navigation
verfasst von: Yoshinobu Masumoto
Shigeo Fukunishi
Tomokazu Fukui
Shinichi Yoshiya
Shoji Nishio
Yuki Fujihara
Shohei Okahisa
Taishi Okada
Makoto Kanto
Ariha Goshi
Futoshi Morio
Yu Takeda
Publikationsdatum: 08.11.2019
Verlag: Springer Paris
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 3/2020
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-019-02589-y

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