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Safe zone total hip

Kurt G Seagrave, Anders Troelsen, Henrik Malchau, Henrik Husted, Kirill Gromov
Background and purpose - Hip dislocation is one of the most common complications following total hip arthroplasty (THA). Several factors that affect dislocation have been identified, including acetabular cup positioning. Optimal values for cup inclination and anteversion are debatable. We performed a systematic review to describe the different methods for measuring cup placement, target zones for cup positioning, and the association between cup positioning and dislocation following primary THA. Methods - A systematic search of literature in the PubMed database was performed (January and February 2016) to identify articles that compared acetabular cup positioning and the risk of dislocation...
November 23, 2016: Acta Orthopaedica
Antonia F Chen, Chi-Lung Chen, Sara Low, Wei-Ming Lin, Karthikeyan Chinnakkannu, Fabio R Orozco, Alvin C Ong, Zachary D Post
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...
October 2016: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
Yusuke Osawa, Yukiharu Hasegawa, Toshiaki Okura, Daigo Morita, Naoki Ishiguro
BACKGROUND: We performed periacetabular osteotomy (PAO) combined with intertrochanteric valgus osteotomy (TVO) to obtain better congruity for patients with acetabular dysplasia and nonspherical femoral head. These patients with PAO-combined TVO demonstrate long-term progression of osteoarthritis, thereby, needing conversion to total hip arthroplasty (THA) and is difficult due to morphological changes. The objective of the present study was to investigate outcomes of patients who underwent THA after PAO-combined TVO...
August 26, 2016: Journal of Arthroplasty
Anita Sadhu, Denis Nam, Benjamin R Coobs, Toby N Barrack, Ryan M Nunley, Robert L Barrack
BACKGROUND: Recently, the importance of acetabular component positioning in the Lewinnek "safe zone" in preventing prosthetic dislocation following total hip arthroplasty (THA) has been questioned. The purpose of this study was to determine the proportion of acetabular components within the Lewinnek safe zone between primary and revision THAs that have sustained a dislocation vs matched controls without a dislocation event. METHODS: This was a retrospective, institutional review board-approved investigation of THAs performed at our institution or referred to our institution between 1997 and 2013...
August 20, 2016: Journal of Arthroplasty
T Nakamura, M Fukunaga, T Nakano, H Kishimoto, M Ito, H Hagino, T Sone, A Taguchi, S Tanaka, M Ohashi, Y Ota, M Shiraki
: In a 2-year randomized, placebo-controlled study of 665 Japanese patients with primary osteoporosis, once-yearly administration of zoledronic acid (5 mg) reduced the risk of new morphometric vertebral fractures. INTRODUCTION: The purpose of this study was to determine the efficacy and safety of once-yearly intravenous infusion of ZOL in Japanese patients with primary osteoporosis. METHODS: This was a two-year multicenter, randomized, placebo-controlled, double-blind, parallel-group comparative study (ZONE Study)...
September 8, 2016: Osteoporosis International
Won-Kee Choi, Myung-Rae Cho, Seung-Bum Chae, Dong-Young Kim
It has been known the highly cross linked polyethylene (HXLPE) has an advantage of improved wear rate. However, the alteration in mechanical properties such as decreased tensile yield and fatigue strength make concerns about fragility of HXLPE. We experienced a case of HXLPE breakage. But, this case of liner breakage happened although patient belonged to normal BMI and proper acetabular cup position so called "safe zone" on radiographs. So, we report this case with reference review.
September 2015: Hip & Pelvis
Eli Kamara, Jonathon Robinson, Marcel A Bas, Jose A Rodriguez, Matthew S Hepinstall
BACKGROUND: Acetabulum positioning affects dislocation rates, component impingement, bearing surface wear rates, and need for revision surgery. Novel techniques purport to improve the accuracy and precision of acetabular component position, but may have a significant learning curve. Our aim was to assess whether adopting robotic or fluoroscopic techniques improve acetabulum positioning compared to manual total hip arthroplasty (THA) during the learning curve. METHODS: Three types of THAs were compared in this retrospective cohort: (1) the first 100 fluoroscopically guided direct anterior THAs (fluoroscopic anterior [FA]) done by a surgeon learning the anterior approach, (2) the first 100 robotic-assisted posterior THAs done by a surgeon learning robotic-assisted surgery (robotic posterior [RP]), and (3) the last 100 manual posterior (MP) THAs done by each surgeon (200 THAs) before adoption of novel techniques...
June 29, 2016: Journal of Arthroplasty
Julio J Jauregui, Samik Banerjee, Randa K Elmallah, Todd P Pierce, Jeffrey J Cherian, Steven F Harwin, Michael A Mont
Although prosthetic hip dislocation is a common reason for revision arthroplasty, few studies have comprehensively evaluated the radiographic factors that may lead to the need for revision. Therefore, the authors radiographically evaluated all prosthetic hip dislocations that were treated at one institution. They then specifically assessed those that required revision surgery. The authors found that the prosthetic center of rotation (pCOR) was located superolateral and inferolateral to the native COR (nCOR) in all patients...
September 1, 2016: Orthopedics
K-H Widmer
INTRODUCTION: Prosthetic impingement and insufficient soft tissue tension are still the most important factors responsible for early dislocation after total hip arthroplasty. Optimal positioning of both prosthetic components, the stem and the socket, optimising their design and restoring individual hip biomechanics, are of the upmost importance in reducing the risk of impingement. This study describes the concept of the combined safe zone (cSafe-Zone) that provides guidelines for the optimal positioning of both components...
August 2016: Zeitschrift Für Orthopädie und Unfallchirurgie
Kenji Kurosaka, Shigeo Fukunishi, Tomokazu Fukui, Shoji Nishio, Yuki Fujihara, Shohei Okahisa, Yu Takeda, Takashi Daimon, Shinichi Yoshiya
Implant positioning is one of the critical factors that influences postoperative outcome of total hip arthroplasty (THA). Malpositioning of the implant may lead to an increased risk of postoperative complications such as prosthetic impingement, dislocation, restricted range of motion, polyethylene wear, and loosening. In 2012, the intraoperative use of smartphone technology in THA for improved accuracy of acetabular cup placement was reported. The purpose of this study was to examine the accuracy of an iPhone/iPad-guided technique in positioning the acetabular cup in THA compared with the reference values obtained from the image-free navigation system in a cadaveric experiment...
July 1, 2016: Orthopedics
Per-Erik Johanson, Martin Antonsson, Bita Shareghi, Johan Kärrholm
BACKGROUND: Radiostereometry (RSA) measurements of early micromotion can predict later failure in hip and knee prostheses. In hip implants, RSA has been particularly helpful in the evaluation of composite-beam stem designs. The Spectron EF Primary stem (Smith & Nephew, London, UK) has shown inferior performance compared with its predecessors in both clinical studies and registry reports. Early RSA studies have shown somewhat greater subsidence for the Spectron EF Primary stem compared with the earlier Spectron EF, but still within boundaries considered to be safe...
October 2016: Clinical Orthopaedics and related Research
Hiroshi Imai, Joji Miyawaki, Tomomi Kamada, Jun Takeba, Naohiko Mashima, Hiromasa Miura
The purpose of this study was to investigate whether postoperative combined anteversion (CA) can be kept within the safe zone while using cementless total hip arthroplasty (THA) using the operative technique which prepares the socket first for developmental dysplasia of the hip (DDH), by estimating the anteversion of the metaphyseal fit stem using preoperative three-dimensional (3D) computerized planning and by adjusting the anteversion of the socket using a navigation system that considers CA. Our subjects were 65 patients (65 hips) that had undergone cementless THA for DDH that could be observed for 1 year or more...
July 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Y Ishidou, M Hirotsu, T Setoguchi, S Nagano, H Kakoi, M Yokouchi, T Yamamoto, S Komiya
PURPOSE: To compare cup-positioning accuracy in total hip arthroplasty (THA) with or without use of a Kirschner wire as a transverse-axis guide for pelvic alignment. METHODS: Records of 18 men and 73 women (mean age, 60 years) who underwent primary THA with (n=49) or without (n=42) use of a Kirschner wire as a transverse-axis guide for pelvic alignment were reviewed. A 2.4-mm Kirschner wire as a transversea-xis guide was inserted to the anterior superior iliac spine and was parallel to a line linking the left and right anterior superior iliac spine...
April 2016: Journal of Orthopaedic Surgery
Krishna R Tripuraneni, Natalie R Munson, Michael J Archibeck, Joshua T Carothers
BACKGROUND: There is purported improvement in component positioning and hip stability with the use of direct anterior approach (DAA) total hip arthroplasty (THA). We sought to determine if there is a difference in acetabular component position or dislocation frequency between DAA and posterior THA. METHODS: One arthroplasty fellowship-trained surgeon introduced DAA THA into his practice. From the initiation of DAA in 4/2012-8/2015, this comparative series resulted in 66 DAA THAs...
October 2016: Journal of Arthroplasty
N Verdier, A Billaud, T Masquefa, J Pallaro, T Fabre, C Tournier
BACKGROUND: Minimising the risk of cup implantation outside the safe zone is among the objectives of navigation during total hip arthroplasty (THA). However, given the technical challenges raised by navigation when the patient is lying on the side, many surgeons still use the freehand technique. We conducted a randomised controlled trial to evaluate the new navigation system NAVEOS in the iliac plane, which is easily identified in the lateral decubitus position, with the objective of determining whether NAVEOS navigation decreased the frequency of cup implantation outside the safe zone compared to freehand cup positioning, without increasing the operative time or the frequency of complications...
June 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Yusuke Osawa, Yukiharu Hasegawa, Taisuke Seki, Takafumi Amano, Yoshitoshi Higuchi, Naoki Ishiguro
BACKGROUND: Periacetabular osteotomy (PAO) is an effective treatment for preosteoarthritis and early osteoarthritis in young and active patients with hip dysplasia. However, conversion to total hip arthroplasty (THA) for failed PAO is difficult owing to morphologic changes. The objective of the present study was to investigate outcomes of patients who underwent THA for failed PAO. METHODS: We performed a case-control study. The participants were 48 patients (52 hips) who underwent THA after PAO (the osteotomy group); type of PAO was eccentric rotational acetabular osteotomy in 36 hips and rotational acetabular osteotomy in 16 hips...
September 2016: Journal of Arthroplasty
A Morvan, S Moreau, B Combourieu, E Pansard, J L Marmorat, R Carlier, T Judet, G Lonjon
AIMS: The primary aim of this study was to analyse the position of the acetabular and femoral components in total hip arthroplasty undertaken using an anterior surgical approach. PATIENTS AND METHODS: In a prospective, single centre study, we used the EOS imaging system to analyse the position of components following THA performed via the anterior approach in 102 patients (103 hips) with a mean age of 64.7 years (sd 12.6). Images were taken with patients in the standing position, allowing measurement of both anatomical and functional anteversion of the acetabular component...
March 2016: Bone & Joint Journal
Andrew John Timperley, David Biau, David Chew, Sarah L Whitehouse
INTRODUCTION: Malorientation of the socket contributes to instability after hip arthroplasty but the optimal orientation of the cup in relation to the pelvis has not been unequivocally described. Large radiological studies are few and problems occur with film standardisation, measurement methodology used and alternative definitions of describing acetabular orientation. METHODS: A cohort of 1,578 patients from a single institution is studied where all patient data was collected prospectively...
March 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Elhadi Sariali, Nadia Boukhelifa, Yves Catonne, Hugues Pascal Moussellard
BACKGROUND: Malpositioning of the acetabular cup during total hip arthroplasty increases the risk of dislocation, edge-loading, squeaking, early wear, and loosening. We hypothesized that the use of three-dimensional (3-D) visualization tools to identify the planned cup position relative to the acetabular edge intraoperatively would increase the accuracy of cup orientation. The purpose of this study was to compare 3-D planning-assisted implantation and freehand insertion of the acetabular cup...
January 20, 2016: Journal of Bone and Joint Surgery. American Volume
Byung-Ho Yoon, Yong-Chan Ha, Young-Kyun Lee, Woo-Lam Jo, Kyoung-Min Lee, Kyung-Hoi Koo
BACKGROUND: Transverse acetabular ligament (TAL) has been used as a landmark for aligning cup anteversion. The use of TAL as a guide is based on the assumption that TAL version is distributed within the safe zone of acetabular cup. However, there was rarely reported to compare anteversion between TAL and acetabulum using direct measurement methods. The purpose of this study was to measure the anteversion of TAL in computed tomography arthrography (CTA) and compare it with Lewinnek's safe zone and anteversion of bony acetabulum...
March 2016: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
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