Undetected Intraoperative Pelvic Movement Can Lead to Inaccurate Acetabular Cup Component Placement during Total Hip Arthroplasty: A Mathematical Simulation Estimating Change in Cup Position

Abstract

Intraoperative patient movement is a common but underappreciated phenomenon in total hip arthroplasty (THA). Such movement can significantly affect the accuracy with which the acetabular cup component is implanted. To evaluate the effect of intraoperative movement on cup position, we performed a study using mathematical modeling to simulate intraoperative movement. Mathematical simulations were used to simulate pelvic movements during THA. Pelvic axial rotation, tilt, and obliquity were simulated, and the resulting changes in intended cup position were calculated. The rate of change of inclination and anteversion per degree of pelvic movement was calculated, establishing a ratio relating cup angle sensitivity to pelvic movement. These sensitivities were used to construct nomograms showing the per-degree effect of pelvic movement on cup position. The effect of pelvic movement on cup position was multifactorial and dependent on the intended cup orientation. For a cup intended to be inserted at 15° anteversion and 40° inclination, each degree of pelvic rotation induced changes of 0.64° and –0.20°, respectively. For this same cup orientation, each degree of pelvic tilt induced changes of 0.77° for anteversion and 0.17° for inclination. Pelvic obliquity was associated with a 1:1 ratio with inclination, with each degree of obliquity inducing 1° of change in inclination. Anteversion was unaffected by changes in pelvic obliquity. This study demonstrates the consequences of undetected pelvic movement on cup position, including the increased risk of the acetabular component being placed in an orientation that could increase wear or the likelihood of impingement and dislocation.

Keywords

total hip arthroplasty - cup position - pelvic movement - mathematical modeling

• References

• 1 Jørgensen CC, Kjaersgaard-Andersen P, Solgaard S, Kehlet H. ; Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group. Hip dislocations after 2,734 elective unilateral fast-track total hip arthroplasties: incidence, circumstances and predisposing factors. Arch Orthop Trauma Surg 2014; 134 (11) 1615-1622
• 2 Hassan DM, Johnston GH, Dust WN, Watson G, Dolovich AT. Accuracy of intraoperative assessment of acetabular prosthesis placement. J Arthroplasty 1998; 13 (01) 80-84
• 3 Kennedy JG, Rogers WB, Soffe KE, Sullivan RJ, Griffen DG, Sheehan LJ. Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration. J Arthroplasty 1998; 13 (05) 530-534
• 4 Oki H, Ando M, Omori H. , et al. Relation between vertical orientation and stability of acetabular component in the dysplastic hip simulated by nonlinear three-dimensional finite element method. Artif Organs 2004; 28 (11) 1050-1054
• 5 Masaoka T, Yamamoto K, Shishido T. , et al. Study of hip joint dislocation after total hip arthroplasty. Int Orthop 2006; 30 (01) 26-30
• 6 Nishii T, Sugano N, Miki H, Koyama T, Takao M, Yoshikawa H. Influence of component positions on dislocation: computed tomographic evaluations in a consecutive series of total hip arthroplasty. J Arthroplasty 2004; 19 (02) 162-166
• 7 Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 1978; 60 (02) 217-220
• 8 Jassim SS, Benjamin-Laing H, Douglas SL, Haddad FS. Robotic and navigation systems in orthopaedic surgery: how much do our patients understand?. Clin Orthop Surg 2014; 6 (04) 462-467
• 9 National Joint Registry. c. 2008–2014. (2016). Retrieved from http://www.njrcentre.org.uk/njrcentre/default.aspx . Accessed August 15, 2017
• 10 Vigdorchik JM, Cross MB, Miller TT, Bogner EA, Muir JM, Schwarzkopf R. Evaluating surgeon estimation of cup position in total hip arthroplasty: a cadaver study. J Hip Surg 2017; 1 (02) 105-111
• 11 Esposito CI, Gladnick BP, Lee YY. , et al. Cup position alone does not predict risk of dislocation after hip arthroplasty. J Arthroplasty 2015; 30 (01) 109-113
• 12 McCollum DE, Gray WJ. Dislocation after total hip arthroplasty. Causes and prevention. Clin Orthop Relat Res 1990; (261) 159-170
• 13 Abdel MP, von Roth P, Jennings MT, Hanssen AD, Pagnano MW. What safe zone? The vast majority of dislocated THAs are within the Lewinnek safe zone for acetabular component position. Clin Orthop Relat Res 2016; 474 (02) 386-391
• 14 Schwarzkopf R, Muir JM, Paprosky WG, Seymour S, Cross MB, Vigdorchik JM. Quantifying pelvic motion during total hip arthroplasty using a new surgical navigation device. J Arthroplasty 2017; 32 (10) 3056-3060
• 15 Milone MT, Schwarzkopf R, Meere PA, Carroll KM, Jerabek SA, Vigdorchik J. Rigid patient positioning is unreliable in total hip arthroplasty. J Arthroplasty 2017; 32 (06) 1890-1893
• 16 DiGioia AM, Hafez MA, Jaramaz B, Levison TJ, Moody JE. Functional pelvic orientation measured from lateral standing and sitting radiographs. Clin Orthop Relat Res 2006; 453 (453) 272-276
• 17 Asayama I, Akiyoshi Y, Naito M, Ezoe M. Intraoperative pelvic motion in total hip arthroplasty. J Arthroplasty 2004; 19 (08) 992-997
• 18 Ezoe M, Naito M, Asayama I, Ishiko T, Fujisawa M. Pelvic motion during total hip arthroplasty with translateral and posterolateral approaches. J Orthop Sci 2005; 10 (02) 167-172
• 19 Maratt JD, Esposito CI, McLawhorn AS, Jerabek SA, Padgett DE, Mayman DJ. Pelvic tilt in patients undergoing total hip arthroplasty: when does it matter?. J Arthroplasty 2015; 30 (03) 387-391
• 20 van Bosse HJ, Lee D, Henderson ER, Sala DA, Feldman DS. Pelvic positioning creates error in CT acetabular measurements. Clin Orthop Relat Res 2011; 469 (06) 1683-1691
• 21 van der Bom MJ, Groote ME, Vincken KL, Beek FJ, Bartels LW. Pelvic rotation and tilt can cause misinterpretation of the acetabular index measured on radiographs. Clin Orthop Relat Res 2011; 469 (06) 1743-1749
• 22 Zhou X, Wang Q, Zhang X, Chen Y, Shen H, Jiang Y. Effect of pelvic obliquity on the orientation of the acetabular component in total hip arthroplasty. J Arthroplasty 2012; 27 (02) 299-304
• 23 Lembeck B, Mueller O, Reize P, Wuelker N. Pelvic tilt makes acetabular cup navigation inaccurate. Acta Orthop 2005; 76 (04) 517-523
• 24 Grammatopoulos G, Pandit HG, da Assunção R. , et al. The relationship between operative and radiographic acetabular component orientation: which factors influence resultant cup orientation?. Bone Joint J 2014; 96-B (10) 1290-1297
• 25 Kanazawa M, Nakashima Y, Arai T. , et al. Quantification of pelvic tilt and rotation by width/height ratio of obturator foramina on anteroposterior radiographs. Hip Int 2016; 26 (05) 462-467
• 26 Elkins JM, Callaghan JJ, Brown TD. The 2014 Frank Stinchfield Award: the ‘landing zone’ for wear and stability in total hip arthroplasty is smaller than we thought: a computational analysis. Clin Orthop Relat Res 2015; 473 (02) 441-452
• 27 Zhao JX, Su XY, Xiao RX. , et al. A mathematical method for precisely calculating the radiographic angles of the cup after total hip arthroplasty. Med Eng Phys 2016; 38 (11) 1376-1381
• 28 Wolf A, DiGioia III AM, Mor AB, Jaramaz B. A kinematic model for calculating cup alignment error during total hip arthroplasty. J Biomech 2005; 38 (11) 2257-2265