Pelvic Positioning in the Supine Position Leads to More Consistent Cup Orientation after Total Hip Arthroplasty

George Grammatopoulos, Wade Gofton, M Cochran, Johanna Dobransky, A Carli, Hesham Abdelbary, Harinderjit Gill, Paul Beaule

Research output: Contribution to journalArticle

Abstract

Aims: This study aims to 1) Determine the difference in pelvic position that occurs between surgery and radiographic, supine, post-operative assessment; 2) Examine how the difference in pelvic position influences subsequent cup orientation and 3) Establish whether pelvic position, and thereafter cup orientation differences exist between THAs performed in the supine versus the lateral decubitus positions. Materials and Methods: 321 THAs who had intra-operative, post-cup impaction, AP pelvic radiograph, in the operative position were studied; 167 were performed with patient supine (anterior approach), whilst 154 were performed in lateral decubitus (posterior approach). Cup inclination/anteversion was measured from intra- and post-operative radiographs and difference (Δ) was determined. The target zone was inclination/anteversion of 40/20°±10°. Change in pelvic position (tilt, rotation, obliquity) between surgery and post-operatively was calculated from Δinclination/anteversion using the Levenberg-Marquardt algorithm. Results: The post-operative inclination/anteversion was 40°±8/23°±9. 74 had Δinclination and/or Δanteversion>±10° (21%). Intra-operatively (compared to post-operative), the pelvis was on average 4°±10 anteriorly tilted; 1°±10 internally rotated and 1°±5 adducted. Having Δinclination and/or Δanteversion >±10° was associated with a 3.5 odds ratio of having a cup outside the target. A greater proportion of hips operated in the lateral decubitus had Δinclination and/or Δanteversion >±10° (54/153), compared to supine (8/167) (p<0.001). A greater number of cups achieved the target orientation in supine (120/167;73%), compared to lateral position (67/153;44%) (p<0.001). Intra-operatively, pelvis was more anteriorly tilted (p<0.001) and hemi-pelvis was more internally rotated (p=0.04) in lateral position. Conclusion: Pelvic movement is significantly less in supine position, which leads to more consistent cup orientation. Significant differences in pelvic tilt and rotation were seen in the lateral position. Clinical Relevance: Understanding the differences in pelvic orientation and cup orientation between supine and lateral decubitus positions may facilitate better intraoperative practices for surgeons.
Original languageEnglish
Pages (from-to)1280-1288
JournalThe Bone & Joint Journal
Volume100-B
Issue number10
Publication statusPublished - 8 Oct 2018

Fingerprint

Supine Position
Pelvis
Arthroplasty
Tacrine
Hip
Odds Ratio

Cite this

Grammatopoulos, G., Gofton, W., Cochran, M., Dobransky, J., Carli, A., Abdelbary, H., ... Beaule, P. (2018). Pelvic Positioning in the Supine Position Leads to More Consistent Cup Orientation after Total Hip Arthroplasty. The Bone & Joint Journal, 100-B(10), 1280-1288.

Pelvic Positioning in the Supine Position Leads to More Consistent Cup Orientation after Total Hip Arthroplasty. / Grammatopoulos, George; Gofton, Wade; Cochran, M; Dobransky, Johanna; Carli, A; Abdelbary, Hesham; Gill, Harinderjit; Beaule, Paul.

In: The Bone & Joint Journal, Vol. 100-B, No. 10, 08.10.2018, p. 1280-1288.

Research output: Contribution to journalArticle

Grammatopoulos, G, Gofton, W, Cochran, M, Dobransky, J, Carli, A, Abdelbary, H, Gill, H & Beaule, P 2018, 'Pelvic Positioning in the Supine Position Leads to More Consistent Cup Orientation after Total Hip Arthroplasty', The Bone & Joint Journal, vol. 100-B, no. 10, pp. 1280-1288.
Grammatopoulos G, Gofton W, Cochran M, Dobransky J, Carli A, Abdelbary H et al. Pelvic Positioning in the Supine Position Leads to More Consistent Cup Orientation after Total Hip Arthroplasty. The Bone & Joint Journal. 2018 Oct 8;100-B(10):1280-1288.
Grammatopoulos, George ; Gofton, Wade ; Cochran, M ; Dobransky, Johanna ; Carli, A ; Abdelbary, Hesham ; Gill, Harinderjit ; Beaule, Paul. / Pelvic Positioning in the Supine Position Leads to More Consistent Cup Orientation after Total Hip Arthroplasty. In: The Bone & Joint Journal. 2018 ; Vol. 100-B, No. 10. pp. 1280-1288.
@article{1eced9765566425db0282253194437b4,
title = "Pelvic Positioning in the Supine Position Leads to More Consistent Cup Orientation after Total Hip Arthroplasty",
abstract = "Aims: This study aims to 1) Determine the difference in pelvic position that occurs between surgery and radiographic, supine, post-operative assessment; 2) Examine how the difference in pelvic position influences subsequent cup orientation and 3) Establish whether pelvic position, and thereafter cup orientation differences exist between THAs performed in the supine versus the lateral decubitus positions. Materials and Methods: 321 THAs who had intra-operative, post-cup impaction, AP pelvic radiograph, in the operative position were studied; 167 were performed with patient supine (anterior approach), whilst 154 were performed in lateral decubitus (posterior approach). Cup inclination/anteversion was measured from intra- and post-operative radiographs and difference (Δ) was determined. The target zone was inclination/anteversion of 40/20°±10°. Change in pelvic position (tilt, rotation, obliquity) between surgery and post-operatively was calculated from Δinclination/anteversion using the Levenberg-Marquardt algorithm. Results: The post-operative inclination/anteversion was 40°±8/23°±9. 74 had Δinclination and/or Δanteversion>±10° (21{\%}). Intra-operatively (compared to post-operative), the pelvis was on average 4°±10 anteriorly tilted; 1°±10 internally rotated and 1°±5 adducted. Having Δinclination and/or Δanteversion >±10° was associated with a 3.5 odds ratio of having a cup outside the target. A greater proportion of hips operated in the lateral decubitus had Δinclination and/or Δanteversion >±10° (54/153), compared to supine (8/167) (p<0.001). A greater number of cups achieved the target orientation in supine (120/167;73{\%}), compared to lateral position (67/153;44{\%}) (p<0.001). Intra-operatively, pelvis was more anteriorly tilted (p<0.001) and hemi-pelvis was more internally rotated (p=0.04) in lateral position. Conclusion: Pelvic movement is significantly less in supine position, which leads to more consistent cup orientation. Significant differences in pelvic tilt and rotation were seen in the lateral position. Clinical Relevance: Understanding the differences in pelvic orientation and cup orientation between supine and lateral decubitus positions may facilitate better intraoperative practices for surgeons.",
author = "George Grammatopoulos and Wade Gofton and M Cochran and Johanna Dobransky and A Carli and Hesham Abdelbary and Harinderjit Gill and Paul Beaule",
year = "2018",
month = "10",
day = "8",
language = "English",
volume = "100-B",
pages = "1280--1288",
journal = "The Bone & Joint Journal",
issn = "2049-4394",
publisher = "British Editorial Society of Bone and Joint Surgery",
number = "10",

}

TY - JOUR

T1 - Pelvic Positioning in the Supine Position Leads to More Consistent Cup Orientation after Total Hip Arthroplasty

AU - Grammatopoulos, George

AU - Gofton, Wade

AU - Cochran, M

AU - Dobransky, Johanna

AU - Carli, A

AU - Abdelbary, Hesham

AU - Gill, Harinderjit

AU - Beaule, Paul

PY - 2018/10/8

Y1 - 2018/10/8

N2 - Aims: This study aims to 1) Determine the difference in pelvic position that occurs between surgery and radiographic, supine, post-operative assessment; 2) Examine how the difference in pelvic position influences subsequent cup orientation and 3) Establish whether pelvic position, and thereafter cup orientation differences exist between THAs performed in the supine versus the lateral decubitus positions. Materials and Methods: 321 THAs who had intra-operative, post-cup impaction, AP pelvic radiograph, in the operative position were studied; 167 were performed with patient supine (anterior approach), whilst 154 were performed in lateral decubitus (posterior approach). Cup inclination/anteversion was measured from intra- and post-operative radiographs and difference (Δ) was determined. The target zone was inclination/anteversion of 40/20°±10°. Change in pelvic position (tilt, rotation, obliquity) between surgery and post-operatively was calculated from Δinclination/anteversion using the Levenberg-Marquardt algorithm. Results: The post-operative inclination/anteversion was 40°±8/23°±9. 74 had Δinclination and/or Δanteversion>±10° (21%). Intra-operatively (compared to post-operative), the pelvis was on average 4°±10 anteriorly tilted; 1°±10 internally rotated and 1°±5 adducted. Having Δinclination and/or Δanteversion >±10° was associated with a 3.5 odds ratio of having a cup outside the target. A greater proportion of hips operated in the lateral decubitus had Δinclination and/or Δanteversion >±10° (54/153), compared to supine (8/167) (p<0.001). A greater number of cups achieved the target orientation in supine (120/167;73%), compared to lateral position (67/153;44%) (p<0.001). Intra-operatively, pelvis was more anteriorly tilted (p<0.001) and hemi-pelvis was more internally rotated (p=0.04) in lateral position. Conclusion: Pelvic movement is significantly less in supine position, which leads to more consistent cup orientation. Significant differences in pelvic tilt and rotation were seen in the lateral position. Clinical Relevance: Understanding the differences in pelvic orientation and cup orientation between supine and lateral decubitus positions may facilitate better intraoperative practices for surgeons.

AB - Aims: This study aims to 1) Determine the difference in pelvic position that occurs between surgery and radiographic, supine, post-operative assessment; 2) Examine how the difference in pelvic position influences subsequent cup orientation and 3) Establish whether pelvic position, and thereafter cup orientation differences exist between THAs performed in the supine versus the lateral decubitus positions. Materials and Methods: 321 THAs who had intra-operative, post-cup impaction, AP pelvic radiograph, in the operative position were studied; 167 were performed with patient supine (anterior approach), whilst 154 were performed in lateral decubitus (posterior approach). Cup inclination/anteversion was measured from intra- and post-operative radiographs and difference (Δ) was determined. The target zone was inclination/anteversion of 40/20°±10°. Change in pelvic position (tilt, rotation, obliquity) between surgery and post-operatively was calculated from Δinclination/anteversion using the Levenberg-Marquardt algorithm. Results: The post-operative inclination/anteversion was 40°±8/23°±9. 74 had Δinclination and/or Δanteversion>±10° (21%). Intra-operatively (compared to post-operative), the pelvis was on average 4°±10 anteriorly tilted; 1°±10 internally rotated and 1°±5 adducted. Having Δinclination and/or Δanteversion >±10° was associated with a 3.5 odds ratio of having a cup outside the target. A greater proportion of hips operated in the lateral decubitus had Δinclination and/or Δanteversion >±10° (54/153), compared to supine (8/167) (p<0.001). A greater number of cups achieved the target orientation in supine (120/167;73%), compared to lateral position (67/153;44%) (p<0.001). Intra-operatively, pelvis was more anteriorly tilted (p<0.001) and hemi-pelvis was more internally rotated (p=0.04) in lateral position. Conclusion: Pelvic movement is significantly less in supine position, which leads to more consistent cup orientation. Significant differences in pelvic tilt and rotation were seen in the lateral position. Clinical Relevance: Understanding the differences in pelvic orientation and cup orientation between supine and lateral decubitus positions may facilitate better intraoperative practices for surgeons.

M3 - Article

VL - 100-B

SP - 1280

EP - 1288

JO - The Bone & Joint Journal

JF - The Bone & Joint Journal

SN - 2049-4394

IS - 10

ER -