Lack of consensus on optimal acetabular cup orientation because of variation in assessment methods in total hip arthroplasty

a systematic review

Journal Article (2019)
Author(s)

T. E. Snijders (Clinical Orthopedic Research Center Midden-Nederland)

Koen Willemsen (Clinical Orthopedic Research Center Midden-Nederland)

Steven M. Van Gaalen (Clinical Orthopedic Research Center Midden-Nederland)

Rene M. Castelein (University Medical Center Utrecht)

Harry Weinans (TU Delft - Biomaterials & Tissue Biomechanics, University Medical Center Utrecht)

Arthur de Gast (Clinical Orthopedic Research Center Midden-Nederland)

Research Group
Biomaterials & Tissue Biomechanics
DOI related publication
https://doi.org/10.1177/1120700018759306
More Info
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Publication Year
2019
Language
English
Research Group
Biomaterials & Tissue Biomechanics
Issue number
1
Volume number
29
Pages (from-to)
41-50

Abstract

Introduction: Dislocation is one of the main reasons for revision of total hip arthroplasty but dislocation rates have not changed in the past decades, compromising patients’ well-being. Acetabular cup orientation plays a key role in implant stability and has been widely studied. This article investigates whether there is a consensus on optimal cup orientation, which is necessary when using a navigation system. Methods: A systematic search of the literature in the PubMed, Embase and Cochrane databases was performed (March 2017) to identify articles that investigated the direct relationship between cup orientation and dislocation, including a thorough evaluation of postoperative cup orientation assessment methods. Results: Twenty eight relevant articles evaluating a direct relation between dislocation and cup orientation could not come to a consensus. The key reason is a lack of uniformity in the assessment of cup orientation. Cup orientation is assessed with different imaging modalities, different methodologies, different definitions for inclination and anteversion, several reference planes and distinct patient positions. Conclusions: All available studies lack uniformity in cup orientation assessment; therefore it is impossible to reach consensus on optimal cup orientation. Using navigation systems for placement of the cup is inevitably flawed when using different definitions in the preoperative planning, peroperative placement and postoperative evaluation. Further methodological development is required to assess cup orientation. Consequently, the postoperative assessment should be uniform, thus differentiating between anterior and posterior dislocation, use the same definitions for inclination and anteversion with the same reference plane and with the patient in the same position.

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