Abstract

Successful total hip arthroplasty (THA) greatly depends on appropriate implant choice and accurate femoral and acetabular component positioning. Preoperative radiographic templating is crucial, and accurate intraoperative execution of the templated plan is important to maximize implant stability and bearing performance. Traditionally, plain radiographs have been used for preoperative planning, as well as postoperative follow-up and assessment of component position, with historically defined “safe zones” for component position. However, as our understanding of optimal implant positioning in the setting of spino-pelvic dynamics has expanded, more advanced methods of radiographic assessment of implant positioning have gained popularity. Given the variations in anatomy and functional kinematics of a patient’s hip joint, the optimal THA component alignment and positioning may differ on a case by case basis, and therefore, advanced methods of assessing optimal patient-specific implant positioning are of prime importance.

Highlights

  • Successful total hip arthroplasty (THA) greatly depends on appropriate implant choice and accurate femoral and acetabular component positioning

  • Given the variations in anatomy and functional kinematics of a patient’s hip joint, the optimal THA component alignment and positioning may differ on a case by case basis, and advanced methods of assessing optimal patient-­ specific implant positioning are of prime importance

  • Traditional plain radiography in the form of an AP pelvis and frog or cross table lateral of the hip are useful but may not capture spino-pelvic dynamics, which are critical to stability of THA

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Summary

13.1 Introduction

Successful total hip arthroplasty (THA) greatly depends on appropriate implant choice and accurate femoral and acetabular component positioning. Preoperative radiographic templating is crucial, and accurate intraoperative execution of the templated plan is important to maximize implant stability and bearing performance. Plain radiographs have been used for preoperative planning, as well as postoperative follow-up and assessment of component position, with historically defined “safe zones”. As our understanding of optimal implant positioning in the setting of spino-pelvic dynamics has expanded, more advanced methods of radiographic assessment of implant positioning have gained popularity. Given the variations in anatomy and functional kinematics of a patient’s hip joint, the optimal THA component alignment and positioning may differ on a case by case basis, and advanced methods of assessing optimal patient-­ specific implant positioning are of prime importance

13.2 Personalized Total Hip Arthroplasty
13.3 Traditional Radiographic Evaluation
13.3.2 Cross Table and Frog-Lateral Views
13.3.3 Shortcomings of Traditional Radiographic Assessment
13.4 Modern Concepts and Radiographic Evaluation
13.4.1 Sitting and Standing Alignment Radiographs
13.4.2 Stepwise Evaluation of Acetabular Component Position in Total Hip Instability
13.5.1 Computed Tomography 3-D Imaging
13.5.2 Statistical Shape Modeling Method of Converting 2-D to 3-D Imaging
13.5.3 The Use of CT Imaging in Assessment of Personalized Component Implantation
13.6 Conclusion
Findings
13.7 Case Presentation
Full Text
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