Abstract
BackgroundAcetabular prosthesis positioning in total hip arthroplasty (THA) is crucial in reducing the risk of dislocation. There has been minimal research on the proper way to put the acetabular components into the safe zone intraoperatively. Assessment of version by intraoperative imaging intensifier is very valuable. The value of Widmer’s method, using the intraoperative C-arm available to determine cup anteversion was assessed.MethodsOne hundred one hips in 91 patients who underwent primary THA were eligible for inclusion. Utilizing intraoperative C-arm images, measurement was performed using the technique described by Widmer. The values obtained using 3D computed tomography postoperatively, which determined the anteversion of the acetabular component, were regarded as the reference standard.ResultsThe method of Widmer obtained values similar to those obtained using 3D computed tomography and was considered accurate (n.s.). All 101 hips were positioned in the set target zone. Among the 101 hips, the cup position in nine hips (8.9%) was changed. The dislocation rate in our study was 1.0% with all dislocations occurring in hips placed in the target zone. The mean Harris hip score after THA in 1 year was 94.2 (82-98).ConclusionsThe method of Widmer was accurate using intraoperative imaging intensifier for the measurement of the anteversion of the acetabular component during THA, with reference to the anteversion obtained from the 3D computed tomography. Also, utilizing intraoperative C-arm imaging was very useful because it allowed for correction of the position of the acetabular cup.
Highlights
Acetabular prosthesis positioning in total hip arthroplasty (THA) is crucial in reducing the risk of dis‐ location
The orientation of the acetabular component in THA is defined by inclination, which is the angle between the face of the implant and the transverse interteardrop axis; and version, which is the angle between the axis of the component and the coronal plane of the patient [3]
Among a total of 121 consecutive cases, 20 hips were excluded (10 cases were excluded due to follow up loss, other implants were used in eight cases, and two cases were excluded as complications of periprosthetic joint infection), 101 cases (91patients, 47 males and 44 females, mean age 61.1) were enrolled in this study
Summary
Acetabular prosthesis positioning in total hip arthroplasty (THA) is crucial in reducing the risk of dis‐ location. There has been minimal research on the proper way to put the acetabular components into the safe zone intraoperatively. The value of Widmer’s method, using the intraoperative C-arm available to determine cup anteversion was assessed. Lewinnek et al proposed a ‘safe zone’ of cup inclination of 40 ± 10 and anteversion of 15 ± 10 to minimize dislocation risk after primary THA [4] and has been regarded. There are a variety of methods of measuring the version on plain AP or cross-table lateral radiographs. There were other reports that Widmer’s method is the reliable way for evaluating the anteversion of the acetabular component on plain radiographs [12]
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