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

Author:

Snijders Thom E1,Willemsen Koen1,van Gaalen Steven M1,Castelein Rene M234,Weinans Harrie23,de Gast Arthur1

Affiliation:

1. Clinical Orthopedic Research Centre - mN, Zeist, Utrecht, The Netherlands

2. Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, The Netherlands

3. Department of Rheumatology, University Medical Center Utrecht, Utrecht, The Netherlands

4. Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands

Abstract

Introduction: Dislocation is 1 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: 28 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.

Publisher

SAGE Publications

Subject

Orthopedics and Sports Medicine,Surgery

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