The Use of Fluoroscopy During Direct Anterior Hip Arthroplasty: Powerful or Misleading?
J Arthroplasty
; 33(6): 1775-1779, 2018 06.
Article
em En
| MEDLINE
| ID: mdl-29500087
ABSTRACT
BACKGROUND:
Direct anterior approach total hip arthroplasty (THA) with fluoroscopic assistance is growing in popularity. Variables such as pelvic tilt, c-arm technique, and patient positioning can affect the perceived fluoroscopic view. This study evaluates the effect of these variables on the position of the acetabular component.METHODS:
Forty-one hips in 40 patients undergoing direct anterior arthroplasty THA with fluoroscopic assistance underwent routine postoperative radiographs and postoperative pelvic computed tomography scan. The acetabular component position as defined by a 3-dimensional reconstruction was compared to the surgeon's intraoperative perception of the component's position and compared to routine postoperative plain radiograph measurements.RESULTS:
Although fluoroscopy was used to create an anteroposterior pelvic radiograph utilizing the coccyx to pubis symphysis distance, a 3D reconstruction created in the same pelvic orientation as the fluoroscopic images confirmed that 39/41 hips were placed with unrecognized excess of anteversion and inclination secondary to imaging the pelvis in extension.CONCLUSION:
Intraoperative imaging during supine direct anterior arthroplasty THA confirms appropriate component placement. Pelvic tilt can greatly affect the perceived position of the acetabular component and cannot be accurately compensated for by assessing the relationship between the coccyx and pubic symphysis due to morphologic variation and orientation. We recommend positioning the c-arm so that the size and shape of the obturator foramen matches the standing preoperative anteroposterior pelvis image. This technique allows for the native standing pelvic tilt to be accounted for intraoperatively and will result in the least variation in intraoperative and postoperative standing acetabular component orientation.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Ossos Pélvicos
/
Tomografia Computadorizada por Raios X
/
Artroplastia de Quadril
Tipo de estudo:
Diagnostic_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article