Acetabular Placement Accuracy With the Direct Anterior Approach Freehand Technique

作者：Soderquist Melissa C; Scully Ryan; Unger Anthony S

来源：Journal of Arthroplasty, 2017, 32(9): 2748-2754.

DOI：10.1016/j.arth.2017.04.011

• total hip arthroplasty
• direct anterior approach
• acetabular cup placement
• hip arthroplasty complications
• post-operative dislocation

Background: Acetabular cup placement in total hip arthroplasty (THA) has been recognized as an important factor in operative success, and accurate cup placement has been the impetus for novel medical technologies.
Methods: This article examines the cup placement in 955 THAs using a freehand Direct Anterior Approach on a standard operating table. Acetabular anteversion and inclination were determined using the circle theorem. Measurements were divided into safe zone placement determined by Callanan et al as 5 degrees- 25 degrees for anteversion and 30 degrees - 45 degrees for inclination, as well as by Lewinnek et al as 5 degrees - 25 degrees for anteversion and 30 degrees - 50 degrees for inclination. Dislocation rate was determined and correlated to safe zone placement.
Results: Although technology has advanced for cup placement, this investigation shows that a freehand technique demonstrates 0.31% dislocation after THA with an accuracy of 85% for the Lewinnek safe zone and 61% for Callanan, potentially because of the sparing of the posterior hip capsule.
Conclusion: The direct anterior approach to the hip on a regular operating table is safe and reliable. Our results demonstrate improvement in cup positioning compared with other freehand techniques. Surgeon awareness and control of the position of the pelvis within space optimizes acetabular component accuracy and precision without the need for special equipment, such as intraoperative fluoroscopy.

• 出版日期2017-9