Acetabular Placement Accuracy With the Direct Anterior Approach Freehand Technique

• Published in: The Journal of arthroplasty Vol. 32; no. 9; pp. 2748 - 2754
• Main Authors: Soderquist, Melissa C., Scully, Ryan, Unger, Anthony S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017
• Subjects: acetabular cup placement; Acetabulum - surgery; Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - methods; Body Mass Index; direct anterior approach; Female; Fluoroscopy; hip arthroplasty complications; Hip Joint - surgery; Hip Prosthesis; Humans; Joint Dislocations - surgery; Male; Middle Aged; post-operative dislocation; Retrospective Studies; total hip arthroplasty; Treatment Outcome; total hip arthroplasty; hip arthroplasty complications; direct anterior approach; post-operative dislocation; acetabular cup placement
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2017.04.011

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. 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°-25° for anteversion and 30°-45° for inclination, as well as by Lewinnek et al as 5°-25° for anteversion and 30°-50° for inclination. Dislocation rate was determined and correlated to safe zone placement. 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. 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.