Cost effective, reliable implantation of acetabular cups in Total Hip Arthroplasty

• Main Author: Young, Claire L
• Format: Dissertation
• Language: English
• Published: University of Strathclyde 2016
• DOI: 10.48730/5rey-g361

Correct positioning of the acetabular cup is critical for success within Total Hip Arthroplasty. Malpositioning of the acetabular cup contributes to many complications, all of which lead to revision surgery. Despite recognition of the importance of correct orientation, there is no consensus on what the optimum orientation of the acetabular cup should be. The suggested orientations in the literature are contradictory and comparison between studies is difficult due to variations in angle definitions, measurement systems and reference systems. These contradictions, the lack of consensus in the literature and results from studies suggest that acetabular orientation must be patient specific. Mechanical guides are the most commonly used device to assist surgeons in positioning the acetabular cup, both in cemented and uncemented arthroplasties. However, these devices have many limitations one of which is a fixed acetabular orientation which does not allow for any patient variability. Using a combination of quantitative and qualitative product design techniques, Harrison User Centred Methodology was developed. This new methodology was adopted to design and develop a device to aid surgeons with positioning the acetabular cup in total hip arthroplasty. The aim was to design a device which could be used for both cemented and uncemented hip arthroplasty. The final device design was a novel positioning guide which addressed the lack of patient variability in current mechanical guides. The device simplified the positioning and limited the movement of the introducer. Feedback from surgeons demonstrated a positive response and with further development, a willingness to try the product. Proof of concept testing was carried out to measure the accuracy of the device. An available (uncemented) introducer was used for testing which demonstrated the device can accurately position the acetabular cup. The accuracy of the developed device and current techniques was compared. The study showed less variation in the position over time using the novel device which highlights an added benefit for cemented procedures demonstrating stability as the cement cures.