Mechanical and Anatomical Alignment Guide Techniques Are Superior to Freehand in Achieving Target Orientation of an Acetabular Component

Background: Achieving accurate and consistent acetabular component orientation remains a major challenge in total hip arthroplasty. Methods: We used a pelvic model to compare freehand techniques vs mechanical and anatomical alignment guides in achieving a target operative inclination (OI) and operat...

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Autores principales:	Robert Bruce-Brand, FRCS, Paul Magill, FRCS, Christopher O’Neill, FRCS, Paul Karayiannis, MRCSEd, Janet Hill, MEng, PhD, David Beverland, FRCS
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Hip arthroplasty Inclination Anteversion Acetabular component positioning Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/11c598b8742b4d63bc16d53f59772487
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spelling	oai:doaj.org-article:11c598b8742b4d63bc16d53f597724872021-11-14T04:34:05ZMechanical and Anatomical Alignment Guide Techniques Are Superior to Freehand in Achieving Target Orientation of an Acetabular Component2352-344110.1016/j.artd.2021.08.016https://doaj.org/article/11c598b8742b4d63bc16d53f597724872021-10-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2352344121001576https://doaj.org/toc/2352-3441Background: Achieving accurate and consistent acetabular component orientation remains a major challenge in total hip arthroplasty. Methods: We used a pelvic model to compare freehand techniques vs mechanical and anatomical alignment guides in achieving a target operative inclination (OI) and operative anteversion (OA). Thirty subjects comprising consultant orthopedic surgeons, orthopedic trainees, and nonsurgical staff positioned an acetabular component in a pelvic model using 3 different methods for guiding inclination and another 3 for guiding version. Results: Using either a standard mechanical alignment guide (MAG) or a spirit level MAG technique eliminated outliers from target OI, while the freehand method resulted in 46.7% of measurements outside the OI target range. The spirit level MAG technique significantly outperformed the standard MAG technique in median unsigned deviation from target OI (0.8° vs 2.1°, P < .001). Either method of referencing the transverse acetabular ligament for version yielded lower deviations from target OA than the freehand method and fewer outliers from the ±5° target range. Surgical experience was not a significant factor for accurately achieving target OI and OA. Conclusions: Even in an idealized in vitro model, a wide range of OI and OA is seen with the freehand technique of cup placement by subjects of all levels of surgical experience. Using either a standard MAG or a spirit level MAG reduces deviations in target OI, with the spirit level MAG method yielding the best accuracy. Using the transverse acetabular ligament to guide cup anteversion yields more accurate OA.Robert Bruce-Brand, FRCSPaul Magill, FRCSChristopher O’Neill, FRCSPaul Karayiannis, MRCSEdJanet Hill, MEng, PhDDavid Beverland, FRCSElsevierarticleHip arthroplastyInclinationAnteversionAcetabular component positioningOrthopedic surgeryRD701-811ENArthroplasty Today, Vol 11, Iss , Pp 222-228 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Hip arthroplasty Inclination Anteversion Acetabular component positioning Orthopedic surgery RD701-811
spellingShingle	Hip arthroplasty Inclination Anteversion Acetabular component positioning Orthopedic surgery RD701-811 Robert Bruce-Brand, FRCS Paul Magill, FRCS Christopher O’Neill, FRCS Paul Karayiannis, MRCSEd Janet Hill, MEng, PhD David Beverland, FRCS Mechanical and Anatomical Alignment Guide Techniques Are Superior to Freehand in Achieving Target Orientation of an Acetabular Component
description	Background: Achieving accurate and consistent acetabular component orientation remains a major challenge in total hip arthroplasty. Methods: We used a pelvic model to compare freehand techniques vs mechanical and anatomical alignment guides in achieving a target operative inclination (OI) and operative anteversion (OA). Thirty subjects comprising consultant orthopedic surgeons, orthopedic trainees, and nonsurgical staff positioned an acetabular component in a pelvic model using 3 different methods for guiding inclination and another 3 for guiding version. Results: Using either a standard mechanical alignment guide (MAG) or a spirit level MAG technique eliminated outliers from target OI, while the freehand method resulted in 46.7% of measurements outside the OI target range. The spirit level MAG technique significantly outperformed the standard MAG technique in median unsigned deviation from target OI (0.8° vs 2.1°, P < .001). Either method of referencing the transverse acetabular ligament for version yielded lower deviations from target OA than the freehand method and fewer outliers from the ±5° target range. Surgical experience was not a significant factor for accurately achieving target OI and OA. Conclusions: Even in an idealized in vitro model, a wide range of OI and OA is seen with the freehand technique of cup placement by subjects of all levels of surgical experience. Using either a standard MAG or a spirit level MAG reduces deviations in target OI, with the spirit level MAG method yielding the best accuracy. Using the transverse acetabular ligament to guide cup anteversion yields more accurate OA.
format	article
author	Robert Bruce-Brand, FRCS Paul Magill, FRCS Christopher O’Neill, FRCS Paul Karayiannis, MRCSEd Janet Hill, MEng, PhD David Beverland, FRCS
author_facet	Robert Bruce-Brand, FRCS Paul Magill, FRCS Christopher O’Neill, FRCS Paul Karayiannis, MRCSEd Janet Hill, MEng, PhD David Beverland, FRCS
author_sort	Robert Bruce-Brand, FRCS
title	Mechanical and Anatomical Alignment Guide Techniques Are Superior to Freehand in Achieving Target Orientation of an Acetabular Component
title_short	Mechanical and Anatomical Alignment Guide Techniques Are Superior to Freehand in Achieving Target Orientation of an Acetabular Component
title_full	Mechanical and Anatomical Alignment Guide Techniques Are Superior to Freehand in Achieving Target Orientation of an Acetabular Component
title_fullStr	Mechanical and Anatomical Alignment Guide Techniques Are Superior to Freehand in Achieving Target Orientation of an Acetabular Component
title_full_unstemmed	Mechanical and Anatomical Alignment Guide Techniques Are Superior to Freehand in Achieving Target Orientation of an Acetabular Component
title_sort	mechanical and anatomical alignment guide techniques are superior to freehand in achieving target orientation of an acetabular component
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/11c598b8742b4d63bc16d53f59772487
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Mechanical and Anatomical Alignment Guide Techniques Are Superior to Freehand in Achieving Target Orientation of an Acetabular Component

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