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General Orthopaedics

THE NATURAL ORIENTATION OF THE ACETABULUM IN ARTHRITIC HIPS

The Indian Orthopaedic Society (UK) (IOSUK)



Abstract

Introduction

Success of total hip replacement (THR) is closely linked to positioning of the acetabular component. Malalignment increases complication rates. Our aim was to describe the anteversion and inclination of the inherent acetabulum in arthritic hips and identify the number that fall out with the ‘safe zone’ of acetabular position described by Lewinnek et al. (anteversion 15±10 degrees; inclination 40±10 degrees).

Materials/Methods

A series of 65 hips undergoing non-image based computer navigated THR for Osteoarthritis were investigated. Anteversion and inclination was measured with the help of cup trials fixed with computer trackers aligned in orientation of the natural acetabulum. The acetabular inclination in all hips was measured on pre-operative digital radiographs.

Results

There were 29 males and 36 females with average age of 68 years. Anteversion of males was significantly lower than females with a mean difference of −5.5 degrees (95% CI-10.5–0.5 degrees) with p value of 0.033. There was no significant difference with respect to inclination. Overall 69 % of patients had a combined inclination and anteversion that fell outside the ‘safe zone’.

Conclusion

Mean acetabular inclination falls outwith the ‘safe zone’ but mean anteversion falls within. The inherent acetabular anatomy of arthritic hips varies widely. Females have significantly more anteversion. Care should be taken when using inherent anatomy of acetabulum as a guide when doing a THR.