In total hip arthroplasty (THA), a high radiographic inclination angle (RI) of the acetabular component has been linked to an increased dislocation rate, liner fracture, and increased wear. In contrast to version, we have more proven boundaries when it comes to a safe zone for angles of RI. Although intuitively it seems easier to achieve a target RI, most studies demonstrate a lack of accuracy and the trend towards a high RI with all surgical approaches when using a freehand technique or a mechanical guide. This is due to pelvic motion during surgery, which can be highly variable. The current study had two primary aims, each with a different primary outcome. The first aim was to determine how accurate a surgeon could obtain the target operative inclination (OI) during THA when using a cementless cup using a digital protractor. The second aim was to determine how accurate a surgeon can estimate the target OI to obtain a RI of 40° based on the patient's hip circumference as demonstrated in a previous study. In this prospective study, we included 200 consecutive patients undergoing uncemented primary THA in the lateral decubitus position using a posterior approach. Preoperatively, the surgeon determined the target OI based on the patient's hip circumference (22.5°, 25°, 27.5° or 30°). Intraoperatively, the effective OI was measured with the aid of a digital inclinometer after seating of the acetabular component. Six weeks postoperatively anteroposterior pelvic radiographs were made and two evaluators, blinded to the effective OI, measured the RI of the acetabular component. The safe zone for inclination was defined as 30°-45° of inclination.Introduction
Methods
Aseptic loosening of the total TMC joint prosthesis occurs frequently and may depend on the design of the prosthesis. Numerous TMC prosthesis designs are available, and new designs are being developed and tested. One of the problems in the clinical studies of TMC prostheses is identifying and predicting prosthetic loosening at an early stage. Roentgen Stereophotogrammetric Analysis (RSA). allows assessment of three-dimensional micromotion of orthopaedic implants with high accuracy. Early micromotion (in the first two postoperative years) of most prostheses is strongly correlated with the development of aseptic loosening. We studied if RSA assessment was possible after total TMC joint arthroplasty. In five cadaveric hands the TMC joint was replaced by the SR-TMC prosthesis. Tantalum beads of 0.8 mm were implanted in the trapezium and first metacarpal bone without extending the standard surgical exposure. The metacarpal prosthesis component was provided with 0.5 mm beads. A three-dimensional surface model of the trapezium component of the SR-TMC prosthesis was prepared to facilitate model-based RSA. After the surgical procedure, RSA radiographs were made of all hands in two commonly used positions for imaging of the TMC joint. The number of visually detected markers for each bone/implant was recorded. Of one cadaver hand, RSA radiographs were made in ten different positions to calculate the measurement error of the performed technique. For the metacarpal bone, all beads were visible in all positions and both (L+R) RSA radiographs. For beads in the polyethylene metacarpal prosthesis component three beads seem sufficient, however in exceptional cases the most proximal placed bead might be invisible due to overprojection by the metal trapezium prosthesis component. Therefore the X-rays should be carefully checked at the radiology department before the patient leaves the ward. Alternatively, an extra bead can be placed in the prosthesis, although this is a lesser option due to possible weakening of the component caused by the placement of the beads. The use of different sizes of beads (0.5/0.8 mm) in the metacarpal bone and metacarpal prosthesis made the interpretation for the analyser easier The accuracy analysis is currently carried out. First results of these measurements are promising and placement of tantalum beads for RSA analysis during TMC-joint replacement seems feasible.
