Delagrammaticas Dimitri E, Ochenjele George, Rosenthal Brett D, Assenmacher Benjamin, Manning David W, Stover Michael D
Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Hip Int. 2020 Jan;30(1):40-47. doi: 10.1177/1120700019868665. Epub 2019 Aug 6.
Intraoperative radiographic evaluation during total hip arthroplasty (THA) has shown to improve the accuracy of acetabular component placement, however, differences in interpretation based on radiographic technique has not been established. This study aims to determine if differences exist in the interpretation of acetabular component abduction and anteversion between different radiographic projections.
55 consecutive direct anterior THAs in 49 patients were prospectively enrolled. Target anteversion and abduction was defined by the Lewinnek zone. Fluoroscopy was used to direct acetabular component placement intraoperatively. After final cup implantation, fluoroscopic posterior-anterior hip and pelvis images were obtained for analysis. After completion of the procedure, an anterior-posterior plain pelvis radiograph was obtained in the operating room. Acetabulum component abduction and anteversion were postoperatively determined using specialised software on each of the 3 image acquisition methods.
Average acetabular cup abduction for intraoperative fluoroscopic posterior-anterior hip (FH), intraoperative fluoroscopic posterior-anterior pelvis (FP), and postoperative, standard, anteroposterior pelvis radiographs (PP) was 40.95° ± 2.87°, 38.87° ± 3.82° and 41.73° ± 2.96° respectively. The fluoroscopic hip and fluoroscopic pelvis tended to underestimate acetabular cup abduction compared to the postoperative pelvis ( < 0.001). Average acetabular cup anteversion for FH, FP, and PP was 19.89° ± 4.87°, 24.38° ± 5.31° and 13.36° ± 3.52° respectively. Both the fluoroscopic hip and fluoroscopic pelvis overestimated anteversion compared to the AP pelvis, with a 6.38° greater mean value measurement for FH ( < 0.001), and an 11° greater mean value measurement for FP ( < 0.001).
Fluoroscopic technique and differences between radiographic projections may result in discrepancies in component position interpretation. Our results support the use of the fluoroscopic posterior-anterior hip as the choice fluoroscopic imaging technique.
全髋关节置换术（THA）术中的影像学评估已显示可提高髋臼组件放置的准确性，然而，基于影像学技术的解读差异尚未明确。本研究旨在确定不同影像学投影在髋臼组件外展和前倾角解读上是否存在差异。
前瞻性纳入49例患者的55例连续直接前路THA。目标前倾角和外展角由Lewinnek区域定义。术中使用荧光透视引导髋臼组件放置。最终髋臼杯植入后，获取荧光透视下的髋关节和骨盆前后位图像进行分析。手术完成后，在手术室获取骨盆前后位平片。术后使用专门软件在三种图像采集方法中的每一种上确定髋臼组件的外展和前倾角。
术中荧光透视下髋关节前后位（FH）、术中荧光透视下骨盆前后位（FP）以及术后标准骨盆前后位平片（PP）的髋臼杯平均外展角分别为40.95°±2.87°、38.87°±3.82°和41.73°±2.96°。与术后骨盆相比，荧光透视下髋关节和荧光透视下骨盆倾向于低估髋臼杯外展角（<0.001）。FH、FP和PP的髋臼杯平均前倾角分别为19.89°±4.87°、24.38°±5.31°和13.36°±3.52°。与前后位骨盆相比，荧光透视下髋关节和荧光透视下骨盆均高估了前倾角，FH的平均值测量值大6.38°（<0.001），FP的平均值测量值大11°（<0.001）。
荧光透视技术和影像学投影之间的差异可能导致组件位置解读的差异。我们的结果支持使用荧光透视下髋关节前后位作为首选的荧光透视成像技术。
