Department of Orthopedic Surgery, Japanese Red Cross Narita Hospital, 90-1 Iida Cho, Narita city, Chiba, 286-8523, Japan.
Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, 1273-2 Aoba-Cho, Chuo-ku, Chiba City, Chiba, 286-0852, Japan.
Arch Orthop Trauma Surg. 2024 Sep;144(9):4217-4223. doi: 10.1007/s00402-024-05509-w. Epub 2024 Sep 4.
Stem anteversion (SA) in total hip arthroplasty (THA) is crucial for postoperative outcomes, affecting dislocation risk and hip function. Accurate SA placement is challenged by intraoperative estimation methods, with discrepancies reported between predicted and true SA. This study investigates the effect of conventional methods and intraoperative fluoroscopic confirmation on SA accuracy in THA performed with a direct anterior approach using a traction table.
This involves 200 patients undergoing primary THA from August 2019 to January 2023, divided into a conventional group (n = 100) and a fluoroscopic group (n = 100). Postoperative SA measurements were conducted using computed tomography scans. Statistical analysis focused on comparing the SA angles and the prevalence of excessive SA (≥>35° and ≥>40°) between the groups.
The fluoroscopic group showed a lower average SA angle (24.3° ± 8.3°) compared to the conventional group (30.0° ± 11.3°), with a statistically significant difference (p < 0.01). Excessive SA (≥>40°) was found in 17% of the conventional group, significantly reduced to 5% in the fluoroscopic group (p < 0.01). Similarly, SA exceeding 35° was present in 39% of the conventional group, compared to only 11% in the fluoroscopic group (p < 0.01), indicating a substantial reduction in excessive SA placements with fluoroscopic guidance.
The study demonstrates that intraoperative fluoroscopic guidance significantly enhances the accuracy of SA placement in THA, reducing the variability and proportion of excessive SA. This suggests a critical reevaluation of conventional estimation methods in favor of fluoroscopic confirmation to improve surgical outcomes.
Intraoperative fluoroscopic confirmation of knee external rotation angle markedly decreases the proportion of excessive SA and enhances the precision of stem placement in THA with a direct anterior approach. This technique represents a significant advancement in surgical practice, offering a simple and effective method to achieve optimal postoperative results.
在全髋关节置换术（THA）中，股骨前倾角（SA）至关重要，它影响着脱位风险和髋关节功能。术中评估方法存在准确性挑战，预测值与真实值之间存在差异。本研究旨在探讨在使用牵引台行直接前入路 THA 时，传统方法和术中透视确认对 SA 准确性的影响。
本研究纳入了 2019 年 8 月至 2023 年 1 月期间行初次 THA 的 200 例患者，分为常规组（n=100）和透视组（n=100）。术后使用计算机断层扫描（CT）测量 SA 角度。重点比较两组间 SA 角度和过度 SA（≥35°和≥40°）的发生率。
透视组的平均 SA 角度（24.3°±8.3°）显著低于常规组（30.0°±11.3°），差异有统计学意义（p＜0.01）。常规组中过度 SA（≥40°）的发生率为 17%，透视组显著降低至 5%（p＜0.01）。同样，常规组中 SA 超过 35°的发生率为 39%，透视组则降至 11%（p＜0.01），表明透视引导下过度 SA 放置的数量显著减少。
本研究表明，术中透视引导可显著提高 THA 中 SA 放置的准确性，降低 SA 过度的变异性和比例。这表明需要对传统的估计方法进行批判性评估，转而支持透视确认，以改善手术结果。
术中透视确认膝关节外旋角度可显著降低过度 SA 的比例，提高直接前入路 THA 中股骨柄的放置精度。该技术代表了手术实践的重大进步，为实现术后最佳结果提供了一种简单有效的方法。
