Khalifa Ahmed A, Abdelaal Ahmed M
Orthopaedic Department, Qena University Hospital, Qena, 83523, Egypt.
Department of Orthopedic Surgery and Traumatology, Assiut University Hospital, Assiut, 71515, Egypt.
Arthroplasty. 2024 Nov 5;6(1):58. doi: 10.1186/s42836-024-00278-8.
Although many factors were suggested to affect acetabular cup positioning during primary total hip arthroplasty, the effect of surgeon handedness was rarely evaluated. We aimed primarily to assess the difference in cup positioning (inclination and anteversion) between the right and left sides during primary THA. Secondly, to check the difference in the percentages of cups positioned in the safe zone for inclination and anteversion and if there will be a difference in cup positioning according to the type of cup fixation (cemented vs. cementless).
Cup inclination and anteversion of 420 THAs were radiographically evaluated retrospectively. THAs were performed by a senior right-handed surgeon, who operated through a direct lateral approach in a lateral decubitus position using manual instruments and freehand technique for cup placement. Patients were assigned to two groups: Group A (right, or dominant side), and Group B (left, or non-dominant side), with equal cases of THAs (n = 210) in each group.
No difference was found in patients' basic characteristics, preoperative diagnosis, and cup fixation (54.3% cemented and 45.7% cementless) between the two groups. There was a significant difference in cup inclination between Groups A and Group B (40.1° ± 6.3° vs. 38.2° ± 6.1°) (P = 0.002). No significant difference was revealed in anteversion between the two groups (11.7° ± 4.4° vs. 11.8° ± 4.7°) (P = 0.95). The percentage of cups located within the safe zone in terms of both inclination and anteversion was 85.2% vs. 83.8% and 69% vs. 73.3% for Group A and Group B, according to Lewinnek and Callahan's safe zones, respectively. There existed a significant difference in the cemented cup inclination between Group A and Group B (40.8° ± 6.4° vs. 38.3° ± 6.3°) (P = 0.004).
Cup inclination is affected by the surgeon's handedness when operating through a direct lateral approach and using a freehand technique, while anteversion is less affected. Furthermore, the difference is greater with cemented cups.
尽管有许多因素被认为会影响初次全髋关节置换术中髋臼杯的位置，但外科医生的惯用手对其影响却鲜有评估。我们主要旨在评估初次全髋关节置换术中右侧和左侧髋臼杯位置（倾斜度和前倾角）的差异。其次，检查倾斜度和前倾角处于安全区内的髋臼杯百分比差异，以及根据髋臼杯固定类型（骨水泥型与非骨水泥型）髋臼杯位置是否存在差异。
对420例全髋关节置换术的髋臼杯倾斜度和前倾角进行回顾性影像学评估。全髋关节置换术由一位资深的右利手外科医生实施，他在侧卧位通过直接外侧入路，使用手动器械并采用徒手技术放置髋臼杯。患者被分为两组：A组（右侧，即优势侧）和B组（左侧，即非优势侧），每组全髋关节置换术病例数相等（n = 210）。
两组患者在基本特征、术前诊断及髋臼杯固定方式（54.3%为骨水泥型，45.7%为非骨水泥型）方面均未发现差异。A组和B组之间髋臼杯倾斜度存在显著差异（40.1°±6.3° vs. 38.2°±6.1°）（P = 0.002）。两组之间前倾角未显示出显著差异（11.7°±4.4° vs. 11.8°±4.7°）（P = 0.95）。根据Lewinnek和Callahan的安全区标准，A组和B组倾斜度和前倾角处于安全区内的髋臼杯百分比分别为85.2%对83.8%以及69%对73.3%。A组和B组骨水泥型髋臼杯倾斜度存在显著差异（40.8°±6.4° vs. 38.3°±6.3°）（P = 0.004）。
在通过直接外侧入路并采用徒手技术进行手术时，髋臼杯倾斜度受外科医生惯用手的影响，而前倾角受影响较小。此外，骨水泥型髋臼杯的差异更大。
