Effectiveness of a Pre-Operative Lateral Decubitus Position Radiologic Examination Using a Goniometer and Rod in THRA

Kye Young Han; Seong Mu Cha

doi:10.5371/jkhs.2010.22.4.260

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Han and Cha: Effectiveness of a Pre-Operative Lateral Decubitus Position Radiologic Examination Using a Goniometer and Rod in THRA

Original Article

The Journal of the Korean Hip Society

The Journal of the Korean Hip Society 2010; 22(4): 260-265.

Published online: 31 December 2010

DOI: https://doi.org/10.5371/jkhs.2010.22.4.260

Effectiveness of a Pre-Operative Lateral Decubitus Position Radiologic Examination Using a Goniometer and Rod in THRA

Kye Young Han, MD, Seong Mu Cha, MD

Department of Orthopedic Surgery, College of Medicine, Kangwon National University, Chuncheon, Korea.

Address reprint request to Kye Young Han, MD. Department of Orthopedic Surgery, Kangwon National University Hospital, 17-1 Hyoja 3-dong, Chuncheon 200-722, Korea. TEL: +82-33-258-2308 FAX: +82-33-244-2205, hkyljh@kangwon.ac.kr

Received 14 July 2010 Revised 17 November 2010 Accepted 22 November 2010

Abstract

Purpose

For inserting an acetabular cup with the correct inclination angle, we checked the pelvic tilts using the lateral decubitus position X-ray and a goniometer and pointer. The accuracy of the cup inclination at the targeted angles was evaluated after insertion of the cup at an adjusted angle with using a goniometer and pointer.

Materials and Methods

Between January 2008 and December 2009, 56 hips in 50 patients who underwent total hip replacement arthroplasty (THRA) were enrolled. The mean age at the time of surgery was 63.8 years. There were 31 male patients (36 hips) and 19 female patients (20 hips). The preoperative diagnoses included osteonecrosis of the femoral head in 27 hips, secondary osteoarthritis in 10 hips and femoral neck fracture in 14 hips. The preoperative pelvic tilts were evaluated according to the lateral decubitus position X-ray with using a goniometer and pointer. The target inclination angle was 40° for 27 hips that underwent ceramic-on-ceramic THRA. The target inclination angle was 45° for the 29 hips that underwent ceramic-on-polyethylene THRA. The inclination of the cup was evaluated after inserting the acetabular cup at the adjusted angle using a goniometer and pointer.

Results

The mean inclination angle of the acetabular cup was 39.3° for the ceramic-on-ceramic THRA and 44.4° for the ceramic-on-polyethylene THRA. There were no significant differences between the 40° and 45° (P=0.059, P=0.071).

Conclusion

The pelvic tilt can be evaluated by checking the lateral decubitus X-ray with a goniometer and pointer. Insertion of an acetabular cup at the adjusted angle could be a credible method for reducing the variability of cup inclination.

Keywords: Hip, THA, Lateral decubitus X-ray, Pelvic tilt, Acetabular cup, Inclination

Figures and Tables

Fig. 1

(A) Goniometer with long pointer targeted to 45° for measuring the pelvic tilt. (B) Goniometer and pointer can be divided for sterilization.

Fig. 2

(A) Preoperative AP X-ray with goniometer and pointer. An angle between inter-teardrop line and pointer is 47.3°. Pelvis was tilted to cephalad 2.3°. (B) The photograph of acetabular cup insertion using goniometer and pointer. This hip was planned for ceramic on ceramic THA(target angle was 40°), so goniometer was fixed at 42.3°. Cup fixation was done parallel to goniometer and pointer. (C) Post-operative inclination angle of cup was 40.4°.

Fig. 3

The distribution table of post-operative inclincation angle of cup. All cases were within acceptable range.

Table 1

Post-Operative Inclination Angle

Table 2

Comparision of Pre- & Post-Operative HHS

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