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Archives of Orthopaedic and Trauma Surgery

Erschienen in:

04.06.2023 | Hip Arthroplasty

Influence of obesity and intra-operative imaging guidance technology on acetabular cup positioning in total hip arthroplasty

verfasst von: Kayti Luu, Scott T. Nishioka, Dylan R. Y. Lawton, Emily Unebasami, Samantha N. Andrews, Cass K. Nakasone

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 11/2023

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Abstract

Background

Accuracy of acetabular cup positioning during total hip arthroplasty (THA) can be improved with intra-operative imaging but may be influenced by body mass index (BMI). This study assessed the influence of BMI (kg/m²) on cup accuracy when using intra-operative fluoroscopy (IF) alone or supplemented with a commercial product.

Methods

This retrospective review included four consecutive cohorts of patients having undergone anterior approach THA with IF alone (2011–2015), IF and Overlay (2015–2016) (Radlink Inc., Los Angeles, CA), IF and Grid (2017–2018) (HipGrid Drone™, OrthoGrid Systems Inc., Salt Lake City, UT) and IF and Digital (2018–2020) (OrthoGrid Phantom®, OrthoGrid Systems, Inc., Salt Lake City, UT). Component placement accuracy was measured on 6-week post-operative weight bearing radiographs and compared between four BMI patient groups (BMI ≤ 25, 25 < BMI ≤ 30, 30 < BMI ≤ 35, and 35 < BMI). Total fluoroscopy times were also recorded directly from the fluoroscopy unit.

Results

Abduction angle significantly increased as BMI increased (p = 0.003) with IF alone but no difference was present in groups with guidance technology. Anteversion was significantly different between BMI groups for IF alone (p = 0.028) and Grid (p = 0.027) but was not different in Overlay (p = 0.107) or Digital (p = 0.210). Fluoroscopy time was significantly different between BMI categories for IF alone (p = 0.005) and Grid (p = 0.018) but was not different in Overlay (p = 0.444) or Digital (p = 0.170).

Conclusion

Morbid obesity (BMI > 35) increases risk for malpositioning of acetabular cups and increases surgical time with IF alone or the Grid. Additional IF guidance technology (Overlay or Digital) increased cup positioning accuracy without decreasing surgical efficiency.

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Titel: Influence of obesity and intra-operative imaging guidance technology on acetabular cup positioning in total hip arthroplasty
verfasst von: Kayti Luu
Scott T. Nishioka
Dylan R. Y. Lawton
Emily Unebasami
Samantha N. Andrews
Cass K. Nakasone
Publikationsdatum: 04.06.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Orthopaedic and Trauma Surgery / Ausgabe 11/2023
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-023-04922-x

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Influence of obesity and intra-operative imaging guidance technology on acetabular cup positioning in total hip arthroplasty