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. 2023 Mar 7:20:101109.
doi: 10.1016/j.artd.2023.101109. eCollection 2023 Apr.

Surgeon Estimations of Acetabular Cup Orientation Using Intraoperative Fluoroscopic Imagining Are Unreliable

Parker L Brush  1 , Adrian Santana  2 , Gregory R Toci  1 , Eric Slotkin  3 , Michael Solomon  4 , Tristan Jones  5 , Arjun Saxena  1
Affiliations

Surgeon Estimations of Acetabular Cup Orientation Using Intraoperative Fluoroscopic Imagining Are Unreliable

Parker L Brush et al. Arthroplast Today. .

Abstract

Background: Accurate acetabular cup orientation is associated with decreased revision rates and improved outcomes of primary total hip arthroplasty. This study assesses surgeon's ability to estimate both the acetabular component inclination and anteversion angles via intraoperative fluoroscopy (IF) images.

Methods: We surveyed orthopedic surgeons to estimate acetabular component inclination and anteversion based on 20 IF images of total hip arthroplasty through a direct anterior approach. Postoperative computed-tomography scans were used to calculate the true inclination and anteversion component angles. The absolute difference between the true and estimated values was calculated to determine the mean and standard deviation of the survey results. Interrater reliability was determined through interclass correlation coefficients.

Results: A majority of surgeons preferred the direct anterior approach (83.3%) and utilized IF during surgery (70%). Surgeons surveyed were on average 5.9° away from the true value of inclination (standard deviation = 4.7) and 8.8° away from the true value of anteversion (standard deviation = 6.0). Respondents were within 5° of both inclination and anteversion in 19.7% of cases, and within 10° in 57.3% of cases. All surgeons were determined to have poor reliability in estimating anteversion (interclass correlation coefficient < 0.5). Only 2 surgeons were determined to have moderate reliability when estimating inclination.

Conclusions: Surgeons, when solely relying on IF for the estimation of anteversion and inclination, are unreliable. Utilization of other techniques in conjunction with IF would improve observer reliability.

Keywords: Total hip arthroplasty; acetabular anteversion; acetabular inclination; direct anterior approach; intraoperative fluoroscopy.

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Figures

Figure 1
Figure 1
Example intraoperative fluoroscopic image used in the survey.
Figure 2
Figure 2
List of the general questions included in the survey.
Supplemental Figure 1
Supplemental Figure 1
Example image of how the 3D reconstruction and measuring software were able to determine acetabular cup inclination.
Supplemental Figure 2
Supplemental Figure 2
Example image of how the 3D reconstruction and measuring software were able to determine acetabular cup anteversion.
See this image and copyright information in PMC

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