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. 2023 Apr 15;13(1):6185.
doi: 10.1038/s41598-023-33501-8.

Determining the orientation of acetabular prosthesis in total hip arthroplasty by refering to the anatomical landmarker of acetabular notches

Heng Zhang #  1   2 , Jiansheng Zhou #  3 , Xiao Ling  4 , Haonan Chen  5 , Mingqiu Du  4 , Jianning Zhao  6
Affiliations

Determining the orientation of acetabular prosthesis in total hip arthroplasty by refering to the anatomical landmarker of acetabular notches

Heng Zhang et al. Sci Rep. .

Abstract

The aim of this study was to explore a novel method to determine the orientation of acetabular prosthesis in total hip arthroplasty (THA) by refering to the anatomical landmarker of acetabular notches. Forty-one normal developmental hips were included in the present study. The acetabulums were reamed according to standard surgical procedures of THA on life-size 3D printing pelvis models. The inferior edge of acetabular cup were placed (1-5) mm proximal and distal to the proximal line of the anterior and posterior acetabular notches (PLAPAN) respectively to determine cup inclination. The inferior edge of acetabular cup were placed (1-5) mm pronating and supinating around the proximal point of acetabular posterior notch (PPAPN) respectively to determine cup anteversion. The pelvis plain radiographs were took and the inclination and anteversion of the acetabular cup at 22 positions were calculated. In the normal developmental hip, the mean inclination of acetabular prothesis were (35.10 ± 3.22)° and (45.90 ± 2.68)° when the inferior edge of the acetabular cup was 3 mm proximal and 1 mm distal to the PLAPAN. The optimal cup inclination could be obtained when the inferior edge of the acetabular cup was 1 mm proximal to the PLAPAN (the mean inclination was (40.71 ± 2.80)°). The mean anteversion of acetabular prothesis were (10.67 ± 4.55)° and (20.86 ± 4.44)° when the inferior edge of the acetabular cup was 1 mm pronating and 1 mm supinating around the PPAPN. The optimal cup anteversion could be obtained when the inferior edge of the acetabular cup was parallel to the PLAPAN (the mean anteversion was (18.00 ± 1.64)°). The inclination and anteversion of acetabular prosthesis could be determined by refering the anatomical landmarks of acetabular notches, which could help orthopedists to install the acetabular prosthesis quickly and safely in THA.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Acetabulum model and anatomical landmarks (PPAPN proximal point of acetabular posterior notch, PLAPAN proximal line of the anterior and posterior acetabular notches).
Figure 2
Figure 2
The position relationship between the inferior edge of acetabular cup and PLAPAN to determine cup inclination.
Figure 3
Figure 3
The position relationship between the inferior edge of acetabular cup and the proximal line of the anterior and posterior acetabular notches to determine cup inclination. (a) 1 mm proximal to the PLAPAN; (b) 3 mm proximal to the PLAPAN; (c) 5 mm proximal to the PLAPAN; (d) 1 mm distal to the PLAPAN; (e) 3 mm distal to the PLAPAN; (f) 5 mm distal to the PLAPAN.
Figure 4
Figure 4
The position relationship between the inferior edge of acetabular cup and PPAPN to determine cup anteversion.
Figure 5
Figure 5
The position relationship between the inferior edge of acetabular cup and the proximal line of the anterior and posterior acetabular notches to determine cup anteversion. (a) 1 mm pronating around the PPAPN; (b) 3 mm pronating around the PPAPN; (c) 5 mm pronating around the PPAPN; (d) 1 mm supinating around the PPAPN; (e) 3 mm supinating around the PPAPN; (f) 5 mm supinating around the PPAPN.
Figure 6
Figure 6
Cup’s inclination of 11 different cup positions in relation to Lewinnek’s safe zone for inclination ((a) left hips; (b) right hips).
Figure 7
Figure 7
Cup’s anteversion of 11 different cup positions in relation to Lewinnek’s safe zone for anteversion ((a) left hips; (b) right hips).
Figure 8
Figure 8
(a) Intraoperative positional safe zone range of cup’s inclination; (b) intraoperative positional safe zone range of cup’s anteversion.
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