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Knowing degree of lateral pelvic tilt before THA may not aid cup placement accuracy
Even when the patient's lateral pelvic tilt reached 15°, the information did not improve an experienced surgeon's accuracy.
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If a surgeon knows the pelvic tilt angle prior to performing a total hip arthroplasty, his or her performance is not likely to improve, according to a presenter from Israel.
A certain amount of lateral tilt of the pelvis with the patient in the lateral decubitus position prior to total hip arthroplasty (THA) may help improve an inexperienced surgeon’s ability to attain ideal acetabular cup inclination that does not lead to added cup wear or loosening over time, but experienced surgeons may not find that information as helpful to know during surgery, based on study findings Leonid A. Kandel, MD, presented at the 16th EFORT Congress.
“It made no difference for both groups knowing the angle. Even when we took the highest degrees, it made no difference,” Kandel said. “However, the tilt can be significant. It does not make any difference for an experienced arthroplasty surgeon. However, maybe for surgeons with less volume, it can be significant and that should be examined, as well.”
Radiographs vs no radiographs
Kandel and colleagues conducted a surgeon-blinded prospective study to investigate the severity of lateral tilt and whether it influenced acetabular component abduction angle for 110 patients with primary osteoarthritis who underwent THA.
Preoperatively, patients had an anteroposterior radiograph in the same lateral surgical position to measure tilt angle. A device with perpendicular bars was placed between the patient and the radiograph plate to help the surgeon and radiologist accurately measure the angle, Kandel said.
Based on the study results, 75 patients had a caudal pelvic tilt angle that averaged 4.4° ± 3.5° and 35 patients had a cranial pelvic tilt angle that averaged 2.6° ± 2°. Twelve patients had caudal and cranial tilts that exceeded 4° and 8°, respectively.
No difference in outcomes
The THAs were performed by two surgeons who did not see the radiographs for the first 60 patients (control group), but for the other 50 patients the surgeons did view the pelvic tilt on the radiographs and knew the tilt measurements prior to performing the surgery.
There was no statistically significant difference in the average cup abduction angles postoperatively in either group. The angles in the first or control group averaged 42.5° ± 4.8°, whereas the angles in the second or study group averaged 43.3° ± 5.3°.
“It made no difference for both groups knowing the angle. Even when we took the highest degrees, it made no difference,” he said.
A younger surgeon with less surgical volume than an experienced surgeon may benefit from knowing the tilt prior to performing the surgery, according to Kandel. – by Robert Linnehan
- Reference:
- Kandel LA, et al. Paper #3397. Presented at: 16th EFORT Congress; May 27-29, 2015; Prague.
- For more information:
- Leonid A. Kandel, MD, can be reached at Hadassah Medical Center, Kiryat Hadassah, POB 12000, Jerusalem, 91120, Israel; email: kandel@hadassah.org.il.
Disclosure: Kandel reports no relevant financial disclosures.