Accuracy of acetabular component position in hip arthroplasty

J Bone Joint Surg Am. 2013 Oct 2;95(19):1760-8. doi: 10.2106/JBJS.L.01704.


Background: Acetabular component malposition is linked to higher bearing surface wear and component instability. Outcomes following total hip arthroplasty and surface replacement arthroplasty depend on multiple surgeon and patient-dependent factors. The purpose of this study was to examine the frequency in which acetabular components are placed within a predetermined target range.

Methods: We evaluated postoperative anteroposterior pelvic radiographs for every consecutive primary total hip arthroplasty and surface replacement arthroplasty completed from 2004 to 2009 at a single institution. Acetabular component abduction and anteversion angles were determined using Martell Hip Analysis Suite software. We defined target ranges for abduction and anteversion for both total hip arthroplasty (30° to 55° and 5° to 35°, respectively) and surface replacement arthroplasty (30° to 50° and 5° to 25°, respectively). Surgeon and patient-related factors were analyzed for risk associated with placing the acetabular component outside the target range.

Results: Of the 1549 total hip arthroplasties, 1435 components (93%) met our abduction target, 1472 (95%) met our anteversion target, and 1363 (88%) simultaneously met both targets. Of the 263 surface replacement arthroplasties, 233 components (89%) met our abduction target, 247 (94%) met our anteversion target, and 220 (84%) simultaneously met both targets. When previously published target ranges of abduction (30° to 45°) and anteversion (5° to 25°) angles were used, only 665 total hip replacements (43%) met the abduction target, 1325 (86%) met the anteversion target, and 584 (38%) simultaneously met both targets. Of the surface replacement arthroplasties, 181 (69%) met the abduction target, 247 (94%) met the anteversion target, and 172 (65%) simultaneously met both targets. Low-volume surgeons were 2.16 times more likely to miss target component position compared with high-volume surgeons (p = 0.002). The odds of missing the target increased by ≥ 0.2 for every 5 kg/m2 increase in body mass index. Minimally invasive approaches, diagnosis, years of surgical experience, femoral head size, and age of the patient did not affect component position.

Conclusions: Increased odds of component malposition were found with lower-volume surgeons and higher body mass index. No other variables had a significant effect on component placement.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

MeSH terms

  • Acetabulum / surgery*
  • Arthroplasty, Replacement, Hip / methods
  • Arthroplasty, Replacement, Hip / standards*
  • Bone Malalignment / prevention & control
  • Clinical Competence / standards
  • Hip Prosthesis / standards*
  • Humans
  • Orthopedics / standards
  • Prospective Studies