Cup positioning relative to the acetabular rim planned with three-dimensional computed tomography improves precision in total hip arthroplasty: a randomized controlled trial.

IF 2.8 3区医学 Q1 ORTHOPEDICS Journal of Orthopaedic Surgery and Research Pub Date : 2025-03-27 DOI:10.1186/s13018-025-05704-4

Anuwat Pongkunakorn, Napon Wongkamthong, Rukthanin Ruktrakul

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Abstract

Background: Accurate acetabular cup positioning is essential for successful total hip arthroplasty (THA) outcomes. The conventional mechanical alignment guide (MAG) method provides moderate accuracy. We developed a novel technique for cup positioning that utilizes preoperative three-dimensional computed tomography (3D-CT) planning based on the native acetabular rim's relative position and compared cup orientation between this method and the MAG technique.

Methods: A randomized controlled trial with 120 patients undergoing primary THA via the posterolateral approach targeted cup positions of 40° radiographic inclination (RI) and 20° radiographic anteversion (RA). The control group (n = 40) used a MAG for cup placement, while the study group (n = 80) utilized preoperative 3D-CT to measure native RI, calculate RA, and determine the cup overhang distance (COD). The cup inclination was positioned relative to the superior rim point and the transverse acetabular notch. The cup anteversion was adjusted to achieve overhang at the posterior or anterior rim point according to the planned COD. Postoperative RI and RA were assessed using tilt-adjusted plain radiographs and CT scans. The percentages of cups positioned within 5° of the target position (RI/RA of 40°/20° ± 5°), and within the Grammatopoulos aiming zone (RI/RA of 40°/20° ± 10°) were compared between the two groups.

Results: The mean RI was 41.7° ± 5.4° (range, 33°-59°) in the control group and 39.9° ± 3.2° (range, 33.8°-45.5°) in the study group (p = 0.019). The mean RA was 19.5° ± 7.6° (range, 3°-33°) in the control group and 20.2° ± 3.3° (range, 12.9°-28.3°) in the study group (p = 0.356). Cup alignment within 5° of the target was achieved in 86.2% (69 hips) of the study group and 32.5% (13 hips) of the control group (p < 0.001). The study group had a significantly higher percentage of cups within Grammatopoulos aiming zone (100% vs. 77.5%, p < 0.001).

Conclusions: 3D-CT-guided cup positioning relative to the acetabular rim can enhance the precision of cup placement in THA to achieve alignment within 5° of the target position.

Trial registration: Thai Clinical Trials Registry (TCTR 20201220001). Registered on 20 December 2020. Prospectively registered.

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三维计算机断层扫描计划的髋臼杯相对于髋臼缘定位可提高全髋关节置换术的精确度：一项随机对照试验。

背景：准确的髋臼杯定位是全髋关节置换术成功的关键。传统的机械导向（MAG）方法提供中等精度。我们开发了一种新的髋臼杯定位技术，利用基于髋臼缘相对位置的术前三维计算机断层扫描（3D-CT）规划，并将该方法与MAG技术之间的髋臼杯方向进行比较。方法：对120例经后外侧入路行原发性THA的患者进行随机对照试验，目标是40°x线倾斜（RI）和20°x线前倾（RA）。对照组（n = 40）使用MAG放置杯子，研究组（n = 80）使用术前3D-CT测量原生RI，计算RA，确定杯子悬垂距离（COD）。杯倾角相对于上缘点和髋臼横向切迹定位。根据计划的COD调整杯前倾以达到后缘或前缘点的悬垂。术后RI和RA通过倾斜调整平片和CT扫描进行评估。比较两组杯子放置在目标位置5°内（RI/RA为40°/20°±5°）和Grammatopoulos瞄准区（RI/RA为40°/20°±10°）的百分比。结果：对照组平均RI为41.7°±5.4°（范围33°-59°），研究组平均RI为39.9°±3.2°（范围33.8°-45.5°）（p = 0.019）。对照组平均RA为19.5°±7.6°（范围3°-33°），研究组平均RA为20.2°±3.3°（范围12.9°-28.3°）（p = 0.356）。研究组86.2%（69髋）和对照组32.5%（13髋）的髋臼杯在目标位置5°内对齐(p结论：3d - ct引导下髋臼杯相对于髋臼缘定位可以提高髋臼杯在THA内放置的精度，达到目标位置5°内对齐。试验注册：泰国临床试验注册中心（TCTR 20201220001）。于2020年12月20日注册前瞻性登记。

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来源期刊

Journal of Orthopaedic Surgery and Research ORTHOPEDICS-

CiteScore

4.10

自引率

7.70%

发文量

494

审稿时长

>12 weeks

期刊介绍： Journal of Orthopaedic Surgery and Research is an open access journal that encompasses all aspects of clinical and basic research studies related to musculoskeletal issues. Orthopaedic research is conducted at clinical and basic science levels. With the advancement of new technologies and the increasing expectation and demand from doctors and patients, we are witnessing an enormous growth in clinical orthopaedic research, particularly in the fields of traumatology, spinal surgery, joint replacement, sports medicine, musculoskeletal tumour management, hand microsurgery, foot and ankle surgery, paediatric orthopaedic, and orthopaedic rehabilitation. The involvement of basic science ranges from molecular, cellular, structural and functional perspectives to tissue engineering, gait analysis, automation and robotic surgery. Implant and biomaterial designs are new disciplines that complement clinical applications. JOSR encourages the publication of multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines, which will be the trend in the coming decades.