Axial pelvic tilt in direct anterior Total hip Arthroplasty using a traction table
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(2020) 21:803
RESEARCH ARTICLE
Open Access
Axial pelvic tilt in direct anterior Total hip Arthroplasty using a traction table A. Aichmair1,2* , M. Dominkus1,2 and J. G. Hofstaetter1,2
Abstract Background: Direct anterior approach total hip arthroplasty may be undertaken on a traction table, but the effects that patient positioning can have on axial pelvic tilt (aPT) are unknown. The aim of this study was to assess the degree of error from patient positioning on the traction table during anterior minimally-invasive surgery (AMIS) THA. Methods: Patients were included who underwent direct anterior THA via the AMIS technique at a single institution between 11/2018 and 03/2019. Axial pelvic tilt was measured (a) in the supine position on the operating table, and (b) after positioning on the traction table, by the same consultant surgeon in all cases. Results: In the above-mentioned study period, 50 patients (F: 32; M: 18) with an average age of 60.6 ± 13.6 (range: 26.5 to 88.3) years, and an average BMI of 27.2 ± 5.0 (range: 17.9 to 41.5) kg/m2 met the inclusion criteria. When measured in supine position, the average aPT was − 0.2 ± 1.7 (range: − 5.6 to 3.8) degrees. After positioning on the traction table, the average aPT was − 3.5 ± 2.1 (− 8.5 to 1.6) degrees (p < 0.001). In patients with an aPT of more than 5 degrees, the caput-collum-diaphyseal (CCD) angle was significantly lower (125 ± 11° vs. 134 ± 8°, p = 0.007). Conclusion: This study raises awareness for the potential risk of aPT during positioning of the patient on the traction table, commonly used during direct anterior THA via the AMIS technique. Keywords: Total hip arthroplasty, Minimally invasive, Direct anterior approach, Cup misplacement, Traction table
Background Osteoarthritis of the hip is among the most common diseases affecting the musculoskeletal system with a prevalence of approximately 8% in the general adult population [1]. Surgical treatment needs to be considered in the case of non-responsiveness to conservative treatment. Total hip arthroplasty is a common procedure for end stage osteoarthritis with good results reported in the literature [2]. There are multiple surgical approaches that can be used, including the transgluteal * Correspondence: [email protected] 1 II. Department of Orthopaedic Surgery, Orthopaedic Hospital Vienna-Speising, Vienna, Austria 2 Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria
(lateral), posterior, and antero-lateral approach [3]. In 2004, the minimally-invasive total hip arthroplasty via the direct anterior approach has been reported as a viable surgical technique. This approach, using the anterior intermuscular and internervous interval, was initially described by Carl Hueter in 1881 [4, 5]. Anterior Minimally Invasive Surgery (AMIS) is frequently performed with a traction table, and has been reported as a safe and reliable surgical technique [3, 6–8]. However, based on observations of the authors, the positioning of the patient on the traction table
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