Moritz M Innmann, Christian Merle, Akaash Ratra, Andrew Speirs, Andrew Adamczyk, David Murray, Harinderjit S Gill, George Grammatopoulos
{"title":"冠状面上髋臼杯的倾斜和前倾角与矢状面上髋臼杯的前倾角的关系：揭露髋臼杯安全区的谬误。","authors":"Moritz M Innmann, Christian Merle, Akaash Ratra, Andrew Speirs, Andrew Adamczyk, David Murray, Harinderjit S Gill, George Grammatopoulos","doi":"10.2106/JBJS.OA.23.00120","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This study aimed to establish an equation for calculating cup ante-inclination (AI) from radiographic cup inclination and anteversion, to validate this equation in a total hip arthroplasty (THA) cohort, and to test whether achieving previously described radiographic cup inclination and anteversion targets would also satisfy sagittal cup AI targets.</p><p><strong>Methods: </strong>A mathematical equation linking cup AI, radiographic inclination (RI), and anteversion (RA) was determined: tan(AI) = tan(RA)/cos(RI). Supine and standing anteroposterior and lateral radiographs of 440 consecutive THAs were assessed to measure cup RI and RA and spinopelvic parameters, including cup AI, using a validated software tool. Whether orientation within previously defined RI and RA targets was associated with achieving the AI target and satisfying the sagittal component orientation (combined sagittal index, 205° to 245°) was tested.</p><p><strong>Results: </strong>The cups in the THA cohort had a measured mean inclination (and standard deviation) of 43° ± 7°, anteversion of 26° ± 9°, and AI of 34° ± 10°. The calculated cup AI was 34° ± 12°. A strong correlation existed between measured and calculated AI (r = 0.75; p < 0.001), with a mean error of 0° ± 8°. The inclination and anteversion targets were both satisfied in 194 (44.1%) to 330 (75.0%) of the cases, depending on the safe zone targets that were used, and 311 cases (70.7%) satisfied the AI target. Only 125 (28.4%) to 233 (53.0%) of the cases satisfied the AI target as well as the inclination and anteversion targets. Satisfying inclination and anteversion targets was not associated with increased chances of satisfying the AI target.</p><p><strong>Conclusions: </strong>Achieving optimal cup inclination and anteversion does not ensure optimal orientation in the sagittal plane. The equation and nomograms provided can be used to determine and visualize how the 2 planes used for evaluating the cup orientation and the pertinent angles relate, potentially aiding in preoperative planning.</p>","PeriodicalId":36492,"journal":{"name":"JBJS Open Access","volume":"9 3","pages":""},"PeriodicalIF":2.3000,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11236406/pdf/","citationCount":"0","resultStr":"{\"title\":\"The Relationship of Cup Inclination and Anteversion in the Coronal Plane with Ante-Inclination in the Sagittal Plane: Exposing the Fallacy of Cup Safe Zones.\",\"authors\":\"Moritz M Innmann, Christian Merle, Akaash Ratra, Andrew Speirs, Andrew Adamczyk, David Murray, Harinderjit S Gill, George Grammatopoulos\",\"doi\":\"10.2106/JBJS.OA.23.00120\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>This study aimed to establish an equation for calculating cup ante-inclination (AI) from radiographic cup inclination and anteversion, to validate this equation in a total hip arthroplasty (THA) cohort, and to test whether achieving previously described radiographic cup inclination and anteversion targets would also satisfy sagittal cup AI targets.</p><p><strong>Methods: </strong>A mathematical equation linking cup AI, radiographic inclination (RI), and anteversion (RA) was determined: tan(AI) = tan(RA)/cos(RI). Supine and standing anteroposterior and lateral radiographs of 440 consecutive THAs were assessed to measure cup RI and RA and spinopelvic parameters, including cup AI, using a validated software tool. Whether orientation within previously defined RI and RA targets was associated with achieving the AI target and satisfying the sagittal component orientation (combined sagittal index, 205° to 245°) was tested.</p><p><strong>Results: </strong>The cups in the THA cohort had a measured mean inclination (and standard deviation) of 43° ± 7°, anteversion of 26° ± 9°, and AI of 34° ± 10°. The calculated cup AI was 34° ± 12°. A strong correlation existed between measured and calculated AI (r = 0.75; p < 0.001), with a mean error of 0° ± 8°. The inclination and anteversion targets were both satisfied in 194 (44.1%) to 330 (75.0%) of the cases, depending on the safe zone targets that were used, and 311 cases (70.7%) satisfied the AI target. Only 125 (28.4%) to 233 (53.0%) of the cases satisfied the AI target as well as the inclination and anteversion targets. Satisfying inclination and anteversion targets was not associated with increased chances of satisfying the AI target.</p><p><strong>Conclusions: </strong>Achieving optimal cup inclination and anteversion does not ensure optimal orientation in the sagittal plane. The equation and nomograms provided can be used to determine and visualize how the 2 planes used for evaluating the cup orientation and the pertinent angles relate, potentially aiding in preoperative planning.</p>\",\"PeriodicalId\":36492,\"journal\":{\"name\":\"JBJS Open Access\",\"volume\":\"9 3\",\"pages\":\"\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2024-07-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11236406/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JBJS Open Access\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2106/JBJS.OA.23.00120\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JBJS Open Access","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2106/JBJS.OA.23.00120","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
背景：本研究的目的是建立一个公式，根据X光片显示的髋臼杯倾斜度和反转角计算髋臼杯前倾角（AI），在全髋关节置换术（THA）队列中验证该公式，并检验实现之前描述的X光片显示的髋臼杯倾斜度和反转角目标是否也能满足矢状面髋臼杯AI目标：方法： 确定了一个连接髋臼杯AI、放射学倾斜度（RI）和前内翻（RA）的数学公式：tan(AI) = tan(RA)/cos(RI) 。使用经过验证的软件工具评估了 440 例连续 THAs 的仰卧位和站立位前正位和侧位照片，以测量髋臼杯 RI 和 RA 以及包括髋臼杯 AI 在内的脊柱参数。测试了在先前定义的RI和RA目标范围内的取向是否与达到AI目标和满足矢状构件取向（综合矢状指数，205°至245°）相关：THA队列中的髋臼杯的测量平均倾斜度（和标准偏差）为43° ± 7°，前倾角为26° ± 9°，AI为34° ± 10°。计算得出的杯AI为34° ± 12°。测量和计算的 AI 之间存在很强的相关性（r = 0.75；p < 0.001），平均误差为 0° ± 8°。根据所使用的安全区目标，有 194 例（44.1%）至 330 例（75.0%）符合倾斜和内翻目标，有 311 例（70.7%）符合 AI 目标。只有 125 例（28.4%）至 233 例（53.0%）既满足 AI 目标，又满足倾斜和反转目标。满足倾斜和内翻目标与满足人工晶体植入目标的几率增加无关：结论：实现最佳的髋臼杯倾角和内翻并不能确保矢状面上的最佳方向。所提供的方程和提名图可用来确定和直观显示用于评估髋臼杯方向和相关角度的两个平面之间的关系，从而为术前规划提供潜在帮助。
The Relationship of Cup Inclination and Anteversion in the Coronal Plane with Ante-Inclination in the Sagittal Plane: Exposing the Fallacy of Cup Safe Zones.
Background: This study aimed to establish an equation for calculating cup ante-inclination (AI) from radiographic cup inclination and anteversion, to validate this equation in a total hip arthroplasty (THA) cohort, and to test whether achieving previously described radiographic cup inclination and anteversion targets would also satisfy sagittal cup AI targets.
Methods: A mathematical equation linking cup AI, radiographic inclination (RI), and anteversion (RA) was determined: tan(AI) = tan(RA)/cos(RI). Supine and standing anteroposterior and lateral radiographs of 440 consecutive THAs were assessed to measure cup RI and RA and spinopelvic parameters, including cup AI, using a validated software tool. Whether orientation within previously defined RI and RA targets was associated with achieving the AI target and satisfying the sagittal component orientation (combined sagittal index, 205° to 245°) was tested.
Results: The cups in the THA cohort had a measured mean inclination (and standard deviation) of 43° ± 7°, anteversion of 26° ± 9°, and AI of 34° ± 10°. The calculated cup AI was 34° ± 12°. A strong correlation existed between measured and calculated AI (r = 0.75; p < 0.001), with a mean error of 0° ± 8°. The inclination and anteversion targets were both satisfied in 194 (44.1%) to 330 (75.0%) of the cases, depending on the safe zone targets that were used, and 311 cases (70.7%) satisfied the AI target. Only 125 (28.4%) to 233 (53.0%) of the cases satisfied the AI target as well as the inclination and anteversion targets. Satisfying inclination and anteversion targets was not associated with increased chances of satisfying the AI target.
Conclusions: Achieving optimal cup inclination and anteversion does not ensure optimal orientation in the sagittal plane. The equation and nomograms provided can be used to determine and visualize how the 2 planes used for evaluating the cup orientation and the pertinent angles relate, potentially aiding in preoperative planning.
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