High accuracy of positioning custom triflange acetabular components in tumour and total hip arthroplasty revision surgery

Demien Broekhuis; Willemijne M H Meurs; Bart L Kaptein; Sascha Karunaratne; Richard L Carey Smith; Scott Sommerville; Richard Boyle; Rob G H H Nelissen

doi:10.1302/2633-1462.54.BJO-2023-0185.R1

High accuracy of positioning custom triflange acetabular components in tumour and total hip arthroplasty revision surgery

Bone Jt Open. 2024 Apr 1;5(4):260-268. doi: 10.1302/2633-1462.54.BJO-2023-0185.R1.

Authors

Demien Broekhuis¹, Willemijne M H Meurs¹, Bart L Kaptein¹, Sascha Karunaratne², Richard L Carey Smith³, Scott Sommerville⁴, Richard Boyle⁵, Rob G H H Nelissen¹

Affiliations

¹ Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, Netherlands.
² Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia.
³ Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Australia.
⁴ Department of Orthopaedic Surgery, Princess Alexandra Hospital, Brisbane, Australia.
⁵ Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.

PMID: 38555947
PMCID: PMC10981996
DOI: 10.1302/2633-1462.54.BJO-2023-0185.R1

Abstract

Aims: Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and pelvic tumour resection procedures. Accurate CTAC positioning is essential to successful surgical outcomes. While prior studies have explored CTAC positioning in rTHA, research focusing on tumour cases and implant flange positioning precision remains limited. Additionally, the impact of intraoperative navigation on positioning accuracy warrants further investigation. This study assesses CTAC positioning accuracy in tumour resection and rTHA cases, focusing on the differences between preoperative planning and postoperative implant positions.

Methods: A multicentre observational cohort study in Australia between February 2017 and March 2021 included consecutive patients undergoing acetabular reconstruction with CTACs in rTHA (Paprosky 3A/3B defects) or tumour resection (including Enneking P2 peri-acetabular area). Of 103 eligible patients (104 hips), 34 patients (35 hips) were analyzed.

Results: CTAC positioning was generally accurate, with minor deviations in cup inclination (mean 2.7°; SD 2.84°), anteversion (mean 3.6°; SD 5.04°), and rotation (mean 2.1°; SD 2.47°). Deviation of the hip centre of rotation (COR) showed a mean vector length of 5.9 mm (SD 7.24). Flange positions showed small deviations, with the ischial flange exhibiting the largest deviation (mean vector length of 7.0 mm; SD 8.65). Overall, 83% of the implants were accurately positioned, with 17% exceeding malpositioning thresholds. CTACs used in tumour resections exhibited higher positioning accuracy than rTHA cases, with significant differences in inclination (1.5° for tumour vs 3.4° for rTHA) and rotation (1.3° for tumour vs 2.4° for rTHA). The use of intraoperative navigation appeared to enhance positioning accuracy, but this did not reach statistical significance.

Conclusion: This study demonstrates favourable CTAC positioning accuracy, with potential for improved accuracy through intraoperative navigation. Further research is needed to understand the implications of positioning accuracy on implant performance and long-term survival.