Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2024; 15(1): 39-44
Published online Jan 18, 2024. doi: 10.5312/wjo.v15.i1.39
Acetabular cup size trends in total hip arthroplasty
Daniel Patrick McKenna, Alex Price, Timothy McAleese, Darren Dahly, Paul McKenna, May Cleary
Daniel Patrick McKenna, Alex Price, Timothy McAleese, Paul McKenna, May Cleary, Department of Trauma and Orthopaedics, University Hospital Waterford, Waterford X91 ER8E, Ireland
Darren Dahly, Department of Epidemiology and Public Health, University College Cork, Cork T12 XF62, Ireland
Author contributions: All of the aforementioned authors contributed to this article; the study concept and design was devised by McKenna P and Cleary M; data collection was performed by McKenna DP and Price A; data analysis was completed by Dahly D; write up was completed by Mckenna DP with edits and proof reading provided by McAleese T, McKenna P and Cleary M.
Institutional review board statement: This study was classified as a service evaluation. In keeping with local guidelines and practice it did not require formal institutional board review.
Informed consent statement: Consent was not sought from subjects given its anonymised and retrospective nature.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The dataset and statistical analysis information can be made available by the corresponding author upon request to danielmckenna21@rcsi.com. Consent was not sought from subjects given its anonymised and retrospective nature.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Daniel Patrick McKenna, MBChB, Surgeon, Department of Trauma and Orthopaedics, University Hospital Waterford, Dunmore Road, Waterford X91 ER8E, Ireland. danielmckenna21@rcsi.com
Received: October 22, 2023
Peer-review started: October 22, 2023
First decision: November 29, 2023
Revised: December 4, 2023
Accepted: December 27, 2023
Article in press: December 27, 2023
Published online: January 18, 2024
Processing time: 85 Days and 14.8 Hours
Abstract
BACKGROUND

Total hip arthroplasty (THA) is a common procedure for end stage osteoarthritis. The learning curve for THA is complex and challenging. One of the most difficult skills to master is acetabular reaming. We wish to identify if experience in arthroplasty leads to preservation of more bone stock.

AIM

To investigate if increasing surgeon experience will predict an ever decreasing acetabular cup size.

METHODS

A retrospective case series of four attending orthopaedic surgeons was completed. All uncemented elective total hip arthroplasties since appointment were selected for inclusion. The size of acetabular cup used was noted and logistic regression was used to identify if a trend to smaller cups existed.

RESULTS

A total of 1614 subjects were included with a mean age of 64 years. Overall cups were on average 0.18mm smaller per year (95% confidence interval -0.25 to -0.11, P < 0.001). Individual surgeon trends showed cup sizes to decrease 0.27 mm/year for surgeon A, 0.02 mm/year for surgeon B, 0.15 mm/year for surgeon C and 0.29 mm/year for surgeon D. Three of the four surgeons had a more pronounced trend to smaller cups for male subjects than their female counterparts.

CONCLUSION

We found increasing surgeon experience to be associated with an ever-decreasing acetabular cup size. Smaller acetabular cup size may act as a surrogate marker of surgical proficiency by virtue of decreased acetabular reaming.

Keywords: Hip, Arthroplasty, Acetabulum, Cup, Learning

Core Tip: The learning curve for total hip arthroplasty is complex and challenging. One of the most difficult skills to master is acetabular reaming. We hypothesise that with increasing surgeon experience there will be a trend to smaller acetabular cup sizes as a result of less acetabular reaming. A retrospective case series of four attending orthopaedic surgeons was completed. A total of 1,614 cups were analysed. Overall cups were on average 0.18mm smaller per year (95% confidence interval -0.25 to -0.11, P < 0.001). We found increasing surgeon experience to be associated with an ever decreasing acetabular cup size.