Published online Mar 20, 2024. doi: 10.5662/wjm.v14.i1.90930
Peer-review started: December 17, 2023
First decision: January 10, 2024
Revised: January 12, 2024
Accepted: February 20, 2024
Article in press: February 20, 2024
Published online: March 20, 2024
Processing time: 80 Days and 15.9 Hours
Selecting the optimal size of components is crucial when performing a primary total hip arthroplasty. Implanting the accurate size of the acetabular component can occasionally be exacting, chiefly for surgeons with little experience, whilst the complications of imprecise acetabular sizing or over-reaming can be potentially devastating.
This paper aims to assist clinicians intraoperatively with a simple and repeatable tip in elucidating the ambivalence when determining the proper acetabular component size is not straightforwardly achieved, specifically when surgeons are inexperienced or preoperative templating is unavailable.
This paper aims to assist clinicians intraoperatively with a simple and repeatable tip in elucidating the ambivalence when determining the proper acetabular component size is not straightforwardly achieved, specifically when surgeons are inexperienced or preoperative templating is unavailable.
This method was employed in 263 operations in our department from June 2021 to December 2022. All operations were performed by the same team of joint reconstruction surgeons, employing a typical posterior hip approach technique. The types of acetabular shells implanted were: The Dynasty® acetabular cup system (MicroPort Orthopedics, Shanghai, China) and the R3® acetabular system (Smith & Nephew, Watford, United Kingdom), which both feature cementless press-fit design.
The mean value of all cases was calculated and collated with each other. We distinguished as oversized an implanted acetabular shell when its size was > 2 mm larger than the size of the acetabular size indicator reamer (ASIR) or when the implanted shell was larger than 4 mm compared to the preoperative planned cup. The median size of the implanted acetabular shell was 52 (48–54) mm, whereas the median size of the preoperatively planned cup was 50 (48–56) mm, and the median size of the ASIR was 52 (50–54) mm. The correlation coefficient between ASIR size and implanted acetabular component size exhibited a high positive correlation with r = 0.719 (P < 0.001). Contrariwise, intraoperative ASIR measurements precisely predicted the implanted cups’ size or differed by only one size (2 mm) in 245 cases.
In our study, we demonstrated that the size of the first acetabular reamer not entering freely in the acetabular rim corroborates the final acetabular component size to implant. This was also corresponding in the majority of the cases with conventional preoperative templating. It can be featured as a valid tool for avoiding the potentially pernicious complications of acetabular cup over-reaming and over-sizing in primary THA. It is a simple and reproducible technical note useful for confirming the predicted acetabular cup size preoperatively; thus, its application could be considered routinely, even in cases where preoperative templating is unavailable.
The robust correlation we detected between the implanted acetabular shell’s size and the acetabular component’s size selected from the preparation of the acetabulum with our method, with a median difference of 2 mm, is of substantial clinical significance, as it provides both the potential to enhance accuracy further and the ability to accomplish predictable and reproducible results in modern hip arthroplasty.