Towards Perfect Acetabular Cup Placement in Total Hip Arthroplasty: Exploring whether an individualized, optimal acetabular cup orientation can be established, accounting for variations in anatomy, motion, and spino-pelvic relationships, to enhance THA stability and avoid impingement

Thom Snijders

    Research output: ThesisDoctoral thesis 1 (Research UU / Graduation UU)

    4 Downloads (Pure)

    Abstract

    In order to further improve THA outcomes and lower revisions risk, ideally the joint reaction forces remain within the boundaries of the acetabular cup, irrespective of the patient’s anatomy, position, and spino-pelvic-femoral motion, without creating impingement. What surgery-related factors play a role in THA impingement and can this be mitigated with personalized THA 3-D planning strategy? To achieve this ideal placement, we first need to understand what constitutes perfect placement and whether a personalized, perfect orientation can be achieved during surgery.
    This thesis identifies and addresses the key obstacles in determining the optimal orientation of the acetabular cup to prevent dislocations after THA namely:
    Methodological heterogeneity: Variations in measurement methods undermine the current consensus on the ‘optimal’ acetabular cup orientation for individual patients.
    Insufficient integration of pelvic, lumbar, and femoral dynamics: Existing frameworks do not adequately account for the relationship between the orientation of the acetabular cup and the positional dynamics of the pelvis, lumbar spine, and femur.
    Uncertain relationship between pelvic movement and acetabular orientation: The effect of pelvic movement on the relative orientation of the acetabular cup is still not sufficiently understood.
    These obstacles are effectively addressed by the development of a 3D trigonometric model capable of accurately measuring and calculating coronal inclination, sagittal anteinclination, and transverse version. Notably, the model integrates sagittal ante-inclination with the sacral-acetabular angle (SAA), thus taking into account pelvic position and its relationship to surrounding anatomical structures. This approach enables assessment of how pelvic movement impacts the relative orientation of the acetabular cup, facilitating evaluation of cup positioning during high-risk movements such as deep sitting.
    This functionality provides a crucial framework for optimizing acetabular cup orientation so that joint reaction forces remain contained within the cup and impingement is avoided regardless of individual anatomy, positioning, or spino-pelvic-femoral motion. By allowing patient-specific adaptations in cup orientation, this approach aims for improved THA outcomes, a reduced risk of dislocation, and lower revision rates. Ultimately, it enables early identification of high-risk patients and supports precise adjustments to ensure correct acetabular cup orientation during the initial procedure, thereby contributing to long-term success.
    Original languageEnglish
    Awarding Institution
    • University Medical Center (UMC) Utrecht
    Supervisors/Advisors
    • Castelein, RM, Supervisor
    • Weinans, Harrie, Supervisor
    • de Gast, A, Co-supervisor, External person
    • Schlösser, Tom, Co-supervisor
    Award date11 Jun 2025
    Publisher
    Print ISBNs978-94-6473-805-6
    DOIs
    Publication statusPublished - 11 Jun 2025

    Keywords

    • total hip arthroplasty
    • dislocation
    • impingement
    • sagittal ante-inclination
    • pelvic tilt
    • sacro-acetabular angle

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