Use of smartphone to improve acetabular component positioning in total hip athroplasty: A comparative clinical study

Abstract

Background: The position of the acetabular cup is important to the outcome of total hip athroplasty (THA). We devised an instrument that uses the level indicator application of smartphone together with a mechanical alignment guide to improve the precision of cup placement. This study aims to determine the percentage of acetabular cups positioned in the Lewinnek safe zone comparing between the conventional technique (using a mechanical alignment guide alone) and the smartphone technique (using a mechanical alignment guide combined with the devised instrument and smartphone).

Methods: A historical controlled trial was conducted among 82 patients who underwent primary THAs through a posterolateral approach. In the conventional group, 41 cups were placed during January 2013 and December 2014, whereas 41 cups in the smartphone group were placed during January 2015 and March 2016. Inclination and anteversion angles were measured in standardized pelvic radiographs. The cup orientation was compared between groups.

Results: The inclination angle in the smartphone group was significantly lower than in the conventional group (40.9° (SD 3.8) vs. 46.3° (SD 6.7), p < 0.001), but the anteversion angle was higher (19.6° (SD 4.4) vs. 16.5° (SD 6.1), p = 0.010). The smartphone group had more cups positioned in the Lewinnek safe zone (90.2% vs. 56.1%, p = 0.001) and longer operative times (136 (SD 27) vs. 119 (SD 23) min, p = 0.011). No significant difference was found for blood loss ( p== 0.384) or dislocation rate ( p = 0.494).

Conclusion: Using the computerized function of smartphone could improve the precision of cup positioning. Most cups were placed within a narrow margin inside the Lewinnek safe zone.

Keywords: acetabular cup positioning; pelvic inclinometer; smartphone; total hip arthroplasty.