Pelvic pitch and roll during total hip arthroplasty performed through a posterolateral approach. A potential source of error in free-hand cup positioning

Alejando Gonzalez Della Valle, Kate Shanaghan, Jessica R. Benson, Kaitlin Carroll, Michael Cross, Alexander McLawhorn, Peter K. Sculco

Intraoperative pelvic motion can alter the perceived cup inclination and version during non-navigated THA. We quantified pelvic motion during different phases of primary THA performed in the lateral decubitus through a posterolateral approach. Pelvic roll (rotation of the coronal plane) and pitch angles (rotation parallel to the coronal plane) were studied in 75 patients undergoing THA for osteoarthritis by four arthroplasty surgeons. Ten steps of surgery were defined. Angular motion was recorded with a miniature surgical device that utilizes inertial sensors. The mean absolute roll ranged from 0.03° detected at the end of surgery to 4.13° detected during acetabular exposure. The mean absolute pitch ranged from 0.05° detected at the end of surgery to 2.54° detected during hip dislocation. The maximum pelvic roll and pitch detected during surgery averaged 17.62° (SD: 5.08) and 9.3° (SD: 3.39) respectively. Absolute roll and pitch angles were not affected by patient's BMI, sex, pre-operative hip motion, or surgeon. Before cup insertion, the greatest mean change in roll was observed during acetabular exposure (10.02° anteriorly), and for pitch was observed during dislocation (1.88° caudally). During THA performed through a posterolateral approach, there is a progressive anterior pelvic roll that peaks before cup insertion. This can lead to underestimation of cup anteversion during non-navigated THA. The anterior roll does not completely correct, even when all retractors and external forces acting on the pelvis are removed. Pelvic pitch that could affect the perceived cup inclination occurs to a lesser extent than pelvic roll.