Abstract
Introduction
To control anteversion of the acetabular cup and femoral stem within an appropriate angle range is extremely important in total hip arthroplasty. The sum of these angles is called the “combined anteversion” (CA), and a navigation system is necessary for its accurate intraoperative evaluation. However, navigation is too expensive and time-consuming to be commonly used. Therefore, a cheaper and easier tool for intraoperative CA evaluation is desired in the clinical field. I had an idea of marking ruler-like scales on a trial femoral head ball for this purpose. The purpose of this study was to introduce the idea in a computer simulation.
Materials and Methods
An acetabular cup, a femoral head, and a femoral stem were designed virtually using three- dimensional computer graphics software (FreeCAD). The head was assembled with the femoral stem, and the axis of the stem was tilted 7 degrees to the vertical axis, referring the angle between mechanical and anatomical axes of the femur. Ruler-like scales and a horizontal line were marked on the surface of the head. The cup inclination angle was fixed at 40 degrees and paired with the head and stem assembly. The cup axis was on the stem–neck plane, which meant that CA was zero before rotating the cup and the stem. The scale at an intersecting point of the inner edge of the cup and the horizontal line was read before and after rotating the cup and the stem. I confirmed if the sum of the rotated angles of the cup and stem and the angle indicated by the scales were consistent when they were rotated at an arbitrary angle.
Results
CA was successfully evaluated by the difference in angle indicated by the scales before and after rotation.
Discussion
There are several definitions for cup and stem anteversion. The CA evaluated in this study was the sum of anatomical anteversion of the cup and the angle between the neck axis and epicondylar or posterior-condylar axes of the knee projected on the horizontal plane. There are several factors that make the CA evaluation by this method inaccurate. For example, when the cup inclination angle is not 40 degrees, or the pelvis or the femur are not held at the intended position, the CA indicated by the scales is not accurate. It is my future work to assess whether this method is accurate enough to be used in the clinical situation.
Conclusion
Marking ruler-like scales on the femoral head would be a low-cost and effective method for rough intraoperative evaluation of CA.
