Clinical Impact of Pelvic Malrotation on X-ray based Preoperative Planning for Total Hip Arthroplasty: A Proof-of-concept and Prudent Prediction of Acceptable Rotation

Abstract IntroductionPelvic rotation (PR) on preoperative X-ray templating can affect various critical measured acetabular angles and potentially outcomes of successful total hip arthroplasty (THA). Optimising anatomical reconstruction of the joint is essential to achieve function, longevity and prevention of complications following surgery. There is limited literature that standardises the degree of acceptable PR on X-ray or its effects on the fitting of acetabular prostheses. ObjectiveThis study aimed to develop a proof-of-concept that quantifies how PR can affect various acetabular angles used in pre-operative THA templating and to formulate a practicable method of determining if the preoperative PR is acceptable. Materials and MethodsComputerised tomography (CT) models from three control and two THA patients were generated and manipulated in various degrees of PR. CT slices were thickened to simulate X-rays and acetabular angles measured. ResultsThe acetabular anteversion distance (AAD) and lateral opening angle (LOA) demonstrated a linear and quadratic relationship with good correlation (R2=0.923, R2=0.710 respectively, p<0.0001) in relation to PR. Change in area of prosthesis (AOP) demonstrated a good linear correlation (r2=0.774 and r2=0.875, p<0.0001) with PR. Two novel measurements were used to estimate the degree of PR from a pelvic X-ray; the horizontal distance between pubic symphysis and middle of sacrococcygeal joint (PSSC) and the simplified pelvic rotation ratio (SPRR). A strong correlation between PSSC and SPRR with change in PR was observed (R2=0.970, R2=0.953, p<0.001). ConclusionPreliminary results suggests that an SPRR >2.0 correlates to PR>20° with potential to have a clinical impact on preoperative measurements.