Operative and Radiographic Acetabular Component Orientation in Total Hip Replacement: Influence of Pelvic Orientation and Surgical Positioning Technique

Orthopaedic surgeons often experience a mismatch between perceived intra-operative and radiographic acetabular cup orientation. This research aimed to assess the impact of pelvic orientation and surgical positioning technique on operative and radiographic cup orientation. Radiographic orientations for two surgical approaches were computationally simulated: a mechanical alignment guide and a transverse acetabular ligament approach, both in combination with different pelvic orientations. Positional errors were defined as the difference between the target radiographic orientation and that achieved. The transverse acetabular ligament method demonstrated smaller positional errors for radiographic version; 4.0° ± 2.9° as compared to 9.4° ± 7.3° for the mechanical alignment guide method. However, both methods resulted in similar errors in radiographic inclination. Multiple regression analysis showed that intraoperative pelvic rotation about the anterior-posterior axis was a strong predictor for these errors (B TAL = −0.893, B MAG = −0.951, p &lt; 0.01). Application of the transverse acetabular ligament method can reduce errors in radiographic version. However, if the orthopaedic surgeon is referencing off the theatre floor to control inclination when operating in lateral decubitus, this is only reliable if the pelvic sagittal plane is horizontal. There is currently no readily available method for ensuring that this is the case during total hip replacement surgery. </p

Factors influencing resilience to postoperative delirium in adults undergoing elective orthopaedic surgery

Introduction Delirium occurs after elective arthroplasty in 17 per cent of adults1, and is associated with poor outcomes, including cognitive decline2, dementia3,4, and death5. Predisposing and precipitating risk factors accumulate and interact to precipitate delirium6. Much of the current literature analyses delirium as a dichotomous outcome, inevitably placing many people with symptoms of delirium, but falling short of a diagnosis, into the no-delirium group. Freedom from delirium symptoms should be investigated as an outcome. As evidence accumulates that delirium symptoms can also be associated with negative outcomes, it is important to identify the resilient groups in these studies and establish modifiable resilience predictors. Studies have explored risk factors for postoperative delirium; however, none to date has defined or considered delirium resilience as an outcome or phenotype. Resilience may be broadly defined as ‘the ability to withstand or recover quickly from difficult conditions’7,8. The aim of this study was to identify predictors of delirium resilience in the perioperative setting

Pelvic orientation for total hip arthroplasty in lateral decubitus:can it be accurately measured?

Introduction During total hip arthroplasty (THA), accurately predicting acetabular cup orientation remains a key challenge, in great part because of uncertainty about pelvic orientation. This pilot study aimed to develop and validate a technique to measure pelvic orientation; establish its accuracy in the location of anatomical landmarks and subsequently; investigate if limb movement during a simulated surgical procedure alters pelvic orientation. Methods The developed technique measured 3-D orientation of an isolated Sawbone pelvis, it was then implemented to measure pelvic orientation in lateral decubitus with post-THA patients (n = 20) using a motion capture system. Results Orientation of the isolated Sawbone pelvis was accurately measured, demonstrated by high correlations with angular data from a coordinate measurement machine; R-squared values close to 1 for all pelvic axes. When applied to volunteer subjects, largest movements occurred about the longitudinal pelvic axis; internal and external pelvic rotation. Rotations about the anteroposterior axis, which directly affect inclination angles, showed &gt;75% of participants had movement within ±5° of neutral, 0°. Conclusions The technique accurately measured orientation of the isolated bony pelvis. This was not the case in a simulated theatre environment. Soft tissue landmarks were difficult to palpate repeatedly. These findings have direct clinical relevance, landmark registration in lateral decubitus is a potential source of error, contributing here to large ranges in measured movement. Surgeons must be aware that present techniques using bony landmarks to reference pelvic orientation for cup implantation, both computer-based and mechanical, may not be sufficiently accurate. </jats:sec

Correction of pelvic adduction during total hip arthroplasty reduces variability in radiographic inclination: findings of a randomised controlled trial

Introduction: The study aims were to identify the incidence of pelvic adduction during total hip arthroplasty (THA) in lateral decubitus and to determine, when aiming for 35° of apparent operative inclination (AOI), which of 3 operating table positions most accurately obtained a target radiographic inclination (RI) of 42°: (1) horizontal; (2) 7° head-down; (3) patient-specific position based on correction of pelvic adduction. Methods: With patients seated on a levelled theatre table, a ruler incorporating a spirit level was used to draw transverse pelvic lines (TPLs) on the skin overlying the pelvis and sacrum. Subsequently, when positioned in lateral decubitus these lines provided a measure of pelvic adduction. 270 participants were recruited, with 90 randomised to each group for operating table position. In all cases target AOI was 35°, aiming to achieve a target RI of 42°. The primary outcome measure was absolute (unsigned) deviation from the target RI of 42°. Results: 266/270 patients demonstrated pelvic adduction (overall mean 4.4°, range 0– 9.2°). No patients demonstrated pelvic abduction. There were significant differences in RI between each of the 3 groups. The horizontal table group displayed the highest mean RI. The patient specific table position group achieved the smallest absolute deviation from target RI of 42°. Discussion: In lateral decubitus, unrecognised pelvic adduction is common and is an important contributor to unexpectedly high RI. The use of preoperative TPLs helps identify pelvic adduction and its subsequent correction reduces variability in RI. Clinical Trial Protocol number: NCT01831401.</p

Let the logo do the talking: the influence of logo descriptiveness on brand equity

Logos frequently include textual and/or visual design elements that are descriptive of the type of product/service that brands market. However, knowledge about how and when logo descriptiveness can influence brand equity is limited. Using a multimethod research approach across six studies, the authors demonstrate that more (vs. less) descriptive logos can positively influence brand evaluations, purchase intentions, and brand performance. They also demonstrate that these effects occur because more (vs. less) descriptive logos are easier to process and thus elicit stronger impressions of authenticity, which consumers value. Furthermore, two important moderators are identified: the positive effects of logo descriptiveness are considerably attenuated for brands that are familiar (vs. unfamiliar) to consumers and reversed (i.e., negative) for brands that market a type of product/service linked with negatively (vs. positively) valenced associations in consumers’ minds. Finally, an analysis of 597 brand logos suggests that marketing practitioners might not fully take advantage of the potential benefits of logo descriptiveness. The theoretical contributions and managerial implications of these findings are discussed

Practical Field Calibration of Portable Monitors for Mobile Measurements of Multiple Air Pollutants

To reduce inaccuracies in the measurement of air pollutants by portable monitors it is necessary to establish quantitative calibration relationships against their respective reference analyser. This is usually done under controlled laboratory conditions or one-off static co-location alongside a reference analyser in the field, neither of which may adequately represent the extended use of portable monitors in exposure assessment research. To address this, we investigated ways of establishing and evaluating portable monitor calibration relationships from repeated intermittent deployment cycles over an extended period involving stationary deployment at a reference site, mobile monitoring, and completely switched off. We evaluated four types of portable monitors: Aeroqual Ltd. (Auckland, New Zealand) S500 O3 metal oxide and S500 NO2 electrochemical; RTI (Berkeley, CA, USA) MicroPEM PM2.5; and, AethLabs (San Francisco, CA, USA) AE51 black carbon (BC). Innovations in our study included: (i) comparison of calibrations derived from the individual co-locations of a portable monitor against its reference analyser or from all the co-location periods combined into a single dataset; and, (ii) evaluation of calibrated monitor estimates during transient measurements with the portable monitor close to its reference analyser at separate times from the stationary co-location calibration periods. Within the ~7 month duration of the study, ‘combined’ calibration relationships for O3, PM2.5, and BC monitors from all co-locations agreed more closely on average with reference measurements than ‘individual’ calibration relationships from co-location deployment nearest in time to transient deployment periods. ‘Individual’ calibrations relationships were sometimes substantially unrepresentative of the ‘combined’ relationships. Reduced quantitative consistency in field calibration relationships for the PM2.5 monitors may have resulted from generally low PM2.5 concentrations that were encountered in this study. Aeroqual NO2 monitors were sensitive to both NO2 and O3 and unresolved biases. Overall, however, we observed that with the ‘combined’ approach, ‘indicative’ measurement accuracy (±30% for O3, and ±50% for BC and PM2.5) for 1 h time averaging could be maintained over the 7-month period for the monitors evaluated here

Patient positioning and cup orientation during total hip arthroplasty: Assessment of current UK practice

Introduction:Acetabular cup orientation during total hip arthroplasty (THA) remains a challenge. This is influenced by patient positioning during surgery and the method used to orientate the acetabular cup. The aim of this study was to assess current UK practice for patient positioning and cup orientation, particularly with respect to patient supports and techniques used to achieve target version and inclination.Methods:A literature review and pilot study were initially conducted to develop the questionnaire, which was completed by British Hip Society members ( n = 183). As the majority of THA surgical procedures within the UK are performed with the patient in lateral decubitus, orthopaedic surgeons who operated with the patient in the supine position were excluded ( n = 18); a further 6% were incomplete and also excluded ( n = 11).Results:Of those who operated in lateral decubitus, 76.6% ( n = 118/154) used the posterior approach. Only 31% ( n = 47/154) considered their supports to be completely rigid. More than 35% ( n = 55/154) were unhappy with the supports that they presently use. The most common methods for controlling operative inclination and version were a mechanical alignment guide (MAG; n = 78/154; 50.6%) and the transverse acetabular ligament (TAL; n = 82/154; 53.2%); 31.2% (48/154) used a freehand technique to control operative inclination.Conclusion:Limited studies have been conducted whereby patient supports have been analysed and key design principles outlined. With 35.7% of the orthopaedic surgeons surveyed having issues with their current supports, a greater awareness of essential characteristics for patient supports is required.</jats:sec