Study on assessment methods for acetabular cup size in total hip arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Jinzi ^1,2 , CHANG Wenju ^1,2 , ZHANG Pei ^1,2 , LI Xiang ^1,2 , ZHANG Yong ¹ , ZHANG Shuoshuo ¹ ,  DING Hai ^1,2

1. Department of Orthopedics, the First Affiliated Hospital of Bengbu Medical University, Bengbu Anhui, 233000, P. R. China;
2. Anhui Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China;

Corresponding author：

DING Hai, Email: dinghaisjtu@163.com

Keywords：

Total hip arthroplasty; acetabular cup; prosthesis; preoperative measurement

DOI：

10.7507/1002-1892.202411005

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate precise assessment methods for predicting the optimal acetabular cup size in total hip arthroplasty (THA). Methods A clinical data of 73 patients (80 hips) who underwent primary THA between December 2022 and July 2024 and met the inclusion criteria was analyzed. There were 39 males and 34 females with an average age of 66.3 years (range, 56-78 years). Among them, 66 cases were unilateral THA and 7 were bilateral THAs. There were 29 patients (34 hips) of osteoarthritis, 35 patients (35 hips) of femoral neck fractures, and 9 patients (11 hips) of osteonecrosis of the femoral head. Based on anteroposterior pelvic X-ray films, three methods were employed to predict acetabular cup size, including preoperative template planning, radiographic femoral head diameter (FHD) measurement, and intraoperative FHD measurement. The predicted acetabular cup sizes from these methods were compared with the actual implanted sizes. Results The predicted acetabular cup sizes using the preoperative template planning, radiographic FHD measurement, and intraoperative FHD measurement were (51.25±2.81), (49.72±3.11), and (49.90±2.74) mm, respectively, compared to the actual implanted cup size of (50.57±2.74) mm, with no significant difference (P>0.05). Regarding agreement with the actual implanted cup size, the preoperative template planning achieved exact matches in 35 hips (43.75%), one-size deviation in 41 hips (51.25%), and two-size deviations in 4 hips (5%); the radiographic FHD measurement achieved exact matches in 12 hips (15%), one-size deviation in 57 hips (71.25%), and two-size deviations in 11 hips (13.75%); and the intraoperative FHD measurement achieved exact matches in 26 hips (32.5%), one-size deviation in 52 hips (65%), and two-size deviations in 2 hips (2.5%). There were significant differences in agreement distributions between the three methods and the actual implanted cup sizes (H=18.579, P<0.001). Conclusion The intraoperative FHD measurement, as a simple, cost-effective, and accurate method, effectively guides acetabular cup selection, reduces the risk of prosthesis wear, enhances postoperative joint stability.

Citation： WANG Jinzi, CHANG Wenju, ZHANG Pei, LI Xiang, ZHANG Yong, ZHANG Shuoshuo, DING Hai. Study on assessment methods for acetabular cup size in total hip arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(2): 163-167. doi: 10.7507/1002-1892.202411005 Copy

1.	Li C, Wang T, Wu D, et al. Total hip arthroplasty after core decompression: Time-to-event analysis and risk factors. Chin Med J (Engl), 2024, 137(16): 1988-1990.
2.	Zhang Z, Yang H, Xu Z, et al. Total hip arthroplasty outcomes in patients with gout: a retrospective analysis of matched large cohorts. Clin Orthop Surg, 2024, 16(4): 542-549.
3.	Layson JT, Hameed D, Dubin JA, et al. Patients with osteoporosis are at higher risk for periprosthetic femoral fractures and aseptic loosening following total hip arthroplasty. Orthop Clin North Am, 2024, 55(3): 311-321.
4.	McKenna DP, Price A, McAleese T, et al. Acetabular cup size trends in total hip arthroplasty. World J Orthop, 2024, 15(1): 39-44.
5.	Sai Sathikumar A, Jacob G, Thomas AB, et al. Acetabular cup positioning in primary routine total hip arthroplasty-a review of current concepts and technologies. Arthroplasty, 2023, 5(1): 59. doi: 10.1186/s42836-023-00213-3.
6.	Hao L, Zhang Y, Bian W, et al. Standardized 3D-printed trabecular titanium augment and cup for acetabular bone defects in revision hip arthroplasty: a mid-term follow-up study. J Orthop Surg Res, 2023, 18(1): 521. doi: 10.1186/s13018-023-03986-0.
7.	Castagnini F, Bordini B, Cosentino M, et al. Modern cementless acetabular cups in total hip arthroplasty performed for primary osteoarthritis: a comparative registry study. Arch Orthop Trauma Surg, 2024, 144(11): 4865-4872.
8.	李董, 张勇, 陈祖庆, 等. X线透视下人工全髋关节置换术臼杯假体覆盖率评估方法研究. 中国修复重建外科杂志, 2024, 38(4): 461-465.
9.	Fontalis A, Yasen AT, Kayani B, et al. Two-dimensional versus three-dimensional preoperative planning in total hip arthroplasty. J Arthroplasty, 2024, 39(9S1): S80-S87.
10.	Winter P, Fritsch E, Tschernig T, et al. Accuracy of personalized computed tomographic 3D templating for acetabular cup placement in revision arthroplasty. Medicina (Kaunas), 2023, 59(9): 1608. doi: 10.3390/medicina59091608.
11.	Di Martino A, Rossomando V, Brunello M, et al. How to perform correct templating in total hip replacement. Musculoskelet Surg, 2023, 107(1): 19-28.
12.	Girgis SF, Kohli S, Kouklidis G, et al. The accuracy of digital preoperative templating in primary total hip replacements. Cureus, 2023, 15(8): e43046. doi: 10.7759/cureus.43046.
13.	Winter P, Fritsch E, König J, et al. Comparison of the accuracy of 2D and 3D templating for revision total hip replacement. J Pers Med, 2023, 13(3): 510. doi: 10.3390/jpm13030510.
14.	Crosswell S, Akehurst H, Ramiah R, et al. Preoperative sizing of hip hemiarthroplasties to accurately estimate head size from non- standardised pelvic radiographs: Can it be done? Injury, 2019, 50(11): 2030-2033.
15.	Arnaout F, Dewan V, Paliobeis C. The 3-dot circle: A reliable method for safe and efficient digital templating of the acetabular component. J Orthop, 2018, 15(3): 787-791.
16.	Moore MR, Lygrisse KA, Singh V, et al. The effect of femoral head size on groin pain in total hip arthroplasty. J Arthroplasty, 2022, 37(7S): S577-S581.
17.	Ashkanfar A, Toh SMS, English R, et al. The impact of femoral head size on the wear evolution at contacting surfaces of total hip prostheses: A finite element analysis. J Mech Behav Biomed Mater, 2024, 153: 106474. doi: 10.1016/j.jmbbm.2024.106474.
18.	邱越, 夏天卫, 袁兆丰, 等. 虚拟现实技术联合股骨头缩小成形术治疗扁平髋的研究. 中国修复重建外科杂志, 2023, 37(3): 284-289.
19.	Warschawski Y, Garceau SP, Joly DA, et al. The effect of femoral head size, neck length, and offset on dislocation rates of constrained acetabular liners. J Arthroplasty, 2021, 36(1): 345-348.
20.	Wu J, Lin C, Zhuang X, et al. How does the position of the pelvis and femur influence the selection of prosthesis size during 2D preoperative planning for total hip arthroplasty? BMC Musculoskelet Disord, 2024, 25(1): 845. doi: 10.1186/s12891-024-07955-4.
21.	Surroca M, Miguela S, Bartra-Ylla A, et al. Surgeon’s experience and accuracy of preoperative digital templating in primary total hip arthroplasty. Hip Pelvis, 2024, 36(2): 129-134.
22.	Park CW, Yoo I, Cho K, et al. Incidence and risk factors of iliopsoas tendinopathy after total hip arthroplasty: a radiographic analysis of 1, 602 hips. J Arthroplasty, 2023, 38(8): 1621-1627.
23.	Heliere G, David G, Cypel S, et al. Does two dimensional templating allow for the use of reduced-size ancillaries in total hip arthroplasty? Int Orthop, 2024, 48(10): 2553-2559.
24.	Pitz-Gonçalves LI, Deckard ER, Meneghini RM. Large femoral heads and select dual-mobility bearings are associated with reduced instability in contemporary posterior approach total hip arthroplasty. J Arthroplasty, 2023, 38(7S): S124-S130.
25.	Assi C, Boulos K, Haykal E, et al. Intraoperative live measurement of femoral head size for acetabular cup sizing: simple, accurate, and green! Int Orthop, 2024, 48(8): 2025-2031.
26.	Ben Lulu O, Rubin G, Krasnyansky S, et al. Measuring the femoral head size—An additional real-time intraoperative monitoring tool for the accuracy of the preoperative process and implant selection. J Arthroplasty, 2015, 30(12): 2201-2203.
27.	Muñoz-Mahamud E, Chimeno C, Tornero E, et al. Can the intra-operative measurement of the diameter of the femoral head help surgeons to choose the best size of the acetabular cup? Int Orthop, 2022, 46(12): 2793-2798.

1. Li C, Wang T, Wu D, et al. Total hip arthroplasty after core decompression: Time-to-event analysis and risk factors. Chin Med J (Engl), 2024, 137(16): 1988-1990.
2. Zhang Z, Yang H, Xu Z, et al. Total hip arthroplasty outcomes in patients with gout: a retrospective analysis of matched large cohorts. Clin Orthop Surg, 2024, 16(4): 542-549.
3. Layson JT, Hameed D, Dubin JA, et al. Patients with osteoporosis are at higher risk for periprosthetic femoral fractures and aseptic loosening following total hip arthroplasty. Orthop Clin North Am, 2024, 55(3): 311-321.
4. McKenna DP, Price A, McAleese T, et al. Acetabular cup size trends in total hip arthroplasty. World J Orthop, 2024, 15(1): 39-44.
5. Sai Sathikumar A, Jacob G, Thomas AB, et al. Acetabular cup positioning in primary routine total hip arthroplasty-a review of current concepts and technologies. Arthroplasty, 2023, 5(1): 59. doi: 10.1186/s42836-023-00213-3.
6. Hao L, Zhang Y, Bian W, et al. Standardized 3D-printed trabecular titanium augment and cup for acetabular bone defects in revision hip arthroplasty: a mid-term follow-up study. J Orthop Surg Res, 2023, 18(1): 521. doi: 10.1186/s13018-023-03986-0.
7. Castagnini F, Bordini B, Cosentino M, et al. Modern cementless acetabular cups in total hip arthroplasty performed for primary osteoarthritis: a comparative registry study. Arch Orthop Trauma Surg, 2024, 144(11): 4865-4872.
8. 李董, 张勇, 陈祖庆, 等. X线透视下人工全髋关节置换术臼杯假体覆盖率评估方法研究. 中国修复重建外科杂志, 2024, 38(4): 461-465.
9. Fontalis A, Yasen AT, Kayani B, et al. Two-dimensional versus three-dimensional preoperative planning in total hip arthroplasty. J Arthroplasty, 2024, 39(9S1): S80-S87.
10. Winter P, Fritsch E, Tschernig T, et al. Accuracy of personalized computed tomographic 3D templating for acetabular cup placement in revision arthroplasty. Medicina (Kaunas), 2023, 59(9): 1608. doi: 10.3390/medicina59091608.
11. Di Martino A, Rossomando V, Brunello M, et al. How to perform correct templating in total hip replacement. Musculoskelet Surg, 2023, 107(1): 19-28.
12. Girgis SF, Kohli S, Kouklidis G, et al. The accuracy of digital preoperative templating in primary total hip replacements. Cureus, 2023, 15(8): e43046. doi: 10.7759/cureus.43046.
13. Winter P, Fritsch E, König J, et al. Comparison of the accuracy of 2D and 3D templating for revision total hip replacement. J Pers Med, 2023, 13(3): 510. doi: 10.3390/jpm13030510.
14. Crosswell S, Akehurst H, Ramiah R, et al. Preoperative sizing of hip hemiarthroplasties to accurately estimate head size from non- standardised pelvic radiographs: Can it be done? Injury, 2019, 50(11): 2030-2033.
15. Arnaout F, Dewan V, Paliobeis C. The 3-dot circle: A reliable method for safe and efficient digital templating of the acetabular component. J Orthop, 2018, 15(3): 787-791.
16. Moore MR, Lygrisse KA, Singh V, et al. The effect of femoral head size on groin pain in total hip arthroplasty. J Arthroplasty, 2022, 37(7S): S577-S581.
17. Ashkanfar A, Toh SMS, English R, et al. The impact of femoral head size on the wear evolution at contacting surfaces of total hip prostheses: A finite element analysis. J Mech Behav Biomed Mater, 2024, 153: 106474. doi: 10.1016/j.jmbbm.2024.106474.
18. 邱越, 夏天卫, 袁兆丰, 等. 虚拟现实技术联合股骨头缩小成形术治疗扁平髋的研究. 中国修复重建外科杂志, 2023, 37(3): 284-289.
19. Warschawski Y, Garceau SP, Joly DA, et al. The effect of femoral head size, neck length, and offset on dislocation rates of constrained acetabular liners. J Arthroplasty, 2021, 36(1): 345-348.
20. Wu J, Lin C, Zhuang X, et al. How does the position of the pelvis and femur influence the selection of prosthesis size during 2D preoperative planning for total hip arthroplasty? BMC Musculoskelet Disord, 2024, 25(1): 845. doi: 10.1186/s12891-024-07955-4.
21. Surroca M, Miguela S, Bartra-Ylla A, et al. Surgeon’s experience and accuracy of preoperative digital templating in primary total hip arthroplasty. Hip Pelvis, 2024, 36(2): 129-134.
22. Park CW, Yoo I, Cho K, et al. Incidence and risk factors of iliopsoas tendinopathy after total hip arthroplasty: a radiographic analysis of 1, 602 hips. J Arthroplasty, 2023, 38(8): 1621-1627.
23. Heliere G, David G, Cypel S, et al. Does two dimensional templating allow for the use of reduced-size ancillaries in total hip arthroplasty? Int Orthop, 2024, 48(10): 2553-2559.
24. Pitz-Gonçalves LI, Deckard ER, Meneghini RM. Large femoral heads and select dual-mobility bearings are associated with reduced instability in contemporary posterior approach total hip arthroplasty. J Arthroplasty, 2023, 38(7S): S124-S130.
25. Assi C, Boulos K, Haykal E, et al. Intraoperative live measurement of femoral head size for acetabular cup sizing: simple, accurate, and green! Int Orthop, 2024, 48(8): 2025-2031.
26. Ben Lulu O, Rubin G, Krasnyansky S, et al. Measuring the femoral head size—An additional real-time intraoperative monitoring tool for the accuracy of the preoperative process and implant selection. J Arthroplasty, 2015, 30(12): 2201-2203.
27. Muñoz-Mahamud E, Chimeno C, Tornero E, et al. Can the intra-operative measurement of the diameter of the femoral head help surgeons to choose the best size of the acetabular cup? Int Orthop, 2022, 46(12): 2793-2798.

Chinese Journal of Reparative and Reconstructive Surgery

Study on assessment methods for acetabular cup size in total hip arthroplasty

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content