Specialty Update   |    
What's New in Total Hip Arthroplasty
Michael H. Huo, MD1; Kristopher G. Stockton, MD1; Michael A. Mont, MD2; Javad Parvizi, MD, FRCS3
1 Department of Orthopedic Surgery, UT Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-8883. E-mail address for M.H. Huo: michael.huo@utsouthwestern.edu
2 The Rubin Institute for Advanced Orthopaedics, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215
3 Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University School of Medicine, 925 Chestnut Street, Philadelphia, PA 19107
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from commercial entities (Stryker Orthopaedics, Smartech, Wright Medical).

Investigation performed at UT Southwestern Medical Center, Dallas, Texas; Sinai Hospital of Baltimore, Baltimore, Maryland; and Thomas Jefferson University School of Medicine, Philadelphia, Pennsylvania
Specialty Update has been developed in collaboration with the Board of Specialty Societies (BOS) of the American Academy of Orthopaedic Surgeons.

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Dec 15;92(18):2959-2972. doi: 10.2106/JBJS.J.00851
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Total hip arthroplasty remains one of the most efficacious orthopaedic reconstructive procedures. This specialty currently faces several challenges, including increasing patient volume, reduction in the number of specialty arthroplasty surgeons performing this procedure, costs, and controversies centered on product liability and implant bearing surfaces. We have included the latest information from publications in major journals as well as abstracts of presentations at the 2010 Annual Meeting of the AAOS (American Academy of Orthopaedic Surgeons), the 2010 Annual Meeting of the ORS (Orthopaedic Research Society), the 2010 Open Meeting of The Hip Society, the 2009 Annual Meeting of the AAHKS (American Association of Hip and Knee Surgeons), and the 2009 fall meeting of The Hip Society.
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    Michael H. Huo, MD
    Posted on March 19, 2011
    Dr. Huo and colleagues respond to Dr. Liaw and colleagues
    Professor, Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas

    To evaluate component positioning in resurfacing, there are a myriad of different ways to position the patients, to capture x-rays (antero-posterior pelvic films, unilateral films, etc.), to utilize other imaging modalities (computer assisted scanning), and to employ various evaluative techniques (such as EBRA software). Some of these methods were mentioned in our review article, but it was not our purpose to espouse one technique as "superior" or preferred for evaluating anteversion and/or abduction angles. We commend the authors of this letter for their interest in this important topic.

    Chen-Kun Liaw, MD, PhD
    Posted on March 19, 2011
    The Definitions Are Important For Acetabular Orientation
    Orthopaedic Doctor, Chief of Orthopaedics, Tao-Yuan General Hospital , Taiwan

    To the Editor:

    We read the recent article, "What's New in Total Hip Arthroplasty" by Michael H. Huo et al. and we had a few comments (2010;92:2959-72).

    We are concerned about the prosthetic positioning in this report. To our knowledge, the acetabular orientation consists of two components, anteversion (version) and abduction (inclination). The relevant definitions are frequently confused. Anteversion has several definitions including anatomical anteversion (true anteversion), radiographic anteversion (planar anteversion), operative anteversion, CT standardized anteversion, and Liaw's anteversion. Similarly, abduction also has a few definitions including anatomical inclination, radiographic inclination, and operative inclination. Murray clarified anatomical, radiographic, and operative definitions of anteversion and inclination and provided the mathematical relationships between these different definitions (1). CT standardized anteversion and Liaw's anteversion are other definitions to solve this positioning problem (2,3).

    The authors provided us with good knowledge about clinical significance of acetabular orientation. However, the authors did not clearly mention relevant definitions of prosthetic position. According to Murray's formula, we used anatomical anteversion (30°) and inclination (35°, 55°) as a standard and calculated anteversion and inclination under other definitions (Table 1). CT standardized anteversion and Liaw's anteversion are both more complex and require more data to be calculated.

    Table 1. Anteversion and inclination under different definitions, according to Murray's formula.
    Definition of acetabular orientationAnatomic anteversion 30°
    Anatomic inclination 35°

    Anatomic anteversion 30°
    Anatomic inclination 55°
    Radiographic anteversion16.67°24.18°
    Radiographic inclination31.23°51.04°
    Operative anteversion19.30°35.53°
    Operative inclination29.78°45.19°

    The largest difference among different definitions lies at 13.3° for anterversion (30.0° versus 16.7°) and 9.8° for inclination (abduction)(55.0° versus 45.2°), respectively. These differences should not be ignored. We therefore suggest that the authors could state the definitions used in their report explicitly so that the readers will not be confused.


    1. Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg Br. 1993;75:228-32.

    2. Liaw CK, Yang RS, Hou SM, Wu TY, Fuh CS. A simple mathematical standardized measurement of acetabulum anteversion after total hip arthroplasty. Computat Math Meth Med. 2010;9:105-19.

    3. Olivecrona H, Weidenhielm L, Olivecrona L, Beckman MO, Stark A, Noz ME, Maguire GQ Jr, Zeleznik MP, Svensson L, Jonson T. A new CT method for measuring cup orientation after total hip arthroplasty: a study of 10 patients. Acta Orthop Scand. 2004;75:252-60.

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