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CC BY 4.0 · Rev Bras Ortop (Sao Paulo) 2025; 60(01): s00451804490
DOI: 10.1055/s-0045-1804490
Nota Técnica

Adjustment of Acetabular Cup Inclination Assisted by Smartphone during Revision Total Hip Arthroplasty: Surgical Technique and Report of Four Cases

Article in several languages: português | English
Ahmed A. Khalifa 
1   Departamento de Ortopedia, Qena Faculty of Medicine and University Hospital, South Valley University, Qena, Egito
2   Departamento de Cirurgia Ortopédica e Traumatologia, Faculty of Medicine, Assiut University, Assiut, Egito
,
Mahmoud Faisal Adam
2   Departamento de Cirurgia Ortopédica e Traumatologia, Faculty of Medicine, Assiut University, Assiut, Egito
3   Faculdade de Medicina, Luxor University, New Tiba City, Egito
,
Mohamed A. Mahran
2   Departamento de Cirurgia Ortopédica e Traumatologia, Faculty of Medicine, Assiut University, Assiut, Egito
› Author Affiliations Financial Support The authors declare that they did not receive financial support from agencies in the public, private, or non-profit sectors to conduct the present study.
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Abstract

We herein present a smartphone-assisted technique for acetabular cup placement during revision total hip arthroplasty (rTHA). Four patients were operated on: three were submitted to second-stage rTHA after infection, and one underwent surgery due to aseptic loosening. The technique entails three main steps: evaluation of the amount of lateral pelvic tilt (either clinically or radiographically); setting a supracetabular rod using the smartphone app as a reference for inclination adjustment; and acetabulum preparation and final cup placement using the smartphone to guide the inclination angle after considering the amount of pelvic tilt. Cup anteversion was adjusted according to the transverse acetabulum ligament. All 4 cases underwent a follow-up that ranged from 17 to 24 months. None of the patients required further revision, and no complications (intraoperative, early, or late postoperative) were observed. All cups were within the Lewinnek safe zone for inclination (42°, 43°, 47°, and 41°). The functional outcome per the Harris Hip Score was excellent for all patients. Smartphones are cheap tools that can assist physicians in the adjustment of acetabular cup inclination during rTHA; however, assessing the possible lateral pelvic tilt and considering it while placing the cup are crucial.

Keywords

acetabulum - arthroplasty, replacement, hip - smartphone

Authors' Contributions

Each author contributed individually and significantly to the development of the present article. AAK conceived the case report, performed the surgeries, and drafted the manuscript. MFA and MAM performed data acquisition, patient assessment, literature search, and prepared the images. A.A.K. and M.A.M. performed the critical revision. All authors read, discussed, and approved the final manuscript.


Work developed at the Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Assiut University, Assiut, Egypt.




Publication History

Received: 03 September 2024

Accepted: 14 December 2024

Article published online:
15 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Ahmed A. Khalifa, Mahmoud Faisal Adam, Mohamed A. Mahran. Ajuste de inclinação do acetábulo assistido por smartphone durante revisão de artroplastia total de quadril: Técnica cirúrgica e relato de quatro casos. Rev Bras Ortop (Sao Paulo) 2025; 60: s00451804490.
DOI: 10.1055/s-0045-1804490
 

  • Referências

  • 1 Ashkenazi I, Christensen T, Oakley C. et al. Trends in Revision Total Hip Arthroplasty Cost, Revenue, and Contribution Margin 2011 to 2021. J Arthroplasty 2023; 38 (7S): S34-S38
    PubMedSearch in Google Scholar
  • 2 Meermans G, Grammatopoulos G, Innmann M, Beverland D. Cup placement in primary total hip arthroplasty: how to get it right without navigation or robotics. EFORT Open Rev 2022; 7 (06) 365-374
    PubMedSearch in Google Scholar
  • 3 van Duren BH, Royeca JM, Cunningham CM, Lamb JN, Brew CJ, Pandit H. Can the use of an inclinometer improve acetabular cup inclination in total hip arthroplasty? A review of the literature. Hip Int 2021; 31 (05) 609-617
    PubMedSearch in Google Scholar
  • 4 Shichman I, Somerville L, Lutes WB, Jones SA, McCalden R, Schwarzkopf R. Outcomes of novel 3D-printed fully porous titanium cup and a cemented highly cross-linked polyethylene liner in complex and revision total hip arthroplasty. Arthroplasty 2022; 4 (01) 51
    PubMedSearch in Google Scholar
  • 5 Sicat CS, Buchalter DB, Luthringer TA, Schwarzkopf R, Vigdorchik JM. Intraoperative Technology Use Improves Accuracy of Functional Safe Zone Targeting in Total Hip Arthroplasty. J Arthroplasty 2022; 37 (7S): S540-S545
    PubMedSearch in Google Scholar
  • 6 Khalifa AA, Bakr HM, Said E, Mahran MA. Technical Note on Using Intraoperative Smartphone Applications to Adjust Cup Inclination Angle during Total Hip Arthroplasty (THA). Arch Bone Jt Surg 2020; 8 (06) 734-738
    PubMedSearch in Google Scholar
  • 7 Kurosaka K, Fukunishi S, Fukui T. et al. Assessment of Accuracy and Reliability in Acetabular Cup Placement Using an iPhone/iPad System. Orthopedics 2016; 39 (04) e621-e626
    PubMedSearch in Google Scholar
  • 8 Khalifa AA, Abdelnasser MK, Ahmed AM, Shetty GM, Abdelaal AM. Smartphone Application Helps Improve the Accuracy of Cup Placement by Young, Less-Experienced Surgeons during Primary Total Hip Arthroplasty. Arch Bone Jt Surg 2022; 10 (03) 278-285
    PubMedSearch in Google Scholar
  • 9 Kanazawa M, Nakashima Y, Ohishi M. et al. Pelvic tilt and movement during total hip arthroplasty in the lateral decubitus position. Mod Rheumatol 2016; 26 (03) 435-440
    PubMedSearch in Google Scholar
  • 10 Okutani Y, Kataoka M, Harada H, Kunishita T, Ryoki H, Arai R. A high body mass index tilts the pelvis caudally in the lateral decubitus position for total hip arthroplasty. Hip Int 2023; 33 (03) 371-376
    PubMedSearch in Google Scholar
  • 11 Ning D, Xu F, Zhang Z, Yang X, Wei J. Application of transverse acetabular ligament in total hip arthroplasty: a systematic review. BMC Musculoskelet Disord 2023; 24 (01) 284
    PubMedSearch in Google Scholar
  • 12 Archbold HA, Mockford B, Molloy D, McConway J, Ogonda L, Beverland D. The transverse acetabular ligament: an aid to orientation of the acetabular component during primary total hip replacement: a preliminary study of 1000 cases investigating postoperative stability. J Bone Joint Surg Br 2006; 88 (07) 883-886
    PubMedSearch in Google Scholar
  • 13 Sharma AK, Cizmic Z, Carroll KM. et al. Computer Navigation for Revision Total Hip Arthroplasty Reduces Dislocation Rates. Indian J Orthop 2022; 56 (06) 1061-1065
    PubMedSearch in Google Scholar
  • 14 Hill JC, Gibson DP, Pagoti R, Beverland DE. Photographic measurement of the inclination of the acetabular component in total hip replacement using the posterior approach. J Bone Joint Surg Br 2010; 92 (09) 1209-1214
    PubMedSearch in Google Scholar