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Purpose: The present study aimed to compare the cup alignment outliers in total hip arthroplasty (THA) using the same surgical approach with the patient in the supine position versus the lateral position.Methods: THA using the muscle-sparing modified Watson-Jones approach was performed in 142 consecutive hips. THA was performed with the patient in the lateral position in 84 hips (lateral group) and in the supine position in 58 hips (supine group). The cup alignment was aimed at 40° inclination and 20° anteversion by referring to the mechanical alignment guide. Cup alignment and outliers (10° > aimed alignment) were assessed using post-operative 3D-CT.Results: The absolute error from the aimed inclination was 6.0 ± 4.7° in the supine group and 4.2 ± 3.6° in the lateral group (p = 0.01). The absolute error from the aimed anteversion was 4.1 ± 3.2° in the supine group and 5.1 ± 3.7° in the lateral group (p = 0.12). The supine group showed a higher rate of outliers than the lateral group for the cup inclination (22% vs 5%; p < 0.01). Inclination and BMI were positively correlated in the spine position group (p < 0.01, R = 0.48), but were not correlated in the lateral position group.Conclusion: THA performed with the patient in the supine position has a higher risk of outliers of cup alignment compared with the lateral position, even when the same surgical approach is used. BMI affected the cup inclination in the supine position. [ABSTRACT FROM AUTHOR]

Polyethylene wear particles are one of the most important factors affecting the results of total hip arthroplasty (THA). To reduce wear generation and to achieve better long‐term results of THA, highly crosslinked polyethylene (HXPE) has recently been introduced and come into wide use. Thus far, however, there have been no reports on in vivo analysis of HXPE wear particles. We isolated HXPE wear particles from periprosthetic tissue of a failed THA and analyzed using scanning electron microscope. The number of particles was 5.33 × 107 g−1. Particle size (equivalent circle diameter) was 0.66 ± 0.40 μm (mean ± standard error). Aspect ratio and roundness were 1.37 ± 0.26 and 1.44 ± 0.67, respectively. All the particles were round shaped, and "fibrils" or "shreds" were not detected. Thus far, this was the first report on in vivo wear particle analysis of HXPE. HXPE generated less, smaller, and rounder particles, compared with the corresponding reported values for particles generated from conventional polyethylene. These characteristics might affect macrophage response, osteolysis, and long‐term results of THA with HXPE. © 2008 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2008 [ABSTRACT FROM AUTHOR]